bluuebunny/crossref_metadata_2025 huggingface dataset:
Relation of C-Reactive Protein to Insulin Resistance and Cardiovascular Risk Factors in Youth
Authors: Moran Antoinette , Steffen Lyn M. , Jacobs David R. , Steinberger Julia , Pankow James S. , Hong Ching-Ping , Tracy Russell P. , Sinaiko Alan R.
Published: March 2007

OBJECTIVE—Insulin resistance and C-reactive protein (CRP) levels are strongly correlated in adults. This study explored the relationship in youth.

RESEARCH DESIGN AND METHODS—Associations between CRP levels, cardiovascular risk, and insulin resistance measured by the euglycemic clamp were investigated in 342 healthy Minneapolis youth.

RESULTS—There was no difference in mean CRP levels among boys (n = 189, CRP 1.10 ± 0.46 mg/l) and girls (n = 153, CRP 1.16 ± 0.63 mg/l; P = 0.32). There was also no difference between CRP and Tanner stage. CRP, adjusted for BMI, was significantly greater in black subjects compared with white subjects (P = 0.03). CRP was strongly related to adiposity in both girls and boys. CRP levels were related to fasting insulin levels (r = 0.16, P = 0.003) but this association was not significant after adjustment for BMI (r = 0.07, P = 0.21). Similarly, M, the euglycemic clamp measurement of insulin sensitivity, was significantly related to CRP levels (r = −0.13, P = 0.02) but not when M was normalized to lean body mass (Mlbm) (r = −0.10, P = 0.09). There was a significant inverse correlation between Mlbm and CRP quartiles, which disappeared after adjustment for BMI. There was no significant association between CRP levels and lipids, blood pressure, physical activity, or left ventricular mass.

CONCLUSIONS—In contrast to adult subjects, after adjustment for adiposity, CRP levels in children age 10–16 years were not significantly associated with insulin resistance or with other factors comprising the metabolic syndrome. This is consistent with the concept that insulin resistance may precede the development of CRP elevation in the evolution of the metabolic syndrome.
Dietary Fat Is Associated With Metabolic Syndrome in Japanese Brazilians
Authors: Freire Renata D. , Cardoso Marly A. , Gimeno Suely G.A. , Ferreira Sandra R.G. ,   for the Japanese-Brazilian Diabetes Study Group
Published: March 2007

OBJECTIVE—The aim of this study was to examine the association of nutrient intakes with metabolic syndrome in a Japanese descendant population at high risk for metabolic abnormalities.

RESEARCH DESIGN AND METHODS—In a population-based study of Japanese Brazilians aged ≥30 years, 412 men and 465 women were studied. The diagnosis of metabolic syndrome was based on the National Cholesterol Education Program criteria modified for Asians. Food intake was assessed by a validated food frequency questionnaire.

RESULTS—Men and women showed similar mean ages (55.7 ± 12.7 and 54.4 ± 11.9 years) and 49% (95% CI 44.8–54.6) and 43% (38.4–47.6) had metabolic syndrome, respectively. As expected, clinical parameters were less favorable in the subset of subjects with metabolic syndrome. Men with metabolic syndrome showed higher cholesterol (233.2 ± 116.3 vs. 211.7 ± 5.8 g/day, P < 0.05) and lower carbohydrate (288.5 ± 45.8 vs. 300.1 ± 39.8 g/day, P < 0.001) intakes than those without metabolic syndrome, but no difference was observed among the women. After adjusting for sex, age, smoking, education level, generation, physical activity, total energy, and dietary fiber intake, a positive association between metabolic syndrome and total fat intake was detected. Comparing people in the highest quintile of total fat consumption with those in the lowest quintile, odds ratio (OR) of metabolic syndrome was 5.0 ([95% CI 1.58–16.00]; P < 0.005). In contrast, linoleic acid intake was inversely associated with metabolic syndrome (OR 0.50 [95% CI 0.26–0.98]; P < 0.05). Considering food groups, after adjustments only fried food intake was shown to be associated with increased risk of metabolic syndrome.

CONCLUSIONS—Despite the limitation of such a study design in investigating cause-effect relationships, our findings favor the hypothesis that dietary total fat may increase whereas linoleic acid intake may reduce the risk of metabolic syndrome in Japanese descendants living in Brazil.
Depression and Diabetes
Authors: Engum Anne , Mykletun Arnstein , Midthjell Kristian , Holen Are , Dahl Alv A.
Published: March 2007

OBJECTIVE—The purpose of this study was to investigate factors associated with depression in type 1 and type 2 diabetes and test whether these differ from factors associated with depression in the nondiabetic population.

RESEARCH DESIGN AND METHODS—In an unselected population study comprising 60,869 individuals, potential sociodemographic, lifestyle, and clinical factors were investigated in participants with and without diabetes. The associations between hyperglycemia and depression in types 1 and 2 diabetes were also studied. The levels of depression were self-rated by using the Hospital Anxiety and Depression Scale.

RESULTS—Several factors were correlated with depression in types 1 and 2 diabetes. However, these factors were not different from those of the nondiabetic population. Comorbid chronic somatic diseases were associated with depression in type 2 but not type 1 diabetes. In type 2 diabetes, those without comorbidity had the same odds of depression as the nondiabetic population with no chronic somatic diseases. No significant associations were found for hyperglycemia in relation to depression in type 1 and type 2 diabetes.

CONCLUSIONS—Type 2 diabetes without other chronic somatic diseases did not increase the risk of depression. Factors associated with depression in type 1 and type 2 diabetes were shared with the nondiabetic population.
Youth and Parent Satisfaction With Clinical Use of the GlucoWatch G2 Biographer in the Management of Pediatric Type 1 Diabetes
Authors:   The Diabetes Research in Children Network (DirecNet) Study Group
Published: March 2007

OBJECTIVE—A continuous glucose monitor satisfaction scale (CGM-SAT) was evaluated during a 6-month randomized controlled trial of the GlucoWatch G2 Biographer (GW2B) in youths with type 1 diabetes.

RESEARCH DESIGN AND METHODS—At the end of the 6-month trial, 97 parents and 66 older children who had been randomized to the GW2B group completed the CGM-SAT, which assesses satisfaction on 37 items using a five-point Likert scale. Descriptive analysis, calculation of several reliability estimates, and assessment of concurrent validity were performed.

RESULTS—The CGM-SAT demonstrated high internal reliability (Cronbach’s α = 0.95 for parents and 0.94 for youths aged ≥11 years), split-half reliability (ρ = 0.91 for parents and 0.93 for youths), and parent-adolescent agreement (ρ = 0.68, P < 0.001). Convergent validity was supported by marginally significant associations with treatment adherence and frequency of GW2B use. CGM-SAT scores did not correlate significantly with changes in treatment adherence, quality of life, or diabetes-related anxiety from baseline to 6 months. Mean scores on CGM-SAT items indicated that 81% of parental responses and 73% of youths’ responses were less favorable than “neutral.” Descriptive analysis indicated the GW2B requires substantial improvement before it can achieve widespread clinical utility and acceptance.

CONCLUSIONS—The results supported the psychometric properties of the CGM-SAT. The CGM-SAT warrants further research use and cross-validation with other continuous glucose monitors. This study provides a benchmark for comparison with new glucose sensors.
Metabolic Syndrome Accompanied by Hypercholesterolemia Is Strongly Associated With Proinflammatory State and Impairment of Fibrinolysis in Patients With Type 2 Diabetes
Authors: Aso Yoshimasa , Wakabayashi Sadao , Yamamoto Ruriko , Matsutomo Rika , Takebayashi Kohzo , Inukai Toshihiko
Published: March 2007

OBJECTIVE—To determine whether plasma concentrations of thrombin-activatable fibrinolysis inhibitor (TAFI) in patients with type 2 diabetes were associated with components of metabolic syndrome (MS), including high-sensitivity C-reactive protein (hs-CRP), plasminogen activator inhibitor (PAI)-1, and LDL cholesterol.

RESEARCH DESIGN AND METHODS—We studied 136 consecutive patients with type 2 diabetes. Diagnosis of MS was diagnosed by current criteria. Hypercholesterolemia (HC) was defined as serum LDL cholesterol >140 mg/dl (3.6 mmol/l) or treatment with a statin. For comparisons, diabetic patients were divided into four groups: those with no MS and no HC (n = 38), with MS but not HC (n = 39), with no MS but with HC (n = 26), and with both MS and HC (n = 33).

RESULTS—Considering all patients with type 2 diabetes, plasma PAI-1 was strongly associated with MS components such as BMI, triglyceride, alanine aminotransferase, a homeostasis model assessment of insulin resistance, and hs-CRP. Plasma TAFI only correlated positively and independently with LDL cholesterol. Plasma concentrations of plasmin-α2-antiplasmin complex (PAP), a measure of fibrinolytic activity in blood, showed a significant negative correlation with plasma PAI-1 but not TAFI. Diabetic patients with both MS and HC had the highest serum hs-CRP concentrations and the lowest plasma PAP concentrations.

CONCLUSIONS—LDL cholesterol is a main determinant of plasma TAFI in patients with type 2 diabetes. Coexistence of MS and HC synergistically accelerates inflammation and impairment of fibrinolysis via elevated concentrations of both TAFI and PAI-1, which inhibit fibrinolysis.
Ethnic Differences in Mortality, End-Stage Complications, and Quality of Care Among Diabetic Patients
Authors: Lanting Loes C. , Joung Inez M.A. , Mackenbach Johan P. , Lamberts Steven W.J. , Bootsma Aart H.
Published: March 2007

OBJECTIVE—To determine the influence of ethnic differences in diabetes care on inequalities in mortality and prevalence of end-stage complications among diabetic patients. The following questions were examined: 1) Are there ethnic differences among diabetic patients in mortality and end-stage complications and 2) are there ethnic differences among diabetic patients in quality of care?

RESEARCH DESIGN AND METHODS—A review of the literature on ethnic differences in the prevalence of complications and mortality among diabetic patients and in the quality of diabetes care was performed by systematically searching articles on Medline published from 1987 through October 2004.

RESULTS—A total of 51 studies were included, mainly conducted in the U.S. and the U.K. In general, after adjusting for confounders, diabetic patients from ethnic minorities had higher mortality rates and higher risk of diabetes complications. After additional adjustment for risk factors such as smoking, socioeconomic status, income, years of education, and BMI, in most instances ethnic differences disappear. Nevertheless, blacks and Hispanics in the U.S. and Asians in the U.K. have an increased risk of end-stage renal disease, and blacks and Hispanics in the U.S. have an increased risk of retinopathy. Intermediate outcomes of care were worse in blacks, and they were inclined to be worse in Hispanics. Likewise, ethnic differences in quality of care in the U.S. exist: process of care was worse in blacks.

CONCLUSIONS—Given the fact that there are ethnic differences in diabetes care and that ethnic differences in some diabetes complications persist after adjustment for risk factors other than diabetes care, it seems the case that ethnic differences in diabetes care contribute to the more adverse disease outcomes of diabetic patients from some ethnic minority groups. Although no generalizations can be made for all ethnic groups in all regions for all kinds of complications, the results do implicate the importance of quality of care in striving for equal health outcomes among ethnic minorities.
Influence of Smoking on Insulin Requirement and Metbolic Status in Diabetes Mellitus
Authors: Madsbad S , McNair P , Christensen M S , Christiansen C , Faber O K , Binder C , Transbøl I
Published: March 2007

This study was performed in order to examine the influence of tobacco smoking on carbohydrate and lipid metabolism and microangiopathy in diabetic patients with normal serum creatinine. Among 163 adult insulin-treated patients 114 smoked daily (smokers). Compared with nonsmokers, smokers had on the average a 15–20% higher insulin requirement (P < 0.001) and serum triglyceride concentration (P < 0.05), increasing to a 30% rise in heavy smokers (P < 0.01). The degree of retinopathy was equal in the two groups, as was the average creatinine clearance [99 ± 2 (mean ± 1 SEM) versus 101 ± 4 ml/min in smokers compared with nonsmokers]. Smokers and nonsmokers were comparable regarding sex ratio, age at diabetic onset, duration of diabetes, residual beta-cell function, fasting hyperglycemia, and glycosuria. Evidently, tobacco smoking represents a strain on both carbohydrate and lipid metabolism in insulin-treated diabetes mellitus.
Diabetes Mellitus as an Emerging Public Health Problem on Guam
Authors: Kuberski Timothy T , Bennett Peter H
Published: March 2007

The magnitude and impact of diabetes mellitus as a public health problem on Guam was assessed by retrospective analysis of birth and death certificates, as well as chart review of hospital deaths for complications. Non-insulin-dependent diabetes is common on Guam; insulin-dependent diabetes is rare. Diabetes and diabetes-associated mortality rates were similar to those of the general United States population; however, the age-specific rates in persons aged 45 yr and over were two to three times greater. The mean age of the Guam population is only 18.9 yr, about 10 yr younger than the United States mainland. These circumstances could result in the number of persons aged 45 yr and over increasing disproportionately in the future, increasing dramatically the number of persons at risk to develop non-insulin-dependent diabetes. The population found to have the highest rates for diabetes and related complications was the Chamorros (indigenous Guamanians), who comprise the major population group of the Territory. This population experinced most of the complications associated with diabetes, heart disease and hypertension being important causes of morbidity and mortality on Guam. It is likely that many of the complications of pregnancy associated with diabetes go unrecognized. The cost of diabetes to the Territory was estimated to be at least 3 million dollars per year.
Development of program-controlled portable insulin delivery devices
Authors: Prestele K , Franetzki M , Kresse H
Published: March 2007

Various alternatives for program-controlled insulin delivery systems, on which we have been working since 1972, are described. Fixed-programmable and demand-programmable devices, both in two parts comprising separate control and delivery units, have been miniaturized and technically improved to the extent that they can now be used for the ambulant, long-term treatment of diabetic patients. The electronic drive systems, including control and safety circuits, that are discussed using the demand-type system as an example have been conventionally designed, using CMOS technology. The mechanical components of the insulin-delivery devices, in particular the roller pump driven by a stepping motor, have been developed in such a way that they can also be employed in implantable devices, without any essential modifications. Particular attention was thus paid to the features of miniaturization, high insulin concentration, low energy consumption, and a high degree of safety and reliability. The experience obtained from broad-based clinical trials of the devices is summarized briefly.
Relative Sensitivity of Postpartum Gestational Diabetic Women to Oral Contraceptive Agents and Other Metabolic Stress
Authors: Kalkhoff Ronald K
Published: March 2007

Women who develop diabetes mellitus during pregnancy very often revert to normal carbohydrate metabolism after parturition. During this quiescent period, however, increased sensitivity to adverse metabolic stress is evident. Recurrence of impaired carbohydrate tolerance with greater frequency than in normal populations is observed following the administration of oral contraceptive agents, glucocorticoids, and certain placental hormones such as human chorionic somatomammotropin. Factors responsible for this vulnerability to adverse stress are unknown but, in part, may reside in subclinical defects in beta-cell function. Ultimately, the great majority of these individuals develop permanent disease, suggesting that diabetes initially manifested only during pregnancy is not transient but progresses to more severe forms later in life.
The Effect of Bran on Glucose Kinetics and Plasma Insulin in Non-insulin-dependent Diabetes Mellitus
Authors: Hall Susan E H , Bolton T M , Hetenyi G
Published: March 2007

Experiments were carried out on two groups of diabetic patients treated (1) by diet alone (group A) and (2) by diet and oral agents (group B), the latter being discontinued 3 days before each test. All patients were tested twice. To measure rates of glucose metabolism, 3H-3-glucose was infused before and during a standard 3-h 50'g oral glucose tolerance test. 14C-1-glucose was added to the glucose solution and the percentage of ingested glucose that appeared in peripheral blood was calculated. Bran improved glucose tolerance only in group B patients by delaying the peripheral appearance of ingested glucose but had no effect on glucose absorption in group A. In contrast, patients in group A showed a marked reduction in their insulin response when bran was mixed with the glucose. Despite this reduction, glucose tolerance, the metabolic clearance rate (MCR) of glucose, arid all other rates measured were unaffected by bran. Thus we conclude that in patients adequately controlled by diet alone, the effect of insulin was potentiated when bran was ingested, but the mechanism involved remains obscure.
Ocular Surgery in Patients with Diabetic Nephropathy
Authors: Abourizk N , Ishaq Arastu M , Arora T , Briones J C , Kaldany A , Aiello L M , D'elia J A
Published: March 2007

Patients with severe diabetic nephropathy often have diabetic retinopathy requiring eye surgery. During the course of their nephropathy, which was treated medically (group A, N = 34), with dialysis (group B, N = 18), or with renal transplantation (group C, N = 2), 54 diabetic patients have had eye surgery. The ophthalmologic procedures included cataract extraction, vitrectomy, scierai buckling, and cyclo-cryosurgery. The complications included postoperative hemorrhagic glaucoma and persistent retinal detachment. These were encountered in two patients of group A and in two of group B. All other cases showed uneventful intra- and postoperative courses. Major eye surgery can be performed safely during therapy for diabetic nephropathy, including hemodialysis with anticoagulation and transplantation with immunosuppression.
Insulin Treatment for the Early 80s: Facts and Questions About Old and New Insulins and Their Usage
Authors: Galloway John A
Published: March 2007

Recent data now emphasize the importance of blood glucose control as a means of forestalling diabetic microvascular disease. As a result, attempts are being made to optimize conventional insulin therapy, and new modes of insulin delivery (e.g., pumps) are being adopted. Also, improvements in manufacturing technology have resulted in the commercial availability of porcine insulin, which is highly effective in preventing the complications of insulin therapy in those patients receiving only this material. Human insulin, produced biosynthetically in bacteria using recombinant DNA technology, is now being tested. While these developments in insulin and its administration offer great promise to the diabetic patient, many more studies will be needed to determine their absolute clinical benefits.
Chemical, Physical, and Biologic Properties of Biosynthetic Human Insulin
Authors: Chance Ronald E , Kroeff Eugene P , Hoffmann James A , Frank Bruce H
Published: March 2007

Human insulin derived via recombinant DNA technology was tested extensively by a complex battery of analytic procedures. This product, which is designated biosynthetic human insulin, was found to be chemically, physically, and immunologically equivalent to pancreatic human insulin and biologically equivalent to both pancreatic human insulin and purified pork insulin.
Binding of Biosynthetic Human Insulin to Erythrocytes of Normal and Insulin-dependent Diabetic Subjects: Comparison with Pork and Human Pancreatic Insulin
Authors: Bachmann Werner , Sieger Caspar , Lacher Florian , Lotz Norbert
Published: March 2007

Biosynthetic human insulin (BHI) was compared with highly purified human pancreatic and pork insulin with regard to its ability to bind to erythrocytes of normal and insulin-dependent diabetic subjects (type I diabetes). The binding affinity or capacity of erythrocyte from both normal and diabetic subjects were comparable for biosynthetic and pancreatic human insulin. In contrast, binding of pork insulin to erythrocytes was significantly decreased at low insulin concentrations in normal as well as in diabetic subjects due to a reduced receptor affinity. The affinity of the “empty sites” was 5.25 × 10−8 M−1 with pork insulin in normal subjects and 6.1 × 10−8 M−1 in diabetic subjects; with both human insulins, the affinities were 6.9 × 10−8 M−1 in normal subjects and 8.6 × 10−8 M−1 in diabetic subjects. The number of insulin receptors per erythrocyte was calculated as being 30 in normal subjects and 35 in diabetic patients.
An Appraisal of the Role of Biosynthetic Human Insulin in the Future Treatment of Diabetes Mellitus
Authors: Gerich John E
Published: March 2007

Although initial laboratory studies using biosynthetic human insulin (BHI) indicate little difference in the intrinsic potency of biosynthetic human and purified pork insulin (PPI) in vitro, certain in vivo observations suggest that BHI may differ pharmacokinetically from pork insulin. If further studies support these suggestions, the use of BHI may be able to provide better glycemic control and more near normal plasma insulin profiles during treatment of insulin-dependent diabetes than can be achieved with presently available insulin preparations. However, BHI appears to offer no advantage over presently available PPI in terms of prevention and treatment of insulin lipodystrophy, insulin allergy, and immune insulin resistance.
Plasma Free Insulin Profiles After Administration of Insulin by Jet and Conventional Syringe Injection
Authors: Taylor Roy , Home Philip D , Alberti K George M M
Published: March 2007

Plasma free insulin profiles in insulin-dependent diabetic subjects were compared after jet and syringe injection of insulin. Jet injection of insulin resulted in a shift of the free insulin profile to the left. Thus higher plasma free insulin levels were found over the first 30 min after injection (P < 0.05), while after 240 min plasma free insulin levels were lower than those seen following syringe injection (P < 0.05). Significant differences in the response of blood glucose and 3-hydroxybutyrate levels reflected the differences in plasma free insulin levels. Jet administration results in more rapid absorption of insulin and could be useful in providing a more physiologic postprandial insulin profile than that seen after conventional injection.
The Role of Gastrointestinal and Neuronal Peptides in the Pathophysiology of Diabetes Mellitus
Authors: Ganda OM P
Published: March 2007

The pancreatic islet hormone secretion is modulated by one or more gastrointestinal peptides (“gut-factor”) secreted in response to various types of ingested nutrients. Among a number of postulated candidates for the putative “gut-factor”, the gastric inhibitory polypeptide (GIP) has recently emerged as a most likely enteric signal of physiologic import, although its precise role in the pathophysiology of diabetes mellitus remains incompletely understood. During the past decade, an avalanche of knowledge has accumulated regarding a number of peptide agents common to the gastro-enteric-pancreatic system and the nervous system. Preliminary evidence indicates a potential role of several of these peptides in the pathophysiology of diabetes. For instance, cholecystokinin and human pancreatic polypeptide (hPP) may be importantly involved in the regulation of appetite and satiety control and the development of obesity whereas somatostatin, “endorphins”, and neurotensin may directly or indirectly modulate islet hormone secretion. Finally the significance of the recently demonstrated presence of insulin and glucagon or glicentin-like peptides in the brain requires close scrutiny.
Nocturnal Cortisol Release During Hypoglycemia in Diabetes
Authors: Scott R S , Scandrett M S
Published: March 2007

Nocturnal hypoglycemia in insulin-treated diabetic persons is often difficult to recognize clinically. It has been suggested that a useful biochemical test to demonstrate this would be the increased excretion of cortisol in the urine during the overnight period. However, of six diabetic persons who had nocturnal hypoglycemia (≤2.5 mmol/L), plasma cortisol profiles and overnight urinary cortisol-creatinine ratios were abnormal in only one. In four others the plasma cortisol levels and cortisol excretion indices were indistinguishable from either a normal control group or a group of five diabetic subjects who did not develop nocturnal hypoglycemia. The remaining patient had a raised urinary cortisol-creatinine ratio, but did not show increased plasma levels of cortisol, growth hormone, or glucagon during the hypoglycemic phase. These data do not support the usefulness of the urinary cortisol-creatinine index as a marker of nocturnal hypoglycemia in diabetes.
Hemoglobin A1c Determinations in Diabetic Pregnancy
Authors: Madsen Hans , Ditzel Jørn , Hansen Peer , Hahnemann Niels , Andersen Ole Peter , Kjaergaard Jens-Jørgen
Published: March 2007

To investigate the relationship of hemoglobin A1c (HbA1c) to average blood glucose concentration and to birth weight of infants of diabetic mothers, HbA1c was determined in 42 consecutive insulin-dependent pregnant diabetic women in the third trimester. HbA1c correlated significantly to the average blood glucose levels in the preceding 8 wk (r = 0.73, P < 0.001). No correlation was found between HbA1c and the relative birth weight ratio (RBWR) for all newborn infants. However, in the major subgroups of pregnancies, White class B and C without prognostically bad signs in pregnancy (PBSP), HbA1c in the third trimester significantly correlated to RBWR (r = 0.59, P < 0.01). In a subgroup of six pregnant diabetic women in whom HbA1c and blood glucose concentrations frequently were determined from the 13th to the 33rd gestational week, a relationship between HbA1c and the average blood glucose concentration of the preceding 8 and 12 wk in the individual pregnant subject was established. In spite of this correlation, HbA1c was found to be a poor predictor of the average blood glucose concentration in the individual patient. This indicates that HbA1c cannot satisfactorily describe the degree of diabetes control without simultaneous determinations of blood glucose. HbA1c determinations were found to be of value as an additional indicator of the quality of regulation during ambulatory control in diabetic pregnancy because an increase in HbA1c suggested an impairment of diabetic control. The perinatal mortality and morbidity of the infants of diabetic mothers were satisfactory in this series, as only one perinatal death, one nonserious malformation, and two cases of mild respiratory distress syndrome occurred among the 43 infants.
Bacteremia in Diabetic Patients with Infected Lower Extremities
Authors: Sapico Francisco L , Bessman Alice N , Canawati Hanna N
Published: March 2007

Eleven cases of bacteremia in diabetic patients with infected lower extremities at Rancho Los Amigos Hospital (RLAH) were observed over a 34-mo period. The yearly incidence was 0.6% of admissions to the Ortho-Diabetes service. Aerobic bacteria were recovered in six cases and anaerobic bacteria in five. Bacteroides fragilis was isolated four times, Staphylococcus aureus three times, and nonfragilis Bacteroides sp., Escherichia coli, group B streptococcus, and viridans streptococcus were each seen once. Ten of the 11 patients were febrile at the time of bacteremia. Clinical, laboratory, radiologic, and ultrasonographic parameters were comparable in patients with aerobic and anaerobic bacteremia, and between bacteremi patients and nonbacteremic controls. Fever, however, was significantly more frequent in bacteremic patients. Foul-smelling lesions were seen in two of the five patients with anaerobic bacteremia, and in none of the patients with aerobic bacteremia. Postoperative B. fragilis bacteremia was observed to be transient and resolved without definitive therapy in one patient. Appropriate antibiotic therapy in 10 patients together with surgical intervention in eight cases resulted in resolution of the infection in the remaining patients.
Causes of Errors in Diabetic Urine Testing by Hospital Personnel
Authors: Davis Ellen D , Cox Edwin B
Published: March 2007

Errors in urine testing were studied using 119 health professionals who tested simulated urine specimens from six hypothetical patients. A record of the hypothetical patients' test results for 2 previous days accompanied each specimen. Five of the six records were loaded high or low to investigate testers' biases as a result of their knowledge of previous values. Testers demonstrated an aversion to extreme readings. At the lower concentration, 83% of erroneous readings were higher than the correct value. At the higher concentration, 70% of errors were below the true value. The results also revealed that readings were influenced by knowledge of past records. A higher reading for the sample with the biased-high record occurred 50% more often than a lower reading. Differences in error were nonsignificant for different educational levels and past experiences of the testers. Urine testing accuracy appears to be affected by a tendency toward avoidance of extremes and knowledge of previous results.
Neonatal Islet Cell Adenoma: A Distinct Type of Islet Cell Tumor?
Authors: Bordi Cesare , Ravazzola Mariella , POllak Arnold , Lubec Gert , Orci Lelio
Published: March 2007

An encapsulated, compact-type islet cell adenoma of the pancreas, found in a newborn infant with hyperinsulinemic hypoglycemia, was investigated by conventional histology and immunofluorescence. Although the histologic structure of the tumor was indistinguishable from that of most islet cell tumors of adults, immunofluorescence revealed that the four islet cell hormones (insulin, glucagon, somatostatin, and pancreatic polypeptide) were all present in the tumor. They were stored in different cells that showed the same spatial distribution usually seen in normal islets. We conclude that neonatal islet cell adenoma can be distinguished from those of adults on the basis of the content and topographic distribution of their constituent endocrine cells.
A Glucose Electrode Using High-Stability Glucose-Oxidase Collagen Membranes
Authors: Thévenot Daniel R , Sternberg Robert , Coulet Pierre
Published: March 2007

A very sensitive glucose electrode was developed using a glucose-oxidase membrane and an anodically polarized platinum disk. Calibration curves were linear over 4.5 concentration decades. It was adapted for human blood samples. The lifetime of glucose-oxidase collagen membranes was greater than 3 yr at 4°C and was ∼6 mo at 20–30°C.
The Composition and Optical Rotary Dispersion of Bovine Aqueous Humor
Authors: Cough David A
Published: March 2007

The concentration of over 20 biochemicals in bovine aqueous humor was determined by conventional means, and the contribution of each to the observed optical rotation was estimated. Of those studied, only glucose and the total proteins made a significant contribution. However, other unidentified chemicals apparently also contribute to the optical activity since it was not possible to reconstruct the actual aqueous humor optical rotation based on the chemicals included. Alternative experimental approaches that may yield more complete results are discussed. With further work, optical rotation might be used as the basis of a noninvasive sensor for measuring the glucose concentration of aqueous humor in the intact eye.
Preliminary Evaluation of a Skin Conductance Meter for Detecting Hypoglycemia in Diabetic Patients
Authors: Pickup J C
Published: March 2007

A portable device (the Diabalert), which measures the electrical conductivity of the skin surface and sounds an alarm at a preset conductivity, was evaluated as a possible detector of hypoglycemia-induced sweating in diabetic subjects. Insulin was infused intravenously into seven insulin-dependent diabetic subjects, and the course of the plasma glucose decline, hypoglycemic symptoms, and state of consciousness of the patients frequently monitored. In five patients sweating occurred with hypoglycemia, and the Diabalert alarm was activated at plasma glucose concentrations between 1.6 and 3.7 mmol/L. Three of these five diabetic patients were by then unaware of the alarm and would have failed to take corrective action to restore normoglycemia. Two further patients had virtually no symptoms despite marked biochemical hypoglycemia and the alarm was not triggered. Studies are needed in larger numbers of diabetic patients at home to fully assess the clinical usefulness of this device.
Response of Non-insulin-dependent Diabetic Patients to an Intensive Program of Diet and Exercise
Authors: James Barnard R , Lattimore Leza , Holly Robert G , Cherny Samuel , Pritikin Nathan
Published: March 2007

To assess the effectiveness of the Pritikin program of diet and exercise for treating patients with non-insulin-dependent diabetes mellitus (NIDDM), data were obtained from 60 patients who completed the 26-day residential program. Of the 23 patients who were taking oral hypoglycemic agents upon entry, all but 2 were off medication by the end of the program. Of the 17 patients who were taking insulin, all but 4 were off medication at discharge. Two of the four had their insulin reduced by 50% while the remaining two had no major change in their insulin dosage. Fasting blood glucose was reduced from 194.9 ± 10.1 to 144.6 ± 7.1 mg/dl. Serum cholesterol was reduced from 225.4 ± 5.7 to 181.7 ± 4.9 mg/dl while triglycerides were reduced from 283.7 ± 28.8 to 186.2 ± 11.6 mg/dl. The group as a whole lost an average of 4.3 kg/body wt and achieved 40.5% of their desired weight loss. Maximum work capacity increased from 5.6 ± 0.3 to 7.9 ± 0.4 METs, while daily walking increased from 11.7 ± 2.4 to 102.8 ± 4-8 min/day. The decrease in fasting glucose was not correlated with weight loss (r = 0.24), increase in walking time (r = 0.00), or increase in MET capacity (r = 0.05). We conclude that the total program is an effective means for treating NIDDM patients. We also feel that the high-complexcarbohydrate, high-fiber, low-fat diet is of primary importance.
Crisis Intervention Program in Newly Diagnosed Diabetic Children
Authors: Galatzer Avinoam , Amir Shoshana , Gil Ruth , Karp Moshe , Laron Zvi
Published: March 2007

A group of 223 insulin-dependent diabetic patients, aged 7–24 yr, who had been under the regular care of our clinic up to 15 yr, were rated by two independent judges on a two-level scale of adjustment and maladjustment. The patients were divided into two groups. Group A (N = 107) comprised those who had been under care from diagnosis of the disease and had been subjected to the special crisis intervention program offered to every family upon referral of a newly diagnosed patient. Group B (N = 116) comprised patients who were diagnosed and treated initially in a clinic that had no crisis intervention program. Significant differences between the two groups were found in respect to three of the four aspects studied, i.e., compliance, familial relationships, and sociability, with group A showing a better adjustment than group B. There was no significant difference in the fourth aspect studied, i.e., school achievement and work performance. It was found that it took three times the effort, i.e., the time invested in counseling and psychotherapeutic measures, to bring group B to a good level of adjustment than it did to achieve similar results with group A. It is suggested that the initial period after diagnosis of diabetes in a child should be considered a period of crisis, requiring special muitidisciplinary services to reduce future psychosocial maladjustments and improve compliance.
Glycosylated Hemoglobin and Fasting Plasma Glucose in the Assessment of Outpatient Glycemic Control in NIDDM
Authors: Pecoraro Roger E , Chen Mei S , Porte Daniel
Published: March 2007

Interpreting measurements of fasting plasma glucose (FPG) and glycosylated hemoglobin (GHb) is subject to inherent limitations. The time course of change in GHb cannot be reliably specified in the individual patient, nor do single measurements of GHb convey any information regarding recent change or stability in glycemic control. To evaluate whether the clinical utility of these measurements may be extended, sequential measurements of FPG and GHb were examined from 16 outpatients with NIDDM followed over periods of 12 successive weeks or longer, including intervals following cessation of prior therapy or initiation of new hypoglycemic therapy with glipizide. In some individuals as well as groups of patients, changes in GHb followed patterns previously described by mean changes among groups of patients. Differing from those patterns, however, other individuals demonstrated prompt improvement in GHb following substantial improvement in FPG, confirming that patterns of change described from group means do not apply to all circumstances of changing glycemic control, though they may represent the most common. By using measurements of both FPG and GHb obtained on a single occasion to calculate a third parameter, called the glycosylated hemoglobin index (GHb-1), accurate information could be obtained regarding changes in glycemic control which occurred over intervals of 1–4 wk prior to the measurements. By this approach the utility of GHb measurements in the management of outpatients with NIDDM may be extended beyond retrospective description of the “average” prior metabolic control to include assessment of recent changes in glycemia, either deterioration or improvement.
Validity of Urine Glucose Measurements for Estimating Plasma Glucose Concentration
Authors: Hayford John T , Weydert Joy A , Thompson Robert G
Published: March 2007

Both physicians and diabetic patients have traditionally relied on measurement of glycosuria as an indirect method of estimating plasma glucose concentration to guide adjustment of insulin and diet therapy. Our observations on the correlation between mean plasma glucose concentration with simultaneous urine glucose concentration or excretion rate re-emphasize the limitations of this approach. Although our observations show a significant correlation (P < 0.0001) between plasma glucose concentration and urine glucose concentration or urine glucose excretion rate, the wide confidence limits [95% confidence limits (minimum) ± 150 mg/dl] on plasma glucose concentration estimated from urine glucose measurements limit the clinical applicability of such estimates. Differences among subjects in the renal resorption of glucose contribute to the wide variance of estimates. However, significant variability in renal glucose resorption within individuals is documented, further reinforcing the limitations of urine glucose determinations for reliable estimates of plasma glucose concentrations. Diabetologists need to reconsider the applicability of urine glucose measurements in evaluation of adequacy of therapy and in adjustment of insulin dosage.
Comparison of the Biologic Activity of Porcine and Semisynthetic Human Insulins Using the Glucose-controlled Insulin Infusion System in Insulin-dependent Diabetes
Authors: Szekeres Agnes , Worcester Beverly , Ascher Michael S , Tuxen Dee , Heyendal Richard , Walsh Kathleen M , Charles M Arthur
Published: March 2007

Semisynthetic human insulin is prepared from porcine pancreas by chemical methods involving the substitution of porcine insulin B-30 alanine with threonine. To compare the effectiveness of porcine and semisynthetic human insulins, eight insulin-dependent diabeticpatients were evaluated during two separate periods using a glucose-controlled insulin infusion system. During each 36-h period, patients received either porcine or semisynthetichuman insulin. Patients ingested mixed meals. The mean daily insulin requirements for porcine and semisynthetic human insulins were 84 ± 9 U and 85 ± 6 U (± SEM), respectively (P = NS). Mean blood glucose values were similar at 95 ±1 mg/dl for porcine and 101 ± 3 mg/dl with semisynthetic human insulin (P = NS). Prior metabolic control or insulin antibody levels did not correlate with intravenous insulin requirements. These studies indicate that semisynthetic human insulin is as effective as porcine insulin in maintaining near-normal blood glucose control in short-term intravenous studies using artificial pancreas techniques in insulin-dependent diabetes.
A Hypocaloric High-Protein Diet as Primary Therapy for Adults with Obesity-related Diabetes: Effective Long-Term Use in a Community Hospital
Authors: Fitz James D , Sperling Eileen M , Fein Henry G
Published: March 2007

The use of reducing diets as the sole therapy for the long-term management of obese diabetic patients has been generally unsuccessful. Most previous attempts took place with a few patients in university hospital clinical research centers. We placed 36 such patients on a hypocaloric high-protein food diet, consisting of 1.7–2.0 g protein/kg ideal body wt, during admission to a community hospital. After beginning this diet, patients could be weaned from sliding-scale regular insulin in an average of 1.9 days. Patients remained on this diet after discharge (mean hospital stay = 4.3 days), and complex carbohydrates were gradually added up to 80 g daily. Outpatient long-term management consisted of alternating biweekly visits to a sole nurse practitioner or physician or to a group discussion meeting. Follow-up averaged 41 wk, during which eight patients (22%) had sustained weight loss throughout and remained euglycemic. Twenty patients (56%) initially lost weight (average: 23% of ideal body weight), then plateaued weight, but have also remained euglycemic. Only eight patients, (22%) required insulin. Side effects of the diet were not serious in any patient; no one had myocardial irritability or serum potassium < 2.9 meq/L. This hypocaloric high-protein diet thus appears to be a generally successful means of weaning obese diabetic adult patients from insulin. This can be done rapidly, safely, and permanently in the community. Such diet therapy appears to require minimal laboratory and hospital resources that are available to all health care providers.
The Role of Circulating Glucose and Triglyceride Concentrations and Their Interactions with Other “Risk Factors” as Determinants of Arterial Disease in Nine Diabetic Population Samples from the WHO Multinational Study
Authors: West Kelly M , Ahuja M M S , Bennett Peter H , Czyzyk Arthur , De Acosta Oscar Mateo , Fuller John H , Grab Bernard , Grabauskas Vili , Jarrett R John , Kosaka Kosaka , Keen Harry , Krolewski Andrezej S , Miki Eishi , Schliack Volker , Teuscher Arthur , Watkins Peter J , Stober Judy A
Published: March 2007

In 9 of the 14 national samples of diabetic patients assembled for the WHO Multinational Study of Vascular Disease in Diabetes additional laboratory data made it possible to relate manifestations of macrovascular disease to blood glucose concentrations as well as to diabetes duration and to other potential determinants. In five of the samples, serum triglyceride concentrations were also measured and were included in simple and multivariate analyses. Ischemic heart disease defined from Minnesota-coded EKGs and standardized WHO questionnaires was more strongly associated with serum triglyceride concentrations than with serum cholesterol concentrations, an association less notable in non-insulin-dependent diabetic patients. Ischemic heart disease was not related to the single fasting plasma glucose estimated for this study. Stroke and amputation were much more strongly related to the known duration of diabetes than was ischemic heart disease, and they were both related to blood glucose concentration measured at the time of study. Despite major variation in arterial disease prevalence rates between collaborating centers, risk for diabetic women appeared to equal that for diabetic men. The major variation in arterial disease prevalence between national groups could be accounted for only in part by the risk factors studied. Other factors, genetic or more likely environmental, are likely to contribute to the variation in arterial disease susceptibility and, if definable, may be potentially preventable.
Limited Joint Mobility in Childhood Diabetes: Family Studies
Authors: Rosenbloom Arlan L , Silverstein Janet H , Riley William J , Maclaren Noel K
Published: March 2007

We examined 204 persons with insulin-dependent diabetes mellitus (IDDM), aged 7–23 yr, and 336 of their first-degree relatives, to determine whether there is a genetic component to the development of limited joint mobility. Simple and multiplex pedigrees with IDDM were studied along with normal controls. Only 1 of 90 normal controls had joint stiffness. Among 225 nondiabetic parents of children with IDDM, 7 (3%) had joint limitation, compared with 42 (21%) of children and youth with IDDM. Only 1 of 108 nondiabetic siblings of diabetic probands had limitation. Three parents had adult-onset diabetes and all had limited joint mobility. None of the 8 nondiabetic relatives with joint limitation had diabetic probands with joint involvement; 5 of these 8 tested were negative for islet cell auto-antibodies. There were 11 IDDM multiplex families with at least one member having joint limitation. The concordance rate for limited joint mobility of persons with diabetes for more than 5 yr who were over 12 yr of age was 56%, not different from the 48% frequency in patients with IDDM who met these age and duration criteria. Thus, evidence that limited joint mobility is a metabolic consequence of diabetes includes the virtual absence of limitation among first-degree relatives of probands, including probands with joint stiffness, and that the frequency of joint involvement is not increased in first-degree relatives of patients with IDDM. Furthermore, two brothers with pancreatic hypoplasia and a non-HLA-associated form of IDDM were affected with limited joint mobility. Nonetheless, the expression of this complication must be influenced by host factors, since not all persons with IDDM develop it, and those who do have variable ages of onset without correlation to control measures.
Improved Serum Insulin Profiles in Diabetic Individuals Who Massaged Their Insulin Injection Sites
Authors: Dillon Richard S
Published: March 2007

Eight insulin-dependent diabetic patients were studied on two consecutive mornings when they injected their usual morning mixtures of insulin. One morning they massaged their insulin injection sites 15 min after the injection. Free insulin levels rose 10.14 ± 9.91 μU/ml higher (P < 0.05) and serum glucose levels fell 8.3% lower (P < 0.05) 30 min after massage than on the control study day.
Sources of Disparity in the Spectrum of Diabetes Mellitus at Incidence and Prevalence
Authors: Melton L Joseph , Ochi James W , Palumbo Pasquale J , Chu Chu-Pin
Published: March 2007

In a population-based study in Rochester, Minnesota, the clinical characteristics of 1135 patients newly diagnosed with diabetes (1945–69) were compared with those of 810 residents with diabetes mellitus on prevalence day (1 January 1970). The prevalence patients were older and the male:female ratio was reduced from that seen among incidence cases. The prevalence patients were more likely to be on oral agents, had lower fasting blood glucose levels, were less likely to be symptomatic, but were more likely to have macrovascular and microvascular complications. These differences seemed to come about as a result of variation in survival rates among patients with specific characteristics, differential migration of certain groups of patients, and changes in the status of individuals.