bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Smoking in a Diabetic Population: The Need for Action
Authors: Jones Raymond B. , Hedley Anthony J.
Published: July 2009

Smoking habits in insulin‐treated diabetics in Nottinghamshire (UK) and clinic‐attending diabetics in Nottingham have been analysed. Compared with the general population, the prevalence of current cigarette smoking is significantly less (p < 0.001) in both diabetic men and women older than 50 years. Fewer diabetic men over 60 years have ever smoked than in the general population (p < 0.001) but this finding does not apply to diabetic women. While intervention probably plays some part in this lower prevalence, the most likely explanation is the multiplicative effect of both smoking and diabetes to produce high mortality risks.

Actuarial analysis of insulin‐treated clinic attenders diagnosed after 1970 showed that at most 14% (95% confidence interval [CI] 9–18%) of the 183 who smoked at diagnosis had given up 5 years later while a minimum of 8% (95% CI, 6–11%) of the 313 who were non‐smokers had started smoking.

Information about the patterns of smoking in patients with chronic disease is incomplete and it appears that too little is being done in clinical services which provide long‐term management for these patients to either discourage smoking or determine why some patients give up smoking but others do not.
The Prognostic Value of Stress Hyperglycaemia and Previously Unrecognized Diabetes in Acute Stroke
Authors: Gray C. S. , Taylor R. , French J. M. , Alberti K. G. M. M. , Venables G. S. , James O. F. W. , Shaw D. A. , Cartlidge N. E. F. , Bates D.
Published: July 2009

In a prospective study of 86 patients with acute stroke, blood glucose and HbA1 were estimated within 72 h of onset. The prevalence of previously diagnosed diabetes mellitus was 8% whereas 28% could be assumed to have had unrecognized hyperglycaemia preceeding the acute event as identified by a stable HbA1 raised more that two SD above the mean reference value. Complete functional recovery of the limbs within 4 weeks of the stroke was confined to those patients with a normal admission blood glucose. None of the patients with a raised admission blood glucose regained full functional recovery within 4 weeks. Cumulative mortality at 4 weeks was significantly raised in patients with an elevated blood glucose value irrespective of their HbA1 values (p <0.05). The prevalence of unrecognized hyperglycaemia as a risk factor for acute stroke is greater than previously reported in the UK and admission blood glucose concentration is of greatest importance in predicting early mortality and morbidity.
Lack of Pharmacokinetic Interaction Between Glibenclamide and Trimethoprim‐Sulphamethoxazole
Authors: Sjöberg S. , Wiholm B. E. , Gunnarsson R. , Emilsson H. , Thunberg E. , Christenson I. , Östman J.
Published: July 2009

Eight patients aged 57–86 years with non‐insulin‐dependent diabetes mellitus (NIDDM) taking long‐term glibenclamide treatment (5–15 mg/day) were given oral trimethoprim‐sulphamethoxazole due to an acute bacterial infection. After 4–6 days of combined treatment, the total plasma glibenclamide concentrations were determined every second hour for 12 h, and the area under the curve (AUC) was computed. A second plasma glibenclamide profile was obtained 2–4 weeks after withdrawal of trimethoprim‐sulphamethoxazole. The levels of plasma glibenclamide did not differ between the two occasions, nor did the simultaneously determined levels of blood glucose and plasma insulin. It is concluded that there is no consistent pharmacokinetic interaction between glibenclamide and trimethoprim‐sulphamethoxazole in NIDDM patients.
Quantitative Sensory Examination in Diabetic Children: Assessment of Thermal Discrimination
Authors: Heimans J. J. , Bertelsmann F. W. , de Beaufort C. E. , de Beaufort A. J. , Faber Y.‐A. , Bruining G. J.
Published: July 2009

Vibration perception thresholds (VPTs) and thermal discrimination thresholds (TDTs) were investigated in 55 insulin‐dependent diabetic children aged 11.3 ± 3.9 years (mean ± SD) and in 81 controls. There was no significant difference in VPTs between the two groups. TDTs were significantly higher in the group of diabetic children (p<0.03). Eight diabetic children had abnormal thermal sensation and one child had abnormal vibratory sensation. TDT correlated positively with duration of diabetes mellitus (r = 0.25; p<0.05). Both investigations can be carried out easily and are unobtrusive, which is an important advantage in the examination of children.
Ethnic Minorities in British Diabetic Clinics: A Questionnaire Survey
Authors: Goodwin A. M. , Keen H. , Mather H. M.
Published: July 2009

A questionnaire was sent by the British Diabetic Association to hospital consultant physicians caring for diabetic patients in the UK to estimate the number of ethnic minority patients attending British Diabetic clinics, and the availability of special facilities for their care. Sixty‐two clinics were estimated to have at least 50 Asian patients, and 25 had at least 200 Asian patients. For Afro‐Caribbeans the corresponding figures were 33 and 14 clinics, respectively. Clinics serving a relatively high proportion of these patient groups were situated primarily in Greater London, the Midlands and the North West. Approximately 40% of clinics with over 50 Asians had no specifically adapted diet sheets, and 34% had no hospital interpreter service. Tapes, slides or video presentations were available in only eight clinics. There is an urgent need to improve the provision of special facilities to clinics with substantial numbers of ethnic minority patients.
Treatment of Patients with Non‐insulin‐dependent Diabetes Mellitus: Diabetic Control and Insulin Secretion and Action After Different Treatment Modalities
Authors: Hollenbeck Clarie B. , Reaven G. M.
Published: July 2009

In order to define the relationship between treatment‐induced changes in diabetic control and improvement in in vivo insulin‐stimulated glucose utilization (insulin clamp technique), 30 patients with non‐insulin‐dependent diabetes mellitus (NIDDM) were treated with either insulin, glipizide or diet alone, depending on their initial weight. Fasting plasma glucose concentrations fell from 16.3±1.2, 15.9±1.0, and 16.3±1.0 mmol/l, (mean ±SE) to 6.3±0.5, 11.6±0.6, and 13.4±1.6 mmol/l, after insulin, glipizide and weight reduction, respectively. These changes in fasting plasma glucose concentration were associated with an improvement in insulin‐stimulated glucose uptake, which increased by 69% after insulin, 45% after glipizide, and 72% after weight reduction. Thus, the improvement in insulin action was comparable in the three different groups of patients following each therapeutic intervention, and appeared to be unrelated to the fall in plasma glucose concentration. These results appear to suggest that the ability of any specific treatment to improve diabetic control can vary independently of its effect on in vivo insulin‐stimulated glucose utilization.
Glucose Tolerance and Glycohaemoglobin: A Population Study of Male‐to‐Female Ratios
Authors: Forrest R. D. , Jackson C. A. , Yudkin J. S.
Published: July 2009

We have studied blood glucose concentrations 2 h after a 75g glucose load, and glycohaemoglobin as assayed by agar gel electrophoresis, in 1084 subjects over the age of 40 in a community screening survey. There were 16 newly diagnosed diabetic women (2.7%) and 11 men (2.5%). The mean level of 2h blood glucose was 5.62±2.04 mmol/l in women and 5.33±2.14 mmol/l in men (p<0.002) but when corrected for age and weight the mean levels were 5.55 mmol/l in women and 5.40 mmol/l in men (p>0.2). Mean levels of glycohaemoglobin were 7.30±1.10% in women and 7.17±1.18% in men (p<0.02) but when adjusted for blood glucose and age these were 7.25% in both sexes (p>0.9). Differences in glucose tolerance in this population are related to differences in age and weight. There is no evidence for differences in glycosylation in men and women.
Surface Charge of Red Blood Cells in Insulin‐dependent Diabetic Patients with Incipient and Overt Nephropathy
Authors: Mathiesen E. R. , Smith C. , Lauritzen M. , Hommel E. , Levin M. , Parving H‐H.
Published: July 2009

The negative surface charge of red blood cells was studied in adults with insulin‐dependent diabetes mellitus, using a chemical assay based on the binding of the cationic dye Alcian‐blue 8GX to anionic sites on the cell surface. Twenty‐one healthy non‐diabetic adults, 21 normoalbuminuric diabetic patients, 25 diabetic patients with incipient nephropathy, and 19 diabetic patients with overt nephropathy were studied. The diabetic patients were matched for age, duration of diabetes, and glycaemic control. The red cell surface charge was nearly identical in the four groups studied. Our study does not suggest that loss of membrane negative charge is a generalized phenomenon in insulin‐dependent diabetic patients with albuminuria.
Effect of Fluctuations in Albumin on Serum Fructosamine Assay
Authors: McCance D. R. , Coulter D. , Smye M. , Kennedy L.
Published: July 2009

Serum fructosamine, albumin and plasma glucose were studied in eight patients during recovery from diabetic ketoacidosis, and in eight patients with “decompensated” diabetes without acidosis. In the ketoacidotic group, serum fructosamine had fallen significantly by a mean of 12% by 8h, and fell further during the remainder of the study. A smaller but significant fall in fructosamine (mean 6.1%) was seen in the decompensated group after only 18h, with again a further fall thereafter. These changes in serum fructosamine were accompanied by decreases in serum albumin. However, when fructosamine was corrected by calculating a fructosamine/albumin index (FAI) (fructosamine × 100/albumin), the FAI did not change significantly in either group until a small reduction was noted in the ketoacidotic group at 5 days, which might reasonably be expected as an index of intermediate‐term glycaemia.

Therefore minor fluctuations in albumin levels seen in diabetic patients can affect fructosamine, and correction may be be advisable for the test to be a valid measure of glycosylated serum proteins.
Increased Diene Conjugates in Diabetic Subjects with Microangiopathy
Authors: Jennings P. E. , Jones A. F. , Florkowski C. M. , Lunec J. , Barnett A. H.
Published: July 2009

Free radicals are highly reactive unstable chemical species which have been implicated in the vascular damage associated with several disease states. Diene conjugates, probable products of free radical activity on lipids, were measured spectrophotometrically in 26 diabetic patients with microangiopathy, 36 uncomplicated diabetic patients, and 36 healthy controls. Total diene conjugates and diene conjugate to triglyceride ratios were signficantly elevated in diabetic patients with microangiopathy (0.57±0.08 and 0.31±0.14 OD units/ml respectively; mean ±SD) when compared with patients without complications (0.32±0.10, p<0.001, and 0.17±0.06, OD units/ml, p<0.011). There was no difference in total diene conjugation and their ratio to triglycerides between healthy controls and uncomplicated diabetic patients and the results were not influenced by the type of diabetes or level of diabetic control. Diene conjugate ratios repeated in 14 patients on two occasions, 6 weeks apart, with stable metabolic control were consistent. Increased diene conjugation suggesting increased free radical activity is associated with microangiopathy and this may have pathogenetic implications.
Guar Sprinkled on Food: Effect on Glycaemic Control, Plasma Lipids and Gut Hormones in Non‐insulin Dependent Diabetic Patients
Authors: Fuessl H. S. , Williams G. , Adrian T. E. , Bloom S. R.
Published: July 2009

The effects of guar granules sprinkled over food on carbohydrate and lipid metabolism were studied in a double‐blind cross‐over trial in 18 patients with non‐insulin‐dependent diabetes mellitus (mean±SEM age 61.3±2.5 years). Five‐gram guar granules (Guarem®, Rybar Laboratories, Amersham, Bucks) were sprinkled over food at each main meal for 4 weeks, and during a 4‐week placebo period (separated by a 2‐week ‘wash‐out’ period), 5 g wheat bran was taken in the same way. Diabetic treatment was not changed during the study. Mean fasting plasma glucose (FPG) concentration and glycosylated haemoglobin (HbA‐1) concentration after treatment were significantly lower than after the placebo period (FPG 8.29±0.47 vs 8.78±0.53 mmol/l, p<0.05; HbA1: 8.70±0.39 vs 9.09±0.39%, p<0.05). There was a 50% reduction in the incremental area under the postprandial glycaemic curve when guar was eaten with a standardized test meal. Total plasma cholesterol decreased from 5.79±0.29 to 5.19±0.22 mmol/l (p<0.05) after the guar treatment period. Guar ingestion reduced postprandial insulin and enteroglucagon responses, the latter significantly so, but had no apparent effect on gastric inhibitory polypeptide, pancreatic glucagon, gastrin, and pancreatic polypeptide.
Absence of the Sensory Action Potential of The Medial Plantar Nerve: a Sensitive Indicator of Diabetic Neuropathy
Authors: Abraham Raju M. , Abraham Ralph R.
Published: July 2009

The sensory action potential of the medial plantar nerve (MPSAP), using needle recording electrodes subcutaneously, was measured in 119 patients with diabetes ((75 insulin‐dependent, mean age 43.7±1.2 SEM years (range 15–73) and in 75 age‐matched normal subjects (mean age 44.0±1.5 years (range 19–75)). The MPSAP was not detectable in 56 out of 119 diabetics; there was only one absent MPSAP response in the normal group, in a patient aged 71 years. Diabetics with absent MPSAP responses were significantly older, heavier and taller and had diabetes of longer duration. The amplitudes and conduction velocities in the sural, common peroneal, and tibial nerves were also significantly smaller. The amplitudes of the MPSAP, when present, correlated with height (r=‐0.47(43), p<0.001), weight (r=‐0.44(43), p<0.001), the distal tibial compound motor action potential (r=0.37(43), p<0.01), and the common peroneal nerve conduction velocity (r=0.32(43), p<0.02). The MPSAP was always absent if the sural SAP was < 5uV but also in 14/59 patients whose sural SAP amplitudes were within 1 sd of the normal mean (> 10.7 uV). The MPSAP was absent at a younger age and with diabetes of shorter duration than is seen with unrecordable sural SAPs. It may therefore represent an early manifestation of neuropathy in diabetes.
A Clinico‐pathological Study of Diabetic Foot Ulcers
Authors: Jones E. W. , Peacock I. , McLain S. , Fletcher E. , Edwards R. , Finch R. G. , Jeffcoate W. J.
Published: July 2009

During a 32‐month period 94 foot ulcers in 54 diabetic patients aged 38–90 years (mean 64 years) were managed in a specialist foot clinic. Fifty‐six percent were men, and they were significantly younger than women; 46% were taking insulin. Mean duration of diabetes was 13.4 years. Comparison with controls revealed a higher prevalence (p<0.01) of retinopathy (60% vs 23%), neuropathy (89% vs 31%), vasculopathy (71% vs 34%), arterial calcification (31% vs 20%) and previous lesions (54% vs 4%). There was no difference in quality of diabetic control, or smoking habit. A simple classification of lesions was used. All types yielded mixed cultures of microorganisms (average 2.1 per swab); the flora obtained was affected by systemic antibiotics. Abnormal pressure was judged to have contributed to all lesions occurring in areas of callus. In addition definable trauma precipitated the event in up to 60% of all other types. Lesions in areas of callus were more likely to have healed by the end of the study period, but average time to healing was significantly longer than other lesions. Despite intensive outpatient support, 33 patients spent a total of 1188 days in hospital during the 974 day period, an average of 36 days per patient and 1.2 beds per day. Further research is urgently required to define optimal methods of prevention and treatment of diabetic foot ulcers.
Portal and Mesenteric Vein Thrombosis in Two Diabetic Patients
Authors: Myszor M. F. , Calam J. , Hodgson H. J. F.
Published: July 2009

We report two adult patients in whom portal and mesenteric vein thrombosis was a serious complication of diabetes. The contribution of a hypercoagulable state is considered and the importance of careful glycaemic control in patients with previous thrombotic episodes is emphasized.
Rapid Detection of Urinary Albumin at low Concentration by an Agglutination Inhibition Techniqué
Authors: Close C. F. , Scott C. S. , Viberti G. C.
Published: July 2009

Subclinical elevation of urinary albumin excretion (microalbuminuria) identifies individuals at high risk of developing nephropathy in insulin‐dependent diabetes. We have evaluated the performance of a new specific method for the rapid detection of microalbuminuria employing a latex agglutination inhibition technique. A total of 96 consecutive sterile first morning urine samples from insulin‐dependent diabetic subjects were tested using AlbuScreen TM (Cambridge Life Sciences). Fifteen samples with albumin concentration >27 μg/ml (range 27.6–780μg/ml) read positive with AlbuScreen and were identified with 100% sensitivity and specificity. This test which is ten times more sensitive than the qualitative methods in current use and which detects a wide range of urinary albumin concentrations from microalbuminuria to heavier proteinuria may prove useful in the outpatients setting.
Pre‐clinical Assessment of the Performance of the Glucostix and Glucometer II Blood Glucose Monitoring System
Authors: Chipchase D. , Watts J. R.
Published: July 2009

The Glucostix/Glucometer II blood glucose system has been evaluated in a hospital laboratory, with the purpose of assessing the suitability for use by nurses and diabetic patients. In the hands of laboratory personnel, the strips and meter gave precise results which correlated well with the laboratory plasma glucose assay, taking into account the difference between plasma and whole blood. The system was simple to use and rapid (50 seconds), and should prove useful and acceptable in the hands of non‐laboratory personnel.
Continuous Subcutaneous Insulin Infusion Versus Injection Therapy: A Randomized Cross‐over Trial Under Usual Diabetic Clinic Conditions
Authors: Marshall S. M. , Home P. D. , Taylor R. , Alberti K. G. M. M.
Published: July 2009

Twelve C‐peptide negative insulin‐dependent diabetic patients participated in a randomized cross‐over study of 6 months treatment with twice or thrice daily insulin injection therapy and continuous subcutaneous insulin infusion (CSII). Standard, non‐intensified management conditions were maintained throughout. Glycosylated haemoglobin levels were similar on both regimens (9.2 ± 0.5 % versus 9.0 ± 0.4%; CSII vs injection therapy; (mean ± SEM). Capillary blood glucose concentrations before breakfast (5.2 ± 0.4mmol/l vs 9.1 ± 0.8mmol/l), after lunch (6.5mmol/l ± 0.8 vs 7.9 ± 1.0mmol/l) and before the evening meal (5.0 ± 0.7mmol/l vs 7.7 ± 0.7mmol/l) were lower on CSII, as were 24‐hour urine glucose excretion and total insulin dose (39.3 ± 2.2 vs 49.8 ± 4.0 U/day). There was a significant positive correlation between glycosylated haemoglobin levels on each regimen with an inverse correlation between fasting blood glucose values and glycosylated haemoglobin on injection but not pump treatment. Thus although blood glucose control at some individual daytime points appeared lower on CSII, overall diabetic control was similar on the two regimens.
A Genetic Analysis of Type 2 (Non‐insulin‐dependent) Diabetes Mellitus in Punjabi Sikhs and British Caucasoid Patients
Authors: Hitman G. A. , Karir P. K. , Mohan V. , Rao P. V. , Kohner E. M. , Levy J. C. , Mather H.
Published: July 2009

A genetic analysis of diabetic and non‐diabetic Punjabi Sikhs (n = 164) was made for markers of non‐insulin‐dependent diabetes mellitus using insulin receptor, insulin, and HLA‐D αchain gene probes. Additionally British Caucasoids (n=163) were studied using the insulin receptor probe. Insulin receptor gene restriction fragment length polymorphisms were defined using Southern blot techniques and the restriction enzyme Bgl II and Bam HI. In Punjabi Sikhs and British Caucasoids neither of the restriction fragment length polymorphisms distinguished non‐insulin‐dependent diabetes mellitus subjects from controls. In the Sikhs no association with non‐insulin‐dependent diabetes mellitus was seen with the hypervariable region of the insulin gene or with HLA‐DR/DQ/DXα chain restriction fragment length polymorphisms. We therefore conclude that despite the high prevalence of non‐insulin‐dependent diabetes mellitus in Asians we were unable to find any genetic markers for this disease using the available cloned gene probes.
Comparison of Overnight, Morning and 24‐Hour Urine Collections in the Assessment of Diabetic Microalbuminuria
Authors: Eshøj O. , Feldt‐Rasmussen B. , Larsen M. L. , Mogensen E. F.
Published: July 2009

With the aim of comparing different urine collection periods in the assessment of micro‐albuminuria, urinary albumin excretion rates (AERs) were measured in samples from 24 h, overnight, and morning urine collections in 54 patients aged 17 to 62 years with insulin‐dependent diabetes mellitus with a mean duration of 15 years. The AER in overnight urine was found to be reduced by 25% compared to the rate in 24 h and morning urine. Assessing the ability to predict a 24 h AER within the microalbuminuric range (20–200 μg/min) we found a sensitivity of 90% and a specificity of 88% for both overnight and morning urine samples. These values were slightly improved by relating AER to the excretion of creatinine and it is concluded that overnight as well as morning urine collections can be used when diagnosing microalbuminuria in insulin‐dependent diabetics. Furthermore the results show that the albumin to creatinine ratio in morning urine is a reliable estimate of 24 h AER and better than measurement of the albumin concentration alone.
The Oxford Community Diabetes Study: Evidence for an Increase in the Prevalence of Known Diabetes in Great Britain
Authors: Neil H. A. W. , Gatling W. , Mather H. M. , Thompson A. V. , Thorogood M. , Fowler G. H. , Hill R. D. , Mann J. I.
Published: July 2009

A prevalence survey for known diabetes was conducted in a geographically defined population of nearly 40 100 in Oxford in April 1982. The age‐adjusted prevalence rate was 10.4/1000 which did not differ significantly from age‐adjusted rates of 9.5/1000 in Poole and 10.5/1000 in Southall. The prevalence increased with age and was higher in men than women over the age of 30 years. Our results confirm that there has been a change in the male to female sex ratio and suggest that there are about 500 000 diagnosed diabetics in England and Wales including about 190 000 insulin‐treated patients. These findings are consistent with a secular increase in the prevalence of diagnosed diabetes over the last two decades which has important implications for the planning and provision of resources for care.
Carbohydrate and Lipid Metabolism of Skeletal Muscle in Type 2 Diabetic Patients
Authors: Falholt K. , Jensen I. , Jensen S. Lindkær , Mortensen H. , Vølund Aa. , Heding L. G. , Petersen P. Noerskov , Falholt W.
Published: July 2009

Peripheral hyperinsulinaemia is the cause of metabolic changes that might contribute to the high incidence of macrovascular disease in patients with diabetes mellitus. In order to test this hypothesis muscle biopsies from 12 Type 2 diabetic patients and 14 age and sex matched non‐diabetic patients, undergoing minor surgery, were obtained. The diabetic patients had significantly elevated fasting serum insulin (0.29±0.05 vs 0.6±0.03 nmol‐l) and glucose (8.3±1.5 vs 4.6±0.5 mmol‐l) and HbA1, levels (8.4±0.4 vs 5.0±0.2 per cent). The fasting and 2‐h postprandial C‐peptide levels were 0.99±0.25 vs 0.39±0.12 and 3.12±0.75 vs 1.09±0.34 nmol/l, respectively. The diabetic patients showed a marked elevation of triglyceride in the striated muscle biopsies compared to the non‐diabetic controls (290±52 vs 48±6 μmol/g wet weight, p<0.001). Moreover, the activities of glucose‐6‐phosphate dehydrogenase (0,25±0.03 vs 0.13±0.01 U/g wet weight) and malic enzyme (0.15±0.01 vs 0.05±0.01 U/g wet weight), necessary for lipid synthesis, were significantly increased (both p<0.001) in the diabetic patients while the glycolytic enzymes, hexokinase (0.65±0.09 vs 1.82±0.11 U/g wet weight), pyruvate kinase (7.3±0.9 vs 13.2±0.9 U/g wet weight), phosphofructokinase (1.3±0.2 vs 2.6±0.2 U/g wet weight), and α‐glycerophosphate dehydrogenase (7.3±0.5 vs 12.5±0.7 U/g wet weight) were decreased (all p<0.001). These data indicate substantial enhancement of lipid synthesis and decreased activity of glucose metabolism in skeletal muscles of peripherally hyperinsulinaemic diabetic patients.
The Importance of the Time Interval Between Insulin Injection and Breakfast in Determining Postprandial Glycaemic Control—A Comparison Between Human and Porcine Insulin
Authors: Patrick A. W. , Collier A. , Matthews D. M. , Macintyre C. C. A. , Clarke B. F.
Published: July 2009

This study assessed the effect of the time interval between insulin injection and breakfast in determining subsequent postprandial glycaemic control and also whether this differed between highly purified porcine insulin and human insulin (crb) in six diabetic patients (age range 24–36 years, duration of diabetes >10 years) usually treated with twice daily Actrapid MC and Monotard MC and with stable insulin requirements and diabetic control. On separate mornings each patient was given, after an overnight fast, their usual dose of either Actrapid MC and Monotard MC or Humulin S and Humulin Zn injected 5, 20, or 40 min before a standard breakfast. The postprandial glycaemic profile was not significantly different at any of the three time intervals with Actrapid MC and Monotard MC. However, with the human insulin the profile was significantly better at the 40 min interval than at the 5 min interval (p<0.05) and this was also better than any of the profiles with the porcine insulin, there being a significant difference between the two types of insulin (p <0.05)

These findings suggest that the time interval between insulin injection and breakfast may be more important with human insulin than with porcine insulin.
Development, Validation and Application of Computer‐linked Knowledge Questionnaires in Diabetes Education
Authors: Meadows K. A. , Fromson B. , Gillespie C. , Brewer A. , Carter C. , Lockington T. , Clark G. , Wise P. H.
Published: July 2009

Multiple choice questionnaires (MCQs) capable of being marked manually or by a newly developed optical mark reader, or by use of an inexpensive inter‐active microcomputer system have been developed for the separate assessment of insulin‐dependent and non‐insulin‐dependent patient knowledge. Forty‐six insulin‐related and non‐insulin‐related multiple choice questions covering six main areas of knowledge were constructed for inclusion into draft questionnaires. From the responses of a total of 180 completed questionnaires, piloted in 18 randomly selected clinics in 14 Regional Health Authorities in England, psychometric analysis was performed to determine reliability, discrimination coefficients, and facility indices. Seventy‐three per cent of insulin‐dependent diabetic patients (IDDM) and 92% of non‐insulin‐dependent diabetic patients (NIDDM) MCQ correct options had facility indices within the acceptable range of 30 to 90%. 82% IDDM and 93% NIDDM correct options had discrimination coefficients exceeding 0.2.

Questionnaire reliability (internal consistency) using the Kudor‐Richardson (KR20) formula was IDDM 0.87 and NIDDM 0.82. Evidence in support of the IDDM questionnaire's criterion validity was based on significant differences (p<0.05) identified between a number of knowledge area scores stratified according to HbA1 levels. Prescriptive correction for screen display and automatic hard copy feedback was designed for both incorrect and omitted question options, providing both educational (patient) and analytical (clinic) documentation. Both technical and psychometric properties of these knowledge assessment instruments should be acceptable for diabetic knowledge evaluation and instruction.
Diuretics and Hyperkalaemia in Diabetic Ketoacidosis
Authors: Olczak S. A. , Fitzgerald M. G. , Nattrass M. , Wright A. D.
Published: July 2009

Diabetic ketoacidosis (DKA) often presents with hyperkalaemia. We investigated whether it was more likely in patients taking potassium‐retaining diuretics. A retrospective survey of all patients (552 cases) presenting in DKA between 1974 and 1984 was undertaken. Initial biochemical data were compared for patients recorded as taking potassium‐retaining diuretics (7 cases) at the time of presentation with those taking potassium‐losing diuretics (13 cases), and age matched control groups were selected from those who presented in DKA but were not taking diuretics. There was no significant difference in initial serum potassium levels between the diuretic treated groups. The serum sodium was higher in the control group than in the potassium losing group (p = 0.045) and the serum urea significantly lower (p = 0.045). We conclude that potassium‐retaining diuretics do not predispose to hyperkalaemia in diabetic ketoacidosis.
Renal Failure in Diabetics in the UK: Deficient Provision of Care in 1985
Authors:   Joint Working Party on Diabetic Renal Failure of the British Diabetic Association, the Renal Association, and the Research Unit of the Royal College of Physicians
Published: July 2009

Two surveys of diabetic renal failure were conducted in 1985. The first survey was designed to identify all diabetic patients having advanced renal failure (serum creatinine greater than 500 μmol/l and/or blood urea greater than 25 mmol/l in six selected health regions of the UK. The study identified 181 such patients indicating that approximately 10 people in every million of the population were affected. It is calculated that there were about 580 patients having diabetic renal failure in the whole of the UK. The majority of the patients (78%) were considered by their physicians to be suitable for renal support treatment. Those who were excluded were considered unsuitable chiefly on account of old age or cardiac problems.

In the second survey all 66 renal units in the UK reported the number of diabetic patients starting renal support treatment in 1985. There were 273 patients, suggesting that there may be a shortfall when compared with the number of diabetics likely to need treatment.

The Working Party recommends that diabetics who develop renal failure should always be considered for treatment by dialysis or transplantation, and that appropriate resources should be made available for them.
Hypertriglyceridaemia and Diabetes Mellitus: Cause or Effect?
Authors: Thomas D. J. B. , Stocks J. , Galton D. J. , Besser C. M.
Published: July 2009

Two patients with hypertriglyceridaemia which was diagnosed several years before the onset of diabetes are described. In the first case a 54‐year‐old man presented with hypertriglyceridaemia and normal glucose tolerance. After 4 years he developed severe hypertriglyceridaemia (22 mmol/l) which was first ascribed to poor compliance but soon afterwards diabetes was diagnosed and good blood glucose control minimized the hypertriglyceridaemia. The second patient, a female, aged 27 years, with the polycystic ovarian syndrome, presented with eruptive xanthoma after several years of mild hyperlipidaemia. There was severe hyperlipidaemia (triglyceride 140 mmol/l, cholesterol 42 mmol/l) which required urgent plasmaphoresis. Diabetes was diagnosed and treated with insulin at this time but the patient was taking the oral contraceptive pill and also had a deficiency of apolipoprotein Cll.
British Diabetic Association Holidays — What are they worth?
Authors: Vyas S. , Mullee M. A. , Kinmonth A.‐L.
Published: July 2009

A postal survey among families of 63 children attending two BDA educational holidays studied their expectations before (Questionnaire 1) and experiences 3 months afterwards (Questionnaire 2). Of 47 families replying to both questionnaires (22M, 25F; mean age 8.4 years, range 5–13.8 years), expectations expressed by parents for their children were that they gain in confidence and independence (n = 36), mix with other diabetic children (n = 32), learn to self‐inject (n = 27), improve diet (n = 23), and have a good holiday (n = 10). Thirty‐five families subsequently reported that their expectations had been met.

After the holiday, although there was no change in frequency of blood or urine testing, there was an increase in children doing tests on their own (Q1: 15, Q2: 28, p = 0.003); more parents reported confidence in their child recognizing a hypoglycaemic episode (Q1:29, Q2: 39, p = 0.001); and there was a sustained increase in independence with insulin injections (Q1:29, Q2:35, p = 0.042).

This study provides evidence that BDA holidays benefit parents and their children, and do so mainly by increasing the children's confidence and independence in diabetic care.
The Medi‐Jector II: Efficacy and Acceptability in Insulin‐dependent Diabetic Patients With and Without Needle Phobia
Authors: Houtzagers C. M. G. J. , Visser A. Ph. , Berntzen P. A. , Heine R. J. , van der Veen E. A.
Published: July 2009

Efficacy and acceptability of the Medi‐Jector II, compared with conventional syringes, was evaluated in a cross‐over study (two 4‐week periods) in 14 adult insulin‐dependent diabetic patients. In 6 out of these 14 patients the clinical diagnosis of needle phobia was confirmed by anxiety tests for trait (45.8 ± 12.8 (SD) versus 34.0 ± 6.2; p<0.05) and state (50.3 ± 10.9 versus 28.9 ± 5.2, p<0.05). Five patients (one needle‐phobic) dropped out, all for Medi‐Jector‐related problems. No significant differences were found in body weight, insulin dosage, and number of hypoglycaemic reactions. HbA1 after the Medi‐Jector period was significantly higher than after the conventional period (9.8 ± 1.2 (SE) versus 9.1 ± 1.1 (SE)%; p<0.05).

The questionnaire, evaluating the Medi‐Jector, revealed poor acceptance of the device (7/9 patients' general impression being moderate or bad). The use of the Medi‐Jector in comparison with conventional injections caused the patients to complain about: more immediate pain (4/9 patients), delayed pain (often: 4/9, sometimes: 2/9), more insulin leakage (6/9), more bleeding (6/9), and more haematomas (5/9). Except for ‘often occurring delayed pain’ (4/5 needle‐phobics versus 0/4 non‐needle‐phobics; p<0.05), needle‐phobic patients scored the questionnaire similarly to the other patients.

We conclude that the use of the Medi‐Jector II did not cause a major short‐term loss of metabolic control, but that the device was not well accepted by our patients, independent of the existence of needle phobia.
Comparison of Continuous Subcutaneous Insulin Infusion with Multiple Insulin Injections Using the NovoPen
Authors: Saurbrey N. , Arnold‐Larsen S. , Møller‐Jensen B. , Kühl C.
Published: July 2009

Twenty‐one patients with insulin‐dependent diabetes mellitus (IDDM) participated in a 20‐week randomized cross‐over comparison of continuous subcutaneous insulin infusion (CSII) with intensified conventional treatment (ICT) using the NovoPen, The Medix or the Auto‐Syringe pumps were used for CSII and, during ICT with NovoPen, conventional plastic syringes were used for injections of intermediate‐acting insulin at bedtime. At entry HbA10 was 8.7±0.4% (mean ±SE) in CSII patients and 8.8±0.5% in the ICF group. HbA10 declined significantly in both groups (ICT 7.6±0.2%; CSII 7.6±0.2%) though there was no significant difference between the responses. Overall mean blood glucose was slightly but significantly lower during CSII than during ICT (CSII: 7.6±0.2 mmol/l; ICT: 8.7±0.4 mmol/l, p<0.05). The number of hypoglycaemic episodes did not differ significantly between patients treated with NovoPen and CSII. At the end of the study, a questionnaire revealed that all but one patient preferred ICT with NovoPen to conventional therapy. Given the choice for future treatment, 6 patients chose CSII, 12 patients preferred ICT with NovoPen and 1 was unsure.
Serum Lipids, Lipoproteins and Macrovascular Disease in Non‐insulin‐dependent Diabetics: A Possible New Approach to Prevention
Authors: Seviour P. W. , Teal T. K. , Richmond W. , Elkeles R. S.
Published: July 2009

The relationship between macrovascular disease and serum lipids, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL), and subfraction cholesterol, and apolipoproteins has been examined in 53 female and 95 male patients with non‐insulin‐dependent diabetes mellitus (NIDDM). In males, those with macrovascular disease had higher serum and LDL cholesterol concentrations than those without. In females, those with macrovascular disease had higher levels of serum triglyceride, cholesterol, LDL cholesterol, as well as lower HDL, HDL2, and HDL3 cholesterol and apoprotein A‐1, than those without. On multivariate analysis, LDL cholesterol was the most important association with macrovascular disease in males and apoprotein A‐1 in females.

In a subgroup of 36 patients, a double‐blind placebo controlled study using bezafibrate or placebo, in addition to conventional oral hypoglycaemic therapy over 4 months, showed falls in serum and LDL cholesterol and in serum triglyceride and a rise in HDL cholesterol in the treated group. These changes should reduce the incidence of macrovascular disease in NIDDM and we suggest further prospective studies of such therapy in addition to conventional oral hypoglycaemic agents.
Non‐insulin‐dependent Diabetes and Renal Replacement Therapy
Authors: Grenfell A. , Bewick M. , Parsons V. , Snowden S. , Taube D. , Watkins P. J.
Published: July 2009

Reports of renal replacement therapy in diabetes usually refer to patients with insulin‐dependent diabetes mellitus (IDDM) only, and little is known about renal failure in non‐insulin‐dependent diabetics (NIDDM). A high proportion, 46/141 (32%), of the diabetics treated at our unit since 1974 had NIDDM. They were older at treatment (56 ± 9 years, mean ± SD) compared to the IDDM patients (39 ± 10 years, p<0.001), and had a shorter duration of diabetes (13 ± 8 years versus 23 ± 8 years, p<0.001). Asians and Afro‐Caribbeans accounted for 48% of the NIDDM patients (22/46) compared to only 7% of those having IDDM (6/95, p<0.0001). Non‐diabetic renal disease accounted for the renal failure in 32% (15/46) of the NIDDM patients but only in 10.5% (10/95) of the IDDMs (p<0.001). Despite these differences the prevalence of other diabetic complications (retinopathy, neuropathy, and cardiovascular disease) was similar. Patient survival after transplantation was poorer in NIDDM than IDDM (23% and 57%, respectively, at 2 years). Survival on dialysis was equally poor in NIDDM and IDDM. Thus, NIDDM patients treated for renal failure are more commonly non‐European and more often have non‐diabetic renal disease. Yet other diabetic complications occur to the same extent in both IDDM and NIDDM patients with diabetic nephropathy.
Type 2 Diabetes in Arab Patients in Kuwait
Authors: Richens E. R. , Abdella N. , Jayyab A. K. , Al‐Saffar M. , Behbehani K.
Published: July 2009

We describe the characteristics of 75 Arab Type 2 diabetic patients in Kuwait. Their age (± SD) at onset was 41 ± 10 years, and fasting serum C‐peptide concentration was 0.32 ± 0.23 nmol/l (n=51). Fifty‐three percent (37/70) possessed HLA‐DR3 or ‐ DR4 epitopes, and 64% (47/73) had a family history of diabetes. Data review suggested that they could be segregated into two groups, those under 40 years old at onset (32 ± 6 years, n=37), and the remainder (48 ± 6 years, n=38) (p<0.001). Those in the former group had a significantly higher frequency of a family history of diabetes than those in the latter group (92% vs 38%, p<0.001) suggestive of a greater genetic influence on the development of Type 2 diabetes in those with early onset disease.
Insulin Compatibility with Polymer Materials Used in External Pump Infusion Systems
Authors: Melberg S. G. , Havelund S. , Villumsen J. , Brange J.
Published: July 2009

In a study designed to mimic actual user conditions for external insulin pump infusion, the insulin quality after passage through the infusion set was assessed by various analytical methods, including high performance liquid chromatography. The two infusion sets tested consisted of, firstly, a polyvinylchloride/rubber syringe and a polyvinylchloride catheter sterilized by gamma irradiation and, secondly, a polyethylene/polypropylene syringe connected to a polyethylene catheter and sterilized by ethylene oxide. The insulin solution delivered through the PVC infusion set showed a reduction of preservative to less than 30% of the initial content and increased formation of chemical transformation products of insulin varying from twice the reference level during the first day to more than three times on the third day. By contrast, the polyethylene/polypropylene infusion system showed only a minor decrease in preservative content and no increase in chemical transformation. These effects were observed irrespective of the brand of insulin and were not affected by increase of the zinc content of the insulin solution. Investigation of the influence of the sterilization methods performed on polyvinylchloride and polyethylene catheters revealed that gamma irradiated polyvinylchloride catheters were markedly harmful to the insulin solution, whereas ethylene oxide sterilization did not influence the chemical stability of insulin.
A Rise in the Plasma Activities of Hepatic Enzymes is not a Common Consequence of Hypoglycaemia
Authors: Jones R. G. , Grant P. J. , Brown D. , Stickland M. , Wiles P. G.
Published: July 2009

Eight otherwise healthy insulin‐dependent diabetic patients were subjected to controlled, symptomatic hypoglycaemia for 20 min (median glucose concentration 1.7 mmol/l, range 1.0–2.6 mmol/l). Concentrations of plasma adrenaline and plasma vasopressin were significantly increased, indicating normal counter‐regulatory responses for these hormones. Plasma activities of the hepatic enzymes AST, ALT, LDH, GGT, and CK did not increase during or following the period of hypoglycaemia. Thus, abnormal plasma enzyme activities noted after clinical hypoglycaemia should be fully investigated, and not disregarded as due to the hypoglycaemic episode.
The Prevalence of Proteinuria Detected by Albustix in a Defined Diabetic Population
Authors: Gatling W. , Mullee M.A. , Hill R. D.
Published: July 2009

All the known diabetic patients (917) from a defined population (90 660) were called for review by a single observer. A total of 842 (92%) attended and proteinuria, identified using Albustix (0.3 g/l or more), was found in 57 cases (6.8%), but in 9 this was in association with a urinary tract infection. Diastolic blood pressure, an ulcerated or amputated lower limb, and smoking category were found to be the only significant predictors of proteinuria after a multiple logistic regression analysis. A serum creatinine greater than 150 μmol/l was found in 29 (3.8%) of the 768 diabetics in whom it was measured. However, proteinuria was only present in 7 of the diabetics with impaired renal function. In those aged less than 65 years, the prevalence of proteinuria with impaired renal function was 0.75%.
Antepartum Pituitary Necrosis in Diabetes Mellitus
Authors: Flynn M. D. , Cundy T. F. , Watkins P. J.
Published: July 2009

Pituitary infarction occurred during pregnancy in two insulin‐dependent diabetic patients aged 32 and 33 years. The diagnosis was delayed in each case before being confirmed biochemically and radiologically. A decreasing insulin requirement and recurrent hypo‐glycaemia made it possible to determine the exact time that pituitary infarction occurred during pregnancy. The clinical features of these cases should alert physicians to the possibility of pituitary infarction in diabetic pregnancy and minimize the delay in diagnosis.
Heart Rate Fluctuations in Diabetic Patients with Cardiac Vagal Dysfunction: A Spectral Analysis
Authors: Weise F. , Heydenreich F. , Runge U.
Published: July 2009

The autonomic nervous control of cardiac function during active orthostatic load has been studied by measuring the power spectrum of heart rate fluctuations in 16 insulin‐dependent diabetic patients and 14 age‐matched control subjects. The patients were subdivided into two groups: 8 with normal respiratory sinus dysrhythmia (RSA+) and 8 with reduced respiratory sinus dysrhythmia (RSA‐). In RSA‐ patients the total power (0.01–0.50 Hz) was significantly reduced compared with control subjects (4.7 versus 15.5 min−2, 2p<0.05) and the pattern of heart rate fluctuatons was characterized by a relative increase in the low‐frequency component (0.01–0.05 Hz) as compared with RSA+ patients and control subjects (45% versus 24% and 27%, both 2p<0.01). There was also a significant reduction in the high‐frequency component (0.15–0.50 Hz) as compared with RSA+ patients and control subjects (17% versus 36% and 33%, both 2p<0.05). During standing, a significant increase in total power was found only in control subjects (2p<0.01) and the difference between control subjects, and RSA+ and RSA‐ patients reached significance (32.2 versus 15.1 and 12.7 min−2, 2p<0.02 and 2p<0.01). The pattern of heart rate fluctuations in RSA‐ patients showed no significant change on standing. These results suggest that the reduced overall heart rate variability in diabetic patients with cardiac autonomic neuropathy is associated with a typical heart rate fluctuation pattern.
Glycosylation and Cross‐linkage of Cardiac Myosin in Diabetic Subjects: A Post‐mortem Study
Authors: Yudkin J. S. , Cooper M. B. , Gould B. J. , Oughton J.
Published: July 2009

We have investigated the possibility that post‐translational modification of myosin by protein glycosylation and cross‐linking occurs in cardiac myosin. Left ventricular muscle was obtained at post‐mortem from 6 diabetic and 7 non‐diabetic subjects. Myosin was extracted from muscle and purified using Sephadex chromatography followed by protein concentration. Glycosylation was estimated using boronate affinity chromatography with the myosin dissolved in a pyrophosphate buffer, the glycosylated myosin being displaced with sorbitol. Cross‐linkage was assessed by fluorescence at 440 nm upon excitation at 370 nm. Diabetic subjects had significantly higher levels (p<0.02) of glycosylated myosin (median 6.0% (range 3.8–6.6%)) than non‐diabetic subjects (median 2.4% (range 0.3–4.2%)) but there was no difference in the degree of cross‐linkage as assessed by fluorescence (diabetic median 9.8 (range 6.5–17.0) arbitrary units; non‐diabetic median 9.7 (range 6.0–11.4) arbitrary units). Glycosylation of left ventricular myosin may be of relevance to the excess risk of congestive cardiac failure in diabetic patients.