bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Long-Term Glycemic Control on Cognitive Function
Authors: Lincoln Nadina B , Faleiro Rachael M , Kelly Catherine , Kirk Bernadette A , Jeffcoate William J
Published: March 2007

OBJECTIVE

To investigate the relationship between recurrent hypoglycemia and cognitive impairment in insulin-dependent diabetic patients.

RESEARCH DESIGN AND METHODS

Seventy patients who were diagnosed as diabetic at age 18 years or older, were under 55 years old, and had no condition likely to affect cognitive abilities were recruited from a diabetic register. Patients were interviewed to obtain information on the frequency of major and minor hypoglycemia. Their cognitive abilities were assessed on tests of premorbid intelligence, current intelligence, reaction time, concentration, memory, and information processing.

RESULTS

There was a significant correlation between the apparent decline in intelligence, expressed as the discrepancy between the estimated premorbid and the actual performance intelligence quotient, and the frequency of major hypoglycemic attacks (rs = −0.30; P < 0.01). Comparison of patients with and without recurrent hypoglycemia showed few significant differences in cognitive ability.

CONCLUSIONS

Results support previous work that suggests that major hypoglycemic attacks have a significant effect on some aspects of cognitive function, but the clinical importance of this finding remains to be determined.
Effects of Breakfast Cereals Containing Various Amounts of β-Glucan Fibers on Plasma Glucose and Insulin Responses in NIDDM Subjects
Authors: Tappy L , Gügolz E , Würsch P
Published: March 2007

OBJECTIVE

To determine whether increasing doses (amounts) of β-glucan present in an extruded breakfast cereal affect the glycemic and insulinemic responses in eight NIDDM subjects, compared with the same responses after a continental breakfast (bread, milk, cheese, ham).

RESEARCH DESIGN AND METHODS

Breakfast cereals were produced using various proportions of oat bran enriched in fiber, which contain an unusually high amount of a viscous polysaccharide, called β-glucan, and oat bran. The carbohydrate load was 35 g.

RESULTS

The maximum increases observed in plasma glucose after the breakfast cereal were 67% (P < 0.05), 42% (P < 0.001), and 38% (P < 0.001) with 4.0, 6.0, and 8.4 g β-glucan, respectively, compared with the continental breakfast. There was a linear inverse relationship between dose of β-glucan and plasma glucose peak or area under the glucose curve (R2 = 0.94, P < 0.05). Postprandial insulin increase was only 59–67% (P < 0.01) as high as the continental breakfast after all three levels of β-glucan.

CONCLUSIONS

The 50% decrease in glycemic response that was observed after the ingestion of 35 g carbohydrate is estimated to occur with ∼5 g β-glucan. This dose of β-glucan can easily be attained without the loss of taste by incorporating oat bran concentrate in products.
The GENNID Study: A resource for mapping the genes that cause NIDDM
Authors: Raffel Leslie J , Robbins David C , Norris Jill M , Boerwinkle Eric , DeFronzo Ralph A , Elbein Steven C , Fujimoto Wilfred , Hanis Craig L , Kahn Steven E , Permutt M Alan , Chiu Ken C , Cruz Jaime , Ehrmann David A , Robertson R Paul , Rotter Jerome I , Buse John
Published: March 2007

OBJECTIVE

To develop a resource, consisting of comprehensive data and lymphoblastoid cell lines, of well-characterized NIDDM families that will be available to the scientific community for genetic studies of NIDDM.

RESEARCH DESIGN AND METHODS

Non-Hispanic white, Hispanic, African-American, and Japanese-American multiplex NIDDM families, with a minimum of one affected sib-pair, are being collected by the eight Harold Rifkin Family Acquisition Centers. Detailed family and medical histories are obtained from all participants. Family members with diabetes have fasting blood samples drawn, while nondiabetic family members have an oral glucose tolerance test and, when possible, insulin sensitivity and insulin secretion measurements by frequently sampled intravenous glucose tolerance testing or euglycemic insulin clamp. Lymphoblastoid cell lines are established for all participants.

RESULTS

Over 1,400 individuals from ∼220 families have been studied since the start of the GENNID (Genetics of NIDDM) program in July 1993. The goal is that by July 1997, data from 300 non-Hispanic white families, > 100 Hispanic families, > 100 African-American families, and 15 Japanese-American families will have been collected.

CONCLUSIONS

The identification of the genes responsible for NIDDM may now be achievable, but only if sound phenotypic data are linked to genetic material from a large number of well-described multiplex families. The GENNID project of the American Diabetes Association is creating a comprehensive resource that will expedite the identification of the genetic basis of NIDDM.
A Case of Hypertensive-Diabetic Cardiomyopathy Demonstrating Left Ventricular Wall Motion Abnormality
Authors: Shimonagata Tsuyoshi , Nanto Shinsuke , Hori Masakazu , Ohara Tomoki , Kim Youngjoon , Takano Yuzuru , Sakamoto Ken'ya , Kamado Keiji , Kubori Syujiro , Kusuoka Hideo , Nishimura Tsunehiko
Published: March 2007

We report a case of hypertensive-diabetic cardiomyopathy demonstrating left ventricular regional wall motion abnormality, with a normal coronary artery documented on coronary arteriography. Dipyridamole-infusion 201Tl scintigraphy demonstrated transient perfusion defects in the infero-posterior wall of the left ventricle, where reduced wall motion was demonstrated on contrast left ventriculography. Myocardial SPECT (single photon emission tomography) imaging with [123I] β-methyliodophenylpentadecanoic acid (BMIPP) and 201Tl demonstrated reduced [123I]BMIPP uptake compared with 201Tl uptake in the infero-posterior wall of left ventricle. These results suggest that the impairment of myocardial free fatty acid metabolism is an etiologic or contributory factor for regional wall motion abnormality, together with small-vessel coronary artery disease, in this patient.
Impact of Disease Duration on Cardiovascular and Pupillary Autonomic Nervous Function in IDDM and NIDDM Patients
Authors: Straub Rainer H , Zietz Bettina , Palitzsch Klaus Dieter , Schölmerich Jürgen
Published: March 2007

OBJECTIVE

To determine the age-independent impact of disease duration on autonomic nervous function in diabetic patients and to compare it with other disease-related complications.

RESEARCH DESIGN AND METHODS

Of the patients with diabetes, 166 (66 IDDM, 100 NIDDM) were investigated using standardized cardiovascular and pupillary test procedures, which provide 10 age-independent percentile values for each patient. Sensorimotor neuropathy was assessed using a standardized clinical examination, retinopathy by fundoscopy, and nephropathy using daily urinary protein excretion and creatinine clearance.

RESULTS

The duration of the disease did not correlate with the results of any one of six standard cardiovascular tests (P > 0.15). Pupillary parameters showed a weak negative correlation with disease duration (P < 0.04). Prevalence of cardiovascular autonomic dysfunction was not different in five different subgroups subdivided according to disease duration (0–6, 7–12, 13–18, 19–24, and ≥ 25 years), whereas prevalence of pupillary dysfunction changed significantly with disease duration (P = 0.016). In contrast, the prevalence of sensorimotor neuropathy (P = 0.006), retinopathy (P < 0.001), and proteinuria (P = 0.010) was significantly higher in patients with long-standing disease. Disease duration was not significantly different in patients without overall cardiovascular dysfunction, as compared with patients with dysfunction (15.6 ± 1.0 vs. 16.5 ± 1.5 years, P = 0.626). This was also found when considering overall pupillary dysfunction (14.5 ± 1.4 vs. 17.2 ± 1.0 years, P = 0.125).

CONCLUSIONS

Disease duration was not correlated with cardiovascular autonomic nervous function, whereas a correlation was observed with pupillary autonomic nervous function, sensorimotor neuropathy, retinopathy, and proteinuria. This may indicate that cardiovascular autonomic nervous function does not markedly change during the course of the disease. The question arises whether cardiovascular autonomic neuropathy may be more a functional abnormality than a structural lesion of the autonomic nervous system, which may be already present at the beginning, or even before, the manifestation of diabetes.
Comparison of the Metabolic Response to a Glucose Tolerance Test and a Standardized Test Meal and the Response to Serial Test Meals in Normal Healthy Subjects
Authors: Owens D R , Wragg K G , Briggs P I , Luzio S , Kimber G , Davies C
Published: March 2007

The plasma glucose and insulin response to a standardized meal test breakfast was compared with the time-honored glucose tolerance test in the same normal healthy subjects. The amplitude of glycemic excursion and between-subject variation was less with the more physiologic standardized test meal than with that seen with the glucose tolerance test. The glucose tolerance test's prime function is to amplify any glucose intolerance, thus aiding diagnosis, whereas a standardized meal gives a more clinically relevant metabolic status. The administration of serial test meals during the same day in a smaller group of normal subjects indicated, as seen previously with repeated glucose tolerance tests, a diminishing carbohydrate tolerance during the day.
Reuse of Disposable Syringe-Needle Units in the Diabetic Patient
Authors: Crouch Mary , Jones Anne , Kleinbeck Elsie , Reece Edward , Bessman Alice N
Published: March 2007

A comparison was made between reuse of plastic disposable needle-syringe units and glass syringes with daily new needles in diabetic patients who take daily insulin injections. Parameters studied were incidence of infection, clarity of syringe readings, ability to use syringe, and sharpness of needle. The plastic disposable units could be reused with safety and patient satisfaction by most patients for at least 3 days. Considerable cost benefit could accrue if disposable units were used more than one time for insulin injections.
The Feasibility of Automated Voice Messaging as an Adjunct to Diabetes Outpatient Care
Authors: Piette John D , Mah Connie A
Published: March 2007

OBJECTIVE

To determine whether automated voice messaging (AVM) systems could be used as an adjunct to primary care for diabetic patients, we examined whether patients were able to respond to AVM queries for clinical information, whether sufficient numbers of problems were identified to warrant the implementation of the service, and whether patients found the system helpful.

RESEARCH DESIGN AND METHODS

The AVM system we examined uses specialized computer technology to telephone patients, communicate messages, and collect information. Sixty-five diabetic patients participated. Based on a review of the literature and the input of diabetes clinician-researchers, we developed an AVM monitoring protocol to inquire about patients’ symptoms, glucose monitoring, foot care, diet, and medication adherence. Patients also were given the option to listen to health promotion messages and to report their satisfaction with the calls. Patients responded by using their touch-tone telephone keypads.

RESULTS

A total of 216 AVM calls were successfully completed, an average of 3.3 out of four calls per patient. Patients reported a variety of health problems that signaled the need for follow-up. Many patients reported not checking their blood glucose or their feet, and one in four reported problems with medication and diet adherence. Health and self-care problems varied across patient subgroups in ways suggesting that the AVM reports were reliable and valid. Overall, 98% of all patients reported that the calls were helpful, 98% reported that they had no difficulty responding to the calls, and 77% reported that receiving AVM calls would make them more satisfied with their health care.

CONCLUSIONS

This study demonstrates that diabetic patients can respond to AVM queries and find the calls helpful. Such calls are a feasible strategy for identifying health and self-care problems that would otherwise go unnoticed by clinicians.
Low Prevalence of Islet Autoantibodies in Patients With Gestational Diabetes Mellitus
Authors: Dozio Nicoletta , Beretta Angelo , Belloni Cristina , Castiglioni Mariateresa , Rosa Susanna , Bosi Emanuele , Bonifacio Ezio
Published: March 2007

OBJECTIVE

To determine the proportion of patients with gestational diabetes mellitus (GDM) who have serological characteristics typical of IDDM.

RESEARCH DESIGN AND METHODS

Islet cell antibodies (ICAs), insulin autoantibodies (IAAs), GAD65, and IA-2 antibodies were measured in 145 pregnant women with GDM, 33 with impaired glucose tolerance (IGT), and in 73 with normal glucose tolerance (NGT). ICAs were measured by indirect immunofluorescence; GAD65 and IA-2 antibodies, by a radio-ligand immunoassay incorporating 35S-labeled recombinant antigen; and IAAs, by a liquid-phase radiobinding assay.

RESULTS

The prevalences of islet autoantibodies were low and not significantly different between groups. ICAs were detected at levels ranging from 5 to 45 Juvenile Diabetes Foundation U in 14 (10%) women with GDM, 2 (6%) women with (GT, and in 4 (5%) women with NGT. IAAs were detected at levels between 3 and 4 SD above the mean in 4 (3%) women with GDM, 0 women with IGT, and in 1 (1%) woman with NGT. None had both ICAs and IAAs. Neither GAD65 nor IA-2 antibodies, which have been detected in the majority of pre-IDDM and IDDM patients, were found in NGT, IGT, or GDM patients.

CONCLUSIONS

Low-titer ICAs and IAAs are not infrequent in pregnant women, but multiple islet autoantibodies and antibodies to GAD65 or IA-2 were not found in GDM. These findings suggest that the serological characteristics of IDDM are rare in GDM.
Efficacy and Safety of Mexiletine in the Treatment of Painful Diabetic Neuropathy. The Mexiletine Study Group
Authors: Oskarsson Per , Ljunggren Jan-Gustaf , Lins Per-Eric
Published: March 2007

OBJECTIVE

To investigate the efficacy and safety of mexiletine in the treatment of painful diabetic neuropathy.

RESEARCH DESIGN AND METHODS

A total of 216 insulin-treated diabetes patients with painful diabetic neuropathy were randomly allocated to three dosages of mexiletine or placebo. The Visual Analog Scale (VAS) for pain/discomfort was scored each day during daytime and nighttime, and sleeping disturbances were also recorded by the patients. Plasma levels of mexiletine and 24-h electrocardiogram (ECG) mapping were assessed before and during the 3-week study period.

RESULTS

A significant reduction in sleep disturbances and pain during nighttime was observed in the group of patients taking the highest dosages (675 mg/day) of mexiletine compared with the other groups. No significant correlation was found between plasma concentration of mexiletine and the therapeutic effect or adverse events. No serious adverse events were seen. The 24-h ECG mapping did not disclose onset of significant arrhythmias in any patient.

CONCLUSIONS

Mexiletine in a dosage of 675 mg daily can reduce pain caused by diabetic neuropathy, and the effect of this drug appears to have a rapid onset.
No Effect of Unfractioned or Low Molecular Weight Heparin Treatment on Markers of Vascular Wall and Hemostatic Function in Incipient Diabetic Nephropathy
Authors: Myrup Bjarne , Jensen Tonny , Gram Jørgen , Kluft Cornelis , Jespersen Jørgen , Deckert Torsten
Published: March 2007

OBJECTIVE

The high risk for cardiovascular disease in IDDM patients with nephropathy may be mediated by abnormal function of the vascular wall. We investigated whether heparin was able to modulate markers of vascular wall and hemostatic function in patients with incipient nephropathy.

RESEARCH DESIGN AND METHODS

Thirty-five IDDM patients with incipient nephropathy were randomized to treatment with placebo, unfractioned heparin, or low molecular weight heparin in a double-blind trial. The treatment was given as 1 h of conventional intravenous high-dose treatment and in a conventional subcutaneous low-dose regime for 3 months. Transcapillary escape rate of albumin and plasma levels of von Willebrand factor, fibrinogen, prothrombin fragment 1 + 2, thrombin-antithrombin III complexes, tissue type plasminogen activator, tissue plasminogen activator inhibitor type 1, total cholesterol, HDL cholesterol, and triglycerides were measured before and after treatment. Of the patients, 31 completed the study.

RESULTS

We found no significant effect of heparin on markers of vascular wall and hemostatic function by any of the treatments.

CONCLUSIONS

Treatment with high- or low-dose heparin induced no modulation of markers of vascular wall or hemostatic function in IDDM patients with incipient diabetic nephropathy.
Hyperinsulinemia and the Development of ST-T Electrocardiographic Abnormalities: An 11-year follow-up study
Authors: Adachi Hisashi , Hashimoto Ryuichi , Tsuruta Makoto , Jacobs David R , Crow Richard S , Imaizumi Tsutomu
Published: March 2007

OBJECTIVE

It has been suggested that insulin resistance and consequent hyperinsulinemia promote atherosclerosis, but few prospective studies have reported the relationships between hyperinsulinemia and the development of ST-T abnormalities in the 12-lead resting electrocardiogram (ECG) in populations in which atherosclerosis is rare.

RESEARCH DESIGN AND METHODS

A total of 304 Japanese men and women, aged 20–69 years, selected for having high blood glucose or more than a trace-positive urine glucose from a population-based health examination in 1981, were followed for 11 years. Of these, 33 died, 1 from myocardial infarction, while 260/271 living were reexamined in 1992. The 237 subjects with a normal ECG at the baseline examination were analyzed.

RESULTS

Incident ST-T abnormalities occurred in 13/237 people. Insulin concentrations were positively associated with the development of ST-T abnormalities (relative risk approximately 8, comparing those in the highest versus lowest quartile of insulin values). Adjustment for age, sex, and systolic blood pressure or other risk factors had little effect on this relationship.

CONCLUSIONS

Hyperinsulinemia was related to the development of ST-T abnormalities in ECGs in the absence of the development of clinical signs of atherosclerosis, independent of blood pressure and other risk factors in men and women with mild glucose intolerance.
Exercise Responses in Patients With IDDM
Authors: Nugent Anne-Marie , Steele Ian C , Al-Modaris Firas , Vallely Stephen , Moore Ann , Campbell Norman P S , Bell Patrick M , Buchanan Keith D , Trimble Elisabeth R , Nicholls D Paul
Published: March 2007

OBJECTIVE

The hemodynamic, respiratory, and metabolic responses to exercise were studied in IDDM patients and control subjects to detect diabetic cardiomyopathy.

RESEARCH DESIGN AND METHODS

Eight subjects aged 25–40 years with diabetes of at least 10 years' duration were compared with eight control subjects aged 21–46 years. All subjects underwent a progressive incremental bicycle exercise test with measurement of gas exchange, blood glucose, lactate, fat metabolite, and catecholamine levels and two steady-state exercise tests with measurement of cardiac output by a CO2 rebreathing method. A new first-pass radionuclide method was used to measure cardiac ejection fractions (EFs) at rest, peak exercise, and steady-state exercise.

RESULTS

The peak achieved oxygen consumption was similar in the diabetic and control subjects (29.9 [25.1–34.6] and 31.4 [26.9–35.9] ml . min−1 . kg−1, respectively; mean [95% CI]). There were no significant differences in heart rate, double product, ventilation, respiratory exchange ratio, or ventilatory equivalents for oxygen and CO2 during the incremental test. Glucose levels were higher in the diabetic subjects, but there were no significant differences in levels of lactate, catecholamines, free fatty acids, glycerol, or β-hydroxybutyrate. Left ventricular EF fell from rest to peak exercise within the diabetic group (66.0% [59.6–72.4] at rest; 53.6% [45.6–61.6] at peak; P < 0.05) but this did not differ significantly from the control group (58.7% [52.3–65.1] at rest; 60.3% [48.9–71.7] at peak). Right ventricular EFs were similar in each group, and there was no reduction in peak filling rate to suggest diastolic dysfunction. The cardiac output responses to exercise were also similar in the two groups.

CONCLUSIONS

There is no evidence of impairment of the exercise response in subjects with long-standing diabetes, and the apparent fall in left ventricular EF at peak exercise could be related to hemodynamic adaptation.
IDDM Accompanied by a Growth Hormone-Producing Pituitary Adenoma: A case report
Authors: Otsuka Fumio , Ogura Toshio , Yamauchi Takayoshi , Shikata Kenichi , Kageyama Jingo , Makino Hirofumi
Published: March 2007

CASE HISTORY

A 30-year-old Japanese man who presented with recurrent ketoacidosis caused by IDDM was found to have increased secretion of growth hormone (GH). On initial cranial magnetic resonance imaging (MRI), no pituitary lesion was detected; however, a pituitary microadenoma was found 2 years later during a repeat MRI. In spite of the hypersecretion of GH, serum IGF-I was dramatically suppressed. Transsphenoidal surgery was performed to resect the pituitary tumor that was histologically an acidophilic pituitary adenoma. Although the GH excess rapidly improved postoperatively, the IGF-I level remained low. Subsequent insulin therapy initiated 1 year after the operation elevated the serum IGF-I level to within the normal range.

DISCUSSION

The first case of coexistent IDDM and a GH-producing pituitary adenoma suggests that patients with uncontrolled IDDM may develop GH hypersecretion. Furthermore, the low IGF-I levels may be closely associated with the GH excess and with the development or progression of GH-secreting pituitary adenomas.
Effect of a Bicultural Community Health Worker on Completion of Diabetes Education in a Hispanic Population
Authors: Corkery Eileen , Palmer Carmen , Foley Mary E , Schechter Clyde B , Frisher Leah , Roman Sheila H
Published: March 2007

OBJECTIVE

To determine the effect of a bicultural community health worker (CHW) on completion of diabetes education in an inner-city Hispanic patient population and to evaluate the impact of completion of the education program on patient knowledge, self-care behaviors, and glycemic control.

RESEARCH DESIGN AND METHODS

Patients were randomized into CHW intervention and non-CHW intervention groups. All patients received individualized, comprehensive diabetes education from a certified diabetes nurse educator after baseline demographic information, diabetes knowledge, diabetes self-care practices, and glycohemoglobin levels were assessed. Rates of education program completion were determined. Diabetes knowledge, self-care practices, and glycohemoglobin levels were reassessed at program completion and at a later postprogram follow-up medical appointment and compared to baseline. Logistic regression analysis and the Mantel-Haenszel χ2 statistic were used to determine the effect of the CHW assignment on program completion. Analyses of covariance were performed with end-of-treatment behavior scores, knowledge scores, and glycohemoglobin levels as outcome variables, controlling for baseline values and testing for the effect of CHW assignment.

RESULTS

Of 64 patients enrolled in the study, 40 (63%) completed and 24 (37%) dropped out before completing the diabetes education program. Of the patients having CHW intervention, 80% completed the education program, compared with 47% of patients without CHW intervention (P = 0.01). “Dropouts” were younger (age 47.5 ± 12.5 years [mean ± SD]) compared with patients who completed the program (55.9 ± 9.9 years) (P = 0.004). Dropout status showed no significant relationship to educational level achieved or literacy level. For the program “completers,” knowledge levels and selected self-care practices significantly improved, and glycohemoglobin levels improved from a baseline level of 11.7% to 9.9% at program completion (P = 0.004) and 9.5% at the postprogram follow-up (P < 0.001). The effect of the CHW assignment on program completion, controlling for financial status and language spoken, was extremely robust (P = 0.007). The effect of the CHW on knowledge, self-care behavior, or glycohemoglobin outcome variables was not statistically significant.

CONCLUSIONS

These findings suggest that intervention with a bicultural CHW improved rates of completion of a diabetes education program in an inner-city Hispanic patient population irrespective of literacy or educational levels attained. Our data further suggests that completion of individualized diabetes educational strategies leads to improved patient knowledge, self-care behaviors, and glycemic control.
Carotid Intima-Media Thickness in Hyperlipidemic Type I and Type II Diabetic Patients
Authors: Kanters Suzan D J M , Algra Ale , Banga Jan-Dirk
Published: March 2007

OBJECTIVE

Ultrasonographic measurements of the combined thickness of the carotid intima and media can be used to examine early vessel wall changes in atherosclerosis. Premature atherosclerosis is common in diabetes, especially when other risk factors are present. Intima-media thickness was quantified in hyperlipidemic type I and type II diabetic patients, and relationships between various risk factors and intima-media thickness were investigated.

RESEARCH DESIGN AND METHODS

Thirty-one patients with type I diabetes and 56 with type II diabetes were examined, with an LDL cholesterol of > 2.6 mmol/l and/or triglycerides of > 1.7 mmol/l and/or HDL cholesterol of < 0.9 mmol/l for men or < 1.1 mmol/l for women. Intima-media thickness was measured on-line, over a length of 1 cm in the common carotid artery. Later, the mean and the maximum of six measurements was calculated (left and right side, both in three directions).

RESULTS

Mean intima-media thickness was 0.63 ± 0.18 (±SD) mm for type I diabetes and 0.80 ± 0.31 mm for type II diabetes. Adjusted for age, the difference was 0.06 mm, with a 95% CI of −0.08 to 0.20 mm. In multivariate regression analysis, age over 50 years and higher HbA1c were independently associated with an increase in mean intima-media thickness in type I diabetes. In type II diabetes, none of the variables reached a significance level of ≤ 0.10. Results for maximum intima-media thickness were essentially the same.

CONCLUSIONS

In general, intima-media thickness is larger in type II diabetes than in type I diabetes. The effect of age is absent in type II diabetes, whereas in type I diabetes, age and blood glucose control have an important effect on intima-media thickness.
High Incidence of IDDM Over 6 Years in Edmonton, Alberta, Canada
Authors: Toth Ellen L , Lee Kwok-Choy , Couch Robert M , Martin Laurence F
Published: March 2007

OBJECTIVE

To determine the incidence of IDDM among children 0–14 years of age in Edmonton, Alberta, between 1990 and 1995 by means of a population-based registry.

RESEARCH DESIGN AND METHODS

Children <15 years of age diagnosed with IDDM between January 1990 and December 1995 were registered according to criteria of the World Health Organization (WHO) Multinational Project for Childhood Diabetes. The primary source of case ascertainment consisted of office records of pediatricians and endocrinologists. The secondary source consisted of inpatient records from the main city hospitals.

RESULTS

Between 1990 and 1995, 211 IDDM patients <15 years of age were detected by the two sources. All but 15 of them were of European ancestry. The ascertainment-corrected incidence rates of this ethnic group (constituting 77% of the population) for the 6 years were 38.6, 23.5, 23.3, 24.2, 22.0, and 24.3 per 100,000, respectively, with case ascertainment rates of 75–95%. The age-adjusted rate over the 6-year period was 25.7 per 100,000 with a case ascertainment rate of 84.3%. No sex difference was observed. The highest incidence occurred in the 10- to 14-year-old age-group, and more cases were detected between January and March than at other periods in the year.

CONCLUSIONS

The incidence of IDDM among the European-derived population in Edmonton between 1990 and 1995 is the highest rate over a 6-year period to be reported in North America, comparable to that in Prince Edward Island, Canada, and to the highest rates in the world.
Diabetes Complications and Mortality Among Alaska Natives: 8 Years of Observation
Authors: Schraer Cynthia D , Adler Amanda I , Mayer Ann Marie , Halderson Karen R , Trimble Brian A
Published: March 2007

OBJECTIVE

To determine the prevalence and incidence of diabetes in Alaska Natives and the incidence of cerebrovascular accidents (stroke), myocardial infarction (MI), end-stage renal disease (ESRD), lower-extremity amputations (LEA), and mortality over a 6- to 8-year period.

RESEARCH DESIGN AND METHODS

The data derive from a registry of diagnosed diabetes (World Health Organization [WHO] criteria) of the Alaska Area Native Health Service (AANHS), from medical records, and from the Alaska Bureau of Vital Statistics.

RESULTS

From 1986 to 1993, the prevalence of diabetes in Alaska Natives increased by 22% from 15.7 to 19.2 per 1,000 people. Of these cases, nearly all were diagnosed with type II diabetes. During the same period, 614 new cases were diagnosed. The incidence was 1.5 per 1,000 Alaska Natives per year. The incidence of confirmed MI was 8.0 per 1,000 person-years of diabetes. Aleuts had the highest rate, followed by Indians and Eskimos. The incidence of confirmed stroke was 10.6 per 1,000 person-years of diabetes. Eskimos had a significantly higher rate than Indians (P = 0.002), and women had a higher rate than men. The incidence of LEA was 5.0 per 1,000 person-years of diabetes. The incidence rate dropped significantly after instituting a foot care program. The incidence for ESRD was 3.3 per 1,000 and also showed a decline with time. The all-cause mortality rate of 43.2 per 1,000 person-years of diabetes was nearly equal between men and women. Among Alaska Natives with diabetes, cardiovascular disease (CVD) was the most common cause of death, followed by cancer and diabetes, per se.

CONCLUSIONS

We conclude that diabetes is increasing in Alaska Natives, who are experiencing both the microvascular and macrovascular complications of diabetes. The incidence of LEA and ESRD show some evidence of a decrease after intervention efforts.
Plasma Endothelin in Normal and Diabetic Pregnancy
Authors: Wolff Kerstin , Carlström Kjell , Fyhrquist Frej , Hemsén Anette , Lunell Nils-Olov , Nisell Henry
Published: March 2007

OBJECTIVE

To examine endothelin-1 (ET-1) concentrations longitudinally throughout pregnancy in healthy and insulin-dependent diabetic women and to evaluate the relationship between ET-1 and big ET-1 in normal pregnancy.

RESEARCH DESIGN AND METHODS

Venous blood samples were obtained consecutively in gestational weeks 18, 28, and 38 from 40 healthy women with uneventful pregnancies and 24 pregnant women with IDDM. By radioimmunoassay, plasma ET-1 and big ET-1 were analyzed in the healthy women and plasma ET-1 in the diabetic women.

RESULTS

In the diabetic pregnant women, plasma ET-1 levels were significantly higher than in healthy pregnant women during the entire observation period (P < 0.001), but did not change with advancing gestational age. Five of the diabetic, but none of the healthy pregnant women, developed preeclampsia. ET-1 levels did not differ between the diabetic women who developed preeclampsia and those who did not. Plasma ET-1 levels in healthy pregnant women were within the range of those in healthy nonpregnant women and did not change during pregnancy. The big ET-1 levels increased and the ET-1/big ET-1 ratio decreased significantly during the observation period.

CONCLUSIONS

Plasma ET-1 levels do not change with advancing gestational length. During normal pregnancy, the ET-1/big ET-1 ratio decrease, indicating a suppressed converting enzyme activity or altered clearance of ET-1. Pregnant women with IDDM have markedly elevated ET-1 levels. Although diabetic women with and without preeclampsia did not differ with respect to endothelial dysfunction, as reflected by elevated ET-1 concentration, we cannot exclude that altered endothelial function may be of importance for the increased frequency of preeclampsia in pregnant IDDM patients.
A Biopsychobehavioral Model of Risk of Severe Hypoglycemia
Authors: Gonder-Frederick Linda , Cox Daniel , Kovatchev Boris , Schlundt David , Clarke William
Published: March 2007

Severe hypoglycemia (SH) is a significant problem for many patients with type I diabetes and presents a major barrier to optimal diabetes control. A critical task facing diabetes research is to understand, predict, and reduce the risk of SH in insulin-treated patients. The purpose of this article is to propose a biopsychobehavioral model of SH risk that integrates and extends previously proposed models. Current biological and psychological models of SH risk, which focus on hormonal counterregulation and symptom awareness, are reviewed. The limitations of these models are also discussed, including their failure to recognize important psychological and behavioral processes that contribute to SH risk. Specifically, the biopsychobehavioral model includes patients' decision-making, judgment, and behavioral responses as significant predictors of SH risk. The proposed model is comprised of seven steps: 1) physiological and behavioral precursors to low blood glucose (BG), 2) low BG occurrence, 3) hormonal and neurological responses to low BG, 4) awareness of symptoms caused by hormonal and neurological changes, 5) detection of low BG, 6) decision-making and judgment, and 7) behavioral response. The model has several advantages, including the ability to mathematically calculate the transitional probabilities from each step to the next as well as the ability to describe SH risk in both hypoglycemia-aware and hypoglycemia-unaware patients. Research findings supporting the biopsychobehavioral model are presented, and its empirical and clinical implications are discussed.
Moderate-to-Severe Diabetic Retinopathy Is More Prevalent in Mexico City Than in San Antonio, Texas
Authors: Villalpando Maria Elena González , Villalpando Clicerio González , Pérez Beatriz Arredondo , Díaz Sandra Virginia Martínez , Mitchell Braxton , Martínez David Rivera , Klein Ronald , Haffner Steven M , Stern Michael P
Published: March 2007

OBJECTIVE

To compare the prevalence of diabetic retinopathy (DR) between low-income Mexicans from Mexico City and Mexican-Americans from San Antonio, Texas.

RESEARCH DESIGN AND METHODS

We designed a cross-sectional population-based study in low-income neighborhoods of Mexico City and San Antonio. The men and non-pregnant women included in the study had NIDDM and were between 35 and 64 years of age. Ophthalmologic evaluation was performed in 414 patients, 204 in San Antonio and 210 in Mexico City. Seven field standard stereophotographs of each eye were obtained, adapting the Early Treatment Diabetic Retinopathy Study protocol, and graded at the Fundus Photograph Reading Center of the University of Wisconsin.

RESULTS

Early nonproliferative DR occurred in 37 (17.6%) and 39 (19.1%) patients in Mexico City and San Antonio, respectively. Moderate-to-severe nonproliferative DR occurred in 55 (26.2%) and 37 (18.1%) patients in Mexico City and San Antonio, respectively, and proliferative DR occurred in 12 (5.7%) and 7 (3.4%) patients in Mexico City and San Antonio, respectively. Using univariate and multivariate logistic regression analysis with DR as the dependent variable, age, duration of disease, and fasting glucose concentration were positively and significantly associated with retinopathy, whereas city, systolic blood pressure, and other selected metabolic variables were not. We defined moderate-to-severe DR to include the categories of moderate-to-severe nonproliferative and proliferative DR. For this combined category, Mexico City patients with diabetes had a significantly higher prevalence (P < 0.01) than those from San Antonio when analyzed by multiple logistic regression analysis (odds ratio for Mexico City/San Antonio, 1.72; 95% CI 1.10–2.70).

CONCLUSIONS

Overall prevalence of DR is similar in both cities. However, moderate-to-severe DR is significantly higher in Mexico City.
Same Eyes, Different Doctors: Differences in Primary Care Physician Referrals for Diabetic Retinopathy Screening
Authors: Lazaridis Emmanuel N , Qiu Chunfu , Kraft Stephanie K , Marrero David G
Published: March 2007

OBJECTIVE

To analyze eye care specialist referral patterns for the diabetic patients of primary care physicians.

RESEARCH DESIGN AND METHODS

In 1993, we conducted a census of primary care physicians to evaluate practice patterns relating to diabetes care in the state of Indiana. Using a logistic regression model and data from this census, we compared 1) physicians' odds of referring type II diabetic patients to an optometrist, as opposed to an ophthalmologist, with those of type I diabetic patients and 2) the referral odds ratios of type II to type I diabetic patients between metropolitan and nonmetropolitan counties.

RESULTS

Overall, 10% of the physicians in our study most often refer some patients to an optometrist. Physicians are more likely to refer their type II diabetic patients to an optometrist, as opposed to an ophthalmologist, than they are to refer type I diabetic patients, both before and after adjustment for covariates. Physicians who practice in metropolitan counties are 1.55 times more likely to refer their type II diabetic patients than their type I diabetic patients to an optometrist. In nonmetropolitan counties, physicians are 2.5 times more likely to refer their type II diabetic patients to an optometrist. The difference between metropolitan and nonmetropolitan physicians is significant (P = 0.027).

CONCLUSIONS

Some physicians mostly refer their diabetic patients to optometrists, instead of ophthalmologists, for eye examinations intended to discover early signs of diabetic eye disease. Type II diabetic patients are more likely to be referred to an optometrist, instead of an ophthalmologist, than are type I diabetic patients. In nonmetropolitan areas, the difference in referral patterns becomes even more marked.
Diabetes Nutrition and Complications Trial (DNCT): Food Intake and Targets of Diabetes Treatment in a Sample of Spanish People With Diabetes
Authors:   The Diabetes and Nutrition Study Group of the Spanish Diabetes Association (GSEDNu)
Published: March 2007

OBJECTIVE

To know the nutritional pattern of people with diabetes in Spain and that pattern's relationship with targets of metabolic control.

RESEARCH DESIGN AND METHODS

The Diabetes Nutrition and Complications Trial (DNCT) is a prospective multicenter study designed to determine the nutritional behavior of diabetic patients in Spain using 7-day food diaries. A total of 337 diabetic patients, 144 (70 men and 74 women) with type I and 193 (81 men and 112 women) with type II diabetes, satisfactorily completed the 7-day food diaries from May 1993 to December 1994.

RESULTS

The median energy intake of the Spanish diabetic subjects was between 1,453 and 2,217 kcal/day (6.1–9.3 MJ/day), distributed as follows: 38–40% from carbohydrate, 19–23% from protein, and 36–41.5% from fat (11.1–13.9% saturated fatty acids, 4.6–5.8% polyunsaturated fatty acids, and 19.7–21.9% monounsaturated fatty acids). Of the subjects, 69% had a cholesterol level <5.6 mmol, 97% had an HDL cholesterol level >0.9 mmol, and 85% had a triglyceride level <1.7 mmol, while <36% had an HbA1c value >8%.

CONCLUSIONS

People with diabetes in Spain have near-optimal serum lipid levels and maintain reasonably good blood glucose control and BMI, suggesting that diabetes management that includes the usual Spanish diet, which is low in carbohydrates and high in fat, especially monounsaturated fat, might be adequate.
The Relationship of Concentrations of Insulin and Proinsulin-Like Molecules With Coronary Heart Disease Prevalence and Incidence: A study of two ethnic groups
Authors: Yudkin John S , Denver A Elizabeth , Mohamed-Ali Vidya , Ramaiya Kaushik L , Nagi Dinesh K , Goubet Stephanie , McLarty Donald G , Swai Andrew
Published: March 2007

OBJECTIVE

To define the potential role of proinsulin-like molecules as risk factors for cardiovascular disease.

RESEARCH DESIGN AND METHODS

Fasting concentrations of proinsulin, des-31,32-proinsulin, and insulin, and of insulin 2 h after a 75-g glucose load, were measured in 1,034 nondiabetic europid subjects and 257 south Asian subjects and related to prevalent coronary heart disease (Minnesota-coded electrocardiographic criteria or ischemic chest pain). In 137 south Asian subjects, the fasting concentrations were related to incident coronary heart disease over a 6.5-year follow-up.

RESULTS

The standardized odds ratios for prevalent coronary heart disease were as follows: fasting insulin, 1.29 (1.11–1.49), P = 0.0006; 2-h insulin, 1.25 (1.08–1.45), P = 0.003; proinsulin, 1.23 (0.99–1.53), P = 0.058; and des-31,32-proinsulin, 1.32 (1.03–1.69), P = 0.026. The odds ratios were similar in the two ethnic groups. These relationships became insignificant when controlling for age, sex, and BMI. The standardized odds ratios for incident coronary heart disease were as follows: fasting insulin, 0.99 (0.63–1.55), P = 0.97; proinsulin, 1.13 (0.72–1.78), P = 0.59; and des-31,32-proinsulin, 1.00 (0.61–1.63), P = 1.00.

CONCLUSIONS

We have found similar relationships between concentrations of proinsulin-like molecules and prevalent coronary heart disease, as are observed for insulin in these nondiabetic subjects, although these molecules comprise only ∼ 10% of all insulin-like molecules. It appears biologically implausible that these relationships represent cause and effect.
Elevated Glycosylated Albumin in NIDDM Is a Function of Recent Everyday Environmental Stress
Authors: Aikens James E , Mayes Rhonda
Published: March 2007

OBJECTIVE

To evaluate the association of recent daily environmental stress (daily hassles) with glycemia in NIDDM.

RESEARCH DESIGN AND METHODS

Fifty-five NIDDM patients reported the number and intensity of daily hassles occurring during the past week and concurrently underwent glycemic assessment.

RESULTS

Hassles were generally unassociated with demographic variables, illness duration, treatment regimen, and the presence of complications. Multiple regression analysis indicated that hassles (in both frequency and intensity) were positively associated with recent glycemia (glycosylated albumin [GA]), even after statistically controlling for long-term glycemia (glycosylated hemoglobin [HbA1c]). The subtypes of hassles having the most potent relationships with GA were work and family/friend-related stressors.

CONCLUSIONS

The frequency and perceived impact of everyday minor stress have proximal positive associations with glycemia that do not necessarily reflect chronic hyperglycemia. Stress arising from work and family/friend sources may be particularly relevant.
A Neural Network Model for Predicting Pancreas Transplant Graft Outcome
Authors: Dorsey Susan G , Waltz Carolyn F , Brosch Laura , Connerney Ingrid , Schweitzer Eugene J , Bartlett Stephen T
Published: March 2007

OBJECTIVE

To compare the results of a neural network versus a logistic regression model for predicting early (0–3 months) pancreas transplant graft survival or loss.

RESEARCH DESIGN AND METHODS

This study was a cross-sectional, secondary analysis of demographic and clinical data from 117 simultaneous pancreas-kidney (SPK), 35 pancreas-after-kidney (PAK), and 8 pancreas-transplant-alone (PTA) patients (n = 160). The majority of patients were men (57%) and were white (90.1%), with a mean age of 39 ± 8.09 years. Of the patients, 23 (14.4%) experienced early graft loss, which included any loss owing to technical or immunological causes, and death with a functional graft. Data were analyzed with a logistic regression model for multivariate analysis and a backpropagation neural network (BPNN) model.

RESULTS

A total of 12 predictor variables were chosen from literature and transplant surgeon recommendations. A logistic model with all predictor variables included correctly classified 93.53% of cases. Model sensitivity was 35.71%; specificity was 100% (pseudo-R2 0.24). Of the predictors, history of alcohol abuse (odds ratio [OR] 32.39; 95% CI 1.67–626.89), having a PAK or PTA (OR 13.6; 95% CI 2.20–84.01), and use of a nonlocal organ procurement center (OPO) (OR 4.51; 95% CI 0.78–25.96) were most closely associated with early graft loss. The BPNN model with the same 12 predictor variables correctly predicted 92.50% of cases (R2 0.71). Model sensitivity was 68%; specificity was 96%. Of the predictors, the three variables most closely associated with graft outcome in this model were recipient/donor weight difference >50 lb, having a PAK or PTA, and use of a nonlocal OPO.

CONCLUSIONS

First, the BPNN model correctly predicted 92.5% of graft outcomes versus the logistic model (93.53%). Second, the BPNN model rendered more accurate predictions (>0.70 = loss; <0.30 = survival) versus the logistic model (>0.50 = loss; <0.50 = survival). Third, the BPNN model was more sensitive (68%) than the logistic model (35.71%) to graft failures and demonstrated an almost threefold increase in explained variance (R2 = 0.71 vs. 0.24). These results suggest that the BPNN model is a more powerful tool for predicting early pancreas graft loss than traditional multivariate statistical models.
Immune Response to Glycated and Oxidized LDL in IDDM Patients With and Without Renal Disease
Authors: Korpinen Eija , Groop Per-Henrik , Åkerblom Hans K , Vaarala Outi
Published: March 2007

OBJECTIVE

To study autoantibodies to oxidized and glycated LDL in IDDM patients with and without diabetic nephropathy and in nephropathy-related macroangiopathy

RESEARCH DESIGN AND METHODS

The study included 101 IDDM patients with a long duration of diabetes and 54 healthy subjects. Patients were divided into two groups according to their median urinary albumin excretion rate (AER); the normoalbuminuric group had AER <20 μg/min and the albuminuric group >200 μg/min. The groups were matched for age and BMI, and the two diabetic groups were matched for duration of diabetes and glycemic control. Antibodies against oxidized LDL (using malondialdehyde-modified LDL as the antigen) and against glycated LDL were measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS

The mean antibody levels against glycated LDL were higher in IDDM patients (0.305 ± 0.399) than in healthy subjects (0.166 ± 0.22 optical density [OD]; P = 0.019), but levels did not differ significantly between normoalbuminuric and albuminuric IDDM patients (0.258 ± 0.354 vs. 0.388 ± 0.459, respectively). Among the three groups, antibody levels to oxidized LDL did not differ. IDDM patients showed an inverse correlation between antibodies to oxidized LDL and HbA1 (r = −0.211, P = 0.04). The antibody levels to glycated and oxidized LDL did not differ among albuminuric IDDM patients with or without clinical macroangiopathy.

CONCLUSIONS

Antibodies to glycated and oxidized LDL do not seem to associate with diabetic nephropathy or nephropathy-related macroangiopathy.