bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiovascular Reflex Abnormalities in Children and Adolescents With Diabetes Mellitus
Authors: Ringel Richard E , Chalew Stuart A , Armour Karen A , McLughun Judith , McCarter Robert J , Kramer Wendy E
Published: March 2007

OBJECTIVE

To assess the usefulness of specific cardiovascular reflex tests in childhood and to estimate the prevalence of cardiovascular reflex abnormalities among children with IDDM. In adults, abnormal cardiovascular reflexes are a frequent complication of diabetes, associated with increased morbidity and mortality.

RESEARCH DESIGN AND METHODS

We measured heart-rate responses to deep breathing and standing in ambulatory children with and without IDDM between 6–19 yr of age. A subgroup of the IDDM patients was retested after 1 yr.

RESULTS

We found the best techniques for detecting cardiovascular reflex abnormality in children were as follows: to record heart-rate responses to deep breathing either as the change inheart rate corrected for inspiratory heart rate or as the ratio of R-R intervals during expiration and inspiration; and to use the Maximum-minimum ratio for heart-rate responses to standing. HR-DBC was lower in diabetic than nondiabetic children (28.6 ± 9.2% [n = 248] vs. 33.6 ± 6.8% [n = 60]; P < 0.0005). Similarly, E:I was lower in children with IDDM than control subjects (1.42 ± 0.19 [n = 248] vs. 1.52 ± 0.15 [n = 60]; P < 0.0005). In the IDDM group, 21% of the children had abnormal HR-DBc or E:I responses. HR-STND M/m was lower in children with IDDM than control subjects (1.28 ± 0.20 [n = 167] vs. 1.38 ± 0.22 [n = 45]; P < 0.014). Among children with IDDM, 11.4% had abnormal HR-STND M/m responses. Overall, 29% of IDDM children tested abnormal in either HR-DBC or HR-STND M/m; 3% were abnormal in both tests. We found no correlation of HbA1c levels (n = 74) or duration of diabetes with either HR-DB, expiration to inspiration (n = 248), or HR-STND M/m (n = 167). In patients who were reevaluated after 1 yr we found a high correlation of the first and repeat HR-DBC tests (r = 0.47, n = 75, P < 0.0001), E:I (r = 0.53, n = 75, P < 0.0001), and HR-STND M/m (r = .49, n = 37, P < 0.002), but no evidence of an increased number of children with cardiovascular reflex abnormality.

CONCLUSIONS

With easily performed HR-DB and HR-STND tests, we detected cardiovascular reflex abnormality in 29% of children with IDDM. We found no correlation of changes in HR-DB and HR-STND with HbA1c or duration of diabetes. These tests provide an objective clinical measurement to monitor autonomic neuropathy in children with diabetes.
Serum Lipoprotein(a) in Patients With Diabetes Mellitus
Authors: Heller Francis R , Jamart Jacques , Honore Patrick , Derue Geneviève , Novik Vicky , Galanti Laurence , Parfonry Alex , Hondekijn Jean-Claude , Buysschaert Martin
Published: March 2007

OBJECTIVE

To investigate subjects with different types of diabetes mellitus regarding their serum levels of lipoprotein(a). High serum Lp(a) concentration is associated with a high risk of coronary heart disease. Diabetic patients are prone to developing coronary heart disease.

RESEARCH DESIGN AND METHODS

The subjects were 66 type I diabetic patients, 100 type II diabetic patients treated with diet alone or diet combined with oral hypoglycemic agents, and 46 insulin-requiring type II diabetic patients. Subjects were compared with 142 nondiabetic outpatients.

RESULTS

Subjects with insulin-requiring type II diabetes mellitus were found to have an increase both in serum Lp(a) concentration and in prevalence of serum Lp(a) concentration >30 mg/dl compared with the other groups of diabetic patients and nondiabetic control subjects. A nonsignificant increase in the prevalence of coronary heart disease was also found in insulin-requiring type II diabetic patients. The levels of serum concentrations of Lp(a) were not significantly related to the degree of glycemic control, duration of diabetes, presence of macrovascular disease, or intake of female hormone therapy. High levels of Lp(a) in this group of diabetic patients could not be explained by the presence of albuminuria.

CONCLUSIONS

Insulin-requiring type II diabetic patients have high levels of Lp(a). Chronic hyperinsulinemia might be an eventual causal factor.
Association of Lipoprotein(a) With Puberty in IDDM
Authors: Couper Jennifer J , Bates David J , Cocciolone Robert , Magarey Anthea M , Boulton T John C , Penfold James L , Ryall Richard G
Published: March 2007

OBJECTIVE— To determine serum lipoprotein(a) in a large sample of IDDM and control children and to examine a possible association with puberty.

RESEARCH DESIGN AND METHODS—Serum lipoprotein(a), apoB-100, and apoA-I were measured under identical conditions in 170 Caucasian children with IDDM aged 12.3 ± 3.59 yr and 233 Caucasian control children aged 13.6 ± 1.12 yr. Patients with persistent microalbuminuria were excluded. Lipoprotein(a), apoB-100, and apoA-I were measured by nephelometry using a specific monoclonal antibody. Pubertal assessment was performed using Tanner staging and testicular volume measurement.

RESULTS— Lipoprotein(a) was higher in the IDDM than control group (geometric mean 237 mg/L, 25–75th percentile 134–465 vs. 172 [99–316] mg/L, P = 0.0008). When analyzed according to pubertal stage, only pubertal and postpubertal patients had higher levels than control subjects (265 [148–560] vs. 174 [101–320] mg/L, P = 0.0001), with prepubertal patients showing no difference. Pubertal and postpubertal patients showed both higher lipoprotein(a) (P = 0.01) levels and higher albumin excretion rates (P = 0.02) than prepubertal patients, correcting for the other variable. Lipoprotein(a) was not related to HbA1c, albumin excretion rate, duration, age, sex, mean arterial pressure, or a family history of premature coronary artery disease in the IDDM group. Lipoprotein(a) was not higher in patients with overnight albumin excretion rate above the 95th percentile but below the microalbuminuric range. ApoB-100 did not differ between IDDM and control children. ApoA-I was significantly lower in the IDDM group (1.04 [0.94–1.17] vs. 1.21 [1.10–1.31] g/L; P < 0.0001).

CONCLUSIONS— Pubertal and postpubertal IDDM patients have higher serum lipoprotein(a) than Caucasian control subjects. Our findings suggest a rise in lipoprotein(a) may occur during puberty in IDDM. Longitudinal studies are required to clarify the relationship between lipoprotein(a), albumin excretion rate, and puberty.
Obesity, Diabetes, and Hyperlipidemia in a Central Australian Aboriginal Community With a Long History of Acculturation
Authors: O'Dea Kerin , Patel Mahomed , Kubisch Doris , Hopper John , Traianedes Kathy
Published: March 2007

Objective— To determine the age- and sex-specific prevalence of diabetes and to examine associations between related anthropometric and metabolic abnormalities in an Aboriginal community in central Australia with a long history of acculturation.

Research Design and Methods— We used a cross-sectional survey of 353 adults > 15 yr of age (87% response rate) and measured the following parameters: weight, height, circumferences of waist and hips; glucose, insulin, cholesterol, triglyceride, and high-density lipoprotein cholesterol in fasting plasma; and plasma glucose and insulin 2 h after 75 g oral glucose.

Results— The prevalence of diabetes was 29.6% in survey participants > 35 yr of age and 5.3% in those < 35 yr of age. Impaired glucose tolerance also occurred with higher frequency in those > 35 yr of age (14.8 vs. 4.7%). Of those > 35 yr of age, 75% of the women and 51% of the men were overweight or obese, with a body mass index ≥ 25 kg/m2. A large insulin response to oral glucose was evident, with the upper tertile of the 2-h insulin response six times higher than the lower tertile (113 ± 43 vs. 19 ± 8 mU/L). Hyperinsulinemia showed a strong, positive association with impaired glucose tolerance, body mass index, waist-to-hip ratio, cholesterol, and triglyceride levels and a negative association with high-density lipoprotein cholesterol levels. Cholesterol levels were on average 0.5 mM higher in men than in women. Deteriorations in carbohydrate and lipid metabolism occurred before 40 yr of age: diabetes, body mass index, waist-to-hip ratio, and fasting triglycerides and cholesterol concentrations peaked and high-density lipoprotein cholesterol concentrations reached their nadir at the end of the fourth decade.

Conclusions— These data suggest that any intervention programs developed to prevent or reduce diabetes prevalence in this population should be targeted at adolescents and young adults.
Effective Treatment of Insulin-Induced Edema Using Ephedrine
Authors: Hopkins David F C , Cotton Stephen J , Williams Gareth
Published: March 2007

Objective— To control insulin-induced edema in a patient with poorly controlled IDDM.

Research Design and Methods— A 31-yr-old woman with a 14-yr history of poorly controlled IDDM first developed peripheral edema 3 yr after diagnosis of IDDM; the edema worsened whenever insulin dosage was increased. In August 1991, severe edema developed after treatment of ketoacidosis, with body weight increasing from 46 to 61 kg. No evidence of cardiac dysfunction or autonomic neuropathy existed, and serum albumin was consistently normal.

Results— Treatment with 15 mg of ephedrine every 8 h produced a prompt diuresis, with body weight falling by 4 kg in 48 h and by 12 kg within 1 wk.

Conclusions— Ephedrine may be an effective treatment for insulin-induced edema and may be preferable to the use of diuretics in such patients.
Renal Effects of Different Types of Protein in Healthy Volunteer Subjects and Diabetic Patients
Authors: Nakamura Hiroshi , Ito Seiki , Ebe Naoko , Shibata Akira
Published: March 2007

OBJECTIVE

To evaluate the effects of acute loading of protein from different sources on the glomerular filtration rate.

RESEARCH DESIGN AND METHODS

A total of 6 healthy volunteer subjects and 6 diabetic patients with normoalbuminuria were studied before and after ingestion on separate days of tuna fish containing 0.7 g/kg body wt of protein, boiled egg white containing the same amount of protein as the tuna fish, or boiled egg white containing 1.4 g/kg body wt of protein. Furthermore, to study the possible role of prostaglandins and amino acids in the response of GFR to protein loading, urinary excretion of prostaglandins, and plasma levels of amino acids were measured during these tests.

RESULTS

In normal subjects, the GFR rose significantly (P < 0.01) after ingestion of tuna fish. No significant differences were found between GFR before and after ingestion of the different amounts of egg white. The GFRs of the diabetic patients after ingestion of each of the meals were similar to the responses in healthy volunteers. Plasma levels of Gly and Ala (amino acids known to induce glomerular hyperfiltration) were higher after ingestion of tuna fish than after administration of egg white in all subjects. No differences were found in the plasma concentrations of any amino acids except Gly and Ala after loads of tuna fish and egg white containing 1.4 g/kg of protein. Urinary 6-keto-PGF1a excretion increased significantly (P < 0.01) after tuna fish loading, but did not change after egg white challenge.

CONCLUSIONS

These findings could be explained either by differences in renal vasodilatory prostaglandin secretion or by increased plasma levels of Gly and Ala, which were increased only after ingestion of tuna fish. Thus, egg white has renal effects on GFR different from those of tuna fish, independent of the quantity of protein ingested.
Self-Monitoring of Blood Glucose by Adults With Diabetes in the United States Population
Authors: Harris Maureen I , Cowie Catherine C , Howie L Jean
Published: March 2007

OBJECTIVE

To evaluate self-monitoring of blood glucose, which is considered an important practice for patients with diabetes. However, little is known about the frequency or determinants of this technique.

RESEARCH DESIGN AND METHODS

A detailed questionnaire on diabetes was administered to a representative sample of 2405 diabetic subjects ≥ 18 yr of age in the U.S. population in the 1989 National Health Interview Survey.

RESULTS

Among subjects with IDDM, 40% monitored their blood glucose at least 1 time/day. Among subjects with NIDDM treated with insulin, 26% monitored at least 1 time/day and among NIDDM subjects not treated with insulin, the percentage was 5%. When stratified by age, little difference was observed between IDDM subjects and insulin-treated NIDDM subjects in the percentage testing at least 1 time/day. By multivariate analysis, age and insulin use were the major determinants of whether diabetic subjects tested their blood glucose. Race and education were also independently related to self-monitoring of blood glucose. Blacks were 60% less likely to test their blood glucose at least 1 time/day compared with non-Hispanic whites and Mexican Americans. Those with college education were 80% more likely to test their blood glucose compared with those with lower education levels. Having had a patient education class in diabetes management and frequent physician visits for diabetes care were positively related to self-testing. Self-monitoring was not related to higher income or having health insurance.

CONCLUSIONS

A large proportion of patients with diabetes do not test their blood glucose. Financial barriers associated with income and health insurance do not appear to impede the practice of self-monitoring. Because of the importance of blood glucose control in the prevention of diabetes complications and the role of self-monitoring in achieving blood glucose control, it may be prudent for physicians and their patients to make greater use of this technique. Special attention should be directed to the subgroups of patients (blacks, patients not treated with insulin, those with less education, and those with no education in diabetes) in which the frequency of self-monitoring is particularly low.
Alanine and Terbutaline in Treatment of Hypoglycemia in IDDM
Authors: Wiethop Brian V , Cryer Philip E
Published: March 2007

OBJECTIVE

To test the hypothesis that, in contrast to administration of glucose or glucagon, administration of the amino acid Ala or of the beta 2-adrenergic agonist terbutaline produces sustained glucose recovery from hypoglycemia.

RESEARCH DESIGN AND METHODS

We developed a model of clinical hypoglycemia using subcutaneous injection of insulin (0.15 U/kg) in patients with IDDM. In comparison with nondiabetic subjects, patients with IDDM exhibited reduced glucagon (P = 0.0001), epinephrine (P = 0.0060), and pancreatic polypeptide (P = 0.0001) responses to hypoglycemia. In addition to placebos, the following were administered during hypoglycemia (2 h after insulin injection) in IDDM patients: oral glucose, 10 and 20 g; subcutaneous glucagon, 1.0 mg; oral Ala, 40 g; oral terbutaline, 5.0 mg; and subcutaneous terbutaline, 0.25 mg.

RESULTS

Glucose (10 and 20 g) and glucagon raised plasma glucose (P = 0.0163, 0.0060, and 0.0001, respectively) from 3.0–3.3 mM to peaks of 5.4 ± 0.4, 6.8 ± 0.7, and 11.8 ± 0.8 mM within 30, 45, and 60 min, respectively, but the responses were transient. Oral Ala raised glucose levels (P = 0.0401) to 4.0 ± 0.4 mM within 30 min; glucose levels then rose gradually to a 6-h value of only 7.1 ± 0.9 mM. Oral terbutaline raised glucose levels (P = 0.0294) to 4.3 ± 0.3 mM within 30 min; glucose levels then rose substantially. In contrast, subcutaneous terbutaline raised glucose levels (P = 0.0249) to 3.7 ± 0.1 mM within 15 min; the levels plateaued at 5.0 mM from ∼60–150 min and then paralleled the placebo curve.

CONCLUSIONS

Ala and terbutaline produce sustained glucose recovery from hypoglycemia in IDDM and are therefore potentially useful agents for the treatment of mild or moderate iatrogenic hypoglycemia, or the prevention of iatrogenic hypoglycemia, when food intake is not anticipated over the following several hours.
Diabetes in Pregnancy in Zuni Indian Women: Prevalence and subsequent development of clinical diabetes after gestational diabetes
Authors: Benjamin Evan , Winters Diane , Mayfield Jennifer , Gohdes Dorothy
Published: March 2007

Objective— To determine the prevalence of gestational diabetes mellitus in Zuni Indian women and the subsequent rate of diabetes among Zuni women with GDM.

Research Design and Methods— A retrospective analysis of 809 deliveries over a 4-yr period among Zuni Indian women was conducted to determine the prevalence of GDM and diabetes antedating pregnancy. A prospective case-control study of 47 full-blooded Zuni Indian women with GDM and 47 control subjects was performed to determine the progression to clinical diabetes in women with a first-time diagnosis of GDM. Cases with GDM delivered during a defined 8-yr period. The control group of Zuni women delivered during the same time period but had plasma glucose values <7.8 mM on the 1-h glucose screening test. Cases with GDM and control subjects were matched for age, body mass index, gravidity, and length of follow-up. All women were re-evaluated for diabetes up to 9 yr after the index pregnancy.

Results— Between 1987–1990, 116 cases of GDM and 8 cases of pre-existing diabetes were identified, giving a prevalence of maternal diabetes in pregnancy of 15.3%. At the time of follow-up, 14 of 47 (30%) women with GDM had developed diabetes after a mean of 4.8 yr compared with only 3 of 47 (6%) from the control group with an average of 5.5 yr follow-up.

Conclusions— GDM is prevalent among Zuni Indians and is associated with an increased risk of diabetes. Glucose tolerance after GDM may deteriorate at a greater rate in Native Americans than in other populations.
Insulinoma in a Patient With NIDDM
Authors: Kane L A , Grant C S , Nippoldt T B , Service F J
Published: March 2007

Objective— To confirm insulinoma as the cause of hypoglycemia in a patient with NIDDM and determine the frequency of the co-occurrence of these two conditions.

Research Design and Methods— The patient underwent an in-hospital prolonged fast (≤72 h), according to standard protocol, and an ultrasound examination of the pancreas. All cases of histologically confirmed insulinoma at this institution over the period of 1927–1992 were reviewed to determine the prevalence of pre-existent diabetes mellitus.

Results— After 10 h of fasting, plasma glucose was low (1.89 mM); plasma insulin (258 pM) and C-peptide (1.39 nM) were elevated in the absence of sulfonylurea in the plasma. An insulinoma detected by ultrasonography was removed surgically with subsequent reoccurrence of insulin-requiring diabetes. Among 313 cases of insulinoma confirmed at this institution, this patient is the only one with pre-existent diabetes mellitus.

Conclusions— Insulinoma occurs extraordinarily rarely in patients with pre-existing NIDDM.
Metabolic Effects of Dietary Sucrose in Type II Diabetic Subjects
Authors: Bantle John P , Swanson Joyce E , Thomas William , Laine Dawn C
Published: March 2007

Objective— To assess in diabetic subjects the effects of dietary sucrose on glycemia and lipemia.

Research Design and Methods— Twelve type II diabetic subjects consumed, in random order, two isocaloric, 55% carbohydrate study diets for 28 days. In one diet, 19% of energy was derived from sucrose. In the other diet, <3% of energy was derived from sucrose, and carbohydrate energy came primarily from starch. Both study diets were composed of common foods. All meals were prepared in a metabolic kitchen where foods were weighed during meal preparation.

Results— No significant differences were noted between the study diets at any time point in mean plasma glucose. At day 28, mean plasma glucose values for the sucrose diet were 9.6 ± 0.5 mM and for the starch diet were 9.4 ± 0.6 mM (P = 0.63). Also, no significant differences were observed between the study diets in urine glucose, fasting serum total, HDL, or LDL cholesterol; fasting serum TG; or peak postprandial serum TG.

Conclusions— A high sucrose diet did not adversely affect glycemia or lipemia in type II diabetic subjects.
South African Indians Show a High Prevalence of NIDDM and Bimodality in Plasma Glucose Distribution Patterns
Authors: Omar Mahomed A K , Seedat Mahomed A , Dyer Robin B , Motala Ayesha A , Knight Lucinda T , Becker Peter J
Published: March 2007

OBJECTIVE

To determine the prevalence of diabetes mellitus and impaired glucose tolerance (IGT) and to test for bimodality in the plasma glucose distribution in South African Indians.

RESEARCH DESIGN AND METHODS

Subjects were selected by systematic cluster sampling in various areas of Durban. They underwent a modified glucose tolerance test whereby fasting and 2-h postglucose (75 g) plasma glucose levels were measured. The program MIX was used to test for bimodality in the plasma glucose distribution.

RESULTS

We tested 2,479 subjects (1,441 women and 1,038 men). Based on the revised World Health Organization criteria, the crude prevalence of diabetes mellitus was 9.8%, and the crude prevalence of IGT was 5.8%; the age- and sex-adjusted prevalence was 13.0 and 6.9%, respectively. IGT was significantly more common in men (7.6%) than in women (4.4%). Obesity was a feature of both diabetes mellitus and IGT, particularly in women. Both fasting and 2-h plasma glucose values did not conform to a single normal distribution pattern in any age-group, whereas unequivocal evidence of bimodality was seen in the 55- to 74-year age-group of both sexes for fasting and 2-h glucose and also in the 2-h levels of men in the 25- to 34-year age-group.

CONCLUSIONS

This study has highlighted a high prevalence of non-insulindependent diabetes mellitus in South African Indians and bimodality in the plasma glucose distribution.
Community Diabetes Care: A 10-year Perspective
Authors: Hiss Roland G , Anderson Robert M , Hess George E , Stepien Cathie J , Davis Wayne K
Published: March 2007

OBJECTIVE

To compare diabetes care and education at the community level in 1981 and 1991 in order to record progress achieved in the decade of the 1980s, determine if there is a gap that must be closed to reach diabetes-related objectives for 2000, and establish a baseline to which changes stimulated by the Diabetes Control and Complications Trial can be compared.

RESEARCH DESIGN AND METHODS

In eight Michigan communities, representative primary-care physicians (61 in 1981; 68 in 1991) and their diabetic patients (428 and 440) were identified. Communities, physicians, and patients were randomly selected. Participating patients were interviewed and examined in their community or home to assess the kind and extent of diabetes care they had been receiving; their metabolic, nutritional, educational, and psychosocial status; their diabetic history and current status; and other related factors. The diabetic status, care, and education of the 1981 community patients were compared with those of patients studied in 1991.

RESULTS

Positive changes in diabetes care and education at the community level from 1981 to 1991 were seen in the areas of patient glucose monitoring, insulin administration practices, hypertension control, exercise recommendations in diabetic management; and smoking rates. Negative changes occurred in the percentage of non-insulin-dependent diabetes mellitus (NIDDM) patients receiving diabetes education and frequency of office visits to the patient's primary-care physician. Changes of indeterminate value included a sharp decline in primary diabetes admissions to the hospital and a decrease in the proportion of NIDDM patients managed with insulin. Many other hoped-for changes from 1981 status, such as screening for retinopathy, foot-care practices, and overall metabolic control of diabetes, did not occur.

CONCLUSIONS

The decade of the 1980s produced modest, but not impressive, improvements in diabetes care and education at the community level. Progress must be accelerated if the diabetes-related objectives included in the national targets for health promotion and disease prevention for 2000 are to be met.
Improved Visual Evoked Potential Latencies In Poorly Controlled Diabetic Patients After Short-Term Strict Metabolic Control
Authors: Ziegler Olivier , Guerci Bruno , Algan Michel , Lonchamp Philippe , Weber Michel , Drouin Pierre
Published: March 2007

OBJECTIVE

To determine whether short-term strict control of blood glucose can improve abnormal visual evoked potentials (VEPs) in poorly controlled diabetic patients with no overt diabetic complications.

RESEARCH DESIGN AND METHODS

VEPs (P100 wave latencies) were recorded in 12 poorly controlled diabetic patients (7 with insulin-dependent diabetes mellitus and 5 with non-insulin-dependent diabetes mellitus) before and after at least 3 days of near normoglycemia obtained by continuous subcutaneous insulin infusion (CSII). Exclusion criteria were overt diabetic neuropathy or retinopathy. The control subjects were 12 healthy subjects matched for age and sex. Fifty-two other subjects formed a reference control population. The intra-individual coefficient of variation for P100 latency was < 3%.

RESULTS

The P100 latencies were longer in diabetic patients than in control subjects (means of both eyes ± SD: 116.8 ± 10.1 vs. 106.2 ± 4.5 ms, P < 0.01), and 4 of the 12 diabetic patients had abnormal VEPs. After 3 days of close blood glucose control (mean blood glucose profile fell from 13.7 ± 2.2 mmol/l to 6.8 ± 1.2 mmol/l, P < 0.01), the mean P100 latencies were significantly shorter (112.5 ± 7.6 ms, P < 0.01) but were still significantly longer than control values. The longer the initial P100 latency, the greater the decrease after CSII. There was no correlation between the fall in blood glucose and improvement in VEPs.

CONCLUSIONS

Short-term blood glucose normalization is associated with improved P100 wave latency in uncomplicated diabetic patients. These data suggest that abnormal VEPs are partly reversible and include functional disturbances related to glucose metabolism.
Perinatal Determinants Among Children Who Later Develop IDDM
Authors: Bock Troels , Pedersen Charlotte R , Vølund Aage , Pallesen Camilla S , Buschard Karsten
Published: March 2007

OBJECTIVE

The aim of this study was to investigate whether children who develop insulin-dependent diabetes mellitus (IDDM) differ in some aspects from a matched control group at the time of birth.

RESEARCH DESIGN AND METHODS

We studied all children who were born in Denmark during the period 1973–1977 and admitted to a Danish hospital with a diagnosis of IDDM during 1978–1989. The study was conducted by combining two nationwide registries, The National Patient Registry and The Birth Registry.

RESULTS

The criteria were fulfilled by 837 children. Data regarding the age of the parents, the number of previous pregnancies of the mother, the month of birth, and the birth weight and length of the children who developed IDDM were compared with the data of an age- and sex-matched control group of 837 children without IDDM. We did not detect any significant differences between the two groups with respect to the parameters studied.

CONCLUSIONS

No differences in perinatal determinants could be demonstrated among Danish children who develop IDDM compared with children without diabetes.
Differences in Peripheral and Autonomic Nerve Function Measurements in Painful and Painless Neuropathy: A clinical study
Authors: Veves Aristidis , Young Matthew J , Manes Christos , Boulton Andrew J M
Published: March 2007

OBJECTIVE

To examine the differences in peripheral and autonomic nerve function measurements between diabetic patients without neuropathy (group 1, n = 38, mean age 50.9, range 29–71 years), with painless neuropathy (group 2, n = 32, mean age 49.2, range 30–71 years), and with painful neuropathy (group 3, n = 52, mean age 51.5, range 28–73 years).

RESEARCH DESIGN AND METHODS

The evaluation of neuropathy was based on clinical symptoms, signs, and quantitative sensory testing, including current perception threshold (CPT) with a neurometer and electrophysiology.

RESULTS

The Neuropathy Symptom Score and the Neuropathy Disability Score were higher in patients with painful neuropathy compared with patients with painless neuropathy (6.8 ± 2.7 vs. 0.5 ± 0.8 [mean ± SD], P < 0.0001, and 12.5 ± 6.2 vs. 8.6 ± 6.8, P < 0.01, respectively). In contrast, no differences were found in the quantitative sensory testing, including CPT measurements, the electrophysiological measurements, and the autonomic nerve system function tests in the two groups. Significant differences were found in all the above measurements when groups 2 and 3 were compared with diabetic patients without neuropathy (group 1). When all diabetic patients were considered as one group, significant correlations were found between CPT and the other peripheral nerve function assessments. In particular, peroneal nerve motor conduction velocity correlated with CPT at 2 kHz (r = −0.48, P < 0.001) and vibration perception threshold (r = −0.50, P < 0.001).

CONCLUSIONS

We conclude that no difference could be found in the function of small and large nerve fibers between painful and painless diabetic neuropathy using conventional tests currently used. The CPT evaluation failed to quantify painful symptoms, but it compared favorably with other quantitative sensory tests in quantifying peripheral neuropathy.
Prevalence of Arterial Hypertension in Diabetic Patients Before and After the JNC-V
Authors: Tarnow Lise , Rossing Peter , Gall Mari-Anne , Nielsen Flemming S , Parving Hans-Henrik
Published: March 2007

OBJECTIVE

To compare the prevalence of arterial hypertension in patients with insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) according to blood pressure (BP) criteria from the World Health Organization (WHO) and The Fifth Report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (JNC-V).

RESEARCH DESIGN AND METHODS

Two cohorts of Caucasian patients attending the outpatient clinic at Hvidöre Hospital were identified: 1) 957 patients with IDDM; 53% men, 40 (18–75) years of age (mean [range]); and 2) 549 patients with NIDDM; 53% men, 60 (20–76) years of age. BP was measured at least yearly, while patients rested in a sitting position, with a standard clinical sphygmomanometer. Patients were classified as hyper- or normotensive based on average BP during a 3-year follow-up period. Patients receiving antihypertensive treatment were classified as hypertensives.

RESULTS

In IDDM patients, the prevalence of arterial hypertension rose from 15 to 42% in the normoalbuminuric group, from 26 to 52% in the microalbuminuric group, and from 61 to 79% in the macroalbuminuric group when WHO and JNC-V criteria were compared. The corresponding rises in NIDDM patients were from 51 to 71% (normo-), from 73 to 90% (micro-), and from 82 to 93% (macroalbuminuria). Of the untreated hypertensive patients, 78% of IDDM patients and 50% of NIDDM patients had stage 1 (140–159/90–99 mmHg) hypertension; 20% of IDDM patients and 37% of NIDDM patients had stage 2 (160–179/100–109 mmHg) hypertension. Two out of three untreated hypertensive patients had isolated systolic hypertension.

CONCLUSIONS

The new JNC-V criteria approved by the American Diabetes Association leads to a considerable increase in the prevalence of arterial hypertension in a population of IDDM and NIDDM patients. Isolated systolic hypertension contributes importantly.
Comparison of World Health Organization and National Diabetes Data Group Procedures to Detect Abnormalities of Glucose Tolerance During Pregnancy
Authors: Pettitt David J. , Bennett Peter H. , Hanson Robert L. , Narayan K. M. Venkat , Knowler William C.
Published: March 2007

OBJECTIVE

To compare the one-step procedure proposed by the World Health Organization (WHO) with the two-step procedure proposed by the National Diabetes Data Group (NDDG) for the identification of abnormalities of glucose tolerance during pregnancy.

RESEARCH DESIGN AND METHODS

One hundred twenty-seven non-diabetic Pima Indian women had a 75-g 2-h glucose tolerance test (WHO criteria). Those with an elevated 1-h glucose concentration (≥ 7.8 mmol/l) were referred for a 100-g 3-h glucose tolerance test (National Diabetes Data Group criteria). The effectiveness of the two test procedures was determined by comparing the frequency of macrosomia and cesarean section as outcomes of pregnancy.

RESULTS

Of 42 women with 1-h plasma glucose concentrations ≥ 7.8 mmol/l, 13 had no 100-g test, 27 had a normal test, and 2 had an abnormal test. Both women (100%) with abnormal two-step 100-g tests also had abnormal one-step 75-g tests, but only 2 of the 11 women (18%) with an abnormal one-step test had an abnormal two-step test. Sixteen of the 127 women delivered babies weighing ≥ 4,000 g. Six of these women (38%) were correctly identified as abnormal using the one-step test and one (6%) using the two-step test. Of seven women delivering by cesarean section, four (57%) had abnormal one-step tests, but none had an abnormal two-step test.

CONCLUSIONS

The one-step WHO test for glucose tolerance during pregnancy was abnormal in a greater percentage of women with adverse outcomes than the more cumbersome two-step NDDG test. The one-step test has the added advantage of being directly comparable to the standard glucose tolerance test used in nonpregnant women.
Comparison of Pharmacokinetics and Pharmacodynamics of Short- and Long-Term Glyburide Therapy in NIDDM
Authors: Jaber Linda A , Antal Edward J , Slaughter Richard L , Welshman Ian R
Published: March 2007

OBJECTIVE

To examine the pharmacokinetics and pharmacodynamics of glyburide after single- and multiple-dose administration in patients with type II diabetes.

RESEARCH DESIGN AND METHODS

Twenty patients with type II diabetes between 40 and 70 years of age participated in the study. A 24-h pharmacokinetic evaluation including a 4-h Sustacal tolerance test was conducted before instituting glyburide therapy (baseline), after the first 2.5-mg test dose of glyburide and at weeks 6 and 12 of chronic glyburide therapy. Glyburide doses were titrated with a target goal of achieving a fasting plasma glucose of ≤ 7.8 mmol/l or to reach maximum daily doses of 20 mg.

RESULTS

A significant prolongation in the elimination half-life (t1/2: week 0, 4.0 ± 1.9 h; week 6, 13.7 ± 10.5 h; and week 12, 12.1 ± 8.2 h) and an increased volume of distribution of glyburide was observed during chronic dosing. These results strongly suggest possible drug accumulation. No differences in pharmacokinetic parameters were noted between evaluations at week 6 or week 12. Changes in pharmacodynamic response of glucose, insulin, and C-peptide to chronic glyburide therapy were observed. Glyburide therapy significantly reduced plasma glucose levels at weeks 6 and 12 (percent changes in AUC0→4. glucose from baseline: week 0, −3 ± 11%; week 6, − 29 ± 13%; and week 12, −26 ± 19%). Pancreatic insulin secretion was acutely enhanced and maintained during long-term therapy. Responsiveness to therapy as assessed by the ratio of AUC0→4.glucose:AUC0→4.C-peptide was significantly improved at all weeks compared with baseline. No pharmacodynamic response differences were observed between the week 6 and the week 12 evaluations.

CONCLUSIONS

This study demonstrates that significant differences in glyburide pharmacokinetics and pharmacodynamics exist between single-dose and steady-state conditions. These differences support the need for careful dosage titration of glyburide to achieve a desired therapeutic response in patients with type II diabetes.
Hyperproinsulinemia of Type II Diabetes Is Not Present Before the Development of Hyperglycemia
Authors: Birkeland Kåre I , Torjesen Peter A , Eriksson Johan , Vaaler Stein , Groop Leif
Published: March 2007

OBJECTIVE

To examine proinsulin and insulin levels in first-degree relatives of patients with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

Comparison of insulin and proinsulin responses to an oral glucose tolerance test in four groups of individuals: 1) 31 patients with newly diagnosed NIDDM treated with diet alone, 2) 34 first-degree relatives of NIDDM patients with impaired glucose tolerance (IGT), 3) 26 relatives with normal glucose tolerance (NGT), and 4) 30 subjects without a family history of diabetes.

RESULTS

Both fasting and post-glucose levels of proinsulin were elevated in patients with diabetes, but not in the relatives with IGT or NGT. Levels of true insulin were highest in the diabetic group, followed by the subjects with IGT, and were lowest among relatives with NGT. Proinsulin levels correlated with glucose levels, suggesting that hyperglycemia is the main stimulus for increased proinsulin secretion.

CONCLUSIONS

First-degree relatives of NIDDM patients, who have a high risk of developing diabetes, do not exhibit elevated levels of fasting or glucose-stimulated proinsulin as long as their fasting glucose levels remain normal.
Impaired Glucose Tolerance and NIDDM: Does a Lifestyle Intervention Program Have an Effect?
Authors: Bourn Diane M , Mann Jim I , McSkimming Barbara J , Waldron Margaret A , Wishart Janet D
Published: March 2007

OBJECTIVE

To determine whether a 2-year lifestyle intervention program improves glucose tolerance and lipid levels in people with persistent impaired glucose tolerance (IGT) or non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

Screening for IGT and NIDDM was carried out in 1,752 people. Subjects with persistent IGT or NIDDM completed three 2-h oral glucose tolerance tests (OGTTs) before the start of the study and after 2 years. A single OGTT was carried out every 3 months. A 4-day food diary and a 7-day exercise diary were completed, and weight, blood pressure, glycated hemoglobin (HbA1), plasma lipids, and fasting and 2-h serum insulin were measured at baseline and every 3 months. Subjects were encouraged to make dietary changes and increase exercise.

RESULTS

Thirty-two subjects with persistent IGT and 20 subjects with NIDDM were recruited. Women reported significant decreases in total and saturated fat and an increase in carbohydrate, but few subjects reached the recommended intakes. Men achieved smaller dietary changes. There were significant decreases in body mass index, fasting and 2-h plasma glucose, HbA1, total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels in both the IGT and NIDDM groups during the study.

CONCLUSIONS

Results suggest that a diet and exercise program can result in significant improvements in a range of clinical and metabolic variables in some people with IGT or NIDDM, although the absence of a control group precludes firm conclusions. Screening for IGT in those at high risk for developing NIDDM and offering those with persistent IGT a lifestyle intervention program could help reduce the progression of IGT to NIDDM.
Prevalence of Adult-Onset IDDM in the U.S. Population
Authors: Harris Maureen I , Robbins David C
Published: March 2007

OBJECTIVE

To investigate the prevalence of adult-onset insulin-dependent diabetes mellitus (IDDM) in a nationally representative sample of adults 30–74 years of age. Although it is a widely held belief that onset of IDDM in adults is rare, there are few objective data to support this. Adult-onset IDDM may represent a disease that is biologically distinct from youth-onset IDDM, and it would be important to distinguish these two entities.

RESEARCH DESIGN AND METHODS

The Second National Health and Nutrition Examination Survey (NHANES II) contained a national probability sample of 12,102 subjects 30–74 years of age in the U.S. population. All subjects with diabetes diagnosed by a physician before the survey were identified. Cases of IDDM defined by age at diagnosis ≥ 30 years, continuous or nearly continuous insulin treatment since diagnosis of diabetes, and relative body weight ≤ 125 were classified as adult-onset IDDM.

RESULTS

Subjects with adult-onset IDDM represented 0.30% of the U.S. population 30–74 years of age and 7.4% of all diabetic patients diagnosed at 30–74 years of age.

CONCLUSIONS

These data indicate that onset of IDDM in adults is uncommon. Given the limitations of the survey instrument, subclinical or slowly progressive IDDM (as distinguished from non-insulin-dependent diabetes mellitus with progressive loss of β-cell function) would not have been detected, and these would constitute additional cases of adult-onset IDDM. However, the data suggest that a very large population base would be required to identify sufficient numbers of adult-onset IDDM cases for study of the etiology and pathogenesis of this disease.
Peripheral Autonomic Impairment in Patients Newly Diagnosed With Type II Diabetes
Authors: McDaid Elizabeth A , Monaghan Bronagh , Parker Ann I , Hayes John R , Allen Judith A
Published: March 2007

OBJECTIVE

To measure both peripheral and central autonomic function in patients newly diagnosed with type II diabetes.

RESEARCH DESIGN AND METHODS

Measurements were made on 49 diabetic patients (8 with long-standing diabetes and neuropathic complications, 41 with newly diagnosed type II diabetes) and on 49 healthy, age- and sex-matched, control subjects. Five of the 41 newly diagnosed type II diabetic patients had retinopathy, and 4 had clinical evidence of neuropathy. No patient or control subject had significant vascular disease. Cardiac autonomic function was investigated by using standard cardiovascular reflex tests. The digital vasoconstrictor responses to deep breathing and body cooling were measured using venous occlusion plethysmography.

RESULTS

The vasoconstrictor responses to a deep breath and body cooling were significantly reduced (P < 0.001) in the fingers and toes of the neuropathic patients compared with their matched control subjects, as were the heart rate responses (P < 0.02). The vasoconstrictor responses were significantly reduced in the toes (P < 0.001) and fingers (P < 0.05, P < 0.01) of the newly diagnosed patients compared with the corresponding responses in the control subjects. There was no significant difference in the heart rate or blood pressure responses of these patients and control subjects during standard tests of cardiac autonomic function.

CONCLUSIONS

Patients with type II diabetes may have impaired peripheral autonomic function at diagnosis.
Diabetes With Mitochondrial Gene tRNALYS Mutation
Authors: Suzuki Susumu , Hinokio Yoshinori , Hirai Satoshi , Onoda Masatoshi , Matsumoto Masahiro , Ohtomo Masataka , Kawasaki Hiromasa , Satoh Yoshinori , Akai Hiroaki , Abe Kohji , Toyota Takayoshi
Published: March 2007

OBJECTIVE

To solve a possible relationship between mtDNA mutation of tRNALYS(8344) and diabetes, we have surveyed the tRNALYS mutation, glucose intolerance, and insulin secretory capacity in a Japanese family with diabetes and myoclonic epilepsy with ragged-red fiber disease. Several lines of evidence suggested possible linkage between mtDNA mutation and diabetes (1–4).

RESEARCH DESIGN AND METHODS

DNA was isolated from peripheral lymphocytes. The polymerase chain reaction analysis for the tRNALYS(8344) mutation of the mtDNA was conducted as described by Larsson (5). Insulin secretory capacity was assessed by 24-h urinary C-peptide immunoreactivity response (CPR) excretion and plasma CPR to glucagon administration.

RESULTS

We identified seven subjects with the tRNALYS mutation as well as seven non-mutated members in the pedigrees. Oral glucose tolerance tests in the pedigree indicated that five of the mutated subjects were diabetic, one had impaired glucose tolerance, and one had normal glucose tolerance (NGT), whereas all nonmutated family members had NGT. The pedigree shows maternal transmission of diabetes and the tRNALYS mutation over three generations. Twenty-four-hour urinary excretion of CPR was significantly reduced in the mutant subjects (mean ± SD, 67.8 ± 79.2 nmol/day, n = 6, P < 0.001) compared with the nonmutant members (276.6 ± 41.8 nmol/day, n = 5) and the age-matched normal control subjects (263 ± 64.3 nmol/day, n = 12). Plasma CPR 6 min after glucagon injection demonstrated a marked reduction in the mutant subjects (3.68 ± 3.45 nmol/l, n = 5, P < 0.001) compared with the nonmutant members (19.4 ± 1.17 nmol/l, n = 5) and the normal control subjects (15.8 ± 3.81 nmol/l, n = 12). Bilateral neurosensory deafness was demonstrated in five of seven (71.4%) mutant subjects (five of five [100%] mutated diabetic patients), but not detected in six nonmutant members.

CONCLUSIONS

This observation is the first report of association of diabetes with the mitochondrial tRNALYS mutation. Insulin secretory capacity was significantly lower in the mutant members than in the nonmutated members. These findings suggest that the pancreatic β-cell secretory defect of insulin might be one of the phenotypes of the mitochondrial tRNALYS mutation.
Urinary chiro-Inositol Excretion is an Index Marker of Insulin Sensitivity in Japanese Type II Diabetes
Authors: Suzuki Susumu , Kawasaki Hiromasa , Satoh Yoshinori , Ohtomo Masataka , Hirai Masashi , Hirai Aki , Hirai Satoshi , Onoda Masatoshi , Matsumoto Masahiro , Hinokio Yoshinori , Akai Hiroaki , Craig James , Larner Joseph , Toyota Takayoshi
Published: March 2007

OBJECTIVE

To determine the relationship between urinary chiro-inositol excretion and insulin sensitivity in Japanese type II diabetic patients.

RESEARCH DESIGN AND METHODS

Eighteen subjects were age-matched, nonobese, type II diabetic patients. Eight subjects had impaired glucose tolerance (IGT), and 10 had normal glucose tolerance (NGT). We quantified urinary chiro-inositol excretion using gas chromatography-mass spectrometry and the insulin sensitivity index (SI), and glucose effectiveness (SG) using Bergman's modified minimal model method.

RESULTS

The urinary excretion of chiro-inositol was much lower in the diabetic patients (32.3 ± 16.0 μmol/day, means ± SD) than in the NGT subjects (96.0 ± 17.6; P < 0.0001) and IGT subjects (58.9 ± 11.6; P < 0.0001). SI was much lower in the diabetic patients (3.81 ± 1.49) than in the NGT subjects 6.30 ± 1.59, P < 0.0005). SG was much lower in the diabetic patients (2.14 ± 0.56) than in the NGT subjects (3.07 ± 0.38, P < 0.0001). There was a significant correlation between urinary chiro-inositol excretion and SI (r = 0.766), as well as a significant correlation between urinary chiro-inositol excretion and SG (r = 0.747).

CONCLUSIONS

There is a direct relationship of urinary chiro-inositol excretion to insulin sensitivity and SG in humans. Urinary chiro-inositol excretion might be useful as a metabolic index of insulin sensitivity in type II diabetes.