bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Troglitazone: A new hypoglycemic agent in patients with NIDDM poorly controlled by diet therapy
Authors: Iwamoto Yasuhiko , Kosaka Kinori , Kuzuya Takeshi , Akanuma Yasuo , Shigeta Yukio , Kaneko Toshio
Published: March 2007

OBJECTIVE

To investigate the clinical efficacy of troglitazone, a newly developed oral hypoglycemic agent, in patients with NIDDM.

RESEARCH DESIGN AND METHODS

There were 284 NIDDM patients (20–82 years of age) whose glycemic control while on a diet was judged stable but was judged unsatisfactory (fasting plasma glucose [FPG] ≥ 8.3 mmol/l) when entered into a multicenter and double-blind study with parallel groups study. They were randomly allocated into two groups, the troglitazone group (the T group: 400 mg/day p.o.) and the placebo group (the P group), and were treated with test drugs for 12 weeks.

RESULTS

We evaluated efficacy in 136 patients of the T group and 126 patients of the P group. There was no significant difference in any of baseline characteristics between the T and P groups. In the T group, FPG and HbA1c decreased significantly after treatment (before versus after, FPG 10.1 ± 1.6 vs. 8.8 ± 1.9 mmol/l, P < 0.001; HbA1c: 8.6 ± 1.5 vs 8.1 ± 1.7%, P < 0.001). FPG and HbA1c did not change after treatment in the P group (before versus after, FPG 10.1 ± 1.8 vs. 9.9 ± 2.1 mmol/l; HbA1c 8.5 ± 1.5 vs. 8.6 ± 1.6%). Of 136 patients in the T group, 62 (45.6%) were classified as responders. Serum triglyceride level also decreased in the T group but not in the P group. Body weight increased slightly only in the T group. There were no differences in changes in blood pressure between the two groups. No serious adverse events occurred in either group.

CONCLUSIONS

Troglitazone at 400 mg/day decreased FPG and HbA1c significantly in NIDDM patients who had failed to respond to diet therapy. Troglitazone, developed as a drug to enhance insulin action, can be a useful hypoglycemic agent for the treatment of NIDDM.
Efficacy of Feedback From Quarterly Laboratory Comparison in Maintaining Quality of a Hospital Capillary Blood Glucose Monitoring Program
Authors: Jones Helen E , Cleave Barbara , Zinman Bernard , Szalai John Paul , Nichol Heather L , Hoffman Barry R
Published: March 2007

OBJECTIVE

A 1-year randomized prospective study was conducted to investigate the efficacy of feedback from split-sample testing as part of a capillary blood glucose quality assurance program.

RESEARCH DESIGN AND METHODS

A total of 124 nurses were randomized to either group A (quarterly comparisons with feedback) or group B (no feedback). The measure of nurse accuracy against the laboratory at 0, 6, and 12 months was determined by an additional five to seven split-sample tests without giving feedback to either group. Mean accuracy was determined in terms of percent absolute deviation from the laboratory result and a clinical consensus limit of ± 20% deviation from the laboratory.

RESULTS

By 12 months, there was a significant effect of feedback on nurse agreement with the laboratory method (P = 0.022 when agreement was scored as the mean percent absolute difference and P = 0.002 when agreement was scored in terms of the ± 20% clinical consensus limit). Nurses in the group who had received no quarterly feedback from split-sample testing produced a 3.5% greater mean percent absolute deviation from the laboratory method and 12% fewer comparisons within the acceptable ± 20% range.

CONCLUSIONS

Feedback received from split-sample testing has a significant effect in maintaining accuracy in capillary blood glucose monitoring.
Attending the Diabetes Center Is Associated With Increased 5-Year Survival Probability of Diabetic Patients: The Verona Diabetes Study
Authors: Verlato Giuseppe , Muggeo Michele , Bonora Enzo , Corbellini Maurizio , Bressan Franco , De Marco Roberto
Published: March 2007

OBJECTIVE

The aim of the present study is to compare the survival of patients attending diabetes centers with that of patients exclusively consulting family physicians.

RESEARCH DESIGN AND METHODS

The study was carried out in the frame of the Verona Diabetes Study, a population-based survey of known diabetes prevalence with a subsequent 5-year mortality follow-up. A cohort of 7,488 diabetic patients were identified on 31 December 1986 from three diﬀerent sources: a drug consumption database, family physicians, and diabetes centers (one for children and one for adults). As of 31 December 1986, 3,288 patients in the entire cohort exclusively consulted their own family physicians, while 4,200 patients also had periodic examinations at the diabetes centers. The life status of the diabetic cohort was ascertained on 31 December 1991.

RESULTS

Compared with the nondiabetic population, diabetic patients seen only by family physicians had a standardized mortality ratio (SMR) of 1.62 (95% CI 1.51–1.74), while patients attending both family physicians and diabetes centers showed an SMR of 1.44 (1.34–1.54), the difference being statistically significant (P = 0.017). The 5-year survival probability, estimated by the Kaplan-Meier method, was 0.76 (0.75–0.78) in patients seen only by family physicians and 0.81 (0.80–0.82) in patients attending the diabetes centers. Multivariate analysis by Cox regression model showed that attending the diabetes centers was an independent predictor of survival even after adjusting for sex, age, and therapy of diabetes. The relative risk of 5-year all-cause mortality amounted to 0.83 (0.75–0.92) in patients also attending the diabetes centers with respect to patients consulting only family physicians (P < 0.001).

CONCLUSIONS

These data on patients' survival indicate that diabetes centers play a crucial role in diabetes care. As a corollary, an integration between primary-care physicians and diabetes centers is strongly recommended.
Is the Incidence of Diabetes Increasing in All Age-Groups in The Netherlands?: Results of the second study in the Dutch Sentinel Practice Network
Authors: Ruwaard Dirk , Gijsen Ronald , Bartelds Aad I M , Hirasing Remy A , Verkleij Harry , Kromhout Daan
Published: March 2007

OBJECTIVE

To assess possible changes in the incidence of diabetes in all age-groups in The Netherlands during a 10-year period (1980–1983/1990–1992).

RESEARCH DESIGN AND METHODS

Since 1970, a network of sentinel stations (the Dutch Sentinel Practice Network) consisting of ∼ 1% of the Dutch population has been in operation to gain insight into the morbidity patterns of the Dutch population as recorded by general practitioners. One of the items recorded from 1990 to 1992 was the incidence of diabetes. The first study with a similar design that registered the incidence of diabetes was conducted from 1980 to 1983.

RESULTS

The overall incidence of diabetes increased significantly by 12.1% in the period between the two studies. This overall increase can largely be attributed to a statistically significant increase in the age-group 45–64 years (30.5%). Although not statistically significant, the 36% increase of diabetes in the age-group 0–19 years is in accordance with the increase of type I diabetes based on the first and second nationwide retrospective studies covering the total Dutch population.

CONCLUSIONS

There is a marked increase in the incidence of diabetes in the age-group 45–64 years. This selective increase is probably not due to a real rise caused by changes in exposure to risk factors but to an earlier recognition of symptoms and signs of diabetes followed by blood glucose measurements and/or to more intensive case finding in general practice.
A Comparison of Renal Disease Across Two Continents: The Epidemiology of Diabetes Complications Study and the EURODIAB IDDM Complications Study
Authors: Lloyd Cathy E , Stephenson Judith , Fuller John H , Orchard Trevor J
Published: March 2007

OBJECTIVE

To compare prevalence rates of increased albumin excretion in the Epidemiology of Diabetes Complications Study (EDC) (in the U.S.) to similar rates in the EURODIAB study (in Europe) and determine if any differences relate to hypertension, glycemic control, or smoking status.

RESEARCH DESIGN AND METHODS

The study population is made up of two epidemiological clinic-based IDDM populations with comparable ages (x = 28 years, both studies), sex distribution (50% male, EURODIAB; 49% male, EDC), and duration characteristics. Comparison of two cross-sectional (prevalence) studies was made. Despite different laboratory assays, comparability was established for urinary albumin (r = 0.98) and GHb measures (r = 0.95). Hypertension was measured with an identical protocol. Renal status was determined by 24-h urine albumin excretion (< 20 μg/min normal, 20–200 μg/min microalbuminuria, > 200 μg/min macroalbuminuria) in EURODIAB. Identical cutoffs were used for EDC, though two of three samples (24-h, 4-h clinic, and/or overnight sample) had to be positive in one range. (Main findings are confirmed using only 24-h results from EDC.)

RESULTS

The prevalence of macroalbuminuria was higher in EDC (27%) than in EURODIAB (12%). Rates of microalbuminuria were similar (22 vs. 25%, respectively). These patterns were seen at all durations and ages and in both sexes. Controlling for glycemic control, hypertension, or smoking did not account for the higher rate in EDC, nor did exclusion of subjects with raised serum creatinine.

CONCLUSIONS

Advanced renal disease is more prevalent in IDDM in EDC (Pittsburgh, PA) than in Europe. This is not explained by hypertension, glycemic control, or smoking.
Circulating catecholamines and metabolic effects of captopril in NIDDM patients
Authors: De Mattia Giancarlo , Ferri Claudio , Laurenti Oriana , Cassone-Faldetta Maria , Piccoli Alfonso , Santucci Anna
Published: March 2007

OBJECTIVE

To evaluate the effects of captopril on circulating catecholamine levels in NIDDM patients and the possible relationship between captopril-related changes in circulating catecholamine levels and insulin sensitivity.

RESEARCH DESIGN AND METHODS

Fourteen nonobese normotensive NIDDM men (aged 44.5 ± 5.1 years) underwent a 2-h euglycemic-hyperinsulinemic clamp (40 mU·m−2 · min−1). Baseline evaluation of insulin sensitivity was followed by the random assignment of each patient to either captopril or placebo treatment, according to a crossover double-blind design. Euglycemic-hyperinsulinemic clamp studies were then repeated for all patients after both placebo and captopril treatments. Plasma norepinephrine (NE) and epinephrine (E) levels were assessed before, during, and after each clamp.

RESULTS

Resulting data showed that plasma catecholamine levels increased during baseline euglycemic-hyperinsulinemic clamp (NE: +23.6% time 0 vs. time 120 min, P < 0.05; E: +24.8% time 0 vs. time 120 min, P < 0.05). Captopril treatment significantly increased total glucose uptake (from 19.0 ± 9.0 to 26.8 ± 10.1 mmol·kg−1 · min−1, P < 0.05) and reduced baseline plasma NE (P < 0.001) and E (P < 0.05) levels. However, the magnitude of the NE (+25.7% time 0 vs. time 120 min, P < 0.001) and E (+27.2% time 0 vs. time 120 min, P < 0.05) increments during euglycemic hyperinsulinemia were not affected by the drug. Percentage changes in the ratio of total body glucose uptake to circulating insulin levels and corresponding decrements of baseline plasma E levels after captopril therapy were negatively correlated (r = −0.57, P < 0.05).

CONCLUSIONS

The reduction of circulating catecholamines could contribute, at least in part, to the captopril-related amelioration of insulin sensitivity.
Continued Insulin Dependence Despite Normal Range Insulin Sensitivity and Insulin Connecting Peptide Levels in a Kidney/Islet Transplant Patient
Authors: Atkison Paul R , Zucker Peter , Hramiak Irene , Paul Terri L , Dupre John , Behme Margaret T , Scharp David W , Lacy Paul E , Olack Barbera J , Stiller Calvin R
Published: March 2007

OBJECTIVE

The majority of islet transplant recipients remain insulin-requiring, although many have near-normal connecting peptide (CP) levels. Insulin resistance may be one possible cause of the continuing need for exogenous insulin in islet transplant recipients. To assess this, we have studied the insulin sensitivity index (S1) in one patient with near-normal CP levels after islet transplant who remained insulin-requiring.

RESEARCH DESIGN AND METHODS

The islet transplant recipient is a 36-year-old woman with no residual CP who received a kidney transplant, followed 7 days later by an islet transplant. The islets were infused into the liver via the umbilical vein. Induction immunosuppression consisted of OKT3, prednisone, cyclosporin A, and azathioprine, with maintenance on the latter three.

RESULTS

Maximum CP levels after a standardized Sustacal meal were 2.09, 1.18, 0.85, and 0.81 nmol/l at 1,6,18, and 24 months posttransplant, respectively. Insulin requirements at the same times were 0.27, 0.45, 0.49, and 0.62 U·kg−1·d−1, while S1 was 36.3, 53.3, and 13.2 min −1·nmol−1·ml at 6,18, and 24 months, respectively. This compares with S1 values of 43.3 ± 10.0 min−1·nmol−1·ml for normal subjects.

CONCLUSIONS

This patient had near-normal S1 and CP levels, but she was unable to discontinue insulin therapy, suggesting that other factors are critical. Despite this, she maintained normal or near-normal glycated hemoglobins, indicating metabolic benefit from the islet transplant.
Glycemic Control and Prognosis in Type I Diabetic Patients With Microalbuminuria
Authors: Bojestig Mats , Arnqvist Hans J , Karlberg Bengt E , Ludvigsson Johnny
Published: March 2007

OBJECTIVE

To investigate the course of microalbuminuria during the 1980s in type I diabetes patients.

RESEARCH DESIGN AND METHODS

This was a 10-year follow-up of 109 patients in whom type I diabetes was diagnosed between 1961 and 1980 before 15 years of age and who were initially investigated between 1977 and 1983 after a diabetes duration of ≥ 3 years. Microalbuminuria was defined as an albumin excretion rate (AER) of 20-200 μg/min in two of three consecutive urine samples.

RESULTS

At the initial investigation, 81 patients had normal AER, 27 had microalbuminuria, and 1 had macroalbuminuria. Between 1989 and 1992, 99 (91%) patients were reinvestigated. Only 5 (19%) of the initially microalbuminuric patients developed macroproteinuria during the 10-year follow-up period, and in 15 (58%) patients, AER decreased to normal. Three (4%) of the normoalbuminuric patients developed microalbuminuria but none macroproteinuria. The initially microalbuminuric patients, in whom AER normalized, improved their glycemic control from 1980-1983 to 1989-1991 (mean ± SE HbA1c 7.5 ± 0.2 to 6.6 ± 0.3%; P = 0.01).

CONCLUSIONS

In the majority of patients with microalbuminuria in whom it is possible to obtain good glycemic control, microalbuminuria will disappear and the risk of developing nephropathy will be markedly reduced.
Effect of Exercise Intensity on Glucose and Insulin Metabolism in Obese Individuals and Obese NIDDM Patients
Authors: Kang Jie , Robertson Robert J , Hagberg James M , Kelley David E , Goss Fredric L , Dasilva Sergio G , Suminski Richard R , Utter Alan C
Published: March 2007

OBJECTIVE

The primary purpose of this study was to evaluate the acute effect of exercise of differing intensity on plasma glucose and insulin responses to an oral glucose challenge.

RESEARCH DESIGN AND METHODS

Six obese men and six obese men with NIDDM of similar age, weight, percentage body fat, and Vo2peak participated in the study. Each subject underwent two 7-day exercise programs in a counterbalanced order at 2-week intervals. During each 7-day exercise period, the subjects cycled every day at a power output corresponding to 50% Vo2peak for 70 min or 70% Vo2peak for 50 min. Muscle glycogen utilization was estimated during exercise on day 7 using a [3H]glucose infusion technique in conjunction with indirect calorimetry. During the day before and after each 7-day exercise period, a 3-h oral glucose tolerance test (OGTT) was administered after a 12-h overnight fast.

RESULTS

The average caloric expenditure did not differ between exercise at 50 and 70% Vo2peak in both obese and obese NIDDM subjects. However, the carbohydrate oxidation was higher (P < 0.05) during exercise at 70 than 50% Vo2peak in obese subjects (77 ± 5 vs. 68 ± 6 g) and obese NIDDM subjects (70 ± 4 vs. 58 ± 6 g). Muscle glycogen utilization was also higher (P < 0.05) during exercise at 70 than 50% Vo2peak in obese subjects (59 ± 9 vs. 30 ± 7 g) and in obese NIDDM subjects (48 ± 5 vs. 24 ± 5 g). In obese subjects, plasma glucose response area during the OGTT did not change after 7 days of exercise at either 50 or 70% Vo2peak. Plasma insulin response area during the OGTT also did not change after 7 days of exercise at 50% Vo2peak. However, plasma insulin response area was reduced (P < 0.05) after 7 days of exercise at 70% Vo2peak (9,644 ± 1,783 vs. 7,538 ± 1,522 μ· ml"1 · 180 min"1). In obese NIDDM subjects, both plasma glucose and insulin response areas during the OGTT did not decrease after 7 days of exercise at either 50 or 70% Vo2peak.

CONCLUSIONS

It is concluded that the exercise-induced improvement in insulin sensitivity is influenced by exercise intensity in obese individuals. The improved insulin sensitivity after 7 days of exercise at 70% Vo2peak in obese individuals may be related to greater muscle glycogen utilization during exercise. The lack of improvement in glucose tolerance and insulin sensitivity after 7 days of exercise at either 50 or 70% Vo2peak in obese NIDDM patients may be due to the fact that the NIDDM patients selected in the present study were relatively hypoinsulinemic.
Postural Rearrangement in IDDM Patients With Peripheral Neuropathy
Authors: Giacomini Pier Giorgio , Bruno Ernesto , Monticone Glovanna , Di Girolamo Stefano , Magrini Antonio , Parisi Leoluca , Menzinger Guido , Uccioli Luigi
Published: March 2007

OBJECTIVE

To evaluate the influence of diabetic peripheral neuropathy on postural strategy.

RESEARCH DESIGN AND METHODS

Static posturography and nerve conduction velocity were performed in the following age-matched subjects: 10 IDDM patients with peripheral neuropathy, 23 IDDM patients without peripheral neuropathy, and 21 control subjects. All subjects with signs or symptoms of postural instability were excluded from the study. The following posturographic parameters were drawn: 1) velocity of body sway, expressed as mean velocity and average of the SDs, 2) VFY, the parameter derived from the velocity variance and the anteroposterior mean position of the body (this parameter monitors the postural strategy pursued by the subject), and 3) fast Fourier transformation on the x (FFTX) and y (FFTY) planes, spectral analysis of the frequencies of body oscillation on frontal (x) and anteroposterior (y) planes.

RESULTS

Mean velocity and its SD were higher in IDDM patients with peripheral neuropathy than in control subjects and IDDM patients without peripheral neuropathy (P < 0.001). VFY was increased in IDDM patients with peripheral neuropathy versus control subjects and IDDM patients without peripheral neuropathy (P < 0.01). A direct relationship was found between parameters of posturography and some parameters of nerve conduction tests.

CONCLUSIONS

Diabetic patients with peripheral neuropathy demonstrate a shift from physiological ankle control to hip postural control as monitored by specific posturography analysis.
Candidate Genes for Insulin Resistance
Authors: Moller David E , BjørbæK Christian , Vidal-Puig Antonio
Published: March 2007

Insulin resistance confers increased susceptibility to NIDDM, atherosclerotic cardiovascular disease, ovarian hyperandrogenism, and possibly hypertension. Insulin resistance is largely inherited, in rare cases as a monogenic disorder or more commonly as a complex trait. The search for insulin resistance genes relies mainly on two complementary approaches: 1) positional cloning using random DNA markers present throughout the genome; and 2) the analysis of specific candidate genes. This report briefly summarizes the candidate gene approach to insulin resistance. Progress related to the analysis of genes encoding molecules that participate in insulin action is reviewed. In addition, the spectrum of potential genetic defects that might contribute to insulin resistance, both at the level of the target cell and secondarily (e.g., obesity genes), is discussed.
The Relationship Between Socioeconomic Status and Diabetes Control and Complications in the EURODIAB IDDM Complications Study
Authors: Chaturvedi Nishi , Stephenson Judith M , Fuller John H ,   The EURODIAB IDDM Complications
Published: March 2007

OBJECTIVE

To determine whether there are socioeconomic differences in diabetes control and complications in people with IDDM.

RESEARCH DESIGN AND METHODS

We conducted a prevalence survey of 1,217 men and 1,170 women with IDDM age 25–60 years from European clinics. Age at completion of education defined socioeconomic status: ≤ 14 years defined those with primary education; 15–18 years, as secondary education; and > 19 years, as college education. Glycemic control, lipids, diet, retinopathy, neuropathy, and heart disease were assessed centrally.

RESULTS

People with a primary education were older and had diabetes for longer than those with a college education. The mean percentage of HbA1c was worst in the primary-educated men (6.6 vs. 6.1%, P = 0.0007 for trend) and women (6.5 vs. 6.0%, P = 0.0007). Total cholesterol level was higher in primary-educated than in college-educated men (5.6 vs 5.3 mmol/l, P = 0.002), as was triglyceride level (1.23 vs. 1.02 mmol/l, P = 0.0001). College-educated people were the least likely to be current smokers (P < 0.0001), and were most likely to partake in vigorous exercise (P < 0.001). Surprisingly, There was little difference in the prevalence of heart disease by educational status in men, while it was highest in the least educated women, but proliferative retinopathy was more common in primary- than in college-educated men (16 vs 10%, P = 0.04) as was macroalbuminuria (15 vs 9%, P = 0.03). Glycemic control could not fully account for these differences.

CONCLUSIONS

Healthy lifestyles are more prevalent in better educated men and women with IDDM, but these are not reflected in heart disease prevalence in men. The lower prevalence of severe microvascular complications in better educated men, unaccounted for by better glycemic control, requires further investigation.
Glucagonostatic Actions and Reduction of Fasting Hyperglycemia by Exogenous Glucagon-Like Peptide I(7–36) amide in type I diabetic patients
Authors: Creutzfeldt Werner O C , Kleine Nicola , Willms Berend , Ørskov Cathrine , Holst Jens J , Nauck Michael A
Published: March 2007

OBJECTIVE

Glucagon-like peptide I(7–36) amide (GLP-1) is a physiological incretin hormone that, in slightly supraphysiological doses, stimulates insulin secretion, lowers glucagon concentrations, and thereby normalizes elevated fasting plasma glucose concentrations in type II diabetic patients. It is not known whether GLP-1 has effects also in fasting type I diabetic patients.

RESEARCH DESIGN AND METHODS

In 11 type I diabetic patients (HbA1c 9.1 ± 2.1%; normal, 4.2–6.3%), fasting hyperglycemia was provoked by halving their usual evening NPH insulin dose. In random order on two occasions, 1.2 pmol · kg−1 · min−1 GLP-1 or placebo was infused intravenously in the morning (plasma glucose 13.7 ± 0.9 mmol/l; plasma insulin 26 ± 4 pmol/l). Glucose (glucose oxidase method), insulin, C-peptide, glucagon, GLP-1, cortisol, growth hormone (immunoassays), triglycerides, cholesterol, and nonesterified fatty acids (enzymatic tests) were measured.

RESULTS

Glucagon was reduced from ∼8 to 4 pmol/l, and plasma glucose was lowered from 13.4 ± 1.0 to 10.0 ± 1.2 mmol/l with GLP-1 administration (plasma concentrations ∼100 pmol, P < 0.0001), but not with placebo (14.2 ± 0.7 to 13.2 ± 1.0). Transiently, C-peptide was stimulated from basal 0.09 ± 0.02 to 0.19 ± 0.06 nmol/l by GLP-1 (P < 0.0001), but not by placebo (0.07 ± 0.02 to 0.07 ± 0.02). There was no significant effect on nonesterified fatty acids (P = 0.34), triglycerides (P = 0.57), cholesterol (P = 0.64), cortisol (P = 0.40), or growth hormone (P = 0.53).

CONCLUSIONS

Therefore, exogenous GLP-1 is able to lower fasting glycemia also in type I diabetic patients, mainly by reducing glucagon concentrations. However, this alone is not sufficient to normalize fasting plasma glucose concentrations, as was previously observed in type II diabetic patients, in whom insulin secretion (C-peptide response) was stimulated 20-fold.
Impaired Glucose Tolerance, Diabetes, and Cardiovascular Disease Risk Factor Profiles in the Elderly: The Honolulu Heart Program
Authors: Rodriguez Beatriz L , Curb Jess David , Burchfiel Cecil M , Huang Boji , Sharp Dan S , Ye Lu Guiqing , Fujimoto Wilfred , Yano Katsuhiko
Published: March 2007

OBJECTIVE

The relationship between glucose tolerance status and other cardiovascular disease (CVD) risk factors was evaluated in a cohort of Japanese-American men (n = 3,741) ages 71–93 years who participated in the fourth examination of the Honolulu Heart Program in 1991–1993.

RESEARCH DESIGN AND METHODS

In this cross-sectional study, subjects were classified by reported diabetes and glucose tolerance status using questionnaires and the World Health Organization (WHO) criteria, respectively.

RESULTS

The prevalence of reported diabetes was 17%. Among the men who completed an oral glucose tolerance test and had no history of diabetes (n = 1,900), 23% were diagnosed as diabetic and 39% had impaired glucose tolerance (IGT) by WHO criteria. The CVD risk factor profiles of men with IGT and diabetes were significantly more adverse compared with men with normal glucose tolerance after adjustment for age. The rates of hypertension, mean levels of BMI, waist-to-hip ratio, triglycerides, and fasting insulin were higher in men with IGT and diabetes compared with normal subjects. Opposite trends were observed for HDL cholesterol. Two-hour insulin was significantly higher among men with IGT and previously undiagnosed diabetes. Men with known diabetes had a lower physical activity index and higher fibrinogen levels than normal subjects. No significant differences were observed for current smoking and alcohol intake. Differences in risk factor levels by glucose tolerance status remained after adjustment for age, physical activity, BMI, and waist-to-hip ratio.

CONCLUSIONS

These findings show that among elderly men of Japanese ancestry, impaired glucose tolerance and undiagnosed and known diabetes are highly prevalent, and these conditions are associated with adverse CVD factor profiles.
Low Risk of Post-Cesarean Section Infection in Insulin-Requiring Diabetic Women
Authors: Riley Laura E , Tuomala Ruth E , Heeren Tim , Greene Michael F
Published: March 2007

OBJECTIVE

The purpose of this study was to determine if insulin-requiring diabetic women undergoing nonelective cesarean section are at higher risk for postoperative infection than nondiabetic women.

RESEARCH DESIGN AND METHODS

Medical records of a cohort of insulin-requiring diabetic women who underwent cesarean section after labor or rupture of membranes and nondiabetic control subjects matched for age and insurance status were retrospectively reviewed. Data abstracted included maternal characteristics, antepartum, intrapartum, and postpartum events.

RESULTS

Post-cesarean section infection including endometritis, wound infection, and septic pelvic thrombophlebitis occurred in 10.2% of 205 diabetic women and 12.1% of control subjects, in whom antibiotic prophylaxis was used in 79% of diabetic women and 84% of control subjects. Duration of rupture of membranes was a significant risk factor for post-cesarean section infection in both groups.

CONCLUSIONS

Insulin-requiring diabetic women undergoing nonelective cesarean section with antimicrobial prophylaxis have a rate of postoperative infection similar to that for nondiabetic women.
Diabetic Foot Infections: Bacteriology and activity of 10 oral antimicrobial agents against bacteria isolated from consecutive cases
Authors: Goldstein Ellie J C , Citron Diane M , Nesbit Catherine A
Published: March 2007

OBJECTIVE

To study the relative frequency of bacterial isolates cultured from community-acquired foot infections and assess their comparative in vitro susceptibility to sparfloxacin, levofloxacin, and eight other commonly used oral antimicrobial agents.

RESEARCH DESIGN AND METHODS

This is a prospective study in which the infected wounds of 25 consecutive diabetic patients seen by one of the authors were cultured as they entered the hospital. Isolates were stored and tested for susceptibility to 10 oral antimicrobial agents using the agar dilution method.

RESULTS

Staphylococcus aurcus was the most common isolate (76% of patients), including methicillin-resistant S. aurcus (MRSA) in 5 of 25 (20%) patient wounds. Streptococci, enterococci, Enterobacteriaceae, and anaerobes were also present in ≥40% of patient wounds. Sparfloxacin and levofloxacin were the most active agents tested with activity against ≥88% of isolates. Isolates resistant to sparfloxacin and levofloxacin included MRSA, enterococci, and some anaerobes. When analyzed by prior exposure to antibiotics, patients who had previously received oral antibiotics were more likely to have MRSA, enterococci, and Pseudomonas aeruginosa isolated and less likely to have Enterobacteriaceae and anaerobes isolated from their wounds.

CONCLUSIONS

MRSA and enterococci are now a common cause of diabetic foot infections, and the increased prevalence may be due to antimicrobial use. These wounds may require use of combined antimicrobial therapy for initial outpatient management. The new fluoroquinolones, sparfloxacin and levofloxacin, were the most active oral agents tested.
Proinsulin Secretion During the First 3 Years After Diagnosis in Diabetic Patients With and Without Islet Cell Antibodies
Authors: Gottsäter A , Owens D R , Luzio S , Sundkvist G
Published: March 2007

OBJECTIVE

To evaluate proinsulin secretion in different types of NIDDM.

RESEARCH DESIGN AND METHODS

Proinsulin and insulin were evaluated at diagnosis of diabetes and 3 years later (fasting and after stimulation with intravenous glucose and glucagon) in 10 NIDDM patients without islet cell antibodies (ICAs) at diagnosis (age 52 ± 4 years), 11 NIDDM patients with ICAs at diagnosis (age 50 ± 5 years), and 21 healthy control subjects (age 53 ± 4 years).

RESULTS

At diagnosis, fasting proinsulin was higher in NIDDM patients without ICAs than in control subjects (39.6 ± 10.0 vs. 12.8 ± 1.6 pmol/l, P < 0.01). Proinsulin response to intravenous glucose decreased in NIDDM patients with ICAs (from 35.6 ± 6.2 to 13.5 ± 5.4 pmol/l, P < 0.05), but remained unchanged in those without ICAs. At 3 years after diagnosis, fasting proinsulin (10.0 ± 3.7 vs. 59.1 ± 17.0 pmol/l) and proinsulin responses to intravenous glucose (13.5 ± 5.4 vs. 103.9 ± 35.1 pmol/l) and to intravenous glucagon (7.4 ± 3.9 vs. 36.0 ± 7.7 pmol/l) were much lower (P < 0.01) in NIDDM patients with ICAs than in those without ICAs.

CONCLUSIONS

After diagnosis of diabetes, proinsulin secretion decreases significantly in NIDDM patients with ICAs and remains constant in those without.
Cardiovascular Disease and Its Risk Factors in IDDM in Europe
Authors: Koivisto V A , Stevens I K , Mattock M , Ebeling P , Muggeo M , Stephenson J , Idzior-Walus B ,   The EURODIAB IDDM Complications Study Group
Published: March 2007

OBJECTIVE

To study the prevalence of cardiovascular disease (CVD), its risk factors, and their associations in IDDM patients in different European countries.

RESEARCH DESIGN AND METHODS

The prevalence of CVD (a past history or electrocardiogram abnormalities) and its risk factors were examined in a cross-sectional study in 3,250 IDDM patients from 16 European countries (EURODIAB IDDM Complications Study). The patients were examined in 31 centers and were stratified between centers for age, sex, and duration of diabetes. The mean ± SD duration of diabetes was 14.7 ± 9.3 years.

RESULTS

The prevalence of CVD was 9% in men and 10% in women. The prevalence increased with age (from 6% in patients 15–29 years old to 25% in patients 45–59 years old) and with duration of diabetes. The between-center variation for the whole population was from 3 to 19%. In both sexes, fasting triglyceride concentration was higher and HDL cholesterol lower in those patients with CVD than in those without. In men, duration of diabetes was longer, waist-to-hip ratio greater, and hypertension more common in patients with CVD. In women, a greater BMI was associated with increased prevalence of CVD. There was no association between insulin dose, HbA1c level, age-adjusted rate of albumin excretion, or smoking status and CVD. Waist-to-hip ratio, particularly in men, was positively associated with age, age-adjusted HbA1c, prevalence of smoking, daily insulin dose, albumin excretion rate, and fasting triglyceride concentrations.

CONCLUSIONS

The overall prevalence of CVD in these IDDM patients was ∼ 10%, increasing with age and duration of diabetes and with a sixfold variation between different European centers. CVD prevalence was most strongly associated with elevated triglyceride and decreased HDL cholesterol concentrations. CVD was also associated with albuminuria, but when adjusted by age, this association vanished. Increasing waist-to-hip ratio was associated with a number of adverse characteristics, particularly in IDDM men, reflecting the metabolic syndrome previously described in other populations.
Mortality and Morbidity in Diabetic and Nondiabetic Patients During a 2-Year Period After Coronary Artery Bypass Grafting
Authors: Herlitz Johan , Wognsen Gunnar Brandrup , Emanuelsson Håkan , Haglid Maria , Karlson Björn W , Karlsson Thomas , Albertsson Per , Westberg Staffan
Published: March 2007

OBJECTIVE

To describe mortality and morbidity during a 2-year period after coronary artery bypass grafting (CABG) among diabetic and nondiabetic patients.

RESEARCH DESIGN AND METHODS

All the patients in western Sweden in whom CABG was undertaken between June 1988 and June 1991 and in whom concomitant procedures were not performed were registered prospectively. The study was a prospective follow-up.

RESULTS

Diabetic patients (n = 268) differed from nondiabetic patients (n = 1,859) in that more women were included, and the patients more frequently had a previous history of myocardial infarction (MI), hypertension, congestive heart failure, intermittent claudication, and obesity. Diabetic patients more frequently required reoperation and had a higher incidence of peri- and postoperative neurological complications. Mortality during the 30 days after CABG was 6.7% in diabetic patients versus 3.0% in nondiabetic patients (P < 0.01). Mortality between day 30 and 2 years was 7.8 and 3.6%, respectively (P < 0.01). During 2 years of follow-up, a history of diabetes appeared to be a significant independent predictor of death. Whereas the development of MI after discharge from the hospital did not significantly differ between the two groups; 6.3% of diabetic patients developed stroke versus 2.5% in nondiabetic patients (P < 0.001).

CONCLUSIONS

Diabetic patients have a mortality rate during the 2-year period after CABG that is about twice that of nondiabetic patients during both the early and late phase after the operation.
A Foot Risk Classification System to Predict Diabetic Amputation in Pima Indians
Authors: Mayfield Jennifer A , Reiber Gayle E , Nelson Robert G , Greene Tom
Published: March 2007

OBJECTIVE

To quantify the contribution of various risk factors to the risk of amputation in diabetic patients and to develop a foot risk scoring system based on clinical data.

RESEARCH DESIGN AND METHODS

A population case-control study was undertaken. Eligible subjects were 1) 25-85 years of age, 2) diabetic, 3) 50% or more Pima or Tohono O'odham Indian, 4) lived in the Gila River Indian Community, and 5) had had at least one National Institutes of Health research examination. Case patients had had an incident lower extremity amputation between 1983 and 1992; control subjects had no amputation by 1992. Medical records were reviewed to determine risk conditions and health status before the pivotal event that led to the amputation.

RESULTS

Sixty-one people with amputations were identified and compared with 183 control subjects. Men were more likely to suffer amputation than women (odds ratio [OR] 6.5, 95% CI 2.6–15), and people with diabetic eye, renal, or cardiovascular disease were more likely to undergo amputation than those without (OR 4.6, 95% CI 1.7–12). The risk of amputation was almost equally associated with these foot risk factors: peripheral neuropathy, peripheral vascular disease, bony deformities, and a history of foot ulcers. After controlling for demographic differences and diabetes severity, the ORs for amputation with one foot risk factor was 2.1 (95% CI 1.4–3.3), with two risk factors, 4.5 (95% CI 2.9–6.9), and with three or four risk factors, 9.7 (95% CI 6.3–14.8).

CONCLUSIONS

Male Sex, end-organ complications of eye, heart, and kidney, and poor glucose control were associated with a higher amputation rate. Peripheral neuropathy, peripheral vascular disease, deformity, and a prior ulcer were similarly equally associated with an increased risk of lower extremity amputation.
Impaired Peripheral Vasomotion in Diabetes
Authors: Stansberry Kevin B , Shapiro Shane A , Hill Michael A , McNitt Patricia M , Meyer Martin D , Vinik Aaron I
Published: March 2007

OBJECTIVE

To test the hypothesis that vasomotion, the rhythmic contraction exhibited by small arteries and arterioles, is impaired in diabetic subjects compared with healthy control subjects.

RESEARCH DESIGN AND METHODS

We mathematically modeled the oscillations in laser Doppler microvascular measurements taken from the pulpar surface of the index finger in 20 healthy control subjects and 20 age-matched diabetic subjects (8 with type I and 12 with type II diabetes). The mean duration of diabetes was 17.1 ± 2.3 years, and mean HbA1c was 9.1 ± 0.4%. Blood flow was measured for 5 min as subjects rested quietly in a closed room. Fast Fourier transformation was performed to provide the frequency power spectrum of each recording. Amplitude of vasomotion was correlated with six quantitative measurements of neuropathy.

RESULTS

Diabetic subjects had impaired low-frequency oscillation vasomotion in 75% of age-matched patients (15 of 20 patients), with mean amplitudes of 24.9 ± 6.4 vs. 129.0 ± 33.2 (P < 0.0039). Of six somatic and autonomic neuropathy variables, only the warm thermal sensory threshold correlated significantly with the mean amplitude of vasomotion (r = −0.75, P < 0.0009).

CONCLUSIONS

Patterns of peripheral vasomotion are clearly disordered in diabetes. The loss of low-frequency oscillations observed here suggests a peripheral vascular abnormality that extends past the capillary network to arterial vessels. It is uncertain whether the accompanying small unmyelinated nerve C-fiber dysfunction is a cause or consequence of the impaired microvascular function. Measurement of vasomotion may prove useful as a novel test for peripheral neurovascular function.
Pain Intensity and Blood Pressure Reactions During a Cold Pressor Test in IDDM Patients
Authors: Luft Dieter , Lay Andreas , Benda Norbert , Kort Christine , Hofmann Valerie , Hardin Hedwig , Renn Walter
Published: March 2007

OBJECTIVE

To determine the contribution of altered pain perception to the impaired blood pressure reactions during a cold pressor test in diabetic patients. Reduced blood pressure increases have been observed in diabetic patients during a cold pressor test and have been attributed to an impaired efferent sympathetic function.

RESEARCH DESIGN AND METHODS

We investigated pain intensities and blood pressure reactions simultaneously during a cold pressor test in 30 IDDM patients (diabetes duration 12 ± 6 years, HbA1c 7.5 ± 1.4%) and in 30 normal control subjects with comparable sex distribution, age, height, BMI, physical fitness, and smoking habits.

RESULTS

Initial pain intensities and respective time courses did not differ between the two groups. The initial blood pressure response was significantly smaller in diabetic patients (P < 0.002). Correlations of diastolic blood pressure increases in diabetic patients with initial pain intensity, standard cardiovascular reflex tests, age, clock time, smoking habits, disease duration, and actual blood glucose concentrations did not reach statistical significance. Pain intensity and diastolic blood pressure increases, however, were correlated to HbA1c concentrations in diabetic patients.

CONCLUSIONS

Impaired pain perception is not the cause of the impaired reactions of blood pressure in diabetic patients during the cold pressor test, leaving very early deterioration of either cerebral processing of pain stimuli, cardiac function, efferent sympathetic nerves, or decreased vascular reactivity as possible explanations.
Diet After Pancreas Transplantation
Authors: Markowski Dawn M , Larsen Jennifer L , McElligott Maxine C , Walter Georgia A , Miller Suzanne A , Frisbie Kecia , Stratta Robert J
Published: March 2007

OBJECTIVE

To determine whether discontinuation of insulin therapy and glucose monitoring and instructions to increase dietary salt and water intake after pancreas transplantation (PTX) resulted in changes in food choices.

RESEARCH DESIGN AND METHODS

All PTX recipients who had completed a preoperative diet record, had received their PTX > 6 months before, had stable pancreas and kidney function, and were on a stable diet were invited to submit a 3-day post-PTX diet record. Of the 14 eligible, 11 agreed to participate and completed the study (2 women and 9 men). Their pre- and post-PTX diet records were analyzed by computer program. Weight, glycohemoglobin, blood pressure, medications, and fasting lipids both before and after PTX were also analyzed.

RESULTS

The recipients were studied 576 ± 60 days post-PTX, on average. Total calories and BMI were unchanged after PTX. Before PTX, 34% of calories were in fats, 49% in carbohydrate, and 17% in protein with no change in distribution of calories after PTX, although there was a trend toward greater saturated fat intake. Total salt intake was increased after PTX (P < 0.01) because of sodium bicarbonate administration, although dietary salt intake did not change. The HDL cholesterol concentration increased and cholesterol-to-HDL ratio decreased after PTX (P < 0.05), while the remaining lipids were unchanged.

CONCLUSION

Weight, total calories and distribution of calories, and dietary salt were unchanged after PTX, and diet did not explain the changes in HDL cholesterol or cholesterol-to-HDL ratio. These preliminary diet results suggest that greater emphasis on dietary instruction may be needed after PTX.
Diabetes With the 3243 Mitochondrial tRNALeu(UUR) Mutation: Characteristic neuroimaging findings
Authors: Suzuki Yoshihiko , Hata Takashi , Miyaoka Hitoshi , Atsumi Yoshito , Kadowaki Hiroko , Taniyama Matsuo , Kadowaki Takasi , Odawara Masato , Tanaka Yasushi , Asahina Takayuki , Matsuoka Kempei
Published: March 2007

OBJECTIVE

To investigate the basis of central nervous system dysfunction in diabetes associated with the 3243 mitochondrial tRNA mutation, we studied neuroimaging findings in patients with this disease.

RESEARCH DESIGN AND METHODS

We screened 205 diabetic patients. Those patients who had the 3243 mutation in leukocytes or muscle were enrolled. All the subjects underwent computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and N-isopropyl-p-[123I]iodoamphetamine ([123I]IMP) single-photon emission computed tomography (SPECT) of the brain.

RESULTS

None of the nine subjects with the 3243 mutation had the typical clinical picture of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes, and none had neurological focal signs. CT or MRI revealed diffuse brain atrophy in three patients (33%) and cerebellar atrophy in one (11%). Abnormal high intensity areas were observed on MRI in five patients (56%). The overall prevalence of brain abnormalities was 56% (5 of 9) on CT and 78% (7 of 9) on MRI scans. MRA revealed no stenotic lesions. SPECT showed reduced accumulation of [123I]IMP in the right or left parieto-occipital region in eight patients (89%).

CONCLUSIONS

Reduced accumulation of [123I]IMP in the parieto-occipital cortex was found in a high proportion of our subjects on SPECT. This imaging finding might be characteristic of diabetes associated with the 3243 mitochondrial tRNA mutation and may be a sign of latent central nervous system dysfunction.
A Major Improvement in the Prognosis of Individuals With IDDM in the Past 30 Years in Japan
Authors: Nishimura Rimei , Matsushima Masato , Tajima Naoko , Agata Toshihiko , Shimizu Hidesuke , LaPorte Ronald E ,   The Diabetes Epidemiology Research International Study Group
Published: March 2007

OBJECTIVE

To evaluate the time trends of mortality among individuals with IDDM in Japan.

RESEARCH DESIGN AND METHODS

A historical prospective study of two independent population-based cohorts composed of individuals who were diagnosed between 1965 and 1969 (1960s cohort) and between 1975 and 1979 (1970s cohort), which included 286 IDDM patients (onset age < 18 years) for the 1960s cohort and 779 patients for the 1970s cohort, was performed. After 10 years of observation, mortality status and causes of deaths between the two cohorts were compared.

RESULTS

The age-adjusted mortality rate per 100,000 person-years of the 1960s cohort was 754 (95% CI, 471–1,141); in contrast, that of the 1970s cohort was only 196 (95% CI, 107–329) (P < 0.001). The standardized mortality ratio of the 1960s cohort was 1,432 (95% CI, 898–2,161), and that of the 1970s cohort was 489 (95% CI, 267—821). Analyses of the causes of deaths revealed a marked decline in recent years in the number of deaths by acute complications and renal disease.

CONCLUSIONS

A major decline in the mortality of diabetic children in Japan may be attributed to the dramatic changes in the quality of care and medical infrastructure that occurred after the mid-1970s.
Influence of Sample Temperature on Reflectance Photometry and Electrochemical Glucometer Measurements
Authors: Fazel Ali , Koutoubi Zaher , Sorg Timothy B , Mehrotra Bhoomi
Published: March 2007

OBJECTIVE

A study was conducted to determine the influence of sample temperature on manual reflectance photometers, automatic reflectance photometers, and electrochemical glucometers.

RESEARCH DESIGN AND METHODS

Aqueous and blood-based control solutions were tested at temperatures ranging from 25 to 44°C. With the Accu-Chek 3, One Touch, and Satellite G glucometers, multiple glucose determinations were performed on each sample.

RESULTS

The results indicate that the manual reflectance photometry glucometer is prominently influenced by variation in sample temperature. The effect of sample temperature is greatest at high glucose levels.

CONCLUSIONS

Caution may be required in the interpretation of manual reflectance photometry glucometer measurements in febrile or hypothermic diabetic patients.