bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Predictive Capabilities of Diabetic Exchange Lists and Glycemic Index of Foods
Authors: Laine Dawin C , Thomas William , Levitt Michael D , Bantle John P
Published: March 2007

To determine whether the diabetic exchange lists or the glycemic index of foods better predicts postprandial responses to carbohydrate-containing foods eaten as part of a mixed meal, three test meals were developed and fed to 12 subjects with non-insulin-dependent diabetes mellitus (NIDDM) and 13 healthy subjects. Each test meal contained exactly the same exchanges (1 milk, 4 starch, 2 fruit, 2 meat, 3 fat, 1 vegetable). In one meal, foods of high glycemic index (GI) were used, in a second meal, foods of intermediate GI were used, and in a third meal foods of low GI were used. The total GIs of the meals were: high, 184; intermediate, 131; and low, 107, thus predicting responses to intermediate and low GI, which were 71 and 58%, respectively, of the responses to high GI. Although some of the observed differences in the glycemic responses to the test meals were statistically significant, primarily in healthy subjects, the differences were usually much < predicted by the GIs of the meals. In NIDDM subjects, peak postprandial plasma glucose, plasma glucose area, plasma glucose area increment, and mean plasma glucose responses after intermediate and low GI were > 90% of the corresponding responses to high GI. In healthy subjects, only the plasma glucose area increment after the low-GI meal was close to the predicted response. High GI produced significantly greater insulin responses than low GI in healthy subjects. We conclude that the diabetic exchange lists more accurately predict postprandial responses to carbohydrate-containing foods eaten as part of a mixed meal than does the GI of foods. Moreover, our data suggest that the responses of healthy subjects to test meals do not accurately predict the responses of NIDDM subjects.
Spectrum of Proteinuria in Type I and Type II Diabetes
Authors: Jerums George , Cooper Mark E , Seeman Ego , Murray Robin M L , McNeil John J
Published: March 2007

We prospectively investigated the evolution of proteinuria in 52 type I diabetics over 7.8 ± 0.3 (mean ± SE) yr and in 61 type II diabetics over 6.4 ± 0.3 yr. Measurements of renal protein clearance were performed serially, and the time course of proteinuria was classified in each subject based on a threshold albumin clearance of 11 nl/s, equivalent to a urinary albumin excretion rate of 30 μg/min. The classification based on this threshold yielded four distinct patterns of albuminuria: minimal, intermittent, progressing, and established. These patterns occurred in both type I and type II diabetics independently of the duration of follow-up. This study has identified a pattern of intermittent microalbuminuria that is also associated with transient elevations of transferrin and IgG clearances.

The relationship of clinical and biochemical parameters to proteinuria patterns was evaluated. No relationship was detected between proteinuria patterns and glycemic control in either type I or type II diabetics. In type I but not type II diabetics, established proteinuria was associated with higher systolic blood pressure and decreased creatinine clearance.

The phase of intermittent proteinuria detected in this study may represent a reversible stage in the development of diabetic nephropathy, but the factors that trigger the transition to progressing proteinuria remain obscure.
Correlations Between Fasting Plasma C-Peptide, Glucagon-Stimulated Plasma C-Peptide, and Urinary C-Peptide in Insulin-Treated Diabetics
Authors: Gjessing Hans J , Matzen Lars E , Frøland Anders , Faber Ole K
Published: March 2007

This study correlated fasting plasma C-peptide (CP), plasma CP 6 min after stimulation with 1 mg glucagon i.v., and the mean of three 24-h urinary excretions of C-peptide (UCP)/creatinine in 132 insulin-treated diabetics. Patients were divided into three groups: group 1, stimulated CP < 0.06 nM (n = 51); group 2, stimulated CP 0.067−0.60 nM (n = 48); and group 3, stimulated CP > 0.60 nM (n = 33). In all patients fasting CP was closely correlated to stimulated CP (r = .988, P < .001), whereas the correlations between UCP and both fasting CP (r = .904, P < .001) and stimulated CP r = .902, P < .001) were slightly less pronounced. The associations between UCP and both fasting CP (r = .716, P < .001) and stimulated CP (r = .731, P < .001) were modest in group 2, and even more so in group 3 (r = .557, P < .001 and r = .641, P < .001, respectively). In conclusion, fasting CP is closely correlated to glucagon-stimulated CP in insulin-treated diabetics and can probably be used equally well in the assessment of β-cell function. The associations between UCP and both fasting and glucagon-stimulated CP are less pronounced, especially in patients with well-preserved β-cell function.
Different Body-Fat Distributions in IDDM and NIDDM
Authors: Lev-Ran Arye , Hill L Robert
Published: March 2007

Stepwise logistic regression was used for the analysis of the following anthropometric parameters in 146 adult patients with diabetes: waist/hips ratio, waist/thighs ratio, ratio of the arms-to-thighs circumferences, and ratio of the subscapular-to-triceps skinfolds. After adjustment for age and body mass index, only the waist/thighs ratio was found to have an independent discriminating value between insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetic patients. The correlation of type of diabetes with the waist/thighs ratio was especially strong in women, exceeding even the role of age and body mass index. Other anthropometric parameters were related to type of diabetes through their correlation with waist/thighs ratio and had no independent discriminating value. The study shows that IDDM and NIDDM belong to different anthropometric types, which probably reflects their different pathogenesis.
Is Aspirin Use Associated With Lower Rates of Cataracts in Diabetic Individuals?
Authors: Klein Barbara E K , Klein Ronald , Moss Scot E
Published: March 2007

The relationship between a history of aspirin use and cataracts in diabetic individuals is examined in this report from a population-based study of 1370 individuals who developed diabetes after 30 yr of age. After pupil dilation lenses were examined for the presence and severity of nuclear sclerotic and posterior subcapsular cataracts and for surgical aphakia. A history of aspirin usage was obtained. Seven hundred eighty-four individuals had used aspirin in the month before the exam. There was no relationship between such usage and cataracts. For 338 people who reported using aspirin daily for at least 3 mo while having diabetes, there was also no association. These data suggest that aspirin usage as measured here has little effect on the prevalence of cataract in older-onset diabetic patients.
Improved Glycemic Control After Supervised 8-wk Exercise Program in Insulin-Dependent Diabetic Adolescents
Authors: Stratton Ron , Wilson Don P , Endres Robert K , Goldstein David E
Published: March 2007

Eight insulin-dependent adolescents (4 boys, 4 girls) participated in an 8-wk program of supervised exercise, and 8 matched controls were encouraged to exercise on their own without supervision. All 16 subjects were asked to follow a standard ADA diet plan, kept a self-reported log of caloric intake, and met with a dietitian weekly to review their diets. Exercise for the supervised subjects was scheduled between the routine afternoon snack and the evening meal, and subjects were asked not to consume additional food on exercise days. After the 8-wk program, glycemic control, as measured by glycosylated serum albumin and blood glucose values (but not by glycosylated hemoglobin), improved in the supervised- exercise group despite reduced daily insulin dosage. Cardiorespiratory fitness, as measured by voluntary maximum treadmill time (Bruce protocol) and submaximal exercise heart rates, also improved. No changes were observed in the unsupervised control group.
Influence of Height on Quantitative Sensory, Nerve-Conduction, and Clinical Indices of Diabetic Peripheral Neuropathy
Authors: Gadia Maria T , Natori Norihiko , Ramos Laura B , Ayyar D Ram , Skyler Jay S , Sosenko Jay M
Published: March 2007

We have examined associations between height and quantitative sensory, nerve-conduction, and clinical indices of diabetic peripheral neuropathy in adult diabetic patients. Vibratory sensitivity was strongly related to height when measurements were made with either the vibration sensitivity tester (P = .02) or the biothesiometer (P < .01); however, there was no relation between thermal sensitivity (as measured with the thermal sensitivity tester) and height. The peroneal and posterior tibial motor nerve - conduction velocities were inversely related to height (P < .05 for both). When age and diabetes duration were included as variables in multiple regression analyses, the associations with height became stronger. Clinical indices of peripheral neuropathy were also related to height in these analyses. Glycosylated hemoglobin was significantly related to thermal sensitivity and the peroneal and posterior tibial motor nerve-conduction velocities but not to vibratory sensitivity. These data indicate that height has a marked influence on quantitative sensory, nerve-conduction, and clinical indices of diabetic peripheral neuropathy.
Reduction in Cardiovascular Risk Factors With Intensive Diabetes Treatment in Insulin-Dependent Diabetes Mellitus
Authors: Rosenstock Julio , Strowig Suzanne , Cercone Susan , Raskin Philip
Published: March 2007

We measured plasma lipid and lipoprotein levels at baseline and at 6-mo intervals in 47 normolipidemic patients with classic insulin-dependent diabetes mellitus treated either with a conventional (n = 21) or intensive (n = 26) diabetes-treatment program. Patients were followed for a mean of 3 yr (range 1–4 yr). Intensive diabetes treatment resulted in a significant improvement in glycemic control that caused sustained changes in plasma lipid and lipoprotein levels that were not evident with the conventional- treatment program. These changes, which persisted for periods averaging 3 yr, can potentially reduce predicted risk for the development of premature atherosclerosis. Thus, long-term near normoglycemia may have a role in the prevention of atherosclerosis in insulin-dependent diabetic patients.
Effect of Pregnancy on Autonomic Nervous Function and Heart Rate in Diabetic and Nondiabetic Women
Authors: Airaksinen K E Juhani , Salmela Pasi I , Ikäheimo Markku J , Kirkinen Pertti , Linnaluoto Markku K , Takkunen Juha T
Published: March 2007

Supine and standing heart rate and heart rate responses to deep breathing and standing up (the 30-to-15 ratio), indices of autonomic nervous function, were measured during each trimester and postpartum in 25 women with insulin-dependent diabetes and 10 nondiabetic women. The groups did not differ with respect to autonomic function in the basal state (postpartum), and the heart rate response to deep breathing diminished progressively in both groups during pregnancy, although the change tended to be less pronounced in the diabetic women. The 30-to-15 ratio did not alter significantly during pregnancy. The diabetic women had a higher supine heart rate than the healthy women in the basal state, but the pregnancy-induced increase in heart rate was less in the diabetic women. Thus, the reversible diminution of heart rate response to deep breathing during pregnancy is a physiological finding and does not denote development of autonomic nervous dysfunction. Second, the increase in heart rate, a primary cardiovascular adjustment to pregnancy, seems to be blunted in diabetic women.
Factors Affecting Interpretation of Postprandial Glucose and Insulin Areas
Authors: Gannon Mary C , Nuttall Frank Q
Published: March 2007

Recently there has been an increased interest in determining the circulating glucose concentration after the ingestion of various individual foods and mixed meals. The purpose of these determinations is to systematically rank foods with respect to their quantitative effect on postmeal glucose concentration. Potentially such data could be useful in designing a diet for individuals with diabetes. We believe this concept is good. However, several factors that may affect interpretation of the data used to develop this ranking need to be considered before the utility of this approach to dietary management can be assessed: 1) duration of time over which the data are collected and analyzed; 2) use of absolute versus incremental areas in the determinations; 3) inclusion or exclusion of negative areas if incremental areas are used; 4) differences in response to a given food in males compared with females; 5) severity of diabetes; 6) confounding effects of oral agents or insulin treatment; 7) reproducibility of data; 8) differences in collection of blood sample; 9) food composition, processing, and preparation; 10) the dose-response relationship to ingestion of a given carbohydrate; 11) the meal being studied, i.e., first, second, or third meal of the day; and 12) a possible effect of the composition of the previous meal, if the response is tested to any meal other than the first meal of the day.
Combined Effect of Exercise and Ambient Temperature on Insulin Absorption and Postprandial Glycemia in Type I Patients
Authors: Rönnemaa Tapani , Koivisto Veikko A
Published: March 2007

We studied the combined effect of cool (10°C) and warm (30°C) ambient temperatures and physical exercise on insulin absorption and postprandial glycemia. Nine type I (insulin-dependent) diabetic patients were injected subcutaneously with their usual morning dose of shortand intermediate-acting human insulin and were given breakfast. Warm temperature was associated with 3- to 5-fold higher insulin absorption (P < .01) and significantly lower blood glucose concentration (P < .001) than cool temperature regardless of exercise. Exercise was associated with 28% (P < .01) and 22% (P < .05) increases in plasma insulin and maximally 5.7 mM (P < .025) and 7.1 mM (P < .01) lower blood glucose at cool and warm temperatures, respectively. Warm temperature and exercise had an additive effect in stimulating insulin absorption and in lowering blood glucose concentrations. However, there was no evidence of synergism between higher temperature and exercise in increasing free-insulin concentrations or decreasing blood glucose concentrations. To avoid postprandial hyperglycemia at cool temperature or hypoglycemia after exercise at warm temperature, appropriate adjustments in diet and insulin dose, or both, should be made.
Clinical Features and Health-Care Costs of Diabetic Nephropathy
Authors: Narins Barbara E , Narins Robert G
Published: March 2007

The nephropathy complicating insulin-dependen diabetes mellitus (IDDM) has been well studied, but that complicating non-insulin-dependent diabetes mellitus (NIDDM) is less well defined. In patients with IDDM, the gl merular filtration rate is often increased early in the course of the disease, approaches normal with insulin therapy, but tends to remain slightly elevated throughout the ensuing 10–15 yr of insulin dependency. After t e onset of overt azotemia, end-stage renal disease (ESRD) develops in ∼5 yrs. Proteinuria may be intermittently positive in the earliest stages of diabetes, evolving into intermittent and then persistent mincroalbuminura, which in turn blossoms into mincroalbuminura. Because 40–50% of IDDM patients develop proteinuria and two thirds of this subpopulation develop ESRD, some 20–30% of any given cohort of IDDM patients eventually need dialysis or transplantation. Evidence indicates that diabetic nephropathy is associated with a greater incidence of eye, nerve, heart, and peripheral vascular disease. Nondiabetic renal disease complicating IDDM and NIDDM is associated with a lesser frequency and severity of these extrarenal manifestations, the prevalence of retin pathy increases with advancing nephropathy. Roughly two-thirds of the deaths from IDDM are related to renal f ilure, and most of the remainder are caused by associated cardiovascular disease. Transplantation from living relatives carries the best prognosis for survival, and little difference is seen between hemodialysis, peritoneal dialysis, and cadaver transplantation. The health-care costs of treating diabetic nephropathy are also reviewed.
Fructosamine Concentrations in General Population of Kawerau
Authors: Baker John , Metcalf Patricia , Scragg Robert
Published: March 2007

We measured fructosamine concentrations in nonfasted serum from 7094 residents (82.8% of the estimated population) of Kawerau, New Zealand, including 65 known diabetic patients (prevalence of 0.92%). Fructosamine results showed a trimodal frequency distribution, with cutting points corresponding to 5th and 95th percentile values. Forty-two diabetic individuals had levels that exceeded the 95th percentile. These individuals had more severe metabolic abnormalities, characterized by lower plasma C-peptide and elevated fasting plasma glucose concentrations. Mean fructosamine values also showed a significant increase with age and a highly significant age-ethnic interaction that paralleled the higher frequency of diabetes in older age groups and among elderly Maori people. However, as a screening method in the general population, fructosamine measurement was diagnostically deficient because of a weak correlation with serum albumin. Arithmetic correction for albumin concentration in the sample did not increase the diagnostic usefulness of the test.
Mortality From Diabetes in Nauru: Results of 4-Yr Follow-Up
Authors: Zimmet Paul Z , Finch Caroline F , Schooneveldt Michael G , King Hilary O , Thoma Kiki
Published: March 2007

A population survey in 1982 confirmed that Nauruan adults suffer from an extremely high prevalence (24%) of non-insulin-dependent diabetes mellitus. A follow-up study of the survey subjects was conducted in 1986. The aim was to assess the burden of diabetes to Nauruans in terms of premature mortality. Age-adjusted mortality rates for diabetic subjects were significantly increased when compared with normal subjects (relative risks for 4-yr mortality were 4.53 in men, P < .01, and 3.96 in women, P < .05). Although there was an excess number of deaths among diabetic subjects compared with normal subjects and subjects with impaired glucose tolerance, there was no significant association between cause of death and diabetes.
Expected Diabetic Control in Childhood and Psychosocial Functioning in Early Adult Life
Authors: Pless Ivan B , Heller Anita , Belmonte Mimi , Zvagulis Inta
Published: March 2007

This study examined relationships between the extent to which doctors seek to achieve good (i.e., tight) diabetic control during childhood and the frequency of psychosocial problems in later life. A sample of 225 young adults with insulin-dependent diabetes mellitus was studied by use of a systematic interview. A measure of the level of control the doctor was attempting to achieve was developed from questionnaires administered to the doctors who provided most of the patient's care during childhood. The results were compared with scores on three indices of psychosocial functioning based on responses given in structured interviews with the patients. Although potentially important psychosocial problems were found for 10–20%, there was no statistically significant relationship between any of these problems and the doctors' desired levels of control. Thus, efforts to achieve good control during childhood, whether successful or not, may not be followed by psychosocial problems in later life. This finding should help support clinicians' attempts to obtain the levels of control during childhood judged to be essential in preventing serious organic complications.
Absence of Dawn Phenomenon in Normal Children and Adolescents
Authors: Marin Gabriela , Rose Susan R , Kibarian Maral , Barnes Kevin , Cassorla Fernando
Published: March 2007

The dawn phenomenon consists of a rise in plasma glucose levels or insulin requirements in the early morning. This phenomenon has been observed in normal adults and in patients with diabetes mellitus. To determine whether this phenomenon also occurs in normal children and adolescents, we evaluated plasma glucose, insulin, C-peptide, and growth hormone levels during the early morning in 31 normal children between the ages of 8 and 18 yr. Blood samples were obtained through an indwelling catheter every 20 min for growth hormone and hourly for glucose, insulin, and C-peptide from 2100 to 0900 h. Glucose levels decreased slowly overnight from 2100 to 0900 h, despite increases in growth hormone levels. No significant rise in insulin or C-peptide levels was detected in the early morning in these normal subjects. There were no signficant differences between prepubertal and pubertal children. We conclude that glucose, insulin, and C-peptide levels remain stable overnight, suggesting that the dawn phenomenon is not observed in normal children.
Rapid Development of Nephrotic Syndrome, Hypertension, and Hemolytic Anemia Early in Pregnancy in Patients With IDDM
Authors: Weinstock Ruth S , Kopecky Richard T , Jones David B , Sunderji Shiraz
Published: March 2007

In recent years, the prognosis for a successful pregnancy has greatly improved for women with insulindependent diabetes mellitus (IDDM) who are under good glycemic control and free of complications such as vascular disease and nephropathy. We report the rapid development of severe nephrotic syndrome, malignant hypertension, and microangiopathic hemolytic anemia during the first trimester of pregnancy in a 29-yr-old woman with IDDM of 18 yr duration. Our patient had no pregestational history of retinopathy or hypertension and only minimal proteinuria. Significant improvement in blood glucose levels had been achieved over the 6 mo before conception. Kidney biopsy performed before the termination of pregnancy at 10 wk gestation revealed diabetic nephropathy. No other etiology for her renal disease could be found. An arteriole was noted to have entrapped red blood cell fragments and platelet thrombi, revealing the probable source of her hemolytic process. By 8 wk postpartum, her nephrotic syndrome and hemolysis had completely resolved. At 3 mo postgestation, the patient's hypertension was still present but less severe. Her serum creatinine has continued to decrease toward normal. This is the first report of a woman with IDDM in White's classification C who developed a toxemia-like syndrome during the first trimester of pregnancy, attributable to the underlying diabetic state.
Increased Plasma Fibronectin Concentration in Diabetic Patients With Microalbuminuria
Authors: Giorgio Lamberto A De , Bartolomei Giancarlo , Gironi Alfredo , Caselli Paolo , Seghieri Giuseppe
Published: March 2007

Raised levels of plasma fibronectin (PF), an α2- glycoprotein produced by vascular endothelia, have been previously described in diabetic patients with retinopathy and overt nephropathy. The aim of this study was to investigate whether the presence of microalbuminuria is associated with increased PF concentrations. Twenty Albustix-negative diabetic outpatients with microalbuminuria [ median albumin excretion rate (AER): 30.2 μg/ min; range 12.1-194 (μ g/ min[ were compared with 58 sex- and agematched patients without microalbuminuria (median AER 3.1 μg/ min; range 0.8-12 μg/ min) and 34 control subjects (median AER 2.8 (μg/ min; range 0.8-12.1 μg/ min). Mean PF was significantly higher in the group with microalbuminuria (406.7 ± 85.5 μg/ml) than in the group without it (325.3 ± 76.5 μg/ml) or in control subjects (334.5 ± 76 μg/ml; P >.05). PF increase associated with microalbuminuria was independent of the presence of retinopathy. Futhermore, in the whole group of diabetic patients, PF was significantly correlated with AER (r = .33; P = .003). Such correlation also remained significant (P = .0002) after covariance analysis by a stepwise discriminant procedure taking into account age, duration of disease, sex, blood pressure, body weight, therapy, and HbA,. In conclusion, PF increase is associated with microalbuminuria independent of the other considered variables; its role as a possible marker for early diabetic nephropathy remains to be fully clarified.
Lower-Extremity Amputation in People With Diabetes: Epidemiology and Prevention
Authors: Bild Diane E , Selby Joseph V , Sinnock Pomeroy , Browner Warren S , Braveman Paula , Showstack Jonathon A
Published: March 2007

The age-adjusted rate of lower-extremity amputation (LEA) in the diabetic population is ∼15 times that of the nondiabetic population. Over 50,000 LEAs were performed on individuals with diabetes in the United States in 1985. Among individuals with diabetes, peripheral neuropathy and peripheral vascular disease (PVD) are major predisposing factors for LEA. Lack of adequate foot care and infection are additional risk factors. Several large clinical centers have experienced a 44–85% reduction in the rate of amputations among individuals with diabetes after the implementation of improved foot-careprograms. Programs to reduce amputations among people with diabetes in primarycare settings should identify those at high risk; clinically evaluate individuals to determine specific risk status; ensure appropriate preventive therapy, treatment for foot problems, and follow-up; provide patient education;and, when necessary, refer patients to specialists, including health-care professionals for diagnostic and therapeutic interventions and shoe fitters for proper footwear. Programs should monitor and evaluate their activities andoutcomes. Many issues related to the etiology and prevention of LEAs requirefurther research.
Diabetes Complications and Glycemk Control: The Pittsburgh Prospective Insulin-Dependent Diabetes Cohort Study Status Report After 5 yr of IDDM
Authors: D'Antonio Joyce A , Ellis Demetrius , Doft Bernard H , Becker Dorothy J , Drash Allan L , Kuller Lewis H , Orchard Trevor J
Published: March 2007

The relationship between glycemic control and complications of insulin-dependent diabetes mellitus (IDDM) remains controversial. With the use of glycosylated hemoglobin (HbA,) to assess glycemic control from diagnosis onward, the Pittsburgh Prospective Insulin-Dependent Diabetes Mellitus Cohort Study prospectively evaluated 80 new cases of IDDM diagnosed at Children's Hospital of Pittsburgh. This study presents findings in 62 patients at 5 yr postdiagnosis. Only 7 patients, all girls, had any retinopathy (microaneurysms). These subjects had an elevated 5-yr mean HbA1 compared to those with no retinopathy (13.0 vs. 11.7%; P < .05). Six female subjects who had an elevated albumin excretion rate (AER; >20 μg/min) had a higher 5-yr mean HbA, (13.3%) than the 26 subjects with AER <20 |xg/min (11.8%; P < .05). Current HbA1 was correlated with AER (r = +.36, P < .05) and systolic blood pressure (r = +.49, P < .01) in females. However, these associations were not observed in males. Positive correlations were found between HbA1 (5-yr mean and current) and serum triglyceride and cholesterol, but only in females was HbA1 inversely related to high-density lipoprotein cholesterol. However, HbA1 was independent of sex, HLA-DR type, and urine C-peptide status. Age adjustment did not change the above results. These analyses suggest that glycemic control is related to AER, systolic blood pressure, presence of microaneurysms, and serum triglyceride and cholesterol concentrations during the first 5 yr of IDDM. However, these associations appear to be predominant in girls.
Longitudinal Relationship of Asymptomatic Hypoglycemia to Cognitive Function in IDDM
Authors: Golden Michael P , Ingersoll Gary M , Brack Catherine J , Russell Barbara A , Wright James C , Huberty Thomas J
Published: March 2007

Early-onset insulin-dependent diabetes mellitus (IDDM) is linked to subsequent learning deficits. To investigate the relationship of learning deficits to metabolic control, 23 children with IDDM (age at testing 71 ± 21 mo, age at diagnosis 35 ± 15 mo) diagnosed before 5 yr of age were followed for periods of 6–78 mo. Mean glycosylated hemoglobin (HbA,), episodes of severe hypoglycemia, and frequency of self-monitoring blood glucose (SMBG) measurements <2.8 mM (50 mg/dl, asymptomatic hypoglycemia) were recorded every 3 mo. Six subjects entered the study 12.3 ± 6.7 mo after diagnosis, and only severe hypoglycemia was present before entry. For the remaining 17 subjects, HbA, and severe and asymptomatic hypoglycemia were present from the time of diagnosis of diabetes. Mean HbA, level was 10.1 ± 1.0%, and mean severe hypoglycemic episodes per patient was 2.9, but the frequency was highly skewed; one patient had 37 episodes, and 14 had none. The mean percentage of SMBG readings <2.8 mM was 2.4 ± 2.1. On the revised Stanford-Binet Intelligence Scale there was no correlation between any subscale and severe hypoglycemia. However, the relative frequency of asymptomatic hypoglycemia correlated with scores on the abstract/visual reasoning scale (r = –.39, P = .037). This relationship was primarily accounted for by the relationship of asymptomatic hypoglycemia to performance on the copying subscale (r = –.42, P = .022). Children with frequent asymptomatic hypoglycemic episodes had lower mean copying scores and abstract reasoning scores than those with infrequent episodes. These findings are consistent with those of previous crosssectional studies of early-onset IDDM and extend previous results by suggesting that hypoglycemia, even if mild or asymptomatic, may be related to the neuropsychological changes previously described.
Taste Impairment and Related Factors in Type I Diabetes Mellitus
Authors: Le Floch Jean-Pierre , Le Lievre Gilles , Sadoun Jacky , Perlemuter Léon , Peynegre Roger , Hazard Jean
Published: March 2007

To study taste in type I (insulin-dependent) diabetes mellitus, 57 consecutive diabetic outpatients (mean ± SE duration of diabetes 11.4 ± 0.4 yr) and 38 control subjects were screened for taste disorders with electrogustometry and chemical gustometry. Both groups were comparable for all subject characteristics except body mass index, which was higher in the diabetic group (P < .05). A taste impairment was found in the diabetic group relative to the control group with electrogustometry (mean threshold 184.3 ± 15.8 vs. 58.7 ± 9.2 μA; P < .001) and chemical gustometry (mean score 13.2 ± 0.7 vs. 17.1 ± 0.8; P < .001). Hypogeusia was found among 73% of the diabetic patients versus 16% of the control subjects (P < .001). The four primary tastes were involved in taste impairment. With multivariate analysis, taste disorders were related to diabetic status and tobacco and alcohol consumption. In the diabetic group, taste impairment was significantly associated with complications and duration of disease. With multivariate analysis, peripheral neuropathy had the strongest association with taste disorders. These results suggest that taste is impaired during the course of type I diabetes mellitus and that taste impairment could be a complication of the disease. A mechanism of the neuropathic type could be involved.
Fundus Polaroid Screening for Diabetic Retinopathy: Is One Print per Patient Enough?
Authors: Chantelau Ernst , Zwecker Manuel , Weiss Hartmut , Kluxen Guido , Berger Michael
Published: March 2007

The CR3-45 NM Canon nonmydriatic fundus camera detects relevant diabetic retinopathy with high sensitivity. To determine whether examination of one eye per patient would suffice for screening purposes, 473 pairs of standard 45° fundus Polaroid prints obtained with the Canon camera were assessed from 167 patients with and 306 without diabetic retinopathy. On the basis of considering only one eye per patient, absence of retinopathy would have been diagnosed in 336 patients, with 9% of the diagnoses false negative. One hundred thirty-seven of the 167 patients with retinopathy in at least one eye would have been diagnosed correctly by considering one eye per patient (sensitivity 82%, specificity 100%). Thus, a standard 45 degree fundus Polaroid print from one eye per patient may suffice for screening purposes if the picture is free from diabetic abnormalities. Otherwise, both eyes should be examined immediately, and the patient should be referred to an expert ophthalmologist who specializes in diabetic retinopathy for confirmation of the diagnosis and staging of diabetic retinopathy status.
Lipoproteins and Apolipoproteins in Young Nonobese Arab Women With NIDDM Treated With Insulin
Authors: Al-Muhtaseb Najah , Al-Yusuf Abdul R , Abdella Nabila , Fenech Frederick
Published: March 2007

The effects of insulin on the lipid values of nonobese non-insulin-dependent diabetic (NIDDM) Arab women requiring insulin was investigated to find whether these patients have the same coronary artery risk factor related to lipid levels. In this study, 55 NIDDM women on insulin therapy (mean age 28 ± 8.1 yr and duration of disease 5 ± 1.2 yr) and 70 control subjects (matched for sex, age, and body mass index) were studied for their plasma levels of lipids, lipoproteins, and apolipoproteins. Concentrations of total cholesterol, very-low-density lipoprotein cholesterol, low-density lipoprotein (LDL) cholesterol, triglyceride (TG), LDL TG, high-density lipoprotein triglyceride (HDL TG), phospholipid, glucose, glycosylated hemoglobin (HbA1c), apolipoprotein B (apoB), LDL-apoB, and apoB/apoAl were significantly elevated in diabetic women compared with control subjects. There was no significant change in the levels of apoAll in plasma and lipoprotein fractions. Concentrations of HDL cholesterol (chol), HDL2-chol, HDL3-chol, plasma apoAl, HDL2-apoAI, HDL3-apoAl, and HDL-apoAl were significantly lower in diabetic women than in control subjects. There was no significant correlation between glucose or HbA1c and most of the lipids, lipoprotein lipids, and apolipoproteins measured. Despite normal body weight and insulin therapy, abnormalities in lipids, lipoprotein lipids, and apoB persisted in NIDDM patients compared with control subjects. Our data may favor an enhanced affinity toward atherosclerosis in these patients.
Prognostic Value of Systolic Ankle and Toe Blood Pressure Levels in Outcome of Diabetic Foot Ulcer
Authors: Apelqvist Jan , Castenfors Jan , Larsson Jan , Stenström Anders , Agardh Carl-David
Published: March 2007

The prognostic value of distal blood pressure measurements has been studied in 314 consecutive diabetic patients with foot ulcers. Systolic toe blood pressure was measured with a strain-gauge technique, and ankle pressure was measured with strain-gauge or Doppler techniques. Wound healing was defined as intact skin for at least 6 mo. One hundred ninety-seven patients healed primarily, 77 had amputations, and 40 died before healing had occurred. In 294 of 300 patients, it was possible to measure either ankle or toe pressure. Fourteen patients were not available for pressure measurements. Of these, 10 patients healed primarily, and 4 died before healing occurred. Both ankle and toe pressures were higher (P < .001) among patients who healed without amputation compared with those who underwent amputation or died before healing. No differences were seen in ankle or toe pressure levels among those who had amputations or died. No patient healed primarily with an ankle pressure < 40 mmHg. An upper limit above which amputation was not required could not be defined. Primary healing was achieved in 139 of 164 patients (85%) with a toe pressure level >45 mmHg, whereas 43 of 117 patients (36%; P < .001) healed without amputation when toe pressure was ≤45 mmHg. In conclusion, a combination of ankle and toe pressure measurements is a useful tool to predict primary healing in diabetic foot ulcers.
Effects of Combined Insulin-Sulfonylurea Therapy in type II Patients
Authors: Lewitt Moira S , Yu Vincent KF , Rennie George C , Carter John N , Marel Geoffrey M , Yue Dennis KS , Hooper Michael J
Published: March 2007

We conducted a double-blind crossover study to determine which patient characteristics best predict a beneficial response to combined insulin-glyburide therapy. Glyburide (15 mg/day) or placebo was added to the treatment regimen of 31 insulin-treated type II (non-insulin-dependent) diabetic subjects. During glyburide therapy, there was a significant improvement in glycemic control with a reduction in glycosylated hemoglobin from 9.9 ± 1.3 to 9.1 ± 1.3% (P < .001). Patients who responded had higher fasting C-peptide levels (P < .001) and shorter durations of insulin therapy (P < .01) than those who did not respond. Glyburide withdrawal was associated with a > expected deterioration in glycemic control. Patients on insulin therapy for > 8 yr are unlikely to benefit significantly from the addition of glyburide to their treatment regimen.
Effect of Age on Systemic Delivery of Oral Glucose in Men
Authors: Tonino Richard P , Minaker Kenneth L , Rowe John W
Published: March 2007

This study examined the effect of age on the posthepatic delivery of oral glucose (PHDG) during steady-state conditions. We used an intravenous-oral modification of the euglycemic insulin-clamp technique to assess PHDG in six men aged 24–39 yr (young) and eight men aged 65–83 yr (old). Each subject underwent two studies in which insulin was infused at 120 mU.m−2 · min−1 for 3 h, and either oral glucose (45 g) or water was given 60 min after initiating insulin. This level of insulin infusion is known to fully suppress hepatic glucose output. For each subject, PHDG was calculated as the difference between the whole-body glucose disposal rates in the paired studies. The time course of PHDG differed in the two groups (P < .0001), with an overall delay in PHDG in the older men. During the 1st h, younger men showed a greater PHDG (58.6 ± 3.8% of the oral load vs. 45.1 ± 4.2%) than the older group (P = .04). During the 2nd h, PHDG was less in the younger group (20.7 ± 4.9%) than the older group (36.6 ± 3.9%, P = .02). Over the 2-h period, total PHDG was comparable in younger (79.3 ± 7.4%) and older (81.7 ± 7.9%) men. These results indicate that normal aging is associated with significantly delayed but overall equal PHDG in men, consistent with the greater effect of age on 2-h rather than earlier postprandial glucose levels. It reinforces the role of impaired peripheral utilization as the primary mechanism of the glucose intolerance of aging.
Toward a hybrid Artificial Pancreas
Authors: Friedman Eli A
Published: March 2007

Management of insulinopenic diabetic individuals centers on administration of insulin by means of multiple injections, a wearable or implantable insulin-infusion pump, or a whole-organ or segmental-pancreas transplant. Preliminary trials indicate that surgical implantation of a hybrid device containing living insulin-secreting tissue may function as a combined glucose sensor and insulin-infusion pump. By means of a chamber composed of a semipermeable membrane shaped into hollow fibers or a box surrounding endocrine tissue, pilot studies have shown that isolated islets of Langerhans, fragments of insulinoma, or a fetal pancreas retains function for days to weeks, as judged by the ability to sustain euglycemic conditions in chemically induced diabetic rats. Lacking clear proof that normalizing blood glucose levels will prevent vascular complications of diabetes in humans, the case for further development of a hybrid (tissue plus fabricated components) device rests mainly on optimistic extrapolation of results attained in the chemically induced diabetic rat and dog. For the minority of diabetic patients who have insulin-dependent diabetes, the benefit afforded by a bionic device establishing internal insulin release regulated by silently sensed blood glucose level is more than enough payoff for the discomfort and surgery involved in its implantation. Further trials of a hybrid artificial pancreas in the dog appear warranted as a logical extension of preliminary studies with this species.
Evaluation of Epidemiology and Immunogenetics of IDDM in Spanish- and Portuguese-Heritage Registries: A Key to Understanding the Etiology of IDDM?
Authors:   Diabetes Epidemiology Research International Group
Published: March 2007

There appears to be extraordinary international variation in the incidence of insulin-dependent diabetes mellitus (IDDM), the reasons for which are not known. By evaluating the incidence of IDDM in Spanish- and Portuguese-heritage populations, important insight into reasons for the major worldwide differences in IDDM risk may be gained. The limited data that are available for Hispanic populations suggest that there is at least a 10-fold difference in risk between individuals of Hispanic ancestry in Colorado and Mexicans in Mexico City. Standard methods for assessing IDDM incidence are needed to further elucidate the patterns of risk among populations of Iberian heritage. Therefore, we propose that comparable IDDM registries be established in the Spanish- and Portuguese-speaking world. Once registries are established, further investigation of the characteristics of IDDM among various populations (including seasonal distributions, sex differences, age at onset, and changing trends over time) may help explain the large international incidence differences among not only Spanish- and Portuguese-heritage populations but also among all children.
Traditional Plant Medicines as Treatments for Diabetes
Authors: Bailey Clifford J , Day Caroline
Published: March 2007

More than 400 traditional plant treatments for diabetes mellitus have been recorded, but only a small number of these have received scientific and medical evaluation to assess their efficacy. Traditional treatments have mostly disappeared in occidental societies, but some are prescribed by practitioners of alternative medicine or taken by patients as supplements to conventional therapy. However, plant remedies are the mainstay of treatment in underdeveloped regions. A hypoglycemic action from some treatments has been confirmed in animal models and non-insulin-dependent diabetic patients, and various hypoglycemic compounds have been identified. A botanical substitute for insulin seems unlikely, but traditional treatments may provide valuable clues for the development of new oral hypoglycemic agents and simple dietary adjuncts.
Evaluation of Albumin Excretion Rate in Overnight Versus 24-h Urine
Authors: Tomaselli Letizia , Trischitta Vincenzo , Vinci Carmela , Frittitta Lucia , Squatrito Sebastiano , Vigneri Riccardo
Published: March 2007

This study was performed to assess whether the albumin excretion rate (AER) measured in overnight urine (N-AER) and 24-h urine (24-h AER) gives comparable results. For this reason we evaluated N-AER and 24-h AER on the same day from 35 control subjects, 57 patients with insulin-dependent diabetes mellitus (IDDM), and 63 patients with non-insulin-dependent diabetes mellitus (NIODM). AER values obtained from the two urine collection procedures were significantly different (P < .01), with 24-h AER ∼30% higher than NAER. Moreover, when the same cutoff value (20 μg/min) was used to define the normal range, 21% of IDDM patients and 6.3% of NIDDM patients had on the same day normal N-AER and abnormal (>20 μg/min) 24-h AER. Although N-AER values were significantly correlated to 24-h AER values (r = 0.67, P < .001), it was not possible to assess an N-AER value able to predict a 24-h AER value >20 μg/min. In conclusion, N-AER and 24-h AER cannot be used as an equivalent method to establish AER.
Measuring Vibration Sensations With Graduated Tuning Fork: Simple and Reliable Means to Detect Diabetic Patients at Risk of Neuropathic Foot Ulceration
Authors: Thivolet Charles , Farkh James El , Petiot Antoinette , Simonet Chantal , Tourniaire Jacques
Published: March 2007

To find a simple and reliable means to measure vibration sensations, 189diabetic patients and 88 control subjects were tested at different sites with a graduated tuning fork. Within-test variation at big toes reached 8.4% in diabetic patients vs. 2.2% in control subjects. Mean contralateral variation was 7.5% in diabetic patients vs. 2.5% in control subjects. Tuning-fork sensations were inversely correlated with duration of diabetes, whereas no correlation was found with HBA1c levels or the severity of retinopathy. Ninety-nine (52%) patients had vibratory sensation at big toes of <99th percentile of normal values for age. In addition, 51% of the patients with clinical symptoms at extremities (n = 67), 70% of the patients without tendon reflexes (n = 50), and 75% of the patients with abnormal nerve conduction velocities (n = 60) also had low vibration sensations. All patients with lower-limb injuries (n = 7) had values at big toes of <2. Altogether, the graduated tuning fork represents a simple and reliable alternative to quantitate vibration sensations. Long-term follow-up of asymptomatic patients willindicate whether these abnormalities reflect underlying neuropathy. Patientswith abnormal values at screening will necessitate additional investigationsand special foot-care education programs.
Weight Gain Associated With Improved Glycemic Control in Population-Based Sample of Subjects With Type I Diabetes
Authors: Wing Rena R , Klein Ronald , Moss Scot E
Published: March 2007

Previous studies have suggested that weight gain is an identifiable risk of efforts to lower blood glucose with intensive insulin therapy in type I (insulin-dependent) diabetic subjects. This study examined this relationship in a population-based sample of type I diabetic subjects participating in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Four hundred five adults (aged >21 yr) with type I diabetes, who were diagnosed before age 30 yr, were studied from 1980 to 1982 and in a follow-up examination from 1984 to 1986. Weight gain over the 4-yr interval averaged 1.8 ± 5.9 kg. Weight gain was significantly associated (r = −0.26, P < 0.001) with improvements in glycosylated hemoglobin levels; the quartile of subjects with the greatest improvements in glycemic control gained 3.4 kg, whereas the quartile of subjects with the smallest improvements in glycemic control lost 0.6 kg. Weight gain was also correlated with increases in the number of shots of insulin per day and change in the treatment regimen from one type of insulin to a combination of short- and long-acting insulins. These results suggest that weight gain may be an adverse consequence of improved glycemic control. Efforts to better understand the mechanism explaining weight gain and to prevent weight gain are needed.
Hypertension and Diabetes in Blacks
Authors: Douglas Janice G
Published: March 2007

This article summarizes the current state of knowledge on the interrelationship between non-insulindependent diabetes mellitus, obesity, insulin resistance, and hypertension in our attempt to explore the pathophysiology of the high incidence of diabetes and hypertension in the Black population in the United States. A central role for hyperinsulinemia is proposed, and questions are raised that are suitable for investigative clinical trials.
Regulation of Glucose-Transporter Function
Authors: Kasanicki Mary A , Pilch Paul F
Published: March 2007

Glucose transport in mammals is mediated by a multigene family whose expression can be highly tissue specific. All cells express at least one transporter isoform in a constitutive fashion, because a certain level of glucose uptake is an absolute necessity, regardless of influences by various regulatory factors. The level of the constitutive transporter, usually the erythroid glucosetransporter isoform, can be regulated by environmental factors, e.g., nutrition and transformation. Certain cells express unique transporter isoforms, the quantitatively most important of which is the muscle-adipocyte glucose-transporter isoform that functions in response to insulin to clear most of the blood glucose after a meal. The available data suggest that the major insulin target tissues are uniquely able to produce this transporter isoform, sequester it in a unique organelle, and bring it to the cell surface in response to insulin. This insulin response is dramatically different from that seen in various fibroblastic cells, quantitatively and qalitatively, and suggests the expression in adipose tissue and muscle of a multigene program that defines the insulin-stimulated glucose transport of relevance to organismal glucose homeostasis.