bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular Physiology and Genetics of NIDDM: Importance of Metabolic Staging
Authors: Granner Daryl K , O'Brien Richard M
Published: March 2007

Insulin resistance and β-cell failure account for the complex clinical presentation of non-insulin-dependent diabetes mellitus (NIDDM). Insulin resistance primarily involves defective regulation of hepatic glucose production and the peripheral utilization of glucose. Considerable progress has been made in understanding the basic molecular biology, biochemistry, and physiology of these processes. Similarly, the mechanisms involved in insulin synthesis, processing, storage, and secretion are being elucidated. The relative contributions of insulin resistance and β-cell failure are difficult to evaluate when the disease is fully established and clinically apparent but may be more obvious early, i.e., in people with impaired glucose tolerance or individuals at risk for developing the disease. The latter can be identified because there is a strong genetic determinant for NIDDM; the offspring of two diabetic parents have a markedly increased incidence of the disease. In addition to genetic factors, environmental components contribute to the multifactorial etiology of NIDDM. Efforts to establish the importance of these different factors will be assisted if a metabolic staging of NIDDM can be agreed on. This staging, which should correlate the pathophysiological events responsible for the transition from normal glucose tolerance to frank NIDDM with clinical status, would be based on what is known about insulin resistance and β-cell function. Staging will also provide for a classification of the number of causes that lead to NIDDM, if indeed, there is more than one cause of the general phenotype. Strategies for defining the gene or genes responsible for NIDDM can be subsequently devised based on the temporal sequence of appearance of pathophysiological defects and what is known about the molecular biology of insulin action. Understanding the defective metabolic code that results in NIDDM will require the concerted efforts of investigators from various disciplines. This is used throughout the text to avoid confusion with those people who have impaired glucose tolerance but not NIDDM.
Incidence of IDDM in Western Australia in Children Aged 0–14 Yr From 1985 to 1989
Authors: Kelly Heath A , Byrne Geoffrey C
Published: March 2007

Objective

To document the incidence of insulin-dependent diabetes mellitus (IDDM) in Western Australia in children aged 0–14 yr between 1985 and 1989 and to test for differences in incidence by year of diagnosis, age of diagnosis, and sex.

Research Design and Methods

A population-based register that used a primary source of case ascertainment (diabetes clinics at teaching hospitals and direct approach to general practitioners and general physicians) and a secondary source (Western Australian Hospital Morbidity Data System) established numerator data. Denominator data were obtained from the Australian Bureau of Statistics.

Results

From 1985 to 1989 inclusive, 235 children in the 0- to 14-yr agegroup were diagnosed with IDDM in Western Australia. Case ascertainment was estimated at 99% complete. The mean age-adjusted (developed-world population) annual incidence of IDDM was 13.2 per 100,000 person-yr and there was no evidence of an increasing incidence over the 5 yr. However, girls were more likely than boys to be diagnosed with IDDM in this period (P = 0.006).

Conclusions

The incidence of IDDM in Western Australia is in the middle range of IDDM incidence in countries throughout the world. The unexpected finding of an increased incidence of IDDM in girls compared with boys needs to be confirmed in a future study.
In Vivo Demonstration of Insulin-Receptor Defect With 123I-Labeled Insulin and Scintigraphic Scanning in Severe Insulin Resistance
Authors: Dozio Nicoletta , Micossi Piero , Galimberti Gabrilla , Sartori Stefano , Pozza Guido , Dosio Flaviand , Savi Annarita , Gerundini Paolo G , Fazio Ferruccio , Chiumello Giuseppe , Gargantini Luigi , Sodoyez-Goffaux Françoise , Sodoyez Jean-Claude
Published: March 2007

Objective

Insulin-receptor function in humans is usually studied in vitro on readily available cells, e.g., erythrocytes and fibroblasts. Although these cells are not metabolically important targets for insulin action, information derived from them are often taken as representative of other tissues. The aim of this study was to investigate insulin receptors in vitro on erythrocytes and in vivo on one of the main insulin-target organs, the liver.

Research Design and Methods

A 16-yr-old girl affected by severe insulin resistance was identified. Insulin receptor binding was measured on the erythrocytes of the patient and of 6 nondiabetic volunteers. The biodistribution of 123I-labeled insulin was studied in vivo by scintigraphic scanning in the insulin-resistant patient and in 10 nondiabetic volunteers.

Results

Erythrocytes of this patient displayed a markedly reduced [125I]insulin binding. In vivo 123I-insulin biodistribution was characterized by lack of hormone uptake by the liver (4 vs. 21% of the injected dose in control subjects) contrasting with intense accumulation of radioactivity in the kidneys.

Conclusions

Our studies show that defects of insulin binding can be directly demonstrated in vivo on liver receptors with a noninvasive technique with low radiotoxicity.
Maintenance of Sulfonylurea Responsiveness in NIDDM: Randomized Double-Blind Study of Intermittent Glyburide Therapy
Authors: Grunberger George
Published: March 2007

Objective

To assess the effectiveness of intermittent administration of sulfonylurea (glyburide) to patients with non-insulin-dependent diabetes mellitus (NIDDM).

Research Design and Methods

A randomized, double-blind, prospective trial compared daily administration with intermittent administration of glyburide to patients who initially responded to the drug. Twenty-eight of 60 patients with NIDDM achieved the predetermined improvement in plasma glucose concentration on glyburide therapy. These 28 responders were enrolled into a 16-wk trial of daily versus intermittent (2 wk on, 2 wk off) glyburide treatment. Laboratory assessment of glycemic control and insulin secretion in fasting and 2-h postprandial states was done every 2 wk.

Results

Patients on continuous glyburide therapy maintained their glycemic control throughout the study. In contrast, patients on the intermittent schedule lost their glycemic control immediately after being placed on placebo. Despite a significant response to each sulfonylurea pulse, these subjects never regained their baseline glycemic levels. Their fructosamine and HbA1c concentrations deteriorated and remained significantly higher than those of the continuously treated subjects.

Conclusions

Results suggest that administration of glyburide on an intermittent basis after a 2-wk drug-free period to patients initially rendered responsive to sulfonylurea therapy is without clinical merit.
Low Incidence of Childhood IDDM in District of Novosibirsk (Russia)
Authors: Shubnikov Evgeni , Podar Toomas , Tuomilehto Jaakko , Nikitin Yuri
Published: March 2007

Objectives

To study the incidence of insulin-dependent diabetes mellitus (IDDM) among 0- to 14-yr-old children of the district of Novosibirsk, in western Siberia, Russia, from 1983 to 1989.

Research Design and Methods

Data were collected with methods recommended by the Diabetes Epidemiology Research International Group.

Results

The average yearly incidence among males and females was 4.7 (95% confidence interval 3.9–5.8) and 4.4 (95% confidence interval 3.6–5.4) per 100,000 people, respectively. The incidence of IDDM among children living in the city of Novosibirsk was significantly higher than in children living in the surrounding counties of the district, 5.7/100,000 (95% confidence interval 4.8–6.8) versus 3.6/100,000 (95% confidence interval 2.9–4.5).

Conclusions

The incidence of childhood IDDM among Russians in Siberia is low. This is the first publication of internationally comparable data on the occurrence of childhood IDDM in the Russian population.
Asymptomatic Hyperglycemia and Atherosclerotic Vascular Disease in the Elderly
Authors: Mykkänen Leena , Laakso Markku , Pyörälä Kalevi
Published: March 2007

OBJECTIVE

To investigate the relationship between asymptomatic hyperglycemia (IGT or newly diagnosed NIDDM) and atherosclerotic vascular disease.

RESEARCH DESIGN AND METHODS

A representative cross-sectional population sample of 1431 subjects (511 men, 920 women; 65–74 yr old). Altogether, 312 men and 515 women had NGT, 84 men and 158 women had IGT, 33 men and 59 women had newly diagnosed NIDDM, and 82 men and 188 women had previously diagnosed NIDDM. Participation rate was 71%. Main outcome measures were prevalence rates of CHD, stroke, and intermittent claudication.

RESULTS

There was no difference in the prevalence of definite or possible MI verified at hospital between subjects with asymptomatic hyperglycemia and NGT (15.5 vs. 13.3% in men, 6.3 vs. 5.3% in women). Men with asymptomatic hyperglycemia had 1.5 × higher prevalence of angina pectoris (29.4 vs. 19.3%, P < 0.05), major Q-QS changes (21.1 vs. 12.0%, P < 0.05), ischemic ECG changes (59 vs. 45%, P < 0.05), and silent MI on ECG (14.8 vs. 7.9%, P < 0.05) compared to men with NGT. Women with asymptomatic hyperglycemia had more often ischemic ECG changes compared to women with NGT (48.3 vs. 39.7%, P < 0.05). There was no difference (NS) in the prevalence of verified stroke (3.5 vs. 4.6% in men, 2.7 vs. 2.5% in women) or claudication (7.0 vs. 7.7% in men, 4.6 vs. 4.3% in women) between subjects with asymptomatic hyperglycemia and NGT. In multiple logistic regression analyses, the association between risk factors and MI or ischemic ECG changes in subjects with asymptomatic hyperglycemia was not consistent.

CONCLUSION

Elderly subjects with asymptomatic hyperglycemia (particularly men) tended to have an increased prevalence of CHD. Thus, asymptomatic hyperglycemia in the elderly is not a benign phenomenon but is associated with cardiovascular morbidity.
Fibrinolytic System During Long-Distance Running in IDDM Patients and in Healthy Subjects
Authors: van Loon Bert-Jan Potter , Heere Leo P , Kluft Cornelius , Briët Ernest , Dooijewaard Gerard , Meinders Arend E
Published: March 2007

OBJECTIVE

Endurance exercise has been advocated in diabetes mellitus to improve both metabolic control and prevent atherosclerotic complications. The response of the fibrinolytic system during prolonged exercise has not been studied in diabetes.

RESEARCH DESIGN AND METHODS

In seven male marathon runners with IDDM and eight healthy nondiabetic male control subjects, matched for age and degree of training, we studied fibrinolytic and coagulation parameters during a 3-h 32-km outdoor running session. Measurements included t-PA, u-PA, PAI-1, PAP (as a measure of in vivo activation of fibrinolysis), FbDPs, FGN, vWF, and VIII:C.

RESULTS

In both IDDM and control subjects, levels of t-PA, u-PA, PAP, vWF, and VIII:C continued to rise throughout the exercise, whereas PAI-1 showed a similar decline in both groups. FbDP rose slightly in both groups, and FGN remained unchanged. t-PA levels during exercise correlated closely with exercise intensity. These findings indicate that continued stimulation by exercise does not deplete endothelial PA stores. Differences between IDDM and control subjects were seen only for t-PA, vWF, and u-PA. The AUC during exercise (AUC0.5−3.0) of t-PA in IDDM was insignificantly lower than in control subjects (53 ± 19 vs. 67 ± 31 ng.ml−1.h), but the ratio of t-PA to exercise intensity was lower in IDDM (0.24 ± 0.11 vs. 0.31 ± 0.13, P < 0.05). The AUC0.5−3.0 of vWF was lower in IDDM than in control subjects (569 ± 268 vs. 880 ± 265%·h, P < 0.05). The AUC0.5−3.0 of u-PA was higher in IDDM than in control subjects (15.1 ± 3.5 vs. 11.2 ± 1.8 ng.ml−1.h, P < 0.05).

CONCLUSIONS

Despite a defect in the exercise-induced endothelial release of vWF and t-PA, the overall potential to activate fibrinolysis is intact in IDDM, possibly by enhancement of u-PA after exercise. Our data suggest that in IDDM, as in nondiabetic subjects, long-distance running may slow the progression of atherosclerosis by stimulating fibrinolysis.
Sex Differences in Incidence of IDDM in Age-Group 15-29 yr: Higher risk in males in Province of Turin, Italy
Authors: Bruno Graziella , Merletti Franco , Vuolo Antonio , Pisu Elisabetta , Giorio Mauro , Pagano Gianfranco
Published: March 2007

Objective— To report the incidence of IDDM in the age-group 0–29 yr in the Province of Turin, Italy (951, 445 inhabitants 0–29 yr of age), over a 5-yr period (1984–1988) according to age, sex, and geographical region within the area and to identify any temporal trend.

Research Design and Methods— The survey used as the primary data source the list of all patients attending diabetic clinics, and as secondary data source, used the list of hospital discharges for diabetes.

Results— We identified 298 incident cases of IDDM in people 0–29 yr of age. Estimated completeness of ascertainment of the registry was 97%. Age-adjusted (world-standard) incidence rates were 7.40/100,000 (95% CI 6.28–8.71), 5.83 (4.95–6.86), and 6.70 (5.97–7.51), respectively, in the age-groups 0–14, 15–29, and 0–29 yr. Incidence was significantly higher in males than in females in the age-group 15–29 yr (7.36, 6.02–8.98, vs. 4.21, 3.12–5.56). An increasing incidence from rural areas to the greater Turin area (city and its industrial belt) was evident. No significant temporal trend during the study period was found, although year-to-year variability was evident, with the highest incidence in 1984.

Conclusions— This study suggests a high male-to-female ratio of incidence of IDDM after 14 yr; either sex hormones or different exposure to environmental determinants could be involved.
Successful Treatment of Severe Refractory Sulfonylurea-Induced Hypoglycemia With Octreotide
Authors: Krentz Andrew J , Boyle Patrick J , Justice Keith M , Wright Alex D , Schade David S
Published: March 2007

Objective— To test the clinical use of octreotide in the treatment of sulfonylurea-induced hypoglycemia.

Research Design and Methods— A case is reported of sulfonylurea-induced hypoglycemic coma in a nondiabetic subject, which was complicated by relapse of hypoglycemia after resuscitation with intravenous dextrose. Subcutaneous octreotide, 50 μg 12 hourly, suppressed stimulated endogenous insulin secretion, thereby preventing a further recurrence of hypoglycemia.

Results— No adverse effects of treatment were observed.

Conclusions— These results suggest a significant role for octreotide as an adjunct to intravenous dextrose in the management of severe and refractory cases of sulfonylurea-induced hypoglycemia.
Prevalence of Diabetes and Its Complications in the Eastern Band of Cherokee Indians
Authors: Farrell Mary A , Quiggins Patricia A , Eller James D , Owle Patricia A , Miner Kingsley M , Walkingstick Ernestine S
Published: March 2007

Objective— To determine the prevalence of diabetes and selected complications among the Eastern Band of Cherokee Indians in North Carolina.

Research Design and Methods— Multiple IHS data systems were used to determine diabetes prevalence and complication rates. The RPMS was used to identify diabetes cases as of April 1989, degree of Indian inheritance, cardiovascular diseases (including hypertension), and retinopathy. Data on laser treatments and LEA were obtained from individual registries. Information on ESRD was obtained by a research assistant. The IHS Ambulatory Patient Care reporting system was used to calculate the number of diabetic patients for the years 1982–1987. The IHS user population was used as the denominator. Rates were age-adjusted to the 1980 U.S. population and diabetic population by the direct method.

Results— Using clinical records, the age-adjusted prevalence of diabetes in 1988 was 105.6/1000 people, four times the U.S. rate. Rates of diabetes were highest in the groups with the highest degree of Indian inheritance. LEAs occurred among diabetic patients at three times the rate for the U.S. Between 1985 and 1989, new cases of ESRD occurred at a crude annualized rate of 578/million, approximately six times the rate for U.S. whites.

Conclusions— Diabetes presents a major burden to the Eastern Band of Cherokees. The limitation inherent in this study probably result in underestimation of the prevalence of diabetes and its complications in the community. Future studies are needed to assess the impact of medical and preventive programs on diabetes prevalence and complications in this community.
Diabetes-Associated Mortality in Native Americans
Authors: Newman Jeffrey M , DeStefano Frank , Valway Sarah E , German Robert R , Muneta Ben
Published: March 2007

OBJECTIVE— To describe diabetes-associated mortality among Native Americans.

RESEARCH DESIGN AND METHODS— In this population-based study, we analyzed diabetes-associated mortality data from the IHS and the NCHS. We also examined diabetes data from the 1986 NMFS.

RESULTS— IHS area-specific diabetes mortality rates for 1984–1986 ranged from 10 to 93/100,000, compared with 15/100,000 for the total U.S. population. NCHS data for the same period listed diabetes as the underlying cause of 708 deaths among Native Americans and the contributory cause of 1252 deaths; 63% of the latter deaths were attributable to circulatory diseases. The 1986 NMFS demonstrated that Native American heritage is underreported by 65% on death certificates. Using deaths identified as Native American by NMFS, the age-adjusted mortality rate for diabetes as the underlying cause for Native Americans (96/100,000) was 4.3 times that for whites and two times that for blacks. Where diabetes was a contributory cause of death, the mortality rate for Native Americans (264/100,000) was 3.7 times that for whites and 2.4 times that for blacks.

CONCLUSIONS— The excessive diabetes-associated mortality among Native Americans is consistent with other indicators of the magnitude of the diabetes problem in this population. Further epidemiological research and expanded diabetes control interventions are needed.
Prevalence and Risk Factors for Diabetes and Diabetes-Related Amputations in American Indians In Southern Arizona
Authors: Wirth Robert B , Marfin Anthony A , Grau David W , Helgerson Steven D
Published: March 2007

OBJECTIVE— To describe the prevalence of NIDDM and LEA using data from a computer-based patient data base.

RESEARCH DESIGN AND METHODS— Diabetic patients with and without LEA, and nondiabetic patients were identified by computer search. Charts of diabetic patients were reviewed for confirmation of diagnosis of diabetes and diabetes-related amputation. The diabetic and nondiabetic populations were described, and certain risk factors were identified.

RESULTS— The overall prevalence of NIDDM in this tribe in 1985–1986 was 18.3/100 adults (≥ 18 yr of age), whereas the prevalence of LEA/100 adults with NIDDM was 10.3%. Females were 1.3 times as likely to have diagnosed diabetes as males (95% CI 1.2–1.4), and males with diabetes were 1.4 times more likely to have had LEA than females with diabetes (95% CI 1.1–1.9).

CONCLUSIONS— Automated health-care delivery data base used for this tribe can be used to maintain surveillance for diabetes and amputations in diabetic patients. Effective programs to prevent complications of diabetes, such as LEA, in this tribe are urgently needed.
The Diabetes Project at Fort Totten, North Dakota, 1984–1988
Authors: Newman William P , Hollevoet Jackie J , Frohlich Karen L
Published: March 2007

OBJECTIVE— To characterize demographic, therapeutic, and complication features of patients in the Fort Totten Diabetes Project and to assess the longitudinal impact of intervention strategies.

RESEARCH DESIGN AND METHODS— Individuals (n = 215) of varying American Indian ethnic origin and a quantum of mean age 53 yr (range 14–86 yr), 62% women, with type II diabetes of 9 yr average duration were studied. Annual chart audits of the complete diabetic population were conducted from 1984 to 1988.

RESULTS— Obesity is a major problem complicating diabetes management (average BMI 32 ± 0.9), but BMI does not correlate with glucose control as assessed by total GHb (r = 0.014, NS). Individuals lost an average of 3.7 kg (P < 0.001) during the audit years. Mean GHb declined for the population (11.3–9.7%, P < 0.025) during the interval, but no significant decline was evident when values for individuals were considered. Complication rates for retinopathy, nephropathy, and neuropathy paralleled those rates published for urban populations.

CONCLUSIONS— Diabetes mellitus in American Indians living in a rural, economically deprived area can be identified and cared for with success similar to that published for urban populations.
The Traditional Pima Indian Diet: Composition and adaptation for use in a dietary intervention study
Authors: Boyce Vicky L , Swinburn Boyd A
Published: March 2007

OBJECTIVE— To examine changes in the Pima Indian diet composition that may have played a role in the dramatic rise in the incidence of NIDDM among Pima Indians over the last century.

RESEARCH DESIGN AND METHODS— We investigated the composition of the foods comparable to those available to the Pima ∼ 100 yr ago, with the aim of reproducing this traditional diet as faithfully as possible for a dietary intervention study. An approximation of the traditional diet was ascertained from the ethnohistoric literature and traditional recipes.

RESULTS— We estimated that the traditional Pima diet, although seasonably variable, was ∼ 70–80% carbohydrate, 8–12% fat, and 12–18% protein. A diet analogous to the traditional Pima diet is largely reproducible with the foods available today. Many native foods are available locally and many commercial products can be substituted when native foods are unavailable.

CONCLUSIONS— The Pima Indian diet of the last century was much higher in carbohydrate and lower in fat compared with the modern-day Pima diet. Any changes that this diabetes-prone population can make toward their traditional diet may help to decrease their incidence of diabetes.
Can Islet Cell Antibodies Predict IDDM in the General Population?
Authors: Bingley Polly J , Bonifacio Ezio , Shattock Marion , Gillmor Hilary A , Sawtell Pamela A , Dunger David B , Scott Robin D M , Bottazzo Gian Franco , Gale Edwin A M
Published: March 2007

Objective— To evaluate the likely prognostic significance of ICAs in children with no family history of IDDM.

Research Design and Methods— We examined the prevalence of ICAs in 2925 English schoolchildren aged 9–13 yr and in 274 age-matched siblings of children with diabetes from the same region, and we compared the estimated risk of progression to diabetes within 10 yr in the two groups.

Results— ICAs were present at levels ≥ 4 JDF U in 2.8% of schoolchildren and 6.6% of siblings and at ≥ 20 JDF U in 0.8% of schoolchildren and 2.2% of siblings. Although ICAs are only 2–3 times more prevalent in siblings than schoolchildren, the estimated cumulative risk that siblings will progress to diabetes by age 21 is 13 times greater (2.8 vs. 0.21%).

Conclusions— ICAs are unexpectedly prevalent in English schoolchildren, but only a small minority, with this evidence of immune activation directed against islet cells, will progress to diabetes. Although ICAs alone have limited predictive value in the general population, combining two or more predictive tests in series could achieve a level of prediction equivalent to that now obtained in first-degree relatives.
Symptoms of Sensory Neuropathy in Adults with NIDDM in the U.S. Population
Authors: Harris Maureen , Eastman Richard , Cowie Catherine
Published: March 2007

OBJECTIVE

To ascertain the prevalence and determinants of sensory neuropathy symptoms through structured interview of a representative sample of people with diabetes in the U.S. population.

RESEARCH DESIGN AND METHODS

The 1989 National Health Interview Survey consisted of a representative sample of 84,572 persons in the U.S. ≥ 18 yr of age. A household respondent identified all people in the household believed to have diabetes (n = 2829). Subjects who could not be personally interviewed (n = 129) and individuals who stated they did not have diabetes (n = 295) were excluded. A detailed questionnaire was administered to 99.3% of the remaining 2405 subjects. Questions on symptoms of sensory neuropathy included whether during the past 3 mo the subjects had experienced numbness or loss of feeling, pain or tingling, or decreased ability to feel hot or cold. The neuropathy questions were also administered to a representative sample of 20,037 subjects who were not known to have diabetes.

RESULTS

Prevalence of symptoms of sensory neuropathy was 30.2% among people with IDDM. This prevalence was 36.0% for men with NIDDM and 39.8% for women with NIDDM, compared with 9.8 and 11.8% for nondiabetic men and women, respectively. In logistic regression, factors independently related to symptoms of sensory neuropathy in people with NIDDM included duration of diabetes, hypertension, hyperglycemia, and glycosuria. Long duration of NIDDM (>20 yr) was associated with a twofold increased risk of symptoms of sensory neuropathy compared with those with 0-4 yr of diabetes. Hypertension was associated with a 60% higher likelihood of symptoms. Diabetic individuals whose blood glucose was high all or most of the time or whose urine tests showed glucose all of the time were > 2 times as likely to have symptoms of sensory neuropathy than those who did not report hyperglycemia or glycosuria. Age, sex, ethnicity, cigarette smoking, and height were not determinants of sensory neuropathy.

CONCLUSIONS

Symptoms of sensory neuropathy affect 30–40% of diabetic patients in the U.S. Men and women are affected equally. Prevalence of these symptoms increases with longer duration of diabetes; hypertension and hyperglycemia predispose to symptoms of sensory neuropathy.
Comparison of Metoclopramide and Erythromycin in the Treatment of Diabetic Gastroparesis
Authors: Erbas Tomris , Varoglu Erhan , Erbas Belkis , Tastekin Gungor , Akalin Sema
Published: March 2007

OBJECTIVE

To compare the effects of erythromycin and metoclopramide on gastric emptying and symptoms of gastroparesis in diabetic patients with delayed gastric emptying.

RESEARCH DESIGN AND METHODS

The study group consisted of 13 patients with symptoms of severe gastroparesis and delayed gastric emptying. Gastric emptying was evaluated using a radionuclide method, and gastrointestinal symptoms were scored. The patients were given either erythromycin (250 mg 3 times/day) or metoclopramide (10 mg 3 times/day) in random order for 3 wk, and after a washout period of 3 wk they were crossed-over to the other medication for another 3 wk. Parameters of gastric emptying were assessed before treatment and after both erythromycin and metoclopramide administration.

RESULTS

The half-time of gastric emptying in diabetic subjects was 110 (77–120) min before treatment. At 60 and 90 min, the median value of residual isotope activity was 66.5 (55–83.5) and 55% (43–74.3), respectively. The half-time decreased to 55 min (28.6–115) after 3 wk of treatment with erythromycin and percentages of meal retention in the stomach at 60 and 90 min were 49.9 (38.4–70) and 40.5% (29.7–60), respectively. After taking metoclopramide, the median value of half-time was 67 min (15–115) and percentages of meal retention at 60 and 90 min were 51 (34.5–93.9) and 42% (24–71.2), respectively. When compared with baseline values a significant difference in gastric emptying parameters was found after both erythromycin and metoclopramide. A significant improvement of the total score for gastrointestinal symptoms was observed with both drugs, but this improvement was more pronounced with erythromycin.

CONCLUSIONS

Erythromycin, a macrolide antibiotic and a motilin receptor agonist, appears to stimulate intestinal motility and seems to be an alternative agent for the treatment of gastroparesis caused by diabetic autonomic neuropathy.
Alcohol With a Meal Has No Adverse Effects on Postprandial Glucose Homeostasis in Diabetic Patients
Authors: Koivisto Veikko A , Tulokas Sirkku , Toivonen Markku , Haapa Eliina , Pelkonen Risto
Published: March 2007

OBJECTIVE

To examine the effect of moderate alcohol intake with a meal on gluco e homeostasis in diabetic patients.

RESEARCH DESIGN AND METHODS

Alcohol (1 g/kg, an aperitif before, wine during, and a drink after a meal) or an equal amount of mineral water was given during a dinner. Blood glucose and insulin concentrations were measured before, uring, and after the meal until the next morning. This study was conducted at the Helsinki University Hospital Metabolic Ward and the Finnish Diabetes Association Education Center. The participants in the study included 10 type I diabetic patients treated with insulin and 16 type II diabetic patients treated with diet alone or with diet and oral drugs. In each subject, we examined hypoglycemic episodes or differences in blood glucose or serum insulin concentrations between alcohol and the control study.

RESULTS

In type I diabetic patients, blood glucose and insulin concentrations were virtually identical in both studies. In type II diabetic patients, alcohol slightly enhanced the meal-induced insulin secretion resulting in lower blood glucose concentrations next morning. No hypoglycemic glucose concentrations were observed in either group after alcohol ingestion.

CONCLUSIONS

Moderate alcohol intake with a meal does not lead to hypo- or hyperglycemia in diabetic patients.
Factors That Influence Outcome in Diabetic Subjects With Myocardial Infarction
Authors: Fava Stephen , Azzopardi Joseph , Muscat Hugo Agius , Fenech Frederick F
Published: March 2007

OBJECTIVE

To compare the outcome of acute myocardial infarction in NIDDM patients and nondiabetic control subjects. The relation of glycemic control, duration of diabetes, and major diabetic complications to the outcome of acute myocardial infarction in diabetic subjects was investigated.

RESEARCH DESIGN AND METHODS

This was a prospective, hospitalbased, case-control study.

RESULTS

One hundred and ninety-six NIDDM patients and 196 nondiabetic control subjects with acute myocardial infarction were entered into the study: 23.5% of diabetic subjects and 34.2% of control subjects received thrombolytic therapy (P < 0.05). Diabetic subjects showed signs of reperfusion less often than control subjects (P < 0.05). Mortality was higher in the diabetic group (17.3 vs. 10.2%, P < 0.05). Pump failure (38.3 vs. 16.8%, P < 0.01) and cardiogenic shock (9.7 vs. 3.6%, P < 0.05) also occurred more frequently in diabetic subjects. Loss of heart rate variability was correlated with both pump failure and mortality; proliferative retinopathy was correlated with pump failure. Glycemic control and other diabetic complications did not correlate with outcome.

CONCLUSIONS

Our findings confirm the higher mortality and incidence of pump failure in acute myocardial infarction with co-morbid diabetes. They suggest that the less frequent use of thrombolytic therapy, lower reperfusion rates, and more advanced coronary artery disease might be contributory. The presence of autonomic neuropathy and microvascular disease probably also contribute to poor outcome; other major diabetic complications and diabetic control did not influence outcome.
Diabetes, Other Risk Factors, and 12-Yr Cardiovascular Mortality for Men Screened in the Multiple Risk Factor Intervention Trial
Authors: Stamler Jeremiah , Vaccaro Olga , Neaton James D , Wentworth Deborah ,   The Multiple Risk Factor Intervention Trial Research Group
Published: March 2007

OBJECTIVE

To assess predictors of CVD mortality among men with and without diabetes and to assess the independent effect of diabetes on the risk of CVD death.

RESEARCH DESIGN AND METHODS

Participants in this cohort study were screened from 1973 to 1975; vital status has been ascertained over an average of 12 yr of follow-up (range 11–13 yr). Participants were 347,978 men aged 35–57 yr, screened in 20 centers for MRFIT. The outcome measure was CVD mortality.

RESULTS

Among 5163 men who reported taking medication for diabetes, 1092 deaths (603 CVD deaths) occurred in an average of 12 yr of follow-up. Among 342,815 men not taking medication for diabetes, 20,867 deaths were identified, 8965 ascribed to CVD. Absolute risk of CVD death was much higher for diabetic than nondiabetic men of every age stratum, ethnic background, and risk factor level—overall three times higher, with adjustment for age, race, income, serum cholesterol level, sBP, and reported number of cigarettes/day (P < 0.0001). For men both with and without diabetes, serum cholesterol level, sBP, and cigarette smoking were significant predictors of CVD mortality. For diabetic men with higher values for each risk factor and their combinations, absolute risk of CVD death increased more steeply than for nondiabetic men, so that absolute excess risk for diabetic men was progressively greater than for nondiabetic men with higher risk factor levels.

CONCLUSIONS

These findings emphasize the importance of rigorous sustained intervention in people with diabetes to control blood pressure, lower serum cholesterol, and abolish cigarette smoking, and the importance of considering nutritional-hygienic approaches on a mass scale to prevent diabetes.
The Prevalence and Identification of Risk Factors for NIDDM in Urban Africans in Cape Town, South Africa
Authors: Levitt Naomi S , Katzenellenbogen Judith M , Bradshaw Deborah , Hoffman Margaret N , Bonnici Francois
Published: March 2007

OBJECTIVE

To determine the prevalence of NIDDM and associated risk factors in urban Africans in Cape Town, South Africa.

RESEARCH DESIGN AND METHODS

With a three-stage, proportional, stratified, random cluster method, we sampled 1000 Africans, > 30 yr of age, living in African residential areas in Cape Town. We assessed glucose tolerance with a 75-g oral glucose tolerance test, according to World Health Organization criteria, and obtained anthropometric and demographic data.

RESULTS

The response rate was 79%. The prevalence of NIDDM was 8.0% (confidence interval 5.8–10.3%), age-adjusted to world population figures and that of impaired glucose tolerance, 7.0% (confidence interval 4.9–9.1%). Multivariate analysis indicated that increased age (odds ratio 4.18), upper-segment fat distribution (odds ratio 2.94), proportion of life spent in an urban area (odds ratio 2.32), and obesity (odds ratio 2.31) were significant independent risk factors for NIDDM. In contrast, sex, family history, alcohol intake, and physical activity were not independent risk factors. Only increased age (odds ratio 4.06) was a significant risk factor for impaired glucose tolerance.

CONCLUSIONS

The prevalence of NIDDM in urban Africans in Cape Town, South Africa, is moderately high, and considerably higher than previous reports from Africa. The association of NIDDM with urbanization has important implications in view of the large-scale urbanization occurring in southern Africa.
Comparison of Morning or Bedtime Insulin With and Without Glyburide in Secondary Sulfonylurea Failure
Authors: Soneru Ileana L , Agrawal Lily , Murphy John C , Lawrence A M , Abraira Carlos
Published: March 2007

OBJECTIVES— New treatment options are needed for glycemic control in NIDDM. We evaluated the effects of bedtime or morning insulin treatment, combined with daytime glyburide or given alone.

RESEARCH DESIGN AND METHODS— Twenty-nine male patients with NIDDM, mean age 63 ± 1.7 yr, body weight 124 ± 2.98% of DBW, received a maximum glyburide dose (20 mg/day) for a minimum of 6 wk, to confirm sulfonylurea failure. Human lente insulin was added for 12 wk either AM (n = 14) or HS (n = 15) and adjusted to obtain fasting euglycemia (FPG; combination treatment phase). Glyburide was then stopped, and insulin was continued for 6 wk, aiming for normal FPG (insulin phase).

RESULTS— After combination treatment phase, FPG decreased (P < 0.02) from 12.43 ± 0.68 to 5.73 ± 0.65 mM (AM) and from 12.68 ± 0.76 to 5.51 ± 0.48 mM (HS) (AM vs. HS, NS). Postbreakfast, presupper, and 0200 AM plasma glucose levels fell equally (P < 0.02) except for 1-h postprandial (AM 12.46 ± 0.51 mM, HS 10.88 ± 0.62 mM, AM vs. HS, P < 0.1). Mean HBA1c fell similarly in both AM and HS groups. At 2 wk of the insulin phase, FPG was higher in AM than HS, 9.8 ± 0.76 vs. 7.56 ± 0.7 mM (P < 0.1). At the end of insulin phase, plasma glucose levels were similar to the end of combination treatment phase, but the insulin dose had to be raised in AM by 39% (P < 0.02) and HS by 30% (P < 0.05). After the combination treatment phase, fasting C-peptide was significantly suppressed in HS group only, from 1.22 ± 0.12 to 0.82 ± 0.09 nM (P < 0.02). At the end of insulin phase, fasting C-peptide was further suppressed in both groups, but 2-h postprandial C-peptide levels decreased significantly in AM group only, from 1.85 ± 0.23 to 1.42 ± 0.13 nM (P < 0.02). Triglycerides and total and HDL cholesterol did not change significantly after either combination treatment phase or insulin phase. Mean weight gain was 6.5 lb during combination treatment phase (NS from baseline), without further change during insulin phase. Hypoglycemic reactions, all mild, were recorded at a rate of 1.35/patient in the AM group and 0.4/patient in the HS group (P < 0.025).

CONCLUSIONS— Normal fasting glycemia and near-normal postprandial glucose profile could be obtained with combination therapy in NIDDM. Results were similar if insulin, alone or in combination with glyburide, was given before breakfast or at bedtime, but hypoglycemic reactions were more common with conventional morning insulin injections.
Relaxation Training for NIDDM: Predicting who may benefit
Authors: Lane James D , McCaskill Cynthia C , Ross Suzanne L , Feinglos Mark N , Surwit Richard S
Published: March 2007

OBJECTIVE

To examine the benefits of relaxation training for patients with NIDDM and to investigate individual differences that could predict a positive response to relaxation training.

RESEARCH DESIGN AND METHODS

Thirty-eight subjects with NIDDM were treated with intensive conventional diabetes therapy after an initial metabolic evaluation and psychological and pharmacological testing. Half were assigned to also receive biofeedback-assisted relaxation training. Treatment effects on GHb levels and glucose tolerance were evaluated after 8 wk.

RESULTS

Subjects demonstrated significant improvements in GHb level, but not in glucose tolerance, after 8 wk of intensive conventional treatment. These improvements persisted throughout the follow-up period. However, the group provided with relaxation training did not experience greater improvements on either measure than the group given conventional diabetes treatment only. Within the group that received relaxation training, correlations occurred between the improvements in glucose tolerance after treatment and individual differences in trait anxiety and in the effect of alprazolam on glucose tolerance. Differences in the effects of EPI on glucose tolerance and personality measures of neuroticism and perceived locus of control also appeared to be related to improvements in glucose tolerance after training.

CONCLUSIONS

Relaxation training did not confer added benefit over and above that provided by conventional diabetes treatment for patients with NIDDM. Additional research is needed to determine whether the administration of relaxation training to selected patients, especially those who are most responsive to stress, would provide benefits for glucose control that are not achieved by conventional treatment.
Cost-Effective Screening for Diabetic Retinopathy Using a Nonmydriatic Retinal Camera in a Prepaid Health-Care Setting
Authors: Peters Anne L , Davidson Mayer B , Ziel Frederick H
Published: March 2007

OBJECTIVE

To assess the efficacy of using a nonmydriatic Polaroid retinal camera as a method for screening diabetic patients for treatable diabetic retinopathy.

RESEARCH DESIGN AND METHODS

All 522 diabetic patients followed in a health maintenance organization-affiliated diabetes program had retinal photos taken. Compliance with the routine referral to one of two retinal specialists (the examiners) was 74%. The results from the examiners were compared with the results of the reader of the retinal photos.

RESULTS

Sensitivity was 100% and specificity was 82% for the diagnosis of serious diabetic retinopathy (preproliferative or proliferative retinopathy or macular edema) by the examiners compared with the diagnosis of any diabetic retinopathy by the reader. No patient had serious diabetic retinopathy inside or outside the photographic field that was missed because all patients with serious diabetic retinopathy showed some diabetic retinopathy within the photographic field. The reader tended to underrate the severity of the diabetic retinopathy, but when the reader diagnosed serious diabetic retinopathy, it was always present on exam.

CONCLUSIONS

The nonmydriatic retinal camera is easy to use, inexpensive, and can be used as part of a general diabetes exam, independent of a physician, in patients who should, but may not, be referred to an ophthalmologist. Any patient with abnormal findings on photos should be referred to an ophthalmologist, and any patient with findings of serious diabetic retinopathy on the photos should be referred immediately for possible laser therapy.
Caloric Restriction Per Se Is a Significant Factor in Improvements in Glycemic Control and Insulin Sensitivity During Weight Loss in Obese NIDDM Patients
Authors: Wing Rena R , Blair Elaine H , Bononi Patricia , Marcus Marsha D , Watanabe Richard , Bergman Richard N
Published: March 2007

OBJECTIVE

To examine the effects of caloric restriction, independent of differences in weight loss, on improvements in glycemic control, fasting insulin, and insulin sensitivity.

RESEARCH DESIGN AND METHODS

We randomized 93 obese type II diabetic patients to two different degrees of calorie restriction (1,674 or 4,185 kJ/day; 400 or 1,000 kcal/day) and compared the changes in fasting glucose, fasting insulin, and insulin sensitivity that resulted from a comparable reduction in body weight (11% of initial body weight). Insulin sensitivity was assessed using the minimal model analysis of frequently sampled intravenous glucose tolerance tests.

RESULTS

Despite equal weight losses, subjects in the 1,674 kJ/day (400 kcal) condition had lower fasting glucose levels (7.61 vs. 10.13 mM, P = 0.03) and greater insulin sensitivity (1.79 vs. 1.13, P = 0.04) after weight loss than did subjects in the 4,185 kJ/day (1,000 calorie) condition. Subjects were restudied 15 weeks later when both groups were consuming a 4,185 kJ/day (1,000 kcal/day) diet. Subjects who increased from 1,674 to 4,185 kJ (400 to 1,000 calories) had worse fasting glycemic control in spite of continued weight loss, whereas subjects who remained on 4,185 kJ (1,000 calories) throughout had further improvements in both blood glucose and insulin sensitivity with increased weight loss.

CONCLUSIONS

Both degree of calorie restriction and magnitude of weight loss have independent effects on improvements in glycemic control and insulin sensitivity.
Insulin Omission in Women With IDDM
Authors: Polonsky William H , Anderson Barbara J , Lohrer Patricia A , Aponte Jennifer E , Jacobson Alan M , Cole Charlotte F
Published: March 2007

OBJECTIVE

To describe the extent of intentional insulin omission in an outpatient population of women with insulin-dependent diabetes mellitus (IDDM) and examine its relationship to disordered eating, attitudes toward diabetes, other psychosocial factors, long-term complications, and glycemic control.

RESEARCH DESIGN AND METHODS

Before their routinely scheduled clinic appointments, female IDDM patients who were 13–60 years of age completed a self-report survey (final n = 341). The survey included standardized questionnaires assessing disordered eating attitudes and behaviors, psychological functioning (general distress, diabetes-specific distress, and hypoglycemic fear), attitudes toward diabetes, and self-care behaviors. All subjects were assessed for glycosylated hemoglobin within 30 days of survey completion. Long-term complications were determined through chart review.

RESULTS

Approximately 31% of the subject sample, representing women of all ages, reported intentional insulin omission, but only 8.8% reported frequent omission. Compared with non-omitters, omitters reported more disordered eating, greater psychological distress (general and diabetes-specific), more hypoglycemic fear, poorer regimen adherence, and greater fears concerning improved diabetes management (which may lead to weight gain). Omitters evidenced poorer glycemic control, more diabetes-related hospitalizations, and higher rates of retinopathy and neuropathy. Multivariate examination revealed only two variables that independently predicted omission: diabetes-specific distress and fear of improved glycemic control (“because I will gain weight”). Of the omitters, approximately half reported omitting insulin for weight-management purposes (weight-related omitters). These subjects evidenced significantly greater psychological distress, poorer regimen adherence (including more frequent omission), poorer glycemic control, and higher rates of complications than did non-weight-related omitters as well as non-omitters. Non-weight-related omitters tended to fall between weight-related omitters and non-omitters on most measures of psychological functioning, adherence, and glycemic control.

CONCLUSIONS

These findings suggest that insulin omission is common, that it is not limited to younger women, and that the medical consequences of omission, especially frequent omission, may be severe. Although a strong association between omission and disordered eating was observed, these data suggest that this link may be complicated by important diabetes-specific factors. Patients preoccupied with eating and weight concerns may also become emotionally overwhelmed by diabetes and/or fearful of normoglycemia (and the associated weight-related consequences), thus reinforcing the desire to omit insulin and maintain elevated blood glucose levels.
Shanghai, China, Has the Lowest Confirmed Incidence of Childhood Diabetes in the World
Authors: Fu Hua , Shen Shui-Xian , Chen Zhao-Wen , Wang Jia-Jun , Ye Ting-Ting , LaPorte Ronald E , Tajima Naoko
Published: March 2007

OBJECTIVE

To determine the incidence of insulin-dependent diabetes mellitus in 0- to 14-year-old children in Shanghai, China, from 1980 to 1991.

RESEARCH DESIGN AND METHODS

Data were collected from hospitals with pediatric departments. The secondary source of validation was primary and middle schools.

RESULTS

The average crude annual incidence rate was 0.61/100,000 (95% confidence interval, 0.48–0.77). The ascertainment-corrected incidence rates were 0.72/100,000 (0.57–0.91).

CONCLUSIONS

The incidence of childhood diabetes in Shanghai, China, was one of the lowest, if not the lowest, in the world.