bluuebunny/crossref_metadata_2025 huggingface dataset:
Dietary Advice Based on the Glycaemic Index Improves Dietary Profile and Metabolic Control in Type 2 Diabetic Patients
Authors: Frost G. , Wilding J. , Beecham J.
Published: July 2009

The effect of dietary education incorporating information about the glycaemic index of carbohydrate was tested against standard dietary advice in a randomized controlled study in 51 newly diagnosed patients with Type 2 diabetes treated as out‐patients with diet only over a 12‐week study period. Outcome was assessed by dietary analysis of 3‐day diet diaries, fasting blood glucose, fructosamine, total cholesterol, LDL‐cholesterol, HDL‐cholesterol, and triglycerides. Dietary analysis indicated that the group who received low glycaemic advice not only had a significantly lower calculated mean diet glycaemic index intake (77 ± 1.1 (SEM) vs 82 ± 1%, p < 0.01) but also had a lower fat intake (25 ± 1 vs 32 ± 2% of total energy day−1, p < 0.001), a higher carbohydrate intake (49 ± 2% vs 44 ± 1% of total energy day−1, p < 0.05) and non‐starch polysaccharide intake (21 ± 1.5 vs 14 ± 1 g, p < 0.01). There was a significantly greater within‐group fall in fructosamine (3.8 ± 0.2 to 3.2 ± 0.2 mmol−1 vs 3.6 ± 0.2 to 3.6 ± 0.3 mmol−1, p < 0.05) and cholesterol (6.1 ± 0.3 to 5.4 ± 0.3 mmol−1 vs. 5.6 + 0.2 to 5.3 ± 0.1 mmol−1, p < 0.05) in the low glycaemic index group. A significant correlation was detected between the glycaemic index of the diet and the fall in fructosamine (r = 0.54, p < 0.01) and fasting blood glucose (r = 0.41, p < 0.05) which could not be demonstrated with the changes in fat or non‐starch polysaccharides content of the diet, irrespective of the original study group, suggesting an independent role of the change in glycaemic index of the carbohydrate in the diet. Subjects given advice to lower the glycaemic index of the carbohydrate in their diet achieve a lower calculated dietary glycaemic intake than those who do not. This appears to have a beneficial effect on the intake of other nutrients and results in an improvement in metabolic control.
Peripheral Neuropathy as a Presenting Feature of Type 2 Diabetes: A Case‐Controlled Study
Authors: Gregory R. , Tattersall R.B. , Allison S.P.
Published: July 2009

The characteristics and outcome of 68 newly diagnosed Type 2 diabetic patients who presented with clinically evident peripheral neuropathy were compared with matched controls who had no neuropathy at diagnosis. All subjects (34 male) whose median age was 68 (range 47–89) yr were identified from a computerized diabetes register and presented in 1982–1990. The groups were compared at diagnosis for haemoglobin A1, body mass index, blood pressure, smoking, and alcohol consumption, and for co‐existent coronary and peripheral vascular disease. Mortality and morbidity were recorded to March 1991. Significantly more patients with neuropathy had co‐existent peripheral vascular disease: 24(35%) compared to 6(9%) controls (p = 0.0021). Twenty (30%) of those with neuropathy and no controls had retinopathy at diagnosis, which was sight‐threatening in 10. Seven (10%) with neuropathy but no controls presented with foot ulcers, one requiring limited amputation. Two more patients with neuropathy and one control subsequently developed foot ulcers resulting in one or more amputation in each group. Twenty‐one (31%) of those with neuropathy and 14 (21%) controls died (p = 0.2109). In conclusion more diabetic patients with clinically evident peripheral neuropathy at diagnosis have peripheral vascular disease than matched patients without neuropathy. It is likely that macrovascular disease either exacerbates or causes the neuropathy in this group of patients. They are at high risk of developing foot ulceration and high priority should be given to foot care in planning their management.
Menstrual Irregularities are more Common in Adolescents with Type 1 Diabetes: Association with Poor Glycaemic Control and Weight Gain
Authors: Adcock C.J. , Perry L.A. , Lindsell D.R.M. , Taylor A.M. , Holly J.M.P. , Jones J. , Dunger D.B.
Published: July 2009

Ovarian function in post‐menarchal girls with Type 1 diabetes was evaluated. Menstrual histories from 24 adolescents with Type 1 diabetes were compared with those from 24 age and sex matched controls. A fasting blood sample was obtained from subjects with Type 1 diabetes for the measurement of ovarian and adrenal sex hormones, LH and FSH, glucose and insulin, insulin‐like growth factor‐l (IGF‐I), and insulin‐like growth factor binding protein‐1 (IGFBP‐1); and an ovarian ultrasound scan was performed. Menstrual irregularity was more prevalent in patients with Type 1 diabetes than controls (54% vs 21%, p < 0.01) and their mean body mass index (BMI) was greater (22.3 ± 0.5 (± SEM) vs 20.7 ± 0.6 kg m−2, p < 0.05). Subjects with Type 1 diabetes with irregular menses (when compared with diabetic subjects with a regular cycle) had a significantly higher HbA***1 (12.8 ± 0.4 vs 10.5 ± 0.5%, p < 0.01) and BMI (23.2 ± 0.6 vs 21.4 ± 0.6 kg m−2, p < 0.05) associated with a lower sex hormone binding globulin (SHBG) (37.2 ± 4.0 vs 52.6 ± 4.0 nmol I−1, p < 0.025) and IGF‐I (1.4 ± 0.2 vs 2.2 ± 0.2 ***mUI−1, p < 0.025) and a higher LH:FSH ratio (2.6 ± 0.5 vs 1.4 ± 0.2, p < 0.05). Polycystic ovarian changes were identified in 10/13 (77%) of these patients with an irregular cycle. Menstrual irregularity is common in post‐menarchal girls with Type 1 diabetes and is associated with poor glycaemic control and weight gain. The apparent high incidence of polycystic ovarian change requires further investigation.
Do We Know How to Screen for Gestational Diabetes? Current Practice in One Regional Health Authority
Authors: Nelson‐Piercy C. , Gale E.A.M.
Published: July 2009

To review current practice for screening and diagnosis of gestational diabetes (GDM) in the North East Thames health region, clinical directors and other relevant individuals in all 17 obstetric units within NE Thames were interviewed personally. Additional information was obtained from local midwives, diabetologists, and chemical pathologists. Thirteen centres had a formal policy for screening and diagnosis of GDM. One centre ran two policies. Six of 18 centres performed a routine blood glucose (BG) screen on all pregnant women, proceeding to OGTT either on the basis of raised BG alone (3 centres), or on the basis of raised BG and/or clinical risk factors (3 centres). Of the remainder, 10 performed a diagnostic test (OGTT or equivalent) in all those with risk factors, and 2 via an intermediate screening BG. The choice and interpretation of screening and diagnostic tests varied considerably. Six centres used random BG, with cut‐off ranging from > 5.8 mmol I−1 to > 9.0 mmol I−1, one used a single fasting BG > 5.0 mmol I−1, and another a 50 g oral glucose challenge (1 h level > 8.0 mmol I−1). Diagnosis of GDM was based on a 75 g (13 centres) or a 50 g OGTT (2 centres), while 1 used a standard mixed meal, and another a timed post‐prandial glucose sample. Timing of tests ranged from booking to 36 weeks gestation and the diagnostic cut‐off levels for GDM varied (fasting: 5.0–8.0 mmol I−1; 2 h: 6.0–10.1 mmol I−1). There is no consensus concerning screening and diagnosis of GDM in the NE Thames region. This may reflect uncertainty about the value of screening for this condition.
Microalbuminuria: Prognostic and Therapeutic Implications in Diabetes Mellitus
Authors: Gilbert R.E. , Cooper M.E. , McNally P.G. , O'Brien R.C. , Taft J. , Jerums G.
Published: July 2009

Thirty years following the development of the first radioimmunoassay for albumin, microalbuminuria is widely acknowledged as an important predictor of overt nephropathy in patients with Type 1 diabetes and of cardiovascular mortality in Type 2 diabetes. In addition, there is accumulating evidence to suggest that diabetic patients with microalbuminuria may have more advanced retinopathy, higher blood pressure, and worse dyslipidaemia than patients with normal albumin excretion rates. Recent studies have focused on the role of intervention, principally with antihypertensive therapy and intensive glycaemic control, in reducing microalbuminuria. While successful in reducing urinary albumin excretion it remains to be established whether such therapies will be translated into a reduction in renal failure and decreased cardiovascular mobidity and mortality.
Incidence of Insulin‐dependent Diabetes Mellitus in Age Groups Over 30 years in Denmark
Authors: Mølbak A.G. , Christau B. , Marner B. , Borch‐Johnsen K. , Nerup J.
Published: July 2009

The incidence of IDDM in the age group over 30 years was estimated in a historical prospective study, using clinical and biochemical measurements at onset as criteria for classification. The study population, nearly one million, represents 20% of the Danish population. The degree of ascertainment was >99%. One thousand two hundred and forty patients were treated with insulin during the study period (1973–77). Based on the clinical and biochemical variables, the patients were classified into three groups: insulin‐dependent diabetes mellitus (IDDM) accounted for 16.2%, insulin‐treated diabetes mellitus for 54.1% and short‐term treated diabetes mellitus for 29.6% of the total insulin‐treated group. The incidence of IDDM in the age group over 30 years at onset was 8.2 100 000−1 year−1. The cumulative incidence rate (0–90 years) was 1.5–1.6 per cent. The present study indicates that IDDM may develop at any age. Thus the life‐time risk of developing IDDM is higher than hitherto expected.
Cow's Milk and Type 1 Childhood Diabetes: No Increase in Risk
Authors: Bodington M.J. , McNally P.G. , Burden A.C.
Published: July 2009

A retrospective case‐control study was undertaken to investigate the relationship between the early introduction of cow's milk and the subsequent risk of developing Type 1 diabetes (< 15 years at diagnosis). A total of 268 children who developed diabetes during the period 1980–1990 (11 years inclusive) in Leicestershire were identified. Age‐, sex‐, and race‐matched controls were identified using the Leicestershire population register. Parents of children with diabetes and their controls completed a structured questionnaire on infant feeding habits from birth. A total of 184 questionnaires (67%) were analysed. There was no difference between the diabetic and control children with respect to the introduction of cow's milk at an early age and the risk of developing diabetes (odds ratio: 0.98 (0.65–1.47)). In addition, short duration of breast‐feeding (< 3 months) had no influence on the incidence of diabetes (1.05 (0.64–1.75)). This study does not support the hypothesis that the early introduction of cow's milk or a short duration of breast‐feeding increases the risk of developing Type 1 diabetes.
Trends in Diabetes Prevalence Among Stroke Patients and the Effect of Diabetes on Stroke Survival: the Minnesota Heart Survey
Authors: Sprafka J.M. , Virnig B.A. , Shahar E. , McGovern P.G.
Published: July 2009

This study documented trends in the prevalence of diabetes among men and women hospitalized for acute stroke and determined the effect of diabetes on short‐ and longterm survival following stroke. These issues were investigated in the Minnesota Heart Survey, a population‐based surveillance system that has monitored trends in stroke morbidity and mortality in the Minneapolis‐St Paul metropolitan area since 1970. Clinical data were obtained from the hospital records of 50% samples of residents ages 30 to 74 years who were discharged with a diagnosis of acute stroke in 1970, 1980, and 1985. Between 1970 and 1985, the prevalence of diabetes as listed on the discharge diagnoses among stroke patients increased significantly in men (22.4% vs 10.5%; p = 0.006) and non‐significantly in women (24.7% vs 15.9%; p = 0.3). During this time period, both in‐hospital and 28‐day case fatality rates declined in non‐diabetic stroke patients but remained unchanged in stroke patients with diabetes. After controlling for the effects of age, sex, survey year, and level of consciousness, diabetes status had little effect on short‐term (28‐day) mortality of stroke patients, but the odds of 5‐year mortality among those surviving to 1 year was 2.0 (95% Cl (1.3,3.2)) times higher in diabetic compared to non‐diabetic individuals. These findings suggest that the prevalence of diabetes has been increasing among stroke patients, and that the diabetic condition is a significant predictor of poorer long‐term but not short‐term survival following stroke.
Effects of a New Oral Hypoglycaemic Agent (CS‐045) on Metabolic Abnormalities and Insulin Resistance in Type 2 Diabetes
Authors: Mimura K. , Umeda F. , Hiramatsu S. , Taniguchi S. , Ono Y. , Nakashima N. , Kobayashi K. , Masakado M. , Sako Y. , Nawata H.
Published: July 2009

The effects of a thiazolidinedione antidiabetic agent (CS‐045) on diabetic metabolic abnormalities were studied in a double‐blind clinical trial. Fourteen patients with Type 2 diabetes were selected according to study criteria. Eight were treated with oral CS‐045 at 400 mg daily, and six were given placebo. A multi‐step, hyperinsulinaemic, euglycaemic clamp study, with simultaneous plasma free fatty acid study, and glucagon tolerance test were performed before and after administration of drug. Following 3 months of treatment with CS‐045, there were significant decreases in the mean levels of fasting plasma glucose (from 9.18 ± 0.95 to 7.78 ± 0.44 mmol l−1), postprandial plasma glucose (from 11.8 ± 1.23 to 10.36 ± 1.06 mmol l−1), and haemoglobin A1c (from 9.3 ± 0.4 to 6.8 ± 0.4%). Insulin sensitivity also improved (1st step: from 3.12 ± 0.33 to 4.70 ± 0.47 mg kg−1 min−1 (p < 0.01); 2nd step: from 5.61 ± 0.63 to 7.54 ± 0.58 mg kg−1 min−1 (p< 0.01); 3rd step: from 9.21 ± 0.67 to 11.10 ± 0.87 mg kg−1 min−1). The fasting free fatty acid level decreased significantly from 0.28 ± 0.04 to 0.22 ± 0.02 g l−1. The residual free fatty acid level (%) under insulin infusion clamp conditions decreased significantly from 63.7 ± 9.7 to 45.0 ± 9.2%. CS‐045 treatment was associated with decrease in total cholesterol, total triglycerides, and increase in HDL cholesterol. Basal C‐peptide immunoreactivity level decreased, but there was no change in the peak C‐peptide immunoreactivity value. None of these changes was observed in the placebo group. CS‐045 improved hyperglycaemia as well as insulin resistance. CS‐045 appears to have a different mode of hypoglycaemic action from that of the sulphonylureas.
Arterial Wall Changes in Type 2 Diabetic Subjects
Authors: Geroulakos G. , Ramaswami G. , Veller M.G. , Fisher G.M. , Renton S. , Nicolaides A. , Waldron H.A. , Diamond J. , Elkeles R.S.
Published: July 2009

Arterial ultrasonic appearances using high resolution ultrasound were studied in 97 subjects with Type 2 diabetes and age‐ and sex‐matched controls. The intima‐media thickness of both common carotid arteries was measured 2 cm proximal to the bifurcation and the presence or absence of plaque on both common and femoral bifurcations was recorded. The mean intima‐media thickness in subjects with diabetes was 0.82 ± 0.22 mm while in the controls 0.66 ± 0.13 mm (p < 0.001). Multiple regression in diabetic subjects only showed no correlation between age, sex, body mass index, smoking, duration of diabetes, systolic or diastolic blood pressure, cholesterol, HDL, LDL, triglycerides, HbA, and the common carotid artery intima‐media thickness. Type 2 diabetes is associated with increased intima‐media thickness which has been found to be a marker of cardiovascular events in the general population.
Pregnancy Outcome and Infant Mortality in Diabetic Patients in Sweden
Authors: Cnattingius S. , Berne C. , Nordström M.‐L.
Published: July 2009

Between 1983 and 1986, 914 single births to women with diabetes mellitus before pregnancy and a randomly selected control sample of 4000 births were identified by using the Swedish Medical Birth Registry. Twenty‐four percent of diabetic women were delivered preterm, as compared with 6% in the control group. The rates of late fetal death were a 1.3% among infants born to women with diabetes and 0.4% in the control group. Infant mortality was 0.9% and 0.5% among infants to mothers with and without diabetes mellitus, respectively. The increased rates of late fetal and infant deaths in the diabetes group were largely explained by higher mortality in the more prevalent preterm deliveries. Fourteen of 20 late fetal and infant deaths occurred among preterm infants in diabetic pregnancies, while in the control group, 17 of 33 late fetal and infant deaths occurred among preterm infants. Elimination of the increased rates of late fetal death and congenital malformation in diabetic pregnancy is required to meet the goals of the St Vincent Declaration. A nation‐wide registry of diabetic pregnancy outcomes is feasible and necessary for further quality assurance of diabetic pregnancies.
Obese Patients with Type 2 Diabetes Poorly Controlled by Insulin and Metformin: Effects of Adjunctive Dexfenfluramine Therapy on Glycaemic Control
Authors: Willey K.A. , Molyneaux L.M. , Yue D.K.
Published: July 2009

Dexfenfluramine is well known for its weight reducing action and has been reported to improve glycaemic control in obese Type 2 diabetic patients not adequately controlled on conventional oral hypoglycaemic therapy. In this double‐blind placebo‐controlled study, 20 obese Type 2 diabetic patients with mean HbA1c of 8.8 ± 0.5% (normal range 3.5–6.0%), and mean body mass index (BMI) of 34.4 ± 1.0 kg m−2, who were poorly controlled on insulin (mean dosage 58.0 ± 6.1 units day−1) were randomized to receive either additional dexfenfluramine or placebo for 12 weeks. Seventeen of these patients were already taking maximum tolerated metformin therapy (mean dosage 1.6 ± 0.2 g day−1) and the other three were unable to tolerate any at all. At baseline, the dexfenfluramine and placebo groups were similar in all parameters studied. After the 12‐week treatment period, median HbA1c had fallen in dexfenfluramine treated patients from 8.5 (interquartile range (IR): 7.5–10.3) to 7.1% (IR: 6.7–7.5; p < 0.02). The fall in HbA1c in individual patients after treatment with dexfenfluramine was strongly associated with weight loss (r = 0.69; p < 0.04), although as a group the changes in weight and BMI were not statistically significant. Placebo was without effect. These results show that in the obese patient with Type 2 diabetes who is poorly controlled despite large daily doses of insulin and metformin, adjunctive dexfenfluramine can improve glycaemic control without exacerbating weight gain.
Growth Factors and Diabetic Neuropathy
Authors: Thomas P.K.
Published: July 2009

A variety of soluble growth factors influence the peripheral nervous system. Although of considerable importance during development and growth, they appear also to be implicated in tissue maintenance in adult life and, particularly, during nerve regeneration. In addition, cell‐surface and extracellular connective tissue matrix molecules are intimately involved in regeneration. So far, the possible participation of such growth factors in the causation of diabetic neuropathy is only speculative, but there are indications that their use could be of value in treatment.
Cholesterol Rich apo B Containing Lipoproteins and Smoking are Independently Associated with Macrovascular Disease in Normotensive NIDDM Patients
Authors: Dean J.D. , Matthews S.B. , Dolben J. , Carolan G. , Luzio S. , Owens D.R.
Published: July 2009

A cross‐sectional study of macrovascular disease (MVD) and associated metabolic and other risk factors was conducted in 87 normotensive NIDDM patients. MVD was assessed by Rose questionnaire, 12 lead resting ECG, duplex scanning of carotid and peripheral vessels, and ankle:brachial systolic blood pressure ratio. Fasting serum total cholesterol, total triglycerides, LDL cholesterol, HDL cholesterol, apolipoproteins AI and B, lipoprotein (a), HbA1, plasma glucose, insulin, and C‐peptide responses to a carbohydrate rich meal, body mass index (BMI), waist‐hip ratio, urinary albumin excretion rate, blood pressure, smoking and family history were assessed as possible ‘risk factors’. Apolipoprotein:lipid ratios were calculated to estimate lipoprotein composition. Thirty‐six patients had demonstrable MVD. The presence of MVD was associated with higher total triglycerides (p < 0.05), BMI (p < 0.05), systolic blood pressure (p < 0.01), a lower apo B:non HDL cholesterol ratio (p < 0.001), and smoking (p < 0.005) but no other measures. Multiple regression analysis revealed smoking and a low apo B:non HDL cholesterol to be independently associated with MVD. The low apo B:non HDL cholesterol suggests a high cholesterol content of apo B containing lipoproteins. This lipoprotein abnormality is not a feature of NIDDM, but when present in these patients may be particularly atherogenic.
Serum Lipoprotein Levels and Plasma Concentrations of Insulin, Intact and 32, 33 Split Proinsulin in Normoglycaemic Relatives of Patients with Type 2 Diabetes
Authors: Gelding S.V. , Andres C. , Niththyananthan R. , Richmond W. , Gray I.P. , Johnston D.G.
Published: July 2009

Type 2 diabetes is associated with abnormal lipoprotein levels and altered plasma concentrations of insulin, intact and 32, 33 split proinsulin. To investigate whether these are early features of the disease, we studied 36 normoglycaemic first‐degree relatives of patients with Type 2 diabetes (13 European, 15 of Asian (Indian‐subcontinent), and 8 of Afro‐Caribbean origin) and 36 control subjects with no family history of diabetes. Relatives and controls were matched for age (mean ± S.E. 33 ± 2 vs 34 ± 2 years), body mass index (23.7 ± 0.5 vs 23.7 ± 0.6 kg m−2), sex (17 M, 19 F) and ethnic origin. After an overnight fast, blood was sampled for measurement of serum lipids, plasma glucose and insulin, intact and 32, 33 split proinsulin by specific immunoradiometric assays. Relatives and controls had similar fasting concentrations of glucose (5.0 ± 0.1 vs 4.9 ± 0.1 mmol l−1), total cholesterol (4.51 ±0.13 vs 4.54 ± 0.17 mmol l−1), HDL‐cholesterol (1.21 ± 0.06 vs 1.10 ± 0.05 mmol l−1), LDL‐cholesterol (2.84 ± 0.14 vs 2.96 ± 0.14 mmol l−1) and triglyceride (median (range) 0.78 (0.44–2.45) vs 0.83 (0.41–4.03) mmol l−1). Fasting levels of insulin (50.4 (18.9–174.0) vs 51.6 (10.0–118.0) pmol l−1 intact proinsulin (2.8 (0.1–15.0) vs 2.1 (0.6–6.4) pmol l−1 and 32, 33 split proinsulin (2.0(0–23.7) vs 1.6 (0.3–6.0) pmol l−1) were not significantly different between relatives and controls. Analysis of results for each ethnic group separately did not alter the findings. It is concluded that glucose‐tolerant subjects at risk of future diabetes have normal fasting lipid concentrations and plasma levels of insulin and its precursors. This suggests that the dyslipidaemia and altered insulin concentrations found in overt Type 2 diabetes are not present before the onset of glucose intolerance.
Human Red Cell Membrane Fluidity and Calcium Pump Activity in Normolipidaemic Type II Diabetic Subjects
Authors: Muzulu S.I. , Bing R.F. , Norman R.I. , Burden A.C.
Published: July 2009

Red cell membrane cholesterol, 1,6‐diphenyl‐1,3,5‐hexatriene (DPH) and 1‐[(4‐trimethylammonium)phenyl]‐6‐phenyl‐1,3,5‐hexatriene (TMA‐DPH) anisotropics and basal and calmodulin‐stimulated calcium pump activities were compared in 16 normolipidaemic Type 2 (non‐insulin‐dependent) diabetic patients and 20 normolipidaemic control subjects using the Mann‐Whitney U‐test. Serum cholesterol, membrane cholesterol, and membrane DPH and TMA‐DPH anisotropics were similar in the two groups but both basal and calmodulin‐stimulated calcium pump activities were reduced in the diabetic group: basal activity (median (inter‐quartile range), μmol mg−1 h−1) 1.66 (1.18–1.97) vs 2.09 (1.90–2.50), p < 0.005 and calmodulin‐stimulated activity 4.19 (3.07–5.48) vs 5.53 (4.70–6.88), p < 0.006. Although there were no correlations between glycaemic control and membrane anisotropy and between glycaemic control and calcium pump activity, the reduction in calcium pump activity is most likely due to a direct effect of diabetes on the calcium pump protein itself.
Occupational Hydrocarbon Exposure and Diabetic Nephropathy
Authors: Yaqoob M. , Patrick A.W. , McClelland P. , Stevenson A. , Mason H. , Percy D.F. , White M.C. , Bell G.M.
Published: July 2009

Exposure to hydrocarbons has been implicated in the pathogenesis of glomerulonephritis but its role in the development of diabetic nephropathy remains unknown. Three groups of patients with Type 1 diabetes of over 10 years duration were studied. Group 1 comprised 45 patients (23 F) with no diabetic nephropathy (urinary albumin excretion (AER) –30 mg 24 h−1), group 2 comprised 37 patients (17 F) with incipient diabetic nephropathy (AER between 30–300 mg 24 h−1), and group 3 comprised 31 patients (15 F) with overt diabetic nephropathy (AER >300 mg 24 h−1). The groups were comparable for age, sex, duration of diabetes, recent glycaemic control, social class, and residential area. Patients were assessed blindly by a validated questionnaire and interview for hydrocarbon exposure, consumption of tobacco, analgesic agents, and alcohol. Exposure scores to hydrocarbons derived from the questionnaire were significantly higher in patients with incipient and overt diabetic nephropathy with smoking adjusted odds ratios of 3.6 and 5.2, respectively. The consumption of alcohol, analgesic agents, tobacco, and smoking habits were similar in the three groups. In conclusion, hydrocarbon exposure may be a key environmental factor in the development of diabetic nephropathy in patients with Type 1 diabetes.
Relationships Between Diabetes Duration, Metabolic Control and β‐cell Function in a Representative Population of Type 2 Diabetic Patients in Sweden
Authors: Clauson P. , Linnarsson R. , Gottsäter A. , Sundkvist G. , Grill V.
Published: July 2009

To clarify whether metabolic control and β‐cell function deteriorate with increasing duration of diabetes, we investigated in a cross‐sectional study Type 2 diabetic patients in an area‐based population. Type 2 diabetic patients (n = 231: 112 males, 119 females) were identified by age at onset > 35 years, fasting levels of C‐peptide > 0.04 nmol l−1, and absence of islet cell antibodies. Body weight was slightly elevated (BMI 26.8 ± 0.3 kg m−2), however 76/210 (36%), had normal weight (BMI < 25 kg m−2). Fasting blood glucose rose significantly during the first 10 years of known diabetes from 8.2 ± 0.3 mmol l−1 in patients with 0–5 years of duration to 9.9 ± 0.7 mmol l−1 in those with 5–10 years of duration, p < 0.01 and HbA1c from 6.4 ± 0.2 to 7.4 ± 0.4%, p < 0.05. Fasting C‐peptide levels decreased after 10 years duration from 0.90 ± 0.06 nmol l−1 during 5–10 to 0.69 ± 0.08 nmol l−1 during 10–15 years of diabetes, p < 0.05. The proportion of insulin treated patients increased from 13% (12/94) with 0–5 years of duration to 33% (13/39) with 10–15 years and 60% (18/30) with more than 15 years of duration. In conclusion in Type 2 diabetic patients without signs of autoimmunity, metabolic control, and β‐cell function deteriorate with increasing duration of diabetes, leading to common but not inevitable occurrence of ‘secondary failure’.
Islet Amyloid Polypeptide: Does it Play a Pathophysiological Role in the Development of Diabetes?
Authors: Bennet W.M. , Smith D.M. , Bloom S.R.
Published: July 2009

There is suggestive evidence that amylin acts physiologically in an autocrine manner within the islet to restrain insulin secretion, but conversely there is little indication that this action of amylin plays any role in the development of NIDDM. Deposition of amylin within pancreatic islets is a feature in patients with NIDDM but is of sufficient degree to disrupt beta‐cell function in only a small minority of individuals. Current evidence suggests that amylin does not have any physiologically important extra‐islet metabolic effects. The potential exists for the development of amylin antagonists as pharmacological agents to enhance insulin secretion in NIDDM but antagonism of systemic CGRP would need to be avoided. There is little, if any, indication that either replacement of amylin or treatment with amylin agonists are likely to have any beneficial role in patients with IDDM.
Autoantibodies to Glutamic Acid Decarboxylase and Insulin in Islet Cell Antibody Positive Presymptomatic Type 1 Diabetes Mellitus: Frequency and Segregation by Age and Gender
Authors: Zimmet P.Z. , Elliott R.B. , Mackay I.R. , Tuomi T. , Rowley M.J. , Pilcher C.C. , Knowles W.J.
Published: July 2009

The frequency of antibodies to glutamic acid decarboxylase (GAD) and insulin (IAA) in presymptomatic Type 1 diabetes mellitus with a positive test for antibodies to islet cell antigen (ICA) was examined. Thirty‐two persons positive for ICA (> 10 JDF units) were tested 2 to 48 months before their ascertained onset of Type 1 diabetes. ICA was quantitated by immunofluorescence as JDF units, anti‐GAD by radioimmunoprecipitation and anti‐insulin by radioimmunoassay. There was a positive test for anti‐GAD in 25 (78%), and for IAA in 23 (72%), of the 32 prediabetic ICA‐positive subjects. Stratification according to age at the onset of diabetes showed differing frequencies of anti‐GAD and IAA in the prediabetic stage. Thus the positivity rate for anti‐GAD for 18 subjects older than 10 years at onset of diabetes was 83%, and for 14 aged 10 or younger at onset was 71%; conversely, the rate for IAA for 18 subjects older than 10 at onset was 56% and for 14 aged 10 or less at time of onset was 93% (p = 0.01). The frequency of anti‐GAD was higher in females (88%) than males (71%) whereas the frequency of IAA was higher in males (82%) than in females (60%). Since autoantibodies to GAD and insulin occur in presymptomatic Type 1 diabetes with differences in frequencies by age and gender, the stimuli to autoimmunity may operate differently at different ages, and may also be gender‐related.
The Influence of Hypertension on Microvascular Blood Flow and Resistance to Flow in the Skin of Patients with Type 2 (Non‐insulin‐dependent) Diabetes
Authors: Jaap A.J. , Shore A.C. , Tooke J.E.
Published: July 2009

Maximum microvascular blood flow and resistance to flow were determined in the skin of nine hypertensive and nine normotensive Type 2 (non‐insulin‐dependent) diabetic patients and nine control subjects to determine the influence of hypertension on these variables. Maximum blood flow was reduced in both the hypertensive (1.05 (0.70–1.42) V) and normotensive (1.04 (0.79–1.63) V) Type 2 diabetic patients when compared with control subjects (1.40 (1.26–2.13) V, p < 0.01 for hypertensive and p < 0.05 for normotensive patients, respectively); however, maximum blood flow was similar in both groups of diabetic patients (p = 0.82). In contrast, resistance to flow was significantly greater in the diabetic patients with hypertension (127.2 (87.5–181.3) mmHg V−1 vs 84.7 (61.9–123.0) mmHg V−1 normotensive diabetic patients, p < 0.02). In addition, R was greater in the normotensive Type 2 diabetic patients than in control subjects (70.7 (44.7–79.9) mmHg V−1, p < 0.05). These results suggest that hypertension is associated with an additional rise in pre‐capillary vascular resistance in Type 2 diabetes which, while protecting the microcirculation from the effects of increased arterial pressure, may further diminish protective hyperaemic responses.
Is There a Role for Beta‐blockers in Hypertensive Diabetic Patients?
Authors: Tse W.Y. , Kendall M.
Published: July 2009

Clinical trials have not yet produced long‐term primary prevention data on the effects of angiotensin converting enzyme inhibitors, calcium antagonists or alpha‐blockers on cardiovascular complications and sudden death in hypertensive patients. Large‐scale secondary preventive studies on calcium antagonists have been disappointing. In contrast, beta‐blockers have an established role in cardioprotection both in primary and secondary preventive studies and there is evidence to show that the cardioprotective effect of beta‐blockers is even greater in the diabetic population. Furthermore, this favourable impact of beta‐blockers was achieved despite diabetic patients having a worse risk factor profile and poorer prognosis. In this review the use of beta‐blockers in diabetic patients will be discussed and their impact on coronary artery disease described.
The Use of Gamma Linolenic Acid in the Prevention and Treatment of Diabetic Neuropathy
Authors: Jamal G.A.
Published: July 2009

A substantial disturbance of the metabolism of the n‐6 essential fatty acids (EFAs) exists in both human and experimental diabetes mellitus. The process of conversion of dietary linoleic acid to gammalinolenic, dihomogammalinolenic and arachidonic acids, and other polyunsaturates is inadequate in diabetic patients. Disturbances of these EFAs and the 1– and 2–series prostaglandins derived from them cause a variety of microvascular, haemorheological, and other abnormalities leading to reduced blood flow and neural hypoxia. This will in turn produce an escalating cycle of further hypoxia through the generation of oxygen‐free radicals and aggravation of neural capillary endothelial damage. Endoneurial hypoxia impairs axonal transport, produces demyelination, and reduces neural ATP‐ase activity. Furthermore, depletion of polyunsaturated fatty acids derived from n‐6 pathway may lead to abnormalities of myelin turnover, membrane‐bound proteins (such as enzymes and receptors) and other axonal structural abnormalities. The disorders postulated here may synergistically interact with the metabolic changes described in both the glycosylation and the myoinositol hypotheses and may have important implications in the approach to treat diabetic neuropathy.
Interpreting Hospital Admissions Data Across the Kørner Divide: the Example of Diabetes in the North Western Region
Authors: Williams D.R.R. , Anthony P. , Young R.J. , Tomlinson S
Published: July 2009

Hospital admission rates and hospital bed utilization rates are presented for all admissions assigned to diabetes mellitus as principal cause in the North Western Region from 1980/81 to 1990/91. Data are derived from Hospital Activity Analysis (1980/81–1986/87) and from the Regional Information System (1988/89–1990/91). Admission rates for all categories of diabetes combined showed little change until 1986/87 after which they rose progressively each year. Hospital bed utilization rates fell progressively from 1986/87 onwards, the number of bed days attributed to diabetes falling from 1.9 % to 0.8 % of the total for all causes. Most of the rise in admission rates from 1988/89 onwards was attributable to diabetes with ophthalmic complications (ICD 250.4). This was heavily influenced by the enumeration of day cases in the Regional Information System. When these are discounted, admission rates for the more recent years are stable. Diabetes without mention of complications (ICD 250.0) showed the most dramatic decline in its contribution to hospital bed utilization. This may be the result of increasing outpatient support from diabetes specialist nurses whose numbers increased in inverse proportion to the fall in bed utilization attributed to ICD 250.0.
Fetal Proinsulin and Birth Weight
Authors: Dornhorst A. , Nicholls J.S.D. , Ali K. , Andres C. , Adamson D.L. , Kelly L.F. , Niththyananthan R. , Beard R.W. , Gray I.P.
Published: July 2009

In both diabetic and non‐diabetic pregnancies fetal insulin is an important anabolic hormone. Fetal hyperinsulinaemia is associated with accelerated fetal growth and increased birth weight. Insulin and C‐peptide concentrations in both umbilical cord and amniotic fluid reflect fetal β‐cell secretion and are correlated with birth weight. In the present study umbilical venous proinsulin and insulin concentrations were measured in 54 term infants born to women with and without mild disturbances of glucose tolerance. Umbilical venous cord proinsulin, assayed using a highly specific immunoradiometric assay, was independently correlated with infant birth weight (Rho = 0.53, p ± 0.0001) and birth percentile (Rho = 0.65, p ± 0.0001). The correlation between birth weight and birth percentile weight with umbilical venous insulin, measured using a non‐specific insulin assay, was lost following correction for the influence of proinsulin. Umbilical venous cord proinsulin appears to be a good indicator of fetal β‐cell activity, and in this study, a superior marker to insulin assayed using a non‐specific insulin radioimmunoassay. The longer half‐life of proinsulin compared with insulin may contribute to proinsulin being a more robust marker of overall fetal β‐cell activity than insulin.
Glucokinase Gene Polymorphisms: a Genetic Marker for Glucose Intolerance in a Cohort of Elderly Finnish Men
Authors: McCarthy M.I. , Hitman G.A. , Hitchins M. , Riikonen A. , Stengård J. , Nissinen A. , Tuomilehto‐Wolf E. , Tuomilehto J.
Published: July 2009

Although mutations in the glucokinase gene are implicated in the pathogenesis of glucose intolerance in pedigrees with maturity‐onset diabetes of the young, the role of such mutations in typical Type 2 diabetes is poorly characterized. We studied a cohort of elderly men born (between 1900 and 1919) in two Finnish communities and exhibiting a continuous spectrum of glucose tolerance at assessments made in 1984 and 1989. Individuals were typed at two polymorphic microsatellites straddling the glucokinase gene, GCK(3’) (n = 169) and GCK(5’) (n = 166): these two markers were in linkage equilibrium in this cohort. Significant associations between alleles at the GCK(3’) marker and glucose tolerance were evident (p = 0.002), the frequency of the (z + 2) allele rising from zero in control subjects (n = 88 chromosomes) to 6.5 % (n = 62) in subjects with impaired tolerance and 12.2 % (n = 188) in subjects with diabetes. Mean 2‐h glucose levels were 10.5 (9.6–11.4, 95 % confidence interval) mmol I‐1 in individuals with the (z + 2) allele and 8.1 (7.6–8.7) mmol I‐1 in those without (p = 0.01, corrected for multiple comparisons). No association was evident between GCK(5’) alleles and glucose tolerance. The GCK(3’) microsatellite is a marker for abnormal glucose tolerance in this cohort of elderly Finnish men.
Cerebral Glucose Metabolism in Type 1 Diabetic Patients
Authors: Ziegler D , Langen K.‐J. , Herzog H. , Kuwert T. , Mühlen H. , Feinendegen L.E. , Gries F.A.
Published: July 2009

To evaluate whether cerebral glucose metabolism is impaired in diabetes the [18F]–2–deoxy–2–fluoro‐d‐glucose method and positron emission tomography were used to determine the regional cerebral metabolic rate of glucose in 12 healthy subjects, 8 newly diagnosed Type 1 diabetic patients, 6 Type 1 diabetic subjects without peripheral neuropathy, and 7 Type 1 diabetic patients with symptomatic peripheral neuropathy, all of whom were men. In addition, multimodal evoked potentials were assessed. Cerebral glucose consumption was significantly reduced in the group with neuropathy as compared with the newly diagnosed diabetic patients and the healthy subjects (26.9 ± 1.0 vs 33.9 ± 1.9 and 32.5 ± 1.1 ±mol 100 g‐1 min‐1; p<0.05), while in the patients without neuropathy it was 30.2 ± 2.5 ±mol 100 g‐1 min‐1 (NS vs the remaining groups). There were no significant differences between the groups regarding brainstem auditory and visual evoked potentials. No relationship was noted between cerebral glucose metabolism and P300 latency of event‐related potentials as an index of cognitive function, but there was an inverse correlation with age (r = ‐0.42; p < 0.05) and duration of diabetes (r = ‐0.67; p < 0.05). These results suggest that cerebral glucose metabolism is normal at the time of diagnosis of Type 1 diabetes, but may become altered with both increasing duration of diabetes and age in the absence of central conduction deficits or cognitive dysfunction. Diabetic neuropathy may constitute a possible additional correlate of reduced cerebral glucose consumption.
Diabetes and Alternative Medicine: Cause for Concern
Authors: Gill G.V. , Redmond S. , Garratt F. , Paisey R.
Published: July 2009

‘Alternative’ medicines are becoming increasingly popular, and in this paper we describe our experience with alternative approaches to orthodox diabetes management. Four patients with insulin‐dependent diabetes reduced or stopped their insulin in favour of therapeutic approaches including prayer, faith healing, unusual diets, and supplements of vitamins and trace elements. This resulted in ketoacidosis in three, in one case life‐threatening; and weight loss and hyperglycaemia in the other. One patient developed serious retinopathy. Additionally, eight other types of alternative diabetic treatment are described, not as far as we know associated with such serious complications. These include homeopathy, reflexology, meditation, herbal treatment, ‘cellular nutrition’, ‘subconscious healing’, ‘pearl therapy’ (drinking milk in which pearls have been boiled) and ‘astrotherapy’ (tying pieces of coral around the arm). Diabetes is a chronic incurable disease, for which modern treatments remain somewhat unsatisfactory. It is therefore perhaps not surprising that some patients seek alternative treatments with more attractive claims. Diabetes health professionals need to be aware of the potential dangers associated with some of these treatments.
A Ward Comparison Between the One Touch II and Glucometer II Blood Glucose Meters
Authors: Kilpatrick E.S. , McLeod M.J. , Rumley A.G. , Small M.
Published: July 2009

A 6–week clinical evaluation of the One Touch II blood glucose meter was performed in a medical ward specializing in diabetic patients and compared to the existing Glucometer II system. Nursing staff trained in both methods performed 267 capillary blood glucose measurements using the two meters. A reference capillary blood glucose was performed simultaneously on 129 of these occasions using a Yellow Springs Instrument analyser. The One Touch II correlated better with the reference (r = 0.97) than the Glucometer II (r = 0.86) and was equally close or closer to the Yellow Springs Instrument on 82 % of occasions. A greater proportion of samples measured by the One Touch II were within 15% of the reference value (83 % vs 66 %). There were also 17 cases where the One Touch II was able to give a measurement which was outwith the analytical range of the Glucometer II. A questionnaire revealed the nursing staff unanimously preferred using the One Touch II to their present meter. It is concluded that in a ward setting the One Touch II meter showed improved accuracy, usefulness in its wider analytical range, and a greater user preference in comparison to the Glucometer II.
The Direct Cost of Type 1 Diabetes Mellitus in Israel
Authors: Stern Z. , Levy R.
Published: July 2009

Estimates of the cost of Type 1 (insulin‐dependent) diabetes mellitus should take into account the development of various complications. In this study, we calculated separately the basic direct costs of a Type 1 diabetic patient over a span of 35 years of living with the disease, and on average, the cost of complications which developed during this period of time. Assessment of costs showed that there is a difference between the cost of treating the disease itself, which decreases over the years, and the cost of treating its complications, which increases. The cost of treating one patient over the 35‐year period amounted to about £247 000 in 1993 prices, and in terms of discount value, to about £104 000. These costs are significant in planning the health expenditure and the investment of resources for prevention of the disease, and in selecting proper methods of treatment of complications.
Reduced Postprandial Energy Expenditure in Women Predisposed to Type 2 Diabetes
Authors: Robinson S. , Niththyananthan R. , Anyaoku V. , Elkeles R. S. , Beard R. W. , Johnston D. G.
Published: July 2009

Type 2 (non‐insulin dependent) diabetes is so common that it has been hypothesized that in the course of evolution the predisposition to it may have conferred some advantage, before or during the reproductive years. It is frequently preceded by gestational diabetes. In order to test the basis for the hypothetical advantage, energy expenditure was investigated in 10 women with documented transient diabetes in a previous pregnancy. They were studied early in a subsequent pregnancy while glucose tolerance was still normal and 9 were re‐studied after pregnancy. Their results were compared with normal matched controls. During pregnancy, resting energy expenditure was similar in the study group and controls (6.58 (5.77–7.55) median (range) vs 6.91 (6.56–7.36) MJ day‐1, respectively). However, the energy response to a mixed meal (42 kJ kg‐1 lean body mass) was decreased in the study group (45 (33–68) vs 76 (50–89) kJ, p<0.05). After pregnancy resting energy expenditure was again similar in the two groups, but the decrease in postprandial thermogenesis persisted (78 (59–84) vs 92 (79–105) kJ, p<0.05). The patients were resistant to exogenous insulin, 0.05 U kg‐1 intravenously (slope of the plasma glucose decline in the 15 min after insulin; during pregnancy patients 52 (37–92) vs controls 111 (104–121) μmol l‐1 min‐1, p<0.01; after pregnancy 130 (88–156) vs controls 186 (152–221) μmol l‐1 min‐1, p<0.01). The postprandial energy saving in these women could constitute an evolutionary advantage. Insulin resistance may be the mechanism for limiting postprandial thermogenesis.
Insulin Regimens for the Non‐insulin Dependent: Impact on Diurnal Metabolic State and Quality of Life
Authors: Taylor R. , Foster B. , Kyne‐Grzebalski D. , Vanderpump M.
Published: July 2009

A randomized prospective study was conducted to determine whether the insulin regimen for NIDDM subjects poorly controlled on oral therapy should be designed primarily to control basal metabolism or to control mealtime hyperglycaemia. Grossly obese subjects were excluded. After a 2‐month run‐in phase involving intensive education, subjects were randomized to therapy with twice daily isophane or three times daily soluble insulin. Both Protaphane and Actrapid brought about similar improvement in HbA1 (9.5 ± 0.5 and 9.7 ± 0.4%) compared with baseline (11.7 ± 0.5%; p<0.001). Diurnal blood glucose profiles showed that despite the good post‐prandial control achieved by pre‐meal soluble insulin, loss of control occurred overnight, resulting in higher fasting blood glucose levels compared with Protaphane therapy (8.0 ± 0.8 vs 10.6 ± 0.8 mmol l‐1; p<0.05). The overall rate of hypoglycaemia was 0.44 patient‐1 year‐1. Thirty‐two mild hypoglycaemic episodes occurred on Protaphane therapy and 79 on Actrapid therapy. Using formal psychometric tests it was shown that insulin therapy was associated with improved treatment satisfaction and that this was greater on Protaphane therapy (p<0.05). Overall well‐being increased similarly in the two groups. All subjects wished to continue with insulin therapy after the conclusion of the study. The insulin regimen for moderately or poorly controlled non‐insulin‐dependent diabetes should primarily be designed to correct the basal insulin deficiency rather than to mimic normal meal‐induced insulin secretion.