bluuebunny/crossref_metadata_2025 huggingface dataset:
Metabolic Control in Non-Insulin-Dependent Diabetes Mellitus: Factors Associated With Patient Outcomes
Authors: O'connor Patrick J , Fragneto Regina , Coulehan John , Crabtree Benjamin F
Published: March 2007

We conducted a cross-sectional study to assess the association of various demographic and medical-care variables with metabolic outcomes in non-insulin-dependent diabetic subjects. The study population was representative of the diagnosed care-seeking diabetic population of a defined geographic community on the Navajo reservation in Arizona. The dependent variable metabolic control was measured as the mean of all random plasma glucose values obtained only at scheduled diabetes clinic visits over 2yr.

Multivariate analysis of the data showed that better metabolic control was most strongly associated with compliance with scheduled appointments. Mode of treatment was also associated with metabolic control. Other variables tested, including source of care, age, sex, duration of diabetes, presence of complications, and weight change, were not associated with metabolic control.

The strongest analysis of covariance model with demographic and medical-care variables accounted for 39% of the variance in metabolic control. The analysis suggests that other variables, possibly including several psychosocial variables, need to be assessed for their contribution to metabolic control.
Comparison of Intravenous Glucagon and Dextrose in Treatment of Severe Hypoglycemia in an Accident and Emergency Department
Authors: Collier Andrew , Steedman David J , Patrick Alan W , Nimmo Graham R , Matthews David M , Macintyre Cecilia C A , Little Keith , Clarke Basil F
Published: March 2007

Hypoglycemia is a serious problem in insulin-treated diabetic patients. In this study the efficacy of intravenous glucagon (1 mg) was compared with that of intravenous dextrose (25 g) in the treatment of hypoglycemia in insulin-treated patients attending an accident and emergency department. In addition, the prevailing glycemic control of these patients was compared with patients routinely attending a diabetic outpatient clinic. Both intravenous glucagon and dextrose were effective in the treatment of hypoglycemic coma. There was a difference in the glycemic profile after intravenous glucagon compared with intravenous dextrose, and recovery of a normal level of consciousness after glucagon was slower than after dextrose (6.5 vs. 4.0 min, respectively; P < .001), although the average duration of hypoglycemic coma was 1.4 h. The glucagon- and dextrose-treated groups had significantly lower HbA1 than comparable patients routinely attending the clinic (9.5 ± 0.8 vs. 12.0 ± 3.8%, respectively; P < .001). In view of the ease of administration and the small risk of vascular and extravascular complications, intravenous glucagon appears to be a useful alternative to intravenous dextrose in the treatment of severe hypoglycemia.
Sensitivity of R-R Variation and Valsalva Ratio in Assessment of Cardiovascular Diabetic Autonomic Neuropathy
Authors: Rothschild Armand H , Weinberg Clarice R , Halter Jeffrey B , Porte Daniel , Pfeifer Michael A
Published: March 2007

R-R variation and the Valsalva ratio are commonly used to quantitatively assess diabetic autonomic neuropathy (DAN). To assess the sensitivity of these two measures to parasympathetic ablation, 12 nondiabetic subjects were tested before and after graded doses (0.3–4.0 mg i.v.) of atropine. R-R variation was significantly reduced at 0.7 mg, whereas Valsalva ratio was not significantly smaller until the 2.0-mg dose of atropine. R-R variation continued to become progressively smaller during the 0.85-, 1.0-, and 2.0-mg doses. Valsalva ratio, but not R-R variation, was further reduced by the 4.0- mg dose. To further compare these two measures, two groups of diabetic subjects were compared with a group of nondiabetic subjects (n = 22). One group of diabetic subjects had symptoms of DAN (n = 22), and the other diabetic group had no symptoms of DAN (n = 19). In DAN subjects, both R-R variation (nondiabetic 33.2 ± 4.3 vs. DAN 9.8 ± 1.2, P < .001) and the Valsalva ratio (nondiabetic 1.98 ± 0.07 vs. DAN 1.55 ± 0.07, P < .001) were reduced. However, in asymptomatic subjects, R-R variation (23.2 ± 3.9, P < .05), but not Valsalva ratio (1.94 ± 0.13, NS), was less than nondiabetic subjects. Even after p-blockade, R-R variation was still less in both groups of diabetic subjects (nondiabetic 34.4 ± 4.2 vs. DAN 7.4 ± 1.3, P < .001; asymptomatic 21.8 ± 3.3, P < .02). Thus, the reduced R-R variation is more likely due to decreased parasympathetic rather than increased sympathetic activity. We conclude that R-R variation is more sensitive than Valsalva ratio in detecting parasympathetic ablation and is useful for early detection and follow-up of mild autonomic dysfunction. Valsalva ratio may be more useful for sequential long-term evaluation in subjects with severe diabetic autonomic dysfunction, in whom R-R variation is maximally suppressed.
Prevalence of Hypertension and Associated Risk Factors Among Diabetic Individuals: The Three-City Study
Authors: Sprafka J Michael , Bender Alan P , Jagger Helen G
Published: March 2007

A cross-sectional study was conducted from 1979 through 1982 in three rural Minnesota cities to describe the natural history of diabetes mellitus. Detailed abstracts of the medical records of physician-defined diabetic individuals were used to construct medical profiles. As part of the effort, the date of physiciandefined hypertension was identified and used to calculate hypertension prevalence. The crude hypertension prevalence was 56.8% for women and 33.99% for men, with an overall crude prevalence of 47.2%. No hypertensive patients were identified among diabetic patients <15 yr old, and most hypertensive diabetic patients were >70 yr old. Hypertension prevalence in diabetic individuals demonstrated a highly significant trend with age (P < .01). Compared with the general population, diabetic individuals had a significantly higher prevalence of hypertension (P < .01), largely explained by the higher prevalence in women. Variables known to be associated with hypertension risk in the general population were also significantly associated with hypertension among diabetic individuals. Older age, being female, nd increased body mass index were strongly associated with hypertension in this study population. Diabetic individuals with hypertension were six times more likely to have renal disease than those without hypertension.
Influence of Small-Group Education Sessions on Glucose Homeostasis in NIDDM
Authors: Raz Itamar , Soskolne Varda , Stein Pnina
Published: March 2007

In patients with non-insulin-dependent diabetes mellitus (NIDDM), the influence of knowledge about their disease on the treatment and control of the disease is not clear. We evaluated the efficacy of educational group meetings with NIDDM patients on improving their knowledge of the disease and on disease management. Fifty-one NIDDM patients were randomly assigned to either intervention or control groups. The intervention group participated in courses of three weekly lessons presented by a physician, nurse, and dietitian once every 4 mo. The intervention and control groups were also followed once every 2 mo in the clinic by the same staff. Medical treatment remained unchanged during the study. After a 12-mo follow-up of the intervention group, no significant improvement in their knowledge of diabetes could be demonstrated. However, mean fasting and postprandial blood glucose levels and HbA1c improved significantly in comparison with the control goup. The same tendency was evident with the weight and lipoprotein profile. We conclude that educational group therapy can improve diabetes control in patients with NIDDM.
Lower-Extremity Amputations in NIDDM: 12-Yr Follow-Up Study in Pima Indians
Authors: Nelson Robert G , Gohdes Dorothy M , Everhart James E , Hartner Judith A , Zwemer Frank L , Pettitt David J , Knowler William C
Published: March 2007

The incidence of lower-extremity amputations was estimated in the Pima Indians of the Gila River Indian Community in Arizona, a population with a high prevalence of non-insulin-dependent diabetes mellitus (NIDDM). Between 1972 and 1984, from a study population of 4399 subjects, lower-extremity amputations were performed on 84 patients, 80 (95%) of whom had NIDDM. Among diabetic subjects, the incidence rate of first lower-extremity amputations was higher in men than in women. Rates increased significantly with increasing duration of diabetes. Presence of medial arterial calcification, retinopathy, or nephropathy; absence of patellar tendon reflexes; impaired great toe vibration-perception threshold; and degree of fasting and 2-h postload hyperglycemia were significant risk factors for amputations. Serum cholesterol concentration, blood pressure, age, and absence of Achilles tendon reflexes were not predictive of amputations. The death rate was greater in diabetic amputees than in diabetic nonamputees of similar age, sex, and duration of diabetes, and a significant increase in cardiovascular deaths was observed in diabetic subjects with amputations. The incidence rate of lowerextremity amputations in diabetic Pima Indians is higher than that reported in other diabetic populations. This may reflect differences in risk or a more complete case ascertainment than was possible in previous studies. If the latter is true, the rate of amputations in diabetic individuals may be higher than has been previously appreciated.
Neurobehavioral Complications of Type I Diabetes: Examination of Possible Risk Factors
Authors: Ryan Christopher M
Published: March 2007

There is increasing interest in the possibility that diabetes mellitus may be associated with a series of neurobehavioral, or neuropsychological, changes; i.e., learning, memory, problem solving, mental and motor speed, and eye-hand coordination may sometimes be disrupted in diabetic children and adults, and this disruption may be a consequence of certain diseaserelated variables. To date, four neurobehavioral risk factors have been identified. For children and adolescents, the most potent risk factors appear to be age at diagnosis and the occurrence of schoolroomrelated problems. Children who develop diabetes early in life are more likely to show serious cognitive impairments on virtually all measures. In addition, diabetic children with school attendance problems tend to score lower than expected on verbal IQ tests and school achievement tests. For adults, the most carefully studied risk factor is degree of metabolic control. Adults in poor control are far more likely to manifest subtle changes on measures of mental efficiency. This may be particularly evident on tasks that require the development and deployment of sophisticated information-processing strategies. A fourth variable— severe episodes of hypoglycemia—is known to disrupt functioning in diabetic subjects of any age, although it has not yet been studied systematically in large-scale studies. Indeed, because virtually all extant studies have been based on limited neurobehavioral and biomedical assessments of relatively few volunteer subjects, this list of risk factors must be considered tentative at best.
Influence of Antihypertensive Therapy on Development and Progression of Diabetic Glomerulopathy
Authors: Anderson Sharon , Brenner Barry M
Published: March 2007

Capillary hypertension is suggested to be the underlying cause of microvascular disease affecting the kidney, the retina, and other organs and tissues in diabetic patients and animals. Hyperglycemia causes an expansion of extracellular volume, which induces a vasodilatory response. Hemodynamic adaptation to vasodilation leads to an increase in intracapillary hydraulic pressure, which subs quently causes vascular damage. In experimental animals, restoration of capillary pressure to normal levels by ingestion of a low-protein diet or administration of an angiotensin l-converting enzyme inhibitor has been s own to prevent microvascular damage in the kidney, and dietary protein restriction limits injury in the retina as well. Atrial natriuretic peptide, which is secreted by atrial myocytes in response to volume expansion, may be involved in mediation of the hemodynamic adaptation (vasodilatory response) that results in diabetic microvascular disease.
Comparative Effect of Captopril and Nifedipine in Normotensive Patients With Incipient Diabetic Nephropathy
Authors: Mimran Albert , Insua Alvaro , Ribstein Jean , Bringer Jacques , Monnier Louis
Published: March 2007

In these studies, the effect of a 6-wk treatment by placebo, the calcium-channel blocker nifedipine, or the converting-enzyme inhibitor captopril was assessed in normotensive patients with insulin-dependent diabetes and incipient nephropathy. In response to captopril and nifedipine, arterial pressure decreased slightly and to a similar extent. These drugs resulted in opposite effects on urinary excretion of albumin [i.e., increase in urinary albumin excretion (UAE) by 40% during nifedipine treatment and decrease by 40% during captopril treatment]. No change in UAE was observed in the p acebo group. This observation of opposite changes in U E i the presence of a similar fall in arterial pressur suggests that the effects of captopril and nifedipine o UAE result from some difference in their intrarenal a ction. The data do not present recommendations for the use or disuse of captopril or nifedipine in such a group of patients and do not allow extrapolation to hypertensive diabetic subjects well controlled by other conventional antihypertensive agents.
Starchy Foods and Glycemic Index
Authors: Jenkins David J A , Wolever Thomas M S , Jenkins Alexandra L
Published: March 2007

Different starchy foods produce different glycemic responses when fed individually, and there is some evidence that this also applies in the context of the mixed meal. A major reason appears to relate to the rate at which the foods are digested and the factors influencing this. A similar ranking in terms of glycemic response to specific foods is seen independent of the carbohydrate tolerance status of the groups tested. Potentially clinically useful starchy foods producing relatively flat glycemic responses have been identified. Many of these are considered ethnic or traditional and include legumes; pasta; grains such as barley, parboiled rice, and bulgur (cracked wheat); and whole-grain breads such as pumpernickel. Specific incorporation of these foods into diets has been associated with reductions in low-density lipoprotein cholesterol and triglyceride levels in hyperlipidemia and with improved blood glucose control in insulin-dependent diabetic patients. To facilitate identification of such foods, it has been suggested that the glycemic response should be indexed to a standard (e.g., white bread) to allow comparisons to be made between the glycemic index of foods tested in different groups of subjects. The scope of application of this principle is subject to further investigation. It may be used to expand the range of possibly useful starchy foods for trial in the diets of diabetic patients.
Dietary Considerations for Obese Diabetic Subjects
Authors: Hansen Barbara C
Published: March 2007

Individuals with an upper-body form of obesity show greater associations with higher glucose excursions, exacerbated insulin resistance, increased abnormality of lipoprotein profile, and higher cardiovascular risk. Individuals with obesity and diabetes are at great risk for cardiovascular disease. Weight reduction and improvement in blood glucose control through dietary interventions for the obese person with non-insulin-dependent diabetes mellitus (NIDDM) hold the greatest potential for reducing morbidity and mortality. The relative merits of different weightreduction programs are unclear, but regimens should be nutritionally complete, easy to follow, and include a program for maintaining the reduced weight level. Improvement in insulin action and the possibility of slowing development of clinical nephropathy or endstage renal disease in NIDDM through weight loss have been found. Very low calorie diets, when used with medical supervision, may lead to significant weight loss, improved metabolic status, and even reduction or elimination of the need for oral hypoglycemic agents or insulin; however, further studies are needed to examine possible negative outcomes in people with NIDDM before very low calorie diets can be recommended. The causes of obesity and its connection with diabetes are unclear, but even modest calorie restriction may be beneficial to obese diabetic patients because of the positive effects on blood glucose levels and requirements for insulin and oral antidiabetic agents.
Hyperglycemia After Intense Exercise in IDDM Subjects During Continuous Subcutaneous Insulin Infusion
Authors: Mitchell Teresa H , Abraham Gebrehiwot , Schiffrin Alicia , Leiter Lawrence A , Marliss Errol B
Published: March 2007

Exercise is conventionally considered a modality for improvement of glycemia in diabetes. We have found that a short period of intense exercise (80% ) in normal lean subjects produces sustained postexercise hyperglycemia 20% above basal with a corresponding 100% increase in plasma insulin. In people with insulindependent diabetes mellitus (IDDM) incapable of this insulin response, it was predicted that postexercise hyperglycemia would be of greater magnitude and/or duration. To investigate this possibility, the effects of the same intense exercise (80% ) were studied in 8 IDDM subjects (2 on 2 occasions) in the postabsorptive state with continuous subcutaneous (abdominal) insulin infusion (CSII). When the preexercise plasma glucose was normal (n = 6, 86 ± 4 mg/dl), there ensued a postexercise hyperglycemia to 127 ± 7 mg/dl (P < .001) sustained for 2 h postexhaustion. Plasma free immunoreactive insulin (IRI) was 1.43 ± 0.12 ng/ml before exercise and did not change postexercise. When mean preexercise plasma glucose was 149 ± 9 mg/dl (n = 4), it rose progressively throughout the 2 h of recovery to 229 ± 28 mg/dl (P < .025). A small but statistically significant decrease in free IRI occurred during the last 80 min of recovery. Hyperglycemia in the diabetic subjects was not explained by abnormal or differing responses of glucagon or catecholamines. Thus, with intense exercise, diabetic control deteriorates rather than improves. Therefore, different therapeutic strategies may be required for intense compared with moderate exercise in IDDM patients.
Atherosclerotic Vascular Disease and Its Risk Factors in Non-Insulin-Dependent Diabetic and Nondiabetic Subjects in Finland
Authors: Laakso Markku , Rönnemaa Tapani , Pyörälä Kalevi , Kallio Veikko , Puukka Pauli , Penttilä Ilkka
Published: March 2007

A cross-sectional study on the prevalence of atherosclerotic vascular disease (ASVD) and its risk factors in non-insulin-dependent diabetic and nondiabetic subjects was carried out from 1982 to 1984 in East Finland (Kuopio)and West Finland (Turku), two areas known to differ markedly in prevalence ofASVD in the nondiabetic population. A total of 510 diabetic and 649 nondiabetic subjects aged 45–64 yr were examined in East Finland and 549 diabetic and 724 nondiabetic subjects of the same age in West Finland. In both areas and in both sexes the prevalence of coronary heart disease (CHD), stroke, and intermittent claudication was higher in diabetic than in nondiabetic subjects. Both in diabetic and nondiabetic subjects the prevalence of ASVD was higher in East Finland than in West Finlandase (CHD), stroke, and intermittent claudication was higher in diabetic than in nondiabetic subjects. Both in diabetic and nondiabetic subjects the prevalence of ASVD was higher in East Finland than in West Finland. In men, the East-West difference in the prevalence of symptomatic CHD and claudication was greater in diabetic than in nondiabetic subjects. In both areas and in both sexes the serum lipid pattern was more atherogenic and hypertension was more frequent in diabetic than in nondiabetic subjects. In both diabetic and nondiabetic subjects, serum total-cholesterol level was somewhat higher and hypertension was more frequent in East Finland than in West Finland. The East-West difference in serum total-cholesterol was greater in diabetic than in nondiabetic subjects. In multiple logistic analyses including cardiovascular risk factors, diabetes status, and area of residence, residence in East Finland was found to be, in addition to diabetes, a strong independent factor associated with CHD, particularly in men.
Progression of Lower-Extremity Arterial Occlusive Disease in Type II Diabetes Mellitus
Authors: Beach Kirk W , Bedford Geri R , Bergelin Robert O , Martin Donald C , Vandenberghe Norma , Zaccardi Molly , Strandness D Eugene
Published: March 2007

The prevalence of lower-extremity arterial occlusive disease (LEAOD), the progression of LEAOD, and the incidence of new LEAOD were determined by noninvasive method in 410 volunteers between the ages of 50 and 70 yr; 252 individuals had type II (non-insulindependent) diabetes, 158 were control subjects. LEAOD was monitored with the ankle/arm systolic blood pressure index in combination with Doppler arterial velocity waveform analysis. LEAODwas much more prevalent in the type II patients (22%, 55 of 252) than in thecontrol subjects (3%, 4 of 158) (P > .00001). The prevalence of risk factors for LEAOD was much higher in the type II patients, including elevated triglyceride, depressed high-density lipoprotein (HDL) cholesterol, hypertension, smoking, and elevated systolic blood pressure. In type II diabetic patients the incidence of new LEAOD over a 2-yr period (14%, 28 of 197) was lower than the incidence of LEAOD progression (87%, 45 of 52). Type II patients with LEAOD also had a high incidence of mortality (22%, 12 of 55) compared with those without LEAOD (4%, 8 of 197) (P < .0005). A risk score including smoking history, duration of diabetes, depressed HDL cholesterol, total cholesterol, elevated systolic blood pressure, and low obesity index is related to LEAOD. After accounting for the effect of all of the risk factors, we suggest that type II diabetes contributes additional risk for LEAOD.
Classification of Newly Diagnosed Diabetic Patients as Insulin-Requiring or Non—Insulin-Requiring Based on Clinical and Biochemical Variables
Authors: Hother-Nielsen Ole , Faber Ole , Sørensen Niels Schwartz , Beck-Nielsen Henning
Published: March 2007

In a prospective study of 41 consecutively referred newly diagnosed diabetic patients, we evaluated the predictive value of fasting and glucagon-stimulated C-peptide values, ketonuria, age, and body weight in the classification of subjects as insulin-requiring (IR) or non-insulin-requiring (NIR). The patients were followed up for ≥12 mo and classified as NIR if adequate glycemic control could be achieved without insulin (i.e., fasting plasma glucose < 8 mM and no glycosuria). Patients who needed insulin to obtain this status were classified as IR. We found that all subjects with plasma C-peptide values >0.60 nM 6 min after intravenous glucagon were NIR, whereas all IR subjects together with 3 NIR subjects had C-peptide values below this limit. All NIR subjects but 1 had fasting C-peptide values > 0.30 nM, and all IR subjects but 1 had C-peptide values below this limit. Seventy-five percent of the subjects could be correctly classified by use of age and percent desirable body weight. Thus, all subjects > 40 yr old and >100% ideal body weight were NIR, and all subjects below both these limits were IR. Ketonuria was found in 10 of 12 IR subjects and in 10 of 29 NIR subjects. We conclude that 1) 75% of the subjects could be correctly classified by use of age and percent desirable body weight only and 2) C-peptide measurements are useful in the classification of newly diagnosed diabetes, whereas presence of ketonuria is of limited value.
Lack of Detectable Deleterious Effects on Metabolic Control of Daily Fructose Ingestion for 2 Mo in NIDDM Patients
Authors: Grigoresco C , Rizkalla S W , Halfon P , Bornet F , Fontvieille A M , Bros M , Dauchy F , Tchobroutsky G , Slama G
Published: March 2007

The effects of a daily intake of 30 g fructose on blood glucose regulation, erythrocyte insulin receptors, and lipid metabolism have been studied in type II (non-insulin-dependent) diabetic subjects. Eight wellcontrolled patients received, in a randomly assigned crossover design over two 2-mo study periods, 30 g of fructose in exchange for an isocaloric amount of starch. Fructose could be taken at any time during the day as part of the 1400–1600 kcal allowed diet (50% carbohydrate, 30% fat, 20% protein). No significant difference was observed concerning body weight, HbA1c, fasting plasma glucose, fasting plasma insulin, uric acid, total cholesterol, high-density lipoprotein cholesterol, and triglycerides, nor was there any change in insulin binding to erythrocytes between the fructose and the control starch period. However, the mean plasma triglyceride levels after the fructose period, although still in the normal range, were significantly higher than baseline values (P < .05). We conclude that moderate amounts of fructose incorporated into the diet of well-controlled type II diabetic subjects have no significant deleterious effect on glycemic control, insulin receptors of erythrocytes, or lipid metabolism.
Trends in Use of Oral Hypoglycemic Agents 1964–1986
Authors: Kennedy Dianne L , Piper Joyce M , Baum Carlene
Published: March 2007

Oral hypoglycemic (OH) agents have been available in the United States for the treatment of non-insulindependent diabetes mellitus (NIDDM) for almost 30 yr. During this time they have been subject to considerable controversy. In this article, we present pharmaceutical marketing research data that provide a review of several facets of OH use. The number of OH prescriptions dispensed peaked in 1973, decreased through 1980, and has been increasing since that year. In 1986, OH agents accounted for 21.5 million prescriptions: 1% of all prescriptions dispensed that year. Chlorpropamide is currently the most frequently ingested OH agent; it is used by 33% of the market. The two OH agents introduced in 1984, glyburide and glipizide, had acquired 41% of the OH market by the end of 1986. The rate of OH use per 1000 diabetes mellitus visits increases with patient's age. Patients aged 60 yr and older received OH prescriptions at a rate of 478 per 1000 diabetes mellitus visits in 1986. Data estimating both the number of patients diagnosed with diabetes and the number of diabetic patients taking OH agents indicate that the percentage receiving OH treatment has increased over the past 5 yr, with ∼35% of all diabetic patients taking OH agents in 1986.
Improvement in Glucose Tolerance After 1 Wk of Exercise in Patients With Mild NIDDM
Authors: Rogers Marc A , Yamamoto Chikashi , King Douglas S , Hagberg James M , Ehsani Ali A , Holloszy John O
Published: March 2007

We investigated the effects of 1 wk of intense exercise on glucose tolerance in 10 men with abnormal glucose tolerance [7 had mild non-insulin-dependent diabetes mellitus (NIDDM), and 3 had impaired glucose tolerance]. The 7 days of exercise did not result in significant changes in body weight or maximal oxygen uptake. Plasma glucose concentration at 120 min averaged 227 ± 23 mg/dl in an oral glucose tolerance test (OGTT) before and 170 ± 18 mg/dl after the 7 days of exercise (P < .001). There was a 36% reduction in the area under the glucose tolerance curve. Plasma insulin concentration at 120 min of the OGTT averaged 172 ± 27μU/ml before and 106 ± 13 μU/ml after 7 days of exercise (P < .001); the area under the insulin curve was decreased by 32%. In contrast to the response to 7 days of exercise, one bout of exercise did not result in an improvement in glucose tolerance. These results provide evidence that regularly performed, vigorous exercise can be effective in decreasing insulin resistance and improving glucose tolerance within 7 days in some patients with mild NIDDM.
Motor Vehicle Accidents and IDDM
Authors: Songer Thomas J , LaPorte Ronald E , Dorman Janice S , Orchard Trevor J , Cruickshanks Karen J , Becker Dorothy J , Drash Allan L
Published: March 2007

A case-control study examining the 1-yr motor vehicle accident experiences of 158 insulin-dependent diabetes mellitus (IDDM) cases and 158 nondiabetic siblings was undertaken to evaluate the risk of motor vehicle accidents among drivers with IDDM. In multivariate analyses the overall accident risk of the cases and control subjects did not differ significantly. Female diabetic drivers, however, showed a marked increased risk for motor vehicle accidents. The accident risk among female cases was five times higher than among the female control subjects (P < .05). Age and marital status were also significantly associated with accident probability in the multivariate model. The results suggest that IDDM could have an effect on the accident rate of diabetic drivers, particularly women. However, the traditional risk factors for automobile accidents, i.e., age and marital status, appear to have an equally strong influence on accident occurrence. Further studies are needed to 1) document the role of IDDM in accidents among representative samples of the IDDM population and 2) properly evaluate the licensing restrictions recommended for diabetic drivers.
Psychomotor Performance and Counterregulatory Responses During Mild Hypoglycemia in Healthy Volunteers
Authors: Stevens Anthony B , McKane William R , Bell Patrick M , Bell Paul , King David J , Hayes John R
Published: March 2007

The effect of mild hypoglycemia on psychomotor performance and counterregulatory responses was studied among 12 healthy volunteers. Each volunteer received two modified hyperinsulinemic glucose clamps. One morning, plasma glucose was held constant at euglycemic levels (4.9 mM) for 95 min, and another morning, it was lowered over 35 min and then held constant at hypoglycemic levels (3.4 mM) for 60 min. A battery of psychomotor tests and a questionnaire assessing hypoglycemic symptoms were administered before and repeated during the last 30 min of each clamp. The questionnaire and three selected psychomotor tests were also administered repetitively during the 1st h of each clamp. During the hypoglycemic studies, a rise was seen in plasma epinephrine and pancreatic polypeptide at 45 min. An increase in symptom scores was first recorded at 50 min during the hypoglycemic studies [median 4 (range 0–13) vs. 2 (5-6), P < .05]. Performance was impaired on two psychomotor tests included in the battery. One was the trail making test on fine motor performance (–19.3 ± 4.2 targets/min, mean ± SE vs. 1.2 ± 4.8 targets/min, P < .05), and the other was the digitsymbol substitution (DSS) test on information processing and memory (18 ± 3 vs. 29 ± 4 symbols/min, P < .03). Of the tests administered during the 1st h, performance was impaired on the DSS. Thi impairment became significant at 45 min (14 ± 4 vs. 22 ± 4 symbols/min, P < .005). In conclusion, mild hypoglycemia selectively impairs psychomotor performance in healthy volunteers but not before the onset of glucose counterregulation and warning symptoms.
Stress in Parents of Children With Diabetes Mellitus
Authors: Hauenstein Emily J , Marvin Robert S , Snyder Andrea L , Clarke William L
Published: March 2007

The level of stress experienced in the parenting role by mothers of 49 children with insulin-dependent diabetes mellitus (IDDM) and its relationshipto glycemic control was examined with the parenting stress index (PSI). A subsample of the research group of 25 children with diabetes (≤11 yr old) was compared with an agematched control group (n = 21) drawn from the original study of the PSI on total stress, parent- and childdomain, and subdomain scale scores. The two groups differed on one child-domain subscale, whereby children with diabetes are perceived by their mothers as more demanding than healthy controls. Three parentsubscale differences existed between the two groups, with mothers of children with diabetes reporting less attachment to their children, less spousal support, and poorer health. Analysis of the diabetes sample demonstrated significant stress on several of the child- and parent-domain subscales in a large proportion of the sample. Stress, at levels s≥70th percentile of the control group, existed on the child scales of acceptability, mood, demanding behavior, and reinforcement for 51% of children with diabetes. Elevations associated with stress in the parenting role were evident on the scales associated with parental attachment, depression, and competence for 33% of parents. No differences in the level of glycosylated hemoglobin (HbA1) existed between children whose mothers reported high levels of stress in themselves and their children and those whose mothers reported little stress. Hierarchal regression analysis demonstrated a significant relationship between the child stress scale of distractibility, the use of self-monitoring blood glucose.
Effects of Sucrose on Carbohydrate and Lipid Metabolism in NIDDM Patients
Authors: Hollenbeck Clarie B , Coulston Ann M , Reaven Gerald M
Published: March 2007

Recently, there has been increasing interest toward the liberalization of sucrose in the diets of individuals with non-insulin-dependent diabetes mellitus (NIDDM). However, there is evidence from several well-controlled prospective studies demonstrating that the consumption of moderate amounts of sucrose may result in hyperglycemia, hyperinsulinemia, hypertriglyceridemia, hypercholesterolemia, and reduced high-density lipoprotein cholesterol concentrations. The fact that not all studies demonstrate these deleterious effects does not negate the positive data. The magnitude of the deleterious effects will probably vary with individual patients, baseline status, and amount of sucrose. Because these metabolic abnormalities are most disturbed in diabetes and are associated with increased risk of coronary artery disease, it would seem reasonable to continue to advise patients with NIDDM to limit sucrose consumption, at least until available data would allow us to predict in which individuals and at what level of sucrose consumption these adverse metabolic effects would not be present.
Relative Clinical Usefulness of Glycosylated Serum Albumin and Fructosamine During Short-Term Changes In Glycemic Control in IDDM
Authors: Winocour Peter H , Bhatnagar Deepak , Kalsi Paramjeet , Hillier Valerie F , Anderson David C
Published: March 2007

Serial changes in glycosylated blood proteins and direct measures of glycemia were studied in 100 subjects with insulin-dependent diabetes mellitus (IDDM) over a 6-wk period while attempts were made to improve glycemic control. All measures of glycemic control improved significantly (P < .001). Mean ± SE glycosylated hemoglobin (HbA,) fell from 9.1 ± 0.2 to 8.0 ± 0.1%, glycosylated serum albumin (GSA) from 9.8 ± 0.4 to 7.3 ± 0.3%, and fructosamine from 3.92 ± 0.08 to 3.42 ± 0.07 mM. Fasting blood glucose levels fell from 11.1 ± 0.6 to 8.1 ± 0.7 mM, mean blood glucose levels from 12.5 ± 0.3 to 8.8 ± 0.3 mM, and the M value from 118 ± 7 to 40 ± 3 U. Mean percentage changes in direct measures of glycemia (32–66%) and GSA (29%) were greater than for fructosamine (11%) or HbA, (12%) levels (P < .001). Furthermore, the correlation between the change in GSA and changes in direct measures of glycemia over the initial 2-wk period was significantly different from the corresponding correlations between direct measures of glycemia and fructosamine over this period (P < .05-.01). Changes in GSA also correlated more closely than HbA, or fructosamine did with direct measures of glycemia after 4 and 6 wk. The Spearman rank-correlation coefficient (rs) of absolute changes in GSA, fructosamine, and HbA1 after 2–6 wk ranged from 0.27 to 0.57, confirming that the three measures responded differently to changing glycemic control. Cross-sectional analysis between different measures of glycemia demonstrated considerable variation in the degree of association at different times, with the closest correlations observed after 6 wk when glycemic control was relatively stable. GSA and fructosamine levels correlated with levels of mean blood glucose and M values estimated 2–4 wk earlier. GSA appears to be a more sensitive indicator of short-term improvement in glycemic control and glycemic instability in IDDM than fructosamine or HbA1.
Effect of Diabetes Education on Self-Care, Metabolic Control, and Emotional Well-Being
Authors: Rubin Richard R , Peyrot Mark , Saudek Christopher D
Published: March 2007

Participants (n = 165) entering a week-long outpatient education program completed a protocol measuring self-care patterns, glycosylated hemoglobin levels, and emotional well-being. Emotional well-being was reassessed at the end of the program, and the entire protocol was completed again at 6 mo (n = 124). At the program's end, participants improved on all measures of emotional well-being (P < .01). Self-esteem and diabetes self-efficacy rose, whereas anxiety and depression fell. At 6 mo, improvement in emotional well-being continued, and important self-care behaviors improved from preprogram levels. Self-monitoring of blood glucose and exercise rose (both P < .001), and binging (P < .01) and glycosylated hemoglobin levels (P < .001) fell. Program effects were unrelated to demographic or disease characteristics but strongly related to initial status. Participants who entered the program with high levels of emotional well-being or good self-care patterns or glycemic control tended to change little, if at all, at later measurements. On the other hand, people who entered the program with low levels of emotional well-being or with poor self-care patterns or glycemic control improved substantially. Our findings suggest that diabetes education can promote long-term benefits in self-care, metabolic control, and emotional status if the program is specifically designed to provide these benefits. Aspects of the program that contribute to its efficacy are discussed.
Pancreatic Diabetes Mellitus
Authors: Sjoberg Robert J , Kidd Gerald S
Published: March 2007

Diabetes mellitus caused by pancreatic exocrine disease is a unique clinical and metabolic form of diabetes. The diagnosis of pancreatic diabetes caused by chronic pancreatitis may be elusive because it is occasionally painless and often not accompanied by clinical malabsorption until after hyperglycemia occurs. Diabetic patients with pancreatic calcification or clinically demonstrable pancreatic exocrine dysfunction will manifest the unique aspects of pancreatic diabetes described herein. Like other forms of diabetes, the primary hormonal abnormality in pancreatic diabetes is decreased insulin secretion. Patients with this disorder are unique in that they have low glucagon levels that respond abnormally to several physiological stimuli, blunted epinephrine responses to insulin-induced hypoglycemia, and malabsorption. In addition, they often have concomitant alcohol abuse with hepatic disease and poor nutrition. These characteristics result in increased levels of circulating gluconeogenic amino acids, decreased insulin requirements, a resistance to ketosis, low cholesterol levels, an increased risk of hypoglycemia while on insulin therapy, and the clinical impression of brittle diabetes. Retinopathy occurs at a rate equal to that of insulin-dependent diabetes but may be less severe in degree. Other complications of pancreatic diabetes have been less well studied but may be expected to be seen more frequently as these patients survive longer. The characteristics of pancreatic diabetes suggest that a conservative approach be taken in regard to intensive insulin therapy and tight blood glucose control.
Effect of Once-a-Week Training Program on Physical Fitness and Metabolic Control in Children With IDDM
Authors: Huttunen Niilo-Pekka , Lankela Sirkka-Liisa , Knip Mikael , Lautala Pentti , Kaar Marja-Liisa , Laasonen Kaisu , Puukka Raija
Published: March 2007

To examine whether a physical activity program could improve physical fitness and glycemic control, 32 children and adolescents with insulin-dependent diabetes mellitus (IDDM) were examined before the program and 3 mo later. Fifty percent of the subjects (n = 16) participated in the training for 1 h/wk (exercise group), whereas the remaining subjects were engaged in nonphysical activities for an equal amount of time (nonexercise group). Age of the subjects ranged from 8.2 to 16.9 yr, (mean 11.9 yr), with mean duration of diabetes 0.6-13.1 yr (5.2 yr). During the 3-mo program peak oxygen consumption (Vo2) rose from 40.0 to 43.8 ml · min-1 · m-2 (P < .01) in the exercise group but only by 1.3 ml · min-1 · m-2 in the nonexercise group (NS). Metabolic control did not improve in either group, with glycosylated hemoglobin level rising from 9.8 to 10.5% (P < .01) in the exercise group and from 9.4 to 9.7% (NS) in the control group. When subjects were stratified according to their participation, metabolic control was significantly better among diabetic subjects participating frequently (5:11 of 13 sessions) than among those participating infrequently (<11 of 13 sessions), regardless of the type of activity. It was concluded that a training program of 1 h/wk for 3 mo does improve physical fitness but not the metabolic control of diabetes. On the other hand, glycemic control appears to be best among diabetic subjects who are motivated to participate in any kind of program related to the treatment of their disease.
Double-Blind Crossover Trial of Isophane (NPH)- and Lente-Based Insulin Regimens
Authors: Tunbridge Felicity K E , Newens Andrew , Home Philip D , Davis Stephen N , Murphy Moira , Burrin Jacky M , Alberti K G M M , Jensen Ivan
Published: March 2007

Isophane (NPH) and lente insulin preparations have been the basis of insulin-injection regimens for many decades but were never formally compared. After a 2-mo run-in period, 82 patients were randomized to NPH (Protaphane) or lente (Monotard) insulin preparations given together with Actrapid as a twicedaily injection regimen in a double-blind study. Patients were seen monthly and crossed over after 5 mo of treatment. Control as assessed by glycosylated hemoglobin (NPH 9. 2 ± 0.1%, lente 9.3 ± 0.1%, mean ± SE) and fructosamine (1.55 ± 0.02 and 1.57 ± 0.02 mM) concentrations was identical for the two regimens as were home-collected laboratory-measured fasting blood glucose (BG) (NPH 8.8 ± 0.5 mM, lente 9.0 ± 0.5 mM) and mean BG (8.2 ± 0.3 and 7.6 ± 0.3 mM) concentrations. For both regimens, the major control problem was the BG concentration before and after breakfast. Total insulin dosage was similar (NPH 56.3 ± 0.6 U/day, lente 57.2 ± 0.6 U/day) with no tendency for a difference in the evening intermediateacting dose (NPH 17.0 ± 0.3 U/day, lente 17.0 ± 0.3 U/day) to counter fasting hyperglycemia. Serum lipid concentrations and body weight confirmed the equivalence of control. Hypoglycemic events were recorded in personal diaries and graded by predetermined criteria. Self-treated, relative-assisted, and hospital/doctor-treated hypoglycemic events did not differ in frequency. We conclude that lente- and NPH-based twice-daily human insulin regimens give indistinguishable metabolic control.
Development of Diabetes Attitude Scale for Health-Care Professionals
Authors: Anderson Robert M , Donnelly Michael B , Gressard Clarice P , Dedrick Robert F
Published: March 2007

This article describes the development of a diabetes attitude scale (DAS) that was designed to measure the attitudes of health-care professionals (HCPs). The DAS was developed through the efforts of a national panel of diabetes experts. The panel developed a 60-item scale that was pilot tested and reduced to a 50-item scale. The 50-item scale was then mailed to a national sample of HCPs with an interest in diabetes. The surveys were returned by 633 nurses, 322 dietitians, 116 physicians, and 67 others totaling 1138 returns (a return rate of 54%). The returned surveys were analyzed, and a 31- item DAS composed of 8 subscales resulted. Evidence for the reliability and validity of the 31-item DAS along with the instrument itself are included in this study.
Effect of Socioeconomic Status on Hyperglycemia and Retinopathy Levels in Mexican Americans With NIDDM
Authors: Haffner Steven M , Hazuda Helen P , Stern Michael P , Patterson Judith K , Heuven W A J Van , Fong Donald
Published: March 2007

Mexican Americans have a threefold greater prevalence of non-insulin-dependent diabetes mellitus (NIDDM) than non-Hispanic Whites. Moreover, Mexican-American diabetic people have more severe hyperglycemia and diabetic retinopathy than non-Hispanic White diabetic people. Mexican Americans are predominantly of low socioeconomic status (SES), and low-SES Mexican Americans have a higher prevalence of NIDDM than higher-SES Mexican Americans. Therefore, we hypothesized that among diabetic people, low SES would be associated with more severe hyperglycemia and retinopathy. Three hundred forty-three Mexican Americans and 79 non-Hispanic Whites with NIDDM were identified from the San Antonio Heart Study, a population-based study of diabetes and cardiovascular disease. Hyperglycemia was assessed as the sum of the fasting, 1-h, and 2-h plasma glucose concentrations during a standard oral glucose tolerance test. Retinopathy was assessed by 7 standard stereoretinal photographs. SES was assessed with three indicators: Duncan's socioeconomic index, education, and income. Contrary to expectations, low SES was not associated with greater levels of hyperglycemia or grades of retinopathy.
Behavioral Strategies for Weight Reduction in Obese Type II Diabetic Patients
Authors: Wing Rena R
Published: March 2007

This article reviews strategies that have been shown to be helpful in the treatment of obesity and are applicable to obese type II (non-insulin-dependent) diabetic patients. Emphasis is placed on the use of behavior modification strategies, including careful description of the behavior to be changed, setting of goals for new behavior, and procedures for modifying the environmental cues and reinforcers that control behavior. It is recommended that weight-loss programs for obese diabetic patients include intensive long-term contact with the patient, therapists with training in behavior modification, and a multifaceted intervention involving behavior modification, diet, and exercise.
Insulin Autoimmune Syndrome Associated With Benign Monoclonal Gammopathy: Evidence for Monoclonal Insulin Autoantibodies
Authors: Wasada Taro , Eguchi Yoko , Takayama Sumiko , Yao Kenshi , Hirata Yukimasa , Ishii Sadao
Published: March 2007

A 64-yr-old man with benign monoclonal gammopathy developed recurrent episodes of severe hypoglycemia but lacked evidence of insulinoma or exogenous insulin administration. The patient's plasma was found to contain anti-insulin antibodies and large amounts of extractable insulin (1110 μU/ml), which was identified as human insulin by high-performance liquid chromatography (HPLC). The anti-insulin antibodies consisted solely of IgG and A-light chains. Scatchard analysis of these antibodies revealed an almost straightline relationship, with markedly low affinity and high capacity. An immune complex made of 125l-labeled insulin and the patient's antibodies emerged in a molecular-sieve HPLC as almost a single peak, suggesting a homogeneous antibody population. In addition, the patient's M protein was separately shownto be the IgG and λ–light-chain type. We suggest that the insulin autoantibodies responsible for the spontaneous hypoglycemia in this patient are monoclonal and of M protein origin.