bluuebunny/crossref_metadata_2025 huggingface dataset:
No association between birth weight and Type 1 diabetes mellitus – a twin‐control study
Authors: Kyvik K. O. , Bache I. , Green A. , Beck‐Nielsen H. , Buschard K.
Published: March 2003

Aims To investigate, by means of a twin‐control study, whether there is a relationship between birth weight and Type 1 diabetes mellitus.

Methods In the youngest part (n = 20 888 pairs) of the Danish Twin Register, 95 twin pairs (26 monozygotic and 69 dizygotic) with Type 1 diabetes were identified. Information about birth weight and birth length, prematurity, maternal age and parity was obtained from midwives' records and from the Danish Medical Birth Registry and analysed using Student's two‐sided t‐test, Chi‐square test and logistic regression.

Results Birth data were available for 83 diabetic and 51 healthy twin individuals, altogether 67 twin pairs (20 monozygotic and 47 dizygotic). Mean birth weight was 2537 g and 2565 g (NS) in monozygotic and dizygotic pairs and the corresponding length at birth 47.6 cm and 48.2 cm (NS). In pairs discordant for diabetes, the mean birth weight was 2538 g in twins with diabetes and 2549 g in twins without diabetes (NS). Logistic regression in discordant pairs showed no relationship between diabetes status and birth weight, birth length, birth order, sex or prematurity. Logistic regression in concordant vs. discordant pairs showed no effect of mean birth weight and birth length, maternal age, parity or weeks of prematurity.

Conclusions There is no association between Type 1 diabetes mellitus and birth weight in this study. Furthermore, variables related to birth weight and length cannot explain why some pairs are concordant while other remain discordant.
Angiotensin‐converting enzyme inhibition by quinapril blocks the albuminuric effect of atrial natriuretic peptide in Type 1 diabetes and microalbuminuria
Authors: McKenna K. , Smith D. , Barrett P. , Glenn A. , Kesson C. M. , Connell J. , Thompson C. J.
Published: March 2003

Aims This study examined the effect of angiotensin‐converting enzyme inhibition, administered at doses with no effect on systemic blood pressure, on the albuminuric action of atrial natriuretic peptide (ANP).

Methods Seven Type 1 diabetic patients with established microalbuminuria participated in a two limb, single‐blind, placebo controlled study. Subjects were administered quinapril 10 mg daily or placebo for 7 days prior to study. On the study day, subjects were euglycaemic clamped and subsequently fluid loaded (20 ml/kg tap water orally plus urinary losses). At steady state diuresis, a 1 h intravenous infusion of ANP 0.05 μg.kg−1.min−1 was administered. Urine was collected at 15‐min intervals for estimation of albumin–creatinine ratio (ACR). Results were analysed by
anova.

Results Baseline mean arterial pressure was similar after pre‐treatment with quinapril and placebo (98.7 ± 3.8 vs. 100 ± 4.5 mmHg, mean ± sd, P > 0.5), and was unaltered by ANP infusion on either study day. Baseline ACR was similar on quinapril and placebo (P = 0.13). ANP infusion induced a rise in urine ACR with placebo (58.4 ± 40.2 to 393.6 ± 262.9 mg/mmol, P = 0.006), but not with quinapril (29.3 ± 10.7 to 81.5 ± 43 mg/mmol, P = 0.15). The urine ACR response to ANP infusion was higher with placebo than with quinapril (P = 0.02).

Conclusions Quinapril blocks the albuminuric effect of intravenous infusion of ANP in subjects with Type 1 diabetes mellitus and established microalbuminuria. This action is independent of changes in mean arterial pressure and creatinine clearance.
Prevalence of symptoms of depression and anxiety in a diabetes clinic population
Authors: Lloyd C. E. , Dyer P. H. , Barnett A. H.
Published: March 2003

Aims To investigate the use of a short questionnaire to measure psychological symptoms in a busy clinic setting, and to examine the prevalence of these symptoms in adults with diabetes. The perceived need for psychological treatment services was also measured.

Methods Adults (> 18 years) with either Type 1 or Type 2 diabetes were invited to complete a short demographic form and the Hospital Anxiety and Depression Scale (HADS) whilst waiting for their routine diabetes outpatients appointment. Complication status was measured via patients' medical records. Glycaemic control (HbA1c) was also recorded.

Results A high response rate (96%) was achieved. Prevalence rates of psychological symptoms were high (overall 28% of study participants reported moderate–severe levels of depression or anxiety or both). Men were somewhat more likely to report moderate–severe depressive symptoms, whereas women reported more moderate–severe anxiety. A significant association between depression and poor glycaemic control was observed in the men, but not in the women. Regression analysis demonstrated that the interaction between sex and glycaemic control, HbA1c and sex were all significantly associated with depression and anxiety (R2 = 0.16 and 0.19, respectively). One‐third of subjects reported that at the moment they would be interested in receiving counselling or psychotherapy if it was currently available at the diabetes clinic.

Conclusions This study has shown that the HADS is an appropriate questionnaire to use in a clinic setting in adults with diabetes. There may be a stronger association between glycaemic control and psychological symptomatology in men than in women. There remains a significant proportion of individuals with diabetes who require psychological support, which, if available, might help improve glycaemic control and thus overall wellbeing.
Role of islet autoimmunity in the aetiology of different clinical subtypes of diabetes mellitus in young north Indians
Authors: Singh A. K. , Bhatia E. , Dabadghao P. , Bhatia V. , Gellert S. A. , Colman P. G.
Published: March 2003

Aims To determine the role of islet autoimmunity in the aetiology of different clinical subtypes of diabetes mellitus in young north Indian patients by measuring islet autoantibodies.

Methods In a cross‐sectional study, 145 young patients with diabetes (onset < 30 years) were subdivided into the following categories: Type 1 diabetes (n = 83), malnutrition‐modulated diabetes mellitus (MMDM, n = 31) and fibro‐calculous pancreatic diabetes (FCPD, n = 31). MMDM subjects presented with emaciation and severe insulin‐requiring but ketosis‐resistant diabetes, while FCPD was associated with idiopathic chronic calcific pancreatitis. Antibodies to glutamic acid decarboxylase (GADA) and IA‐2 (IA‐2 A) were detected by immunoprecipitation of 35S‐labelled recombinant antigens and cytoplasmic islet cell antibody (ICA) by indirect immunofluorescence.

Results GADA were present in a significant proportion (23%) of patients with MMDM. In contrast, IA‐2 A was increased only among patients with Type 1 diabetes (22%), but not MMDM (3%, P < 0.05). Among patients with a duration of diabetes < 2 years, GADA and/or IA‐2 A were found in 61% of Type 1 diabetic and 37% of MMDM patients (P < 0.01). MMDM patients who were positive for GADA had a shorter duration of diabetes, but did not differ in their age at onset of diabetes, body mass index, fasting plasma C‐peptide, or frequency of thyroid microsomal and parietal cell antibodies. FCPD subjects had the lowest prevalence of autoantibodies: IA‐2 and ICA were absent, while GADA were present in 7% (P < 0.05 vs. Type 1 diabetes).

Conclusions GADA, though not IA‐2 A, were present in a substantial proportion of patients with the MMDM variant of diabetes, suggesting that islet autoimmunity may play a role in its pathogenesis. In contrast, none of the islet antibodies was increased in subjects with FCPD, making it likely that it is a secondary type of diabetes.
Dissociated sensory loss in diabetic autonomic neuropathy
Authors: Winkler A. S. , Ejskjaer N. , Edmonds M. , Watkins P. J.
Published: March 2003

Aims Clinical observation has led to the idea that there might be a distinctive form of selective sensory and autonomic neuropathy affecting patients with Type 1 diabetic mellitus with severe symptomatic autonomic neuropathy (Type 1‐DAN) and this study was conducted to evaluate the presence of such a neuropathy in Type 1‐DAN.

Methods Nineteen Type 1 diabetic patients presenting for treatment of severe symptomatic autonomic neuropathy were examined (all had ≥ 2 autonomic symptoms; age 39.3 ± 10.2 years; duration of disease 25.6 ± 10.5 years). For comparison, 19 Type 1 diabetic patients with neuropathic foot ulcers (age 44.5 ± 6.6 years; duration of disease 26.7 ± 9.2 years), 14 clinically uncomplicated Type 1 diabetic patients (age 39.9 ± 5.6 years; duration of disease 22.9 ± 9.3 years) and 16 non‐diabetic healthy people as controls (age 39.3 ± 10.7 years) were also examined.

Results The large fibre modalities (light touch and vibration perception) were better preserved in the Type 1‐DAN group than in the foot ulcer group. Thus, light touch sensation was normal in 11 out of 19 Type 1‐DAN patients compared to only three out of 19 foot ulcer patients (P < 0.01), and vibration perception was 24.9 ± 15.0 V and 40.5 ± 7.9 V, respectively (P < 0.002) with some of the Type 1‐DAN patients in the normal range. In contrast, the small fibre modalities, thermal perception and autonomic function, were grossly abnormal in both groups (hot thermal perception 14.1 ± 2.5°C and 12.6 ± 3.7°C; cold thermal perception 13.8 ± 2.7°C and 10.9 ± 4.7°C; heart rate variation 2.9 ± 1.5 beats/min and 4.8 ± 4.0 beats/min, respectively).

Conclusions There is indeed a subgroup of Type 1 diabetic neuropathy patients who suffer from severe autonomic symptoms associated with a selective small fibre sensory and autonomic loss with relatively preserved large fibre sensory modalities.
Enhanced albuminuric response to atrial natriuretic peptide in normoalbuminuric patients with Type 1 diabetes mellitus – a pilot study
Authors: McKenna K. , Smith D. , Moore K. , Glen A. , Kesson C. M. , Thompson C. J.
Published: March 2003

Aims  To ascertain whether intravenous infusion of atrial natriuretic peptide (ANP) can induce microalbuminuria in patients with Type 1 diabetes mellitus (DM), as already demonstrated in patients with microalbuminuria, and to compare the albuminuric response to ANP infusion in Type 1 DM and a matched group of healthy non‐diabetic controls.

Methods
 Eight normoalbuminuric DM patients participated in a three limb, randomized, double‐blind, placebo‐controlled study. Subjects were kept euglycaemic by insulin infusion, and subsequently water‐loaded (20 ml/kg orally plus urinary losses). When in steady state, a 30‐min infusion of either placebo, ANP 0.025 μg.kg−1.min−1 or ANP 0.05 μg.kg−1.min−1 was administered intravenously. Urine was collected every 15 min for 90 min for the estimation of albumin–creatinine ratio (ACR). In addition, eight non‐diabetic volunteers received a single infusion of ANP 0.025 μg.kg−1.min−1.

Results
 ACR was unaltered by placebo in DM subjects (1.4 ± 0.7–1.7 ± 1.1 mg/mmol, mean ± sd, anova, P > 0.9), and by low dose ANP in controls (1.4 ± 0.9–2.6 ± 1.9 mg/mmol, P = 0.4). ACR increased with low dose ANP (1.3 ± 0.5–14.6 ± 13.6 mg/mmol, P = 0.02), and high dose ANP (1.3 ± 0.7–26.4 ± 31 mg/mmol, P = 0.01) in DM subjects. The ACR response to low dose ANP was greater in the DM than control subjects (P = 0.02).

Conclusions  ANP increases urine albumin excretion rate in normoalbuminuric Type 1 DM patients, and this effect is more pronounced than in healthy volunteers.
Survey of dietetic provision for patients with diabetes
Authors: Nelson M. , Lean M. E. J. , Connor H. , Thomas B. J. , Lord K. , Hartland B. , Waldron S. , McGough N. , Walker L. , Ryan A. , Start K.
Published: March 2003

SUMMARY

Aims  To survey dietitians involved in diabetes care regarding the provisions for patients with diabetes.

Methods  A national survey of 512 dietitians known to be engaged in provision of diabetes care was conducted in 1997 and 391 (76%) responded.

Results  Nationally the median provision of dietetic care for diabetes reported was 10.7 h per 100 000 general population per week, but the provision was uneven ranging from 2.0 to 27.6 h per 100 000. Eighty‐five per cent of dietitians worked in areas where the provision was less than 22 h per 100 000 general population per week (the current recommended minimum standard). Dietetic provision was greater in secondary care (median 9.1 h per 100 000 general population per week) than in general practice, residential homes and other locations (median 4.4 h per 100 000 general population per week). Provision was greater in those areas in which a designated dietitian had responsibility for co‐ordinating the dietetic service for diabetes than in areas where the co‐ordinator was not a dietitian or where there was no co‐ordinator. Over 90% of dietitians reported following British Diabetic Association (BDA) recommendations regarding advice on carbohydrate, sugar, fat and fibre consumption, but only one‐third routinely advised on salt restriction. Of the 17% of dietitians who continue to use carbohydrate exchanges, all combine this method with other approaches. Of the recommendations made by the Clinical Standards Group, only 69% of dietitians reported seeing more than half of newly diagnosd adult patients within four weeks, and less than 50% reported offering half or more of their patients an annual review. Amongst the literature in current use, 98% of dietitians use BDA literature for teaching patients and 90% use BDA publications in their own education. Seventy‐six per cent of dietitians believed that there was a role for commercial slimming organizations in weight management of people with diabetes

Conclusions  Given the proven value of dietetic input in diabetes management, there would be advantages to correcting the regional inequalities in dietetic provision for diabetes care in the UK.
Preservation of sight in diabetes: developing a national risk reduction programme
Authors: Garvican L. , Clowes J. , Gillow T.
Published: March 2003

SUMMARY

Background  Early treatment for diabetic retinopathy is effective at saving sight, but dependent on pre‐symptomatic detection. Although 60% of people with diabetes have their eyes examined annually, few UK health authorities have systematic programmes that meet the British Diabetic Association's standards for sensitivity (> 80%) and specificity (> 95%). Screening is generally performed by general practitioners and optometrists, with some camera‐based schemes, operated by dedicated staff. The National Screening Committee commissioned a group to develop a model and cost estimates for a comprehensive national risk‐reduction programme.

Ophthalmoscopy Evidence indicates that direct ophthalmoscopy using a hand‐held ophthalmoscope does not give adequate specificity and sensitivity, and should be abandoned as a systematic screening technique. Indirect ophthalmoscopy using a slit lamp is sensitive and specific enough to be viable, and widespread availability in high street optometrists is an advantage, but the method requires considerable skill.

Photographic schemes The principal advantage of camera‐based screening is the capturing of an image, for patient education, review of disease progression, and quality assurance. Digital cameras are becoming cheaper, and are now the preferred option. The image is satisfactory for screening and may be transmitted electronically. With appropriate training and equipment, different professional groups might participate in programme delivery, based on local decisions.

Cost issues Considerable resources are already invested in ad hoc screening, with inevitable high referral rates incurring heavy outpatient costs. Treatment for advanced disease is expensive, but less likely to be effective. The costs of a new systematic screening and treatment programme appear similar to current expenditure, as a result of savings in treatment of late‐presenting advanced retinopathy.

Conclusion  A systematic national programme based on digital photography is proposed.
Gastric parietal cell antibodies are associated with glutamic acid decarboxylase‐65 antibodies and the HLA DQA1*0501‐DQB1*0301 haplotype in Type 1 diabetes mellitus
Authors: De Block C. E. M. , De Leeuw I. H. , Rooman R. P. A. , Winnock F. , Du Caju M. V. L. , Van Gaal L. F. , Registry The Belgian Diabetes
Published: March 2003

SUMMARY

Aims  To assess the prevalence of thyrogastric autoimmunity in relation to age, sex, β‐cell antibody status and HLA DQ haplotypes in Type 1 diabetes mellitus.

Methods  One hundred and seventy‐one patients with Type 1 diabetes mellitus were studied (male/female 86/85; mean age 19 ± 11 years; duration of diabetes 5 ± 4 years). Islet cell antibodies (ICA) and parietal cell antibodies (PCA) were measured using indirect immunofluorescence; glutamic acid decarboxylase‐65 antibodies (GADA) by radiobinding assay and thyroid peroxidase antibodies (TPO) with an immunoradiometric assay (IRMA).

Results  The majority of subjects (81.3%) showed one or more autoantibodies. The prevalence rates were: GADA 64.9%, ICA 46.2%, PCA 19.9% and TPO 19.3%. Patients with ICA+ ≥ 3 years after diagnosis had a higher prevalence of GADA (P = 0.03, odds ratio (OR) 2.66) and thyrogastric antibodies (P = 0.05, OR 2.23) than subjects ICA– after 3 years. PCA+ patients were older (P = 0.04), had a higher prevalence of GADA (P = 0.005, OR 3.89) and TPO (P = 0.05, OR 2.50) than PCA– subjects. Logistic regression analysis showed that PCA status was determined by the HLA DQA1*0501‐DQB1*0301 haplotype (β = 2.94, P = 0.04) and GADA status (β = 2.44, P = 0.041).

Conclusions  Thyrogastric antibodies are highly prevalent in Type 1 diabetes mellitus, especially in patients with persisting ICA. Screening for gastric autoimmunity is particularly advised in patients who are positive for GADA and for the HLA DQA1*0501‐DQB1*0301 haplotype.
Incidence and risk factors for neonatal hypoglycaemia among women with gestational diabetes mellitus in South Auckland
Authors: Simmons D. , Thompson C. F. , Conroy C.
Published: March 2003

SUMMARY

Aims  To describe the incidence and risk factors for neonatal hypoglycaemia among the offspring of women with gestational diabetes mellitus (GDM) in South Auckland, New Zealand

Methods  A retrospective audit was undertaken of singleton pregnancies delivered between 1991 and 1994. Data were obtained for 373 women and their deliveries (57 European, 76 Maori, 198 Pacific Islands, 42 other).

Results  Pacific Islands women were most likely to have large babies with neonatal hypoglycaemia in spite of a high use of insulin. Postnatally Maori and Pacific Islands women had a high incidence of Type 2 diabetes mellitus (21.4, 21.7 vs. 4.3% Europeans, 12.0% others, P = 0.035). Babies experiencing hypoglycaemia were more likely to have a mother with past GDM (51.2 vs. 27.2%, P = 0.01) and greater hyperglycaemia (at diagnosis fasting 6.8 ± 1.7 vs. 5.7 ± 1.1 mmol/l, P < 0.001; finger‐prick glucose 5.7 ± 1.0 vs. 5.2 ± 0.8 mmol/l, P < 0.001). Macrosomia, Caesarian section and special care baby unit admission were more common in pregnancies complicated by neonatal hypoglycaemia.

Conclusions  Maternal hyperglycaemia was a major contributing factor to neonatal hypoglycaemia in this population. Undiagnosed Type 2 diabetes was common among Maori and Pacific Islands women, confirming the need for earlier detection and treatment.
The effects of ulcer size and site, patient's age, sex and type and duration of diabetes on the outcome of diabetic foot ulcers
Authors: Oyibo S. O. , Jude E. B. , Tarawneh I. , Nguyen H. C. , Armstrong D. G. , Harkless L. B. , Boulton A. J. M.
Published: March 2003

SUMMARY

Aims  The outcome of foot ulcers is affected by wound depth, infection, ischaemia and glycaemic control. The aim of this study was to determine the effects of ulcer size, site, patient's age, sex and type and duration of diabetes on the outcome of diabetic foot ulcers.

Methods  Diabetic patients with new foot ulcers presenting during a 12‐month period had demographics and ulcer characteristics recorded at presentation. Ulcers were followed‐up until an outcome was noted.

Results  One hundred and ninety‐four patients (77% males) with a mean (± sd) age and duration of diabetes of 56.6 ± 12.6 and 15.4 ± 9.9 years, respectively, were included in the study. The majority of ulcers were neuropathic (67.0%) and present on the forefoot (77.8%) with a median (interquartile range) area of 1.5 (0.6–4.0) cm2. Amputations were performed for 15% of ulcers; 65% healed; 16% remained unhealed and 4% of patients died. The median (95% confidence interval) time to healing was 10 (8.8–11.6) weeks. Ulcer area at presentation was greater in the amputation group compared to healed ulcers (3.9 vs. 1.2 cm2, P < 0.0001). Ulcer area correlated with healing time (rs = 0.27, P < 0.0001) and predicted healing (P = 0.04). Patient's age, sex, duration/type of diabetes, and ulcer site had no effect on outcome.

Conclusions  Ulcer area, a measure of ulcer size, predicts the outcome of foot ulcers. Its inclusion into a diabetic wound classification system will make that system a better predictor of outcome.
Augmentation of central arterial pressure in Type 2 diabetes
Authors: Brooks B. A. , Molyneaux L. M. , Yue D. K.
Published: March 2003

Aims  Aortic systolic blood pressure has been shown to be augmented in Type 1 diabetes, indicative of more rapid pulse wave reflection due to increased arterial stiffness. This abnormality is more pronounced in diabetic males. The aim of this study was to examine the effects of diabetes on augmentation of aortic systolic pressure in subjects with Type 2 diabetes.

Methods  Radial artery pressure waveforms were obtained non‐invasively by applanation tonometry. A central aortic waveform can be derived using a transfer function obtained from previous studies during cardiac catheterization. A total of 88 subjects with Type 2 diabetes (51 men and 37 women, aged 55.8 years (interquartile range (IR) 49.7–64.1), duration of diabetes 7.5 years (IR 2.4–12.4), HbA1c 7.6% (IR 6.6–8.7)) and 85 controls subjects (40 men and 45 women, aged 55.3 years (IR 44.2–66.4)) were studied. The central aortic waveform allowed determination of the: (i) aortic augmentation index and (ii) subendocardial viability ratio.

Results  Similar to Type 1 diabetic subjects, patients with Type 2 diabetes had a significantly higher aortic augmentation index (136.1 ± 18.0% vs. 128.3 ± 19.2%, t = 2.8, P = 0.006) and lower subendocardial viability ratio (137.4 ± 25.0% vs. 155.1 ± 25.9%; t = 4.6, P = 0.0001) compared with controls. Multivariate analysis identified diabetes as an important determinant of aortic augmentation index (t = 4.0, P = 0.0001). The higher aortic augmentation index was due mainly to the male cohort (t = 2.6; P = 0.01) and was not apparent for females with diabetes (P = 0.2).

Conclusions  Type 2 diabetes is characterized by higher augmentation of aortic systolic pressure and unfavourable ratio of myocardial perfusion to cardiac workload. These results are consistent with increased arterial stiffness. The age‐related progression of arterial stiffness is similar in Type 1 and Type 2 diabetes. Anti‐hypertensive agents that reduce wave reflection and augmentation may help to prevent systolic hypertension and cardiac hypertrophy in diabetes.
TBI or not TBI: that is the question. Is it better to measure toe pressure than ankle pressure in diabetic patients?
Authors: Brooks B. , Dean R. , Patel S. , Wu B. , Molyneaux L. , Yue D. K.
Published: March 2003

Aims Measurement of ankle blood pressure is a simple method of assessing lower limb arterial blood supply. However, its use in diabetes has been questioned due to the presence of medial artery calcification. Measurement of toe blood pressure has been advocated as an alternative but it is technically more difficult. The aim of this study was to obtain information to guide clinicians as to when pressure measurements should be taken at the toe.

Methods Ankle brachial index (ABI) and toe brachial index (TBI) were measured by Doppler ultrasound, or photoplethysmography on 174 subjects with diabetes and 53 control subjects. The Bland and Altman method, and the Cohen's method of measuring agreement between two tests were used to compare ABI with TBI.

Results The mean differences between ABI and TBI in control and diabetic subjects are 0.40 ± 0.13 and 0.37 ± 0.15, respectively. Nearly all diabetic patients with an ABI < 1.3 have an ABI–TBI gradient falling within the normal range established from the non‐diabetic cohort. In contrast, the majority of diabetic subjects with an ABI ≥ 1.3 have ABI–TBI differences outside this range. When patients are categorized according to ABI and TBI, there is also good agreement between the tests when ABI is low or normal (84% and 78% agreement, respectively), but not when ABI is elevated.

Conclusion
 
In the majority of patients with diabetes, assessment of TBI conveys no advantage over ABI in determining perfusion pressure of the lower limbs. Only in those patients with overt calcification, which gives an ABI ≥ 1.3, are toe pressure measurements superior. This guideline should simplify assessment and treatment of diabetic patients with disease of the lower limbs.

Diabet. Med. 18, 528–532 (2001)
Lighting up insulin action
Authors: Tavaré J. M. , Fletcher L. M. , Oatey P. B. , Tyas L. , Wakefield J. G. , Welsh G. I.
Published: March 2003

Understanding the mechanism of insulin action remains one of the most important challenges in modern medical biology. Recent advances in cell imaging techniques, increased processing power of computers and the internet, and the introduction of novel fluorescent reagents such as green fluorescent proteins (GFPs) have revolutionized our ability to scrutinize insulin action by time‐lapse microscopy at the single‐cell level. This article outlines some of the advances made in the authors' laboratory, with particular reference to imaging the movements of the insulin‐sensitive glucose transporter, GLUT4, and the generation of phosphoinositide lipids.
Adverse metabolic and cardiovascular risk following treatment of acute lymphoblastic leukaemia in childhood; two case reports and a literature review
Authors: Amin P. , Shah S. , Walker D. , Page S. R.
Published: March 2003

We report two patients who survived childhood acute lymphoblastic leukaemia (ALL) following treatment with chemotherapy, total body irradiation (TBI) and bone marrow transplantation (BMT). The first case presented with an acute cerebral infarction at 23 years of age and was found to have non‐ketotic diabetes and gross mixed hyperlipidaemia; the second presented with non‐ketotic diabetes, hypertension, proteinuria and dyslipidaemia at age 16 years. The association of glucose intolerance with other vascular risk factors in young adult survivors of BMT was recently highlighted in a follow‐up study of 23 survivors of BMT [1], but none presented with such gross mixed hyperlipidaemia. The improving survival rates of childhood malignancy over the last two decades will present adult physicians with patients who have accelerated vascular risk at a young age who will require early treatment to modify it.

Diabet. Med. 18, 849–853 (2001)
Population‐based survey and analysis of trends in the prevalence of diabetic nephropathy in Type 1 diabetes
Authors: Harvey J. N. , Rizvi K. , Craney L. , Messenger J. , Shah R. , Meadows P. A.
Published: March 2003

Aims  To determine the prevalence of the various stages of diabetic nephropathy in Type 1 diabetes in a population‐based survey. To make direct comparison with results from previous published studies to assess current trends.

Methods  Identification of all Type 1 patients using a population‐based diabetes register. Urine samples for albumin assay were obtained at clinic visit and by postal request. Prevalence rates were calculated specifically for direct comparisons with previously published surveys.

Results  This study and European data from the 1990s show a clear reduction in the cumulative prevalence of microalbuminuria and established nephropathy compared with surveys from Copenhagen (1985), Pittsburgh (1986–8) and Boston (1992). In North Wales in 1999 the overall cumulative prevalence of microalbuminuria was 27.2% (95% confidence interval (CI) 24.3–30.1%) and established nephropathy was 9.6% (7.7–11.5%). Comparisons with data from EURODIAB and from Spain indicated similar results, although the prevalence of microalbuminuria was lower in North Wales than in the EURODIAB study. Significantly lower rates of nephropathy were seen in more recent Swedish cohorts. Diabetic nephropathy remains more common in males. Microalbuminuria before 10 years duration of diabetes was seen at all post‐pubertal ages.

Conclusions  Rates of nephropathy in Europe in the 1990s are lower than a decade ago. Modern methods of management are therefore associated with demonstrable benefit at the population level. The lowest rates of nephropathy are associated with optimum glycaemic control in Swedish data, indicating the importance of metabolic in addition to haemodynamic factors.

Diabet. Med. 18, 998–1002 (2001)
Surrogate estimates of insulin sensitivity in Chinese diabetic patients and their offspring
Authors: Kuo C. S. , Hwu C. M. , Kwok C. F. , Hsiao L. C. , Weih M. J. , Lee S. H. , Lee Y. S. , Ho L. T.
Published: March 2003

Aims To evaluate the relationship between surrogate measures of insulin sensitivity and results from euglycaemic insulin clamp in Chinese diabetic patients and their offspring.

Methods The study included 59 volunteers from 20 diabetic families. Each participant completed a 75‐g oral glucose tolerance test (OGTT) and a euglycaemic insulin clamp. We tested the correlation of surrogate measures of insulin sensitivity with M‐values and M/I ratios (the amount of glucose infused during 90–120 min of the clamp was defined as M, and the mean values of plasma insulin during 90–120 min as I) from the euglycaemic insulin clamp. These measures included fasting insulin (FPI), insulin at 120 min of OGTT, insulin area under the curve of OGTT, fasting glucose‐to‐insulin ratio, homeostasis model assessment for insulin sensitivity (HOMA‐IR and HOMA %S) and the Matsuda–DeFronzo index from OGTT.

Results The Matsuda–DeFronzo index closely correlated to M‐value and M/I in 21 diabetic, 38 non‐diabetic individuals and the 59 participants overall (with M‐value, r = 0.68, 0.84 and 0.84; with M/I, r = 0.71, 0.72 and 0.75, respectively, all P < 0.001). Without OGTT, HOMA %S was a good surrogate index for diabetic (correlated to M‐value and M/I, r = 0.71 and 0.68, P = 0.001) and for non‐diabetic subjects (to M‐value, r = 0.73; to M/I, r = 0.55, both P < 0.001). FPI was as good as HOMA %S and Matsuda–DeFronzo index.

Conclusions The Matsuda–DeFronzo index, HOMA %S and FPI are good surrogate estimates of insulin sensitivity in Chinese diabetic subjects and their offspring.
Diabetes care in Kilimanjaro region: clinical presentation and problems of patients of the diabetes clinic at the regional referral hospital—an inventory before structured intervention
Authors: Neuhann H. F. , Warter‐Neuhann C. , Lyaruu I. , Msuya L.
Published: March 2003

Background In order to improve care for diabetic patients in a developing country at the regional referral hospital for the Northern zone of Tanzania, a specialized clinic was established in November 1996.

Aim The aim of this study was to provide a situational analysis about the problems of the diabetic patient population treated at the hospital. For all patients who registered at the clinic a questionnaire was completed about personal data, diabetes history, symptoms, treatment, eating habits and psycho‐social aspects of the disease. Results from patients who registered between November 1996 and December 1998 were analysed.

Results Data from 474 diabetic patients (46% female) were obtained. Mean age was 53.75 (± 16; range 4–88 years), 15% were classified Type 1, 75% Type 2 and 10% remained unclassified. A body mass index of < 25 was recorded in > 80% of the Type 1 and approx. 50% of the Type 2 patients. Among complications, numbness of the legs was mentioned by 44%, hypertension was diagnosed in about 25%, retinopathy in 14%, foot ulcers in 10% and nephropathy in 7.5% of the patients. About 50% of the patients saw their disease as a big physical and psychological problem. Monthly cost for an average insulin‐treated patient equalled around 25% of the minimal wage.

Conclusion Diabetes care in a developing country needs to address the specific background of the patient population, their needs, the medical problems and the social constraints. Active participation of the patients can help to overcome some of the difficulties.
Insulin resistance in non‐diabetic subjects is associated with increased incidence of myocardial infarction and death
Authors: Hedblad B. , Nilsson P. , Engström G. , Berglund G. , Janzon L.
Published: March 2003

AimsTo compare the incidence of myocardial infarction and death in non‐diabetic subjects with and without insulin resistance.

MethodsPopulation‐based prospective cohort study, in Malmö, Sweden, of 4748 non‐diabetic subjects (60% women), aged 46–68 years, with no history of myocardial infarction or stroke. The prevalence of insulin resistance was established by the homeostasis model assessment (HOMA) and defined as values above the sex‐specific 75th percentile (1.80 for women and 2.12 for men). Incidence of myocardial infarction and death is based on record linkage with local and national registers. Cox’s proportional hazards model was used to assess the influence of insulin resistance after adjustment for age, sex, hyperglycaemia, raised arterial blood pressure, dyslipidaemia, central obesity, smoking and leisure‐time physical activity.

ResultsSixty‐two subjects suffered a coronary event, and 93 subjects died during the 6‐year follow‐up period. Insulin resistance was after adjustment for other factors included in the insulin resistance syndrome and other potential confounders, associated with an increased incidence of coronary events (relative risk (RR) 2.18; 95% confidence interval (CI) 1.22–3.87;P = 0.008) and deaths (RR 1.62; 1.03–2.55;P = 0.038).

ConclusionsInsulin resistance, as assessed by the HOMA method, was in this cohort of middle‐aged non‐diabetic subjects associated with an increased incidence of myocardial infarction and death. This risk remained when smoking, low physical activity and factors included in the insulin resistance syndrome were taken into account in a stepwise regression model.

Diabet. Med. 19, 470–475 (2002)
The assessment of insulin resistance in man
Authors: Wallace T. M. , Matthews D. R.
Published: March 2003

Background Insulin resistance exists when a normal concentration of insulin produces a less than normal biological response. The ability to measure insulin resistance is important in order to understand the aetiopathology of Type 2 diabetes, to examine the epidemiology and to assess the effects of intervention.

Methods We assess and compare methods of measurement and have undertaken a literature review from 1966 to 2001.

Results Quantitative estimates of insulin resistance can be obtained using model assessments, clamps or insulin infusion sensitivity tests. There is considerable variation in the complexity and labour intensity of the various methods. The most well‐established methods are the euglycaemic clamp, minimal model assessment and homeostatic model assessment (HOMA). No single test is appropriate under all circumstances.

Conclusions There are a number of well‐established tests used to measure insulin resistance: the choice of method depends on the size and type of study to be undertaken. Although the so‐called ‘gold‐standard’ test, the euglycaemic clamp, is useful for intensive physiological studies on small numbers of subjects, a simpler tool such as HOMA is more appropriate for large epidemiological studies. It is important to be aware that most techniques measure stimulated insulin resistance whereas HOMA gives an estimate of basal insulin resistance. Caution should be exercised when making comparisons between studies due to variations in infusion protocols, sampling procedures and hormone assays used in different studies.
Is multidisciplinary learning effective among those caring for people with diabetes?
Authors: Munro N. , Felton A. , McIntosh C.
Published: March 2003

The role of multi‐professional learning for those providing clinical services to people with diabetes has yet to be defined. Several assumptions are generally made about education in the context of multi‐professional settings. It is argued that different professions learning together could potentially improve professional relationships, collaborative working practices and ultimately standards of care. Greater respect and honesty may emerge from a team approach to learning with a commensurate reduction in professional antagonism. Personal and professional confidence is reportedly enhanced through close contact with other professionals during team‐based learning exercises. We have examined current evidence to support multidisciplinary learning in the context of medical education generally as well as in diabetes education. Previous investigation of available literature by Cochrane reviewers, aimed at identifying studies of interprofessional education interventions, yielded a total of 1042 articles, none of which met the stated inclusion criteria. Searches involving more recent publications failed to reveal more robust evidence. Despite a large body of literature on the evaluation of interprofessional education, studies generally lacked the methodological rigour needed to understand the impact of interprofessional education on professional practice and/or health care outcomes. Nevertheless, planners continue to advocate, and endorse, joint training between different groups of workers (including nurses, doctors and those in professions allied to medicine) with the objective of producing an integrated workforce of multidisciplinary teams. Whilst the concept of multi‐professional learning has strong appeal, it is necessary for those responsible for educating health care professionals to demonstrate its superiority over separate learning experiences.
Cardiovascular autonomic reactivity is decreased in adolescents with Type 1 diabetes
Authors: Riihimaa P. H. , Suominen K. , Knip M. , Tapanainen P. , Tolonen U.
Published: March 2003

Aims To characterize autonomic nervous system function by means ofthe heart rate and blood pressure responses to various stimuli in relationto pubertal maturation in patients with Type 1 diabetes mellitus (DM).

Methods One hundred out of 138 eligible patients at the Out‐patient Diabetes Clinicand 100 healthy control subjects were examined in terms of cardiovascularparameters at rest, during deep breathing and when standing. Heartrate variabil‐ity was analysed with time domain,frequency domain and fractal dimension parameters. Tanner pubertalstaging was performed before the examinations.

Results The time domain parameters of heart rate variability at restor during standing did not significantly differ between the patientsand controls in total or at pubertal stages. In the spectral analysis ofheart rate variability the very low frequency band was decreasedin the patients during standing (P = 0.023).The increase in the very low frequency (P = 0.013)and low frequency (P = 0.031) spectralpowers upon changing from a supine position to standing was attenuatedin the patients in total, while no significant differences wereobserved within the Tanner pubertal stages between patients and controls.Heart rate variability during deep breathing was decreased in the patientswith distal polyneuropathy (P = 0.006).

Conclusions Although cardiovascular integrity is in the main well preserved inadolescent patients with Type 1 DM, these patients are prone toattenuated autonomic nervous system reactivity.

Diabet. Med. 19, 932–938 (2002)
The status of diabetes control in Asia—a cross‐sectional survey of 24 317 patients with diabetes mellitus in 1998
Authors: Chuang L.‐M. , Tsai S. T. , Huang B. Y. , Tai T. Y.
Published: March 2003

Aims To establish the status of diabetes control in Asia, the Diabcare‐Asia 1998 study collected data from 230 diabetes centres in Bangladesh, People's Republic of China, India, Indonesia, Malaysia, Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Thailand and Vietnam from March to December 1998.

Methods Data were obtained either by patient interview during the enrolment visit or by reviewing medical records for the most recent laboratory assessment and clinical examinations. Blood samples were also collected during patients’ visits for central assessments of HbA1c (normal range 4.7–6.4%).

Results The mean of centrally measured HbA1c was 8.6 ± 2.0% for 18 211 patients (82% of the analysis population). Of the patients with central HbA1c measurements, the majority (55%) had values exceeding 8%, indicative of poor glycaemic control. The prevalence of retinopathy, microalbuminuria and neuropathy was also higher in the group of patients with higher HbA1c. Based on the findings from central HbA1c measurements and reported local HbA1c assessments, it also appears that more patients with poor glycaemic control did not have access to glycated haemoglobin measurements. Mean HbA1c of the diabetic populations in Bangladesh, Indonesia, Korea, Malaysia and Taiwan were significantly lower (all P = 0.0001, except P = 0.0007 for Malaysia), while that of China, India, Philippines and Vietnam was significantly higher (all P = 0.0001) than the grand mean.

Conclusions In our study population of the Asian diabetes patients treated at diabetes centres, more than half were not well controlled. The prevalence of diabetic microvascular complications was higher in the group of patients with higher HbA1c. Further therapeutic actions to improve glycaemic control are required to prevent chronic diabetic complications.

Diabet. Med. 19, 978–985 (2002)
Heritability of features of the insulin resistance syndrome in a community‐based study of healthy families
Authors: Freeman M. S. , Mansfield M. W. , Barrett J. H. , Grant P. J.
Published: March 2003

Aims To investigate genetic and environmental influences on anthropometric, metabolic and fibrinolytic traits of the insulin resistance syndrome (IRS) in a population not characterized by a high degree of insulin resistance.

Methods We recruited 537 adults from 89 randomly ascertained healthy families of white north European origin from the general population. We used maximum likelihood analysis to estimate the heritabilities and effects of environmental covariates on traits of the IRS in these families.

Results Adjusted for age, sex and body mass index, the traits showed considerable heritability. For waist–hip ratio, heritability was 15%. The heritabilities of fasting glucose, insulin and estimated insulin resistance were 20%, 23% and 23%, respectively. Heritabilities were 20%, 24% and 43% for triglycerides, LDL‐cholesterol and HDL‐cholesterol, respectively. For PAI‐1 Ag and t‐PA Ag they were 20% and 26%. Covariates explained 20–25% of the variance of lipids and insulin resistance and 35–36% of fibrinolytic factors. Childhood household influences significantly affected variance for waist–hip ratio (4%), fasting insulin (11%) and estimated insulin resistance (12%).

Conclusions These family data demonstrate significant genetic influence on anthropometric, fibrinolytic and glucose‐related traits of the IRS in a healthy white North European population.

Diabet. Med. 19, 994–999 (2002)
Regional‐scale spatial patterns of fire in relation to rainfall gradients in sub‐tropical mountains, NW Argentina
Authors: Grau Héctor Ricardo
Published: March 2003

Spatial patterns of burns are described using Landsat TM images from the sub‐tropical mountains of north‐west Argentina, over a span of 6 degrees of latitude, and a precipitation range from 250 to 1300 mm/yr. Burns were discriminated easily from unburnt vegetation, mainly by using infrared spectral bands from images taken at the end of the fire season of 1986.

Nineteen sampling units were defined on the basis of geographical proximity and relatively homogeneous rainfall as inferred from topography, and they were characterized in terms of percentage of burnt area and burn size distribution during one fire season. Regression and Correspondence Analysis were used to assess the relationship between rainfall and spatial descriptors of fire regime.

Burnt size area was log‐normally distributed with most fires in the small‐size classes. Of a total of 643 burns, the five largest (more than 2000 hectares each) represented about 30% of the total burnt area.

Percentage of burnt area, density of burns per unit area, and skewness of the burn‐size frequency distribution showed a unimodal pattern along the rainfall gradient, peaking between 700 and 900 mm/yr. Mean and maximum burn size showed a negative but weak correlation with rainfall. The first axis of a Correspondence Analysis ordination of sampling units, on the basis of different descriptors of spatial patterns of fire, was significantly correlated with the rainfall of the sampling unit.

The results suggest that climate is an important factor controlling fuel conditions and therefore fire regime at the spatial scale of this study, which includes different mountain ranges spanning ≈ 700 km.
Reproductive ecology and pollen representation among neotropical trees
Authors: Bush Mark B. , Rivera Robert
Published: March 2003

Three years of pollen trapping data from Barro Colorado Island, Panama, are compared with local vegetation inventories. Two hypotheses relating pollen representation to ‘messy’ pollination and flower form are tested. Dioecious taxa were found to be over‐represented in pollen spectra compared with their occurrence in local forests. Similarly, anemophilous and ‘messy’ pollination types were found to be over‐represented. While anemophilous taxa were the best dispersed pollen types, zoophilous taxa were also well‐represented in dispersal classes of 20–40 m and > 40 m. Thus pollen arriving to lake sediments is most likely to be from anemophilous species or those zoophilous species exhibiting ‘messy’ pollination syndromes. Pollination mechanisms will predictably bias the fossil record against certain flower morphologies. These data are of significance to those using the fossil pollen record to reconstruct the timing and sequence of angiosperm evolution. These data help prioritize plants to be included in modern pollen reference collections and to focus the search for ‘unknown’ types on most‐likely candidate families.
Ecological life zones of Saint Lucia
Authors: Isaac Cornelius , Bourque Charles P.‐A.
Published: March 2003

Aim

The purpose of this study is to apply geographical information and artificial neural network (ANN) technologies in assessing ecosystem distribution on the island of Saint Lucia, as well as to develop an improved ecological classification using Holdridge’s system of natural life zones.

Location

Saint Lucia is a Caribbean island state located at 14°N and 61°W and of a land area of 616 km2.

Methods

The main inputs for classifying life zones were a 25‐m × 25‐m digital elevation model of Saint Lucia (DEM), mean annual temperature and annual total precipitation. The DEM was initially obtained by digitizing contour lines on a topographic map. Elevation–temperature regressions developed for Puerto Rico were used to generate point‐estimates of mean temperature across the island of Saint Lucia. A generalized (trained) ANN was employed to create an annual total rainfall surface for the island. The variables of longitude, latitude and elevation were used to construct the rainfall model. Comparison of predicted and observed total precipitation revealed that the ANN explained over 95% of variability exhibited in the observed data, within a standard error of estimate of 123 mm (~6% of the total precipitation).

Results

Three complete and three transitional life zones were identified as occurring on Saint Lucia. Twelve per cent of the island was classified as tropical premontane moist/wet, 20% as tropical premontane wet, 6% as subtropical dry/moist, 29% as subtropical moist, 26% as subtropical moist/wet and 7% as subtropical wet.

Conclusion

Quality of life zone delineation depends on an objective application of universally accepted criteria and available terrain analysis technologies.