bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediction of Diabetic Retinopathy from Clinical Variables and Color Vision Data
Authors: Aspinall Peter A , Kinnear Paul R , Duncan Leslie J P , Clarke Basil F
Published: March 2007

Predictions about the onset of retinopathy in 295 diabetic patients, all originally having no evidence of retinopathy, have been made in a longitudinal study over 7 yr. Out of many color vision tests and clinical variables, the best individual predictor was a measure of yellow-blue discrimination, using an anomaloscope. The other predictors of significance were the degree of blood glucose control and the duration of diabetes. Although the predictions from a linear logistic model were significant in classifying the diabetic subjects into those whose fundus will remain normal and those in whom it will develop retinopathy, the number of misclassifications was substantial. An examination of the goodnessof fit between the data and the model suggested a criterion value (P) of around P = 0.3 for the probability that a patient develops retinopathy. At this value, the probability of being normal for an individual classed as normal was 0.82, and the probability ofdeveloping retinopathy for an individual classed as having retinopathy was 0.54.
Evaluation of Diabur-Test 5000: A Cooperative Study Carried Out at 12 Diabetes Centers
Authors: Banauch D , Koller P U , Bablok W
Published: March 2007

Diabur-Test 5000, a new test strip for urinary glucose, permits the accurate measurement of up to 5% glucose concentrations in urine. In a survey carried out at 12 diabetes centers in Europe, the new test strip was tested in laboratory trials and routine self-monitoring. There was good agreement between the test strip and the quantitative glucose determination on 4105 urine samples in the laboratory trials. A total of 185 patients used Diabur-Test 5000 for self-monitoring; nearly all reported favorably on the new test strip. Both the laboratory tests (on 1677 urine samples) and self-monitoring (on 4309 urine samples) showed Diabur-Test 5000 to be more sensitive compared with other rapid diagnostic tests. The new test strip is highly suitable for the determination of urinary glucose, particularly in routine self-monitoring.
Quantitative Assessment of Dietary Adherence in Patients with Insulin-dependent Diabetes Mellitus
Authors: Christensen Nedra K , Terry R Dale , Wyatt Sharon , Pichert James W , Lorenz Rodney A
Published: March 2007

Research on the education of diabetic patients in diet management suffers from lack of an adequate method for describing patients' dietary behavior. In this report, a method is proposed for the quantitative assessment of dietary adherence in patients with IDDM. The method relies on comparisons between individualized diet plans and actual consumption as reflected by 24-h diet recalls. Data are presented that suggest this method has reliability and validity. In a sample of 97 patients with IDDM, nearly two-thirds adhered to the number and timing of planned feedings, while only about 10% of patients adhered to planned exchanges, 90% of the time. The average patient added or deleted one exchange for every four exchanges in the diet plan.
Urinary Excretion of N-Acetyl-Beta-D-Glucosaminidase in Children with Type I Diabetes Mellitus
Authors: Ellis Eileen N , Brouhard Ben H , Lagrone Lavenia , Travis Luther B
Published: March 2007

N-acetyl-beta-D-glucosaminidase (NAG), a lysosomal enzyme, has been shown to be increased in the urine of patients with various glomerulonephritides, tubulointerestitial diseases, renal allograft rejection, toxic renal injury, and diabetes mellitus. Although it has been suggested that urinary NAG may reflect blood glucose control, no studies have correlated this with other measures of metabolic control. Thirty-four children from a diabetic summer camp were found to have urinary NAG to creatinine ratios significantly above those of normal controls of similar age (5.22 ± 1.19 versus 1.51 ± 0.17 U). Urinary NAG was found to positively correlate with an arbitrary control index (r =0.82; P < 0.05) and in seven patients with hemoglobin A1c (r =0.70; P < 0.001). In a closely followed group of 40 clinic patients, urinary NAG to creatinine ratio was again found to be significantly increased over normal controls (7.55 ± 0.70 versus 1.51 ± 0.17 U; P < 0.05). Again, urinary NAG was positively correlated with HbA1c (r =0.62; P < 0.001) and urinary albumin to creatinine ratio (r =0.47; P < 0.01). In neither group was there a correlation with UNAG:UCr and duration of disease. Thus, these data suggest that urinary NAG to creatinine ratio appears to be a reflection of blood sugar control.
A Controlled Trial on the Effects of Patient Education in the Treatment of Insulin-dependent Diabetes
Authors: Korhonen Timo , Huttunen Jussi K , Aro Antti , Hentinen Maija , Ihalainen Olli , Majander Heleena , Siitonen Onni , Uusitupa Matti , Pyörälä Kalevi
Published: March 2007

The effect of patient education on diabetic control in insulin-treated diabetic adults was studied in 77 subjects randomized into two groups: intensive patient education (group A) and control (group B). The subjects in group A received intensive patient instruction, both individually and in small groups, from a team of physicians, teaching nurses, and a dietitian. The patients in group B received a short instruction course consisting mainly of printed material. A highly significant improvement in diabetic control was observed in both groups immediately after the education programs, with gradual return to the original level during the following 3–6 mo. No difference was observed between the two groups in any of the measured parameters during the 18-mo investigation. Factors related to good control during the study included the length of school education, the quality of the control at the beginning of the study, and the high degree of self-confidence and lack of signs of anxiety in the psychological tests. The results demonstrate that the effects of educational programs are of limited value if they do not lead to permanent changes in attitudes and motivation, which are critical factors affecting long-term diabetic control.
Effects of Chromium and Yeast Supplements on Carbohydrate and Lipid Metabolism in Diabetic Men
Authors: Rabinowitz Michael B , Gonick Harvey C , Levin Seymour R , Davidson Mayer B
Published: March 2007

Diabetes mellitus has been shown to develop as a consequence of chromium (Cr) deficiency in experimental animals and in humans sustained by prolonged total parenteral nutrition. Prior limited trials in humans had indicated that Cr supplements, in either inorganic or organic form, may improve carbohydrate utilization. We report here a clinical double-blind, random crossover trial of inorganic Cr trichloride, a brewer's yeast that contained Cr as glucose tolerance factor (GTF), a brewer's yeast extract without GTF, and a placebo. Forty-three outpatient diabetic men received three of these supplements for 4 mo each. Subgroups included 21 ketosis-prone men; 7 ketosis-resistant, nonobese men; and 15 ketosis-resistant obese men. Chromium levels were followed pre- and posttreatment in hair, red blood cells, plasma, and urine. Response of carbohydrate metabolism to treatment was assessed in terms of change in insulin requirements, fasting plasma glucose, plasma cholesterol, and triglycerides, as well as change in plasma glucose, glucagon, and insulin or C-peptide levels in response to a standard meal. In some men, these parameters were also measured after i.v. tolbutamide. Both the inorganic and organic oral Cr supplements increased measurable body pools of Cr in hair and red blood cells by about 25%. However, fasting plasma glucose and lipids and the glucose response to either the standard meal or to tolbutamide were not significantly altered by any of the treatments. Despite this lack of effect on carbohydrate levels, the ketosis-resistant subgroups demonstrated a significant increase in postprandial insulin after treatment with the brewer's yeast that contained GTF.
Normo-osmolar, Nonketotic, Hyponatremic Diabetic Syndrome Associated with Impaired Renal Function
Authors: Ryder Robert E J , Hayes Tom M
Published: March 2007

A case is reported of a nonketotic woman with diabetes who presented with a blood glucose of 72.8 mmol/L (1310 mg/dl), plasma sodium of 92 mmol/L, normal osmolality, impaired renal function, and alert clinical state. Before the implication of the unusual nature of the metabolic disturbance was fully considered, the initial treatment was with a rapid infusion of saline. On consideration, however, it was postulated that as her hyperglycemia had developed, the expected osmotic diuresis was prevented by the impairment of her renal function. This had allowed compensatory hyponatremia to develop to maintain normal osmolality and protect the patient from coma. The high-dose saline infusion was stopped, and she was successfully treated with insulin and potassium but only minimal saline. The use of large quantities of saline in normo-osmolar, nonketotic, hyponatremic diabetic syndrome associated with impaired renal function and alert mental state is unnecessary and potentially dangerous.
Potential Barriers to Diabetes Care
Authors: Cohen Stuart J
Published: March 2007

To examine a potential reason why physicians sometimes fail to adhere to standards of care with which they are in agreement, 103 consecutive patients with diabetes mellitus were interviewed immediately after their doctor's appointment in a general medicine clinic of a city/county hospital. The mean age of the patients was 57 yr and the average duration of diabetes was 9 yr. Sixty percent of these patients had their feet examined. A major factor in determining the physicians' behavior was whether the nurse or aide had the patient remove his shoes and socks before being seen by the physician. Physicians were more than three times as likely to perform foot examinations when patients were presented barefoot than when presented wearing shoes and socks. Rarely in medical and continuing medical education do we consider how clinic routines can influence physicians' behavior in the management of diabetes.
Comparison of Visidex and Chemstrip bG with Beckman Glucose Analyzer Determination of Blood Glucose
Authors: Frindik J Paul , Kassner Deborah A , Pirkle Donna A , Kemp Stephen F , Hoff Charles
Published: March 2007

Chemical test strips for estimating blood glucose have been shown to be reliable, rapid, and convenient when properly used. This study compares a new product, the Ames Visidex (Miles Laboratories, Elkhart, Indiana), and an established product, the Bio-Dynamics Chemstrip bG (Boehringer-Mannheim, Indianapolis, Indiana) with plasma glucose as measured by standard laboratory methods. Determination of blood glucose by visual inspection of both chemical strips gave an estimation of true plasma glucose in the hypoglycemic and euglycemic ranges. Both strips were reliable in predicting those values that were hyperglycemic (>180 mg/dl).
Self-Management in Diabetic Children
Authors: Christensen Karen S
Published: March 2007

The level of self-management of 157 type I (juvenile-onset, insulin-dependent) children with diabetes was assessed using a self-management assessment tool developed by the investigator and validated by a panel of diabetes experts. Subjects ranged from 7 to 16 yr and attended the 1981 session of Camp Hertko Hollow, a camp for children with diabetes near Boone, Iowa. The extent of knowledge about diabetes was determined for each subject by the knowledge questionnaire developed and validated by the Diabetes Education Program in Nashville, Tennessee. This knowledge score was then correlated with the self-management score to determine the relationship between the two variables. The t test and regression analysis showed a significant association (P ≤ 0.05) between knowledge and self-management and indicates that children with diabetes are more likely to achieve effective self-management when an adequate knowledge base of the disease also exists.
The Validation of a Diabetes Patient Knowledge Test
Authors: Hess George E , Davis Wayne K
Published: March 2007

Diabetes knowledge tests, used in conjunction with measures of patient attitudes and behaviors, can provide a useful basis for assessing educational needs and designing appropriate instructional experiences. Accurate decisions require instruments that measure patient knowledge of diabetes and its management with high reliability and validity. Data obtained from more than 950 administrations of two parallel forms of a Diabetes Patient Knowledge Test have provided documentation of patient knowledge levels, insight into the effectiveness of educational programs, and support for ongoing program revisions. These data have also allowed study of the psychometric properties of the test instruments, including factor structure, reliability, and validity. Each test form has an overall reliability of 0.89 and the forms are of equal difficulty. Five subcomponents (factors) labeled “Carbohydrates,” “Blood Sugar,” “Basics,” “Food Exchanges,” and “Insulin Administration” are measured in the tests. Evidence of content, construct, concurrent, and discriminant validity has been demonstrated.
Kinetics and Metabolic Activity of Biosynthetic NPH Insulin Evaluated by the Glucose Clamp Technique
Authors: Benedetti M Massi , Bueti A , Mannino D , Bellomo G , Antonella M A , Calabrese G , Zega G , Brunetti P
Published: March 2007

The glucose clamp technique has been used to evaluate the metabolic activity of NPH biosynthetic insulin in diabetic subjects free from anti-insulin antibodies. After overnight blood glucose normalization with a glucose-controlled insulin infusion system (Biostator), an s.c. injection of NPH insulin was given in the abdominal region. The insulin dose (0.236 ± 0.05 U/kg body wt) was related to the usual intermediate-acting insulin requirement in the morning. Glucose was clamped at 100 mg/dl by a feedback i.v. glucose infusion. The end of the action of s.c. injected insulin considered conventionally to be the time of the spontaneous rise of blood glucose to 110 mg/dl. Free insulin levels were higher and the length of action was longer after NPH porcine than after NPH biosynthetic human insulin (BHI) (area under the free insulin curve: porcine 1423 ± 556 mU/L/h; BHI 1045 ± 338 mU/L/h, P < 0.05; length of action: porcine 16.0 ± 3.2 h; BHI 13.7 ± 0.9 h, P < 0.05); the glucose requirement was higher after porcine (76.8 ± 13.5 g) than after BHI (58.5 ± 14.6 g) without reaching statistical significance. However, the metabolic activity of the bioavailable insulin (index of plasma free insulin activity) was similar for the two insulins (porcine 381 ± 77.4, BHI 342.8 ± 54.2 mU/L/g of glucose/h). We conclude that a difference in pharmacokinetics exists between NPH BHI and porcine NPH insulin, which makes the latter metabolically more active. The different behavior does not seem to be related to the insulin molecule itself but could be a consequence of the unequal content of protamine in the two pharmacologic preparations.
Accelerated Bilateral Cataract Formation in Insulin-dependent Diabetes Mellitus
Authors: White F A , Richert Miller M
Published: March 2007

A 21-yr-old Caucasian man developed accelerated irreversible dense bilateral cataracts 4 wk after control of his newly diagnosed insulin-dependent diabetes mellitus (IDDM) and 12 wk after the onset of his symptoms. Although transitory cataracts have been identified in patients with newly diagnosed IDDM, there is no mention in the literature of irreversible cataract formation this soon after diagnosis (see ref. 1).
Effects of a High-Starch Diet with Low or High Fiber Content on Postabsorptive Glucose Utilization and Glucose Production in Normal Subjects
Authors: Nestel Paul J , Nolan Christopher , Bazelmans Jeff , Cook Russel
Published: March 2007

The effects of fiber, added to a high-starch diet, on glucose and insulin metabolism were studied in seven healthy men in a controlled environment. Diets rich in starch (carbohydrate provided 62% energy) contained either 16 g or 100 g of fiber from several sources of food and were given for 10-day periods. Two parameters of glucose control weremeasured: glucose metabolism during insulin-glucose infusions (seven subjects) and glucose production measured by infusing tritiated glucose tracer (five subjects). Three sets ofstudies were carried out in the sequence: low-fiber, high-fiber, low-fiber. The respective mean values (± SE) for glucose utilization were 6.70 ± 1.4, 7.01 ±1.02, and 6.77 ± 1.34 mg/kg · min. Analysis of variance failed to show a significant effect of dietary change. Values for basal glucose production were 2.0 ± 0.1, 1.9 ± 0.2, and 2.4 ± 0.3 mg/kg · min with the low-fiber, high-fiber, and low-fiber diets, respectively, which were not significantly different. The one significant response to the high-fiber diet was a lowering in plasma cholesterol, the mean values for the seven subjects during the three periods being 154 ± 12, 138 ± 10, and 156 ± 13 mg/dl (P < 0.05).
Comprehension Assessment of Diabetes Education Program Participants
Authors: McNeal Belinda , Salisbury Zora , Baumgardner Pat , Wheeler Frances C
Published: March 2007

Diabetes education program participants were assessed to determine their reading and comprehension skill levels, and written and oral instructions were evaluated to determine the reading level of information presented in the education program. A significant mismatch was found between the reading and comprehension levels of program participants and thelevel of oral instruction and printed materials. More than half of the program participants could not fully comprehend educational materials at 5th-grade level, while nearly all written materials and oral instructions were presented at the 9th-grade level or above.
Oral Propranolol and Metoprolol Both Impair Glucose Recovery from Insulin-induced Hypoglycemia in Insulin-dependent Diabetes Mellitus
Authors: Popp Dennis A , Tse Thomas F , Shah Suresh D , Clutter William E , Cryer Philip E
Published: March 2007

To the extent that they have deficient glucagon secretory responses to plasma glucose decrements, as they commonly do, patients with insulin-dependent diabetes mellitus (IDDM) are dependent on epinephrine-mediated β-adrenergic mechanisms to promote recovery from hypoglycemia. Thus, they are at increased risk for prolonged hypoglycemia if treated with a nonselective β-adrenergic antagonist such as propranolol. If the hyperglycemic actions of epinephrine are mediated through β2-adrenergic mechanisms, therapeutic efficacy (e.g., for hypertension or ischemic heart disease) could be accomplished without increased risk of hypoglycemia by selective β1-adrenergic blockade in such patients. However, oral administration of the relatively selective β1-adrenergic antagonist metoprolol (100 mg) and of the nonselective β-adrenergic antagonist propranolol (80 mg) both impaired recovery from insulin-induced hypoglycemia in patients with IDDM. Thus, at a dose of 100 mg, oral metoprolol is not safer than oral propranolol with respect to recovery from hypoglycemia in patients with IDDM.
Bedside Capillary Glucose Monitoring in the General Hospital
Authors: Barr Barbara , Leichter Steven B , Taylor Lindley
Published: March 2007

We assessed the accuracy and reliability of capillary glucose monitoring (CGM) for 20 hospitalized patients as an alternative to repeated venipunctures for laboratory blood glucose (LBG) determination. A total of 330 pairs of observations was obtained. Pearson correlation between patient estimates using Chemstrip bG and the laboratory glucose-oxidase method was 0.87. The mean LBG determination was 197 ± 5 mg/dl compared with 176.4 ± 4.3 mg/dl for patient CGM estimates. The mean deviation was 17.6 ± 2.9 mg/dl or 8.9%, which is well within the 20% range that is generally accepted as sufficiently accurate. Certain individual patients may require relatively more instruction and supervision to reliably carry out these measurements. These patients may represent 10–25% of all diabetic patients. Neither age nor years of schooling is a useful index to identify these patients. Therefore, we suggest as a routine that 10 or more CGM be checked against simultaneous LBG to confirm accuracy before relying on bedside CGM estimates alone in managing the hospitalized patient. Patients who can carry out CGM accurately may be managed with CGM alone.
Anaphylaxis and Immunologic Insulin Resistance in a Diabetic Woman with Ketoacidosis
Authors: Ross Jonathan M , Murali Mandakolathur R , DeLara Teresita C , Cheron Robert G
Published: March 2007

A diabetic woman presented with diabetic ketoacidosis after demonstrating immediate-type hypersensitivity to heterologous insulin. She had had interrupted insulin therapy in the past. Insulin requirements during the course of treatment for the acidosis suggested marked resistance, with 50,000 U of insulin needed in the first 36 h. Anaphylaxis requiring intubation and emergency treatment developed after intravenous purified pork insulin was administered. Elevated titers of insulin-specific IgG (441.6 U/L serum) demonstrated immunologic insulin resistance. Positive intradermal skin tests for beef and pork insulins and detection of insulin-specific IgE by RAST assay revealed concurrent immediate-type allergy. A review of the literature revealed the unique occurrence in this patient of simultaneous ketoacidosis, insulin allergy, anaphylaxis, and immunologic resistance. Interrupted insulin therapy in susceptible individuals remains a potential danger, even with the availability of purified insulin preparations.
Metabolic Alterations After a Two-hour Nocturnal Interruption of a Continuous Subcutaneous Insulin Infusion
Authors: Scheen André , Castillo Manuel , Jandrain Bernard , Krzentowski Georges , Henrivaux Philippe , Luyckx Alfred S , Lefèbvre Pierre J
Published: March 2007

In order to evaluate the metabolic consequences of a 2-h nocturnal interruption of continuous subcutaneous insulin infusion (CSII), seven insulin-dependent diabetic patients without residual insulin secretion were investigated. The changes in blood glucose, plasmafree insulin, glucagon, free fatty acids, and 3-hydroxybutyrate (3 OH-B) concentrations have been compared during two randomized tests carried out either during the normal functioning of a Mill-Hill pump from 10 p.m. to 8 a.m. (1.00 ± 0.06 U insulin/h, keeping adequate metabolic control) or during the same conditions but with a deliberate arrest of the pump between 11 p.m. and 1 a.m. Considering the value recorded at 11 p.m. asreference, interruption of the insulin infusion resulted in: (1) a rapid (already significant after 1 h) and sustained (maximal fall: –12.5 ± 2.5 mU/L at 3 a.m.) decrease in plasma free insulin; (2) a delayed (significant after 4 h) and linear rise in blood glucose (maximal increase: + 4.0 ± 1.3 mmol/L at 5 a.m.); (3) an early (significant at midnight) and prolonged rise in plasma free fatty acids (+ 387 ± 148 μumol/L at 3 a.m.); (4) a delayed (significant after 3 h) and sustained increase in plasma 3 OH-B (+ 347 ± 88 μumol/L at 3 a.m.); and (5) no significant changes in plasma glucagon. Thus, a 2-h interruption of CSII in resting nocturnal conditions is sufficient to induce significant, delayed, and sustained metabolic alterations in C-peptide-negative patients despite good baseline blood glucose control. Resetting the pump at its basal rate is insufficient to quicklyrestore adequate circulating insulin levels and effectively counteract the metabolic disturbances. The efficacy of a bolus insulin injection in these conditions should be evaluated.
Psychological and Social Correlates of Glycemic Control
Authors: Mazze Roger S , Lucido David , Shamoon Harry
Published: March 2007

Eighty-four persons with insulin-dependent diabetes participated in this study to determine whether glycemic control was related to personality, anxiety, depression, and/or quality of life. The subjects were placed on either a conventional treatment regimen consisting of one to two injections of mixed short and intermediate-acting insulin, with urine testing or an intensive treatment regimen consisting of two or more injections of mixed insulins, with self-monitoring of blood glucose. Personality was found to have no relationship to level of glycemic control either at the beginning of the study or at any point during the study. In contrast, anxiety, depression, and quality of life showed a significant relationship to metabolic control at entry and throughout the study period. Lower anxiety and depression scores and better quality of life scores were recorded for those subjects in good control (HbA1 < 8.9%) when compared with those in average control (HbA1 9.0–11.9%) and those in poor control (HbA1 > 11.9%) at entry (P = 0.01). At each point during the study the difference between those in good control and those in poor controlin terms of anxiety, depression, and quality of life was significant (P = 0.02). Change in glycemic control was found to account for up to 20% of the between-patient variability for these psychosocial parameters.
Insulin Gene Structure and Function: A Review of Studies Using Recombinant DNA Methodology
Authors: Permutt M Alan , Chirgwin John , Rotwein Peter , Giddings Steve
Published: March 2007

This review focuses on recent advances in molecular biology as they pertain to the insulin gene and diabetes mellitus. The structure of the human insulin gene is examined, andfactors related to its normal functioning in the beta cells of the pancreas are explored.DNA polymorphisms near the insulin locus and their relationship with certain types of diabetes are considered, as are recently characterized human insulin gene mutations. Events in animal models for diabetes that reflect altered insulin gene expression are discussed and the potential application of gene therapy in human diabetes is examined. Recombinant DNA methodology holds great promise as a tool for providing better understanding of the causes of diabetes and potential curative treatment.
Association of Differing Dietary, Metabolic, and Clinical Risk Factors with Microvascular Complications of Diabetes: A Prevalence Study of 503 Mexican Type II Diabetic Subjects. II
Authors: Paisey R B , Arredondo G , Villalobos A , Lozano O , Guevara L , Kelly S
Published: March 2007

The overall prevalences of microvascular complications and their association with dietary, clinical, and metabolic characteristics have been studied in 503 Mexican type II diabetic subjects. Average daily dietary intakes were 1866 kcal, 46.5% as carbohydrate, 13.7 mmol cholesterol, 8.7 g fiber, and a polyunsaturated/saturated fat ratio of 0.98. Prevalence rates of microvascular and metabolic complications were as follows: background retinopathy 12.3%, exudative retinopathy 24.2%, proliferative retinopathy 8.1% (1% blind, 4% able to read large print only), 9.1% of patients had cataract, 15.9% nephropathy, and 40.8% peripheral neuropathy. In addition, 3.6% had experienced transient lower motor neuron facial paralysis and 0.2% oculomotor paralysis. Patients with retinopathy had a longer mean duration of diabetes, were less obese at the time of examination, and had higher initial and mean blood pressures and higher mean fasting blood glucose levels when compared with those without retinopathy. Similar differences were observed between groups with and without nephropathy except that mean blood glucose levels were similar in the two groups. The presence of peripheral neuropathy was associated with longer duration of diabetes, less obesity, higher mean blood pressure and mean blood glucose levels, and lower hemoglobin concentration. Patients treated with diet alone had significantly lower prevalences of all three microvascular complications but they also had significantly shorter duration of diabetes and lower mean blood glucose levels. However, multivariate analyses on the subgroup of 360 patients who had repeated fasting blood glucose measurements for at least 5 yr demonstrated associations between retinopathy and duration of diabetes, mean blood pressure and mean blood glucose, and percent calories from carbohydrate. Nephropathy was associated with duration, percent calories from carbohydrate, and mean blood pressure. Neuropathy was related to duration, hemoglobin concentration, and mean blood glucose. The significance of these results and dissociation of risk factors for macro- and microvascular disease in this group of patients is discussed.
Pathophysiology of Insulin Secretion in Non-insulin-dependent Diabetes Mellitus
Authors: Ward W Kenneth , Beard James C , Halter Jeffrey B , Pfeifer Michael A , Porte Daniel
Published: March 2007

The pathogenesis of the abnormal metabolic state in patients with non-insulin-dependent diabetes (NIDDM) is controversial. Even the term NIDDM stirs controversy because of the easily drawn inference that individuals with this form of diabetes do not need insulin treatment. Yet many patients with NIDDM are treated with insulin; some even develop hyperosmolar coma if not given insulin. Ketoacidosis, however, is very infrequent in this syndrome, implying that these patients are not dependent on insulin treatment to prevent mass mobilization of fatty acids and ketone bodies. The phrase noninsulin-dependent is therefore appropriate when used in this restricted fashion but inappropriate when used to imply adequacy of insulin secretion. The evaluation of the adequacy of islet function in this syndrome has been complex, since there is no standard of insulin output that can be defined for normal islets without specifying the physiologic setting under which the assessment has been made. For example, individuals with normal glucose levels but variable degrees of obesity have widely varying insulin secretion rates. Thus, the choice of controls is critical when comparing islet function in NIDDM to normal. In addition, the efficiency of the B-cell response to a challenge (e.g., oral glucose tolerance test) can markedly influence the magnitude of the stimulatory glucose level during the period of testing. For example, a subject with some impairment of insulin output will tend to become more hyperglycemic during the test. The hyperglycemia may then stimulate more insulin secretion so that the overall insulin output may appear equal to or even greater than that of a normal individual. In such a closed-loop system, strict control of input variables is necessary to evaluate whether or not insulin secretion is normal. As will be discussed, control of glucose level and other variables is seldom accomplished in dynamic glucose tolerance tests. As will be presented in this review, the development of appropriately controlled studies of islet function has provided convincing evidence that islet B-cell function is abnormal in patients with NIDDM. Since these studies are based on an understanding of normal islet function, normal islet B-cell physiology is discussed before pathophysiology. Finally, the implications of this analysis for the treatment of NIDDM with diet, hypoglycemic sulfonylureas, and insulin will be discussed.
An Analysis of Diabetic Pregnancies at Mayo Clinic, 1950–79
Authors: Lufkin Edward G , Nelson Roger L , Hill Lyndon M , Melton L Joseph , O'Fallon W Michael , Evans Arthur T
Published: March 2007

We reviewed the records of pregnant diabetic women attended at Mayo Clinic during the years 1950–79 and matched each nonaborted diabetic pregnancy with two control pregnancies. Abortions occurred in 49 of 277 diabetic pregnancies (17.7%). The relative risk of other adverse outcomes of pregnancy (± 95% confidence interval) in comparison with controls was as follows: perinatal mortality, 7.0 (3.6–13.8); major congenital birth defects, 6.3 (2.8–14.2); and respiratory distress, 9.0 (4.5–17.9). Diabetic ketoacidosis resulted in fetal death in 5 of 18 cases. Patients with mean fasting blood glucose levels of ≤ 140 mg/dl had a perinatal mortality of 81 per 1000 births and an incidence of respiratory distress and congenital birth defects of 18.9% and 9.9%, respectively. Patients with mean blood glucose levels > 140 mg/dl had corresponding rates of 306 per 1000, 20.4%, and 11.2%, respectively. Hydramnios occurred almost exclusively in diabetic women, and its presence was associated with a twofold increase in the frequency of perinatal death. Analysis of diabetic pregnancy outcome by decade showed no appreciable decrease in the occurrence of perinatal mortality, congenital birth defects, or respiratory distress over the 30-yr period.
Relationship Between Health Locus of Control, Health Value, and Social Support and Compliance of Persons with Diabetes Mellitus
Authors: Schlenk Elizabeth A , Hart Laura K
Published: March 2007

Thirty insulin-dependent outpatients were interviewed during one of their diabetes clinic visits. Questionnaires were used to measure the independent variables of health locus of control, health value, and perceived social support. Self-report and direct observation were used to measure the dependent variable, compliance with insulin administration, diet, exercise, hypoglycemia management, self-monitoring of blood glucose (SMBG), and foot care prescriptions. All patients complied with at least 70% of the points measured; half the group complied with at least 80% of the regimen. However, no one complied with all the behaviors deemed essential for good control. The group was most compliant with SMBG, hypoglycemia management, and insulin administration and least compliant with foot care and exercise. A statistically significant relationship was found between compliance and social support (P < 0.001), powerful others health locus of control (PHLC) (P < 0.01), and internal health locus of control (IHLC) (P < 0.05). A multiple regression analysis found that social support and PHLC accounted for at least 50% of the variance in compliance scores. The multiple-R of the independent variables with compliance reached a significance level of P < 0.005. However, only the two variables of social support and PHLC added significantly (P < 0.05) to prediction accuracy. The multiple-R of these two variables used as a set reached the significance level of P < 0.001.
Potential Pitfalls in the Use of Glucoscan and Glucoscan II Meters for Self-Monitoring of Blood Glucose
Authors: Laus Victor G , Dietz Mark A , Levy Richard P
Published: March 2007

We discovered that skilled nurses only casually trained in the use of a fingertip blood glucose reflectance meter (Glucoscan, Lifescan, Mountainview, California) had a 36% incidence of unacceptable results (> 15% from reference). A controlled study was undertaken and showed that with Glucoscan I (GI) 4 of 27 readings were unacceptable and with Glucoscan II (GII) 3 of 27 readings were unacceptable, a statistically nonsignificant difference. Minor deviations from the manufacturer's recommended technique had a significant effect on the results with GI. In contrast, GII was much less sensitive to variations in recommended technique. GI underestimated the reference glucose concentration by 11.7%, and GII overestimated by 6.5%, a statistically significant difference. We conclude that the health professional must be aware of interdevice and intradevice variability in self-monitoring of blood glucose (SMBG). Patients need careful training in the method of SMBG. The results of any single value should be interpreted with caution.
Continuous Intravenous Insulin Infusion in the Management of Brittle Diabetes: Etiologic and Therapeutic Implications
Authors: Williams Gareth , Pickup John C , Keen Harry
Published: March 2007

Continuous intravenous insulin infusion (CIVII) was used to treat five brittle insulin-dependent diabetic women (aged 16–29 yr) who had failed to achieve satisfactory glycemic control during intensified subcutaneous insulin treatment including continuous subcutaneous insulin infusion (CSII). Insulin was infused through an indwelling central venous catheter by a portable pump for 3–16 mo. During CIVII, only three subjects obtained satisfactory glycemic control and only for short periods. Generally, as with CSII, control was erratic and unpredictable and three subjects intermittently had high insulin requirements (200 U/day). By contrast, three stable insulin-dependent diabetic subjects achieved near-nor-moglycemia within 1–3 days of starting CIVII with daily insulin dosages of 30–90 U. The lives of all five brittle subjects continued to be disrupted by frequent hospital admissions during CIVII treatment. Deliberate interference with their own treatment (including tampering with pumps and central venous catheters) was thought to be a major contribution to instability in two of the brittle subjects. In the others, the ineffectiveness of CIVII suggests that brittleness was not due solely to defective subcutaneous insulin absorption, as had previously been suggested in other CSII-unresponsive brittle subjects. Although CIVII has reportedly been successful in managing brittle diabetes, the technique may not be useful in all brittle individuals, as illustrated by the poor glycemic responses of these subjects and the serious complications (including local infection, septicemia, and thrombosis) they suffered.
Rarity of a Marked “Dawn Phenomenon” in Diabetic Subjects Treated by Continuous Subcutaneous Insulin Infusion
Authors: Bending Jeremy J , Pickup John C , Collins Andrea C G , Keen Harry
Published: March 2007

We assessed the quality of overnight glycemic control and the frequency of the “dawn phenomenon” (nadir–0800 h glycemic increase) in 41 insulin-dependent diabetic patients treated by continuous subcutaneous insulin infusion (CSII). Mean plasma glucose levels were near-normal during the 24 h and, in particular, constant throughout the night. In a subset of six patients overnight plasma free insulin concentrations were also constant during CSII. The majority of profiles (88%) showed a glucose nadir from 2.0 to 5.9 mmol/L (most frequently at 0600 h) and had an 0800 h value from 2.0 to 6.9 mmol/L (92%). A large proportion (46%) of profiles showed a zero or negative nadir-0800 h glycemic increase. In 22 patients with three or more profiles recorded at the same basal insulin infusion rate, only one of 103 profiles had a fasting glycemic increase greater than an arbitrary value of 5.0 mmol/L (5.3), although many patients exhibited small dawn glycemic increases (e.g., 14 of 22 had a mean increase of from 0 to 2 mmol/L). In 12 subjects a 15% reduction in basal insulin infusion rate increased the mean ± SEM dawn glycemic increase from 0.58 ± 0.25 mmol/L to 2.7 ± 0.76 mmol/L (P < 0.025) as well as significantly increasing the nocturnal nadir and 0800 h plasma glucose concentrations. Thus, a marked dawn phenomenon is rare when a single but adequate basal infusion rate is used for CSII, and this questions the need in the majority of patients for preprogrammable pumps with nocturnal infusion rate changes.
Pharmacokinetics and Bioavailability of Injected Glucagon: Differences Between Intramuscular, Subcutaneous, and Intravenous Administration
Authors: Mühlhauser Ingrid , Koch Jutta , Berger Michael
Published: March 2007

Pharmacokinetics and bioavailability of 1 mg glucagon injected intramuscularly (i.m.), subcutaneously (s.c.), or intravenously (i. v.) were studied in 6 nondiabetic men rendered hypoglycemic by s.c. injection of 10 U regular insulin. At 90 min after the insulin injection, when blood glucose levels had fallen to a mean of 49 mg/dl, glucagon was administered. Ten minutes later plasma glucagon levels had risen from a mean of 246 to 3233 pg/ml (s.c. experiment) and from 250 to 2638 pg/ml (i.m. experiment). Accordingly, there was no difference in blood glucose behavior whether glucagon was injected s.c. or i.m. In the i.v. experiment, plasma glucagon levels were significantly higher during the first 15 min after the glucagon injection when compared with the other experiments. The initially high levels of plasma glucagon after i.v. administration were associated with a steeper rise of glycemia during the first 5 min after glucagon injection; the maximal increase of blood glucose was, however, not different when compared with the s.c. or i.m. route of glucagon administration. Thus, in case of severe hypoglycemia, therapeutically administered glucagon will be most efficient when injected i.v., but there is no difference between the i.m. and s.c. routes of administration with regard to the efficacy to increase blood glucose levels.
Heart Rate Variability in Diabetes: Relationship to Age and Duration of the Disease
Authors: Masaoka Shirley , Lev-Ran Arye , Robert Hill L , Vakil Gita , Hon Edward H G
Published: March 2007

Heart rate variability (HRV) during deep breathing was studied with a neonatal heart monitor in 143 control subjects and 218 patients with diabetes (102 with IDDM and 116 with NIDDM). In the control group HRV decreased after age 20 by 4–5 beats per decade (from 29.7 ±5.8 beats at age 20–29 to 11.8 ± 5.4 beats at age 60 +). In all age groups HRV in IDDM was lower than in the controls, and both age and duration of diabetes played a role in the decrease of HRV (from 21.5 ± 5.3 beats at age 20–29 to 6.3 ± 5.4 at age 60 +). In NIDDM aging seemed to play a less important role, and the influence of the duration of the disease was not statistically significant. In both groups of patients the frequency of HRV below the 2.5th percentile was 82% in those with symptoms and/or signs of autonomie neuropathy, 64% in patients with peripheral neuropathy only, and 36% in those who had no obvious signs or symptoms of neuropathy. Interindividual variability was pronounced, and age and duration of the disease together accounted for only 36% of the observed differences between IDDM and the controls. Determination of HRV with a standard neonatal heart monitor presents an easy, simple, and nonstressful test of cardiac autonomie neuropathy. The norms of the test are age related.
C-Peptide Responses to Glucose Load in Maturity-Onset Diabetes of the Young (MODY)
Authors: Mohan Viswanathan , Snehalatha Chamukuttan , Ramachandran Ambady , Jayashree Ramaswamy , Viswanathan Moopil
Published: March 2007

Pancreatic beta cell responses were measured in obese and nonobese maturity-onset diabetes of the young (MODY) patients by estimating serum immunoreactive insulin (IRI) and C-peptide (CP) during oral glucose tolerance testing (OGTT). The serum CP responses were generally low in MODY patients and more pronounced in obese patients. The IRI responses were heterogenous; some patients had normal and others low responses. It was observed that in several patients there was a relatively higher IRI concentration in comparison with the CP values, as indicated by low CP and normal IRI values. This is suggestive of altered metabolic fates of insulin and CP in the MODY patients.
The Prevalence of Symptomatic, Diabetic Neuropathy in an Insulin-treated Population
Authors: Boulton Andrew J M , Knight Graham , Drury John , Ward John D
Published: March 2007

The prevalence of symptomatic sensorimotor polyneuropathy has been determined in a population of 382 insulin-treated diabetic subjects aged 15–59 yr. Forty-one subjects (10.7%) were found to have diabetic neuropathy, according to strict diagnostic criteria that required the presence of symptoms and signs of nerve dysfunction in the absence of peripheral vascular disease. There was a significant correlation between glycosylated hemoglobin levels and motor conduction velocity in the median and peroneal nerves in all subjects. This finding further emphasizes the importance of metabolic factors related to hyperglycemia in the impaired nerve function seen in diabetic patients.
Mother-Daughter Interaction and Adherence to Diabetes Regimens
Authors: Bobrow Elisa S , AvRuskin Theodore W , Siller Jerome
Published: March 2007

This study explores the relationship of mother-daughter interaction to adherence to treatment plans among diabetic adolescents. Fifty mother-daughter dyads discussed conflict issues and feelings, problems, and concerns related to diabetes. Discussions were analyzed using the Hill Interaction Matrix and modified Beavers-Timberlawn Family Evaluation Scales. Interview questionnaires provided information on adherence, feelings, problems and concerns, parental supervision, adjustment, and family life. The less adherent the adolescent, the more emotionally charged the interaction, the more directly confrontive mother and daughter were, and the less efficient they were at negotiating issues. The adolescent's statements about herself confirmed observations that poor adherers, more than good adherers, had difficulty discussing feelings, problems, and concerns with their mothers (r = −0.51, P ≤ 0.001). Poor adherers reported believing less strongly that adherence would delay/avoid complications (r = 0.51, P ≤ 0.001), became more anxious about seeing a disabled diabetic person (r = −0.29, P ≤ 0.29), and worried more about future health (r = −0.27, P = NS). No relationships were found between adherence and adolescent-physician rapport. Many adolescents were not engaging in good self-care behaviors, were quite concerned about future health, perceived mothers to be very concerned, hesitated telling peers about their illness, and did not share deeper illness-related concerns with their closest nondiabetic friends.
Medication Compliance in Non-insulin-dependent Diabetes: A Randomized Comparison of Chlorpropamide and Insulin
Authors: Diehl Andrew K , Sugarek Nancy J , Bauer Richard L
Published: March 2007

Medication compliance may be a problem in the management of patients with diabetes. Some physicians initially treat patients having non-insulin-dependent diabetes with oral sulfonylureas because they fear greater compliance problems with insulin therapy. We compared compliance with insulin and chlorpropamide in patients newly beginning medication for NIDDM. Seventy-seven adults with hyperglycemia despite diet therapy were randomly assigned to chlorpropamide or insulin. Compliance was measured four times over 24 wk. Patients then crossed over to the other medication and were followed for 24 additional weeks. Overall, there were no differences in compliance with the two medications in terms of percent of prescription used, proportion taking at least 80% of prescribed medication, self-report of medication or diet compliance, or protocol dropout rates. However, treatment satisfaction was higher with chlorpropamide, and most patients preferred chlorpropamide to insulin (P < 0.0001). While such differences in satisfaction may affect long-term compliance, physicians should not assume that their patients will be less compliant with insulin than with oral sulfonylureas.
Methods for the Control of Diabetes After Acute Myocardial Infarction
Authors: Husband D J , Alberti K G M M , Julian D G
Published: March 2007

Blood glucose control in patients with diabetes after myocardial infarction is often poor, and this may contribute to increased mortality in the diabetic patient. A retrospective review of the records of 71 diabetic patients admitted with suspected myocardial infarction, and managed using a variety of methods, showed that adequate control (mean blood glucose <234 mg/dl; 13 mmol/L) was achieved in only 60%. Continuation of oral hypoglycemic agents and the use of irregular intermittent insulin in response to hyperglycemia were particularly associated with poor control. In a prospective study 68 consecutive patients were managed using regular subcutaneous insulin injections three times daily or a glucose-insulin-potassium intravenous infusion (in those with cardiogenic shock, severe hyperglycemia, or unable to eat). Control was adequate in 87% (P < 0.001 versus retrospective group) and mean blood glucose concentration on days 1 and 2 were significantly lower than in the retrospective group (167 versus 232; 165 versus 236 mg/dl; both P < 0.001). Simple protocols using three-times-daily subcutaneous insulin or glucose-insulin-potassium infusion provide a practical method for achieving good glycemic control in the diabetic patient with suspected acute myocardial infarction.