bluuebunny/crossref_metadata_2025 huggingface dataset:
Tissue Plasminogen Activator Inhibition in Diabetes Mellitus
Authors: Small Michael , Kluft Cornelius , MacCuish Angus C , Lowe Gordon D O
Published: March 2007

Depression of fibrinolysis may be relevant to the vascular complications of diabetes mellitus. Plasminogen activator inhibitor (PAI) is an important inhibitor of fibrinolysis in humans, and we have found basal activities of PA inhibition to be elevated in patients with diabetes compared with a reference group of healthy subjects (mean ± SD 268 ± 268 vs. 105 ± 48%; P < .0001). With a monoclonal antibody, it was shown that high inhibition values were due to PAI-1. No differences in PA inhibition were noted in relation to type of diabetes, diabetic treatment, or presence or absence of vascular complications. Basal PA inhibition did not correlate with in vivo (Bβ15-42 antigen) or ex vivo (fibrin plate) fibrinolytic activity or HbA,. In patients with noninsulin- dependent diabetes mellitus, treatment with the anabolic steroid stanozolol significantly reduced PA inhibition. These findings suggest a further abnormality of fibrinolysis in diabetes, but the lack of a relationship among other measures of fibrinolysis renders its biologic significance uncertain
Effect of Metformin on Carbohydrate and Lipoprotein Metabolism in NIDDM Patients
Authors: Wu M-S , Johnston P , Sheu WH-H , Hollenbeck CB , Jeng C-Y , Goldfine ID , Chen Y-DI , Reaven GM
Published: March 2007

The effect of metformin treatment on various aspects of carbohydrate and lipoprotein metabolism has been defined in 12 patients with non-insulin-dependent diabetes mellitus (NIDDM). Patients were studied before and after ∼ 4 mo of metformin therapy. Treatment was initiated with a single dose of 500 mg/day, increased at weekly intervals, and maintained at a final dose of 2.5 g/day (given at divided intervals) for the last 3 mo of the treatment program. Results demonstrated that both fasting and postprandial glucose concentrations were significantly lower after metformin administration, with the greatest change seen after meals. As a result, the total incremental plasma glucose response above basal measured from 0800 to 1600 after metformin was <25% of that seen initially. The improvement in ambient plasma glucose concentration in association with metformin occurred despite a modest but statistically significant decrease in circulating plasma insulin concentration. In addition, insulin-stimulated glucose uptake measured during hyperinsulinemic clamp studies was similar before and after metformin treatment. Furthermore, changes in insulin binding and insulin internalization by isolated monocytes did not correlate with the improvement in glycemic control. Thus, the ability of metformin to lower plasma glucose concentration in NIDDM does not appear to be secondary to an improvement in insulin action. Finally, metformin treatment was associated with a significant (P < 0.01) decrease in plasma triglyceride concentration and an increase in plasma high-density lipoprotein cholesterol concentration. These results indicate that metformin treatment of patients with NIDDM led to an improvement in both glycemic control and lipoprotein metabolism.
Survey of Diabetes Professionals Regarding Developmental Changes in Diabetes Self-Care
Authors: Wysocki Tim , Meinhold Patricia , Cox Daniel J , Clarke William L
Published: March 2007

There are no empirically obtained data defining appropriate developmental expectations for the acquisition of self-care independence by children with insulin-dependent diabetes mellitus. This study surveyed diabetes professionals about their estimates of ages at which children typically master 38 diabetes skills. The 229 survey respondents represented a broad range of professions and clinical settings and had extensive experience as diabetes professionals. Mean mastery age estimates were <14 yr for the 38 skills assessed. Responses to each item were variable among respondents, with a mean SD of 2.1 yr in estimated mastery ages for all items. Estimated mastery ages were below the age ranges recommended by the American Diabetes Association for 14 of 20 comparable skills. Physicians generally expected the diabetes skills to be mastered at later ages than did nurses or other health-care professionals. There were no other consistent response patterns related to respondent characteristics, i.e., years of clinical experience, employment setting, current patient load, or method of survey distribution.
Lack of Cutaneous Hyperemia in Response to Insulin-Induced Hypoglycemiain IDDM
Authors: Åman Jan , Berne Christian , Ewald Uwe , Tuvemo Torsten
Published: March 2007

Cutaneous blood flow was measured with the laser Doppler technique and by recording cutaneous O2 tension on the forearm and forehead in nine young adult patients with insulin-dependent diabetes mellitus (IDDM) andnine sex- and age-matched healthy control subjects after induction of hypoglycemia. In the healthy subjects, cutaneous blood flow measured with the laser Doppler technique was increased by 120 ± 26% in the forehead (P < 0.01) and 196 ± 50% in the forearm (P < 0.01) at the glucose nadir (blood glucose 1.8 ±0.2 mM) compared with basal blood flow. In contrast, in diabetic patients, cutaneous blood flow was unchanged. The corresponding changes, at the glucose nadir, with cutaneous O2 tension recordings were 286 ± 131% (P < 0.05) in control subjects and −22 ± 15% (NS) in diabetic patients. An impairment of sympathetic nervous function, not detectable by simple cardiovascular tests, could be responsible for the lack of cutaneous hyperemia and sweating and could contribute to unawareness of hypoglycemia in diabetic patients.
Controlled Study in Diabetic Children Comparing Insulin-Dosage Adjustment by Manual and Computer Algorithms
Authors: Chiarelli Francesco , Tumini Stefano , Morgese Guido , Albisser A Michael
Published: March 2007

A controlled trial of a new microprocessor device for insulin-dosage adjustment was undertaken in two matched groups of a priori well-controlled diabetic children. A prospective study design with three equal 8-wk periods wasused. In the first period, both groups used manual methods for insulin-dosage adjustment after manual criteria. In the second period, one group of children adjusted insulin dosage by computer algorithms, whereas the other continued to use manual methods. In the third period, both groups again adjusted insulin by traditional methods. Mean premeal glycemia and glycosylated hemoglobin levels did not change in either group throughout the study. During the second period, episodes of hypoglycemia were more frequent in children without the computer than in those who used the device. In keeping with the latter outcome, the group that used the microprocessor device was given less insulin in the second period than the first (0.88 ± 0.02 vs. 0.94 ± 0.02 U · kg−1 · day−1, P < 0.0001) and in comparison to the control group of patients who concurrently were given an increased insulin dose in the second period compared with the first. This study showed that insulin treatment through specific computer-mediated dosage-adjusting algorithms was safe and minimized hypoglycemia by effectively accommodating seasonally changing insulin requirements. We recommend the device to help diabetic children and their families in the care of insulindependent diabetes.
Cross-Sectional Analysis of Renal Function in Black Americans With NIDDM
Authors: Lebovitz Harold E , Palmisano JoAnne
Published: March 2007

Our objective was to define glomerular filtration rate (GFR) and renal plasma flow (RPF) in Black Americans with non-insulin-dependent diabetes mellitus (NIDDM). This was a cross-sectional study of 71 Black NIDDM patients with diagnosed diabetes duration from 1 mo to 21 yr. Hyperglycemia was regulated and stabilized before patients were entered into the study. GFR and RPF were determined by the clearance of [l25I]iothalamate and 131I-labeled hippuran, respectively, with a constant-infusion technique and four urine collection periods. Hyperfiltration, as defined by a GFR of >140 ml · min−1 · 1.73 m−2, was found in 7 of 20 patients (35%) with newly diagnosed (<2 yr duration) NIDDM. The percentage of patients with hyperfiltration decreased with increasing duration of diagnosed diabetes. Decreasing GFR and RPF occurred with increasing duration of diagnosed diabetes. In conclusion, renal hemodynamic changes in Black Americans with NIDDM are similar to those known to occur in White populations with IDDM.
Risk Factors for Gestational Diabetes in Black Population
Authors: Bell David SH , Barger Bruce O , Go Rodney CP , Goldenberg Robert L , Perkins Laura L , Vanichanan Chotip J , Roseman Jeffrey , Acton Ronald T
Published: March 2007

In a long-term longitudinal study of gestational diabetes mellitus in Black women, risk factors that were identified were age, obesity, a family history of diabetes, and the presence of hypertension. Poor predictors were a history of a previous large-for-date infant, parity, and age at first pregnancy. The prevalence of smooth muscle and nuclear autoantibodies was higher in gestational diabetic subjects. Gestational diabetic subjects who required insulin for glycemic control were more obese, had a lower frequency of the Bf-F phenotype and a higher frequency of the Bf-F1 phenotype, and had a lower frequency of the type 2 allele at the polymorphic locus adjacent to the insulin gene. Restriction-fragmentlength polymorphisms flanking the insulin and apolipoprotein A-l and C-MI genes, although not associated with gestational diabetes mellitus, may be associated with hyperlipidemia and subsequent atherosclerosis.
Diabetic Retinopathy in Blacks
Authors: Rabb Maurice F , Gagliano Donald A , Sweeney Howard E
Published: March 2007

Diabetic eye disease, particularly diabetic retinopathy, is the leading cause of new cases of legal blindness in people 20–74 yr of age in the United States. The prevalence and rate of diabetes in this age-group are higher in Blacks than in Whites. The rate of blindness from diabetic eye disease is also higher in Blacks than in Whites. Severe macular edema, the most frequent cause of decreased vision in diabetic retinopathy, appears to be more common in Blacks. Risk factors for developing macular edema include poorly controlled hypertension, hyperglycemia, and duration of disease. The higher prevalence of hypertension in Blacks may contribute to the increased severity of diabetic retinopathy. Further evaluation is necessary to determine the influence of race on the severity of diabetic retinopathy.
Intensive Insulin Therapy for Treatment of Type I Diabetes
Authors: Hirsch Irl B , Farkas-Hirsch Ruth , Skyler Jay S
Published: March 2007

Intensive insulin therapy is best defined as a comprehensive system of diabetes management with the patient and management team as partners. The system is directed at improvement of glycemia and patient well-being. Glycemic targets should be individually defined. Frequent self-monitoring of blood glucose, probably at least four times per day, is essential for meticulous control. The benefits include improved psychosocial functioning and the potential of lessening the risks of chronic complications of diabetes. The risks relate to problems associated with hypoglycemia, which are increased if meticulous glycemic control is sought. One of the important elements of intensive therapy is a multiple-component insulin program designed to provide effective insulinemia coinciding with each major meal and continuous basal insulinemia throughout the 24-h day. This may be achieved with continuous subcutaneous insulin infusion (CSII) or multiple injections with various insulin regimens, although CSII may offer real advantages in terms of the pharmacokinetics of insulin delivery. Other pharmacokinetic issues to be considered involve selection of injection sites, timing of premeal insulin, and mixing insulins. Many studies have shown that, albeit with effort, excellent glycemic control can be achieved by various intensive insulin-therapy regimens. The implementation of a program of intensive therapy involves patient self-management in terms of altering insulin dosages, food intake, and/or activity in an attempt to achieve the target level of glycemia selected. In motivated patients willing to embark on such a course of therapy, intensive insulin therapy can be worthwhile. It should be considered for all patients with type I (insulin-dependent) diabetes mellitus.
Failure of Nocturnal Hypoglycemia to Cause Daytime Hyperglycemia in Patients With IDDM
Authors: Hirsch Irl B , Smith Lori J , Havlin Carolyn E , Shah Suresh D , Clutter William E , Cryer Philip E
Published: March 2007

To test the hypothesis that nocturnal hypoglycemia causes postprandial hyperglycemia the next day (the Somogyi phenomenon) in patients with insulindependent diabetes mellitus (IDDM), we studied 10 moderately well controlled patients, who were on their usual therapeutic regimens, from 2000 to 2000 on three occasions. On a control day, samples were obtained without intervention. On another day, nocturnal hypoglycemia was prevented (by intravenous infusion of glucose, if necessary, from 2200 to 0400 to keep plasma glucose levels at >5.6 mM). On another day, nocturnal hypoglycemia was induced (by stepped intravenous insulin infusions between 2200 and 0200 to reduce plasma glucose levels to <2.8 mM). After nocturnal hypoglycemia (1.9 ± 0.2 mM), fasting (0800), morning (0800-1100), afternoon (1200-1500), evening (1600- 2000), and entire-day (0800-2000) plasma glucose concentrations were no higher than those after prevention of nocturnal hypoglycemia or sampling only. On the control day, fasting and daytime plasma glucose levels were directly related to the preceding 2200 (r = 0.723, P < 0.02, and r = 0.762, P = 0.01, respectively) and nocturnal nadir (r = 0.714, P < 0.02, and r = 0.728, P < 0.02) plasma glucose concentrations. Daytime plasma glucose levels were unrelated to peak nocturnal plasma glucagon, epinephrine, norepinephrine, growth hormone, or cortisol concentrations. We conclude that nocturnal hypoglycemia does not appear to cause clinically important daytime hyperglycemia in patients representative of most patients with IDDM.
Course of Peripheral Occlusive Arterial Disease in Diabetes: Vascular Laboratory Assessment
Authors: Osmundson Philip J , O'Fallon W Michael , Zimmerman Bruce R , Kazmier Francis J , Langworthy Alice L , Palumbo P J
Published: March 2007

To determine comparative rates of development and progression of peripheral occlusive arterial disease, 110 healthy nondiabetic control subjects, 112 patients with peripheral occlusive arterial disease (POAD), 240 patients with diabetes mellitus (DM), and 100 patientswith diabetes mellitus and peripheral occlusive arterialdisease (DM + POAD) were studied over 4 yr with noninvasive techniques. The presence of peripheral occlusive arterial disease was determined by postexercise ankle-brachial index (ABI) values; progression of peripheral occlusive arterial disease was determined by the rate of change in postexercise ABI. Patients who underwent peripheral arterial reconstructive surgery or amputation were also classified as having progression of their peripheral occlusive arterial disease. On this basis, follow-up revealed that peripheral occlusive arterial disease developed and therefore progressed in 1 (1%) of the control group and 22 (9%) of the DM. Peripheral occlusive arterial disease progressed in 31 (28%) of the POAD and 26 (26%) of the DM + POAD. The presence of peripheral occlusive arterial disease predisposes to progression of disease, and peripheral occlusive arterial disease is more likely to develop in diabetic patients who do not have peripheral occlusive arterial disease than in nondiabetic control subjects. However, the presence of diabetes mellitus in patients with peripheral occlusive arterial disease does not seem to increase the risk of progression.
Depressive Symptomatology in Obese Adults With Type II Diabetes
Authors: Wing Rena R , Marcus Marsha D , Blair Elaine H , Epstein Leonard H , Burton Lisa R
Published: March 2007

This study compared depressive symptomatology in 32 obese subjects with type II (non-insulin-dependent) diabetes (16 men, 16 women) and their obese nondiabetic spouses. All subjects completed the Beck Depression Inventory (BDI) before participation in a behavioral weight-loss program. Diabetic subjects reported significantly more depressive symptomatology than their overweight nondiabetic spouses (10.6 ± 6.4 vs. 7.5 ± 6.2, P < 0.04). Diabetic subjects scored higher than their spouses on 15 of 20 BDI items, with significant differences in feelings of being punished, perceived appearance, and interest in sex. Mean BDI score in the diabetic spouses was similar to that observed in the first 123 diabetic subjects to enter the weight-loss program (BDI 11.2 ± 6.9). Further studies are needed to determine whether diabetic subjects differ from age-, sex-, and weight-matched nondiabetic individuals in clinical depression and depressive symptomatology.
Second Messengers of Insulin Action
Authors: Saltiel Alan R
Published: March 2007

Despite significant advances in past years on the chemistry and biology of insulin and its receptor, the molecular events that couple the insulin-receptor interaction to the regulation of cellular metabolism remain uncertain. Progress in this area has been complicated by the pleiotropic nature of the actions of insulin. These most likely involve a complex network of pathways resulting in the coordination of mechanistically distinct cellular effects. Because the well-recognized mechanisms of signal transduction (i.e., cyclic nucleotides, ion channels) appear not to be central to insulin action, investigators have searched for a novel second-messenger system. A low-molecular-weight substance has been identified that mimics certain actions of insulin on metabolic enzymes. This substance has an inositol glycan structure, and is produced by the insulin-sensitive hydrolysis of a glycosylphosphatidylinositol in the plasma membrane. This hydrolysis reaction, which is catalyzed by a specific phospholipase C, also results in the production of a structurally distinct diacylglycerol that may selectively regulate one or more of the protein kinases C. The glycosyl-phosphatidylinositol precursor for the inositol glycan enzyme modulator is structurally analogous to the recently described glycosyl-phosphatidylinositol membrane protein anchor. Preliminary studies suggest that a subset of proteins anchored in this fashion may be released from cells by a similar insulin-sensitive phospholipase-catalyzed reaction. Future efforts will focus on the precise role of the metabolism of glycosyl phosphatidylinositols in insulin action.
Blood or Urine Glucose-Based Insulin Therapy and Control of Glycemia: Computer-Simulation Study
Authors: Albisser A M , Sozzi S , Strack T R
Published: March 2007

Adjustment algorithms for conventional insulin therapy must be tested for safety and efficacy before clinical implementation. We did this by computer simulation. Accordingly, a computer simulator of human intermediary metabolism created 10 randomly chosen diabetic subjects for study. All were well defined with respect to compliance (i.e., medication and diet) and life-style (i.e., physical and emotional stress). Insulinadjustment algorithms that were tested calculated daily insulin dosages for these computer-simulated patients based on either blood or urine glucose concentrations self-measured 4 times/day before breakfast, lunch, dinner, and bedtime snack. The twofold purpose of the simulation study was to determine the ability of the adjustment algorithms to improve initially poor metabolic control and to compare the outcomes when either blood or urine glucose measurements were the basis on which glycemic control was implemented. A significant improvement in metabolic control could be achieved with either blood or urine glucose measurements as input to the algorithms. Detailed comparisons between blood and urine glucose-based treatments showed no significant advantage of blood glucose-based algorithms at breakfast (122 ± 21 vs. 131 ± 16 mg/dl) and dinner (117 ± 27 vs. 130 ± 23 mg/dl), whereas mean glycemia at lunch (122 ± 24 vs. 164 ± 21 mg/dl) and bedtime (117 ± 25 vs. 150 ± 21 mg/dl) after 120 days of simulation did differ significantly (P < 0.01). Hypoglycemia was not provoked by either treatment. Total daily insulin doses evolved by blood glucose-based algorithms were significantly (P < 0.05) higher than the doses used by urine glucose-based algorithms (53 vs. 47 U). We conclude that either blood or urine glucose-based insulin-adjustment algorithms that we devised promise to achieve improved glycemic control with only minor differences between the two. Clinical studies can now safely be conducted.
Evidence for Early Impairment of Macular Function With Pattern ERG in Type I Diabetic Patients
Authors: Caputo Salvatore , Leo Mauro A S Di , Falsini Benedetto , Ghirlanda Giovanni , Porciatti Vittorio , Minella Angelo , Greco Aldo V
Published: March 2007

The electroretinogram (ERG) elicited by alternating gratings at constant mean luminance (pattern ERG) is a focal response reflecting the activity of the directly stimulated retinal area. In addition, pattern ERG is related, unlike the flash ERG, to ganglion cell activity. Therefore, this technique may be used to evaluate the integrity of inner retinal layers in the macular region. In this study, the steady-state pattern ERG, in response to alternating gratings (1.7 cycles/deg spatial frequency; 9° field size) temporally modulated at 8 Hz, was recorded in 42 type I (insulin-dependent) diabetic patients with zero to four microaneurysms on fluorescein angiography and a duration of disease <11 yr. No patient had concomitant ocular or systemic complications. Mean pattern-ERG amplitude was significantly reduced in patients compared with age-matched control subjects (analysis of variance, F = 25.6, P < 0.0001). Significant differences were observed between control and diabetic subjects without retinopathy (Scheffe Ftest, P < 0.0001), between control and retinopathic subjects (Scheffe F test, P < 0.0001), and between diabetic patients without retinopathy and those with early retinopathy (Scheffé F test, P < 0.02). Pattern-ERG amplitude was inversely correlated with duration of diabetes (r = 0.22, P < 0.05). Our results suggest a macular dysfunction in early diabetes resulting from metabolic and/or vascular injuries in the neurosensory retina.
Diabetes Control and Complications Trial (DCCT): Update
Authors:   DCCT Research Group
Published: March 2007

The Diabetes Control and Complications Trial (DCCT) is a prospective randomized multicenter clinical trial to compare the effects of intensive insulin therapy aimed at near normalization of blood glucose levels with the effects of conventional therapy on the early microvascular complications of insulin-dependent diabetes mellitus. With the successful completion of its planning and feasibility phases, the DCCT is currently conducting the full-scale long-term trial. The total study cohort (n = 1441) has been recruited and randomized to either intensive or standard therapy. The range of follow-up for all subjects will be 5–10 yr, with a median of 7 yr at the trial's end in 1993. Adherence to the study protocol and prescribed regimens remains excellent. Glycemic separation between the randomized treatments, demonstrated during the 1-yr feasibility phase, remains over the first 3 yr of the study. This update reviews the rationale and design of the DCCT,changes in the protocol since its inception, study progress to date, including baseline characteristics of the entire study population, and the results of analyses of baseline data.
Influence of Frequency, Time Interval From Initial Instruction, and Method of Instruction on Performance Competency for Blood Glucose Monitoring
Authors: Kucler Marcia A , Goormastic Marlene , Hoogwerf Byron J
Published: March 2007

In a sample of 178 nurses who had been instructed in the performance of fingerstick monitoring of blood glucose (MBG), we investigated variables that may predict their proficiency at subsequent MBG performance. All nurses were given initial instruction in a classroom-type setting or via a self-instructional packet, and initial proficiency was documented by initial testing. All nurses were retested 1–8 mo later. To address whether actual frequency of performing MBG at work affected proficiency, the nurses were categorized based on the frequency of performing MBG groups: >1 test/day (n = 53), >1 test/wk (n = 51), >1 test/mo (n = 52), and <1 test/mo (n = 22). No differences in test and retest scores were detected. To address whether the time interval from the original instruction and test to the retest affected proficiency, the nurses were divided into groups who had initial test <6 mo (n = 108) and >6 mo (n = 70) before the retest. Mean change in test scores was less in the >6-mo group than in the <6-mo group (P < 0.01), and they had a lower retest fail rate (3 vs. 12%, P = 0.03). To explain this unexpected finding, test scores were analyzed by groups based on the type of original instruction. Nurses who attended class (n = 79) were compared with those who had self-instruction (n = 99). The classroom-trained group had less change in test-to-retest score (P = 0.0002) and a lower retest failure rate (3 vs. 12%, P < 0.05).
Colorado IDDM Registry: Incidence and Validation of IDDM in Children Aged 0–17 Yr
Authors: Hamman Richard F , Gay Elizabeth C , Cruickshanks Karen J , Cook Magdalena , Lezotte Dennis C , Klingensmith Georgeanna J , Chase H Peter
Published: March 2007

The purpose of this study was to determine the incidence of insulin-dependent diabetes mellitus (IDDM) among children aged 0–17 yr for age, sex, season, and urban and rural residence of onset in Colorado. Retrospective registration of new-onset cases was conducted from 1978 to 1980, and then prospective registration continued through 1983 with the use of physician reporting with hospital validation. The annual incidence of IDDM was 15.2/100,000 per year (95% confidence interval [Cl] 14.1, 16.3), with little difference between the sexes. The highest incidence was in the 10- to 14-yr age-group for both sexes. There was a seasonal peak of winter onset in those aged 10–17 yr, with similar patterns between sex and ethnic groups. No temporal trend over the 6 yr was seen, although an excess of cases was seen for 15- to 17-yr-old boys in 1980–1982. Rates were similar for urban and rural areas of the state. Case ascertainment was estimated to be 93.2% complete (95% Cl 91.5, 95.5). Incidence was similar in Colorado to other populations in the United States at similar latitudes. These data serve as a baseline for evaluation of changes in incidence over time, by region, and for the identification of possible outbreaks.
Pancreatic C-Peptide Response to Oral Glucose in Fibrocalculous Pancreatic Diabetes: Improvement After Treatment
Authors: Yajnik Chittaranjan S , Kanitkar Sudha V , Shelgikar Kishore M , Naik Sadanand S , Alberti K George M M , Hockaday Derek
Published: March 2007

β-Cell function (plasma C-peptide) in 17 fibrocalculous pancreatic diabetic (FCPD) subjects (14 newly diagnosed) was not different at presentation from that in 14 matched insulin-dependent diabetic subjects. After insulin treatment and improvement in the patients′ nutritional and metabolic status, fasting and postglucose plasma C-peptide concentrations showed a significant increase (fasting 0.06 ± 0.01 to 0.17 ± 0.03 nM, peak 0.11 ± 0.02 to 0.29 ± 0.06 nM, mean ± SE; P < 0.01 for both). Thus, severely diminished β-cell function in FCPD is partially reversible after treatment. This could contribute to the clinical metabolic peculiarities of this group of patients.
Occurrence of Diabetes Mellitus After Gestational Diabetes Mellitus in Trinidad
Authors: Ali Zulaika , Alexis Sunney D
Published: March 2007

We undertook this study to determine the incidence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) after gestational diabetes mellitus (GDM). It is a follow-up study of a consecutive sample of women with GDM in a tertiary care center in Trinidad, West Indies. The cohort was a consecutive sample of 157 women with GDM who delivered in the hospital between June 1981 and December 1984. Of these, a volunteer sample of 60 women (38%) consented to participate 3.5–6.5 yr later. The two groups were remarkably similar in ethnic composition, mean age at index delivery, marital status, and family history of DM. Interviews revealed that 26 women (43%) had already developed DM for which they were receiving treatment. The remaining 34 women (57%) were given a 2-h 75-g oral glucose tolerance test, and fasting and half-hourly venous blood samples were obtained and analyzed for plasma glucose. Based on accepted diagnostic criteria, 11 (32%) of 34 had DM, 10 (29%) had IGT, and 13 (38%) had normal glucose tolerance. A total of 37 (62%) of 60 women had developed DM, and another 10 (17%) had IGT in the intervening 3.5–6.5 yr. The results support findings that GDM is associated with an increased risk of mothers developing DM in later life.
Evening Insulin Strategy
Authors: Riddle Matthew C
Published: March 2007

A series of regimens based on intermediate-acting insulin given in the evening have been proposed as an alternative to conventional insulin therapy for non-insulin-dependent diabetes mellitus (NIDDM). This concept dates back to the earliest use of sustained-action insulin and has a rationale strengthened by recent physiological insights. Specifically, the predominance of fasting over postprandial hypoglycemia and occurrence of the dawn phenomenon in NIDDM argue for carefully timed overnight delivery of insulin. High nocturnal concentrations of free fatty acids in NIDDM may contribute to hepatic insensitivity to insulin and fasting hyperglycemia and can be suppressed by evening insulin. Although several clinical studies suggest that evening insulin regimens are safe and effective, their role in clinical practice is not yet established. Further study of this approach may clarify not only its proper use but also the best use of conventional strategies.
Screening Measure to Assess Knowledge of Diabetes in Pregnancy
Authors: Spirito Anthony , Ruggiero Laurie , Bond Andrea , Rotondo Lee , Coustan Donald R
Published: March 2007

The purpose of this study was to develop a brief measure to assess knowledge regarding diabetes in pregnancy (Diabetes in Pregnancy Knowledge Screen [DPKS]). A test-retest design was used for subjects enrolled in a diabetes in pregnancy program at a university hospital. There were 58 women with overt diabetes (OD; insulin dependent and non-insulin dependent) and 67 women with gestational diabetes (GD). Three forms of the DPKS scale were developed for use with women with OD and women with GD treated or not treated with insulin. Adequate readability, internal consistency (r = 0.71), and testretest reliability (r = 0.76) were demonstrated with the DPKS. Initial support for the validity of the measure is suggested by its ability to differentiate women with GD versus OD, women on insulin versus those who are diet controlled, and women with shorter versus longer duration of illness. The DPKS may prove a useful clinical tool for diabetes educators working with pregnant women.
Accuracy of Reported Family History of Diabetes Mellitus: Results From San Luis Valley Diabetes Study
Authors: Kahn Louise B , Marshall Julie A , Baxter Judith , Shetterly Susan M , Hamman Richard F
Published: March 2007

There are two possible sources of bias in the assessment of family history of diabetes: 1) a person with diabetes may be more likely to report a diabetic relative than a nondiabetic person would be, and 2) relatives of individuals with diabetes may be more likely to be tested for diabetes than relatives of nondiabetic individuals. We conducted a study on a subsample of families of subjects in the San Luis Valley Diabetes Study to examine these issues. A sample of 5 White and 5 Hispanic subjects (probands) with diabetic glucose tolerance tests and the same number with normal glucose tolerance were selected. The 20 probands all provided contact information on their 227 primary family members. Ninety-two percent of the family members had interviews completed by themselves or, if deceased, by surrogates other than the proband. Family members were asked by telephone if they had ever been tested for diabetes, when they had been most recently tested, why they had been tested, and if they had ever been told they had diabetes. The results showed that study subjects accurately reported family history of diabetes, because there were no discrepancies between proband and family reports. A positive family history of diabetes was associated with increased reported screening in Hispanics, but a similar effect in White families was not seen. Women were also more likely to report being screened than men regardless of whether there was a positive family history of diabetes. These data indicate that, although diabetic and control subjects accurately report their family history of known diabetes, indications of differential screening exist that may alter the amount of known and subsequently reported diabetes in families.
Effects of Fish Oil Supplements in NIDDM Subjects: Controlled Study
Authors: Hendra Timothy J , Britton Mary E , Roper David R , Wagaine-Twabwe Daniel , Jeremy James Y , Dandona Paresh , Haines Andrew P , Yudkin John S
Published: March 2007

The aim of this study was to evaluate the effects of a fish oil preparation (MaxEPA) on hemostatic function and fasting lipid and glucose levels in non-insulin-dependent diabetic (NIDDM) subjects. Eighty NIDDM outpatients aged 55.9 yr (mean SD 11.5 yr) participated in a prospective double-blind placebo-controlled study of MaxEPA capsules (10 g/day) or olive oil (control) treatment over 6 wk. Patients received either MaxEPA or olive oil in addition to preexisting therapy. Metabolic and hemostatic variables were measured before treatment and after 3 and 6 wk. Platelet membrane eicosapentaenoic acid (EPA) content increased in the treatment group (P < 0.001). MaxEPA supplementation was associated with a significant fall in total triglycerides (P < 0.001) but did not affect total cholesterol (P = 0.7) compared with control treatment. Fasting plasma glucose increased after 3 wk (P = 0.01) but not after 6 wk (P = 0.17) treatment with MaxEPA. Spontaneous platelet aggregation in whole blood fell in the MaxEPA group (P < 0.02) after 6 wk, but there were no changes in agonist-induced platelet aggregation, thromboxane generation in platelet-rich plasma, or plasma P-thromboglobulin and platelet factor IV levels. An increase in clotting factor VII (P = 0.02), without changes in fibrinogen or factor X levels, occurred in the MaxEPA group. Similar reductions in blood pressure were observed in both groups. Dietary supplementation with MaxEPA capsules (10 g/day) in NIDDM subjects is associated with improvement in hypertriglyceridemia but with deleterious effects in factor VII and blood glucose levels. Most indices of platelet function are unaffected by this therapy.
Effects of Childbearing on Glucose Tolerance and NIDDM Prevalence
Authors: Boyko Edward J , Alderman Beth W , Keane Ellen M , Baron Anna E
Published: March 2007

The goal of this study was to estimate the effects of childbearing on subsequent glucose tolerance and non-insulin-dependent diabetes mellitus (NIDDM) prevalence. A sample of subjects from 64 different locations in the United States were recruited for inclusion in the Second National Health and Nutrition Examination Survey. A complex survey design was used to select a probability sample of subjects from each location. A total of 4577 women were recruited, of whom 3057 underwent clinical and laboratory evaluation for the presence of diabetes mellitus. Women were classified as to their glucose tolerance based on the results of an oral glucose tolerance test or previous physician diagnosis of diabetes mellitus combined with current use of hypoglycemic medication. Childbearing was defined as number of live births experiencedby each woman at the time of the interview. Fasting plasma glucose increasedlinearly with increasing number of live births (coefficient 0.009, 95% confidence interval [Cl] 0.006–0.012), as did the 2-h value (coefficient 0.015, 95% Cl 0.009–0.021). Adjustment for age, body mass index (BMI), education, and income substantially reduced the magnitude of the association between childbearing and either plasma glucose measurement. When the prevalence of NIDDM in relation to childbearing was examined with logistic regressionanalysis, a significant linear increase in diabetes prevalence was seen withincreasing number of live births (relative prevalence of NIDDM, 1 birth vs. 0 = 1.73, 95% Cl 1.39-2.15), but adjustment for age, BMI, education, and income greatly reduced the magnitude of this association (relative prevalence of NIDDM, 1 birth vs. 0 = 1.07, 95% Cl 0.98-1.17). These data do not support a role for childbearing in the subsequent development of NIDDM.
Comparison of Albumin Excretion Rate Obtained With Different Times of Collection
Authors: Wiegmann Thomas B , Chonko Arnold M , Barnard Martha J , MacDougall Margaret L , Folscroft John , Stephenson Janet , Kyner Joseph L , Moore Wayne V
Published: March 2007

This study was undertaken to assess the usefulness of different techniques for determination of albumin excretion rate (AER). Ninety patients with type I (insulindependent) diabetes mellitus and 45 with type II (noninsulin- dependent) diabetes mellitus, with AER/24 h of <200 μg/min, were included. All patients were free of major systemic complications of diabetes and overt kidney disease (mean serum creatinine 1.1 ± 0.1 mg/dl, range 0.4-1.2 mg/dl). We compared timed day, night, and 24-h specimens, as well as timed spot specimens during water-induced diuresis. Most patients with type I (75 of 90) and type II (30 of 45) diabetes had AER <20 μg/min and showed significant differences in AER that were dependenton the collection time. Differences were diminished or absent with AER <20 μg/min. Sensitivity, specificity, and prediction rates of AER in different specimens were evaluated against 24-h AER. Use of albumin concentrations and albumin-creatinine ratios did not improve test performance in comparison with AER. Sampling time and the overall rate of AER influenced measurement of urinary albumin excretion. Day or 24-h AER is most useful to determine the presence of abnormal AER. AER and albumin concentration in spot samples are of limited use for initial screening and frequently require day or 24-h specimens of AER for confirmation. Day or 24-h AER should be used for long-term follow-up of the diabetic patient.
Relationship of Psychiatric Illness to Impotence in Men With Diabetes
Authors: Lustman Patrick J , Clouse Ray E
Published: March 2007

Clinical data from 37 adult males with diabetes mellitus (insulin dependent, n = 22; non-insulin dependent, n = 15) who had undergone psychiatric diagnosis and peripheral nerve conduction studies were reviewed to determine whether psychiatric illness was significantly related to complaints of sexual dysfunction. Main-effects testing revealed that impotence was associated with both neuropathy (P < 0.01) and psychiatric illness (P < 0.001). Logistic regression analysis was then used to determine the independent relationships of these two variables with impotence. After controlling for the effects of neuropathy, psychiatric illness (generalized anxiety disorder and depression) remained significantly associated with sexual dysfunction (P < 0.01). These data allow for the hypothesis that psychiatric illness may be an important contributor to impotence in diabetic men, as it is in nondiabetic men, even when neuropathic complications of the disease are present.
Comparison of HbA1 and Fructosamine in Diagnosis of Glucose-Tolerance Abnormalities
Authors: Guillausseau Pierre Jean , Charles Marie-Aline , Paolaggi Françoise , Timsit José , Chanson Philippe , Peynet Jacqueline , Godard Valérie , Eschwege Eveline , Rousselet François , Lubetzki Jean
Published: March 2007

Total glycosylated hemoglobin (HbA1) and fructosamine were evaluated as screening tools for detection of glucose-tolerance abnormalities in 144 asymptomatic subjects undergoing a 75-g oral glucose tolerance test. Subjects were classified according to World Health Organization criteria as having normal (n = 78), impaired (n = 40), or diabetic (n = 26) glucose tolerance. We found good specificity for HbA1 and fructosamine (100 and 97%, respectively) but low sensitivity (15 and 19%, respectively). At the intersection of the curves of sensitivity and specificity drawn from various thresholds of normality, both sensitivity and specificity were 75% for HbA1 and 55% for fructosamine. Thus, neither HbA1 nor fructosamine seems to be suitable for the diagnosis of mild abnormalities in glucose tolerance.
Devices for Insulin Administration
Authors: Selam Jean-Louis , Charles M Arthur
Published: March 2007

There is a significant need for revised, safe, and more effective insulin-delivery methods than subcutaneous injections in the treatment of both type I (insulindependent) and type II (non-insulin-dependent) diabetes. The aim of this review is to describe the rationale and methods for better use of injection and infusion devices for intensive insulin therapy and to describe results of animal and human research that will lead to an implantable artificial pancreas. Injection devices, e.g., jet injectors, insulin pens, and access ports, cannot be considered as a major breakthrough in the quest for improved control, although they may improve the patient's comfort. External pumps have benefits over multiple injections and conventional insulin therapy only in specific subgroups of patients, e.g., those with recurrent severe hypoglycemia, but only when used by experienced personnel. The external artificial pancreas (Biostator) is also to be used by experienced personnel for limited clinical and research applications, e.g., surgery of the diabetic patient. The development of an implantable version of the artificial pancreas is linked to progress in the field of reliable long-duration glucose sensors. Finally, programmable implantable insulin pumps, used as an open-loop delivery system, are the most promising alternative to intensive subcutaneous insulin strategies in the short term, although clear evidence of improved safety and efficacy remains to be documented.
Racial Differences in Metabolic Control of Children and Adolescents With Type I Diabetes Mellitus
Authors: Delamater Alan M , Albrecht Dawn R , Postellon Daniel C , Gutai James P
Published: March 2007

Objective

This study evaluated racial differences in the metabolic control of children and adolescents with insulin-dependent (type I) diabetes mellitus and examined the interactive effects of race with age and sex.

Research Design and Methods

Data on several demographic and clinical variables were obtained for 102 black and 108 white children, including the percentage of total HbA1, age, age at diagnosis, duration of diabetes, pubertal status, insulin dose (U · kg−1 · day−1), body mass index, number of clinic visits kept and missed, number of hospitalizations for diabetic ketoacidosis (DKA) for the year, and socioeconomic status (SES).

Results

Black children had higher insulin dosages (P < 0.05) and lower SESs (P < 0.001) than white children. HbA1 was higher in black than white children (P < 0.01) after statistically adjusting for the effects of insulin dose, diabetes duration, and SES. With HbA1-based criteria, more black than white children were in poor and fewer in good metabolic control (P < 0.001). Older children (≥ to 13 yr) had higher HbA1 levels than younger (< 13 yr) children (P < 0.002), but there were no differences in HbA1 between males and females nor were there interactive effects of race, sex, and age-group. Black children were hospitalized for DKA more frequently than white children (P < 0.04). More black than white children missed clinic visits (P < 0.01), but they did not differ in number of visits kept.

Conclusions

Black youths with type I diabetes mellitus are in poorer metabolic control than white youths.
Demonstration of Insulin Transformation Products in Insulin Vials by High-Performance Liquid Chromatography
Authors: Gregory Robert , Edwards Susan , Yateman Nigel A
Published: March 2007

Objective

To assess the importance of temperature, light, agitation, and regular withdrawal of insulin on the rates of appearance of three groups of insulin transformation products (ITPs) in vials of human and beef soluble insulin.

Research Design And Methods

Twelve insulin-treated patients (6 receiving human soluble insulin, 6 receiving beef soluble insulin) participated in the study. Reverse-phase high-performance liquid chromatography was used to measure ITP in serial samples from vials stored in various laboratory environments or issued to patients. Vials in the laboratory were analyzed on nine occasions over 26 wk; those issued to patients were analyzed weekly.

Results

Results were expressed as rates of change (% total protein/wk). Except for human insulin stored at 4°C, sampling did not accelerate transformation. Storage at higher temperatures caused more rapid transformation to all ITP groups, and human insulin was more susceptible than beef insulin. Exposure to light accelerated transformation mainly to group 3 ITP. Fibrillation occurred in beef but not human insulin carried in a shirt pocket. Results from patients' vials were consistent with reported storage conditions.

Conclusions

All three ITP groups form in human and beef soluble insulin. Their rate of production is a function of temperature and light exposure. Differences between the two insulins were probably due to differences in formulation. Patients should be discouraged from hoarding vials and storing insulin in direct sunlight. One or more ITPs could contribute to the residual immunogenicity of modern insulin preparations.
International Evaluation of Cause-Specific Mortality and IDDM
Authors:   Diabetes Epidemiology Research International Mortality Study Group
Published: March 2007

Objective

A cross-cultural study was completed to evaluate differences in mortality patterns in four population cohorts in Japan; Israel; Allegheny County, Pennsylvania; and Finland.

Research Design and Methods

Cases were diagnosed between 1 January 1965 and 31 December 1979. Mortality was determined as of 1 January 1985. There were 147 deaths occurring in the 8212 insulin-dependent diabetes mellitus (IDDM) patients in the four countries. A standardized protocol for assessing causes of death (cause-specific mortality) was developed; in this article, we report the causes.

Results

Major overall mortality differences by country appeared, with IDDM subjects in Japan much more likely to die than in the other countries. In Japan, the elevated mortality was the result of acute diabetes-related complications and kidney disease. For all countries, mortality from acute diabetes-related complications accounted for a surprisingly high percentage of deaths (> 25% in each country). A larger percentage of cases in Finland died as a result of suicide than for the other three countries.

Conclusions

The results suggest that there are major cross-country differences in cause-specific mortality and that much of the premature mortality associated with diabetes is potentially preventable.