bluuebunny/crossref_metadata_2025 huggingface dataset:
The Importance of Self-Assessed Health in Patients with Diabetes
Authors: Linn Margaret W , Linn Bernard S , Skyler Jay S , Harris Rachel
Published: March 2007

The role of self-assessment of health was compared in 150 diabetic and nondiabetic male outpatients matched for age and race. Data were collected (1) directly from the patient at intake into the study and then again in 2 mo, (2) from the medical record, and (3) from the physician. Variables included background information, symptomatology, satisfaction with care, attitudes, use of medical facilities, medications, diagnoses, compliance arid physician's estimate of patient's compliance, current health, and whether improvement was expected. A 2 × 2 factorial design was used to compare diabetic and nondiabetic patients with good and poor perceptions of health. Diabetic patients who viewed their health as poor had significantly more clinic visits, greater symptomatology, and were less satisfied with the doctor-patient relationship. The physician's rating of health did not confirm that this group actually had poorer health than the diabetic patients who perceived their health as good, and there was no difference in number of diagnoses between these groups. Data suggest that self-health perception is an important variable in diabetic patients. For those who see their health as poor, there may be a lack of concordance between patient and physician, which may result from these patients being more negativistic and difficult to treat. This may represent a group for whom a different type of treatment approach is needed.
Effect of Guar Gum on 24-hour Insulin Requirements of Insulin-dependent Diabetic Subjects as Assessed by an Artificial Pancreas
Authors: Christiansen J Sandahl , Bonnevie-Nielsen V , Svendsen P Aaby , Rubin P , Rønn B , Nerup J
Published: March 2007

The effect of guar gum on insulin requirements, mean blood glucose (MBG), and mean amplitude of glycemic excursions (MAGE) was investigated in seven insulin-dependent diabetic subjects without endogenous insulin secretion by means of an artificial pancreas (Biostator). Fifty-four hours after the withdrawal of long-acting insulin, the patients were controlled for two consecutive days by the artificial pancreas, under standardized and identical conditions, except for the ingestion of guar gum before meals on the second day. The 24-h insulin requirements were significantly reduced by 12.4% on the day with guar gum (P < 0.05). No statistically significant effects were observed on MBG and MAGE.
Diabetic Staff Simulation of Insulin-dependent Diabetic Life
Authors: Welborn T A , Duncan Nina
Published: March 2007

Diabetic staff members, including doctors, nurses, and paramedical personnel, participated in a 1-wk experiment in which the life-style of a patient with insulin-dependent diabetes was simulated. The respondents underwent teaching in (1) urine testing and recording results, (2) twice daily “insulin” regimen, and (3) diet involving regularly spaced carbohydrate in meals and snacks. Evaluation was conducted at several levels. The nurse educator assessed the pseudo-patients' performance. Staff members evaluated the teaching. Most important, the staff came to appreciate unforseen minutiae and pitfalls in the practical aspects of daily living as ordinarily prescribed by medical attendants. The simulation experiment is recommended for all staff involved in diabetic education.
Nutrition Therapy in Non-insulin-dependent Diabetes Mellitus
Authors: Streja Dan , Boyko Evelyn , Rabkin Simon W
Published: March 2007

The purpose of this study was to evaluate nutritional therapy for non-insulin-dependent diabetic subjects by examining the changes in, and interrelationship of, the outcome criteria of efficacy, namely, blood glucose, body weight and serum lipids, total cholesterol, and triglycerides. Eight-two patients, who represented all those seen by one nutritionist at a diabetic education center, were contacted for long-term follow-up data, which was obtained on 80.5% of the patients. They had short-term follow-up 66.0 ± 4.5 days after the initial visit and long-term follow-up 31.0 ± 1.1 mo later. Four treatment groups were defined: group 1, diet only at entry and follow-up; group 2, oral hypoglycemic agents at entry and follow-up; group 3, intensified treatment (diet or oral agents at entry and oral agents or insulin at follow-up; and group 4, decrease in intensity of treatment (oral agents at entry but not at long-term follow-up). Serum glucose fell significantly (P < 0.05) at short- and long-term follow-up in groups 1, 2, and 3. Body weight reductions were significant at short-term follow-up in all groups and were significant at long-term follow-up only in group 1. Serum cholesterol was significantly reduced at short-term follow-up in group 2. Serum triglyceride changes were significantly reduced at short-term follow-up in groups 1 and 2 and at long-term follow-up in group 1. Serum glucose changes correlated with changes in serum cholesterol and triglycerides but did not correlate with body weight changes. These findings demonstrate the effectiveness of nutritional counseling, show that lowering serum glucose did not correlate with weight reduction, and suggest that more attention should be given to factors reducing serum glucose and less attention to weight loss in the treatment of non-insulin-dependent diabetes.
Psychosocial Crisis in Diabetic Renal Failure
Authors: D'Elia John A , Piening Suzanne , Kaldany Antoine , Malarick Charlene , Unger Kathy , Ice Susan , Anderson Rev Raymond B , Miller Donald G , Lundin Andrew P
Published: March 2007

Twenty-nine diabetic renal failure patients suffered a psychosocial crisis at the time when chronic dialysis or renal transplantation was required. These patients could be classified into groups as to the impact of the crisis in terms of participation in life-support therapy. Group 1 consisted of potentially lethal mechanism (9 patients): discontinued dialysis (5); refused to start dialysis (3); overt act to cause personal harm (1). Group 2 contained probably nonlethal mechanism (11 patients): threatened to discontinue dialysis or to never start dialysis if not given a chance for a transplant (5); threatened to discontinue dialysis or to never start dialysis (5); threatened to cause personal harm (1). Group 3 consisted of a combination of mechanisms (9 patients): with drug abuse (4); without drug abuse (5). Important similarities between the groups were easier to document than were subtle differences in the kinds of options in family and employment relationships; in the degree of objective and subjective handicap due to impaired vision; in the level of expectation and/or disappointment following renal transplantation; and in the capacity to cope with changing personal relationships produced by the complications of diabetes.
Comparison of Chlorpropamide and Glibenclamide Treatment of Maturity-onset Diabetes: Control Assessed by Fasting Plasma Glucose Concentrations
Authors: Ward E A , Lang D A , Phillips M R , Turner R C
Published: March 2007

Twelve maturity-onset diabetic subjects were treated with chlorpropamide once daily, glibenclamide once daily, or glibenclamide twice daily in a crossover design study. Doses were increased until the fasting blood glucose concentrations became < 6 mmol/L (108 mg/dl), at which time the patients were admitted for a 24-h study period. There was little difference between the plasma glucose and insulin responses to chlorpropamide or glibenclamide given twice daily (mean doses 489 and 11 mg/day, respectively). When glibenclamide was given once daily (mean dose 9 mg/day), similar plasma glucose concentrations during the day were obtained with slightly higher plasma glucose concentrations during the night. Four patients had chlorpropamide-induced flushing with alcohol, and six patients had postprandial hypoglycemia on glibenclamide. Chlorpropamide once daily or glibenclamide twice daily are suitable for control based on fasting blood glucose measurements.
Insulin, Pancreatic Polypeptide, and Glucagon Antibodies in Insulin-dependent Diabetes Mellitus
Authors: Asplin Christopher M , Hollander Priscilla , Pecoraro Roger E , Brodsky Joel , Palmer Jerry P
Published: March 2007

To assess the possible value of the use of high-purity pork insulin (HPPI) in the United States, the serum insulin (I), pancreatic polypeptide (PP), glucagon (G), and somatostatin (SRIF) antibody binding characteristics have been determined in 90 conventional insulin-treated diabetic subjects and related to their degree of metabolic control, as assessed by glycosylated hemoglobin (HbA1) concentration. All diabetic subjects had antibodies to insulin, but there was no relationship between any of the antibody binding characteristics and HbA1 level: 47% possessed PP antibodies; mean ± SEM HbA1 in these patients was 14.5 ± 0.3%, identical to those without PP antibodies (14.5 ± 0.4%); 10% had G binding antibodies with HbA1 levels of 14.6 ± 0.8%, similar to those without G antibodies. No subject possessed SRIF antibodies. This lack of correlation between antibody characteristics and metabolic control makes it unlikely that, in the majority of patients, treatment with a less immunogenic insulin (HPPI) versus conventional insulin will result in improved diabetic control.
A Comparison of Accuracy and Estimated Cost of Methods for Home Blood Glucose Monitoring
Authors: Shapiro Brahm , Savage Peter J , Lomatch Diane , Gniadek Thomas , Forbes Ray , Mitchell Rebecca , Hein Karla , Starr Renate , Nutter Marie , Scherdt Betty
Published: March 2007

Venous serum glucose concentrations determined by a laboratory hexokinase technique were compared over a wide range of glucose concentrations with concentrations of capillary blood glucose determined by three reflectance meter techniques currently available in the United States (Eyetone and Dextrometer, Ames Company; StatTek, Bio-Dynamics BMC) and by visual interpretation of reagent strips (Chemstrip bG, Bio-Dynamics BMC). The Chemstrip bG reagent strip was read by patients, nurses, and a physician. In all cases, there was an excellent correlation between laboratory serum glucose concentrations and reflectance meter blood glucose determinations (r = 0.90–0.94, P < 0.0001) or visual interpretation of Chemstrip bG (r = 0.85–0.92, P < 0.0001). Chemstrip bG appears to be the least expensive method of glucose measurement. This method offers additional advantages in not requiring a reflectance meter, which needs frequent recalibration and other ancillary equipment for blood glucose determination.
Intravenous Home Blood Glucose Monitoring
Authors: Schade David S , Eaton R Philip , Mitchell Wiliam J , Friedman Neal M
Published: March 2007

This study examines the correlation between the blood glucose concentration estimated by diabetic subjects at home using a Chemstrip bG reagent strip, and the blood glucose concentration subsequently measured in a Beckman glucose analyzer. Blood samples were obtained by eight diabetic patients throughout a period of 30 days in the home environment. Using the technique of i.v. blood withdrawal, a 250-μl portion of each blood sample was stored for later physician verification of the blood glucose concentration. The preservative in these stored sampled inhibited the utilization of glucose in the blood samples for at least 30 days. Our results demonstrate that in the home setting, a highly significant correlation (R = 0.85, P < 0.001) can be obtained between the plasma glucose concentration as estimated by Chemstrip bGs and the blood glucose concentration as estimated by Beckman automated glucose analysis. However, within the diabetic group, marked variation existed in correlation coefficients such that the highest correlation coefficient was 0.94, and the lowest was 0.72. Furthermore, the use of Chemstrip bGs tends to influence a patient's reading toward the preselected color chart of glucose concentration on the Chemstrip bG label. We conclude that i.v. home blood glucose monitoring provides a method whereby the physician can assess the accuracy with which his patients can monitor their blood glucose concentrations in a home environment.
The Effectiveness of Rectal Administration of Insulin Suppository on Normal and Diabetic Subjects
Authors: Yamasaki Yoshimitsu , Shichiri Motoaki , Kawamori Ryuzo , Kikuchi Mikio , Yagi Toshihito , Arai Sadao , Tohdo Ryohei , Hakui Nobuyoshi , Oji Nobuyoshi , Abe Hiroshi
Published: March 2007

The effectiveness of insulin administration by rectal suppository was examined in normal and non-insulin-dependent nonobese diabetic subjects. A 100-U insulin suppository (mean 1.8 U/kg) given to the diabetic subjects caused four times as great a fall in plasma glucose compared with the normal subjects given the same dose (mean 1.6 U/kg). The insulin response after suppository administration demonstrated a significantly positive correlation (r = 0.83, P < 0.01) with the plasma glucose level before administration. Diabetic subjects given a 100-U insulin suppository (mean 1.7 U/kg) 15 min after meals three times daily showed a significant (P < 0.05) improvement in postprandial hyperglycemia accompanied by a restoration of the normal circadian profile of plasma IRI and a reduction of urinary glucose from 26 ± 5.9 to 2.0 ± 1.0 g/day. No untoward reactions were observed. These data strongly imply a unique characteristic of the insulin suppository in spite of low bioavailability.
Qualitative Issues in Developing Educational Diagnostic Instruments and Assessment Procedures for Diabetic Patients
Authors: Windsor Richard A , Roseman Jeffrey , Gartseff George , Kirk Katharine A
Published: March 2007

With one exception, psychometric analyses of the quality of instrumentation and educational assessment procedures for diabetic patients have not been reported in the literature. Following an extensive internal review process, a pilot test of 56 diabetic patients found that the newly developed instrument had a high degree of internal consistency for the major indexes, 0.89 and 0.85, respectively. An item analysis found individual questions to be of an acceptable quality. An analysis of interrater reliability of patient assessment procedures produced an r = 0.93. Some support for content and concurrent validity was noted. Using an external review by an expert panel, a revised instrument and protocol was used to conduct a formal field test of 100 diabetic patients. Levels of internal consistency similar to the pilot, 0.87 adn 0.86, were found. An item analysis produced similar positive results. While some support for concurrent validity of the data was found, little support for discriminant validity was evident. The instrument and assessment procedures need to undergo more extensive and rigorous examination of its psychometric characteristics, particularly stability and predictive validity.
Glycosylated Hemoglobin in Relation to Rapid Fluctuations in Blood Glucose in Children with Insulin-dependent Diabetes: A Comparison of Methods With and Without Prior Dialysis
Authors: Ditzel J , Kjærgaard J J , Kawahara Reiko , Østergaard G Z , Mourits-Andersen T
Published: March 2007

To evaluate the importance of dialysis in the determination of glycosylated hemoglobin (HbA1), we studied blood glucose and HbA1 in 38 insulin-dependent diabetic children during a morning fast and again 6 h postprandially. We used two methods to determine glycosylated hemoglobin: (1) the conventional macrocolumn method of Trivelli, which uses dialyzed hemolysate and (2) a commercially available microcolumn procedure, Isolab's Fast Hemoglobin Test System, which uses undialyzed blood samples. When the 6-h changes were assessed, the mean blood glucose had increased from 11.6 to 16.3 mmol/L (P < 0.001). HbA1 determined by the microcolumn procedure simultaneously increased from 12.6% to 13.4% (P < 0.001), and the increment in HbA1 correlated significantly with the increment in blood glucose (r = 0.62, P < 0.001). HbAx determined by the macrocolumn method increased slightly from 13.1% to 13.4% (P < 0.01), and no correlation was present between the increment in blood glucose and HbA1 (r = –0.02, NS). When the microcolumn procedure was modified by employing dialyzed hemolysate, this method became unaffected by acute blood glucose variations. Therefore, dialysis in sample preparation appears to be important in minimizing the effect of acute changes in blood glucose on the level of glycohemoglobin. Methods in which dialyzed hemolysates are used may be more useful as an index of long-term glucose control.
Lipid Disorders in Diabetes
Authors: Goldberg Ronald B
Published: March 2007

Hyperlipidemia is common in diabetic patients. While our understanding of lipid and lipoprotein metabolism in diabetes is incomplete, a pathophysiologic approach to this problem is presented. It is based on the recognition that diabetes is metabolically heterogeneous. Thus the roles of insulin deficiency, insulin resistance, obesity, and genetic factors are discussed in relation to their effects on lipoprotein production and catabolism. The most important defect in insulin-deficient subjects appears to be a deficiency of lipoprotein lipase, which is responsible for the removal of the triglyceride-rich lipoproteins. In non-insulin-dependent subjects there is evidence for a removal defect as well as, in some patients, for overproduction of VLDL-triglyceride. Cholesterol levels may be elevated and it is important to distinguish between VLDL, LDL, and HDL as the causes for these increases. HDL-cholesterol levels may be increased in insulin-dependent subjects, whereas they may be decreased in obese non-insulin-dependent patients. Mild elevations of LDL-cholesterol may occur in inadequately controlled type I and II diabetic patients, while elevated VLDL may raise the serum cholesterol in addition to the triglyceride levels. The rationale for therapy is based on the complications of severe hypertriglyceridemia and the risk of occlusive atherosclerosis. Management is directed at improving glycemic control, altering dietary composition, and reducing calories in obese patients. Improved glycemic control is effective in reducing triglyceride and cholesterol levels in insulin-deficient subjects. The response of the non-insulin-dependent diabetic patient to improved control may be complicated by associated obesity or familial hyperlipidemia. The advantages and disadvantages of fat versus carbohydrate restriction in the diet are discussed. Finally, resistant hyperlipidemia may require drug therapy. Diabetic hyperlipidemia should be viewed as resulting from an interaction between the diabetic syndrome, the genetic background of the patient, and the environment.
The Dawn Phenomenon, an Early Morning Glucose Rise: Implications for Diabetic Intraday Blood Glucose Variation
Authors: Schmidt Maria Ines , Hadji-Georgopoulos Angeliki , Rendell Marc , Margolis Simeon , Kowarski Avinoam
Published: March 2007

Eleven insulin-dependent (type I) diabetic subjects were studied during a 24-h period to assess intraday blood glucose (BG) variation and related free insulin (FI) levels. Ten patients exhibited the dawn phenomenon, a rise in early morning fasting blood glucose (123 ± 81.1 m/dl; mean ± SD). This increase was positively and significantly correlated with the morning postprandial BG peak (r = 0.723; P = 0.012). FI/BG ratios were highest during the night (0.717 and 0.666 at 2200 and 0400 h, respectively) and lowest during the early morning (0.294 at 0800 h) (P < 0.01). Three of the four observed hypoglycemic episodes occurred during the period when free insulin levels were high relative to BG. We conclude that the dawn phenomenon contributed directly and significantly to the BG maximum and indirectly, in some cases, to nocturnal hypoglycemia. It thus played an important role in the intraday blood glucose variation of such patients.
Combined Continuous Subcutaneous Insulin Infusion and Multiple Subcutaneous Injections in Type I Diabetic Patients
Authors: Schiffrin Alicia , Belmonte Mimi
Published: March 2007

Seven insulin-dependent diabetic patients (aged 16–34 yr) were treated for 10 mo with a combination of continuous subcutaneous insulin infusion (CSII) during the night and premeal boluses of insulin during the day. The technology and strategy of the system are discussed. Three of these patients had been on CSII for 1 yr before the start of this study. Mean fasting (126 ± 44 mg/dl), mean preprandial blood glucose (131 ± 54 mg/dl), and mean postprandial blood glucose (216 ± 73 mg/dl) before starting this treatment fell to 86 ± 12 mg/dl, 83 ± 19 mg/dl, and 132 ± 1 7 mg/dl, respectively, after 1 mo of treatment. Glycosylated hemoglobin (10,8 ± 2.9% before the study) reached normal values (7.8 ± 0.6%) after 2 mo of treatment. Improvement of glycemic control may be achieved with this form of insulin administration, which is of immediate practical application, until an ideal system of insulin delivery becomes available. This technique provides the conditions for testing the hypothesis that near normalization of glycemic control prevents or minimizes the degenerative complications associated with diabetes mellitus.
The Influence of Pyridoxine in Diabetic Peripheral Neuropathy
Authors: Levin Ellis R , Hanscom Thomas A , Fisher Mark , Lauvstad Walter A , Lui Alec , Ryan Ann , Glockner David , Levin Seymour R
Published: March 2007

To determine the role of pyridoxine in the treatment of diabetic peripheral neuropathy, 18 symptomatic diabetic patients were treated with vitamin B6 or placebo in a double-blind controlled study. Only one patient had a low plasma pyridoxal phosphate level at the start of the study. After 4 mo of treatment with pyrodoxine hydrochloride (50 mg three times daily) 6 of 9 pyridoxine-treated and 4 of 9 placebotreated patients noted significant relief from their neuropathic symptoms. There was no difference between the two groups with regard to fasting plasma glucose, motor nerve conduction velocity, or ophthalmologic examination at the beginning or at the conclusion of the study. Our results suggest that vitamin B6 deficiency is not a factor in the etiology of diabetic peripheral neuropathy. Furthermore, treating diabetic peripheral neuropathy with high dose vitamin B6 or placebo results in a similar frequency of symptomatic improvement.
The Relationship Between Psychological Factors and Blood Glucose Regulation in Insulki-dependent Diabetic Adolescents
Authors: Simonds J , Goldstein D , Walker B , Rawlings S
Published: March 2007

Fifty-two insulin-dependent diabetic, white, rural, middle-class adolescent subjects who had diabetes 5 or more years participated in a project comparing psychological and personality variables to the degree of altered blood glucose regulation as measured by hemoglobin A1c (HbA1c) levels. An HbA1c level of 9.5% was arbitrarily chosen as a cutoff score to divide subjects into two groups: those having “adequate” (N = 25) and those having “inadequate” (N = 27) blood glucose regulation. There were no significant differences between high and low HbA1c groups for all psychological variables tested, i.e., anxiety, locus of control, self-concept, and various personality traits measured by the High School Personality Questionnaire (HSPQ). Female subjects scored significantly higher on the anxiety scale and had significantly higher HbA1c values and weight percentiles compared with male subjects. Six self-report diabetes questionnaires dealing with various aspects of diabetes care and adjustment were completed by mothers and five similar questionnaires were completed by the adolescents. There were no significant differences in the mean scores of the 11 diabetes questionnaires between the high and low HbA1c groups. Girls scored significantly higher than boys in “self-care” and on individual items pertaining to dysphoric feelings about diabetes. Our findings may have resulted from the homogeneity of the sample, but underlying metabolic and genetic factors need to be considered in differentiating subjects according to the level of blood glucose regulation.
Electron Microscopy of Insulin Precipitates
Authors: Schade David S , Eaton R Philip , DeLongo Judi , Saland Linda C , Ladman Aaron J , Carlson Gary A
Published: March 2007

Morphologic characteristics of insulin precipitates were examined by both scanning and transmission electron microscopy. Insulin precipitate obtained after 1 wk of in vivo storage in an implanted dog reservoir was compared with insulin precipitate produced in vitro by isoelectric precipitation, acid-freeze-heat precipitation, and motion-induced precipitation. Insulin precipitate produced in vivo had several morphologic forms, with spherical-lamellar structures predominating. In vitro isoelectric precipitated insulin produced microcrystalline material, whereas acid-freeze-heat and motion-induced precipitated insulin were associated with elongated fibrils. The morphologic appearance of the in vivo precipitated insulin was not entirely reproduced by any of the three in vitro methods of insulin precipitation. We conclude that insulin precipitation in vivo is a process that may involve more than one of the known mechanisms by which insulin precipitates in vitro.
Peer Instruction of Home Glucose Monitoring
Authors: Warzak William J , Ayllon Teodoro , Delcher Harry K
Published: March 2007

During a 2-wk summer camp for insulin-dependent children aged 9–15 yr, a voluntary program of home glucose monitoring using an Ames' Dextrometer was offered. The primary instructors were campers who had mastered the procedure and who, with limited staff assistance, tutored naive campers. By camp's end, 96% of all naive campers had practiced this new home glucose monitoring procedure. Procedural errors were infrequent and decreased as a function of practice. No significant differences were found in error rates as a function of either the age or sex of the user. The data suggest that home glucose monitoring could be incorporated into the treatment regimen of many young patients and that peer instruction is an effective method of introducing the procedure to young children.
Salicylates as Hypoglycemic Agents
Authors: Baron Steven H
Published: March 2007

Salicylates lower blood sugar and enhance glucose-stimulated insulin secretion in normal and diabetic man. Although the hypoglycemic effect appears to be mediated by enhanced insulin secretion, extrapancreatic mechanisms cannot be excluded. The mechanism of the enhanced insulin secretion appears to be mediated by prostaglandin synthesis inhibition. The effect of salicylates on insulin secretion mediated by other secretagogues is imprecisely known. In addition to their glucose lowering action, salicylates have been reported to lower free fatty acids, triglycerides, and cholesterol. Salicylates have been imprecisely evaluated as hypoglycemic and hypolipidemic agents. Knowledge of their mechanism of action may provide further insight into the pathogenesis of diabetes mellitus and hyperlipidemic states.
The Effect on Mortality of Low-Dose Insulin Therapy for Diabetic Ketoacidosis
Authors: Sheppard Michael C , Wright A D
Published: March 2007

The presentation, treatment, and outcome in 353 episodes of diabetic ketoacidosis have been examined to assess the effect of low-dose insulin therapy on mortality. There were 19 deaths during the period of study, with a mortality rate of 4.4% for patients treated with infrequent large doses of soluble insulin and 4.6% for patients treated with frequent intramuscular injections or continuous infusion of insulin. We conclude that in a center which practices an intensive care approach to the management of diabetic ketoacidosis, the use of a low-dose insulin regimen has not altered mortality.
Risk Factors Associated with Severe Proliferative Retinopathy in Insulin-dependent Diabetes Mellitus
Authors: Bodansky H J , Cudworth A G , Drury P L , Kohner Eva M
Published: March 2007

The natural history of disease and suspected risk factors for bad prognosis were investigated in 40 subjects with insulin-dependent diabetes mellitus who had severe retinopathy and in 22 patients with a similar duration of diabetes without evidence of complications. The retinopathy group showed a marked excess of men (ratio 2:1). Examination of the data in the literature also showed a striking excess of men, 61% (P < 0.001) in patients with insulin-dependent diabetes and severe microvascular disease. In addition, proliferative retinopathy was found to have significant associations with current poor diabetic control, hypertension, and previous treatment with once-daily insulin regimens, particularly with protamine zinc insulin.
Glucose Concentration at Possible Sensor Tissue Implant Sites
Authors: Wolfson S K , Tokarsky J F , Yao S J , Krupper M A
Published: March 2007

It is generally acknowledged that the ideal automatic insulin infusion system would be a closed loop that metered insulin delivery in response to a feedback sensor such as an implantable glucose detector. Most current efforts are aimed at a transducer located within the blood vascular tree. We believe that the blood constitutes an especially hostile environment for such a device. The possibility of placing the sensor with a reasonably rapid response to dynamic alterations in glucose metabolism in a space containing fluid outside the bloodstream was studied. The subcutaneous extracellular space, peritoneum, pleura, and pericardium were included. Generally, the concentration of glucose ranged between 50 and 115 mg/dl under steady-state conditions. The experimental design did not permit monitoring rapid responses to artificially induced dynamic changes. There were several situations where lower values were recorded, suggesting that a wide range of concentrations might occur. The authors have concluded that these experimental results are compatible with the possibility of a suitable locus for the glucose sensor in the extracellular, extravascular space.
The Role of Gastric Inhibitory Polypeptide in the Augmented Insulin Response to Sucrose
Authors: Falko James M , Reynolds James C , O'Dorisio Thomas M , Bossetti Brenda , Cataland Samuel
Published: March 2007

To evaluate the role of gastric inhibitory polypeptide (GIP) in the augmented insulin response to sucrose, seven normal volunteers ingested four separate meals of 100 g sucrose (S), 50 g glucose (G), 50 g fructose (F), and 50 g glucose + 50 g fructose (G + F). Serum insulin, glucose, and GIP were measured. In each of the 3 h after sugar ingestion the integrated insulin response to (S) was greater than to (G) with the 3-h total being 104% greater. The integrated glucose response to (S) was slightly greater than to (G) in the first and second hours but the differences were not significant. Integrated GIP response to (S) was greater than to (G) in hours 2 and 3. Although significant insulin and glucose responses to (F) occurred in hour 1, G + F led to insulin and glucose responses similar to G. G + F led to greater GIP levels than G in hour 3. These studies show that GIP may play a role in the augmented insulin response to S in hours 2 and 3. This may result from delayed gastric emptying and glucose absorption. The augmentation of insulin to S in the first hour may result from fructose, extra glucose equivalent of the sucrose test solution, or from endocrine mechanisms other than those subserved by GIP.
Continuous Subcutaneous Insulin Infusion in the Management of Painful Diabetic Neuropathy
Authors: Boulton Andrew J M , Drury John , Clarke Bernard , Ward John P
Published: March 2007

Nine patients with diabetic neuropathy were treated as outpatients with continuous subcutaneous insulin infusion (CSII). Painful symptoms were scored on a 10-cm horizontal graphic rating scale; motor conduction velocity (MCV) was measured in the median and peroneal nerves; and vibration perception threshold (VPT) was recorded in the great toes. All investigations were repeated after 6 wk and at the completion of 4 mo of CSII. Improved diabetic control was confirmed by significantly lower mean blood glucose levels, M-values, and glycosylated hemoglobin. Symptomatic relief was noted by all patients and was accompanied by a significant improvement in pain scores. There was also significant improvement in VPT and MCV after 6 wk of CSII, which was maintained throughout the 4-mo period. However, sensory studies in the median nerve showed no significant changes during the study. It is concluded that strict glucoregulation is indicated in all cases of symptomatic diabetic neuropathy. It remains to be seen whether strict diabetic control from diagnosis will lead to a reduction in the incidence of this complication.
Glycosylated Hemoglobin in the Diagnosis of Non-insulin-dependent Diabetes Mellitus
Authors: Kesson Colin M , Young Richard E , Talwar Dinesh , Whitelaw James W , Robb Donald A
Published: March 2007

Fifty-one patients aged over 35 yr were referred because of glycosuria for a glucose tolerance test (GTT). In each patient hemoglobin A1 (HbA1) was estimated by a commercial minicolumn method and compared with hemoglobin A1c (HbA1c) determined by a modification of the method of Trivelli et al. Both HbA1 and HbA1c levels were normal in 96% of those patients with normal GTTs. In patients with diabetic GTTs, HbA1 was elevated in 90% but HbA1c was raised in only 43%. HbA1 estimation is a useful screening test for non-insulin-dependent diabetes and should be considered when criteria for diagnosis of diabetes mellitus are discussed.
The Long-term Effects of Chlorpropamide on Insulin, C-Peptide, and Proinsulin Secretion
Authors: Elkeles R S , Heding L G , Paisey R B
Published: March 2007

It had been suggested that long-term lowering of blood glucose by sulfonylureas in non-insulin-dependent (NIDD) diabetes is not due to a sustained increase in insulin secretion. We have re-examined this question. Thirteen nonobese NIDD patients not controlled on diet alone were studied prospectively on treatment with chlorpropamide for over 3 mo. Of these, 9 were also studied after 1 yr. Improvement in glucose tolerance was associated with an increase in fasting and postglucose serum insulin and C-peptide concentration. We conclude that at least for over 1 yr chlorpropamide increases insulin secretion. After 3 and 12 mo the fasting proinsulin percentage of immunoreactive insulin was increased.
Evaluation of Hypo-test, a Semiquantitative Audio Urine-Glucose Analyzer for Blind Diabetic Individuals
Authors: Birch Kjeld , Sestoft Leif , Marshall Michael
Published: March 2007

Hypo-test (Hypoguard Ltd., Suffolk, United Kingdom), a new semiquantitative audio urine-glucose analyzer for blind diabetic individuals, was tested for accuracy and reproducibility against a laboratory glucose method, and for ease of operation by two blind diabetic subjects. Hypo-test results were accurate for urine glucose in the range 0–0.75%, but there was a pronounced tendency for results to be too low at higher urine-glucose concentrations. The reproducibility at high urine-glucose concentrations was poor, and the meter was too sensitive to delays or decreases in the prescribed timing procedure. However, the two blind diabetic subjects found the instrument easy to operate.
Reversible Acute Pulmonary Edema due to Uncontrolled Hyperglycemia in Diabetic Individuals with Renal Failure
Authors: Kaldany Antoine , Curt Gregory A , Estes N Mark , Weinrauch Larry A , Christlieb A Richard , D'elia John A
Published: March 2007

On eight separate occasions, four functionally anephric diabetic patients (on maintenance hemodialysis) experienced episodes of severe hyperglycemia with acute interstitial and alveolar pulmonary edema demonstrated clinically and by chest x-ray without electrocardiographic or enzymatic evidence of an acute myocardial lesion. Three patients had normal stress 201Tl scanning. The fourth patient, who experienced three such episodes, had normal coronary angiograms and only a mild elevation of the left-ventricular end-diastolic pressure. Clinical and chest x-ray improvement were immediate following insulin therapy and control of hyperglycemia, without phlebotomy or dialysis. Since these episodes were observed during a 1-yr period, this syndrome may be more common than suspected. It is concluded that in functionally anephric diabetic individuals: (1) pulmonary edema can be precipitated by uncontrolled diabetes; (2) endogenous fluid shifts may contribute to the cause of acute pulmonary edema; (3) clinical and radiologic improvement can be achieved with adequate insulin therapy; and (4) blood glucose levels should be monitored and controlled in diabetic patients with renal failure.
Quantitative Evaluation of Sympathetic and Parasympathetic Control of Iris Function
Authors: Pfeifer Michael A , Cook Daniel , Brodsky Joel , Tice David , Parrish Daniel , Reenan A , Halter Jeffrey B , Porte Daniel
Published: March 2007

The use of quantitative measurements of pupil size as an index of autonomic nervous system (ANS) activity in normal and diabetic subjects is described. The dual innervation of the iris by the parasympathetic (PNS) and sympathetic (SNS) nervous system was demonstrated by measurement of steadystate pupil size before and after changes in ANS activity by pharmacologic agents. In the presence of total PNS blockade, dark-adapted pupil size was a reliable index of SNS activity to the iris. Latency time (time from light stimulation to initial pupil response) appeared to be a good index of PNS activity. However, increased SNS activity may also prolong the latency time. Thus, consideration of SNS activity is necessary when evaluating the latency time. In 25 diabetic subjects, there was evidence of impaired SNS activity (smaller dark-adapted pupil size during total PNS blockade) and PNS activity (prolonged latency time). In a subgroup of diabetic subjects without clinical manifestations of autonomic neuropathy and normal subjects, both dark-adapted pupil size during PNS blockade (SNS index) and latency time (PNS index) were abnormal. The coefficient of variation for these two indices was less than 5% in glycemic stable diabetic subjects. Thus, these two indices are reliable and sensitive measures of the SNS and PNS activity to the iris in normal and diabetic subjects.
Diet Liberalization and Metabolic Control in Type I Diabetic Outpatients Treated by Continuous Subcutaneous Insulin Infusion
Authors: Chantelau E , Sonnenberg G E , Stanitzek-Schmidt I , Best F , Altenahr H , Berger M
Published: March 2007

In 10 type I diabetic outpatients treated by continuous subcutaneous insulin infusion (CSII), dietary habits and metabolic control were investigated. Under conditions of a conventional diabetes diet (including 5–6 meals per day and a strictly planned meal intake) as well as under a “less restricted diabetes diet” (e.g., free choice of number, timing, and amount of carbohydrate intake) near normoglycemia could be achieved. Mean daily blood glucose levels did not change significantly when the patients' nutrition was alternated between both diets. During the “less restricted diabetes diet,” the patients opted for a rather high fat intake (51 ± 5% fat, 34 ± 5% carbohydrate, and 15 ± 2% protein). Despite this unintended dietary behavior, serum lipids and body weight remained normal after an observation period of 4–6 mo. It is concluded that during permanent near normoglycemia achieved by CSII a partial liberalization of the diabetes diet does not introduce any short-term or long-term metabolic risk factors for cardiovascular diseases
Kidney Function After Improved Metabolic Control in Newly Diagnosed Diabetes and in Diabetic Patients with Nephropathy
Authors: Ciavarella Adolfo , Flammini Miranda , Stefoni Sergio , Borgnino Luigi C , Forlani Gabriele , Bacci Luigi , Vannini Pietro
Published: March 2007

To evaluate the effect of improved metabolic control on kidney function, urinary excretion rate of β-2- microglobulin, lysozyme, and γ-glutamyltransferase were evaluated in nine poorly controlled, newly diagnosed diabetic patients before and during treatment. In six poorly controlled insulin-dependent nephropathic diabetic patients, besides the parameters cited above, urinary albumin excretion rate and IgG/transferrin clearance ratio were further investigated to estimate the permeability and the selectivity of glomerular barrier during conventional treatment and after improvement of the metabolic control by a glucose-controlled insulin infusion system (GCIIS). The improved glycemic control resulted in a significant reduction of urinary β-2-microglobulin and lysozyme excretion in all diabetic patients. Significant decreases of urinary albumin excretion and of IgG/transferrin clearance ratio (indicating a more selective proteinuria) during strict metabolic control were also observed in nephropathic diabetic patients. The reduction of urinary β-2-microglobulin and lysozyme excretion indicates that a tubular reabsorptive dysfunction, reversible with the amelioration of glycemic control, can be observed in poorly controlled, newly diagnosed and in insulin-dependent nephropathic diabetic patients during conventional treatment. In the latter patients, the permeability and the selectivity properties of glomerular barrier also improved during GCIIS.
Iincidence and Hospitalkation Patterns of Insulkin-dependent Diabetes Mellitus
Authors: Fishbein Howard A , Faich Gerald A , Ellis Susan E
Published: March 2007

Data from a statewide insulin-dependent diabetes mellitus (IDDM) registry in Rhode Island show that IDDM affects young adults (20–29 yr) as frequently as adolescents and teenagers (10–19 yr). Overall incidence <30 yr was 14/100,000 population. Peak incidence occurred at 10–14 yr (19/100,000 population). Poor diabetic control and infection accounted for 46–62% of hospitalizations among 275 known diabetic persons. Despite a 10-yr mean duration of diabetes, only 31% of hospitalized diabetic persons < 30 yr of age reported ever having received outpatient diabetes education of two or more hours. Readmissions 1 yr after initial registration were more frequent for known (43%) than new-onset (18%) IDDM cases. Increased risk of readmission for both groups was associated with a poverty socioeconomic status. Total direct hospitalization costs for IDDM in persons under 30 yr of age in Rhode Island was $530,000 per year of $2,245 per patient.
Dynamic Foot Pressure and Other Studies as Diagnostic and Management Aids in Diabetic Neuropathy
Authors: Boulton Andrew J M , Hardisty Colin A , Betts Roderic P , Franks Christopher I , Worth Richard C , Ward John D , Duckworth Thomas
Published: March 2007

The pressures and loads under the feet during walking have been compared in three groups of 41 patients each, using a microprocessor-controlled optical system. Group A consisted of patients with diabetic neuropathy, group B of non-neuropathic diabetic patients, and group C of nondiabetic controls. Thirteen patients in group A had a history of neuropathic foot ulceration. Other investigations in the diabetic patients included motor conduction velocity (MCV) in the median and peroneal nerves, vibration perception threshold (VPT) in the great toes, the valsalva response (VR), skin resistance (SR), and the ankle pressure index (API). Fifty-one percent of neuropathic feet had abnormally high pressures underneath the metatarsal heads compared with 17% of the diabetic controls and 7% of nondiabetic subjects. All those feet with previous ulceration had abnormally high pressures at the ulcer sites. Of the other investigations, the VPT correlated most significantly with the presence of foot ulceration. In addition, a low median and peroneal nerve MCV, an abnormal VR, a high API, and the absence of sweating all correlated with the presence of foot ulceration. We therefore conclude that simple bedside investigations, such as measurement of the VPT alone, may be useful in identifying those patients at risk of foot ulceration. Foot pressure studies may then be used in such patients as a predictive and management aid by determining specific areas under the foot that are prone to ulceration.
Comparison of Two Indices of Glycemic Control in Diabetic Subjects: Glycosylated Serum Protein and Hemoglobin
Authors: Mehl Thomas D , Wenzel S E , Russell B , Gardner D , Merimee T J
Published: March 2007

Glycosylated serum protein (GSP) and glycosylated hemoglobin (GHb) were measured in 263 insulindependent and 41 non-insulin-dependent diabetic subjects. Both indices provided useful information in type II diabetes, but were extremely poor in judging control in type I diabetes. In both groups, there was poor correlation of the fasting serum glucose with either GSP or GHb. Only 4% of type I diabetic subjects had normal values for both GSP and GHb. Of subjects with elevated GSP, 98% had elevated GHb; 25% of subjects with elevated GHb values had normal values for GSP.
Absorption and Miscibility of Regular Porcine Insulin After Subcutaneous Injection of Insulin-treated Diabetic Patients
Authors: Kølendorf K , Bojsen J , Deckert T
Published: March 2007

The absorption and miscibility of subcutaneously injected 125I-regular porcine insulin was examined in 20 insulin-treated diabetic patients. The disappearance half-life (t1/2) was 2.1 ± 0.8 h (SD) after injection of regular insulin (40 U/ml) and 2.3 ± 0.7 h when mixed with porcine NPH insulin (NS). A significant inverse relation was demonstrated between insulin concentration and absorption, as t1/2 was 1.8 ± 0.7 h (P < 0.05) when using 20 U/ml. The interindividual coefficients of variation for absorption of regular insulin were 30.9–41.6% and independent of the presence of NPH insulin. The intrapatient variability, however, was much smaller, 14.5–23.6%.
Reproducibility of Insulin Dosage on Consecutive Days of Blood Glucose Control by an Artificial Beta-Cell in Brittle Diabetic Patients
Authors: Bruns Waldemar , Bombor Hans , Jutzi Erich , Ratzmann Klaus-Peter , Schulz Bernd , Abel Peter , Fischer Uwe
Published: March 2007

The profiles of blood glucose and of insulin dosage were compared between the first and second of 2 consecutive days of Biostator administration under constant conditions in 12 brittle type I diabetic inpatients. All blood glucose criteria and the daily insulin doses were reproducible between these 2 days for the entire group of patients. In nearly all patients, however, there were distinct but unsystematic differences between the 2 daysin the diurnal patterns of insulin dose distribution. These differences could be ascribedto some stress reaction or inherent metabolic lability. It is concluded that, in these extremely labile diabetic patients, due to the insufficient short-term reproducibility of the outcome of an extracorporal artificial beta-cell, caution must be used when constant profiles are to be predicted from these doses for open-loop insulin delivery systems or for conventional subcutaneous injection therapy.
The Relationship of Hand Abnormalities to Diabetes and Diabetic Retinopathy
Authors: Lawson P M , Maneschi F , Kohner E M
Published: March 2007

The hands of 299 diabetic patients with and 161 without retinopathy were examined forabnormalities. Almost all abnormalities were finger joint contractures resulting in limited joint mobility (LJM) and/ or Dupuytren's contractures (DC). Both LJM and DC occurred not only in insulin-dependent diabetes (IDDM) but also in non-insulin-dependent diabetes (NIDDM). In retinopathy patients LJM and DC occurred in 48% and 36% of patients, respectively, compared with 24% and 16% in those without retinopathy. These differences were statistically significant (P < 0.001). The higher prevalence of LJM in the retinopathy group affected mainly those with severe retinopathy, there being no difference between background and nonretinopathy patients. DC was less clearly related to severe retinopathy. LJM was more severe in those with than without retinopathy. LJM and DC were also related to age and duration of known diabetes. Subgroups matched for age and duration of known diabetes showed that the main relationship of hand abnormalities was to retinopathy inIDDM, but more to age and duration of known diabetes in NIDDM.