bluuebunny/crossref_metadata_2025 huggingface dataset:
Fish Oil in Diabetic Nephropathy
Authors: Rossing Peter , Hansen Birgitte V , Nielsen Flemming S , Myrup Bjarne , Hølmer Gunhild , Parving Hans-Henrik
Published: March 2007

OBJECTIVE

Recent studies in nondiabetic kidney diseases suggest that dietary supplementation with n-3 polyunsaturated fatty acids (fish oil) may have beneficial effects on albuminuria, kidney function, arterial blood pressure, and dyslipidemia. Therefore, we evaluated the long-term effect of fish oil in diabetic nephropathy.

RESEARCH DESIGN AND METHODS

A 1-year double-blind randomized controlled study comparing fish oil (4.6 g n-3 fatty acids/day) with placebo (olive oil) was performed in an outpatient clinic in a tertiary referral center. Thirty-six normotensive IDDM patients with diabetic nephropathy were included; 18 were treated with fish oil. Seven patients dropped out (four received fish oil), and results for the remaining 29 are presented. Albuminuria (enzyme immunoassay), glomerular filtration rate (51Cr-labeled EDTA plasma clearance), 24-h ambulatory blood pressure, and lipid profile were determined every 6 months.

RESULTS

Albuminuria increased by 22% (1–46%) (mean [95% CI]) in the fish oil group vs. 15% (−11–49%) in the placebo group (NS). Glomerular filtration rate decreased from 116 ± 7 to 105 ± 7 ml · min−1 · 1.73 m−2 (mean ± SE) vs. from 108 ± 6 to 103 ± 7, fish oil and placebo, respectively (NS). No significant changes occurred in 24-h ambulatory blood pressure: from 141 ± 4/82 ± 2 mmHg to 142 ± 5/83 ± 2 vs. from 140 ± 4/78 ± 2 to 144 ± 4/80 ± 3, fish oil and placebo, respectively (NS). In the fish oil group, serum triglycerides (median [range]) decreased from 0.97 (0.5–4.0) mmol/l to 0.8 (0.4–3.0) vs. from 1.01 (0.4–2.0) to 1.09 (0.4–2.0) in the placebo group (P < 0.05) and VLDL cholesterol decreased from 0.45 (0.23–1.88) to 0.37 (0.21–1.43) mmol/l vs. from 0.44 (0.21–0.94) to 0.41 (0.17–1.94) (P < 0.05), but total and LDL cholesterol rose in the fish oil compared with the placebo group.

CONCLUSIONS

Our study does not suggest that fish oil has beneficial effects on albuminuria, kidney function, blood pressure, and dyslipidemia in normotensive IDDM patients suffering from diabetic nephropathy.
Metabolic Effects of Dietary Sucrose and Fructose in Type II Diabetic Subjects
Authors: Malerbi Domingos A , Paiva Ellen Simone A , Duarte Ana Lucia , Wajchenberg Bernardo L
Published: March 2007

OBJECTIVE

To investigate the metabolic effects of dietary fructose and sucrose in type II diabetic patients.

RESEARCH DESIGN AND METHODS

Sixteen well-controlled type II diabetic subjects were fed three isocaloric diets for 28 days each. The three diets provided 50–55, 15, and 30–35% of total energy from carbohydrate, protein, and fat, respectively. In one diet, 20% of total calories were derived from fructose; in another, 19% of total calories were derived from sucrose; and in the control diet, only 5% of daily calories were derived from sugars, all other carbohydrates being supplied as polysaccharides.

RESULTS

No significant differences were observed between either the fructose or the sucrose diet and the control polysaccharide diet in any of the measures of glycemic control, serum lipid levels, or insulin and C-peptide secretion.

CONCLUSIONS

Our data suggest that in the short and middle terms, high fructose and sucrose diets do not adversely affect glycemia, lipemia, or insulin and C-peptide secretion in well-controlled type II diabetic subjects.
Adjunctive Systemic Hyperbaric Oxygen Therapy in Treatment of Severe Prevalently Ischemic Diabetic Foot Ulcer: A randomized study
Authors: Faglia Ezio , Favales Favales , Aldeghi Aldeghi , Calia Patrizia , Quarantiello Antonella , Oriani Giorgio , Michael Michael , Campagnoli Pietro , Morabito Alberto
Published: March 2007

OBJECTIVE

To evaluate the effectiveness of systemic hyperbaric oxygen therapy (s HBOT) in addition to a comprehensive protocol in decreasing major amputation rate in diabetic patients hospitalized for severe foot ulcer.

RESEARCH DESIGN AND METHODS

From August 1993 to August 1995, 70 diabetic subjects were consecutively admitted into our diabetologic unit for foot ulcers. All the subjects underwent our diagnostic-therapeutic protocol and were randomized to undergo s-HBOT. Two subjects, one in the arm of the treated group and one in the arm of nontreated group, did not complete the protocol and were therefore excluded from the analysis of the results. Finally, 35 subjects received s-HBOT and another 33 did not.

RESULTS

Of the treated group (mean session = 38.8 ± 8), three subjects (8.6%) underwent major amputation: two below the knee and one above the knee. In the nontreated group, 11 subjects (33.3%) underwent major amputation: 7 below the knee and 4 above the knee. The difference is statistically significant (P = 0.016). The relative risk for the treated group was 0.26 (95% CI 0.08–0.84). The transcutaneous oxygen tension measured on the dorsum of the foot significantly increased in subjects treated with hyperbaric oxygen therapy: 14.0 ± 11.8 mmHg in treated group, 5.0 ± 5.4 mmHg in nontreated group (P = 0.0002). Multivariate analysis of major amputation on all the considered variables confirmed the protective role of s-HBOT (odds ratio 0.084, P = 0.033, 95% CI 0.008–0.821) and indicated as negative prognostic determinants low ankle-brachial index values (odds ratio 1.715, P = 0.013, 95% CI 1.121–2.626) and high Wagner grade (odds ratio 11.199, P = 0.022, 95% CI 1.406–89.146).

CONCLUSIONS

s-HBOT, in conjunction with an aggressive multidisciplinary therapeutic protocol, is effective in decreasing major amputations in diabetic patients with severe prevalently ischemic foot ulcers.
Increased Plasma Apolipoprotein(a) Levels in IDDM Patients With Diabetic Nephropathy
Authors: Tarnow Lise , Rossing Peter , Nielsen Flemming S , Hansen Birgitte V , Dyerberg Jørn , Parving Hans-Henrik
Published: March 2007

OBJECTIVE

The relative mortality from cardiovascular disease (CVD) is increased 40-fold in IDDM patients suffering from diabetic nephropathy as compared with nondiabetic subjects on average. We assessed the potential contribution of dyslipidemia in general and elevated serum apolipoprotein (a) [apo(a)] in particular to CVD in nephropathic patients with IDDM.

RESEARCH DESIGN AND METHODS

We investigated 199 IDDM patients with diabetic nephropathy and 192 normoalbuminuric IDDM patients matched for sex, age, diabetes duration, and BMI.

RESULTS

The prevalence of CVD was 30 and 12% in patients with and without nephropathy, respectively (P < 0.001). The level of apo(a) was significantly higher in patients with nephropathy, 189 (20–2,350) U/l as compared with the normoalbuminuric group, 103 (20–1,940) U/l (P < 0.005). The prevalence of plasma apo(a) > 300 U/l (at-risk level for cardiovascular pathogenicity) was 38% (31–45) vs. 22% (16–28) in patients with and without nephropathy, respectively (P < 0.0005). In nephropathic patients, the prevalence of plasma apo(a) > 300 U/l was raised in patients with CVD (48%, 36–61%) as compared with patients without (34%, 26–42%) (P = 0.05). Furthermore, the serum concentrations of the following apolipoproteins and lipids were higher in patients with nephropathy as compared with normoalbuminuric patients: apoB 1.33 ± 0.37 vs. 1.06 ± 0.26 g/l; total cholesterol 5.6 ± 1.2 vs. 4.8 ± 0.9 mmol/l; and triglycerides 1.22 (0.31–9.87) vs. 0.77 (0.28–3.05) mmol/l, P < 0.0001. Multiple logistic regression analysis of cardiovascular risk factors revealed that plasma apo(a) concentration > 300 U/l is an independent risk factor for coronary heart disease, odds ratio 1.86 (1.03–3.36) (P < 0.05).

CONCLUSIONS

Dyslipidemia and raised plasma concentrations of apo(a), particularly > 300 U/l, may contribute to the enhanced morbidity and mortality from CVD characteristically observed in IDDM patients with diabetic nephropathy.
Accuracy of home blood glucose meters during hypoglycemia
Authors: Trajanoski Z , Brunner GA , Gfrerer RJ , Wach P , Pieber TR
Published: March 2007

OBJECTIVE

To evaluate the accuracy of home blood glucose meters during hypoglycemia.

METHODS

Six blood glucose meters—One Touch II (LifeScan, Milpitas, CA), Companion II (Medisense, Cambridge, U.K.), Reflolux (Boehringer Mannheim, Mannheim, Germany), Accutrend (Boehringer Mannheim), Elite (Bayer, Munich, Germany), and HemoCue (HemoCue, Ängelholm, Sweden)—were compared with a reference method (Beckman Glucose Analyzer 2). Glucose concentrations from arterialized venous blood samples were measured using all glucose meters (whole blood) and the reference method (plasma) during hypoglycemic-hyperinsulinemic clamps in 15 subjects.

RESULTS

In total, 663 blood glucose monitor readings and 119 reference values ranging from 2.28 to 3.89 mmol/l were analyzed. The correlation coefficients and the percentage of measurements within 20% and outside 40% of the reference values for each glucose meter were as follows: One Touch II: 0.91, 99.2% and 0%; Companion II: 0.81, 88.2% and 2.5%; Reflolux: 0.78, 85.0% and 0.9%; Accutrend: 0.88, 46.0% and 6.6%; Elite: 0.78, 75.6% and 4.2%; and HemoCue: 0.93, 96.6% and 0% (P < 0.001).

CONCLUSIONS

There were substantial differences between the blood glucose meters during hypoglycemia, and none of the devices met the latest criteria recommended by the American Diabetes Association.
Comparison of LysB28, ProB29-Human Insulin Analog and Regular Human Insulin in the Correction of Incidental Hyperglycemia
Authors: Holleman Frits , Van Den Brand Joop JG , Hoven Roland ARA , Van Der Linden Jos M , Van Der Tweel Ingeborg , Hoekstra Joost B L , Erkelens D Willem
Published: March 2007

OBJECTIVE

To obtain clinically applicable data on the effects of regular human insulin and the LysB28, ProB29-human insulin analogue (lispro) on the correction of incidental hyperglycemia.

RESEARCH DESIGN AND METHODS

The insulins were compared in a non-clamped randomized crossover study of 27 male IDDM patients. Hyperglycemia was induced by the withdrawal of the normal evening dose of insulin; the next morning patients fasted and received a single dose of study insulin according to a dosing nomogram. Blood glucose concentration and GR (a measure of glucose corrected for differences in administered insulin dose: GR = glucose concentration × BMI × insulin dose−1) were followed for 4 h.

RESULTS

The time courses of blood glucose concentration and GR were significantly different after regular insulin in comparison with lispro (multiple analysis of variance, P < 0.001). At t = 120 min, glucose concentrations had decreased 1.4 mmol/l more with lispro than with regular insulin (95% confidence interval [CI] 0.6–2.3, P = 0.002). Similarly, GR had decreased 4.4 mol · kg · IU−1 · m−5 more with lispro than with regular insulin (95% CI 2.6–6.2, P < 0.001). The overall difference in glucose values was 0.87 mmol/l (lispro < regular insulin, P = 0.036), and the overall difference in GR values was 1.96 mol · kg · IU−1 · m−5 (lispro < regular insulin, P = NS). Unexpectedly, the intrinsic variability of GR was higher for lispro than for regular insulin.

CONCLUSIONS

The more rapid action of lispro is an advantage in the correction of hyperglycemia, even though actual differences in glucose concentrations are smaller than suggested by previous clamped studies.
Influence of Simulated Altitude on the Performance of Five Blood Glucose Meters
Authors: Gautier Jean-Francois , Bigard Andre Xavier , Douce Philippe , Duvallet Alain , Cathelineau Gerard
Published: March 2007

OBJECTIVE

To determine the reliability of five blood glucose meters (BGMs) at various simulated altitudes using a hypobaric chamber.

RESEARCH DESIGN AND METHODS

Blood glucose levels (ranged from 1.5 to 26.3 mmol/l, according to the reference method) were measured in 18 venous blood samples by each BGM at 200, 1,000, and every 500 m up to 4,000 m in a hypobaric chamber, where temperature and humidity were held constant.

RESULTS

Four BGMs underestimated and one overestimated blood glucose concentration while barometric pressure decreased. The average percent error varied in relation to simulated altitude from 0.26 ± 4.8% (SD) at 200 m to −28.9 ± 4.5% at 4,000 m (Glucometer 3; P < 0.05), from 28.4 ± 5.7 to 49.3 ± 5.9% (Accu-Chek Easy; P < 0.05), from −10.5 ± 2.6 to 19.8 ± 4.3% (Tracer, P < 0.05), from −5.5 ± 2.6 to −11.2 ± 3.0% (Reflolux; NS), and from 17.8 ± 4.3 to 14.8 ± 3.6% (One Touch; NS). The most accurate seemed to be the Reflolux, except for high blood glucose levels at simulated high altitudes. The One Touch II showed a good agreement, whatever the barometric pressure and the range of blood glucose concentrations. The highest underestimation was seen with the Glucometer 3.

CONCLUSIONS

Except for the Accu-Chek Easy, low barometric pressure underestimated the BGM results in comparison with measurements taken at simulated low altitudes. The lack of accuracy and consistency of performance > 2,000 m should be known by diabetic patients practicing sports activities, such as trekking or skiing at high altitudes.
Influence of Intensive Diabetes Treatment on Quality-of-Life Outcomes in the Diabetes Control and Complications Trial
Authors:   The Diabetes Control and Complications Trial Research Group
Published: March 2007

OBJECTIVE

To evaluate the effect of intensive diabetes treatment on patient quality of life assessed by the Diabetes Quality-of-Life Measure, the Symptom Checklist-90R, the Medical Outcome Study 36-Item Short Form Survey, and intercurrent psychosocial events in the Diabetes Control and Complications Trial (DCCT).

RESEARCH DESIGN AND METHODS

The DCCT was a 29-center prospective controlled clinical trial that demonstrated the beneficial effect of intensive diabetes treatment on retinopathy, nephropathy, and neuropathy. The 1,441 volunteers with IDDM, aged 13–39 years, were randomly assigned to intensive or conventional diabetes therapy. The volunteers were followed for a mean of 6.5 years (range 3–9 years). Quality-of-life data were collected during annual visits. Of the volunteers, 99% completed the study, and >95% of scheduled tests were completed.

RESULTS

All analyses of quality of life, psychiatric symptom indexes, and psychosocial event data showed no differences between intensive and conventional diabetes treatment.

CONCLUSION

Under careful treatment conditions, such as those followed in the DCCT, patients undergoing intensive diabetes treatment do not face deterioration in the quality of their lives, even while the rigor of their diabetes care is increased.
Symptoms and Well-Being in Relation to Glycemic Control in Type II Diabetes
Authors: Van der Does Ferdinand E E , De Neeling J Nico D , Snoek Frank J , Kostense Pieter J , Grootenhuis Peter A , Bouter Lex M , Heine Robert J
Published: March 2007

OBJECTIVE

To describe the cross-sectional relation between glycemic control and physical symptoms, emotional well-being, and general well-being in patients with type II diabetes.

RESEARCH DESIGN AND METHODS

The study population consisted of 188 patients with type II diabetes between 40 and 75 years of age. Patients were treated with blood glucose-lowering agents or had either a fasting venous plasma glucose level ≥7.8 mmol/l or an HbA1c level > 6.1%. Multiple regression analyses were performed. Dependent variables were scores on the Type II Diabetes Symptom Checklist, the Profile of Mood States, the Affect Balance Scale, and questions regarding general well-being. The primary determinant under study was HbA1c. In addition, age, sex, neuroticism (indicating a general tendency to complain), insulin use, and comorbidity were included as determinants in all analyses. Other potential determinants taken into consideration were hypoglycemic complaints, marital status, diabetes duration, cardiovascular history, blood pressure, BMI, waist-to-hip ratio, perceived burden of treatment, and smoking. None of these potential determinants had to be included to correct confounding of the relation between HbA1c and well-being scores.

RESULTS

Higher HbA1c levels were significantly associated with higher symptom scores (total score, hyperglycemic score, and neuropathic score), with worse mood (total score, displeasure score, depression, tension, fatigue), and with worse general well-being. The relative risks varied between 1.02 and 1.36 for each percentage difference in HbA1c. The relation between HbA1c and some mood states was modified by neuroticism: in the less neurotic patient (i.e., one who is less inclined to complain), the relation was more evident.

CONCLUSIONS

These data suggest that better glycemic control in type II diabetes is associated with fewer physical symptoms, better mood, and better well-being, in a nonhypoglycemic HbA1c range.
Reduction in Severe Hypoglycemia With Long-Term Continuous Subcutaneous Insulin Infusion in Type I Diabetes
Authors: Bode Bruce W , Steed R Dennis , Davidson Paul C
Published: March 2007

OBJECTIVE

To compare the incidence of severe hypoglycemia in patients crossed over from multiple daily injections (MDIs) of insulin to continuous subcutaneous insulin infusion (CSII).

RESEARCH DESIGN AND METHODS

From a population of 255 patients using CSII, all patients who met the following selection criteria were included in the present study: 1) a minimum of 12 months on intensive therapy with MDIs before switching to CSII, and 2) a minimum of 12 months on CSII after crossover. Glycemic control and adverse event rates for the 1-year MDI control period were compared with those for the CSII therapy period.

RESULTS

The incidence of severe hypoglycemia during MDI therapy declined from 138 to 22 events per 100 patient-years during the 1st year of CSII (P < 0.0001) and remained significantly lower in years 2, 3, and 4 on CSII (26, 39, and 36, respectively). HbA1c levels did not change significantly between the MDI phase and any year on CSII. However, in the subgroup of patients who had pre-CSII HbA1c levels of ≥8.0%, the change to CSII was associated with a significant reduction in HbA1c from baseline to year 1 (8.9 ± 0.8 vs. 8.1 ± 1.0%, P = 0.0004). The difference in diabetic ketoacidosis rates between the MDI year (14.6 events per 100 patientyears) and the CSII period (7.2 events per 100 patient-years) was not statistically significant.

CONCLUSIONS

CSII therapy was associated with a marked and sustained reduction in the rate of severe hypoglycemia without adversely affecting the level of glycemic control attained during MDI therapy. The more reproducible and flexible insulin delivery afforded by CSII was considered to be the major factor contributing to the improvement in severe hypoglycemia rates.
A Metabolic Syndrome in Whites and African-Americans: The Atherosclerosis Risk in Communities baseline study
Authors: Schmidt Maria Inês , Duncan Bruce B , Watson Robert L , Sharrett A Richey , Brancati Frederick L , Heiss Gerardo ,   The Atherosclerosis Risk in Communities Study Investigators
Published: March 2007

OBJECTIVE

To describe clustering of hypertriglyceridemia, low HDL cholesterol, hypertension, diabetes, and hyperuricemia and its association with fasting insulin, waist-to-hip ratio (WHR), and BMI for African-American and white men and women.

RESEARCH DESIGN AND METHODS

Observed frequencies of clusters were compared with those expected in 14,481 participants, 45-64 years of age, of the Atherosclerosis Risk in Communities (ARIC) baseline survey, 1987–1989. Associations of clusters with insulin, central adiposity, and overall obesity, as well as with abnormalities, were analyzed through multiple logistic regression.

RESULTS

Clustering beyond chance was observed in all four sex/ethnic groups (P < 0.001), with 7% of the sample presenting 30% of the abnormalities in large clusters (≥ 3 abnormalities per individual). The odds ratio (OR) for the association of each abnormality with clustering of the remaining four ranged from 1.6 to 8.8 (P < 0.01). These odds of clustering were notably large in white women. Of the abnormalities, hypertriglyceridemia demonstrated the highest OR (5.0–8.8) and diabetes had the lower OR in African-American subjects than in white subjects (P < 0.001). Insulin, WHR, and BMI were statistically associated with clustering in all groups (P < 0.001, except for BMI in African-Americans.

CONCLUSIONS

Clustering of abnormalities consistent with the concept of a metabolic syndrome is present in both white and African-American subjects.
Trends in Hospital Admissions Among Children Aged 0–19 Years with Type I Diabetes in The Netherlands
Authors: Hirasing Remy A , Reeser H Maarten , de Groot Regina R M , Ruwaard Dirk , Van Buuren Stef , Verloove-Vanhorick S Pauline
Published: March 2007

OBJECTIVE

To determine the number and duration of hospital admissions due to diabetes in children aged 0–19 years between 1980–1991.

RESEARCH DESIGN AND METHODS

Secondary analysis of data collected by the SIG Health Care Information was based on the 9th revision of the International Classification of Diseases. The subjects were all children in The Netherlands, aged 0–19 years. The main outcome measures were number and duration of hospital admissions due to type I diabetes (ICD 9 code 250.0–250.9).

RESULTS

The hospital admission rate due to diabetes decreased > 30%. This decrease was statistically significant in all age subgroups. The total number of days in hospital due to diabetes decreased dramatically: from 24,961 in 1980 to 11,305 in 1991. The average duration of hospital stay length due to diabetes decreased as well from 14.5 days in 1980 to 11.9 days in 1991.

CONCLUSIONS

The hospital admission rate and the length of hospital stay for diabetes in children aged 0–19 years have decreased, in spite of an increasing incidence. The hospital admission rate may decrease still further if more children with newly diagnosed diabetes can be adequately managed by team management at home in the initial phase.
GHb Is a Better Predictor of Cardiovascular Disease Than Fasting or Postchallenge Plasma Glucose in Women Without Diabetes: The Rancho Bernardo Study
Authors: Park Sue , Barrett-Connor Elizabeth , Wingard Deborah L , Shan Jun , Edelstein Sharon
Published: March 2007

OBJECTIVE

To examine the relation between GHb, fasting plasma glucose (FPG), postchallenge plasma glucose (PCPG), and mortality from cardiovascular disease (CVD) and ischemic heart disease (IHD) in older adults.

RESEARCH DESIGN AND METHODS

A community-based study of 1,239 nondiabetic older adults followed for an average of 8 years, from baseline (1984–1987) to 1993.

RESULTS

GHb, but not FPG or PCPG, was significantly related to CVD and IHD mortality in women but not men. The age-adjusted relative hazard for those in the highest quintile of GHb (≥ 6.7%) compared with women with lower levels was 2.37 for fatal CVD (95% CI = 1.30−4.31, P = 0.005) and 2.43 for IHD (95% CI = 1.12−5.25, P = 0.024). This association persisted after adjustment for all covariates (age, systolic blood pressure, BMI, LDL, HDL, triglycerides, cigarette smoking, antihypertensive medication use, and estrogen use). GHb was significantly associated with LDL and HDL levels in women, but the association between GHb and CVD or IHD persisted after adjustment for these lipoproteins.

CONCLUSIONS

We concluded that GHb is a better predictor of CVD and IHD mortality than FPG or PCPG in women without diabetes; no single measure of glycemia was predictive in men. The reason for the sex difference is unexplained.
A Family History of NIDDM Is Associated With Decreased Aortic Distensibility in Normal Healthy Young Adult Subjects
Authors: Hopkins Kathileen D , Lehmann Eldon D , Jones Robin L , Turay Ramina C , Gosling Ray G
Published: March 2007

OBJECTIVE

NIDDM is associated with stiffer arteries and an increased incidence of macrovascular disease. NIDDM has strong familial inheritance. We studied the associations of a family history of NIDDM with blood pressure-corrected aortic distensibility (Cp).

RESEARCH DESIGN AND METHODS

Because age is a strong determinant of arterial distensibility, we studied an age-select cohort of 67 healthy normotensive normoglycemic young adults along with fasting measurements of glucose and insulin concentrations. Cp was calculated from noninvasive Doppler ultrasound measurements of pulse wave velocity along the descending thoracoabdominal aorta.

RESULTS

The mean age of the subjects was 20.6 ± 0.7 (mean ± SD) years. A total of 22 subjects gave a positive family history of NIDDM in a parent or grandparent. Subjects with a positive family history of NIDDM had significantly less distensible (i.e., stiffer) aortas than their age- and sex-matched counterparts who gave no family history of NIDDM (Cp [dimensionless]: 0.22 ± 0.04 vs. 0.25 ± 0.04, P = 0.02). Subjects with a positive family history of NIDDM also had significantly higher fasting glucose (5.1 ± 0.4 vs. 4.9 ± 0.4 mmol/l, P = 0.009) and insulin (7.5 ± 5.5 vs. 4.2 ± 2.0 mU/l, P = 0.02) levels and BMIs (23.2 ± 2.3 vs 21.1 ± 2.5 kg/m2, P = 0.002). On multivariate regression analysis, family history of NIDDM (P = 0.03) was the only significant independent predictor of Cp.

CONCLUSIONS

A positive family history of NIDDM is associated with decreased aortic distensibility in early adult life. The relevance of these observations to future cardiovascular events merits further investigation.
Does Suppression of Postprandial Blood Glucose Excursions by the α-Glucosidase Inhibitor Miglitol Improve Insulin Sensitivity in Diet-Treated Type II Diabetic Patients?
Authors: Johnson Andrew B , Taylor Roy
Published: March 2007

OBJECTIVE

Insulin sensitivity is impaired in patients with type II diabetes and is exacerbated by high mean blood glucose (BG). Potentially, large postprandial swings in BG could result in further decrements of insulin sensitivity. Because alpha-glucosidase inhibitors cause a marked reduction in the amplitude of BG changes, the aim of this study was to determine if such a BG-smoothing effect improves insulin sensitivity in well-controlled type II diabetic subjects treated with diet alone.

RESEARCH DESIGN AND METHODS

Patients received either miglitol (BAY m 1099) (50 mg three times daily) or placebo for 8 weeks in a randomized double-blind parallel study. The miglitol (9 men, 2 women) and placebo (7 men, 3 women) groups were well matched (mean ± SD) for age, weight, and blood glucose control (fasting BG, 6.4 ± 1.0 vs. 6.9 ± 1.6 mmol/l; HbA1, 7.7 ± 1.0 vs. 7.9 ± 0.4%; fructosamine, 0.99 ± 0.08 vs. 1.07 ± 0.17 mmol/l). The glucose metabolic clearance rate was calculated during the last 30 min of a 150 min glucose/insulin sensitivity test (glucose, 6 mg · kg−1 · min−1; insulin, 0.5 U · kg−1 · min−1).

RESULTS

There was no significant improvement in metabolic clearance rate (0.21 ± 0.27 vs. 0.16 ± 0.35 l · kg−1 · min−1) for the miglitol- and placebo-treated groups, respectively. There were no statistically significant differences between miglitol and placebo for changes from baseline in BG (0.1 ± 0.1 vs. -0.1 ± 0.2 mmol/l), HbA1 (0.1 ± 0.1 vs. 0.3 ± 0.1%), and fructosamine (−0.06 ± 0.02 vs. −0.03 ± 0.02 mmol/l).

CONCLUSIONS

α-glucosidase-induced improvement in postprandial hyperglycemia does not result in increased insulin sensitivity.
Increased Resting and Exercise-Induced Oxidative Stress in Young IDDM Men
Authors: Laaksonen David E , Atalay Mustafa , Niskanen Leo , Uusitupa Matti , Hänninen Osmo , Sen Chandan K
Published: March 2007

OBJECTIVE

To assess the effect of acute physical exercise on oxidative stress and glutathione redox status and the relation to physical fitness in otherwise healthy young men with IDDM.

RESEARCH DESIGN AND METHODS

Nine men with IDDM (HbA1c 7.3 ± 1.7%), ages 21–30 years, and 13 matched control subjects exercised on a bicycle ergometer for 40 min at 60% of their maximal oxygen consumption (VO2max). Oxidative stress was assessed with plasma thiobarbituric acid reactive substance (TBARS) levels (an index of lipid peroxidation) and, in response to exercise, also glutathione redox status. For glutathione redox status, blood total glutathione (TGSH) and oxidized glutathione (GSSG) were determined. Blood samples were drawn immediately before and after exercise.

RESULTS

Resting plasma TBARS levels were markedly elevated in diabetic patients (2.2 ± 0.7 vs. 0.9 ± 0.4 μumol/l; P = 0.0002). Mean blood TGSH was higher in diabetic subjects (1,203 ± 221 vs. 936 ± 156 mmol/l; P = 0.002), with no significant difference in GSSG or GSSG/TGSH values. Exercise increased plasma TBARS and blood GSSG by ∼50% in both groups. Resting plasma TBARS had a strong inverse correlation (r = −0.82; P = 0.006), and the exercise-induced percentage increase in TBARS had a strong positive correlation (r = 0.81, P = 0.008) with VO2max in diabetic subjects only.

CONCLUSIONS

Glutathione redox status appears to be adequate in healthy young moderately active diabetic men. On the other hand, they demonstrated increased resting and postexercise oxidative stress as indicated by plasma TBARS. Although exercise acutely induces oxidative stress, in patients with diabetes, physical fitness may have a protective effect against oxidative stress.
Glycemic Responses to Exercise in IDDM After Simple and Complex Carbohydrate Supplementation
Authors: Soo Karen , Furler Stuart M , Samaras Katherine , Jenkins Arthur B , Campbell Lesley V , Chisholm Donald J
Published: March 2007

OBJECTIVE

Subjects with IDDM should take carbohydrate before exercise to avoid hypoglycemia. However, there is little information on the glycemic effect of recommended supplementation. This study is aimed to determine the glycemic effects of oral glucose or bread (30 g carbohydrate) before 45 min of moderate exercise.

RESEARCH DESIGN AND METHODS

Nine subjects with uncomplicated IDDM did 45 min of bicycle ergometer exercise at 60% VO2max in the morning before insulin injection on three occasions: 1) with no carbohydrate supplement, 2) with 30 g glucose in water at −5 min, and 3) with 30 g carbohydrate as white bread with water at −20 min. The glycemic responses were determined. The glycemic responses to glucose and bread were also determined without exercise in six subjects.

RESULTS

Without carbohydrate, exercise caused a small fall (−1.2 ± 0.6 mmol/l, mean ± SE) in plasma glucose (PG). With either glucose or bread, PG rose (the change in plasma glucose relative to basal [Δ PG] = 5.1 ± 0.8 and 2.6 ± 0.8, respectively). The rise was greater (P < 0.01) without exercise (Δ PG = 6.9 ± 0.7 and 4.5 ± 0.7, respectively). During exercise, glucose increased PG levels more than bread increased glucose levels P < 0.05).

CONCLUSIONS

Before morning insulin injection, the fall in PG during moderate exercise in IDDM subjects is generally small or absent. The glycemic effects of complex carbohydrate are slightly < glucose before exercise. Under these circumstances, the usually recommended amount of carbohydrate tends to cause an unwanted elevation of PG; thus, IDDM subjects should anticipate reducing or even omitting carbohydrate supplementation after monitoring their individual glycemic response.
Risk Factors Predicting Lower Extremity Amputations in Patients With NIDDM
Authors: Lehto Seppo , Rönnemaa Tapani , Pyörälä Kalevi , Laakso Markku
Published: March 2007

OBJECTIVE

To examine the predictors of lower extremity amputation in patients with NIDDM.

RESEARCH DESIGN AND METHODS

At baseline, risk factors for amputation were determined in 1,044 NIDDM patients (571 men, 473 women) aged 45 to 64 years. These patients were followed up to 7 years with respect to amputation.

RESULTS

The incidence of amputation was 5.6% in men and 5.3% in women. High fasting plasma glucose at baseline examination and the duration of diabetes were associated with a twofold risk for amputation. Similarly, glycemic control measured at baseline by HbA1 was an important predictor of amputation. There was a dose-response relationship between plasma glucose or HbA1 and the risk for amputation. The effect of hyperglycemia on the risk of amputation was seen clearly even after the adjustment for other cardiovascular risk factors. Signs of peripheral neuropathy and bilateral absence of Achilles tendon reflexes and vibration sense were important predictors for amputation. Furthermore, absent peripheral artery pulses and femoral artery bruit on auscultation predicted amputation.

CONCLUSIONS

Our 7-year follow-up study gives strong evidence that poor glycemic control is an important predictor of amputation in patients with NIDDM in addition to clinically detectable peripheral arterial disease and peripheral neuropathy.
Diabetes and Nontraumatic Lower Extremity Amputations: Incidence, risk factors, and prevention—a 12-year follow-up study in Nauru
Authors: Humphrey A R G , Dowse G K , Thoma K , Zimmet P Z
Published: March 2007

OBJECTIVE

To measure the 12-year incidence (1982–1994) of nontraumatic lower extremity amputations (LEAs) in Nauruans, a population at high risk for NIDDM, and to determine the risk factors for amputation in Nauruans with diabetes.

RESEARCH DESIGN AND METHODS

Amputation data were abstracted from operating theater records in Nauru, hospital databases in Australia, and Nauru government records. Baseline characteristics of a cohort of 1,564 Nauruans aged ≥ 20 years examined during a population-based survey in 1982 were used to determine risk factors for first LEAs.

RESULTS

Over this 12-year period, 46 first LEAs were performed on people with NIDDM, of whom 30 were members of the 1982 study cohort. The incidence of first LEAs in Nauruans aged ≥ 25 years with NIDDM was 8.1 per 1,000 person-years in the study cohort and an estimated 7.6 per 1,000 person-years nationally. Amputations were associated significantly with lower BMI, lower blood pressure, higher fasting plasma glucose (FPG) level, and longer mean duration of diabetes at baseline, but levels of other risk factors, including cigarette smoking, plasma triglycerides, and plasma cholesterol, were also elevated in amputees. There were no amputations among individuals with baseline FPG levels < 7.8 mmol/l, irrespective of diabetes duration. FPG, baseline diabetes duration, and male sex were independent risk factors for first amputation using the Cox proportional hazards model. There was a decrease in the incidence of amputations after the commencement of a national foot care health education and prevention campaign in June 1992.

CONCLUSIONS

The incidence of LEAs in diabetic Nauruans was higher than in other populations after adjusting for age and duration. Given the apparent success of the Nauruan footcare program in reducing amputation rates, other populations with high rates of NIDDM and LEAs should consider population-wide prevention strategies.
The Natural Progression of Autonomic Neuropathy and Autonomic Function Tests in a Cohort of People With IDDM
Authors: Levitt Naomi S , Stansberry Kevin B , Wynchank Sinclair , Vinik Aaron I
Published: March 2007

OBJECTIVE

To test the natural progression of symptoms of autonomic neuropathy (AN) and function tests in subjects with IDDM.

RESEARCH DESIGN AND METHODS

Seventy-six subjects with IDDM of < 10 years duration had cardiovascular autonomic reflex tests and were evaluated for signs and symptoms of AN.

RESULTS

Fifty-seven subjects (66%) were available for restudy 9 years later (15 had died, 4 could not be located). Of the symptoms of AN, only gastroparesis increased in prevalence (P < 0.01). Of the five cardiovascular AN measures, only the R-R response to the Valsalva maneuver deteriorated (F[1,44] = 10.61, P < 0.01).

CONCLUSIONS

The progression of AN in IDDM is monitored best longitudinally by the Valsalva maneuver because of the small variance ratio in repeated measures. Prevalence rates can be monitored by expiration-to-inspiration R-R or Valsalva ratios. Most clinical signs and symptoms of AN do not progress, underscoring the need for objective and quantitative autonomic function tests to identify people at risk for premature death.
Glycemic Effect of a Single High Oral Dose of the Novel Sweetener Sucralose in Patients With Diabetes
Authors: Mezitis Nicholas H E , Maggio Carol A , Koch Pamela , Quddoos Arshad , Allison David B , Pi-Sunyer F Xavier
Published: March 2007

OBJECTIVE

To examine the effect of a single high oral dose of the novel noncaloric sweetener sucralose on short-term glucose homeostasis in patients with IDDM or NIDDM.

RESEARCH DESIGN AND METHODS

A total of 13 IDDM and 13 NIDDM patients with glycosylated hemoglobin levels < 10% completed this double-blind cross-over study. After an overnight fast, patients were administered opaque capsules containing either 1,000 mg sucralose or cellulose placebo, followed by a standardized 360-kcal liquid breakfast. Plasma glucose and serum C-peptide levels were measured over the next 4 h.

RESULTS

Regardless of the type of diabetes, areas under the curves for changes of plasma glucose and serum C-peptide levels after sucralose administration were not significantly different from those after placebo. During test meals with sucralose, one episode of symptomatic hypoglycemia occurred in each of three IDDM patients, but these episodes were not considered the result of sucralose administration.

CONCLUSIONS

The present results support the conclusion that sucralose consumption does not adversely affect short-term blood glucose control in patients with diabetes.
Diabetes Complications in NIDDM Kindreds Linked to the MODY3 Locus on Chromosome 12q
Authors: Velho Gilberto , Vaxillaire Martine , Boccio Valérie , Charpentier Guillaume , Froguel Philippe
Published: March 2007

OBJECTIVE

To assess the prevalence of diabetes complications and the severity of diabetes in kindreds with NIDDM linked to the MODY3 locus (chromosome 12q) and to compare these parameters with data obtained in glucokinase (GCK)-deficient and other-MODY (unlinked to any of the three known loci) families, as well as with data from families with a late age of onset of NIDDM.

RESEARCH DESIGN AND METHODS

Clinical and biological data were obtained from 667 affected members of 7 MODY3, 25 GCK-deficient, 6 other-MODY, and 81 NIDDM families. Severity of diabetes (glucose tolerance status and insulin secretion) was assessed by an oral glucose tolerance test. Neurological examination and eye fundus examination were performed in 349 and 251 subjects, respectively, and proteinuria was tested with strips in 282 family members.

RESULTS

A higher prevalence of proliferative retinopathy was observed in MODY3 (21%) and NIDDM subjects (23%) than in GCK-deficient (3%) and other-MODY subjects (8%; P = 0.004). Proteinuria was detected in 19, 7, 5, and 0% (P = 0.07) of subjects, respectively. Prevalence of neuropathy was higher in NIDDM (17%; P = 0.005) than in MODY3 (4%), GCK-deficient (5%) and other-MODY (0%) subjects. MODY3 and NIDDM subjects had significantly higher fasting glucose levels than subjects in the other groups. Glucose levels after 2 h were significantly higher, and the ratios of insulin to glucose levels were significantly lower in MODY3 subjects than in the other three groups.

CONCLUSIONS

The MODY3 subtype of NIDDM is characterized by a severe insulin secretory defect and by major hyperglycemia that progresses rapidly to overt diabetes. Microvascular complications of diabetes were frequently observed in the MODY3 subjects and the subjects with a late age of onset of NIDDM in this cohort. Both the duration and the severity of diabetes were independently associated with these complications.
Metformin Improves Hemodynamic and Rheological Responses to L-Arginine in NIDDM Patients
Authors: Marfella Raffaele , Acampora Rita , Verrazzo Giovanni , Ziccardi Patrizia , Rosa Nicoletta De , Giunta Riccardo , Giugliano Dario
Published: March 2007

OBJECTIVE

The endothelium plays a pivotal role in the regulation of vascular tone by releasing nitric oxide (NO). Increased availability of L-arginine, the natural precursor of NO, induces vasodilatation and inhibits platelet activity. We studied the effect of metformin on hemodynamic and rheological responses to L-arginine in patients with NIDDM.

RESEARCH DESIGN AND METHODS

Ten newly diagnosed NIDDM patients with mild fasting hyperglycemia (7.5 ± 0.3 mmol/l) and without evidence of both micro- and macrovascular complications were investigated. They received an intravenous infusion of L-arginine (1 g/min for 30 min) with evaluation of plasma glucose and insulin, systolic (sBP) and diastolic (dBP) blood pressure, heart rate and plasma catecholamines, platelet aggregation, and blood viscosity and filterability. The L-arginine test was repeated after an 8-week treatment with metformin (850 mg b.i.d.).

RESULTS

Metformin treatment significantly reduced basal fasting plasma glucose, HbA1c, and platelet aggregation to ADP (P < 0.05); the other parameters did not change. During pretreatment test, L-arginine infusion decreased sBP (from 137 ± 4.1 to 129 ± 4.5 mmHg, P < 0.01) and dBP (from 79 ± 1.9 to 75 ± 1.2 mmHg, P < 0.01) without affecting heart rate or plasma catecholamines. Both platelet aggregation and blood viscosity showed significant decrements after L-arginine, while blood filterability did not change. After metformin treatment, the decrease in blood pressure after L-arginine infusion was significantly enhanced, with a maximal decrease of sBP of 12 ± 3.4 mmHg (8 ± 2.5 mmHg pretreatment, P < 0.05) and dBP of 9.5 ± 2.4 mmHg (4.5 ± 1.9 mmHg pretreatment, P < 0.01). Heart rate, plasma norepinephrine levels, and blood filterability also rose significantly (P < 0.05–0.01). The decrease in both platelet aggregation and blood viscosity after L-arginine was significantly amplified after metformin.

CONCLUSIONS

We conclude that L-arginine infusion in newly diagnosed NIDDM patients without vascular complications produces relevant hemodynamic and theological changes, which are amplified by an 8-week treatment with metformin. Whether these vascular effects of metformin will improve the poor cardiovascular outlook of the diabetic patient is still unknown.
Seven-Year Changes in Body Fat and Visceral Adipose Tissue in Women. Association with indexes of plasma glucose-insulin homeostasis
Authors: Lemieux Simone , Prud'homme Denis , Nadeau André , Tremblay Angelo , Bouchard Claude , Després Jean Pierre
Published: March 2007

OBJECTIVE

To study the associations between changes in body fatness, visceral adipose tissue (AT), and indexes of plasma glucose-insulin homeostasis over a 7-year follow-up period.

RESEARCH DESIGN AND METHODS

A sample of 30 nondiabetic women aged 35.2 ± 5.6 (SD) years at baseline was studied.

RESULTS

Changes in visceral AT and in subcutaneous AT (measured by computed tomography) as well as changes in body fat mass (obtained by hydrostatic weighting) were significantly related to changes in fasting plasma insulin levels and in plasma insulin area measured after a 75-g oral glucose load (0.47 ≤ r ≤ 0.62; P < 0.01). Changes in visceral AT but not in body fat mass or in subcutaneous AT area were significantly associated with changes in plasma glucose area (r = 0.37; P < 0.05). When two subgroups of women with similar mean increases in body fat mass but with either small or large increases in visceral AT were compared, the subgroup with the largest gain in visceral AT showed the greatest deterioration in indexes of plasma glucose-insulin homeostasis. On the other hand, when two subgroups with similar mean increases in visceral AT but with different changes in body fat mass were compared, both subgroups showed similar changes in plasma glucose and insulin concentrations.

CONCLUSIONS

Results of this 7-year follow-up study in women suggest that changes in indexes of plasma glucose-insulin homeostasis are significantly associated with changes in visceral AT, even after control for changes in body fat mass.
Drug Use in Patients With Diabetes
Authors: Wändell Per E , Brorsson Bengt , Åberg Hans
Published: March 2007

OBJECTIVE

To describe the use of pharmaceutical medications by patients with diabetes in Sweden.

RESEARCH DESIGN AND METHODS

We analyzed the computerized Surveys of Living Conditions (SLC), performed regularly in Sweden, for the years 1988 and 1989, among individuals aged 16–84 years. Drug use (during a 2-week period) and the use of health services (during a 3-month period) were registered for subjects with diabetes (n = 361) and compared with age- and gender-standardized figures (using the diabetes group as the standard) in subjects with hypertension but without diabetes (n = 980), in subjects with a musculoskeletal condition but without diabetes (n = 2,187), in healthy subjects free from any medical condition (n = 6,664), and in the general population sample (n = 12,717).

RESULTS

The reported use of medication was higher for subjects with diabetes compared with the general population regarding overall use (92.5 vs. 71.9%; P < 0.001), the use of cardiovascular drugs (52.2 vs. 36.3%; P < 0.001), all use of analgesics (43.8 vs. 36.5%; P < 0.05), and use of psychoactive drugs (23.5 vs. 15.3%; P < 0.01). Compared with the hypertension group, the use was lower regarding cardiovascular drugs (52.2 vs. 93.3%; P < 0.001), and compared with the musculoskeletal group, the use was lower regarding all use of analgesics (43.8 vs. 56.5%; P < 0.01) and the use of herbal products (6.8 vs. 11.8%; P < 0.05), but was higher regarding cardiovascular drugs (52.2 vs. 37.8%; P < 0.001). The use was higher compared with the healthy individuals, regarding all groups of drugs with the exception of vitamins and herbal products.

CONCLUSIONS

Diabetic subjects have a higher overall use of drugs compared with the general population. Compared with other chronic illnesses, the differences are small except for disease-specific drugs (cardiovascular drugs in the hypertension group and analgesics in the musculoskeletal group). The main difference concerns the comparison with healthy subjects who had a markedly higher drug rate among diabetic subjects, thus signifying a greater impact on health.
Diabetes and Glucose Tolerance as Risk Factors for Cardiovascular Disease: The Framingham Study
Authors: Kannel W B , McGee D L
Published: March 2007

This report examines prospectively, in the Framingham cohort, the relation of diabetes and impaired glucose tolerance to each of the cardiovascular sequelae, taking into account age, sex, and associated cardiovascular risk factors. The incidence of cardiovascular disease, as well as the levels of cardiovascular risk factors, were found to be higher in diabetic than in nondiabetic men and women. The relative impact of diabetes on coronary heart disease, peripheral vascular disease, or stroke incidence was the same in men and women, but for cardiovascular mortality and cardiac failure the impact is greater for women. Present evidence suggests that alleviation of associated cardiovascular risk factors is the most promising course in reducing cardiovascular sequelae in diabetic patients.
Hypocalcemia, Hypomagnesemia, and Transient Hypoparathyroidism During Therapy with Potassium Phosphate in Diabetic Ketoacidosis
Authors: Zipf William B , Bacon George E , Spencer Martha L , Kelch Robert P , Hopwood Nanacy J , Hawker Charles D
Published: March 2007

The effects of intravenous administration of potassium phosphate in the treatment of diabetic ketoacidosis were studied in nine children, ages 99/12 to 1710/12 yr. During phosphate infusion (20–40 meq/L of fluid), all children maintained normal serum concentrations of phosphorus. Transient hypocalcemia occurred in six and transient hypomagnesemia in five patients. One child developed carpopedal spasms refractory to intravenous infusion of calcium gluconate but responsive to intramuscular injection of magnesium sulfate. In three patients, serum levels of intact parathyroid hormone were low at the time of hypocalcemia, an observation that suggests transient hypoparathyroidism. This study indicates that the use of potassium phosphate as the sole source of potassium replacement might potentiate ketoacidosis-induced hypocalcemia through multiple mechanisms.