bluuebunny/crossref_metadata_2025 huggingface dataset:
Diabetic Ketoacidosis Among Obese African-American Adolescents With NIDDM
Authors: Pinhas-Hamiel Orit , Dolan Lawrence M , Zeitler Philip S
Published: March 2007

OBJECTIVE

To determine whether ketosis at the time of presentation occurs among African-American adolescents with NIDDM.

RESEARCH DESIGN AND METHODS

We reviewed the charts of all islet cell antibody (ICA) negative patients diagnosed with NIDDM at Children's Hospital Medical Center (CHMC) between 1982 and 1995.

RESULTS

Between 1982 and 1985, 70 adolescents were diagnosed with NIDDM. Of these, ICA determinations were available and negative on 42 subjects (28 African-American, 12 white). Twelve of 28 (42%) African-American patients presented with ketonuria, and seven of 28 (25%) presented with DKA. In comparison, none of the 12 white adolescents with NIDDM had ketonuria at presentation or during their subsequent course. Mean follow-up time for patients with ketosis at presentation was 24 months. There was no difference between the age, BMI, or sex distribution of patients with and without ketosis. Previously diagnosed hypertension was present in 42% of patients presenting with ketosis, compared with 17% of the general NIDDM population at CHMC.

CONCLUSIONS

We conclude that ketosis may occur among African-American adolescents with NIDDM, as has been previously reported among African-American adults with NIDDM. Therefore, ketosis in obese young African-American patients with new-onset diabetes does not necessarily imply the presence of IDDM and insulin dependence.
Ethnic Differences in the Incidence of Childhood IDDM in Israel (1965–1993): Marked increase since 1985, especially in Yemenite Jews
Authors: Shamis Igor , Gordon Orit , Albag Yael , Goldsand George , Laron Zvi
Published: March 2007

OBJECTIVE

To establish the changes in the incidence of childhood IDDM during the years 1965–1993 in the different ethnic groups in Israel.

RESEARCH DESIGN AND METHODS

A whole-country register of childhood IDDM (0–17 years) was started in Israel in 1965. Onset of IDDM was considered to be the date of first insulin injection. The data were collected from all outpatient clinics and hospitals. Ascertainment is estimated to be over 95%.

RESULTS

A total of 1,868 patients were registered for a period of 28 years. Marked differences were found between ethnic groups. The highest incidence was among the Yemenite Jews, who reached an incidence of 18.5/105, followed by Ashkenazi Jews (10.0/105), non-Ashkenazi Jews, except Yemenites (7.3/105), and Arabs (2.9/105). In addition, it was found that in all Jewish subgroups, in contrast with the Arabs, there was a marked increase in incidence after 1985.

CONCLUSIONS

Israel is a country with low, intermediate, and high incidence of childhood IDDM. The interethnic differences in incidence are probably due to genetic factors. However, the significant increase in incidence since 1985 in the Jewish population is ascribed to thus far unidentified environmental factors. It is hypothesized that the marked increase in IDDM is due to environmental factors linked to changes in affluence and lifestyle. These may also explain the difference in incidence between the Jewish and Arab populations, the latter living more in rural areas and leading a more traditional lifestyle.
Waist Circumference and Waist-to-Hip Ratio Are Related to Gestational Glucose Tolerance
Authors: Branchtein Leandro , Schmidt Maria Inês , Mengue Sotero S , Reichelt Ângela J , Matos Maria Cristina G , Duncan Bruce B
Published: March 2007

OBJECTIVE

To evaluate the relationship of central fat distribution with gestational glucose tolerance during the usual time for screening gestational diabetes.

RESEARCH DESIGN AND METHODS

This cross-sectional study investigated 1,113 consecutive women, ≥ 20 years old, pregnant for ∼ 21 to 28 weeks, without history of previous diabetes outside pregnancy, who attended two general prenatal care units in Porto Alegre, Brazil, from 1991 to 1993. Weight, height, waist and hip circumferences, and skinfolds were measured, and a 2-h, 75-g glucose tolerance test was performed. Data were analyzed using multiple linear regression models.

RESULTS

Waist-to-hip ratio (WHR) and waist circumference were independently associated with higher 2-h glycemia. Glycemic level was 0.11 and 0.13 mmol/l greater for each standard deviation increase in WHR (0.06) and waist circumference (8.0 cm), respectively (P < 0.02). Restricting analyses to the subset of women with uterine height ≤ 26 cm improved the association (0.13 and 0.19 mmol/l, respectively, P < 0.02); differences of 0.22 and 0.19 mmol/l were observed for 1 SD changes in the sum of skinfold thicknesses (24.7 mm) and in age (5.5 years), respectively.

CONCLUSIONS

Central fat distribution measured in pregnancy is an independent predictor of gestational glucose intolerance. This finding supports the concept that NIDDM and gestational diabetes are parts of the same disease, differing basically in their moment of detection. The usefulness of these anthropometric measurements in identifying pregnant women at high risk of having gestational glucose intolerance merits further investigation.
Prevalence of Diabetes and Impaired Glucose Tolerance in Aragón, Spain
Authors: Tamayo-Marco Benito , Faure-Nogueras Eduardo , Roche-Asensio María José , Rubio-Calvo Emilio , Sánchez-Oriz Enrique , Salvador-Oliván José Antonio
Published: March 2007

OBJECTIVE

To determine the prevalence of diabetes and impaired glucose tolerance (IGT) and to investigate their associated cardiovascular risk factors in Aragón, Spain.

RESEARCH DESIGN AND METHODS

We performed a population-based cross-sectional study with stratified and purposive sampling of residents aged 10–74 years. A sample of 935 subjects (427 men and 508 women) was selected. All except those with a previous history of diabetes underwent an oral glucose tolerance test (OGTT), and World Health Organization (WHO) criteria were used for diagnosis of undiagnosed diabetes and IGT. Plasma lipid levels, blood pressure, BMI, and waist-to-hip ratio were also measured.

RESULTS

The prevalence of diagnosed and undiagnosed diabetes and IGT was 3.1, 3.0, and 7.2%, respectively. In the age range of 30–64 years, the age-adjusted prevalence of diabetes (using the world population of Segi) was 7.1% in men and 5.6% in women. Both diabetes and IGT were associated with high blood pressure, high triglyceride levels, low HDL cholesterol levels, and overweight and upper-body fat distribution. Only upper-body fat distribution in women was significantly higher in subjects with diabetes than in subjects with IGT.

CONCLUSIONS

The prevalence of diabetes in Aragón was moderately high (6.1%) and comparable with that reported in other white populations around the world. The proportion of unknown cases of diabetes was nearly 50%. Cardiovascular risk factors associated with diabetes and IGT supported the existence of an insulin resistance or metabolic syndrome, but there were not sufficient differences between diabetes and IGT to suggest a possible pathogenetic relation of hyperinsulinemia and associated risk factors.
Effect of Socioeconomic Risk Factors on the Difference in Prevalence of Diabetes Between Rural and Urban Populations in Bangladesh
Authors: Sayeed M Abu , Ali Liaquat , Hussain M Zafirul , Rumi M A , Banu Akhtar , Azad Khan A K
Published: March 2007

OBJECTIVE

To compare the prevalence of diabetes between the poor and rich of rural and urban populations in Bangladesh.

RESEARCH DESIGN AND METHODS

A total of 1,052 subjects from urban and 1,319 from rural communities (age ≥ 20 years) of different socioeconomic classes were investigated. Capillary blood glucose levels, fasting and 2 h after a 75-g glucose drink (2-h blood glucose [BG]), were measured. Height, weight, waist, hips, and blood pressure were also measured.

RESULTS

Age-adjusted (30–64 years) prevalence of NIDDM was higher in urban (7.97% with 95% CI 6.17–9.77) than in rural subjects (3.84%, CI 2.61–5.07), whereas impaired glucose tolerance (IGT) prevalence was higher in rural subjects. In either urban or rural areas, the highest prevalence of NIDDM was observed among the rich, and the lowest prevalence was observed among the poor socioeconomic classes. The rural rich had much higher prevalence of IGT than their urban counterpart (16.5 vs. 4.4%, CI 6.8–17.4). Increased age was an important risk factor for IGT and NIDDM in both rural and urban subjects, whereas the risk related to higher BMI and waist-to-hip ratio (WHR) was less significant in rural than urban subjects. Using logistic regression and adjusting for age, sex, and social class, the urban subjects had no excess risk for NIDDM. In contrast, an excess risk for glucose intolerance (2-h BG ≥ 7.8 mmol/l) was observed in the rural subjects.

CONCLUSIONS

Adjusting for age, sex, and social class, the prevalence of NIDDM among urban subjects did not differ significantly from that among rural subjects. Increased age, higher socioeconomic class, and higher WHR were proven to be independent risk factors for glucose intolerance in either area.
Glycemic Control and Prevention of Retinopathy in Japanese NIDDM Patients: A 10-year follow-up study
Authors: Nakagami Tomoko , Kawahara Reiko , Hori Sadao , Omori Yasue
Published: March 2007

OBJECTIVE

To examine glycemic control for the prevention of retinopathy in early diagnosed Japanese NIDDM patients.

RESEARCH DESIGN AND METHODS

There were 137 patients with NIDDM but without retinopathy who first visited our facility from 1983–1985. Their age at diagnosis ranged from 30–65 years, with a disease duration of < 3 years. The optic fundi were examined at least annually. The prevalence of retinopathy in the 10th year after registration in the study was compared in four groups stratified by mean HbA1c values for 10 years. Multiple logistic regression analysis was used to assess the relationship between retinopathy and covariates.

RESULTS

None of the patients with a mean HbA1c <6% had retinopathy. The prevalence of retinopathy was 17.2% in the group with a mean HbA1c of 6–6.9%, 14.3% in the group with a mean HbA1c of 7–7.9%, 41.9% at a mean HbA1c of 8–8.9%, and 54.8% when the mean HbA1c exceeded 9%. The prevalence of retinopathy increased with the increase in the mean HbA1c values over 10 years (trend, P < 0.005). Multiple logistic regression analysis revealed that mean HbA1c was the only significant risk factor for the development of retinopathy.

CONCLUSIONS

Our results support the concept that an early diagnosis and better control lessen the risk for the development of retinopathy in Japanese NIDDM patients.
Intimal-Medial Thickness of the Carotid Artery in Nondiabetic and NIDDM Patients: Relationship with insulin resistance
Authors: Bonora Enzo , Tessari Roberto , Micciolo Rocco , Zenere Marina , Targher Giovanni , Padovani Roberto , Falezza Giancarlo , Muggeo Michele
Published: March 2007

OBJECTIVE

The aim of this study was 1) to compare intimal-medial thickness (IMT) of the carotid artery in nondiabetic and NIDDM patients and 2) to evaluate the association of this early marker of atherosclerosis with several cardiovascular risk factors, including plasma insulin and insulin resistance.

RESEARCH DESIGN AND METHODS

A total of 58 nondiabetic and 56 NIDDM patients, randomly selected among those attending the outpatient Diabetes Clinic or the Clinic for Internal Medicine were examined. BMI, waist-to-hip ratio (WHR), blood pressure, glycohemoglobin (HbA1c), and fasting concentrations of plasma glucose, serum lipids (total and HDL cholesterol, triglycerides), and serum insulin were measured. Insulin resistance was assessed by computing glucose disappearance rate from plasma after intravenous insulin injection (Kitt). IMT of the carotid artery was measured by ultrasonography.

RESULTS

IMT was significantly higher in diabetic patients, and the difference remained highly significant after adjusting for sex, age, BMI, WHR, presence of hypertension and dyslipidemia, and smoking status (1.39 vs. 1.24 mm, common SD 0.12, P < 0.001). Univariate regression analyses showed that IMT was negatively correlated with Kitt in either nondiabetic (r = −0.348, P < 0.01) or diabetic patients (r = −0.492, P < 0.001). However, multiple regression analyses showed that IMT was independently associated with age and WHR in nondiabetic subjects, whereas in diabetic patients, IMT was independently predicted by Kitt and hypertension. These two variables explained ∼ 62% and ∼35% of the variability of IMT in nondiabetic and diabetic patients, respectively. Plasma insulin was not independently associated with IMT in either groups.

CONCLUSIONS

These results indicate that 1) diabetes is characterized by a greater thickness of the carotid artery independently of other established risk factor of atherosclerosis, 2) early atherosclerosis is independently associated with insulin resistance in diabetic but not in nondiabetic patients, 3) central adiposity is an independent predictor of IMT in nondiabetic individuals.
Therapeutic Footwear Can Reduce Plantar Pressures in Patients With Diabetes and Transmetatarsal Amputation
Authors: Mueller Michael J , Strube Michael J , Allen Brent T
Published: March 2007

OBJECTIVE

To compare how footwear (full-length shoe or short shoe), a total contact insert, a rigid rocker-bottom (RRB) sole, and an ankle-foot orthosis (AFO) affect peak plantar pressure (PPP) on the distal residuum and contralateral extremity of patients with diabetes and transmetatarsal amputation (TMA).

RESEARCH DESIGN AND METHODS

Thirty patients with diabetes and TMA participated (mean age 62 ± 4 years). In-shoe plantar pressures during walking were measured in six types of footwear. Each measurement occurred after a 1-month adjustment period. Repeated measure analysis of variance (ANOVA) was used to compare treatments.

RESULTS

All five types of therapeutic footwear reduced plantar pressures compared with regular shoes with a toe-filler (P < 0.05). A full-length shoe, total contact insert, and RRB sole resulted in lower pressures on the distal residuum (222 vs. 284 kPa) and forefoot of the contralateral extremity (197 vs. 239 kPa), compared with a regular shoe and toe-filler. Footwear with an AFO showed reduced PPP on the residuum, but most patients complained of reduced ankle motion during walking. A short shoe reduced pressures on the residuum, but not on the contralateral extremity, and many patients had complaints regarding cosmesis of the shoe.

CONCLUSIONS

The full-length shoe, total contact insert, and an RRB sole provided the best pressure reduction for the residuum and contralateral foot, with the optimal compromise for cosmetic acceptance and function.
The Efficacy and Safety of Miglitol Therapy Compared With Glibenclamide in Patients With NIDDM Inadequately Controlled by Diet Alone
Authors: Segal P , Feig PU , Schernthaner G , Ratzmann KP , Rybka J , Petzinna D , Berlin C
Published: March 2007

OBJECTIVE

To compare the therapeutic effects of the α-glucosidase inhibitor miglitol (BAY m 1099), the sulfonylurea glibenclamide, and placebo on parameters of metabolic control and safety in patients with NIDDM that is inadequately controlled by diet alone.

RESEARCH DESIGN AND METHODS

After a 4-week placebo run-in period, 201 patients in 18 centers in 4 countries were randomized in a double-blind manner to miglitol (50 mg t.i.d., followed by 100 mg t.i.d.), glibenclamide (3.5 mg q.d/b.i.d.), or placebo for 24 weeks. Efficacy criteria were changes from baseline of HbA1c, fasting and postprandial blood glucose and insulin levels, body weight, and serum triglycerides.

RESULTS

Efficacy was assessed in 119 patients who completed the full protocol, and the results were similar to those obtained in 186 patients who fulfilled the validity criteria for analysis. Compared with placebo, mean baseline-adjusted HbA1c decreased by 0.75% (P = 0.0021) and 1.01% (P = 0.0001) in the miglitol and glibenclamide treatment groups, respectively. Blood glucose decreased slightly in the fasting state and considerably in the postprandial state in both treatment groups but not in the placebo group. Fasting insulin levels increased slightly (NS) in all treatment groups; however, postprandial insulin levels decreased with miglitol, while increasing markedly with glibenclamide (P = 0.0001 between all treatment groups). Gastrointestinal side effects (flatulence and diarrhea) occurred mostly in the miglitol-treated patients, while some glibenclamide-treated patients had symptoms suggestive of hypoglycemia.

CONCLUSIONS

Miglitol monotherapy is effective and safe in NIDDM patients. Compared with glibenclamide, it reduced HbA1c less effectively and caused more gastrointestinal side effects. On the other hand, glibenclamide, unlike miglitol, tended to cause hypoglycemia, hyperinsulinemia, and weight gain, which are not desirable in patients with NIDDM.
Symptom Awareness Is Affected by the Subjects' Expectations During Insulin-Induced Hypoglycemia
Authors: Pohl Johannes , Frohnau Georg , Kerner Wolfgang , Fehm-Wolfsdorf Gabriele
Published: March 2007

OBJECTIVE

To assess how expectations and symptom beliefs based on a previous episode of insulin-induced hypoglycemia influence symptom awareness after a second insulin injection in healthy subjects.

RESEARCH DESIGN AND METHODS

After a first episode of insulin-induced hypoglycemia in session 1, half of 40 healthy male subjects were told at the beginning of session 2 that they would receive human insulin (0.05 IU/kg), the other half saline. According to a 2 × 2 balanced placebo design, only half of each group received the announced substance, whereas the other half received the substance contrary to their expectations. Data collection at 10–15 min intervals included a symptom checklist, blood pressure, heart rate, plasma glucose, and counterregulatory hormone levels.

RESULTS

The expectation of a repeated hypoglycemia clearly influenced the subjects' psychophysiological responses. Without knowledge about the actual treatment, there was only an average maximum confidence of 65% of having received insulin. Expecting the insulin injection led to an increased sum score of neuroglycopenic symptoms but not of autonomic symptoms. Subjects expecting the insulin injection reported more weakness, blurred vision, and inner restlessness than those subjects expecting the saline injection. Those subjects correctly informed about receiving insulin experienced the most drowsiness, dizziness, and headaches. The expectations of the insulin injection increased the norepinephrine levels and the heart rate. The told insulin/given insulin group showed the highest glucagon levels.

CONCLUSIONS

The results support the hypothesis that the subjects' expectations influence their perceived symptoms.
Psychological Adjustment to IDDM: 10-Year Follow-Up of an Onset Cohort of Child and Adolescent Patients
Authors: Jacobson Alan M , Hauser Stuart T , Willett John B , Wolfsdorf Joseph I , Dvorak Ramona , Herman Leanna , Groot Mary De
Published: March 2007

OBJECTIVE

To evaluate the psychological adjustment of young adults with IDDM in comparison with similarly aged individuals without chronic illness.

RESEARCH DESIGN AND METHODS

An onset cohort of young adults (n = 57), ages 19–26 years, who have been followed over a 10-year period since diagnosis, was compared with a similarly aged group of young adults identified at the time of a moderately severe, acute illness (n = 54) and followed over the same 10-year period. The groups were assessed at 10-year follow-up in terms of 1) sociodemographic indices (e.g., schooling, employment, delinquent activities, drug use), 2) psychiatric symptoms, and 3) perceived competence. In addition, IDDM patients were examined for longitudinal change in adjustment to diabetes.

RESULTS

The groups differed only minimally in terms of sociodemographic indices, with similar rates of high school graduation, post-high school education, employment, and drug use. The IDDM group reported fewer criminal convictions and fewer non-diabetes-related illness episodes than the comparison group. There were no differences in psychiatric symptoms. However, IDDM patients reported lower perceived competence, with specific differences found on the global self-worth, sociability, physical appearance, being an adequate provider, and humor subscales. The IDDM patients reported improving adjustment to their diabetes over the course of the 10-year follow-up.

CONCLUSIONS

Overall, the young adults with IDDM appeared to be as psychologically well adjusted as the young adults without a chronic illness. There were, however, indications of lower self-esteem in the IDDM patients that could either portend or predispose them to risk for future depression or other difficulties in adaptation.
Intake of a Diet High in Trans Monounsaturated Fatty Acids or Saturated Fatty Acids: Effects on postprandial insulinemia and glycemia in obese patients with NIDDM
Authors: Christiansen Erik , Schnider Sibylle , Palmvig Birthe , Tauber-Lassen E , Pedersen Oluf
Published: March 2007

OBJECTIVE

High intake of trans fatty acids and saturated fatty acids (SFAs) is known to increase the risk of coronary heart disease. We studied the effects of diets enriched in various fatty acids on postprandial insulinemia and fasting serum levels of lipids and lipoproteins in obese patients with NIDDM.

RESEARCH DESIGN AND METHODS

Sixteen obese NIDDM patients were studied in a free-living outpatient regimen. After a run-in period, the patients received three different isocaloric diets for 6 weeks using a randomized crossover design. The patients were instructed to keep the energy intake from carbohydrate and protein constant at 50 and 20 E% (percent of energy intake), respectively, on all three diets. The fat composition of the diets differed: saturated fat (SAT) diet (20 E% SFAs, 5 E% polyunsaturated fatty acids [PUFAs], and 5 E% monounsaturated fatty acids [MUFAs]) versus cis monounsaturated fatty acid (CMUFA) diet (20 E% cis-MUFAs, 5 E% PUFAs, and 5 E% SFAs) versus trans monounsaturated fatty acid (TMUFA) diet (20 E% trans-MUFAs, 5 E% PUFAs, and 5 E% SFAs). Fasting serum levels of lipids and lipoproteins were measured at baseline and in the fasting state before meal tolerance tests at the end of each study period. Insulin secretion was assessed from incremental serum insulin and C-peptide responses during the meal tests.

RESULTS

BMI, waist-to-hip ratio, and glycemic control remained stable throughout the study. After meal stimulation, postprandial glycemic responses were similar on all diets; however, serum insulin and C-peptide responses were greater following the TMUFA and SAT diets than following the baseline or CMUFA diets (P < 0.05). No statistical difference was found in fasting levels of serum lipids (total cholesterol, triglyceride, phospholipid, and nonesterified fatty acids) or lipoproteins of HDL cholesterol, VLDL cholesterol, LDL cholesterol, and apolipoprotein B between diets.

CONCLUSIONS

In the presence of unchanged glycemia, both dietary trans fatty acids and SFAs induce an increase in postprandial insulinemia in obese patients with NIDDM.
Increased Serum Levels of Advanced Glycation End Products (AGEs) in Children and Adolescents With IDDM
Authors: Berg Tore J , Dahl-Jørgensen Knut , Torjesen Peter A , Hanssen Kristian F
Published: March 2007

OBJECTIVE

To investigate whether the serum levels of advanced glycation end products (AGEs) are increased in IDDM children and adolescents and to study the effect of puberty on serum levels of AGEs (S-AGEs).

RESEARCH DESIGN AND METHODS

A total of 68 children and adolescent IDDM patients (age, 13.3 ± 4.0 years; duration of diabetes, 5.0 ± 3.6 years; HbA1c, 8.2 ± 2.0%; Tanner stage [public hair], 1 vs. 2–5, 24/42) recruited from the pediatric outpatient clinic at Aker University Hospital were compared with 25 healthy nondiabetic control subjects. S-AGEs were measured by a fluoremetric immunoassay.

RESULTS

S-AGEs were significantly elevated in the diabetic group when compared with the control group (14.4 ± 3.5 vs. 11.7 ± 3.0 U/ml, P < 0.002). A significant correlation (r = 0.26, P < 0.04) was found between S-AGEs and HbA1c in the diabetic group but not in the control group. No significant correlation was found between S-AGEs and the duration of diabetes in the diabetic group or S-AGEs and blood glucose concentration or age in either group. We found no difference between S-AGEs in boys and girls and in prepubertal and pubertal diabetic or control subjects.

CONCLUSIONS

S-AGEs are increased in young patients with diabetes before puberty. Since AGEs are linked to the pathogenesis of vascular complications, this observation suggests that the pathological processes leading to diabetic late complications start even before puberty.
Transcapillary Escape Rate of Albumin in Type II Diabetic Patients: The relationship with microalbuminuria and hypertension
Authors: Nannipieri Monica , Penno Giuseppe , Rizzo Loredana , Pucci Laura , Bandinelli Simona , Mattei Paola , Taddei Stefano , Salvetti Antonio , Navalesi Renzo
Published: March 2007

OBJECTIVE

To study why in type II diabetes, microalbuminuria, a marker of generalized vascular dysfunction, and hypertension have been linked with both renal and cardiovascular organ damage.

RESEARCH DESIGN AND METHODS

To investigate the effect of moderately elevated blood pressure on vascular damage, the transcapillary escape rate of albumin (TERalb) was measured by intravenous injection of purified 125I-human serum albumin in 9 healthy control subjects (group 1), 9 nondiabetic hypertensive subjects (group 2), and 73 nonobese type II diabetic patients stratified as follows: group 3: 17 normoalbuminuric-normotensive subjects; group 4: 22 normoalbuminuric-hypertensive subjects (systolic blood pressure [sBP] ≥ 140 mmHg or diastolic blood pressure [dBP] ≥ mmHg or both); group 5: 16 normotensive subjects with microalbuminuria (albumin excretion rate [AER]: 20–200 μg/min); and group 6: 18 microalbuminuric-hypertensive subjects.

RESULTS

Groups 3–6 had similar age, sex, duration of diabetes (group 3: 7.8 ± 5.5; group 4: 9.7 ± 8.7; group 5: 12.1 ± 8.1; and group 6: 10.7 ± 8.3 years), BMI, HbA1c (7.8 ± 1.1, 7.5 ± 1.5, 8.7 ± 1.5, and 7.7 ± 1.1%, respectively), blood glucose, and lipid profile. Systolic and diastolic blood pressure did not differ in the three hypertensive group (group 2: 154 ± 3/99 ± 6; group 4: 149 ± 13/95 ± 6; group 6: 154 ± 15/91 ± 9 mmHg) and were significantly lower (P < 0.001) in group 3 (126 ± 12/76 ± 7), group 5 (128 ± 11/77 ± 5), and healthy control subjects (group 1: 133 ± 7/81 ± 4). TERalb was similar in control subjects (5.77 ± 1.06%/h) and in normoalbuminuric-normotensive subjects (5.81 ± 1.51%/h) but significantly higher (P < 0.0001) in microalbuminuric subjects with or without hypertension (9.11 ± 1.65 and 8.60 ± 1.50%/h, respectively) as well as in normoalbuminuric diabetic patients with hypertension (8.10 ± 2.27%/h) and in essential hypertensive subjects (8.12 ± 1.68%/h).

CONCLUSIONS

By stepwise regression, TERalb was related (step 1) to log-AER (r = 0.30) or to the presence of microalbuminuria (r = 0.36) and (step 2) to dBP (multiple r = 0.40) or to the presence of hypertension (multiple r = 0.51) in the whole diabetic cohort (groups 3–6). TERalb was related to dBP (r = 0.47) or to the presence of hypertension (r = 0.56) only in normoalbuminuric diabetic patients (groups 3 and 4) and to log-AER (r = 0.56) or the presence of microalbuminuria (r = 0.68) only in normotensive patients (groups 3 and 5). In type II diabetic patients, TERalb was elevated in subjects with increased albuminuria, irrespective of blood pressure levels, but also was independently related to the presence of mild-to-moderate systemic hypertension.
The Independent and Combined Effects of Aerobic Exercise and Dietary Fish Intake on Serum Lipids and Glycemic Control in NIDDM: A randomized controlled study
Authors: Dunstan David W , Mori Trevor A , Puddey Ian B , Beilin Lawrie J , Burke Valerie , Morton Alan R , Stanton Kim G
Published: March 2007

OBJECTIVE

The triglyceride-lowering effects of ω-3 fats and HDL cholesterol-raising effects of exercise may be appropriate management for dyslipidemia in NIDDM. However, fish oil may impair glycemic control in NIDDM. The present study examined the effects of moderate aerobic exercise and the incorporation of fish into a low-fat (30% total energy) diet on serum lipids and glycemic control in dyslipidemic NIDDM patients.

RESEARCH DESIGN AND METHODS

In a controlled, 8-week intervention, 55 sedentary NIDDM subjects with serum triglycerides > 1.8 mmol/l and/or HDL cholesterol < 1.0 mmol/l were randomly assigned to a low-fat diet (30% daily energy intake) with or without one fish meal daily (3.6 g ω-3/day) and further randomized to a moderate (55–65% VO2max) or light (heart rate < 100 bpm) exercise program. An oral glucose tolerance test (75 g), fasting serum glucose, insulin, lipids, and GHb were measured before and after intervention. Self-monitoring of blood glucose was performed throughout.

RESULTS

In the 49 subjects who completed the study, moderate exercise improved aerobic fitness (VO2max) by 12% (from 1.87 to 2.07 l/min, P = 0.0001). Fish consumption reduced triglycerides (0.80 mmol/l, P = 0.03) and HDL3 cholesterol (0.05 mmol/l, P = 0.02) and increased HDL2 cholesterol (0.06 mmol/l, P = 0.01). After adjustment for age, sex, and changes in body weight, fish diets were associated with increases in GHb (0.50%, P = 0.05) and self-monitored glucose (0.57 mmol/l, P = 0.0002), which were prevented by moderate exercise.

CONCLUSIONS

A reduced fat diet incorporating one daily fish meal reduces serum triglycerides and increases HDL2 cholesterol in dyslipidemic NIDDM patients. Associated deterioration in glycemic control can be prevented by a concomitant program of moderate exercise.
Relationship Between Weight Change in Young Adulthood and the Risk of NIDDM: The Sotetsu Study
Authors: Sakurai Yutaka , Teruya Koji , Shimada Naoki , Wakabayashi Kazuo , Umeda Takashi , Honjo Satoshi , Todoroki Isao , Tanaka Hiroyuki , Muto Takashi , Sakurai Masaru , Nakamura Kou
Published: March 2007

OBJECTIVE

To investigate the independent effect of weight change in young adulthood on the risk of prevalent NIDDM among middle-aged Japanese men.

RESEARCH DESIGN AND METHODS

A case-control study was carried out in 895 male employees aged ≥ 30 years of a railway company located in the vicinity of Tokyo. Adjusted odds ratios (ORs) were calculated for prevalent diabetes in each category of weight change (obtained from subjects' medical records) in young adulthood and adulthood. Adjustment for current age, initial BMI, and weight change in each age stratum was performed by the Mantel-Haenszel method or multiple logistic regression analysis.

RESULTS

Weight change between 20 years of age and the age at maximum weight was not associated with the risk of NIDDM. Weight gain between 20 and 25 years of age was significantly and positively associated with the risk of NIDDM (OR 3.87 for gains ≥ 10.0 kg, 2.53 for gains of 5.0–9.9%, and 3.73 for gains ≥ 10.0%). On the other hand, moderate weight gain after 30 years of age was significantly inversely associated with NIDDM (OR 0.44 for gains of 5.0–9.9 kg, 0.15 for gains of 10.0–19.9%, and 0.38 for gains of 20.0–29.9%).

CONCLUSIONS

Extreme weight gain between 20 and 25 years of age is a significant predictor of NIDDM, independent of current age, BMI at 20 years of age, and weight change within other age strata.
Diabetes Associated With a Novel 3264 Mitochondrial tRNALeu(UUR) mutation
Authors: Suzuki Yoshihiko , Suzuki Susumu , Hinokio Yoshinori , Chiba Masaki , Atsumi Yoshihito , Hosokawa Kazuhiro , Shimada Akira , Asahina Takayuki , Matsuoka Kempei
Published: March 2007

OBJECTIVE

To present a novel mitochondrial DNA mutation in a diabetic family

RESEARCH DESIGN AND METHODS

The proband was a 64-year-old man. In the family, diabetes was maternally inherited. He had diabetes, cerebellar ataxia, cervical lipoma, hearing loss, olfactory dysfunction, ophthalmoplegia, and facial nerve bilateral palsy. On examination, early insulin secretion was blunted, and the M value on glucose clamp test was low. In muscle, ragged red fibers were not found. T-to-C mutation at position 3264 was detected in the proband (0.5% mutant DNAs in leukocyte and 30% in muscle), but was not detected in 201 normal individuals.

RESULTS

Heteroplasmy of mutation, maternal inheritance of diabetes, and symptoms related to mitochondrial dysfunction suggest the pathogenecity of this 3264 mutation. As for diabetes etiology, both impaired insulin secretion and decreased insulin sensitivity seem to be important. In phenotypic characteristics, the combination of cerebellar ataxia and lipoma is a symptom sometimes found in myoclonic epilepsy and ragged red fibers (MERRFs). Ophthamoplegia is a symptom of chronic progressive external ophthalmoplegia (CPEO). These suggest that our proband had phenotypic overlap with MERRF and CPEO. Conversely, facial nerve bilateral palsy is a rare finding. The pictures that focused on his cranial nerves were thus unique, suggesting the heterogeneity of mitochondrial DNA (mtDNA)-related diabetes.

CONCLUSIONS

A novel 3264 mitochondrial DNA mutation in diabetes gives new insight to the etiology of mitochondrial diabetes. Its pathogenecity supports the belief that the tRNA(Leu)(UUR) gene is an etiological hot spot of mitochondrial diseases.
Mortality of Childhood-Onset IDDM Patients: A cohort study in Havana City Province, Cuba
Authors: Collado-Mesa Fernando , Díaz-Díaz Oscar , Melián-Torres Ruber , Suárez-Pérez Rolando , Vera-González Manuel , Aldana-Padilla Deysi
Published: March 2007

OBJECTIVE

To determine the survival pattern and the underlying cause of death in a cohort of childhood-onset IDDM subjects from Havana City Province, Cuba.

RESEARCH DESIGN AND METHODS

This was a descriptive study carried out on a historical cohort of IDDM subjects with disease onset before 15 years of age in Havana City Province, Cuba. The cohort was assembled from several sources. Subjects were diagnosed from 1965 to 1980, and their vital status was assessed at 31 December 1991. Cumulative survival rate was calculated by the Kaplan-Meier method, and a univariate analysis was performed. To test survival differences between groups, the Cox-Mantel test was used. To compare the cohort mortality with the general population, standardized mortality ratios by sex and age were calculated. Specific causes of death were determined by a committee examining death certificates, clinical records, and necropsy reports.

RESULTS

A total of 504 subjects were identified, and the mean follow-up time was 17.5 years. Of the subjects, 70 (13.9%) had died at 31 December 1991. Overall, the cohort had a 71% cumulative survival rate at 25 years of IDDM duration. There were no survival differences according to sex or calendar period of IDDM diagnosis. Statistically significant differences were found among age-at-diagnosis groups. The group with a peripubertal age at diagnosis showed the worst prognosis. The cohort experienced 8.5 times the all-causes death rate, compared with the general population. Renal disease accounted for almost half the deaths.

CONCLUSIONS

IDDM subjects from Havana City Province, Cuba, showed a better survival pattern than IDDM subjects from other developing countries. However, when compared with IDDM populations from developed countries, there is a survival reserve to be achieved by reducing mortality due to renal disease and infections.
Serum Insulin and Lipoprotein(a) Concentrations: The Jichi Medical School Cohort Study
Authors: Inoue Kazuo , Nago Naoki , Matsuo Hitoshi , Goto Tadao , Miyamoto Takeshi , Saegusa Tomohiro , Ishikawa Shizukiyo , Kario Kazuomi , Nakamura Yosikazu , Igarashi Masahiro
Published: March 2007

OBJECTIVE

To examine the relationship between serum insulin and lipoprotein(a) [Lp(a)] concentrations in both sexes in a large population.

RESEARCH DESIGN AND METHODS

The authors conducted a cross-sectional investigation of fasting serum concentrations of insulin and Lp(a), other blood tests, blood pressures, anthropological measurements, physical activity index, smoking habit, alcohol consumption, and menopause. The subjects were 1,121 men and 1,480 women, ranging between 30 and 90 years of age, who were voluntary participants in the Jichi Medical Cohort Study and who resided in one of five rural communities in Japan.

RESULTS

In men, insulin, age, BMI, LDL cholesterol, triglycerides, glucose, and fibrinogen were significantly correlated with Lp(a). In women, insulin, age, LDL cholesterol, fibrinogen, and activated coagulation factor VII were significantly correlated with Lp(a). However, all correlations were weak in either sex. Insulin was inversely correlated with Lp(a) in both sexes. However, the coefficients were weak (r = −0.16 in mean and r = −0.06 in women). In the partial correlation analyses, Lp(a) was not significantly associated with insulin in either sex. The result was not influenced by selecting the subjects on the basis of detectable values of insulin and Lp(a) and stratifying them by serum glucose level.

CONCLUSIONS

There was no significant relationship found between serum insulin and Lp(a) concentrations in either sex of the cohort, which indicates that Lp(a) does not play a role in the increased risk of cardiovascular disease in hyperinsulinemic subjects.
Which Features of Smoking Determine Mortality Risk in Former Cigarette Smokers With Diabetes? The World Health Organization Multinational Study Group
Authors: Chaturvedi Nish , Stevens Lynda , Fuller John H ,   The World Health Organization Multinational Study Group
Published: March 2007

OBJECTIVE

The effects of quitting smoking on mortality risk in individuals with diabetes is unknown and may differ from the benefits observed in the general population. We therefore determined the mortality risks in ex-smokers with diabetes, compared with subjects who have never smoked, by the number of years since quitting, the number of cigarettes smoked, and the number of years of smoking.

RESEARCH DESIGN AND METHODS

An international cohort study of 4,427 individuals with diabetes was studied. Baseline examinations were performed in 1975–1977 when smoking habits were determined by questionnaire. Mortality follow-up continued until 1988.

RESULTS

All-cause mortality risks were higher for recent quitters (1–9 years; relative risk [RR], 1.53 [95% CI 1.19–1.97]; P = 0.001) than for those who quit earlier (≥ 10 years; RR, 1.25 [95% CI 1.03–1.52]; P = 0.02), compared with subjects who have never smoked. These risks were highest in those who had smoked the longest (≥ 30 years: RR, 1.66 [95% CI 1.22–2.26]; P = 0.001; vs. 1–9 years: RR, 1.17 [95% CI 0.85–1.60]; P = 0.3). Risks were also highest in those who had smoked the most and least number of cigarettes. Adjustment for key confounders, which included a previous history of heart disease, proteinuria, and blood pressure, did not materially affect these relationships.

CONCLUSIONS

Quitting smoking does reduce mortality risk in ex-smokers with diabetes, but risks remain high several years after quitting and are highly dependent on the duration of smoking. Thus, individuals with diabetes who smoke should be encouraged to quit as soon as possible in the course of disease.
Preservation of Physiological Responses to Hypoglycemia 2 Days After Antecedent Hypoglycemia in Patients With IDDM
Authors: George Emad , Marques Jefferson L , Harris Nigel D , Macdonald Ian A , Hardisty Colin A , Heller Simon R
Published: March 2007

OBJECTIVE

To assess the effects of short-term antecedent hypoglycemia on responses to further hypoglycemia 2 days later in patients with IDDM.

RESEARCH DESIGN AND METHODS

We studied eight type I diabetic patients without hypoglycemia unawareness or autonomic neuropathy during two periods at least 4 weeks apart. On day 1, 2 h of either clamped hyperinsulinemic (60 mU · m−2 · min−1) hypoglycemia at 2.8 mmol/l or euglycemia at 5.0 mmol/l were induced. Hyperinsulinemic hypoglycemia was induced 2 days later with 40 min glucose steps of 5.0, 4.0, 3.5, 3.0, and 2.5 mmol/l. Catecholamine levels and symptomatic and physiological responses were measured every 10–20 min.

RESULTS

When compared with the responses measured following euglycemia, the responses of norepinephrine 2 days after hypoglycemia were reduced (peak, 1.4 ± 0.4 [mean ± SE] vs.1.0 ± 0.3 nmol/l [P < 0.05]; threshold, 3.4 ± 0.1 vs. 2.9 ± 0.1 mmol/l glucose [P < 0.01]). The responses of epinephrine (peak, 4.0 ± 1.4 vs. 3.5 ± 0.8 nmol/l [P = 0.84]; threshold, 3.8 ± 0.1 vs. 3.6 ± 0.1 mmol/l glucose [P = 0.38]), water loss (peak, 194 ± 34 vs. 179 ± 47 g−1 · m−2 · h−1 [P = 0.73]; threshold, 2.9 ± 0.2 vs. 2.9 ± 0.2 mmol/l glucose [P = 0.90]), tremor (peak, 0.28 ± 0.05 vs. 0.37 ± 0.06 root mean square volts (RMS V) [P = 0.19]; threshold, 3.2 ± 0.2 vs. 3.1 ± 0.2 mmol/l glucose [P = 0.70]), total symptom scores (peak, 10.6 ± 2.1 vs. 10.8 ± 1.9 [P = 0.95]; threshold, 3.3 ± 0.2 vs. 3.6 ± 0.1 mmol/l glucose [P = 0.15]), and cognitive function (four-choice reaction time: threshold, 2.9 ± 0.2 vs. 3.0 ± 0.2 mmol/l glucose [P = 0.69]) were unaffected.

CONCLUSIONS

The effect on hypoglycemic physiological responses of 2 h of experimental hypoglycemia lasts for 1–2 days in these patients with IDDM . The pathophysiological effect of antecedent hypoglycemia may be of shorter duration in IDDM patients, compared with nondiabetic subjects.
Lispro Analog for Treatment of Generalized Allergy to Human Insulin
Authors: Kumar Dinesh
Published: March 2007

OBJECTIVE

To evaluate the clinical usefulness of the human insulin analog lispro in a patient with generalized allergy to human insulin.

RESEARCH DESIGN AND METHODS

A 34-year-old obese female patient developed systemic allergic reactions to human insulin but tolerated insulin lispro. Sequential analyses of the anti-insulin IgE and IgG immunoglobulins were performed.

RESULTS

On intradermal test, the lispro insulin produced a 50% less intense wheal-flare response, compared with human insulin, which was presumed to be due to lispro's molecular form. The intradermal reactivity to both human and lispro insulins decreased with time and disappeared by week 25.125I-labeled lispro and human insulin binding antibody titers of both the IgE and IgG immunoglobulins were high initially, but decreased progressively, becoming very low by the end of 1 year. In in vitro immunoassay, thelispro and human insulins show a complete cross-reactivity.

CONCLUSIONS

Lispro may be useful for the management of allergy to human insulin. This analog of human insulin appears to have a reduced immunogenic potency.
Comparison of a Neurothesiometer and Vibration in Measuring Vibration Perception Thresholds and Relationship to Nerve Conduction Studies
Authors: Bril Vera , Kojic Jasna , Ngo Mylan , Clark Kelly
Published: March 2007

OBJECTIVE

To compare vibration perception thresholds (VPTs) obtained with two different instruments, a neurothesiometer and a vibratron, and to characterize variability of repeat measures and correlation with sural nerve conduction parameters.

RESEARCH DESIGN AND METHODS

A total of 152 patients with diabetic peripheral neuropathy received electrodiagnostic evaluation and quantitative VPT testing with the Vibratron II and the Horwell Neurothesiometer. Of the patients, 42 returned for repeat nerve conduction studies and VPT testing with both types of equipment on threeseparate occasions.

RESULTS

The variability of repeat testing for the vibratron was 34 and 31% in the right and left first toes, respectively. Variability for neurothesiometer was 8 and 6% for the right and left toes. This variability compares with that of sural nerve conduction velocity of 2% and that of sural nerve amplitude of 8% in this series of patients.

CONCLUSIONS

We conclude that VPT determined with the neurothesiometer is less variable than with the vibratron and more reflective of peripheral nerve function. Our results indicate that the neurothesiometer can be used reliably in clinical research trials.
U.K. Prospective Diabetes Study 22: Effect of age at diagnosis on diabetic tissue damage during the first 6 years of NIDDM
Authors: Davis Timothy ME , Stratton Irene M , Fox Charles J , Holman Rury R , Turner Robert C ,   U.K. Prospective Diabetes Study (UKPDS) Group
Published: March 2007

OBJECTIVE

To assess the effect of age at diagnosis on the initial prevalence and subsequent risk of the progression of diabetic tissue damage in patients with NIDDM.

RESEARCH DESIGN AND METHODS

The prevalence of Q-wave myocardial infarction, absent dorsalis pedis pulses, retinopathy, absent ankle jerks, hypertension, and microalbuminuria were determined at baseline and at 3 and 6 years of follow-up in five consecutive 6-year age-cohorts of 3,027 newly diagnosed white patients aged between 36 and 65 years recruited to the U.K. Prospective Diabetes Study. The effect of age at diagnosis on the initial prevalence and the risk of progression of these complications and associated conditions was analyzed using logistic regression and proportional odds methods, respectively.

RESULTS

Q-wave myocardial infarction and hypertension were more prevalent in older patients at presentation, but age at diagnosis did not have a significant effect on the increased risk of either after 6 years of NIDDM. Absent dorsalis pedis pulses and ankle jerks were also more prevalent in the older age-groups at presentation, but age at diagnosis was a significant predictor of the increasing prevalence of both during follow-up. The baseline prevalence of retinopathy and microalbuminuria was not related to age. The subsequent risk of retinopathy, but not microalbuminuria, increased significantly with age at diagnosis.

CONCLUSIONS

Age at diagnosis has a variable impact on different types of diabetic tissue damage and may thus be an important variable in epidemiological and intervention studies in NIDDM. Regular ophthalmologic surveillance and examination of the feet increase in importance with increasing age since the diagnosis of NIDDM.
Lack of Change of Lipoprotein(a) Levels by the Optimization of Glycemic Control With Insulin Therapy in NIDDM Patients
Authors: Caixàs Assumpta , Pérez Antonio , Qrdóñez-Llanos Jordi , Bonet Rosa , Rigla Mercedes , Castellví Agustina , Bayén L , Leiva Alberto De
Published: March 2007

OBJECTIVE

To evaluate the effect of glycemic control improvement with insulin therapy on lipoprotein(a) [Lp(a)] levels in patients with NIDDM.

RESEARCH DESIGN AND METHODS

We performed a longitudinal study in a tertiary referral center to compare lipid and Lp(a) levels before and after 3 months of insulin therapy in 60 poorly controlled NIDDM patients (32 men, 28 women). Patients previously treated with oral hypoglycemic agents (n = 50) received one to two insulin doses, and those previously treated with insulin (n = 10) received multiple insulin doses. Lp(a) levels were measured by the Terumo method. Differences between the two periods were assessed by the paired t test and Wilcoxon's test.

RESULTS

After 3 months of insulin therapy, HbA1c decreased from 9.6 ± 1.9 to 6.0 ± 1.4% (P < 0.0005) in all patients and from 9.1 ± 2.1 to 6.1 ± 2.9% (P < 0.05) in patients under multiple insulin doses, being ≤ 6.0% in 59% of patients. Total triglyceride and VLDL cholesterol levels decreased (P < 0.01) and HDL cholesterol increased significantly (P < 0.0005). However, no changes in Lp(a) levels were observed in all patients (25.3 ± 25.0 vs 25.7 ± 27.2% mg/dl) and in patients with baseline Lp(a) levels above (63.5 ± 15.5 vs. 65.1 ± 23.1 mg/dl) or below 30 mg/dl (11.5 ± 7.5 vs. 11.5 ± 7.3 mg/dl). In addition, patients reaching HbA1c levels ≤ 6.0% or > 6.0% presented similar Lp(a) levels (26.0 ± 29.1 vs 25.3 ± 25.0 mg/dl). Moreover, no correlations were observed between changes in Lp(a) levels and in the glycemic control parameters.

CONCLUSIONS

This study shows that the improvement of glycemic control by insulin therapy does not influence plasma Lp(a) levels, measured by the Terumo method, in NIDDM patients, independently of baseline values and the degree of glycemic control reached.