bluuebunny/crossref_metadata_2025 huggingface dataset:
The Glycohaemoglobin Assay as a Screening Test for Diabetes Mellitus: The Islington Diabetes Survey
Authors: Forrest Richard D. , Jackson Caroline A. , Yudkin John S.
Published: July 2009

Blood glucose 2 h after an oral glucose load (2hBG) and glycohaemoglobin (GHb) (Corning agar‐gel electrophoresis) levels were used as screening tests in a general practice diabetic screening programme. The diagnosis of diabetes (DM) was based on a separate oral glucose tolerance test (OGTT) in 223 of 1040 screened subjects, selected as a stratified sample biased towards higher levels of 2hBG and GHb. The GHb assay was also repeated at the recall examination and urine was tested for glycosuria before and after glucose administration.

At a cut‐off level of 8.1%, the screening GHb assay correctly identified 90% of all probable diabetics with a specificity of 85.3% (95% CI 83.3–87.3%) and a positive predictive value of 14.0% (9.0–19.0%). The specificity of the screening GHb assay as a screening test for true DM was 45.8% (39.0–52.4%) at 90% sensitivity, and that of the recall GHb assay was 64.5% (57.9–71.1%). The screening 2hBG was 93.3% (88.9–97.7%) specific at 90% sensitivity as a screening test for true DM diagnosed by OGTT at recall. The test characteristics for fasting glycosuria were: sensitivity 16.7% (0–37.8%) and specificity 98.0% (96.0–100.0%). Equivalent values for the post‐glucose test for glycosuria were: 72.7% (46.4–99.0%) and 77.4% (70.1–84.7%), respectively.

While GHb assay is a poorer screening test for DM than the 2hBG at the single cut‐off level quoted, comparison of the accuracy of the two tests shows that the GHb assay is only marginally less accurate. It is superior to testing for glycosuria as a screening test for DM and can be performed on any random blood sample, facilitating its use in population screening.
Reproducibility of the Glucagon Test
Authors: Arnold‐Larsen S. , Madsbad S. , Kühl C.
Published: July 2009

The influence of the fasting blood glucose (FBG) concentration on the ß‐cell responsiveness to glucagon was studied twice in 9 insulin‐dependent diabetic patients with residual ß‐cell function. At a FBG of 7.7±0.3 mmol/l (mean ±SEM) all patients displayed a preserved ß‐cell function with a plasma C‐peptide concentration of 0.25±0.03 nmol/l 6 min after an i.v. injection of glucagon. In contrast, at a FBG of 3.2±0.01 mmol/l 4 out of 9 patients would have been classified as not having an endogenous insulin secretion. All the patients had the lowest 6 min C‐peptide concentration 0.06±0.01 nmol/l on the day with the lowest blood glucose concentration.

The reproducibility of the glucagon test was assessed by comparing the results from two test days in 12 insulin‐dependent, 9 non‐insulin‐dependent diabetic patients and 6 normal subjects. The 6 min plasma C‐peptide concentration, the peak plasma C‐peptide concentration, and the area under the plasma C‐peptide curves were not different on the two test days in any subgroup. In all diabetic patients and normal subjects, the 6 min plasma C‐peptide concentration (r = 0.93, coefficient of variation (CV) = 0.16), the peak plasma C‐peptide concentration (r = 0.93, CV = 0.16) and the area under the plasma C‐peptide curve (r = 0.94, CV = 0.16) were all significantly correlated.

The results show that the prevailing FBG significantly affects the outcome of the glucagon test and confirm its reproductibility.
A Comparison of Semisynthetic Human NPH Insulin and Porcine NPH Insulin in the Treatment of Insulin‐dependent Diabetes Mellitus
Authors: Pedersen C. , Høegholm A.
Published: July 2009

Twenty‐two insulin‐dependent diabetic patients participated in a double‐blind, cross‐over study, where treatment with semisynthetic human NPH insulin (Novo Industri) was compared with porcine NPH insulin (Nordisk). Each treatment period lasted 8 weeks. Blood glucose level, glycosylated haemoglobin, insulin requirements, and frequency of hypoglycaemic events were compared. No difference was found in 24‐hour blood glucose profiles. Fasting blood glucose level was 8.3 mmol/l during treatment with human insulin and 8.7 mmol/l during treatment with porcine insulin (p<0.1). Mean HbA1c was 7.7% at the end of study compared to 9.5% at baseline (p<0.01), but this decline in HbA1c was independent of the treatment regimen. Forty‐six hypoglycaemic events occurred during treatment with human insulin compared to 39 events during treatment with porcine insulin. No difference was found regarding insulin requirements during the study.

It is concluded that semisynthetic human NPH insulin is indistinguishable from porcine NPH insulin with respect to 24‐hour blood glucose profile, HbA1c level and insulin dose requirements.
Use of Hospital Services by Elderly Diabetics: The Frederica Study of Diabetic and Fasting Hyperglycaemic Patients Aged 60–74 Years
Authors: Damsgaard E. M. , Frøland A. , Green A.
Published: July 2009

The use of hospital services was studied in 228 patients with known diabetes (KD) (52 insulin treated, 101 diet plus oral hypoglycaemic agents (OHAs), 66 diet treated and 9 without treatment) and 87 subjects with fasting hyperglycaemia (FH) found by screening of a well‐defined population aged 60–74 years. Ninety per cent were NIDDM as evaluated by a high C‐peptide response on glucagon stimulation. Information about all admissions during the year before ascertainment was obtained from the complete regional computerized hospital registration system.

The overall average admission rate per year for KD males was 0.47 and for females 0.50. The average number of bed‐days occupied per person‐year was 6.8 for KD males and 8.2 for females. These rates are 2–3 times higher than those of the general population. Insulin treated NIDDM patients had a rate of 23.9, whereas IDDM patients had a rate of 15.2 bed‐days per person‐year. The corresponding figures for patients treated with OHAs were 3.5 and for patients treated with diet 4.6. FH had overall bed‐day occupancy rates of 0.50 and 1.09 for males and females, respectively, which was less than half of that expected from the general population.

If discharge diagnosis (principal and/or subsidiary) had been used for identification of hospitalized patients with diabetes the bed‐days used by KD patients would have been underestimated by 15.3%, most pronounced for diabetics treated with OHAs (21.1%) or diet (21.6%).
The Effect of Metformin on Glycaemic Control, Intermediary Metabolism and Blood Pressure in Non‐insulin‐dependent Diabetes Mellitus
Authors: Campbell I. W. , Duncan C. , Patton N. W. , Broadhead T. , Tucker G. T. , Woods H. F.
Published: July 2009

Fourteen non‐insulin‐dependent diabetics (9 female, 5 male), aged 46 to 64 years, uncontrolled by diet (fasting plasma glucose ≥8 mmol/l), were treated with metformin, 1–3 g daily, and followed prospectively at 1 week, then at 2‐weekly intervals for 6 months. The fasting plasma glucose fell significantly (p<0.01) after 1 week of therapy and HbA1 showed a significant reduction, 13.4 ± 2.5% (mean ±SD) to 10.7 ± 1.8% (normal range 5.1–9.3%) at 8 weeks (p<0.001). There was no significant change in body weight, plasma insulin, serum cholesterol or triglycerides, blood lactate, pyruvate, glycerol, alanine, 3‐hydroxybutyrate or acetoacetate concentrations. Systolic, diastolic, and mean arterial blood pressures, along with resting heart rate remained unchanged. This study shows that metformin effectively lowers plasma glucose without hyperinsulinism or significant rise in fasting blood lactate and other gluconeogenic precursors.
The Variability of Overnight Urinary Albumin Excretion in Insulin‐Dependent Diabetic and Normal Subjects
Authors: Cohen D.L. , Close C.F. , Viberti G.C.
Published: July 2009

The variability of overnight urinary albumin excretion rate (AER) and albumin to creatinine ratio was assessed in eight normal subjects and two groups of insulin‐dependent diabetic patients divided on the basis of an initial overnight urinary albumin excretion rate below (n=15) or above (n=12) 30 μg/min. The latter group is known to be at risk of developing clinical diabetic nephropathy. An albumin to creatinine ratio of 2.6 and above identified all patients with an initial albumin excretion rate greater than 30 μ/min. The mean of the coefficients of variation, calculated from five successive overnight urine collections, for all subjects was 38% for albumin excretion rate and 37% for albumin to creatinine ratio. There was no significant difference in the variation of albumin excretion rate and albumin to creatinine ratio within or between the groups. Subsequent AERs from diabetics with an initial rate greater than 30 Mg/min changed category more often (X2 = 11.9, p < 0.001) than those from diabetics with lower initial rates and normal subjects. This was due to four subjects with initial values close to the cut‐off level, whose subsequent values varied around it. Albumin excretion rates in normal subjects never exceeded 11 μ/min. Whether a patient's risk status is influenced by the degree of variation of albumin excretion rate around a risk level, or whether the classification of risk is improved by multiple collections, awaits testing in prospective subjects.
Variability of Albumin Excretion in Insulin‐dependent Diabetics
Authors: Chachati A. , von Frenckell R. , Foidart‐Willems J. , Godon J.P. , Lefebvre P.J.
Published: July 2009

Sixteen adults patients with insulin‐dependent diabetes mellitus and 16 healthy controls, matched for sex and age, were asked to collect their urine during the night and during the day at rest, at weekly intervals on four occasions. Subjects with heart failure, kidney disease, hypertension, abnormal urinanalysis (Albustix positive) or poorly controlled diabetes prior to entry in the study, were excluded.

A high variability in the albumin excretion rates (AER) was observed in both diabetic and control groups but the variance was significantly greater in diabetics. Moreover the variance in AER was higher in daytime as compared to overnight urine collections in both groups. Overnight urine collections are more precise than daytime urine collections for the determination of AER.
Protein Kinase Activity of the Partially Purified Insulin Receptor from Human Adipocytes
Authors: Handberg Aase , Gammeltoft Steen , Juhl Henning
Published: July 2009

Insulin receptors were partially purified by wheatgerm agglutinin chromatography from adipocytes of fasted healthy female subjects. The partially purified receptors showed binding characteristics similar to those of intact calls with an apparent affinity for insulin (half maximal binding) of 1.6 × 10−9 mol/l. Insulin receptor alpha‐ and beta‐subunits were identified by affinity labelling and phosphorylation with (γ‐32p)ATP, respectively. The electrophoretic mobility was 135 K for the alpha‐subunit, and 97.5 K for the beta‐subunit. The intrinsic tyrosine kinase activity of the insulin receptor was demonstrated by autophosphorylation of receptors purified by immunoprecipitation, and by phosphorylation of a synthetic substrate: poly(Glu, Tyr (4:1)). The kinase was activated by insulin in a dose‐dependent manner with half maximal stimulation at 8 × 10−10 mol/l. The Km value for ATP was 50 μmol/l. The dose‐response relationship between percentage maximal kinase activation and fractional receptor occupancy by insulin was sigmoidal with half maximal effect when 35% of receptors are occupied. It is suggested that positively cooperation interactions between the receptor monomers are involved in stimulation of kinase activity and receptor autophosphorylation by insulin.
Sulphonylurea Failure in Type 2 Diabetes: Treatment with a Basal Insulin Supplement
Authors: Holman R. R. , Steemson J. , Turner R. C.
Published: July 2009

Many diabetic patients continue to have hyperglycaemia on maximal sulphonylurea therapy. Five different therapeutic options, with the prime aim of achieving normal fasting plasma glucose concentrations, have been compared in 15 asymptomatic, sulphonylurea‐treated type 2 diabetic patients in a randomized crossover study of 8‐week periods. In 24 h metabolic profiles the overnight mean (±1SD) basal plasma glucose level on sulphonylurea therapy was 8.9±4.2 mmol/l. This was slightly improved with added metformin therapy (7.3±4.3 mmol/l, p=0.013), but reduced to normal by added ultralente insulin (5.2±3.2 mmol/l, p<0.001), ultralente insulin alone (5.1±1.6 mmol/l, p=0.005) or by ultralente and soluble insulin (4.7±1.4 mmol/l, p=0.003). The mean glycosylated haemoglobin concentration was reduced significantly only by the treatments which included insulin. None of the patients had severe or incapacitating hypoglycaemia and only when on additional soluble insulin did patients show a significant gain in weight. Combining sulphonylurea therapy with ultralente insulin did not significantly improve overall glucose control over treatment with ultralente alone, although the insulin dose required to restore fasting normoglycaemia was significantly lower (median (interquartile range), 25 (12–41) versus 40 (27–80) U/day, p=0.001). In type 2 diabetic patients who continue to have fasting hyperglycaemia on maximal sulphonylurea therapy, fasting normoglycaemia can be achieved easily, without minimal changes in diet or lifestyle, by means of a basal insulin supplement.
A Pilot Diabetic Support Service Based on Family Practice Attenders: Comparison with Diabetic Clinics in East London
Authors: Boucher B. J. , Claff H. R. , Edmonson M. , Evans S. , Harris B. T. H. , Hull S. A. H. , Jones E. J. , Mellins D. H. , Safir J. G. , Taylor B. , Udezue E. , Young M. R. Y. , Yudkin J. S.
Published: July 2009

A pilot Diabetic Support Service (DSS) based on a computer register was devised for diabetic patients identified within three group practices in an inner city district of London. Of 159 eligible diabetics, 142 were followed over 2 years. Glycosylated haemoglobin (GHb) monitoring and adequacy of clinic reviews were audited. Care achieved by the DSS was compared with conventional Diabetic Clinic (DC) management of a sample of 200 diabetics from the same district. Serial GHb measurements were made on 66.2% of DSS and 44.5% of DC patients: GHb fell significantly only in DSS patients (13.1% to 11.4%). Proportional falls in GHb were comparable in each DSS treatment group (diet alone, oral hypoglycaemic agents, and insulin) and for hospital attenders and non‐attenders equally. The planned clinical reviews were achieved in 40.1% of DSS patients entered (29% GP only, 54% of clinic attenders) and in 15% of DC patients (plus 75% fundal and blood pressure examination).

The study led to provision of a formal diabetic clinic annual review system, diabetic mini‐clinics in two of the three group practices, and the appointment of two Diabetic Liaison Sisters. With administrative simplification the system is to be made available to all diabetics in the District through their GPs during 1986–8.
Ambulatory Medical Care for Elderly Diabetics: The Fredericia Survey of Diabetic and Fasting Hyperglycaemic Subjects aged 60–74 years
Authors: Damsgaard Else Marie , Frøland Anders , Holm Niels
Published: July 2009

The use of services from the primary health care system and hospital outpatient clinics was studied in persons aged 60–74 years. We studied 228 persons with known diabetes (KD) (52 insulin treated, 101 OHA, 66 diet, 9 untreated) and 87 with fasting hyperglycaemia (FH) and compared with sex and age matched controls (223 CKD, 82 CFH). Information on all services provided by the primary health care system during the 12 months before ascertainment was obtained from local and national registers.

FH did not receive more primary care services and did not visit outpatient clinics more than controls. Two to three times more KD than controls received all kinds of services from general practice or visited outpatient clinics. No difference was seen for specialists, except for dentists and otologists who provided fewer services to KD than to CKD. Of insulin treated KD 56% had ≥10 contacts with physicians during the year, independent of residual beta‐cell function. The corresponding proportions for OHA‐treated and diet treated KD were 27% and 29%. Outpatient clinics were visited by 79% of insulin treated KD (88% with high and 65% with low C‐peptide secretion), 26% of OHA‐treated KD and 33% of diet‐treated KD. The prevalence of ischaemic heart disease, hypertension, and microalbuminuria was not increased in the KD using most primary care services.
Educational Achievements, Employment and Social Class of Insulin‐Dependent Diabetics: A Survey of a Young Adult Clinic in Liverpool
Authors: Ardron Mark
Published: July 2009

The educational achievements, current employment, and social class of 137 diabetic patients aged 20.9 ± 3.0 years (mean ± SD), attending a Young Adult Diabetic clinic in North Liverpool were surveyed. The duration of diabetes was 7.8 ± 5.0 years. Patients who developed diabetes in childhood (age at diagnosis <13 years) were more likely to have achieved educational qualifications, be employed, and be of social class I or II than those developing diabetes aged 13–25 years. Compared with non‐diabetic young adults from North Liverpool, diabetics achieved similar educational qualifications and were as likely to be employed after leaving full‐time education. This is an encouraging finding in the present harsh economic climate. The clustering of social classes I and II in childhood diabetics found in this study requires a larger epidemiological study of social class and insulin‐dependent diabetes for confirmation.
Alpha Glucosidase Inhibition in the Treatment of Non‐Insulin‐Dependent Diabetes Mellitus
Authors: Scott A. R. , Tattersall R. B.
Published: July 2009

Two studies of the new alpha‐glucosidase inhibitor, miglitol, in patients with non‐insulin‐dependent diabetes mellitus (NIDDM) are reported. In the first, 13 patients, poorly controlled on sulphonylureas, received miglitol 50mg three times daily for 4 weeks. Post‐prandial blood glucose was reduced after breakfast, lunch, and tea compared with placebo (p<0.05–0.01) but there was no improvement in fasting blood glucose, serum fructosamine or haemoglobin A1.

In a dose‐response study the effect of a single dose of miglitol (0,50,100,150 or 200mg) on post‐prandial glycaemia after a test breakfast was assessed in 20 patients with mean ± SEM fasting blood glucose 9.9 ± 0.4 mmol/l. With 50mg miglitol, there was a significant reduction in blood glucose from 30 to 120 min post‐prandially compared with placebo. Increasing doses of miglitol further depressed the post‐prandial rise in blood glucose and with 200mg there was no significant change from fasting levels. Side‐effects were limited to flatus and loose stools particularly with the higher doses but were not severe.

Miglitol effectively reduces post‐prandial blood glucose rise in NIDDM with as little as 50mg but there is considerable individual variation. Larger doses may be necessary in patients already poorly controlled on sulphonylureas.
Hormonal and Metabolic Changes During Hypothermic Coronary Artery Bypass Surgery in Diabetic and Non‐diabetic Subjects
Authors: Crock P. A. , Ley C. J. , Martin I. K. , Alford F. P. , Best J. D.
Published: July 2009

Hormonal and metabolic responses to hypothermic coronary artery bypass grafting (CABG) were studied in three groups: 8 non‐diabetic patients, 8 patients with non‐insulin‐dependent diabetes mellitus (NIDDM) given a glucose pump priming solution and 8 NIDDM patients given a non‐glucose infusion. There were no significant differences in stress hormone responses between NIDDM and non‐diabetic patients, with adrenaline concentrations rising 10‐fold, noradrenaline 4‐fold and cortisol 2 to 3‐fold. Glucagon rose significantly during bypass only in the NIDDM patients who did not receive a glucose prime. Comparable marked hyperglycaemia was seen in both glucose primed groups during bypass and exclusion of glucose from the prime in NIDDM patients prevented this major rise. Postoperatively, the rise in insulin in the glucose primed NIDDM patients contrasted with the slower rise in the non‐glucose primed NIDDM patients who were also hyperglycaemic by this stage. Perioperative hyperglycaemia in NIDDM patients undergoing CABG can be prevented by using a non‐glucose priming solution and by giving insulin infusion, particularly postoperatively.
The Feasibility of a Potentially ‘Ideal’ System of Integrated Diabetes Care and Education Based on a Day Centre
Authors: Day J. L. , Johnson P. , Rayman G. , Walker R.
Published: July 2009

A new system of clinical and educational care designed to replace traditional diabetic clinics is described. The overall aims were to provide adequate consultation time, patient access according to diabetic and social needs, minimal waiting time, continuity with experienced staff and objective based learning programmes in an environment suited to learning. This was achieved by changing the role of the diabetes nurse specialist from undertaking delegated tasks to providing primary consultative care, reorganization of existing staff and provision of a purpose designed unit. This gave sufficient flexibility to arrange daily early morning and weekly evening clinic sessions for routine diabetes counselling and medical audit with primary education scheduled at other times. A year's experience showed that our major targets had been met, with the provision of adequate consultation time, halving of waiting time, ease of patient access and continuity with either the doctor or nurse in consulting role. Default rates have fallen and patient and staff morale has improved substantially. Apart from an underestimate of receptionist and a small increase in technician hours, these changes have been achieved within the predicted small revenue cost.
A Comparison of Arterial and Non‐arterialized Capillary Blood Gases in Diabetic Ketoacidosis
Authors: Hale P.J. , Nattrass M.
Published: July 2009

The results of acid‐base and blood gas estimations in arterial and non‐arterialized capillary blood have been compared in samples obtained simultaneously from patients presenting with diabetic ketoacidosis. Highly significant correlations were obtained for pH, pCO2 and bicarbonate measurements. Small but significant differences were observed with capillary pH slightly lower and capillary pCO2 and bicarbonate slightly higher than arterial values. These differences were of no clinical significance. Non‐arterialized capillary samples are a reliable indicator of acid‐base status in this form of metabolic acidosis and are preferable to repeated arterial puncture.
Diabetic Ketoacidosis During NovoPen Therapy
Authors: MacRury S. M. , Small M. , Boal A. , Paterson K. R. , McCuish A. C.
Published: July 2009

To improve flexibility and acceptability of diabetic management five patients (age 15–26 years) were changed to NovoPen therapy (Human Actrapid Insulin 3 x daily + Human Ultratard Insulin at night). Diabetic ketoacidosis developed within 2–4 months of commencing this regimen and in one patient twice in only 4 weeks. All failed to increase their insulin dose in response to hyperglycaemia and two patients omitted insulin when they did not take meals believing this to be appropriate irrespective of the prevailing blood glucose.

The NovoPen regimen may increase the risk of diabetic ketoacidosis in patients who do not monitor and control their diabetes assiduously and should not be seen as a solution for poorly motivated or ill‐educated patients.
Microalbuminuria: A Major Risk Factor in Non‐insulin‐dependent Diabetes. A 10‐year Follow‐up Study of 503 Patients
Authors: Schmitz A. , Vaeth M.
Published: July 2009

The impact of microalbuminuria on mortality as well as other risk factors was investigated in a 10‐year follow‐up study of 503 predominantly non‐insulin‐dependent diabetic patients of whom 265 had died. Using Cox's regression analysis the prognostic influence of age, sex, age at diagnosis, known diabetes duration, blood pressure, fasting plasma glucose, relative weight, serum creatinine, retinopathy, and treatment was evaluated as well as morning urine albumin concentration (UAC) in four categories, i.e. UAC 15 μg/ml (normal), 15 μg/ml < UAC 40 μg/ml, 40 μg/ml < UAC 200 μg/ml and UAC > 200 μg/ml. Age, UAC, known duration, and serum creatinine were the only significant risk factors. After correction for the other three independent risk factors, the hazard ratios in the elevated UAC categories relative to the group with UAC 15 μg/ml were 1.53 (p= 0.007), 2.28 (p= 0.000002), and 1.82 (p= 0.02). The statistically significant correlations with UAC were: age (r= 0.09,p< 0.05), duration (r= 0.14,p< 0.01), systolic blood pressure (r= 0.12,p< 0.01), serum creatinine (r= 0.33,p< 0.001), and fasting plasma glucose (r= 0.12,p< 0.01). Increased UAC was associated also with retinopathy (p= 0.01). Fifty‐eight per cent of the deaths were caused by cardiovascular disease or stroke; only 3% died from uraemia. A reinvestigation including blood pressure, fasting plasma glucose, and UAC was made on 208 survivors.
Detection of Antibodies against Wheat Germ Agglutinin Bound Glycoproteins on the Islet‐cell Membrane
Authors: Kitano N. , Taminato T. , Ida T. , Seno M. , Seino Y. , Matsukura S. , Kuno S. , Imura H.
Published: July 2009

An attempt was made to detect islet cell surface antibodies (ICSAb) using solubilized islet‐cell glycoproteins as antigens. Isolated rat islets were labelled with 125l‐wheat germ agglutinin (WGA) and solubilized by Nonidet P‐40 with sonication. 125l‐WGA‐bound islet‐cell proteins were incubated with test sera, and bound antibodies were precipitated with anti‐human IgG or IgM immunobeads. Serum which had a bound percent beyond the mean plus 2SD of control sera was defined as antibody‐positive. Results obtained by this method correlated well with those by the immunofluorescence method of detecting ICSAb. Prevalences of antibodies were 21/114 (18%) for IgG antibodies and 9/114 (8%) for IgM antibodies in patients with insulin‐dependent diabetes mellitus (IDDM). The prevalence was highest for both IgG and IgM antibodies in patients within a year of the onset of disease (38 and 25%, respectively), and decreased thereafter. The prevalence of IgM antibodies was lower than that of IgG antibodies at all stages. In NIDDM patients, the prevalence of antibodies was 5/72 (7%) for both IgG and IgM antibodies. If these preliminary results are confirmed, this radioassay may be developed to detect antibodies against islet cell membrane proteins on a large scale.
UK Prospective Diabetes Study. IV. Characteristics of Newly presenting Type 2 Diabetic Patients: Male Preponderance and Obesity at Different Ages
Authors:   Multi‐centre Study
Published: July 2009

The characteristics of newly presenting Type 2 diabetes mellitus have been examined in 1857 newly diagnosed diabetic patients aged 25–65 years inclusive. The males were less obese than the females (121% vs 141% IBW, respectively), but a male‐dominated sex ratio of 1.54 was found. Taking into account the prevalence of obesity in the general population, males had a 2.5‐fold relative risk of presenting with diabetes, although with increasing obesity the male preponderance was lost. Presentation increased with age up to the age of 55 years. Patients presenting at all ages had similar glycaemia and were similarly obese. Those presenting at a younger age were usually particularly obese in relation to the general population. Obese patients were less physically active than normal weight patients. Type 2 diabetes had a seasonal variation of presentation with a peak in January to April.
Geographical Variation in the Incidence of Diabetes Mellitus in Scottish Children During the Period 1977–1983
Authors: Patterson C. C. , Smith P. G. , Webb J. , Heasman M. A. , Mann J. I.
Published: July 2009

Routinely collected Scottish hospital discharge data were used to identify newly diagnosed cases of diabetes mellitus under the age of 19 years. In the period 1977–83 there were 2183 cases, an average annual incidence of 21.0 per 100 000 per annum. This rate is one of the highest reported and represents a continuation of the increase in incidence which occurred during the period 1968–76. Statistically significant geographical variation in incidence was observed with the highest incidence in the least densely populated areas. Seasonal variation in the month of first admission was evident in all except the under‐five age group with peaks occurring in winter. An estimated 60% of newly diagnosed cases were readmitted within 5 years and the pattern of readmission was found to differ little between males and females or between age groups.
A Measure of Treatment Satisfaction Designed Specifically for People with Insulin‐dependent Diabetes
Authors: Lewis K. S. , Bradley C. , Knight G. , Boulton A. J. M. , Ward J. D.
Published: July 2009

The psychometric properties of a diabetes‐specific treatment satisfaction scale were examined with responses from 128 adults with insulin‐dependent diabetes who had used one of three treatment options for a period of 12 months. The reliability of the seven‐item measure was found to be satisfactory (Cronbach's Alpha = 0.76) and factor analyses indicated three useful sub‐scales (Perceived General Management; Perceived Compatibility with Lifestyle; Perceived Frequency of Hypo/hyperglycaemia). Use of the treatment satisfaction measure in a feasibility study of continuous subcutaneous insulin infusion (CSII) demonstrated the measure's ability to distinguish between three treatment groups (CSII, intensified conventional therapy and conventional therapy). People choosing to use CSII reported significantly greater improvements in satisfaction than those choosing either form of conventional therapy (F = 36.6; df 2, 125; p<0.001). If used in conjunction with measures of blood glucose control, the Treatment Satisfaction measure offers the opportunity for a more holistic appraisal of outcomes in studies evaluating and comparing treatments for insulin‐dependent diabetes.
An Amperometric Needle‐type Glucose Sensor Tested in Rats and Man
Authors: Matthews D. R. , Bown E. , Beck T. W. , Plotkin E. , Lock L. , Gosden E. , Wickham M.
Published: July 2009

An amperometric glucose‐measuring 25 gauge (0.5mm diameter) needle‐type sensor has been developed using a glucose oxidase and dimethyl ferrocene paste behind a semi‐permeable membrane situated over a window in the needle. Electron transfer results in direct current generation. Sensors have been tested subcutaneously in the abdomen both in anaesthetized rats (40 sensors, 11 rats) and in normal, conscious man (20 sensors, 10 subjects). In rats the blood glucose was modulated by glucose and by insulin infusion. In man the glucose concentrations were rapidly changed by use of a glucose clamp at 12 mmol/l plasma concentration for 2 h, after which the glucose returned to normal. In rats the median correlation between glucose change was 0.83 with an interquartile range from 0.70 to 0.92, and in man the median correlation was 0.80 with an interquartile range 0.67 to 0.86. Hysteresis, a measure of the accuracy on the upswing and downswing, was not a problem and cross‐correlation showed no phase‐lag. There were quantitative differences between in vitro calibration and the performance in vivo, reflecting the different conditions of use. The current in response to a glucose concentration was stable over 6.0 h in rats and 4.5 h in man.
Diabetes in Hypertensive Women: an Effect of Antihypertensive Drugs or the Hypertensive State Per Se?
Authors: Bengtsson C. , Blohmé G. , Lapidus L. , Lundgren H.
Published: July 2009

A total of 226 women participating in a longitudinal study who were found to be hypertensive (initial values ≥160 mmHg for the systolic blood pressure and/or >95 mmHg for the diastolic blood pressure) were followed up with respect to the risk of developing diabetes during a 12‐year study period. For each year of follow‐up, information on whether each participant was taking antihypertensive drugs or not was collected. As a result there were 1339 ‘treatment years’ and 1449 ‘non‐treatment years’ of follow‐up. All 16 women who developed diabetes during the follow‐up period were taking antihypertensive drugs at the time of onset of their diabetes. A similar observation was made when 145 women within the upper age‐specific decentiles of systolic blood pressure were followed up in the same way. These results suggest that in hypertensive subjects antihypertensive drugs rather than the hypertensive state per se predispose to diabetes mellitus.
Management of Non‐insulin‐dependent Diabetes Mellitus in Europe: A Concensus View
Authors: Alberti K. G. M. M. , Gries F. A.
Published: July 2009

Non‐insulin‐dependent diabetes mellitus (NIDDM) is a very common disorder, but less attention is paid to it than to the more dramatic but less prevalent insulin‐dependent diabetes. The majority of patients receive their care from primary health care physicians or doctors without particular training in diabetes. Care is highly variable and often inadequate. In the USA this problem has been tackled by promoting a national education programme involving extensive use of television together with written guidelines for management. These latter have been looked at with interest by many diabetologists in Europe, but it has been felt that the guidelines were not entirely suitable for European practice. As a result an initiative was taken to generate more suitable materials for European use.

Diabetologists from 14 European countries, representing the European NIDDM Policy Group (EUR‐NIDDM‐PC) therefore met in Amsterdam in 1986 with the blessing of the Council of the European Region of the IDF. The aims were first to establish whether a concensus view on management of non‐insulin‐dependent diabetes could be achieved, and if this was possible then to produce written materials for use in the care of people with non‐insulin‐dependent diabetes aimed particularly at the primary health care sector and the general physician. A remarkable degree of concensus was reached considering the different backgrounds and specialities represented by the group. Discussions were lengthy but constructive and were pervaded by a determination to improve care for such patients in Europe. The first output from the group is the short concensus document which follows. This has already been published in the IDF Bulletin but is now reproduced in full in Diabetic Medicine in order to broaden the readership of the document. It is meant as a discussion paper. As such it was presented at a meeting of diabetologists in Berlin in September 1987 and was amended as a result of these discussions. Further comments and input will be welcome. Once such comments have been received the group will produce a desk‐top manual for physicians together with a more comprehensive volume discussing the problems of non‐insulin‐dependent diabetes.
Side‐room Tests to Screen for Micro‐albuminuria in Diabetes Mellitus
Authors: Watts G. F. , Hodgson B. , Morris R. W. , Shaw K. M. , Polak A.
Published: July 2009

Three side‐room tests (latex bead immunoagglutination test, LBT; 25% sulphosalicylic acid test, SST; microalbutest, MAT) for the detection of microalbuminuria in diabetics are described and their screening potential and practicability assessed. One hundred insulin‐dependent diabetics attending a diabetic clinic provided an early morning urine sample (Albustix‐negative) which was subjected to each of the three tests, and urinary albumin concentration (UA) was assayed by RIA. Tests were assessed in random order by two trained operators using a semiquantitative grading scale with 100% concordance between 10 observers. All test results trace +ve were sufficiently sensitive (sensitivity 90%) in detecting UA>15mg/l, but MAT exhibited a significantly reduced specificity (69%) and positive predictive value (58%). For a reference UA>30mg/l, LBT and SST results trace +ve and MAT results +ve showed a sensitivity of 100%, a specificity > 85% and a positive predictive value >60%. Reagent shelf‐life was shortest with LBT. SST involved centrifugation or filtration. Technical skill required was highest with LBT and lowest with MAT. Costs were slightly higher with LBT than SST and were not available for MAT.
Insulin Requirement in Non‐insulin‐dependent Diabetes Mellitus: Relation to Simple Tests of Islet B‐cell Function and Insulin Sensitivity
Authors: Gjessing H. J. , Matzen L. E. , Pedersen P. C. , Faber O. K. , Frøland A.
Published: July 2009

Evaluation of simple tests of islet B‐cell function and insulin sensitivity as predictors of metabolic control was performed during 3 months of insulin withdrawal in 25 insulin‐treated diabetic subjects. All patients had a glucagon stimulated plasma C‐peptide concentration above 0.33 nmol/l and a fasting plasma C‐peptide concentration above 0.20 nmol/l a few days before insulin withdrawal. Insulin sensitivity was measured as the glucose disappearance rate (k) during an intravenous insulin tolerance test. Two patients were considered insulin‐requiring due to high fasting blood glucose levels (>20 mmol/l) and two patients due to an increase in glycosylated haemoglobin of more than 1.1% (>∼3SD) in combination with weight loss. None of the remaining patients had a significant increase in glycosylated haemoglobin.

An inverse correlation was found between stimulated C‐peptide levels and insulin sensitivity (r=‐0.41, p<0.05). Fasting and stimulated C‐peptide concentrations of 0.40 and 0.70 nmol/l, respectively, separated non‐insulin‐requiring patients from a group consisting of both insulin‐ and non‐insulin‐requiring patients. At these C‐peptide levels the predictive value of a positive test was 100%, while the predictive value of a negative test was as low as 33%, or 27%, depending on whether fasting or stimulated C‐peptide concentration was used. Including the k value in the prediction only increased the predictive values of negative tests to 40%, and 33%, respectively.
Limited Joint Mobility in the Diabetic Foot: Relationship to Neuropathic Ulceration
Authors: Delbridge L. , Perry P. , Marr S. , Arnold N. , Yue D. K. , Turtle J. R. , Reeve T. S.
Published: July 2009

Limited joint mobility in the hand is a common manifestation of diabetes with the reported prevalence in insulin‐dependent diabetes varying between 8 and 43%. Sixty‐two subjects were studied in three groups (controls, diabetic patients without foot problems, and diabetic patients with neuropathic ulceration) to determine whether similar changes occur in the joints of the foot and to examine any possible relationship with neuropathic ulceration. There was a significant impairment of mobility in the range of motion of the sub‐talar joint in diabetic patients with ulcers when compared with controls (p=0.0001) or with the other diabetic patients (p=0.004). There was a significant correlation between sub‐talar range of motion and mobility in other joints of the foot such as at the hallux (r=0.59, p<0.001), or with mobility of the 5th finger (r=0.41, p<0.01). There was also a significant association between the clinical presence of limited joint mobility in the hand, Dupuytren's contracture, and mobility of the sub‐talar joint (p<0.05). Furthermore, impairment of mobility of the sub‐talar joint was greatest on the affected side in those diabetic patients with neuropathic ulceration (p=0.029). We conclude that the syndrome of limited joint mobility also affects the joints of the feet of diabetic patients and may predispose to ulceration in susceptible neuropathic feet.
Progression of Proteinuria in Type 1 and Type 2 Diabetes
Authors: Cooper M. E. , Frauman A. , O'Brien R. C. , Seeman E. , Murray R. M. L. , Jerums G.
Published: July 2009

A longitudinal study evaluating the time course of the transition from normal to micro‐albuminuria, and then on to macroalbuminuria, was made over a mean period of 7 years in a cohort of 52 patients with Type 1 diabetes and 61 patients with Type 2 diabetes. Transient episodes of micro‐ and macroalbuminuria were often observed before the ultimate development of persistent Albustix‐positive proteinuria. The transition from normal to micro‐albuminuria and from micro‐ to macroalbuminuria was characterized by rises in renal albumin clearance accompanied by lesser rises in total proteinuria.

Seven patients with Type 1 and 12 with Type 2 diabetes showed evidence of progression, the interval for the transition from normal to macroalbuminuria varying from 3 to 5 years. In Type 1 diabetic patients, the development of micro‐ and macroalbuminuria was associated with a decline in renal function and a rise in systolic blood pressure without a significant change in blood glucose control. In Type 2 diabetic patients, the development of microalbuminuria was associated with a small decline in renal function but no change in blood pressure or blood glucose control.

It is concluded that the transition from normal to micro‐ and on to macroalbuminuria may be more rapid then previously reported and varies considerably among individuals.
Excess Body Fat Distribution and Glucose Homeostasis in Obese Arab Women
Authors: Emara M. , Abdella N. , Luqman W. , Senthilselvan A. , Salman A. , Fenech F. F.
Published: July 2009

The relationship of body fat distribution to glucose intolerance and non‐insulin‐dependent diabetes mellitus in Arab women was studied in 102 obese non‐diabetic and 40 obese women with diabetes. The obese women underwent a glucose tolerance test. Linear regression analysis revealed a significant correlation between the waist/hip ratio and the plasma glucose concentration at 120 min. When divided into two groups according to the median of their waist/hip ratio (0.815), obese women without history of diabetes but with high waist/hip ratio (0.86 ± 0.07, mean ± SD) had significantly higher prevalence of glucose intolerance and of diabetes mellitus than those with the low ratio (0.78 ± 0.03, χ2 = 9.32, p<0.001). The highest ratio (0.89 ± 0.06) was observed in the obese women with known diabetes mellitus.
District Diabetes Centres in the United Kingdom
Authors: Day J. L. , Spathis M.
Published: July 2009

Dissatisfaction with standards of diabetes care in general, and the traditional diabetic clinic in particular, is widespread. Problems include the large numbers of attenders, short consultation times (often with inexperienced medical staff), lack of continuity and prolonged waiting times. Standards of education and control fall woefully below those that are desired. In recent years several different strategies have been adopted to provide solutions, including general practitioner cooperative care schemes to reduce numbers and improve community care, the appointment of diabetes specialist nurses to take on the major educational role, and the commissioning of special education units designed to remove the educational element from the traditional clinic environment. Lately consideration has been given to the development of Diabetes Centres, to provide more comprehensive diabetes care, both educational and clinical. A workshop was held in January 1987 to analyse in greater detail the concept of Diabetes Centres and the consequences of their implementation.
Basal Rate Subcutaneous Insulin Infusion: Absorption Kinetics and Relation to Local Blood Flow
Authors: Hildebrandt P. , Birch K.
Published: July 2009

Twenty diabetic patients received a constant subcutaneous infusion of125l‐labelled short‐acting insulin (1.12 U/h) into the anterior abdominal wall. Measurement of the size of the insulin depot at the infusion site was performed by measuring the radioactivity and by using a calibration bolus to transform count rate to units of insulin in the depot. By the133Xenon technique, local subcutaneous blood flow rate was measured on the contrala‐teral side of the anterior abdominal wall. From the start of the infusion the SC depot built up slowly, but did not reach steady‐state by 6 h. After 24 h of infusion, the size of the depot ranged between 2.7 and 10.9 U (5.2 ± 0.5 U, mean ± SE). The size of this steady‐state depot was inversely correlated with SC blood flow. After stopping the infusion, insulin disappeared according to first order kinetics without any lag period. The insulin disappearance rate from the depot was positively correlated with the blood flow in a curvilinear fashion. The results suggest that the relationship between blood flow and the size of the insulin depot is best explained by a predominantly blood flow limited removal of insulin at low rates of blood flow, with increasing limitation by diffusion at higher rates.
Health Attitudes, Self‐monitoring of Blood Glucose, Metabolic Control and Residual Insulin Secretion in Type 1 Diabetic Patients
Authors: Sjöberg S. , Carlson A. , Rosenqvist U. , Östman J.
Published: July 2009

The aim of the present cross‐sectional study was to determine in patients who have had insulin‐dependent diabetes mellitus for a long time, the relationship between residual insulin secretion and self‐monitoring of blood glucose, psychological factors, and blood glucose control (HbA1c). In 97 patients with a disease duration of 9–16 years a sample from a 24‐h urine collection was analysed for C‐peptide excretion. In 35 of these patients an excretion 0.2 nmol/24 h was detected. They were matched for age at onset and disease duration with patients without any detectable C‐peptide excretion. Twenty‐nine matched pairs were obtained and 22 of them have been further investigated. HbA1c was lower in the C‐peptide excretors than in the non‐excretors (6.9 ± 0.3 vs 7.9 ± 0.3%) (p<0.025). The patients were interviewed by means of a questionnaire dealing with their ‘health beliefs’. It was shown that in the group with residual insulin secretion there was a significantly lower perceived risk of developing kidney disease (p<0.025) than in the group without residual insulin secretion, but in all other items measured there was no difference between the two groups. Furthermore, in the group with residual insulin secretion we found a correlation (p<0.01) of low HbA1c with high frequency of self‐monitoring of blood glucose and high perceived vulnerability. In the group without residual insulin secretion a low HbA1c was only found to be correlated (p<0.01) with high perceived barriers to treatment and showed no correlation with frequency of self‐monitoring of blood glucose. These results may indicate that patients with residual insulin secretion find it helpful to perform self‐tests in order to achieve a better blood glucose control. They may also indicate that patients without any sign of residual insulin secretion have to impose restrictions on their whole lifestyle, thus perceiving great barriers to treatment in order to achieve a better blood glucose control.
Scleroedema Diabeticorum: a Minor but Often Unrecognized Complication of Diabetes Mellitus
Authors: Sattar M. A. , Diab S. , Sugathan T. N. , Sivanandasingham P. , Fenech F. F.
Published: July 2009

The association of specific dermatological complications with diabetes mellitus is well recognized. Of 100 hospital‐based patients with diabetes mellitus (age 48 years ± 2SE), 14% had scleroedema diabeticorum. The affected subjects had a higher prevalence of retinopathy (p<0.001) and albuminuria (p<0.025). The duration of scleroedema correlated with the duration of diabetes (p<0.005). These findings highlight the relatively common occurrence of this skin condition which often goes unrecognized in people with diabetes.
A Proficiency Score for Assessing the Reliability of Self Blood Glucose Monitoring
Authors: Pollard R. H. , Bridgman J. F. , North M. , Reid J.
Published: July 2009

The reliability of self blood glucose analysis was studied in 83 insulin‐treated diabetic patients. Reliability was assessed by laboratory analysis of capillary blood samples collected simultaneously on filter paper. Patient and laboratory results were compared using a scoring system which produces an easily understood Proficiency Score. The score was designed to highlight unreliable performance in measuring glucose concentrations in the euglycaemic as well as hypo‐ and hyperglycaemic ranges. Only 17 % of patients achieved acceptable Proficiency Scores by maintaining adequate performance on five occasions.
Haemoglobin K‐Woolwich as Cause of Falsely Elevated HbA1
Authors: Van den Enden E. J. , De Leeuw I.
Published: July 2009

Falsely elevated levels for haemoglobin A1 can be found with the haemoglobinopathies. A case is reported where falsely high levels for haemoglobin A1 were caused by the asymptomatic presence of haemoglobin K‐Woolwich.