bluuebunny/crossref_metadata_2025 huggingface dataset:
Prolonged QTc interval predicts mortality in patients with Type 1 diabetes mellitus
Authors: Rossing P. , Breum L. , Major‐Pedersen A. , Sato A. , Winding H. , Pietersen A. , Kastrup J. , Parving H. ‐H.
Published: December 2004

SUMMARY

Aims To evaluate prolonged QTc interval and QT dispersion as predictors of all‐cause and cardiovascular mortality after adjustment for well‐established risk factors in Type 1 diabetic patients.

Methods From a cohort of all adult Type 1 diabetic patients, duration of diabetes ≥ 5 years, attending the clinic in 1984 and followed in an observational study for 10 years (n = 939), all subjects with resting baseline electrocardiograms were identified (n = 697, 360 males). The QT length was measured and corrected for heart rate (QTc). Maximal QTc length (QTc max) and QT dispersion were determined.

Results At baseline, 431 had normoalbuminuria (< 30 mg/24 h), 138 had microalbuminuria (30–299 mg/24 h) and 128 had macroalbuminuria (≥ 300 mg/24 h) of whom 66 (15%), 35 (25%) and 61 (48%) died during follow‐up, respectively (26 (6%), 14 (10%), 21 (16%) from cardiovascular disease). QTc max. was 442 (1.2) ms (mean (sem)) for survivors and 457 (3.7) in patients who died (P < 0.001). In a Cox proportional hazards model including baseline values of putative risk factors, independent predictors of death were QTc max (P = 0.03), age (P < 0.001), presence of hypertension (P = 0.001), male sex (P < 0.001), log urinary albumin excretion (P < 0.001), smoking (P = 0.04), log serum‐creatinine (P < 0.001), height (P < 0.001), low social class (P = 0.04), whereas QT dispersion, heart rate, and HbA1cwere not included. In the subgroup with macroalbuminuria, but not for all patients, QTc max was an independent risk factor for cardiovascular mortality.

Conclusion QTc prolongation, but not increased QT dispersion, is an independent marker of increased mortality in patients with Type 1 diabetes mellitus.
Prevalence and determinants of diabetes mellitus and glucose intolerance in a Canarian Caucasian population – comparison of the 1997 ADA and the 1985 WHO criteria. The Guía Study.
Authors: De Pablos‐Velasco P. L. , Martínez‐Martín F. J. , Rodríguez‐Pérez F. , Anía B. J. , Losada A. , Betancor P.
Published: December 2004

Aims  To estimate the prevalence of diabetes mellitus, impaired fasting glucose and impaired glucose tolerance in a Canarian population according to the 1997 ADA and the 1985 WHO criteria; and to study the cardiovascular risk factors associated with these categories.

Methods  A total of 691 subjects over 30 years old were chosen in a random sampling of the population (stratified by age and sex). An oral glucose tolerance test was performed (excluding known diabetic patients) and lipids were determined in the fasting state. Anthropometric and blood pressure measurements were performed, and history of smoking habits and medications was recorded.

Results  The prevalence of diabetes was 15.9% (1997 ADA) and 18.7% (1985 WHO); the prevalence of impaired fasting glucose and impaired glucose tolerance was 8.8 and 17.1%, respectively. The age‐adjusted prevalence of diabetes (Segi's standard world population) for the population aged 30–64 years was 12.4% (1985 WHO). The risk factors significantly associated with diabetes (1997 ADA and 1985 WHO) were age, body mass index; waist‐to‐hip ratio, systolic and mean blood pressure, triglycerides, total cholesterol and low HDL‐cholesterol. Age, body mass index and systolic blood pressure were associated with impaired fasting glucose and impaired glucose tolerance; triglycerides were also associated with impaired fasting glucose.

Conclusions  The prevalence of diabetes mellitus and glucose intolerance in Guía is one of the highest among studied Caucasian populations. The new 1997 ADA criteria estimate a lower prevalence of diabetes. Impaired fasting glucose also had a lower prevalence than impaired glucose intolerance and the overlap of these categories was modest.
Correction of hyperglycaemia reduces insulin resistance and serum soluble E‐selectin levels in patients with Type 2 diabetes mellitus
Authors: Matsumoto K. , Nakamura H. , Ueki Y. , Tominaga T. , Miyake S.
Published: December 2004

SUMMARY

Aims  To investigate the effects of glycaemic control on insulin sensitivity and serum concentrations of soluble vascular cell adhesion molecule (sVCAM)‐1 and E‐selectin (sE‐selectin) in patients with Type 2 diabetes mellitus. To examine whether reductions in serum adhesion molecule levels correlate with improvement in insulin resistance.

Methods  A total of 54 patients with Type 2 diabetes were treated for 4 weeks with either diet alone, sulphonylurea or insulin. Fasting glucose, insulin sensitivity, lipids, sVCAM‐1, and sE‐selectin levels were measured before and after treatment.

Results  All treatment modalities successfully corrected hyperglycemia. Reductions in blood glucose levels resulted in improvement in insulin sensitivity (diet KITT 2.40 ± 0.26–3.09 ± 0.36, P < 0.01; sulphonylurea 2.24 ± 0.16–2.94 ± 0.18, P < 0.01; insulin 1.68 ± 0.27–2.16 ± 0.22%/min, P < 0.05), and decrease in sE‐selectin levels (diet 88.4 ± 14.9–66.2 ± 10.8, P < 0.05; sulphonylurea 85.1 ± 11.6–59.8 ± 7.8, P < 0.01; insulin 84.4 ± 8.7–66.8 ± 7.4 ng/ml, P < 0.01), but no change in sVCAM‐1 levels. There was a significant correlation between the degree of decrease in sE‐selectin levels and improvement in insulin sensitivity (r = −0.38, P < 0.01).

Conclusions  Correction of hyperglycaemia, independent of treatment modality, resulted in improvement of insulin resistance and decrease in sE‐selectin levels. These changes might, in part, contribute to reduce the risk of diabetic microvascular and macrovascular complications in patients with Type 2 diabetes mellitus.
Factor analysis of thermal and vibration thresholds in young patients with Type 1 diabetes mellitus
Authors: Kalter‐Leibovici O. , Yosipovitch G. , Gabbay U. , Yarnitsky D. , Karp M.
Published: December 2004

Aims  To identify factors that represent relationships among sets of interrelated thermal and vibration threshold variables and to find clinical correlates that are significantly associated with these factors.

Methods  Thermal and vibration perception thresholds were tested in the hands and feet of Type 1 diabetic patients treated in an outpatient clinic for juvenile‐onset diabetes. Factor analysis was used to identify factors that represent relationships among sets of thermal and vibration threshold variables.

Results  One hundred and forty‐eight patients (47.3% males, median current age 22.3 years and median duration of diabetes 11.4 years) were evaluated. Three factors explained 77% of the total variance: ‘hand sensation’ factor, underlying cold, warmth and vibration perception thresholds in the hand; ‘foot sensation’ factor, underlying the same sensory thresholds in the foot; and ‘heat‐related pain’ factor, underlying heat pain perception threshold in both limbs. The ‘foot sensation’ factor was the only factor that significantly correlated with diabetes‐related variables (e.g. duration and cumulative glycaemic control of the disease) and concurrent diabetic microangiopathy. Male sex was associated with higher values of the ‘heat‐related’ factor, while the ‘hand sensation’ factor did not correlate with any of the study variables.

Conclusions  The distribution of the various thermal and vibration threshold variables according to the three factors may point at length‐dependent mechanism of axonal degeneration. Cold, warmth and vibration perception thresholds in the foot may be the only valuable psychophysical parameters in the evaluation of early sensory impairment associated with diabetes.
Pathophysiological implications of insulin resistance on vascular endothelial function
Authors: Wheatcroft S. B. , Williams I. L. , Shah A. M. , Kearney M. T.
Published: December 2004

Background Insulin resistance is a key component of the insulin resistance syndrome and is a crucially important metabolic abnormality in Type 2 diabetes. Insulin‐resistant individuals are at significantly increased risk of cardiovascular disease, although the underlying mechanisms remain incompletely understood. The endothelium is thought to play a critical role in maintaining vascular homeostasis, a process dependent on the balance between the production of nitric oxide, superoxide and other vasoactive substances. Endothelial dysfunction has been demonstrated in insulin‐resistant states in animals and humans and may represent an important early event in the development of atherosclerosis. Insulin resistance may be linked to endothelial dysfunction by a number of mechanisms, including disturbances of subcellular signalling pathways common to both insulin action and nitric oxide production. Other potential unifying links include the roles of oxidant stress, endothelin, the renin angiotensin system and the secretion of hormones and cytokines by adipose tissue. Lifestyle measures and drug therapies which improve insulin sensitivity and ameliorate endothelial dysfunction may be important in delaying the progression to overt cardiovascular disease in at risk individuals.

Methods We conducted a literature search using Medline, restricted to articles published in the English language between 1966 and the present, and reviewed bibliographies of relevant articles. An initial search strategy employing combinations of the MeSH terms: insulin resistance; endothelium, vascular; insulin; nitric oxide or hyperinsulinaemia produced over 300 references. Focused searches using keywords relevant to the molecular aspects of endothelial function and insulin signalling, and lifestyle or pharmacological interventions relevant to insulin resistance or endothelial function, produced over 300 further references. Abstracts of all references were screened before selecting those relevant to this review.
Impaired fasting glucose and impaired glucose tolerance in urban population in India
Authors: Ramachandran A. , Snehalatha C. , Satyavani K. , Vijay V.
Published: December 2004

Aims To study prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in urban Indians and their demographic and anthropometric characteristics.

Methods Data on capillary blood glucose (OGTT), anthropometric and demography details were available in 10 025 subjects (M : F 4711 : 5314) aged ≥ 20 years. Glucose tolerance was categorized as normal, isolated IFG, isolated IGT, IFG + IGT and diabetes using the fasting and 2‐h blood glucose (2hBG; 75‐g glucose load) values. Subjects with known diabetes were excluded.

Results Age‐standardized prevalences of IFG, IGT and newly detected diabetes were 8.7%, 8.1% and 13.9%, respectively. IFG was more prevalent in women (9.8%) than in men (7.4%) (χ2 = 13.62, P = 0.0002), while the gender differences in IGT (men 8.4%, women 7.9%) and diabetes (men 13.3%, women 14.3%) were not significant. Body mass index and waist circumference were higher in glucose‐intolerant groups than in normal glucose tolerance (NGT). Prevalence of diabetes, IGT and IFG + IGT increased with age. Among the IFG, 4% had diabetes and 27.1% had IGT using 2hBG criteria. In IFG, the fasting and 2hBG values were not correlated.

Conclusions Prevalences of IFG and IGT were similar in urban Indians and an overlap occurred in only less than half of these subjects. IFG was more common in women. Subjects with IFG were older and had more adverse anthropometric characteristics in comparison with NGT. IFG did not show an increasing trend with age.

Diabet. Med. 20, 220–224 (2003)
Transcription factor 1 and β‐cell function in glucose‐tolerant subjects
Authors: Chiu K. C. , Chuang L.‐M. , Chu A. , Wang M.
Published: December 2004

Aims Although β‐cell dysfunction and insulin resistance are observed in patients with Type 2 diabetes, β‐cell dysfunction plays a crucial role in the development of the disease. Mutations of transcription factor 1 (TCF1, or hepatocyte nuclear factor‐1α) affect β‐cell function. We examined the impact of amino acid polymorphisms of this gene on β‐cell function in 60 glucose‐tolerant Caucasians.

Methods Insulin sensitivity index (ISI) and 1st and 2nd phase insulin responses (1stIR, 2ndIR) were measured using the hyperglycaemic clamp. The genotypes were determined from genomic DNA and their impact on β‐cell function was investigated.

Results Among three polymorphisms (I27L, A98V, and S487N), significant impact on β‐cell function was found in the I27L polymorphism. Univariate analyses revealed differences for the I27L polymorphism in both 1stIR (P = 0.0052) and 2ndIR (P = 0.0432). Multivariate analysis revealed that the I27L polymorphism (P = 0.0124) with ISI accounted for 32% of the variation in 1stIR and had a marginal impact on 2ndIR (P = 0.0343), accounting for 52% of the variation with ISI and age. By dissecting out the impact of other covariate(s), the I27L polymorphism independently explained 12% of the variation in 1stIR and 6% of the variation in 2ndIR.

Conclusion The I27L polymorphism of TCF1 is an independent determinant of β‐cell function by affecting both 1st and 2nd phase insulin response. This polymorphism could play a role in the pathogenesis of Type 2 diabetes. A large‐scale association study (approx. 2000 subjects) will be required to demonstrate the genetic susceptibility of this polymorphism to Type 2 diabetes.

Diabet. Med. 20, 225–230 (2003)
How do people with Type 2 diabetes perceive and respond to cardiovascular risk?
Authors: Carroll C. , Naylor E. , Marsden P. , Dornan T.
Published: December 2004

Objectives To explore how people with Type 2 diabetes perceive cardiovascular risk, and how those perceptions might affect their motivation to make lifestyle changes.

Methods The setting was a diabetes clinic in a UK teaching hospital. A qualitative study was conducted, using semistructured individual interviews and template analysis of content. The participants were 20 Type 2 diabetic patients, aged between 52 and 77 years, half with and half without cardiovascular disease (CVD).

Results Whether they had CVD or not, most people were aware they were at risk of it, of its causative factors, and possible effects. However, they were more likely to attribute it to unchangeable factors like ‘stress’ and ‘heredity’, than medical risk factors like cholesterol and smoking. Patients with pre‐existing CVD correctly regarded their risk as higher than those without. Few saw any direct link between being diabetic per se and cardiovascular risk. Lifestyle changes were precipitated by major life events and motivated by family support, fear of complications, and a belief that one should follow doctors’ advice. A common reaction to CVD and diabetes was stoical acceptance, allowing patients to view their lives positively, whilst living with unpredictable potentially disabling diseases.

Conclusions Patients were unaware how strongly diabetes influences cardiovascular risk. Their ideas about risk were very different from those of conventional medicine, and provided individual rationales for making choices about treatment and risk‐influencing behaviour. Contextual factors, such as family milieu, also influenced their behaviour. Clinicians should not assume patients share the same mental model of risk as they, and must be prepared to explore peoples’ individual constructs and health beliefs.

Diabet. Med. 20, 355–360 (2003)
Does the autonomic nervous system play a role in the development of insulin resistance? A study on heart rate variability in first‐degree relatives of Type 2 diabetes patients and control subjects
Authors: Lindmark S. , Wiklund U. , Bjerle P. , Eriksson J. W.
Published: December 2004

Aims To investigate dysregulation of the autonomic nervous system as a potential mechanism for early insulin resistance in the development of Type 2 diabetes.

Methods Thirteen healthy individuals with first‐degree relatives with Type 2 diabetes (R) were compared with 14 control subjects without family history of diabetes (C), matched for age, body mass index and sex. An oral glucose tolerance test and a hyperinsulinaemic euglycaemic clamp were performed. Analysis of heart rate variability during rest, controlled breathing, an orthostatic manoeuvre and a standardized physical stress (cold pressor test (CPT)), were used to evaluate the activity of the autonomic nervous system.

Results Fasting blood glucose, HbA1c and serum insulin were similar in the R and C groups. The M‐value, reflecting insulin sensitivity, did not differ significantly between the groups. Total spectral power and high‐frequency power were lower in R during controlled breathing (P = 0.05 and P = 0.07, respectively), otherwise there were no significant differences between R and C in heart rate variability. However, low‐frequency (LF)/high‐frequency (HF) spectral power ratio during CPT, reflecting sympathetic/parasympathetic balance, was negatively associated with insulin sensitivity (r = −0.53, P = 0.006). When all subjects were divided into two groups by the mean M‐value, the low M‐value group displayed an overall higher LF/HF ratio (P = 0.04). HF power was lower in the low M‐value group during controlled breathing and CPT (P = 0.01 and P = 0.03, respectively).

Conclusion An altered balance of the parasympathetic and sympathetic nervous activity, mainly explained by an attenuated parasympathetic activity, might contribute to the development of insulin resistance and Type 2 diabetes.

Diabet. Med. 20, 399–405 (2003)
Development, reliability and validity of the Diabetes Illness Representations Questionnaire: four studies with adolescents
Authors: Skinner T. C. , Howells L. , Greene S. , Edgar K. , McEvilly A. , Johansson A.
Published: December 2004

Aims This article reports on the development and validity of a Diabetes‐specific Illness Representations Questionnaire (DIRQ) to assess all five dimensions of an individual's perception of diabetes, for adolescents with Type 1 diabetes mellitus.

Methods There were two development studies. Study 1: participants (n = 115) completed a questionnaire assessing perceptions of the consequences of diabetes and the effectiveness of treatment, along with a questionnaire assessing self‐care. Study 2: participants (n = 79) completed a questionnaire assessing their identity, timeline and causal beliefs, along with a diabetes self‐efficacy and barriers to adherence questionnaire. Subsequently there were two validation studies. Study 3: participants (n = 44 adolescents and 28 parents) completed the DIRQ and questionnaires assessing their self‐care and psychological well‐being. Glycaemic control was assessed through retrieval of routine assay results. Study 4: participants (n = 70) completed the DIRQ and questionnaires to assess their psychological well‐being, with glycaemic control assessed through retrieval of routine assay results.

Results The development studies suggest that the perceived consequences of diabetes consist of two subscales, perceived threat and perceived impact, and provide further support for the distinction between treatment effectiveness to control diabetes and treatment effectiveness to prevent complications. Along with the validation studies, the results indicate that the questionnaire scales showed good internal consistency and construct validity through their associations with measures of self‐care and psychological well‐being.

Conclusion The data reported here suggest that the DIRQ has the potential to be a useful tool for clinical assessment and evaluating the impact of psycho‐educational and medical interventions.

Diabet. Med. 20, 283–289 (2003)
Prediction of cardiovascular risk in people with diabetes
Authors: Winocour P. H. , Fisher M.
Published: December 2004

People with diabetes are at high risk of cardiovascular morbidity and mortality, especially if they have already developed vascular problems. For patients who are apparently free of vascular complications, risk tables are often used to assess the risk of cardiovascular events in the following years, and to decide on treatment with statins or anti‐platelet therapy. These risk prediction tables include estimates of traditional cardiovascular risk factors and are based on populations, some of which only contained a very small number of people with diabetes. Multiple problems can be identified with these tables, and many seriously underestimate cardiovascular risk in people with diabetes. Possible ways of addressing this include using risk estimation tools based solely on diabetic populations, adding in additional traditional variables such as triglycerides or left ventricular hypertrophy, including novel cardiovascular risk factors, or intervening at a lower level of estimated risk in people with diabetes compared with non‐diabetic subjects. Alternatively, estimates of individual risk could be abandoned and all people with diabetes could be treated with statins and other effective agents.

Diabet. Med. 20, 515–527 (2003)
Central fat predicts deterioration of insulin secretion index and fasting glycaemia: 6‐year follow‐up of subjects at varying risk of Type 2 diabetes mellitus
Authors: Kriketos A. D. , Carey D. G. , Jenkins A. B. , Chisholm D. J. , Furler S. M. , Campbell L. V.
Published: December 2004

Aims To examine the relationships between body composition and changes in fasting glycaemia, and in indices of insulin secretion and insulin action over 6 years in females with a family history of Type 2 diabetes with or without prior gestational diabetes (‘at risk’ group, AR) and control females (control group, C).

Methods At baseline and at follow‐up, an oral glucose tolerance test and dual energy X‐ray absorptiometry assessment of body composition were performed. Indices of insulin resistance (HOMA R′) and insulin secretion (HOMA β′) were obtained from fasting insulin and glucose concentrations.

Results At baseline, the groups were similar for age, body mass index, fasting levels of plasma glucose and insulin, HOMA R′ and HOMA β′. Despite similar total body fatness, AR had significantly greater waist circumference and central fat (both P < 0.02) compared with C. At follow‐up there was a significant increase in central adiposity only in AR, and the fasting plasma glucose (FPG) level was higher in AR compared with C (5.0 ± 0.2 vs. 4.3 ± 0.2 mmol/l, P = 0.02). This rise in plasma glucose in AR was related to a decline in HOMA β′ (r = 0.45, P = 0.0065). Both the baseline and the increments in total and central abdominal fat mass were associated with the time‐related decline in HOMA β′.

Conclusions Six years after initial assessment, AR showed deterioration in FPG levels due predominantly to a decline in insulin secretion index without major change in insulin resistance index. Importantly, baseline body fatness (especially central adiposity), as well as increases in fatness with time, were the major predictors of the subsequent decline of insulin secretion index and the consequent rise in FPG.
Associations of LDL size with in vitro oxidizability and plasma levels of in vivo oxidized LDL in Type 2 diabetic patients
Authors: Scheffer P. G. , Bos G. , Volwater H. G. F. M. , Dekker J. M. , Heine R. J. , Teerlink T.
Published: December 2004

Aims Oxidative modification of low‐density lipoprotein (LDL) is believed to be a key step in the genesis of atherosclerotic lesions. The presence of small, dense LDL is associated with accelerated atherosclerosis and is common in diabetic patients. The aim of this study was to investigate the relationship of in vitro LDL oxidizability and circulating in vivo oxidized LDL with LDL particle size in Type 2 diabetic patients and healthy control subjects.

Subjects and methods The study group consisted of 58 elderly well controlled Type 2 diabetic patients and 58 control subjects with normal glucose metabolism. LDL particle size was measured by high‐performance gel‐filtration chromatography. In vitro oxidizability of LDL was measured by monitoring conjugated diene formation and plasma levels of circulating oxidized LDL were determined by ELISA.

Results In vitro susceptibility of LDL to oxidation was not related to plasma levels of in vivo oxidized LDL, nor to LDL particle size. In the diabetic patients, but not in the control group, an inverse relation between LDL size and in vivo oxidized LDL was observed (r = −0.35, P = 0.007). This relation was strengthened after controlling for LDL‐cholesterol concentration (r = −0.52, P < 0.001).

Conclusions In agreement with the view that small, dense LDL accelerates atherosclerosis, an inverse relationship was observed between LDL size and circulating in vivo oxidized LDL in Type 2 diabetic patients. Our results also suggest that in vitro susceptibility to oxidation is not a suitable surrogate measure for in vivo LDL oxidation.

Diabet. Med. 20, 563–567 (2003)
Improving glycaemic control in patients with Type 2 diabetes mellitus without insulin therapy
Authors: Goudswaard A. N. , Stolk R. P. , De Valk H. W. , Rutten G. E. H. M.
Published: December 2004

Aims In general practice at least 30% of those with Type 2 diabetes do not achieve good glycaemic control. We studied the effect of improving oral glucose‐lowering medication in a primary care setting in patients treated with oral hypoglycaemic agents without satisfactory glycaemic control.

Methods We provided flowcharts to general practitioners and outreach visits by trained facilitators, who checked adherence to the protocol. Fifty‐two Dutch general practices with 2140 Type 2 diabetes mellitus (DM) patients recruited 288 patients ≤ 75 years old inadequately controlled (HbA1c > 7%) by diet or oral medication. Outcome measures were decrease of HbA1c, number of patients with HbA1c ≤ 7%, and non‐compliance rate.

Results After a mean of 3.3 consultations over 14 weeks, 209 patients were following the protocol fully with a reduction in HbA1c from 8.7% to 6.7% (P < 0.001). One hundred and fifty‐eight patients (55%) achieved HbA1c≤ 7%, and 51 (18%) persisted with HbA1c > 7% unless fasting blood glucose ≤ 7 mmol/l (n = 18) or a maximum of medication (n = 33). Seventy‐nine patients (27%) did not adhere to the protocol, mostly due to loss of motivation and non‐attendance.

Conclusions A simple flowchart and relatively little support by trained facilitators results in improved glycaemic control.

Diabet. Med. 20, 540–544 (2003)
Peripheral vascular disease in Type 2 diabetic Chinese patients: associations with metabolic indices, concomitant vascular disease and genetic factors
Authors: Thomas G. N. , Critchley J. A. J. H. , Tomlinson B. , Cockram C. S. , Chan J. C. N.
Published: December 2004

Aims  Conventional and genetic risk factors have been reported to play a role in the pathogenesis of vascular disease, but do not explain the lower burden of cardiac and peripheral vascular disease (PVD) in Chinese compared with Caucasians. The role of renin‐angiotensin system (RAS) gene polymorphisms and conventional vascular risk factors has not been determined.

Methods  A total of 3097 Chinese diabetic subjects were screened for PVD, which was identified in 194 of the 2967 patients with Type 2 diabetes. Biochemical parameters and the genotype and allele frequencies of three RAS gene polymorphisms, the angiotensin‐converting enzyme (ACE) insertion/deletion, angiotensinogen (AGT) M235T and angiotensin II type 1 receptor (AT1R) A1166C polymorphisms were then compared between the PVD patients and 1046 age, gender and diabetes duration‐matched patients without PVD.

Results  PVD identified in 6.5% was associated with significantly worse glycaemic control, lipid profile and renal function. Smoking was more common, as were the other macro‐ and microvascular diseases. The prevalence of hypertension was similar between the groups, yet diastolic blood pressure was slightly lower in the PVD group. The ACE D allele was significantly more frequent in patients with PVD compared with the matched diabetic controls (38.1 vs. 29.8%, P = 0.039). No differences in the AT1R or AGT polymorphisms were observed.

Conclusions  PVD was associated with a worse metabolic profile and greater concomitant vascular disease than controls. The ACE I/D polymorphism was associated with PVD in these Type 2 diabetic patients.

Diabet. Med. 20, ***–*** (2003)
Specialist general practitioners and diabetes clinics in primary care: a qualitative and descriptive evaluation
Authors: Nocon A. , Rhodes P. J. , Wright J. P. , Eastham J. , Williams D. R. R. , Harrison S. R. , Young R. J.
Published: December 2004

Aims  The aim of this study was to evaluate an innovative approach to the provision of primary care‐based diabetes services in Bradford, UK. The service model differs from others in comprising 19 clinics which offer a specialist service, intermediate between primary and secondary care, to all patients within the Bradford area.

Methods  The study included: analysis of referral, attendance and register data; questionnaires to general practitioners (GPs) and specialist clinic providers; qualitative interviews with clinic and other professional staff and patients; and an economic analysis.

Results  The 19 clinics adopt a range of organizational models. In the first 3½ years, 2415 patients were referred. There was a significant reduction in out‐patient attendances at hospital, but also a significant increase in overall patient attendances. Specialist clinic patients differed from hospital patients in being older and having had diabetes for longer since diagnosis. Ten of the 14 clinics run by practising GPs attracted more referrals from within their practices than from outside. GPs and patients across the city believed the clinics were valuable, the main benefits being geographical accessibility, availability of specialists in a community setting, short waiting times for first appointments at most clinics, and continuity of staff. Their reservations included a lack of strategic planning in the location of clinics, long waiting times at some clinics, and poor communication at some clinics with referring GPs. The cost of the primary care clinics is similar to hospital clinics.

Conclusions  This model of specialist primary care services offers an opportunity to develop diabetes services that are convenient to patients, popular with practitioners, and increase capacity. However, the shortcomings as well as the advantages of the model need to be addressed if it is to be implemented elsewhere or for other patient groups.
Sudden hearing loss as a first complication of long‐standing Type 1 diabetes mellitus: a case report
Authors: Gawron W. , Pospiech L. , Noczynska A. , Koziorowska E.
Published: December 2004

The term ‘sudden hypoacusis’ describes a hearing loss of a rapid onset and unknown origin that can progress to severe deafness. Its pathophysiology is still unknown, the proposed aetiological mechanisms being vascular disease or autoimmune reaction. We present the case of a 19‐year‐old woman with Type 1 diabetes mellitus who experienced sudden hearing loss on her right side. She had no complications related to diabetes. After being referred to the hospital she was diagnosed with sudden sensorineural right‐sided hearing loss accompanied by high frequency tinnitus. After administration of vasoactive drugs, there was partial improvement after 7 days, followed by gradual improvement over the next 4 weeks to 5 months. The tinnitus did not disappear completely. We conclude that hearing organ disturbances can be present in Type 1 diabetes and represent an early complication.
Automated detection of diabetic retinopathy in digital retinal images: a tool for diabetic retinopathy screening
Authors: Usher D. , Dumskyj M. , Himaga M. , Williamson T. H. , Nussey S. , Boyce J.
Published: December 2004

Aims  To develop a system to detect automatically features of diabetic retinopathy in colour digital retinal images and to evaluate its potential in diabetic retinopathy screening.

Methods  Macular centred 45° colour retinal images from 1273 patients in an inner city diabetic retinopathy screening programme. A system was used involving pre‐processing to standardize colour and enhance contrast, segmentation to reveal possible lesions and classification of lesions using an artificial neural network. The system was trained using a subset of images from 500 patients and evaluated by comparing its performance with a human grader on a test set of images from 773 patients.

Results  Maximum sensitivity for detection of any retinopathy on a per patient basis was 95.1%, accompanied by specificity of 46.3%. Specificity could be increased as far as 78.9% but was accompanied by a fall in sensitivity to 70.8%. At a setting with 94.8% sensitivity and 52.8% specificity, no cases of sight‐threatening retinopathy were missed (retinopathy warranting immediate ophthalmology referral or re‐examination sooner than 1 year by National Institute for Clinical Excellence criteria). If the system was implemented at 94.8% sensitivity setting over half the images with no retinopathy would be correctly identified, reducing the need for a human grader to examine images in 1/3 of patients.

Conclusion  This system could be used when screening for diabetic retinopathy. At 94.8% sensitivity setting the number of normal images requiring examination by a human grader could be halved.
The implementation of nutritional advice for people with diabetes
Authors:   Nutrition Subcommittee of the Diabetes Care Advisory Committee of Diabetes UK
Published: December 2004

These consensus‐based recommendations emphasize the practical implementation of nutritional advice for people with diabetes, and describe the provision of services required to provide the information. Important changes from previous recommendations include greater flexibility in the proportions of energy derived from carbohydrate and monounsaturated fat, further liberalization in the consumption of sucrose, more active promotion of foods with a low glycaemic index, and greater emphasis on the provision of nutritional advice in the context of wider lifestyle changes, particularly physical activity. Monounsaturated fats are now promoted as the main source of dietary fat because of their lower susceptibility to lipid peroxidation and consequent lower atherogenic potential. Consumption of sucrose for patients who are not overweight can be increased up to 10% of daily energy derived from carbohydrate provided that this is eaten in the context of a healthy diet and distributed throughout the day. Evidence is presented for the effectiveness of advice provided by trained dieticians. The increasing evidence for the importance of good metabolic control and the growing requirement for measures to prevent Type 2 diabetes in an increasingly obese population will require major expansion of dietetic services if the standards in National Service Frameworks are to be successfully implemented.
Electromyographic Biofeedback-Assisted Relaxation Training in Juvenile Episodic Tension-Type Headache: Clinical Outcome at Three-Year Follow-Up the in of and for on with at is an as by
Authors: Grazzi L , Andrasik F , D'Amico D , Leone M , Moschiano F , Bussone G
Published: December 2004

Although tension-type headaches are more common than migraine in children and adolescents, the limited studies that have been conducted with juveniles have focused chiefly on migraine treatment and its course. This report describes the clinical benefits for an electromyographic biofeedback-assisted relaxation treatment program for a group of children and adolescents experiencing episodic tension-type headache and examines whether the clinical presentation changed for headaches that remained. Of the 54 consecutive juveniles who began treatment, 38 completed and were available to participate in the 3-year follow-up. Headaches improved measurably immediately following treatment, with further gains being evident through 3 years. The few headaches that did occur at 3 years were nearly identical symptom-for-symptom to those that were experienced prior to treatment. This report suggests that behavioural treatment is a viable and durable intervention for juvenile episodic tension-type headache, but more definitive claims cannot be made due to the uncontrolled nature of the study. Further investigation is warranted.
The ‘Dry-Needle Technique’: Intramuscular Stimulation in Tension-Type Headache
Authors: Karakurum B , Karaalin O , Coskun ö , Dora B , üçler S , Inan LE
Published: December 2004

The ‘dry-needle technique’, an intramuscular stimulation technique carried out by using a fine solid, 1-inch long, 30-gauge needle, was investigated in the treatment of tension-type headache (TTH) in a randomized, placebo-controlled trial. Fifteen patients with TTH received intramuscular needle insertions into six designated trigger points, while 15 controls received subcutaneous insertions. Headache indices, muscle tenderness and neck ROMs were evaluated before and after treatment. Mean headache indices improved significantly after treatment, both in the treatment group and in the placebo group, but the difference between the two groups was insignificant. In the treatment group the tenderness score and the neck ROM limitation score were significantly improved after treatment, while there was no significant improvement in the placebo group. We conclude that more and larger controlled, comparative trials are needed to show whether the dry-needle technique is an effective non-pharmacological alternative for the treatment of TTH.
Failure of Omega-3 Polyunsaturated Fatty Acids in Prevention of Migraine: A Double-Blind Study Versus Placebo
Authors: Pradalier A , Bakouche P , Baudesson G , Delage A , Cornaille-Lafage G , Launay JM , Biason P
Published: December 2004

Omega-3 polyunsaturated fatty acids (OPFA) have beneficial effects on inflammatory reactions and production of cytokines. They decrease the release of 5HT by platelets and possess vasorelaxant activity. This led them to be tried in the prophylactic treatment of migraine. After 4 weeks of a single-blind placebo run-in period, patients were randomized and treated in double-blind condition by placebo or OPFA 6 g a day for 16 weeks, followed by a 4-week placebo run-out period. The intention to treat population included 196 patients. Those who received all four treatment periods included 96 patients taking OPFA and 87 taking placebo. The primary efficacy analysis was the number of migraine attacks during the last 4 weeks of treatment. During this period, the mean number of attacks was 1.20 ± 1.40 in the OPFA group and 1.26 ± 1.11 in the placebo group (NS). The total number of attacks during the 4-month period of the study was significantly different between groups: 7.05 in the placebo group, 5.95 in the OPFA group ( P = 0.036). Mean intensity, mean duration of the attacks and rescue medication use, were not significantly different between the two groups. Except for a significant difference against OPFA for eructations, the tolerance was satisfying. Despite a run-in placebo period of 1 month, a very strong placebo effect was observed in this trial: 45% reduction of the attacks between run-in and 4-month treatment period (55% in the OPFA group, P = 0.058). Finally, this large study did not confirm two previous studies based on a small number of patients.
The Threshold for Phosphenes is Lower in Migraine
Authors: Aurora SK , Welch KMA , Al-Sayed F
Published: December 2004

We have reported a preliminary study confirming hyperexicitability of occipital cortex in migraine with aura (MwA) using transcranial magnetic stimulation (TMS). We have now completed a blinded study to investigate the occipital cortex in MwA and without aura (MwoA) compared with normal controls (NC) using TMS. TMS was performed using the Caldwell MES-10 stimulator. A circular coil 9.5 cm diameter was applied to the occipital scalp (7 cm above the inion). Stimulator intensity was increased in 10% increments until subjects reported visual phenomena or 100% intensity was reached. Stimulation intensity was then fine tuned to determine the threshold at which phosphenes were seen. Fisher's exact t-test and logrank test were used for statistical comparisons. Ten subjects with MwA and MwoA were compared to 10 NC. The difference in the proportion of subjects with phosphene generation was statistically significant (MwA 100%, MwoA 60% and NC 30%) [ P = 0.003]. The difference in threshold levels for phosphenes was also significant for MwA 42.8%, and controls 57.3% [ P = 0.0001]. There is a difference in threshold for excitability of occipital cortex in MwA and MwoA compared to NC. This is a direct neurophysiological correlate for clinical observations, which have inferred hyperexicitability of the occipital cortex in migraineurs.
Excitability of Visual V1-V2 and Motor Cortices To Single Transcranial Magnetic Stimuli in Migraine: A Reappraisal Using A Figure-Of-Eight Coil
Authors: Bohotin V , Fumai A , Vandenheede M , Bohotin C , Schoenen J
Published: December 2004

We used transcranial magnetic stimulation (TMS) with a figure-of-eight coil to excite motor and visual V1-V2 cortices in patients suffering from migraine without (MO) ( n = 24) or with aura (MA) ( n = 13) and in healthy volunteers (HV) ( n = 33). Patients who had a migraine attack within 3 days before or after the recordings were excluded. All females were recorded at mid-cycle.

Single TMS pulses over the occipital cortex elicited phosphenes in 64% of HV, 63% of MO and 69% of MA patients. Compared with HV, the phosphene threshold was significantly increased in MO ( P = 0.001) and in MA ( P = 0.007), but there was no difference between the two groups of migraineurs. The motor threshold tended to be higher in both migraine groups than in HV, but the differences were not significant. In conclusion, this study shows that two-thirds (64.86%) of patients affected by either migraine type present an increased phosphene threshold in the interictal period, which suggests that their visual cortex is hypoexcitable.
Course of Migraine During Pregnancy and Postpartum: A Prospective Study
Authors: Sances G , Granella F , Nappi RE , Fignon A , Ghiotto N , Polatti F , Nappi G
Published: December 2004

The aim of this study was to investigate prospectively the course of migraine during pregnancy and postpartum. Of all the pregnant women consecutively attending an obstetrics and gynaecology department for a routine first-trimester antenatal check-up, 49 migraine sufferers - two were affected by migraine with aura (MA) and 47 by migraine without aura (MO) - who had experienced at least one attack during the 3 months preceding pregnancy were identified, enrolled in the study and given a headache diary. Subsequent examinations were performed at the end of the second and third trimesters and 1 month after delivery. Migraine was seen to improve in 46.8% of the 47 MO sufferers during the first trimester, in 83.0% during the second and in 87.2% during the third, while complete remission was attained by 10.6%, 53.2%, and 78.7% of the women, respectively. Migraine recurred during the first week after childbirth in 34.0% of the women and during the first month in 55.3%. Certain risk factors for lack of improvement of migraine during pregnancy were identified: the presence of menstrually related migraine before pregnancy was associated with a lack of headache improvement in the first and third trimesters, while second-trimester hyperemesis, and a pathological pregnancy course were associated with a lack of headache improvement in the second trimester. Breast feeding seemed to protect from migraine recurrence during postpartum.
Catamenial Synkinetic Retroauricular Pain
Authors: Jacome DE
Published: December 2004

A report of two female patients with persistent unilateral retroauricular pain and cranial synkinesis following Bell's palsy. Pain occurred during menses in the first patient and was exacerbated by menses in the second patient. Retroauricular pain often precedes or follows Bell's palsy. Pain normally disappears within 2 weeks from the onset of paralysis. Neurological examination, brain magnetic resonance imaging (MRI), computed tomography of the head and cranial electrophysiological testing were performed. The first patient had severe right retroauricular pain during her menses for several years following Bell's palsy. Her brain MRI showed non-specific T2 white matter hyperintensities. On her electromyogram she had facial synkinesis with tonic motor unit discharges on her right orbicularis oris and mentalis muscles during sustained eye closure. The second patient reported hearing a sound over her left ear when she blinked or protruded her jaw after Bell's palsy. She had ipsilateral retroauricular pain, exacerbated during menses. Her brain MRI was normal. Electromyogram showed facial synkinesis. Chronic retroauricular pain, occurring or exacerbated during menses, may be a rare complication of Bell's palsy. It can be associated with facial subclinical synkinetic dystonia and trigemino-facial synkinesis.
Emotional and Behavioural Problems in Children and Adolescents with Primary Headache
Authors: Just U , Oelkers R , Bender S , Parzer P , Ebinger F , Weisbrod M , Resch F
Published: December 2004

Psychiatric co-morbidity is an important risk factor for chronification of primary headache into adulthood. The aim of this study was to investigate the extent and clinical relevance of emotional and behavioural problems in children and adolescents with primary headache. Children and adolescents (n = 128) with primary headache (International Headache Society, codes 1.1, 1.2, 2.1) and 83 matched controls aged 6-18 years were examined by standardized dimensional psychomet-rical tests (Child Behaviour Checklist, Depression Inventory for Children and Adolescents, Anxiety Questionnaire for Pupils). Children and adolescents with primary headache suffer more often from internalizing problems (depression, anxiety, somatization) than healthy controls. The detected emotional and behavioural problems are clinically relevant and require particular therapy in every third child suffering from headache. Two out of three children and adolescents with primary headache do not show clinically relevant psychopathology and may benefit from minimal therapeutic intervention. One of three examined headache patients needs additional psychiatric therapy.
Migraine Prophylactic Medication Usage Patterns in the Netherlands
Authors: Rahimtoola H , Buurma H , Tijssen CC , Leufkens HG , Egberts ACG
Published: December 2004

This study aims to investigate usage patterns of specific migraine prophylactic medications in ergotamine and triptan patients commencing this treatment for the first time during 1 January 1992 until 31 December 1998. Usage patterns of specific migraine prophylactic drugs were evaluated for each patient by accessing data from a large prescription database and were characterized as continued, switch or stop use during the patient observation period. Several patient and medication-related factors were explored in order to identify a possible relationship with the specific usage pattern defined. Approximately 75% of the study population ( n = 729) had terminated (stop or switch) prophylactic treatment after 1 year. Age < 40 years (relative risk (RR) 1.9; 95% confidence interval (CI) 1.2-3.2) and the concomitant use of non-steroidal anti-inflammatory drugs (RR 3.2; 95% CI 1.2-5.5) or specific abortive migraine drugs resulted in a faster onset of treatment modification (switch). Overall, migraine prophylactic treatment is used for a relatively short period, probably attributable to the common limitations associated with migraine prophylaxis, such as poor compliance and/or limited therapeutic efficacy. Patterns of use can be influenced by a variety of factors, including age, type of prescriber and certain co-medication. Patient interview studies are required to clarify these issues further.