bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors for Development of Retinopathy in Elderly Japanese Patients With Diabetes Mellitus
Authors: Araki Atsushi , Ito Hideki , Hattori Akinori , Inoue Junichiro , Sato Tadahiro , Shiraki Masataka , Orimo Hajime
Published: March 2007

OBJECTIVE

To define the risk factors for the development of diabetic retinopathy in elderly patients with diabetes mellitus.

RESEARCH DESIGN AND METHODS

We studied 110 diabetic outpatients > 60 yr of age who were free of diabetic retinopathy at the first visit and were followed for at least 5 yr to examine the relationships between the initial findings and the subsequent development of retinopathy.

RESULTS

A total of 49 of the subjects developed diabetic retinopathy during the follow-up period; of these, 4 patients progressed to preproliferative and 3 to proliferative retinopathy. Univariate analysis showed that the initial fasting plasma glucose levels, the HbA1 values, the 2-h postload plasma glucose levels, the estimated duration of diabetes, and the presence of persistent proteinuria were all associated with the development of diabetic retinopathy. However, age at the initial examination, estimated age at diabetes onset, sex, body mass index, type of therapy, and hypertension had little impact on the development of retinopathy. Stepwise multiple Cox regression analysis revealed that the initial HbA1 or fasting plasma glucose, the diabetes duration, and the presence of persistent proteinuria are significant independent predictors for the development of retinopathy.

CONCLUSIONS

Initial fasting plasma glucose, diabetes duration, and proteinuria are important risk factors for the development of retinopathy in elderly patients with diabetes mellitus.
Painful Neuropathy and Foot Ulceration in Diabetic Patients
Authors: Veves Aristidis , Manes Christos , Murray Heather J , Young Matthew J , Boulton Andrew J
Published: March 2007

OBJECTIVE

To examine the prevalence of painful symptoms in neuropathic patients with or without foot ulceration. It has been suggested that there are two clinical presentations of sensory diabetic neuropathy with little overlap: painful (acute or chronic) and painless with recurrent foot ulceration.

RESEARCH DESIGN AND METHODS

We examined three groups of diabetic patients matched for age and duration of diabetes–24 without neuropathy on clinical grounds (mean age 56.1 yr [range 38–76 yr], diabetes duration 12.6 yr [0.4–40 yr]), 30 with neuropathy (mean age 55.3 yr [range 21–73 yr], diabetes duration 17.3 yr [range 0.2–61 yr[), and 40 with neuropathic foot ulceration (mean age 58.1 yr [range 41–72 yr], diabetes duration 18.5 yr [range 1–46 yr])–and compared them with 20 healthy subjects (mean age 50 yr [range 37–69 yr]). For evaluation of neuropathy, the neuropathy symptom score, neuropathy disability score, and vibration perception threshold were measured.

RESULTS

No difference existed between the neuropathic and foot ulcer groups in the neuropathy symptom score (4.2 ± 3.9 [mean ± SD] vs. 2.5 ± 2.1, NS) and neuropathy disability score (15.1 ± 5.7 vs. 16.8 ± 6.1, NS), but the vibration perception threshold was lower in the neuropathic group (30.1 ± 13.4 vs. 40.5 ± 13.8 V, P < 0.001). Painful symptoms (neuropathy symptom score > 3), either in the past or during the time the study was conducted, had been experienced by none of the control subjects, 7 (29%) of the nonneuropathic group, 18 (60%) of the neuropathic group, and 17 (43%) of the foot ulcer group (NS for the last two groups), and were present at the time of examination in 13 (43%) of the neuropathic group and in 13 (33%) of the foot ulcer group (NS in all groups). Duration of symptoms was < 12 mo in 12 (40%) neuropathic and 15 (38%) foot ulcer patients (NS).

CONCLUSIONS

We conclude that painful symptoms are frequent in diabetic neuropathy, irrespective of the presence or absence of foot ulceration and that these symptoms can occur at any stage of the disease. These results suggest that there is a spectrum of neuropathic syndromes from the painful to the patients with foot ulceration, and that much overlap exists.
A Cold Spot of IDDM Incidence in Europe: Macedonia
Authors: Kocova Mirjana , Trucco Massimo , Konstantinova Marina , Dorman Janice S
Published: March 2007

Objective— To determine, for the first time, the incidence of IDDM among children 0–15 yr of age in Macedonia, the south republic of former Yugoslavia, and to compare these rates with those from neighboring countries.

Research Design and Methods— Children <15 yr of age, with IDDM diagnosed between January 1985 and December 1991, were registered using the criteria established for the WHO Multinational Project for Childhood Diabetes. The primary source of case ascertainment consisted of clinical records from the University Pediatric Clinic in Skopje, the capital of Macedonia. The secondary source consisted of records for insulin supplies from the pharmacy in Skopje and from 15 local hospitals.

Results— During 1985–1991, 112 children <15 yr of age were diagnosed with IDDM in Macedonia. The completeness of case ascertainment was 96.6%. The age-adjusted IDDM incidence rate was very low, only 2.45/100,000 per yr. No significant sex difference in incidence was observed. The highest incidence rate occurred in the 10- to 15-yr age-group. No temporal trends were observed.

Conclusions— The incidence of IDDM in Macedonia is the lowest in Europe and among the lowest reported for Caucasian populations. However, the descriptive epidemiology is similar to that for high incidence populations. Further etiological studies are required to evaluate potential reasons for the very low incidence of IDDM in Macedonia.
Ultrasonographic Abnormalities of the Pancreas in IDDM and NIDDM Patients
Authors: Silva Maria E R , Vezozzo Denise P , Ursich Mileni J M , Rocha Dalva M , Cerri Giovanni G , Wajchenberg Bernardo L
Published: March 2007

Objective— To evaluate the relationship between the type and duration of diabetes and pancreas size by ultrasonography.

Research Design and Methods— Pancreas images of 40 IDDM and 36 NIDDM patients with 0.3–34 yr of disease were compared with those of 60 normal healthy control subjects.

Results— The diameters ± SD of the head, body, and tail of the pancreas in IDDM patients (1.9 ± 0.3; 0.9 ± 0.2; and 1.4 ± 0.2 cm, respectively) were smaller than in NIDDM patients (2.7 ± 0.4; 1.2 ± 0.3; and 1.8 ± 0.4 cm, respectively) and control group subjects (2.4 ± 0.4; 1.1 ± 0.3; and 1.8 ± 0.4 cm, respectively). The pancreatic shrinkage in IDDM patients was clearly evident after 10 yr of the disease. NIDDM patients and control subjects had similar pancreatic dimensions, except for a greater body thickness in NIDDM patients with >10 yr of disease (1.2 ± 0.4 vs. 1.1 ± 0.3 cm). These results were not related to differences in age, sex, and body size. Pancreas image was hypoechogenic in 72.5% of IDDM patients and hyperechogenic in 83.3% of NIDDM patients.

Conclusions— Smaller pancreases in IDDM patients in comparison with NIDDM patients and control subjects were clearly demonstrated only after 10 yr of disease. Patients with NIDDM were not affected by pancreatic dimensions, except for a greater body thickness after 10 yr of disease. Pancreatic echogenicity increased with age.
Therapeutic Comparison of Metformin and Sulfonylurea, Alone and in Various Combinations: A double-blind controlled study
Authors: Hermann Leif S , Scherstén Bengt , Bitzén Per-Olof , Kjellström Thomas , Lindgärde Folke , Melander Arne
Published: March 2007

OBJECTIVE

To assess and compare the therapeutic efficacy and safety of metformin (M) and sulfonylurea (glyburide, G), alone and in various combinations, in patients with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

Of 165 patients (fasting blood glucose [FBG] ≥ 6.7 mmol/l) initially treated with diet alone, 144 (FBG still ≥6.7 mmol/l) were randomized to double-blind, double-dummy controlled treatment with M, G, or primary combination therapy (MG). The dose was titrated, withFBG <6.7 mmol/l as target, using, at most, six dose levels. The first three dose levels comprised increasing single-drug therapy (M or G) or primary combination at increasing but low dosage (MGL), and the second three levels were composed of various high-dose combinations, i.e., add-on therapy (M/G or G/M) and primary combination escalated to high dosage (MGH). Medication was maintained for 6 months after completed dose titration.

RESULTS

The FBG target was achieved in 9% of patients after diet alone. Single-drug therapy was insufficient in 36% and MGL in 25% (NS) of the randomized patients. There was further improvement in glucose control by the high-dose combinations. Mean FBG ± SE was reduced (P = 0.001) from 9.1 ± 0.4 to 7.0 ± 0.2 mmol/l in those maintained on single-drug treatment or low-dose primary combination. Those treated with different high-dose combinations had a large mean FBG reduction, from 13.3 ± 0.8 to 7.8 ± 0.6 mmol/l. HbA1c levels showed corresponding reductions, and glycemic levels rose after drug discontinuation. Fasting C-peptide rose during treatment with G and MGL but not with M, while fasting insulin was not significantly changed. Meal-stimulated C-peptide and insulin levels were unchanged by M but increased by G and, to a lesser extent, by MGL. There were no significant insulin or C-peptide differences between the different high-dose combinations (M/G, G/M, and MGH). Body weight did not change following treatment with M or combination but increased by 2.8 ± 0.7 kg following G alone. Blood pressure was unchanged. Overall effects on plasma lipids were small, with no significant differences between groups. Drug safety was satisfactory, even if the reporting of (usually modest) adverse events was high; the profile, but not the frequency, differed between groups.

CONCLUSIONS

Dose-effect titrated treatment with either metformin or glyburide promotes equal degrees of glycemic control. The former, but not the latter, is able to achieve this control without increasing body weight or hyperinsulinemia. Near-normal glycemia can be obtained by a combination of metformin and sulfonylurea, even in advanced NIDDM.
The Effect of Recurrent Practice at Home on the Acceptability of Capillary Blood Glucose Readings: Accuracy of self blood glucose testing
Authors: Kabadi Udaya M , O'Connell Kathleen M , Johnson Jennal , Kabadi Mary
Published: March 2007

OBJECTIVE

To judge how reliably patients perform capillary blood glucose testing over time with recurrent practice at home and to assess if a clinic glucose meter is an acceptable alternative to the clinical laboratory for monitoring patient performance.

RESEARCH DESIGN AND METHODS

We compared capillary blood glucose readings obtained by patients with their own equipment and the venous blood glucose determinations by the clinical laboratory at three biweekly visits during the initial phase in 40 subjects attending the diabetes clinic at the Veterans' Affairs Medical Center in Phoenix, Arizona. We also compared patient-generated readings using their own equipment and the readings obtained by the clinic glucose meter and strips at five weekly visits during the second phase in 11 subjects who continued further participation. Error grid analysis was used for both comparisons. Capillary blood glucose readings obtained with clinic glucose meter and strips on one hand were correlated with venous blood glucose levels determined by the clinical laboratory.

RESULTS

During the initial phase, 30 subjects consistently obtained clinically acceptable comparisons (zone A on the error grid, i.e., within 20% of the laboratory value) or improved over time, 9 subjects showed deterioration, and 1 subject failed to obtain zone A results on any of the visits. Three subjects who had consistently obtained zone A results during the initial phase maintained their performance, whereas eight subjects who had failed to achieve zone A values by the end of the initial phase gradually improved and ultimately achieved zone A values by the end of the study. A highly significant correlation was noted between clinic meter readings and laboratory values (r = 0.93, P < 0.00001).

CONCLUSIONS

Clinically acceptable user proficiency in capillary blood glucose testing can be maintained in most subjects, with recurrent intensive education during follow-up clinic visits. Therefore, we recommend that these comparisons be performed and patient's technique be observed at each visit to monitor their performance. The clinic glucose meter is a suitable alternative to a clinical laboratory for user proficiency checks.
Frequency and Determinants of Screening for Diabetes in the U.S
Authors: Cowie Catherine C , Harris Maureen I , Eberhardt Mark S
Published: March 2007

OBJECTIVE

To determine the prevalence of risk factors for non-insulin-dependent diabetes mellitus (NIDDM) and the frequency of screening for NIDDM in U.S. adults.

RESEARCH DESIGN AND METHODS

A detailed questionnaire was administered to a representative sample of 19,680 adults ≥18 years of age who reported no medical history of diabetes in the 1989 National Health Interview Survey (NHIS). Information was obtained on risk factors for diabetes, complications related to diabetes, and whether the subjects had been screened for diabetes in the past year. Women reporting pregnancy in the past year were excluded from analysis. The prevalence of undiagnosed NIDDM according to the frequency of risk factors for NIDDM was determined based on oral glucose tolerance data from the National Health and Nutrition Examination Survey (NHANES) II and Hispanic Health and Nutrition Examination Survey (HHANES).

RESULTS

Prevalence of undiagnosed NIDDM based on the NHANES II and HHANES increased with age, obesity, and family history of diabetes, reaching 11.7% in people with all three risk factors. Based on the NHIS, 77.5% of U.S. adults with no medical history of diabetes (131 million people) had at least one risk factor for NIDDM or complication related to NIDDM, and 22.9% (38 million people) had three or more risk factors or complications. Approximately 31% of adults reported being screened for diabetes in the past year. Screening rates increased with an increasing number of risk factors, but even among those with three risk factors, only 38.6% were screened for NIDDM.

CONCLUSIONS

More than 7 million U.S. adults have undiagnosed NIDDM. Nevertheless, screening for diabetes in high-risk groups occurs substantially less frequently than necessary to detect undiagnosed NIDDM and institute appropriate hypoglycemic treatment.
Risk Factors For Distal Symmetric Neuropathy in NIDDM: The San Luis Valley Diabetes Study
Authors: Franklin Gary M , Shetterly Susan M , Cohen Jeffrey A , Baxter Judith , Hamman Richard F
Published: March 2007

OBJECTIVE

To investigate risk factors for distal symmetric (sensory) neuropathy among prevalent cases of non-insulin-dependent diabetes mellitus (NIDDM) in apopulation-based study in southern Colorado.

RESEARCH DESIGN AND METHODS

Prevalent neuropathy was identified in 77 of 277 people with NIDDM by a standardized history and neurologic examination. Fifteen known or suspected risk factors for neuropathy were determined without knowledge of neuropathy status.

RESULTS

Older age at examination, longer duration of diabetes, higher glycohemoglobin percentage, lower fasting C-peptide, insulin use, and presence of retinopathy and nephropathy (microalbumin ≥ 200 µg/ml) were all significantly associated with neuropathy. Sex, ethnicity (Hispanic versus non-Hispanic white), height, systolic blood pressure, peripheral vascular disease, cigarette and alcohol use, and serum lipid levels were not significantly associated with neuropathy. In a multivariate logistic model, increasing age (odds ratio [OR] = 1.3, 95% confidence interval [CI] = 1.1–1.6), longer duration of diabetes (OR = 1.3, CI = 1.0–1.6), increased glycohemoglobin percentage (OR = 1.5, CI = 1.1–2.1), and insulin use (OR = 2.8, CI = 1.3–6.1) were associated with neuropathy. Retinopathy (OR = 3.0, CI = 1.2–7.7), but not nephropathy, was important when added to this model.

CONCLUSIONS

Worse glycemic control and insulin use were independently associated with neuropathy in people with NIDDM. Whether insulin use represents another marker for severity of the metabolic disturbance or is an independent risk factor for neuropathy requires further study. We could not confirm associations of neuropathy with height, with nephropathy, or with retinopathy, independent of duration of diabetes.
Insulin Withholding for Weight Control in Women With Diabetes
Authors: Biggs Melanie M , Basco Monica Ramirez , Patterson Gayle , Raskin Philip
Published: March 2007

OBJECTIVE

To provide a description of the clinical characteristics that distinguish individuals who withhold insulin for weight control from those who do not. Some individuals with insulin-dependent diabetes mellitus (IDDM) control their weight by withholding insulin and purging excessive calories. This process places patients at risk for developing severe hyperglycemia, diabeticketoacidosis, and increases the risk of long-term complications of diabetes.

RESEARCH DESIGN AND METHODS

Forty-two women with IDDM, ages 16–40, were interviewed and divided into two groups: insulin withholders (IWs) and non-insulin withholders (non-IWs). These groups were compared on physiological, behavioral, psychological, and psychiatric variables.

RESULTS

Compared with non-IWs, patients who withheld insulin to control their weight exhibited poorer glycemic control, reported more negative attitudes toward diabetes, were more likely to have pathological scores on the Eating Disorder Inventory 2, and were more likely to report current or past symptoms of anorexia or bulimia nervosa. IWs were also more likely to report lying to physicians about their degree of compliance with their diabetes regimens.

CONCLUSIONS

The results of this study indicated that IWs exhibit more symptoms associated with the spectrum of eating disorders than non-IWs. This study showed that insulin withholding for weight control not only exists, but is associated with some maladaptive symptoms and behaviors that need to be addressed by diabetes treatment teams.
High Prevalence of NIDDM and IGT in an Elderly South Indian Population With Low Rates of Obesity
Authors: Ramachandran Ambady , Snehalatha Chamukuttan , Shyamala Panchaksharam , Vijay Vlswanathan , Viswanathan Moopil
Published: March 2007

OBJECTIVE

To assess the prevalence of diabetes and impaired glucose tolerance (IGT) in the urban and rural elderly population in south India.

RESEARCH DESIGN AND METHODS

Urban and rural populations ≥60 years of age and representative of the areas (873 urban and 588 rural subjects) were screened for diabetes and IGT using fasting and 2-h postglucose capillary blood glucose measurements.

RESULTS

In the urban area, 211 (23.7%) had diabetes, and 101 (12.4%) had IGT. In the rural area, 56 (9.9%) had diabetes, and 82 (14.9%) had IGT. The ratio of newly diagnosed to known diabetes was 1:3 in the urban and 1:1 in the rural areas. Positive family history of diabetes, body mass index (BMI), subscapular-to-triceps ratio, and waist-to-hip ratio were significantly associated with diabetes in the urban population. Only age and BMI showed significant association with diabetes in the elderly rural population. None of the tested parameters, except age in the urban subjects, showed association with IGT.

CONCLUSIONS

This study highlights the high prevalence of glucose intolerance in elderly south Indians having low mean BMI (mean ± SD; urban 21.7 ± 4.6, rural 17.9 ±3.3 kg/m2). Although there was a twofold higher prevalence of diabetes in the urban area, the occurrence of IGT was similar in urban and rural populations.
Type I Diabetes Masquerading as Type II Diabetes: Possible implications for prevention and treatment
Authors: Leslie R David , Pozzilli Paolo
Published: March 2007

Type I diabetes is probably due to the immune-mediated destruction of islet insulinsecreting β-cells. This chronic destructive process is associated with both cellular and humoral immune changes in the peripheral blood that can be detected months, even years, before the onset of clinical diabetes. Throughout this prediabetic period, metabolic changes, including altered glucose tolerance and reduced insulin secretion, deteriorate at variable rates toward full-blown diabetes. The ability to predict subsequent clinical diabetes in those nondiabetic individuals with immune and metabolic changes has led to attempts to prevent the disease onset by therapeutic intervention. A small fraction of individuals with immune changes develop clinical diabetes that does not require insulin treatment. The onset of diabetes in these cases is usually in adult life, and because their diabetes is, at least initially, not insulin-dependent, they appear clinically to have type II diabetes. Such patients probably have the same disease process as patients with type I diabetes in that they have similar human leukocyte antigen (HLA) genetic susceptibility as well as autoantibodies to islet antigens. It is proposed that non-insulin-dependent diabetic patients who have markers that characterize individuals at risk of type I diabetes may be suitable candidates for those same therapeutic strategies that seek to prevent progression to insulin-dependence or even to reestablish normal glucose tolerance.
Medial Artery Calcification Predicts Cardiovascular Mortality in Patients With NIDDM
Authors: Niskanen Leo , Siitonen Onni , Suhonen Matti , Uusitupa Matti I
Published: March 2007

OBJECTIVE

To study the predictive value of medial artery calcification (Mönckeberg's sclerosis) in relation to 10-year cardiovascular mortality in patients with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

We studied the predictive value of thigh medial and intimal artery calcifications to 10-year cardiovascular mortality in a well-characterized group of 133 middle-aged, newly diagnosed patients with NIDDM (70 men and 63 women).

RESULTS

At baseline, medial artery calcifications were found in 17% of the patients and intimal-type calcifications were found in 23%. During the follow-up, 21% of the diabetic patients died from cardiovascular causes. The age-adjusted odds ratio for cardiovascular mortality was 4.2 (95% confidence intervals: 1.5−11.3) for medial-type and 1.6 (0.6−4.3) for intimal-type calcifications. In multiple logistic regression analysis, including age, sex, systolic blood pressure, low-density- and high-density-lipoprotein cholesterol, very-low-density lipoprotein triglycerides, smoking, body mass index, fasting serum insulin, blood glucose, urinary albumin, and ischemic ECG changes, as well as the intimal artery calcification, the medial artery calcification was the dominant factor predicting cardiovascular mortality.

CONCLUSIONS

In this study medial artery calcification was a strong independent predictor of cardiovascular mortality in patients with newly diagnosed NIDDM. Whether these subjects had a longer duration of hyperglycemia before the diagnosis than those without medial artery calcifications remains unknown.
The ROC Curve in the Evaluation of Fasting Capillary Blood Glucose as a Screening Test for Diabetes and IGT
Authors: Bortheiry Aida L. , Malerbi Domingos A. , Franco Laercio J.
Published: March 2007

OBJECTIVE

To assess the performance of different cutoff points of fasting capillary glycemia (FCG) in the diagnosis of diabetes and impaired glucose tolerance (IGT) using the receiver operating characteristics (ROC) curve approach.

RESEARCH DESIGN AND METHODS

This study included a sample of 4,019 subjects without a previous history of diabetes who were recruited for a confirmatory 2-h post-glucose challenge capillary glycemia from a larger sample of 21,847 individuals screened with FCG. The sensitivity and the specificity of FCG as a screening test were analyzed in the cutoff range 3.9–8.9 mmol/l, and the corresponding ROC curves were plotted to assess the performance of the test.

RESULTS

The screening test performance was better for diabetes than for IGT in the full range of cutoff points studied. Sensitivities ranged between 37.9 and 97.1% for diabetes and 1.8 and 94.4% for IGT; the areas under the ROC curves were 0.91 ± 0.01 and 0.75 ± 0.01, respectively. The cutoffs showing the best equilibrium between sensitivity and specificity approached 5.6 and 5.0 mmol/l for diabetes and IGT, respectively. Factors such as age, color, and family history of diabetes can affect the screening test performance.

CONCLUSIONS

ROC curves can provide useful information toward improving the usefulness of FCG as a screening test for abnormalities of glucose tolerance.
Hospital Use Among Diabetic Patients and the General Population
Authors: Aro Seppo , Kangas Tero , Reunanen Antti , Salinto Marjo , Koivisto Veikko
Published: March 2007

OBJECTIVE

This register-based linkage study compared hospital use among diabetic and nondiabetic populations. The study focused on overall use, use by disease categories, and inpatient care caused by complications.

RESEARCH DESIGN AND METHODS

The patient data were derived from the Hospital Discharge Register and the Central Drug Register in Finland. All drug-treated diabetic patients and discharges of patients in a 3-year period were included in the study. Hospital use was measured by inpatient days, mean length of stay, and discharge rate.

RESULTS

Among diabetic patients were eligible for drug reimbursement, 14.2% had at least one hospital stay because of diabetes in a year, while 50.7% had at least one hospital stay for any cause. Only 12.4% of the nondiabetic population was hospitalized annually. Patients with diabetes as the principal diagnosis consumed about 3% of all inpatient days; patients who had diabetes either as the principal or as a subsidiary diagnosis used 8.3%; and people who were eligible for antidiabetic drug reimbursement used 13.3% of total inpatient days. Among diabetic children, the risk for hospitalization was 6.5 times higher than among nondiabetic children. With advancing age, causes other than diabetes increasingly dominated hospitalization among diabetic patients. Inpatient days because of cardiovascular diseases were 1.6−18 times more common among diabetic patients than among nondiabetic patients, depending on gender and age-group. Diabetic patients used many more hospital inpatient days than did the nondiabetic population for a number of other disease categories that are usually not related to diabetes.

CONCLUSIONS

Hospital use among diabetic patients is substantially > that among the nondiabetic population, mainly because of cardiovascular and microvascular complications, but also because of diseases unrelated to diabetes.
Cholesterol Absorption and Cholesterol and Bile Acid Synthesis in Two Brothers With IDDM and Diarrhea
Authors: Gylling Helena , Miettinen Tatu A
Published: March 2007

OBJECTIVE

To determine the best possible treatment for two brothers who had IDDM and bile acid malabsorption-associated disabling diarrhea that was resistant to cholestyramine, antibiotics, clonidine, loperamide, or anticholinergic drugs.

RESEARCH DESIGN AND METHODS

Our study paired these two brothers with control subjects. Serum noncholesterol sterols and fecal elimination of cholesterol and plant sterols were quantitated by gas-liquid chromatography.

RESULTS

Fecal losses of bile acids exceeded four to six times the control values, and cholesterol synthesis was increased two to three times. Cholesterol absorption efficiency and serum cholesterol concentrations were, respectively, within the high and low control range.

CONCLUSIONS

Bile acid malabsorption might have resulted from deranged intestinal motility, possibly contributed by gastrointestinal neuropathy, and some genetic factor.
Diet and Exercise in the Treatment of NIDDM: The need for early emphasis
Authors: Barnard R James , Jung Tiffany , Inkeles Stephen B
Published: March 2007

OBJECTIVE

To investigate the effectiveness of an intensive diet and exercise program for controlling non-insulin-dependent diabetes mellitus (NIDDM) and reducing risk factors associated with macrovascular complications.

RESEARCH DESIGN AND METHODS

Medical charts obtained from 4,587 participants in a lifestyle modification program were screened for patients with NIDDM. A total of 652 patients was identified, and their responses to the 3-week program were analyzed.

RESULTS

Fasting glucose level was reduced from 10.0 to 8.45 mmol/l, and 71% of 197 subjects taking oral hypoglycemic agents and 39% of 212 taking insulin were able to discontinue their medication. Of the 243 not taking medication, 76% reduced their fasting glucose levels to ≤ 7.84 mmol/l. Blood pressure was significantly reduced, and of the 319 initially taking antihypertension drugs, 34% had their medication discontinued. Serum total and low-density lipoprotein cholesterol were reduced by 22% and triglycerides by 33%. The ratio of total to high-density lipoprotein cholesterol was reduced by 13%.

CONCLUSIONS

Lifestyle modification consisting of diet combined with aerobic exercise can be effective for controlling NIDDM and reducing risk factors associated with macrovascular complications in both men and women. The program was far more effective in controlling the disease in patients taking no medication or oral agents compared with patients taking insulin. These results stress the need for early emphasis on lifestyle modification in the treatment of NIDDM.
Relationship Between Dairy Product Consumption and Incidence of IDDM in Childhood in Italy
Authors: Fava Danila , Leslie R David G , Pozzilli Paolo
Published: March 2007

OBJECTIVE

To test the hypothesis that the consumption of dairy products, including fluid cows' milk and cheese, is related to the incidence of insulin-dependent diabetes mellitus (IDDM), we correlated incidence rates in children 0–14 years of age with cows' milk and cheese consumption in nine regions of a single country, Italy.

RESEARCH DESIGN AND METHODS

Data on the incidence of IDDM were derived from the only nine Italian regions where primary and secondary sources of ascertainment were available for 1991. Data on fluid cows' milk and cheese consumption in the corresponding year in each region were obtained from the National Institute of Statistics.

RESULTS

The correlation between fluid milk consumption and incidence of IDDM in Italy was 0.84 (P < 0.004, Poisson regression analysis). Cheese consumption was not related to IDDM incidence.

CONCLUSIONS

The results indicate that there is a relationship, even in a single country, between dairy product consumption and the incidence of IDDM that is confined to fluid milk consumption. Cows' milk may contain a triggering factor for the development of diabetes, but the high incidence of IDDM in Sardinia and in other countries worldwide cannot be explained simply by the quantity of fluid cows' milk consumed.
Physicians' Practices in Screening for the Development of Diabetic Nephropathy and the Use of Glycosylated Hemoglobin Levels
Authors: Miller Karen L , Hirsch Irl B
Published: March 2007

OBJECTIVE

To compare outpatient screening of diabetic patients for nephropathy and measurement of glycosylated hemoglobin (GHb) levels to published American Diabetes Association (ADA) guidelines.

RESEARCH DESIGN AND METHODS

We reviewed charts from 157 diabetic patients followed for 27 months at the University of Washington's primary care clinics. The number of screening urinalyses, 24-h urine measurements, and GHb measurements were obtained. From these values, the frequency of screening tests, normalized by patient-year, could be compared with the ADA guidelines.

RESULTS

Forty-two percent of the patients received at least one urinalysis, and 5% had 24-h urine measurements. There were 0.48 urinalyses and 0.05 24-h urine measurements per patient-year. Of 14 type I diabetes patients, 5 had a urinalysis and 1 received a 24-h urine measurement. At least one GHb was measured for 85% of patients, and there were 1.66 GHb measurements per patient-year. Only 29% of patients received GHb concentrations as recommended by ADA guidelines.

CONCLUSIONS

Diabetic patients at this institution are not screened for nephropathy and do not receive GHb measurements according to the ADA guidelines. Because of recent advancements in the treatment of diabetic nephropathy and the results of the Diabetes Control and Complications Trial (DCCT), further efforts are needed for educating primary care physicians about standards of care of patients with diabetes.
Increased Risk Factors for Coronary Artery Disease in Japanese Subjects With Hyperinsulinemia or Glucose Intolerance
Authors: Yamada Nobuhiro , Yoshinaga Hideyo , Sakurai Noboru , Shimano Hitoshi , Gotoda Takanari , Ohashi Yasuo , Yazaki Yoshio , Kosaka Kinori
Published: March 2007

OBJECTIVE

To understand the interrelationship of coronary artery disease (CAD) risk factors including hyperlipidemia, hypertension, and glucose intolerance to prevent and better manage this disease.

RESEARCH DESIGN AND METHODS

We performed a 100-g oral glucose tolerance test in 2,113 subjects, and we evaluated their plasma lipid levels, blood pressure (BP), and plasma glucose and plasma insulin responses.

RESULTS

Multiple regression analysis demonstrated a significant relationship of either BP, plasma triglyceride (TG), or high-density lipoprotein (HDL) cholesterol levels to plasma insulin and glucose response after the glucose load. Plasma cholesterol levels were related only to the plasma glucose response. In subjects matched for age, sex, and body mass index (BMI) with hyperinsulinemia or normoinsulinemia, the hyperinsulinemic subjects had a significantly higher mean BP and plasma TG level than the normoinsulinemic subjects (128.8/82.3 vs. 122.9/79.3 mmHg and 172.1 vs. 119.4 mg/dl), and the HDL-cholesterol level was significantly lower (43.9 vs. 47.8 mg/dl). Furthermore, subjects matched for age, sex, and BMI with glucose intolerance had a higher mean BP (128.4/81.8 vs. 123.5/78.7 mmHg) and higher plasma TG level (154.2 vs. 123.0 mg/dl) than those without glucose intolerance.

CONCLUSIONS

Based on these findings, subjects with hyperinsulinemia or glucose intolerance should be carefully managed to prevent CAD, because they have more numerous and more severe risk factors than subjects with normal plasma insulin levels or subjects without glucose intolerance.
The Predictive Value of Microalbuminuriq in IPPM: A five-year follow-up study
Authors: Almdal Thomas , Nörgaard Kjrsten , Feldt-Rasmussen Bo , Deckert Torsten
Published: March 2007

OBJECTIVE

To investigate the predictive value of microalbuminuria and the annual increase of albumin excretion as risk factors for diabetic nephropathy.

RESEARCH DESIGN AND METHODS

A 5-year follow-up of patients with microalbuminuria (urinary albumin excretion [UAE\ = 30-299 mg/24 h) and matched patients with normoalbuminuria (UAE < 30 mg/24 h). The initial classification was based on one single 24-h urine collection. The annual increase in UAE was calculated by linear regression analysis of log-transformed UAE on time. This study was conducted at the outpatient clinic of the Steno Diabetes Center. The study subjects included 118 insulin-dependent diabetes mellitus (IDDM) patients between 18 and 50 years of age with microalbuminuria and 112 matched control patients with normal UAE with an age at diabetes onset of <31 years. The main outcome measures were UAE, annual change in UAE rate (percentage per year), and the prevalence of retinopathy.

RESULTS

After 5 years, 39 (33%, 24-42 CI [95% confidence interval]) patients with microalbuminuria had normoalbuminuria, 57 (48%, 38-57 CI) still had microalbuminuria, and 22 (19%, 12-27 CI) had developed diabetic nephropathy. Among the 112 patients with normoalbuminuria in 1985, 9 (8%, 4-15 CI) had developed microalbuminuria, and 2 (2%, 0-6 CI) had developed diabetic nephropathy. Of the 79 patients with persistent albuminuria, only 36 (46%, 34-57 CI) were progressors with a rate of progression of >5%/year. Progressors had significantly higher HbA1c, higher mean blood pressure, and a higher incidence of proliferative retinopathy compared with nonprogressors. Multiple regression analysis only identified mean HbA1c as an independent predictor of the rate of progression. Smoking was significantly more prevalent in patients with persistent albuminuria.

CONCLUSIONS

Microalbuminuria is a predictor of progression to diabetic nephropathy; however, not as strong as suggested previously. Calculation of the annual increase in UAE seems to be a more specific method of identifying patients who will develop diabetic nephropathy.
Smoking Is Associated With Progression of Diabetic Nephropathy
Authors: Sawicki Peter T , Didjurgeit Ulrike , Mühlhauser Ingrid , Bender Ralf , Heinemann Lutz , Berger Michael
Published: March 2007

OBJECTIVE

To investigate the association between cigarette smoking and the progression of diabetic nephropathy.

RESEARCH DESIGN AND METHODS

A prospective, follow-up study over one year was conducted in a sequential sample of 34 smokers, 35 nonsmokers, and 24 ex-smokers with type I diabetes, hypertension, and diabetic nephropathy. Progression of renal disease was defined according to the stage of nephropathy as an increase in proteinuria or serum creatinine or a decrease in the glomerular filtration rate.

RESULTS

Progression of nephropathy was less common in nonsmokers (11%) than in smokers (53%) and patients who had quit smoking (33%), P > 0.001. In a stepwise logistic regression analysis, cigarette pack years, 24-h sodium excretion, and GHb were independent predictive factors for the progression of diabetic nephropathy. Because blood pressure (BP) was well controlled in these patients and most values were within a normotensive range, neither standing, sitting, nor supine BP values were associated with progression of nephropathy.

CONCLUSIONS

Cigarette smoking represents an important factor associated with progression of nephropathy in treated hypertensive type I diabetic patients.
Ethnic Differences in Human Leukocyte Antigen Markers of Susceptibility to IDDM
Authors: Cruickshanks Karen J , Jobim Luiz F , Lawler-Heavner Janet , Neville Terri G , Gay Elizabeth C , Chase H Peter , Klingensmith Georgeanna , Todd John A , Hamman Richard F
Published: March 2007

OBJECTIVE

To determine whether genetic differences explain the lower risk of developing insulin-dependent diabetes mellitus (IDDM) for Hispanic versus non- Hispanic white children in Colorado.

RESEARCH DESIGN AND METHODS

Hispanic (n = 62) and non-Hispanic white (n = 82) subjects with IDDM identified from the Colorado IDDM Registry and healthy, nondiabetic control subjects were recruited. Human leukocyte antigen (HLA) serologic typing and sequence-specific oligonucleotide typing of DQA1 and DQB1 alleles were performed.

RESULTS

HLA and allele associations with IDDM were similar in both ethnic groups. HLA-DR3 and HLA-DR4 were more common in IDDM subjects in both ethnic groups. Subjects with DQB1 alleles encoding aspartic acid (Asp) in position 57 were less likely to have IDDM, irrespective of ethnic background. HL A-DR3 was less common among Hispanic subjects than non-Hispanic white control subjects (4.4 vs. 17.5%, Hispanics vs. non-Hispanic whites, P = 0.04).

CONCLUSIONS

These data suggest that the lower prevalence of HLA-DR3 in the Hispanic population, a pattern consistent with the presence of Amerindian admixture, may explain the lower rate of IDDM in the Hispanic population.
Linear Loss of Insulin Secretory Capacity During the Last Six Months Preceding IDDM: No effect of antiedematous therapy with ketotifen
Authors: Böhmer Kirsten P , Kolb Hubert , Kuglin Bernd , Zielasek Jürgen , Hübinger Achim , Lampeter Eberhard F , Weber Bruno , Kolb-Bachofen Victoria , Jastram H U , Bertrams Jörg , Arnold Gries F
Published: March 2007

OBJECTIVE

To investigate the effect of an antiedematous therapy with the histamine antagonist ketotifen on β-cell function in late prediabetes.

RESEARCH DESIGN AND METHODS

In a randomized double-blind placebo-controlled study, ketotifen was administered for 3 months to 9 islet cell antibody positive (ICA+) prediabetic patients with a first-phase insulin response (FPIR) below the 2.5th percentile to preserve residual β-cell function. Patients were followed by intravenous glucose tolerance tests (IVGTTs) every 4—6 weeks for determination of FPIR, HbA1, ICAs, and insulin autoantibodies. In 5 patients, the immune activation state was followed by determination of serum levels of tumor necrosis factor-α (TNF-α), (β2-microglobulin, and C-reactive protein (CRP).

RESULTS

Seven of nine patients developed diabetes within one year of followup. Irrespective of treatment with ketotifen, a slow and linear decline (P < 0.05) of 1 + 3-min insulin values was observed in sequential IVGTTs in those 7 patients who developed insulin-dependent diabetes mellitus (IDDM) during follow-up. The 2 other patients showed wide fluctuations of the insulin response with a threefold increase of initial insulin levels. HbAi did not correlate with FPIR. Fasting blood glucose increased significantly during the study (P < 0.05). Individual levels of serum TNF-α, CRP, and β2-microglobulin did not change during the study.

CONCLUSIONS

The study could not demonstrate preservation of β-cell function by ketotifen in the late stage before manifestation of clinical diabetes. Manifestation is preceded in the last 6 months by a steady loss of the FPIR without rapid deterioration immediately before diagnosis and without signs of increased immune activity.
Use Of Runs Test to Assess Cardiovascular Autonomic Function in Diabetic Subjects
Authors: Chau Nguyen Phong , Mestivier Denis , Chanudet Xavier , Bauduceau Bernard , Gautier Daniel , Larroque Pierre
Published: March 2007

OBJECTIVE

We suggest a simple, noninvasive method to assess the autonomie function in diabetic subjects. The method requires only a monitoring of heart rate (HR) with subjects in the sitting position.

RESEARCH DESIGN AND METHODS

Sixty diabetic subjects, 44 men and 16 women, between 20-80 years of age, were recruited, chronologically, for this study. Subjects treated for high blood pressure were not included. Their autonomic function was assessed by the total score of five classical cardiovascular function tests. In the same subjects and in 44 healthy subjects, blood pressure and HR were determined from beat to beat by the Finapres system with subjects in the sitting position. We examined the randomness of the HR changes by calculating the z statistic of the runs test on 1,000 successive HR readings (the z value is low if the HR changes are random). When the HR changes are random, we consider that the autonomic control of HR is impaired.

RESULTS

The z values of HR changes were significantly lower in diabetic subjects compared with normal subjects (2.98 ± 0.97 vs. 3.54 ± 0.97, ,P < 0.004). In diabetic subjects, the z value was closely correlated to the total score of disautonomy (r = –0.66, P < 0.0001, after correction for age effect) and to the office systolic blood pressure (r = –0.43, P < 0.001).

CONCLUSIONS

The z value of HR changes might be a marker of the autonomic function in diabetic subjects.
A Mathematical Model for the Determination of Total Area Under Glucose Tolerance and Other Metabolic Curves
Authors: Tai Mary M
Published: March 2007

OBJECTIVE

To develop a mathematical model for the determination of total areas under curves from various metabolic studies.

RESEARCH DESIGN AND METHODS

In Tai's Model, the total area under a curve is computed by dividing the area under the curve between two designated values on the X-axis (abscissas) into small segments (rectangles and triangles) whose areas can be accurately calculated from their respective geometrical formulas. The total sum of these individual areas thus represents the total area under the curve. Validity of the model is established by comparing total areas obtained from this model to these same areas obtained from graphic method Gess than ±0.4%). Other formulas widely applied by researchers under- or overestimated total area under a metabolic curve by a great margin.

RESULTS

Tai's model proves to be able to 1) determine total area under a curve with precision; 2) calculate area with varied shapes that may or may not intercept on one or both X/Y axes; 3) estimate total area under a curve plotted against varied time intervals (abscissas), whereas other formulas only allow the same time interval; and 4) compare total areas of metabolic curves produced by different studies.

CONCLUSIONS

The Tai model allows flexibility in experimental conditions, which means, in the case of the glucose-response curve, samples can be taken with differing time intervals and total area under the curve can still be determined with precision.
Insulin Antibody Responses After Long-Term Intraperitoneal Insulin Administration via Impiantatile Programmable Insulin Delivery Systems
Authors: Olsen Craig L , Chan Eve , Turner Dee S , Iravani Mohamed , Nagy Maria , Selam Jean-Louis , Wong Nathan D , Waxman Ken , Charles M Arthur
Published: March 2007

OBJECTIVE

To determine whether insulin antibodies are generated in diabetic patients after short- and long-term intraperitoneal insulin use and, if so, whether they are of potential clinical interest. Insulin antibodies commonly develop in diabetic patients who use subcutaneous human insulin, although their clinical significance remains controversial. Few data are available regarding insulin antibody responses to intraperitoneal insulin.

RESEARCH DESIGN AND METHODS

We studied insulin antibody levels and clinical diabetes control in 25 type 1 diabetic patients treated for 3-6 years with intraperitoneal surfactant-stabilized porcine modified human insulin delivered by implantable programmable insulin delivery systems.

RESULTS

All patients had preimplantation insulin antibody levels <20 μU/ml, with a mean value of 2 ± 2 μU/ml (1 SD). Mean antibody levels increased throughout the study period to a mean maximum of 197 ± 326 μU/ml (P < 0.02) with 11 of 25 (44%) patients' levels exceeding 20 μU/ml (insulin responders). The mean time to significant antibody development was 21.8 ± 4.4 months. Of the 11 responder patients, 4 had clinical syndromes that consisted of increasing daily insulin requirements and/or nocturnal hypoglycemia despite minimal nighttime basal insulin infusion rates associated with peak antibody levels >200 μU/ml. None of the nonresponder patients (antibody levels <20 (μU/ml) had these clinical findings.

CONCLUSIONS

Our results indicate that insulin antibody levels observed during intraperitoneal administration of human insulin are 1) similar to those reported during subcutaneous administration; although the rise in antibody level may be delayed compared with subcutaneous human insulin, 2) associated with a patient subset who are insulin antibody responders after switching from subcutaneous to intraperitoneal human insulin, 3) associated with a decrease in levels among responder patients regardless of whether they discontinue or continue pump use, and 4) associated with increased insulin needs and/or nocturnal hypoglycemia despite minimal basal rate insulin infusion at nighttime when antibody levels exceed 200 μU/ml.