bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Height and Glycosylated Hemoglobin in Abnormal Nerve Conduction in Pediatric Patients With Type I Diabetes Mellitus After 4–9 yr of Disease
Authors: Duck Stephen C , Wei Feifei F , Parke Julie , Swick Herbert M
Published: March 2007

Objective

To determine the role of height and glycosylated hemoglobin in abnormal nerve conduction in pediatric patients with insulin-dependent (type I) diabetes mellitus.

Research Design And Methods

Sixty-six pediatric patients (aged 6.3–18.2 yr) with a duration of diabetes from 4 to 8.5 yr but free of clinical neuropathy were evaluated for abnormal nerve conduction.

Results

Mean HbA1 values for 1 and 2 yr before study were available. Electroneurographic findings were significantly different from control subjects in upper and lower extremities and included all five measured velocities, three sensory latencies, and one amplitude. Stepwise regression analysis identified an adverse effect of height on latency (5 of 6) and of mean HbA1 concentration on decreasing velocity (4 of 5). The data analysis from 52 patients who were restudied and who had a duration of diabetes from 5.3 to 9.6 yr confirmed that all velocity values slowed; one of five values did so significantly. The coefficients associated with mean HbA1 concentration usually increased in both upper- and lower-extremity velocity analyses at the follow-up examination. The change in peroneal motor velocity between the first and last examinations was significantly related to the increasing time interval between examinations.

Conclusions

Prospective evaluation of nerve conduction parameters in pediatric patients with diabetes should include both height (the most significant independent variable in latency analysis) and mean glycemic control (the most consistent variable in velocity analyses) as variables in the assessment of the natural history of evolving peripheral neuropathy.
Insulin and Cardiovascular Disease: Paris Prospective Study
Authors: Fontbonne Annick M , Eschwège Eveline M
Published: March 2007

The Paris Prospective Study is a long-term investigation of coronary heart disease (CHD) risk factors in a large population of working men. The baseline cohort included 7028 men, 6093 who had a 75-g oral glucose tolerance test with measurement of plasma insulin and glucose levels (0 and 2 h) and 125 who were known non-insulin-treated diabetic patients. After a mean follow-up of 11 yr, 126 deaths ascribed to CHD were reported. Major independent predictors of CHD death were blood pressure, smoking, plasma cholesterol level, and fasting and 2-h postload plasma insulin level. Impairment of glucose tolerance, including overt diabetes, did not rank as an independent predictor when other baseline variables were accounted for. In the subset of the baseline cohort who presented with impaired glucose tolerance or diabetes (n = 943), 26 died from CHD during the follow-up. The strongest independent predictor of subsequent CHD death in this subsample with abnormal glucose tolerance was plasma triglyceride level. In view of the accumulating evidence that hyperinsulinemia and hypertriglyceridemia generally occur in the same type of subjects, in relation to insulin resistance and central obesity, the epidemiological findings of the Paris Prospective Study and of other investigations support the hypothesis that a constellation of mild metabolic abnormalities may play a deleterious role with regard to cardiovascular disease risk.
Obesity and Hypertension
Authors: Dustan Harriet P.
Published: March 2007

There is a close association of obesity with hypertension through mechanisms not now understood. Hypertension occurs frequently in industrialized societies where weight gain with advancing years is a common feature and is rare in primitive societies where weight and age are negatively correlated. Hemodynamically, obesity is characterized by an expanded blood volume and increased cardiac output. Hypertension results if/when systemic vascular resistance fails to decrease as cardiac output increases. When calorie restriction leads to weight loss, both blood volume and cardiac output decrease; when the blood pressure falls, this is because peripheral resistance is unchanged. Weight-loss programs are helpful for the obese hypertensive because when hypertension is mild, blood pressure often (but not always) normalizes. Also, weight loss has been shown to decrease antihypertensive drug requirements. Interest in obesity-associated hypertension focuses on hyperinsulinemia/insulin resistance as causative factors. Although the evidence is tempting, it is far from conclusive and it seems likely that the mechanism of this type of hypertension is as multifactorial as those of other types.
Accuracy of Blood Glucose Estimation by Children With IDDM and Their Parents
Authors: Gonder-Frederick Linda A , Snyder Andrea L , Clarke William L
Published: March 2007

Objective

To evaluate the accuracy of blood glucose symptom recognition and subjective blood glucose estimation in insulin-dependent diabetic (IDDM) children and their parents.

Research Design and Methods

Blood glucose estimation questionnaires were completed 4 times/day at home during routine activities. A sequential sample of 19 families, who attended a pediatric diabetes clinic, with IDDM children <2265; 12 yr old and IDDM duration of > or equal to 9 mo comprised the study.

Results

Error grid analysis showed that both children and parents demonstrated poor accuracy, making clinically significant errors as frequently as clinically accurate estimates. The most common error was the failure to detect extreme blood glucose levels, with a significant tendency to underestimate hyperglycemia. Children often reported hypoglycemia when blood glucose was hyperglycemic. Confidence in the ability to estimate blood glucose was unrelated to measured accuracy.

Conclusions

IDDM children and their parents demonstrated a higher rate of blood glucose estimation errors than IDDM adolescents and adults in previous studies. Even in families who use self-monitoring of blood glucose frequently, self-reported ability to recognize symptoms and estimate blood glucose should be viewed with caution. Families with IDDM children need more education about errors in symptom recognition and blood glucose estimation. They should also be encouraged to use self-monitoring of blood glucose before treating children's reported hypoglycemic symptoms whenever possible.
Therapeutic Potentials of Acarbose as First-Line Drug in NIDDM Insufficiently Treated With Diet Alone
Authors: Hanefeld Markolf , Fischer Sabine , Schulze Jan , Spengler Manfred , Wargenau Manfred , Schollberg Karl , Fücker Katja
Published: March 2007

Objecative

Acarbose inhibits α-glucosidases of the small intestine and thus delays glucose release from complex carbohydrates. Therefore, its efficacy and acceptability as a first-line drug in non-insulin-dependent diabetes mellitus (NIDDM) insufficiently treated with diet alone was tested in a randomized double-blind placebo-controlled study.

Research Design And Methods

Ninety-four NIDDM subjects, aged 43–70 yr with average body mass index of 28 kg/m2 and undergoing a pretreatment period of at least 3 mo with diet alone, were treated with 100 mg acarbose three times daily or placebo for 24 wk. The patients were recruited after a 4-wk screening period of dietary reinforcement. The inclusion limits for patients termed diet not satisfactory were fasting blood glucose (FBG) ≥ 7.8 mM and/or postprandial blood glucose (BG) ≥ 10 mM.

Results

FBG was lowered in the acarbose group from 9.8 to 8.4 mM and in the placebo group from 10.2 to 9.6 mM after 24 wk (P = 0.007 vs. placebo). The most impressive therapeutic effect was a highly significant reduction of postprandial hyperglycemia for at least 5 h after the test meal (1-h postprandial BG with acarbose 10.4 mM and placebo 13.5 mM at 24 wk, P < 0.001) accompanied by a significant decrease in HbA1 (acarbose 8.65%, placebo 9.32%, P = 0.003). Whereas C-peptide and fasting serum insulin were not significantly affected by acarbose, postprandial insulin increment was ∼ 30% lower after 24 wk compared with placebo. Furthermore, acarbose significantly reduced 1-h postprandial triglyceride levels. After an initial phase of > 4 wk (when 76.6% in the acarbose group vs. 28% on placebo complained about flatulence, P < 0.001), the drug was well accepted. At the end of the study, only 32% showed mild or moderate gastrointestinal sensations.

Conclusions

Extrapolation shows that acarbose is an efficient and acceptable drug for the treatment of NIDDM with poor metabolic control by diet alone. It has beneficial effects on postprandial hyperinsulinemia and postprandial hypertriglyceridemia.
Body Mass is a Poor Predictor of Peak Plantar Pressure in Diabetic Men
Authors: Cavanagh Peter R , Sims David S , Sanders Lee J
Published: March 2007

Objective

To examine the relationship between peak plantar pressure during walking and body mass in diabetic patients and age-matched control subjects.

Research Design And Methods

A volunteer sample of 56 male diabetic veterans (12 insulin dependent, 44 non-insulin dependent) with a mean age of 58.9 yr, mean duration of diabetes of 16.9 yr, and mean vibration perception threshold of 30.8 and 27 age-matched nondiabetic control subjects comprised the study.

Results

Peak plantar pressure was measured with a 1000-element piezoelectric platform during the first step of gait. The correlation between body mass and peak pressure was found to be only 0.37 in the patients with diabetes and 0.36 in the control subjects, indicating that body mass accounts for < 14% of the variance in peak plantar pressure. The body mass and peak plantar pressure of the 14 patients who experienced plantar ulcers was not significantly different from those who did not ulcerate, but vibration perception thresholds and monofilament perception thresholds of the ulcer patients were significantly higher.

Conclusions

Although the correlation between body mass and peak plantar pressure is statistically significant, the functional relationship between the two variables is weak. Elevated plantar pressures are as likely to occur in small individuals as they are in those with large body mass. Foot deformity, in the presence of neuropathy and other permissive factors, is itself likely to be an important risk factor for plantar ulceration in diabetes, and this hypothesis deserves further exploration.
Effect of Meal on Retinal Blood Flow in IDDM Patients
Authors: Sullivan Paul M , Parfitt Vernon J , Jagoe Roger , Newsom Richard , Kohner Eva M
Published: March 2007

Objective

The effect of postprandial hyperglycemia on retinal blood flow was examined in 11 adults with insulin-dependent diabetes mellitus (IDDM) and 9 nondiabetic subjects.

Research Design And Methods

Retinal blood flow was measured with bidirectional laser Doppler velocimetry before and 60 and 120 min after a 50-g carbohydrate breakfast. Diabetic subjects were studied twice, being randomized to take their usual insulin (isoglycemic study) or to omit their morning short-acting insulin (hyperglycemic study). Nondiabetic subjects were studied once and received no insulin.

Results

Plasma glucose rose significantly (from 11.5 ± 5.2 to 22.1 ± 5.5 mM, P < 0.001) during the hyperglycemic study but not during the isoglycemic or nondiabetic studies. There were no significant changes in blood pressure or retinal blood flow in any of the groups studied.

Conclusions

Short-term hyperglycemia does not increase retinal blood flow.
In-Hospital Prognosis of Ppatients With Fasting Hyperglycemia After First Myocardial Infarction
Authors: O'Sullivan John J , Conroy Ronan M , Robinson Killian , Hickey Noel , Mulcahy Risteard
Published: March 2007

Objective

To investigate the incidence and prognostic significance of fasting hyperglycemia in a large group of patients with a first myocardial infarction.

Research Design and Methods

Blood glucose was measured after an 8-h overnight fast in 752 patients with a first myocardial infarction. Three groups of patients were identified: patients with normal fasting blood glucose (92.5%), patients with fasting hyperglycemia but no prior history of glucose intolerance (3%), and patients previously known to have diabetes mellitus (4.5%).

Results

The fasting hyperglycemic patients were significantly older and had significantly more in-hospital complications than the normal blood glucose group. Previously known diabetic subjects tended to be older and had more mechanical complications postinfarction than the group with normal blood glucose but the difference did not reach statistical significance. There was no significant difference between the diabetic subjects and patients with fasting hyperglycemia in mean age and in-hospital prognosis.

Conclusions

Fasting hyperglycemia detected after a first myocardial infarction is associated with a poor in-hospital prognosis that was not due to larger infarct size, as reflected in peak levels of cardiac enzymes. The measurement of a fasting blood glucose level provides additional information in identifying high-risk groups of patients postinfarction.
Glutathione Infusion Potentiates Glucose-Induced Insulin Secretion in Aged Patients With Impaired Glucose Tolerance
Authors: Paolisso Giuseppe , Giugliano Dario , Pizza Gennaro , Gambardella Antonio , Tesauro Paola , Varricchio Michele , D'Onofrio Felice
Published: March 2007

Objective

–To evaluate the effect of glutathione infusion on β-cell response to glucose in elderly people with impaired glucose tolerance (IGT).

Research Desigh and Methods

–Ten patients with normal glucose tol-erance and 10 patients with IGT were matched for age (mean ± SE, 72.1 ± 2.8 vs. 71.0 ± 3.4 yr), body mass index (23.1 ± 1.1 vs. 22 ± 2.1 kg/m2), and sex (6/4 vs. 5/5, men/women) underwent glutathione infusion (10 mg/min) under basal conditions and during 75-g oral glucose tolerance tests and intravenous glucose tolerance tests (0.33 g.kg body wt−1.3 min−1). Patients with IGT were also submitted to euglycemic-hyperinsulemic and hyperglycemic glucose clamps.

Results

–In subjects with normal glucose tolerance, glutathione infusion failed to affect β-cell response to glucose. In contrast, glutathione significantly potentiated glucose-induced insulin secretion in patients with IGT. Furthermore, in the latter group studied by hyperglycemic clamps, glutathione infusion significantly potentiated the beta-cell response to glucose when plasma glucose levels varied between 10 and 15 mM. This effect disappeared at plasma glucose levels <15 mM. No effect of glutathione on insulin clearance and action was observed.

Conclusios

–Glutathione infusion enhances insulin secretion in elderly people with IGT.
Prevalence of Diabetes and Impaired Glucose Tolerance Among Navajo Indians
Authors: Sugarman Jonathan R , Gilbert Timothy J , Weiss Noel S
Published: March 2007

Objective

To estimate the prevalence of diabetes mellitus and impaired glucose tolerance and the incidence of clinically diagnosed diabetes in a community of Navajo Indians.

Research Design and Methods

We conducted a survey of a representative Navajo community screened for diabetes 3 yr previously. We used 75-g oral glucose tolerance tests to determine the prevalence of diabetes mellitus and impaired glucose tolerance and conducted medical record reviews to identify cases of diabetes that were diagnosed during routine medical care after the earlier study.

Results

By World Health Organization diagnostic criteria, the age-adjusted diabetes prevalence among 419 Navajo Indians 20–74 yr of age was 13.9% (95% confidence interval [CI] 9.2–18.5) for men and 18.4% (95% CI 14–22.8) for women. The ratio of the prevalence of diabetes among the Navajo population studied to that in the general United States population was 2.5. The prevalence of impaired glucose tolerance was 8% (95% CI 3.3–12.7) among men and 12.9% (95% CI 7.9–17.9) among women. Based on clinical diagnoses of diabetes made during routine medical care, mean ± SE age-adjusted incidence of diagnosed diabetes among men was 8.6 ± 4.3/1000 person-yr and 11.1 ± 4.4/1000 person-yr among women.

Conclusions

Although lower than that of some other tribes, the prevalence of diabetes among Navajo Indians is substantially higher than that in the general U.S. population. The high rate of clinical diagnoses suggests that the prevalence of the disease may continue to rise.
Randomized Comparison of Metabolic Control Achieved by Intraperitoneal Insulin Infusion With Implantable Pumps Versus Intensive Subcutaneous Insulin Therapy in Type I Diabetic Patients
Authors: Selam Jean-Louis , Raccah Denis , Jean-Didier Nathalie , Lozano Jim L , Waxman Ken , Charles M Arthur
Published: March 2007

Objective

–To compare intraperitoneal implantable insulin infusion (IP) to subcutaneous (SC) intensive insulin therapy.

Research Design and Methods

–Twenty-one insulin-dependent (type I) diabetic patients aged 24–61 yr underwent a 3-mo treatment optimization using multiple SC daily injections or external pumps. Patients were then randomized (time 0 mo) to IP infusion using Infusaid-programmable pumps or continuation on SC intensive insulin for 6 mo.

Results

–No differences were noted between study and control group data. However, longitudinal within-group comparisons from baseline showed that glycosylated hemoglobin improved to near-normal in both groups: IP, 9.0 ± 0.5 vs. 7.8 ± 0.6% (P < 0.05) and SC, 8.4 ± 0.5 vs. 7.5 ± 0.3% (P < 0.5) at 0 and 4 mo, respectively (normal < 6.9%). The percentage of blood glucose tests > 11 mM at 0 and 6 mo was 28 ± 5 vs. 16 ± 4% in the IP group (P < 0.05) and 22 ± 5 vs. 24 ± 7% in the SC group (NS). At 0 and 6 mo, the standard deviation of blood glucose values, an index of glycemic fluctuations, was 4.3 ± 0.4 vs. 3.2 ± 0.5 mM in the IP group (P < 0.05) and 3.7 ± 0.3 vs. 4.0 ± 0.4 mM in the SC group (NS). Weight, insulin dosages, circulating lipid levels, and the frequency of severe hypoglycemic reactions and biochemical hypoglycemias were similar and did not change in the two groups.

Conclusions

–IP-implantable pumps compared with SC intensive insulin therapy have similar effects on most metabolic variables and are equally effective at achieving near-normal glycemic levels. Only longitudinal data suggest that IP treatment may be more effective at limiting glycemic fluctuations.
Benefits and Risks With Glyburide and Glipizide in Elderly NIDDM Patients
Authors: Brodows Robert G
Published: March 2007

Objective

–To compare the efficacy, benefits, and risks of glyburide and glipizide in elderly patients with non-insulin-dependent diabetes mellitus (NIDDM).

Research Design and Methods

–Twenty-one elderly outpatients (mean age 70 yr) were treated for 8 wk, after being dose-titrated to achieve a fasting plasma glucose (FPG) concentration of < 7.8 mM with glyburide or glipizide in a randomized crossover trial. FPG and postprandial plasma glucose, serum C-peptide, and HbA1c levels were measured. In 13 patients, self-monitoring of blood glucose (SMBG) with a memory meter was performed seven times per week.

Results

–Glipizide (11.9 mg) and glyburide (8.4 mg) produced similar fasting and postprandial plasma glucose and HbA1c concentrations. No significant differences in basal or stimulated C-peptide levels were detected. Despite a few patient reports of hypoglycemia, a high incidence of SMBG readings < 4.5 mM was attributed to the use of both drugs.

Conclusions

–Both treatments proved effective for glycemic control; however, both second-generation sulfonylureas are associated with a significant risk of hypoglycemia in elderly NIDDM patients. The proper use of sulfonylureas in this population should include close surveillance of ambulatory glucose monitoring and intensive and repeated patient education about the risks of hypoglycemia.
Relationship of Fetal Macrosomia to Maternal Postprandial Glucose Control During Pregnancy
Authors: Combs C Andrew , Gunderson Erica , Kitzmiller John L , Gavin Laurence A , Main Elliot K
Published: March 2007

OBJECTIVE

To determine the gestational ages at which maternal hyperglycemia is most closely related to fetal macrosomia; to determine whether macrosomia is related to elevations of fasting glucose, postprandial glucose, or both; and to assess the relationship of macrosomia to maternal insulin dose and caloric intake.

RESEARCH DESIGN AND METHODS

One hundred eleven consecutive pregnant women with Class B through RF diabetes were studied longitudinally from 13 to 36 wk gestation. Macrosomia was defined by birthweight > 90th percentile for gestational age based on California norms. Women who delivered macrosomic infants were compared with those without macrosomic infants on pre- and postprandial blood glucose, GHb, insulin dose, macronutrient intake, and several other maternal variables.

RESULTS

Macrosomia occurred in 32 (29%) cases, although several measures indicated reasonable glycemic control throughout pregnancy. Women delivering macrosomic infants did not differ from those without macrosomic infants in maternal age, prepregnant weight, duration of diabetes, White class, macronutrient intake, GHb, or fasting glucose. Macrosomia was associated with higher postprandial glucose levels up to 32 wk gestation and lower insulin doses from 29 to 36 wk gestation. In multiple logistic regression, macrosomia was significantly associated with postprandial glucose only between 29 and 32 wk gestation. Postprandial glucose values < 7.3 mM (< 130 mg/dl) were associated with a higher risk of small-for-gestational-age infants (18%) compared with values above this level (1%).

CONCLUSIONS

Because macrosomia was related to postprandial glucose but not fasting glucose, we conclude that postprandial glucose measurement should be a part of routine care for diabetes in pregnancy. A target 1-h postprandial glucose value of 7.3 mM (130 mg/dl) may be the level that optimally reduces the incidence of macrosomia without increasing the incidence of small-for-gestational-age infants.
Effect of Insulin Therapy on Blood Pressure in NIDDM Patients With Secondary Failure
Authors: Randeree Hoosen A , Omar Mahomed A K , Motala Ayesha A , Seedat Mohomed A
Published: March 2007

OBJECTIVE

To assess the effect of insulin therapy on blood pressure in NIDDM patients with secondary failure.

RESEARCH DESIGN AND METHODS

The influence of insulin treatment on blood pressure was assessed retrospectively in a group of 80 NIDDM patients with secondary failure to diet and maximum doses of oral hypoglycemic agents. Weight, blood glucose, and blood pressure were recorded over a 3-mo period before and after the initiation of insulin therapy.

RESULTS

There was a significant rise in systolic (131.8 ± 1.7 to 148 ± 1.9 mmHg, P < 0.05) and diastolic (80.9 ± 0.9 to 89.2 ± 1.0 mmHg, P < 0.02) blood pressures with insulin treatment. Insulin treatment was associated with a significant decrease in blood glucose (18.36 ± 0.28 to 10.4 ± 0.34 mM, P < 0.01) and an increase in weight (72.1 ± 1.6 to 78 ± 1.7 kg, P = 0.01). A control group of 80 NIDDM patients matched for age, weight, BMI, and duration of diabetes demonstrated no significant change in blood pressure over a matched period of follow-up.

CONCLUSIONS

This study has shown that insulin therapy is associated with significant elevation of both systolic and diastolic blood pressures.
Prevalence of Carotid Atherosclerosis in Diabetic Patients Ultrasound high-resolution B-mode imaging on carotid arteries
Authors: Kawamori Ryuzo , Yamasaki Yamasaki , Matsushima Hiroyuki , Nishizawa Hideko , Nao Katsunori , Hougaku Hougaku , Maeda Hiroaki , Handa Nobuo , Matsumoto Masayasu , Kamada Takenobu
Published: March 2007

OBJECTIVE

To quantitatively assess atherosclerosis of the carotid artery in subjects with and without diabetes.

RESEARCH DESIGN AND METHODS

Ultrasound high resolution B-mode imaging of carotid arteries was conducted on 71 nondiabetic subjects without hyperlipidemia or hypertension and 295 diabetic patients to determine IMT of the arterial wall.

RESULTS

IMT was linearly related with age in nondiabetic (IMT = [0.0087 × age] + 0.3318) and diabetic subjects (IMT = [0.0155 × age] + 0.32450). The regression coefficient for age was significantly greater in diabetic than nondiabetic subjects. IMT (mean ± SD) of diabetic subjects aged 20–29 was significantly > that of nondiabetic subjects aged 20–29 (0.73 ± 0.27 vs. 0.52 ± 0.07 mm, P < 0.01). Multivariate regression analysis of 275 NIDDM patients indicated smoking, hyperlipidemia, duration of diabetes, hypertension, and age were factors determining thickness of the carotid arterial wall.

CONCLUSIONS

Diabetes, along with age, hyperlipidemia, smoking, and hypertension, aggravates carotid atherosclerosis.
Diabetes Mellitus in Alaskan Yup'ik Eskimos and Athabascan Indians after 25 Yr
Authors: Murphy Neil J , Schraer Cynthia D , Bulkow Lisa R , Boyko Edward J , Lanier Anne P
Published: March 2007

OBJECTIVE

To estimate the prevalence of diabetes mellitus and overweight in two populations of Alaska Natives and to compare the results with previous data.

RESEARCH DESIGN AND METHODS

Participants' heights, weights, and random plasma glucose levels were determined. Those with a glucose of ≥ 6.72 mM received a follow-up glucose-tolerance test, interpreted by WHO criteria. Overweight was defined by National Center for Health Statistics criteria and also by criteria used in previous studies. The subjects were Eskimo and Athabascan residents ≥ 40 yr of age in 15 villages in southwestern Alaska.

RESULTS

Diabetes prevalence was 4.7% for Eskimos and 10.0% for Indians. Among Eskimo men and women, the prevalence of overweight was 34 and 56%, respectively, among Indian men and women, it was 29 and 55%, respectively. Comparisons with past data indicate that the prevalence of diabetes has increased from 1.7% in 1962 for Eskimos and 1.8% in 1969 for Indians.

CONCLUSIONS

The prevalence of diabetes appears to have increased among Eskimos and Indians in Alaska. Overweight appears to be a significant problem in both groups.
Increased Plasma Endothelin in NIDDM Patients With Retinopathy
Authors: Kawamura Makiko , Ohgawara Hisako , Naruse Mitsuhide , Suzuki Nobuhiro , Iwasaki Naoko , Naruse Kiyoko , Hori Sadao , Demura Hiroshi , Omori Yasue
Published: March 2007

OBJECTIVE

To elucidate the significance of ET in diabetic microvascular disease.

RESEARCH DESIGN AND METHODS

We determined plasma levels of ir-ET-1 in 25 NIDDM patients without hypertension and/or renal dysfunction.

RESULTS

The plasma levels of ir-ET-1 in NIDDM patients with simple (n = 8) and proliferative (n = 8) retinopathy were 0.58 ± 0.04 pM and 0.60 ± 0.04 pM, respectively, which were significantly higher than those in normal, nondiabetic subjects (0.24 ± 0.02 pM [n = 31]) and NIDDM patients without retinopathy (0.30 ± 0.05 pM [n = 9]).

CONCLUSIONS

These results suggest that plasma ET-1 is related to diabetic microvascular disease.
Stress and Diabetes Mellitus
Authors: Surwit Richard S , Schneider Mark S , Feinglos Mark N
Published: March 2007

Stress is a potential contributor to chronic hyperglycemia in diabetes. Stress has long been shown to have major effects on metabolic activity. Energy mobilization is a primary result of the fight or flight response. Stress stimulates the release of various hormones, which can result in elevated blood glucose levels. Although this is of adaptive importance in a healthy organism, in diabetes, as a result of the relative or absolute lack of insulin, stress-induced increases in glucose cannot be metabolized properly. Furthermore, regulation of these stress hormones may be abnormal in diabetes. However, evidence characterizing the effects of stress in type I diabetes is contradictory. Although some retrospective human studies have suggested that stress can precipitate type I diabetes, animal studies have shown that stressors of various kinds can precipitate—or prevent—various experimental models of the disease. Human studies have shown that stress can stimulate hyperglycemia, hypoglycemia, or have no affect at all on glycemic status in established diabetes. Much of this confusion may be attributable to the presence of autonomic neuropathy, common in type I diabetes. In contrast, more consistent evidence supports the role of stress in type II diabetes. Although human studies on the role of stress in the onset and course of type II diabetes are few, a large body of animal study supports the notion that stress reliably produces hyperglycemia in this form of the disease. Furthermore, there is mounting evidence of autonomic contributions to the pathophysiology of this condition in both animals and humans.
Evaluating Diabetes Education: Are we measuring the most important outcomes?
Authors: Glasgow Russell E , Osteen Virginia L
Published: March 2007

This article reviews the published literature on diabetes education evaluations and makes recommendations for outcome measures to be used in future research. We conclude that program evaluations to date have focused too narrowly on assessing knowledge and GHb outcomes to the exclusion of other important variables. To reflect the changing emphasis and conceptual basis of diabetes education, we recommend that future evaluations do the following: 1) report on the program's target population, recruitment methods, and representativeness of participants; 2) collect measures of self-efficacy and patient-provider interaction; 3) include quality of life and patient-functioning outcomes; and 4) use more standardized and objective measures of diabetes management behaviors. We close by providing practical examples of feasible collection measures for most settings and references to studies that have done so.
Family History of Diabetes in Relation to Different Types of Obesity and Change of Obesity During 12-yr Period: Results from prospective population study of women in Göteborg, Sweden
Authors: Lapidus Leif , Bengtsson Calle , Lissner Lauren , Smith Ulf
Published: March 2007

OBJECTIVE

To assess the relationship between family history and different types of obesity and change in obesity in a longitudinal population study.

RESEARCH DESIGN AND METHODS

A longitudinal population study of 1462 randomly selected women (38–60 yr old) was conducted in Göteborg, Sweden, in 1968–69. The women were restudied after 12 yr.

RESULTS

A family history of diabetes in mothers but not fathers showed, in univariate analysis, a significant positive association with obesity expressed as BMI. A family history of diabetes in the mothers was inversely related to body fat distribution expressed as WHR. No other association was observed between family history of diabetes and WHR. The association with BMI was independent of age, WHR, smoking habits, blood glucose, systolic blood pressure, serum cholesterol, serum triglycerides, maternal obesity, and the incidence of diabetes during the 12-yr follow-up period. Twelve years later, in 1980–1981, an independent association still existed between family history for diabetes and BMI measured at that examination, whereas there was no relationship with WHR. Women who had a family history of diabetes increased their BMI significantly more during the 12-yr follow-up compared with the women without a family history of diabetes, whereas there was no difference for the change of WHR. Family history of coronary heart disease and family history of cancer did not correlate to any kind of obesity.

CONCLUSIONS

These findings indicate that family history of diabetes is related to overall obesity but not to abdominal adiposity per se.
Contraception in Women With IDDM: An epidemiological study
Authors: Kjær Karen , Hagen Claus , Sandø Steen H , Eshøj Ole
Published: March 2007

OBJECTIVE

To study whether suitable contraceptive methods to women with diabetes mellitus in fact are applied.

RESEARCH DESIGN AND METHODS

A questionnaire survey on the use of contraceptives in all 18-to-49-yr-old women (n = 261) with IDDM in Funen County, Denmark, and an age-comparable control group, (n = 287) was performed. Data were collected from 1987 to 1990. Response was achieved from 94% diabetic women and 88% control subjects.

RESULTS

The overall use of contraception in diabetic women (77.1%) was almost identical to that of control subjects (73.6%). Compared with control subjects, significantly fewer diabetic women were using the OCP (P < 0.005) and partner sterilization (P < 0.05), whereas more diabetic women were sterilized (P < 0.0005). Among diabetic contraceptive users, the IUD, female sterilization, condoms, and the OCP each accounted for roughly 20%. Diabetic women using the OCP were predominantly young, and most had never been pregnant; ∼ 20% of them used high-dose formulations. Sterilization was frequently used by older diabetic women, and most of these women had 2 or more children; 27% of the diabetic women using an IUD were nulligravidae. Further, 18% used a method with an unsuitable high failure rate.

CONCLUSIONS

Our study demonstrates that diabetic women are not sufficiently advised concerning use of contraception.
Psychosocial Problems and Interventions in Diabetes: A review of the literature
Authors: Rubin Richard R , Peyrot Mark
Published: March 2007

This article reviews and organizes the recent literature on psychosocial problems and interventions in diabetes to see if it is possible to identify effective modes of treatment for numerous different psychosocial problems. An attempt was made to review extensively the references on psychosocial problems and to review exhaustively the references on psychosocial interventions. The review was organized under four major headings: psychological sequelae of medical crises, psychopathology in diabetes, stress and hassles in living with diabetes, and family dysfunctions. Results of the literature review were similar for all areas: although some studies suggested that these problems are especially severe for people with diabetes, the best-designed studies suggested that this was not so. Regardless of the prevalence of these problems in the diabetic population at large, individuals who suffer from these problems are at special risk for reduced physical and emotional well-being, so they need psychosocial interventions that effectively resolve their difficulties. Unfortunately, the literature on psychosocial interventions in diabetes is meager, and it lacks the systematic, quantitative evaluations necessary to identify effective modes of treatment for different psychosocial problems. It is possible to state tentatively that certain interventions have been used for specific problems with some indication that they can be effective. Issues for future research are identified. Addressing these issues might provide a foundation for making decisions about areas ripe for clinical trials, and ultimately determining which intervention is best suited for treating any given psychosocial problem.
Effects of Exercise on Insulin Sensitivity in Humans
Authors: Devlin John T
Published: March 2007

Physical exercise is promoted as one of the primary therapeutic strategies available to increase insulin sensitivity in individuals deemed at risk from insulin resistance and its attendant hyperinsulinism. Subjects with non-insulin-dependent diabetes mellitus (NIDDM) and impaired glucose tolerance (IGT) represent the major clinical population in which physical training is promoted as a treatment modality to improve insulin sensitivity. This manuscript reviews both the acute effects of muscular contractions and the effects of physical training on insulin sensitivity in NIDDM and insulin-dependent diabetic (IDDM) human subjects. Additionally, the effects of localized (regional) muscular contractions on insulin-mediated glucose disposal in previously exercised and nonexercised muscle groups will be discussed briefly.
Does Training Spare Insulin Secretion and Diminish Glucose Levels in Real Life?
Authors: Dela Flemming , Mikines Kári J , von Linstow Michael , Galbo Henrik
Published: March 2007

Compared with untrained subjects, in trained subjects the increased insulin sensitivity and decreased glucose induced insulin secretion will tend to promote health by decreasing glucose levels and insulin secretion, whereas the increased food intake will tend to increase these variables. To evaluate the net effect of training, we administered oral glucose loads making up identical fractions of daily carbohydrate intake (i.e., same relative glucose loads) to 8 athletes and 7 sedentary subjects (age: 25 ± 1 vs. 24 ± 1 yr [mean ± SE] [NS]; body weight: 76.0 ± 1.3 vs. 79.3 ± 2.3 kg [NS]; maximal oxygen uptake: 76 ± 2 vs. 48 ± 1 ml O2 · kg−1 · min−1 [2P < 0.05], respectively). Furthermore, 24 h plasma concentration profiles of glucose, C-peptide, and insulin were determined during ordinary living conditions. Daily carbohydrate intake was higher (2P < 0.05) in athletes compared with sedentary subjects (678 ± 34 vs. 294 ± 18 g · day−1, respectively). In response to same relative oral glucose loads, glucose and C-peptide responses were similar in athletes compared to sedentary subjects. Twenty-four hour integrated glucose and C-peptide concentrations did not differ between athletes and sedentary subjects (7.4 ± 0.2 vs. 7.3 ± 0.6 mol · L−1 · 1440 min [2P > 0.05] and 923 ± 99 vs. 1047 ± 175 pM · ml−1 · 1440 min [2P > 0.05], respectively), and insulin concentrations tended to be lower in athletes compared with sedentary subjects (124 ± 13 vs. 175 ± 38 pM · ml−1 · 1440 min [2P > 0.05]). It is concluded that, during training, adaptations in pancreas and insulin sensitive tissues allow the necessary increase in food intake without harmful hyperglycemia and overloading of (β-cells, but sparing of insulin secretion and reductions in glucose levels are only relative to food intake. However, training may be wholesome by increasing hepatic insulin extraction and thereby decreasing arterialinsulin levels.
Telematic expert system Diabeto: New Tool for Diet Self-Monitoring for Diabetic Patients
Authors: Turnin Marie-Christine G , Beddok René H , Clottes Jacqueline P , Martini Pascale F , Abadie Robert G , Buisson Jean-Christophe , Dupuy Chantal-Soulé , Bonneu Michel , Camaré Rita , Anton Jean-Paul , Chrisment Claude Y , Farreny Henri , Bayard Francis , Tauber Jean-Pierre J
Published: March 2007

Objective

— To evaluate Diabeto, a computer-assisted diet education system.

Research Design And Methods

— One hundred five patients with insulin-dependent diabetes mellitus (IDDM) or non-insulin-dependent diabetes mellitus (NIDDM) were divided into two randomized groups to participate in the evaluation of Diabeto. With free access through Minitel, the French public videotex network, Diabeto helps diabetic patients self-monitor their diets and balance their meals with personalized counseling.

Results

— During the first 6-mo study, group A (54 patients) used Diabeto, whereas group B (51 patients) were control subjects. For the second 6-mo study, group B used the system. Evaluation was based on patients' dietetic knowledge, dietary habits, and metabolic balance.

Conclusions

–Diabeto led to a significant improvement of dietetic, knowledge in group A (P < 0.0005) and also to improved dietary habits; decreased caloric intake in patients initially overeating (P < 0.05), increase of dietary carbohydrate from 39.7 ± 0.7 to 42.9 ± 0.9% in patients with an initial intake <45% carbohydrate, and decrease of fat intake from 41.9 ± 0.9 to 37.4 ± 1.1% in patients with an initial intake of >35% fat (P < 0.0005). In the second study, in addition to similar improvements to those observed in the first study, HbA1 decreased from 11.0 ± 0.4 to 9.9 ± 0.4% (P < 0.005) and fructosamine from 5.00 ± 0.17 to 4.57 ± 0.17% (P < 0.001). Diabeto appears to be an effective therapeutic tool in the control of metabolic diseases.
Assessment of Experts' Approach to Insulin Therapy and Development of a Simulator for Diabetes Insulin Adjustment
Authors: Hauser Thomas , Kraegen Edward W , Campbell Lesley V , Compton Paul J , Sammut Claude , Chisholm Donald J
Published: March 2007

Objective

— To develop a computer program (Macintosh) to predict changes in blood glucose after changes in insulin dose, timing, and regimen.

Research Design and Methods

— We established program parameters (apparent insulin action profiles; different for insulin-dependent and non-insulin-dependent diabetes mellitus) to match predictions by five diabetes specialists at our hospital of blood glucose changes after insulin-dose adjustment in 22 hypothetical patient cases. We compared the action profiles, which represent the blood glucose changes predicted by the experts with glucose-clamp studies of insulin action. We tested the program's performance in 22 different hypothetical cases against the responses of 15 specialists from outside our hospital.

Results

— The specialists, when predicting effects of insulin dose adjustment, integrate numerous processes (insulin action, diet, sequential blood glucose interactions). They could not specify algorithms for determining these individual factors, but they could easily predict the overall effect in the context of patient cases. The computer program's insulin-action profiles simulate this “composite” approach. The developed program incorporates multiple insulin regimens, which may be changed during the stimulation, and adjusts predicted responses according to the patient's estimated sensitivity to insulin. Its predicted change in 172 blood glucose levels (22 cases) correlated well with the corresponding means of the outside specialists (r = 0.83, P = 0.0001). Comparing this correlation with that of individual specialists ranked the program third.

Conclusions

—A computer program can simulate specialists' “composite” approach (not based purely on conscious application of physiological data) to insulin adjustment.
Pathogenesis of NIDDM: A Balanced Overview
Authors: DeFronzo Ralph A , Bonadonna Riccardd C , Ferrannini Eleuterio
Published: March 2007

Non-insulin-dependent diabetes mellitus (NIDDM) results from an imbalance between insulin sensitivity and insulin secretion. Both longitudinal and cross-sectional studies have demonstrated that the earliest detectable abnormality in NIDDM is an impairment in the body's ability to respond to insulin. Because the pancreas is able to appropriately augment its secretion of insulin to offset the insulin resistance, glucose tolerance remains normal. With time, however, the β-cell fails to maintain its high rate of insulin secretion and the relative insulinopenia (i.e., relative to the degree of insulin resistance) leads to the development of impaired glucose tolerance and eventually overt diabetes mellitus. The cause of pancreatic “exhaustion” remains unknown but may be related to the effect of glucose toxicity in a genetically predisposed β-cell. Information concerning the loss of first-phase insulin secretion, altered pulsatility of insulin release, and enhanced proinsulin-insulin secretory ratio is discussed as it pertains to altered β-cell function in NIDDM. Insulin resistance in NIDDM involves both hepatic and peripheral, muscle, tissues. In the postabsorptive state hepatic glucose output is normal or increased, despite the presence of fasting hyperinsulinemia, whereas the efficiency of tissue glucose uptake is reduced. In response to both endogenously secreted or exogenously administered insulin, hepatic glucose production fails to suppress normally and muscle glucose uptake is diminished. The accelerated rate of hepatic glucose output is due entirely to augmented gluconeogenesis. In muscle many cellular defects in insulin action have been described including impaired insulin-receptor tyrosine kinase activity, diminished glucose transport, and reduced glycogen synthase and pyruvate dehydrogenase. The abnormalities account for disturbances in the two major intracellular pathways of glucose disposal, glycogen synthesis, and glucose oxidation. In the earliest stages of NIDDM, the major defect involves the inability of insulin to promote glucose uptake and storage as glycogen. Other potential mechanisms that have been put forward to explain the insulin resistance, include increased lipid oxidation, altered skeletal muscle capillary density/fiber type/blood flow, impaired insulin transport across the vascular endothelium, increased amylin, calcitonin gene-related peptide levels, and glucose toxicity.
Measurement of Health Status in Diabetic Patients: Diabetes Impact Measurement Scales
Authors: Hammond G Steven , Aoki Thomas T
Published: March 2007

Objective

To develop an instrument to measure health status in adult insulin-dependent (type I) and non-insulin-dependent (type II) diabetic patients.

Research Design and Methods

Correlative study to examine psychometric properties of the questionnaire. Test-retest reliability, item-scale correlations, principal-components analysis, correlations with global clinical ratings, and correlations with clinical data extracted from medical records were examined at the diabetes clinics at the University of California, Davis, Medical Center. Patients were volunteer clinic patients able to complete the questionnaire. One hundred thirty patients completed a first administration of the questionnaire, and 52 completed a second administration.

Results

Test-retest reliability was satisfactory. Item-scale correlations showed that 40 of 44 questionnaire items were highly correlated with subscale and total scale scores. Principal-components analysis identified one major factor measured by the questionnaire. Cronbach's α, a measure of the scales' internal consistency, was of satisfactory magnitude. Global ratings of clinical status by patients and clinicians were highly correlated with scale scores. Correlations of scale scores with clinical data were generally of low magnitude but, where significant, were consistently in the direction hypothesized if the scale truly measures health status or disease impact.

Conclusions

The Diabetes Impact Management Scales (DIMS) is an easily administered questionnaire with internal consistency and test-retest reliability. Preliminary correlative analyses support the validity of the instrument as a measure of health status in adult type I and type II diabetic patients. Further work will be necessary to firmly establish the validity of the DIMS and its usefulness in clinical outcomes research.
Microalbuminuria in Type I Diabetic Patients: Prevalence and Clinical Characteristics
Authors:   Microalbuminuria Collaborative Study Group
Published: March 2007

Objective

To estimate the prevalence of microalbuminuria, overnight urinary albumin excretion rate (AER) ≥30 and ≤250 μg/min, in a large sequential sample of nonhypertensive insulin-dependent (type I) diabetic patients attending hospital diabetic clinics, to identify micro- and normoalbuminuric patients in this sample for subsequent intervention and natural history follow-up studies, and to compare the clinical characteristics of the micro- and normoalbuminuric patients identified.

Research Design and methods

Screening was conducted in two phases. In phase 1, all eligible patients were asked to provide an early morning urine specimen for measurement of albumin concentration and albumin-creatinine ratio. In phase 2, all patients with an albumin concn ≥15 mg/L and/or an albumin-creatinine ratio ≥3.5 mg/mmol and a random sample of those with an albumin concn <15 mg/L and albumin-creatinine ratio <3.5 mg/mmol were asked to collect a timed overnight urine specimen for determination of AER.

Results

Among 1888 patients (16–60 yr old, diabetes onset <40 yr, and duration of diabetes <35 yr) who were screened, the prevalence of microalbuminuria was ∼3.7% (95% confidence interval (CI) 2.7–7.6%). Duration of diabetes was significantly longer in micro- than normoalbuminuric patients (20 vs. 15 yr, respectively; P <0.001), and in no patient with microalbuminuria was the duration of diabetes <5 yr. Systolic and diastolic blood pressures, higher in micro- than normoalbuminuric patients (132 vs. 122 mmHg, P <0.01; 77 vs. 72 mmHg, P <0.01), were strongly associated with AER.

Conclusions

Microalbuminuria in type I diabetes, which appears to represent an earlier phase in the development of clinical nephropathy, is associated with elevated blood pressure and a longer duration of diabetes.