bluuebunny/crossref_metadata_2025 huggingface dataset:
Glomerular Hyperfiltration and Urinary Prostaglandins in Type 1 Diabetes Mellitus
Authors: Viberti G. C. , Bognetti E. , Wiseman M. J. , Benigni A. , Remuzzi G.
Published: July 2009

In order to determine whether glomerular hyperfiltration in diabetes is related to renal prostaglandin production we have studied the urinary excretion of PGE2, 6‐keto‐PGF1α, and TXB2 in two sex, age and duration of diabetes matched groups of 9 and 10 Type 1 diabetic patients with either normal (mean 121, range 105–129 ml min−1 1.73 m−2) or supranormal glomerular filtration rate (154, 135–206 ml min−1 1.73 m−2). A group of 15 matched healthy volunteers served as control subjects. Urine was collected overnight for an uninterrupted period of at least 6 h. All studies in the patients were performed during insulin‐induced sustained euglycaemia to prevent the confounding effect of variable degrees of blood glucose control on urinary prostaglandin excretion. Blood pressure was normal in all subjects. Urinary excretion of 6‐keto‐PGF1α was significantly higher in the patients with glomerular hyperfiltration (median 17.1, range 4.5–33.6 ng h−1) than in those without (8.8, 1.5–13.8 ng h−1; p < 0.05) or in normal control subjects (9.6, 5.2–15.5 ng h−1; p < 0.05). No significant differences were found in the excretion rates of PGE2 and TXB2 between the three groups. Under conditions of controlled plasma glucose and insulin concentrations the urinary excretion of 6‐keto‐PGF1α, the stable breakdown product of PGI2, a compound of endothelial, possibly glomerular, origin was elevated only in the diabetic patients with glomerular hyperfiltration.
Plasma Hepatic Glutathione S‐Transferase Concentrations after Insulin‐Induced Hypoglycaemia in Normal Subjects and Diabetic Patients
Authors: Howie A. F. , Beckett G. J. , Patrick A. W. , Collier A. , Frier B. M. , Fisher B. M.
Published: July 2009

Plasma glutathione S‐transferase basic isoenzyme (GST B1) concentrations have been measured by specific radioimmunoassay in Type 1 diabetic patients and in normal subjects, before and after controlled insulin‐induced hypoglycaemia, and in a further group of Type 1 diabetic patients in hypoglycaemic coma. The activities of alanine aminotransferase (ALT), aspartate amino‐transferase (AST), and gamma‐glutamyl transferase (γGT) were also measured. GST B1 concentrations were significantly increased 3 h after controlled insulin‐induced hypoglycaemia, both in the diabetic patients (p < 0.02) and in the normal group (p < 0.05), but the magnitude of the rise did not differ between these two groups. Four of the 9 patients presenting in hypoglycaemic coma had a GST B1 concentration above the reference range. ALT, AST, and γGT activities did not rise following hypoglycaemia in any of the groups.
Type 1 Diabetes in the Maltese Islands
Authors: Schranz A. G. , Prikatsky V.
Published: July 2009

The prevalence of Type 1 diabetes in Malta was estimated by identifying all cases aged less than 32 years by the end of 1987 who had attended the island's principal diabetic clinic. The age‐adjusted prevalence rate for 0–19 year olds was 110.3 per 100 000 (girls 126.2 (n = 65), boys 95.3 (n = 52)). The mean annual incidence, during the period 1980–1987, in 0–19 year olds was 13.3 per 100 000 (n = 113, girls 14.1 and boys 12.6). Males developed Type 1 diabetes 2.1 years later than females (13.7 ± 6.9 (± SD) vs 11.6 ± 6.7 years). The commonest age of onset was 10 to 14 years. The peak period of onset occurred during the cooler months of November to February. The incidence rates are close to those in Nordic countries and indicate that Type 1 diabetes in Malta is underestimated.
Basal and Tolbutamide‐induced Plasma Somatostatin in Healthy Subjects and in Patients with Diabetes and Impaired Glucose Tolerance
Authors: Segers O. , De Vroede M. , Michotte Y. , Somers G.
Published: July 2009

Peripheral levels of basal and tolbutamide‐induced somatostatin have been measured in patients with diabetes or impaired glucose tolerance (IGT) and compared with those in normal individuals. Basal somatostatin was significantly higher in patients with Type 1 diabetes than in age‐matched control subjects. This increase was most pronounced at diagnosis, and appeared to be related to metabolic control in insulin‐treated patients. No increase was noted in patients with Type 2 diabetes or with IGT. Intravenous bolus injection of tolbutamide enhanced peripheral somatostatin levels in healthy volunteers in a biphasic manner. Patients with IGT also exhibited a biphasic response but the amplitude of the first phase was higher. No secretory response was detected in 27/29 Type 1 diabetic patients at diagnosis; a somatostatin response to tolbutamide became detectable again in Type 1 patients with normalization of their basal somatostatin levels but was then paradoxically related to poor blood glucose control. In Type 2 diabetes, basal somatostatin levels were similar to age‐matched control subjects, but decreased upon intravenous tolbutamide administration.
The Action Profiles of Human NPH Insulin Preparations
Authors: Starke A. A. R. , Heinemann L. , Hohmann A. , Berger M.
Published: July 2009

The complete time—action profiles of four subcutaneously injected human NPH insulin preparations (Protaphane HM/Novo; Insulatard Human/Nordisk; Huminsulin Basal/Eli Lilly; Basal H‐Insulin/Hoechst) have been investigated by means of the euglycaemic clamp technique (blood glucose 5.0 mmol I−1). Six normal male subjects were connected to a Biostator on five occasions in randomized order including a control study without insulin injection. A stable basal insulin level of about 10 mU I−1 was established by means of a low dose insulin infusion (0.1 mU kg−1 min−1) which subsequently suppressed C‐peptide by 35 ± 19% (mean ± SD) to levels of around 0.3 nmol I−1. Twelve units of NPH insulin were injected subcutaneously into the abdominal wall and glucose infusion rates were monitored for 19 h. In the control study, the mean glucose infusion rate was 1.11 ± 0.60 (range 0.32–1.95) mg kg−1 min−1. Maximal glucose infusion rates, reached 5–7 h after injection, were comparable (4.3–4.9 mg kg−1 min−1) for the four different preparations used. Glucose infusion rates returned to basal rates within the 19 h study period. Mean plasma free insulin levels peaked at 17.5–18.6 mU I−1 3–4.5 h after injection and returned to basal levels within 16 h. The time ranges of >90, >75, >50, and >25% of maximal insulin action (as estimated from glucose infusion rates) revealed no significant differences between the four insulin preparations tested. No significant insulin action was observed beyond 17 h after insulin injection of any preparation.
What Do Statistics Really Tell Us About the Quality of the Data from Self‐Monitoring of Blood Glucose?
Authors: Dedrick R. F. , Davis W. K.
Published: July 2009

Recently a number of studies have examined the quality of the data obtained from various systems used in the self‐monitoring of blood glucose. Many of these studies have used parametric statistical techniques such as the Pearson product‐moment correlation (r) and linear regression to evaluate the errors associated with self‐monitoring results. These statistical methods, while well known and easily computed on modern computers, are often inappropriate for evaluating either the amount of error associated with self‐monitoring or the clinical significance of these errors. For example: 1. a correlation of 1.00 does not necessarily mean that the measurements from a self‐monitoring system agree with the true values and are without error; 2. a correlation close to 0.00 does not necessarily mean that the measurements from self‐monitoring differ widely from the true values and possess large amounts of error; 3. a slope of 1.0 and a y‐intercept of 0.0 in a linear regression equation do not necessarily mean that the self‐monitoring measurements agree with the true values; 4. a slope and y‐intercept that deviate significantly from 1.0 and 0.0, respectively, do not necessarily mean that such measurements differ widely from the true values. The present paper illustrates some of the limitations and common misconceptions concerning these statistics, and shows that a reliance on these techniques alone can, in certain circumstances, lead to misleading estimates of the amount of error associated with self‐monitoring systems and inappropriate descriptions of the clinical significance of these errors. We would wish to discourage the use of these statistics for evaluating the clinical significance of the errors in self‐monitoring results, and encourage the use of more appropriate analyses such as error grid analysis.
How Does Glibenclamide Lower Plasma Glucose Concentration in Patients with Type 2 Diabetes?
Authors: Jeng C.‐Y. , Hollenbeck C. B. , Wu M.‐S. , Chen Y.‐D. I. , Reaven G. M.
Published: July 2009

Twelve patients with Type 2 diabetes and uncontrolled hyperglycaemia, never before treated with anti‐diabetic drugs, were studied before and after several months of glibenclamide therapy. Fasting plasma glucose fell significantly (p<0.01) from 12.5±1.1 (mean±SE) to 8.3±0.4 mmol−1 with glibenclamide therapy, as did glycosylated haemoglobin (from 12.0±0.9 to 8.4±0.7%). The improvement in blood glucose control was accompanied by an increase in postprandial plasma insulin concentration measured hourly from 0800 to 1600 h (p<0.001). Over the same period, plasma NEFA and lactate levels were significantly (p<0.001) lower after treatment with glibenclamide. Mean (±SE) insulin‐mediated glucose metabolic clearance rate was evaluated during glucose clamp studies, and was significantly higher (p<0.001) after glibenclamide therapy at steady‐state insulin levels of ˜ 10 mU I−1 (53±3 vs 38±2 ml m−2 min−1) and ˜70 mU I−1 (78±9 vs 55±6 ml m−2 min−1). Hepatic glucose production was also lower following glibenclamide treatment at both the lower (56±5 vs 68±5 mg m−2 min−1) and higher (22±4 vs 32±6 mg m−2 min−1) insulin levels. Although all metabolic variables measured appeared to improve in association with the administration of glibenclamide, the only statistically significant correlations with the decrease in plasma glucose concentration were the increase in integrated plasma insulin concentration (r=‐0.64, p<0.02) and the decrease in integrated plasma NEFA concentration (r=0.68, p<0.01). Based upon these findings we propose that the increase in ambient insulin level was primarily responsible for the decline in plasma glucose level following glibenclamide therapy, possibly by lowering plasma NEFA concentrations.
Attitudes, Knowledge and Blood Glucose Control
Authors: Lockington T. J. , Powles S. , Meadows K. A. , Wise P. H.
Published: July 2009

The hypothesis that management‐related diabetes knowledge and attitudes may be more directly related to diabetic control than general knowledge of or general attitude towards diabetes is examined. Sixty Type 1 diabetic patients were studied using an itemized knowledge questionnaire and an attitude scale measuring a general attitude to diabetes but containing a previously defined subgroup of items concerned with attitudes to management. A significant linear correlation was found between management‐related knowledge (r=‐0.39; p<0.01) and HbA1c. However, knowledge of insulin, diet, footcare, and glucose monitoring were not significantly correlated with HbA1c, poor control being associated with both very low and very high knowledge status. A significant linear correlation was found between management‐related attitudes (but not general attitude) and HbA1c (r=‐0.47; p<0.01). The multiple regression correlation between HbA1c and both management knowledge and attitudes was −0.51. Most (63%) of the association between knowledge and HbA1c was attributable to attitude. This study provides support for education strategies based upon achieving improved patient attitudes and motivation rather than comprehensive knowledge as the most effective way of improving patient diabetic control.
Elevated Albumin Excretion and Retinal Changes in Children with Type 1 Diabetes are Related to Long‐term Poor Blood Glucose Control
Authors: Nørgaard K. , Storm B. , Graae M. , Feldt‐Rasmussen B.
Published: July 2009

All diabetic children (n = 113) under 19 years old and with more than 2 years of diabetes attending the Steno Memorial Hospital in 1987 were studied. Normal urinary albumin excretion (< 30 mg 24 h−1) was found in 96 patients (85%), 15 had microalbuminuria (30–300 mg 24 h−1) (13%), and 2 patients were proteinuric (>300 mg 24 h−1) (2%). Retinal morphology was evaluated by colour fundus photography. Background retinopathy was more frequent in the group with elevated albumin excretion (71%) than in a matched normoalbuminuric group (20%, 2p < 0.001). Long‐term blood glucose control was assessed from all previous HbA1c measurements in the hospital records, an average of nine per patient. The mean observation period was 48 (3–76) months. Children with elevated albumin excretion had a higher mean HbA1c than children with normal urinary albumin excretion (10.3 ± 1.9 vs 9.2 ± 1.3% (± SD), 2p < 0.05). Children with retinopathy had an HbA1c of 9.9 ± 1.7 vs 9.0 ± 1.2% in patients without retinopathy (2p < 0.01).
Postprandial Glucose and Insulin Responses to Rolled Oats Ingested Raw, Cooked or as a Mixture with Raisins in Normal Subjects and Type 2 Diabetic Patients
Authors: Rasmussen O. , Winther E. , Hermansen K.
Published: July 2009

Cooking and processing of food may account for differences in blood glucose and insulin responses to food with similar contents of carbohydrate, fat, and protein. The present study was carried out to see if short‐term cooking of rolled oats caused an increase in blood glucose. Furthermore, we wanted to see if dried fruit could substitute for some of the starch without deterioration of the postprandial blood glucose response. We therefore compared the blood glucose and insulin responses to three isocaloric, carbohydrate equivalent meals in 11 normal subjects and 9 type 2 diabetic patients. Meals composed either of raw rolled oats, oatmeal porridge or a mixture of raw rolled oats with raisins were served. In normal subjects, the three meals produced similar glucose (75 ± 22, 51 ± 16 and 71 ± 23 (± SE) mmol I−1 180 min, respectively) and insulin response curves (3160 ± 507, 2985 ± 632 and 2775 ± 398 mU I−1 180 min, respectively). Type 2 diabetic patients also showed similar postprandial blood glucose (515 ± 95, 531 ± 83 and 409 ± 46 mmol I−1 180 min, respectively) and insulin (5121 ± 850, 6434 ± 927 and 6021 ± 974 mU I−1 180 min, respectively) responses to the three meals. Thus short‐term cooking of rolled oats has no deleterious effect on blood glucose and insulin responses, and substitution of 25 % of the starch meal with simple sugars (raisins) did not affect the blood glucose or insulin responses.
The Dundee Prevalence Study of Insulin‐treated Diabetes; Intervals Between Diagnosis and Start of Insulin Therapy
Authors: Waugh N.R. , Jung R.T. , Newton R.W.
Published: July 2009

A population‐based survey of the prevalence of insulin‐treated diabetes mellitus in the Dundee area showed a crude prevalence of 0.34%, but analysis by interval between diagnosis of diabetes and start of insulin shows that around a third of patients started insulin therapy more than 1 month after diagnosis. This suggests that the prevalence of insulin‐dependent diabetes is around 0.2% of the population, with the other patients being those with non‐insulin‐dependent diabetes who need insulin for metabolic control, though there is an intermediate zone where classification is difficult. There is a male excess. The proportion of true insulin‐dependent diabetes falls with age of onset, but around 50% of such patients have an onset over the age of 30 years.
Co‐occurrence of Hypercalciuria and Hypouricaemia in Type 2 Diabetic Patients
Authors: Ishihara M. , Shinoda T. , Yamada T.
Published: July 2009

The relationship between the urinary excretion of calcium (Ca2+) and uric acid was investigated in 151 Type 2 diabetic patients and 48 normal subjects. In the diabetic patients, uric acid clearance/creatinine clearance (Clurate/Clcr) was higher and the serum level of uric acid was lower than in the normal subjects (Clurate/Clcr: 10.9 ± 5.8 vs 8.1 ± 2.6%, p < 0.001; serum uric acid: 304 ± 86 vs 357 ± 89 μmol l−1, p < 0.001). Calcium clearance/Clcr (Clca/Clcr) also increased in the diabetic patients, as did urinary excretion rate, but the serum Ca2+ level was not different to normal control subjects (Clca/Clcr: 2.29 ± 1.59 vs 1.56 ± 0.98%, p < 0.001; Ca2+ excretion rate: 2.24 ± 1.67 vs 1.63 ± 1.11 mmol day−1, p < 0.01; serum Ca2+ level: 2.34 ± 0.11 vs 2.33 ± 0.08 mmol l−1). In the diabetic patients, Clcr positively and the serum uric acid negatively correlated with the urinary excretion of Ca2+ (p < 0.001 for both correlations in the multivariate regression analysis). These data suggest that the diabetic patients have increased fractional excretion of both Ca2+ and uric acid.
Brittle Diabetes in the Elderly
Authors: Griffith D.N.W. , Yudkin J.S.
Published: July 2009

The term ‘brittle diabetes’ is now commonly used to describe patients whose lives are disrupted by major variations in metabolic control, whatever their cause. Most reports have focused on the occurrence of such problems in young people, but little attention has been paid to brittle diabetes occurring in elderly patients. We describe six such cases and comment on differences in aetiology and management when compared with younger patients. Although less rigorous objectives for tight blood glucose control as compared with younger people, and more ready acceptance of insulin administration being supervised by another person, such as a district nurse, may reduce swings in blood glucose control in the elderly, accidental mismanagement by the patient as a result of incipient or established senile dementia may be an important factor in generating instability, as was evident in three cases. In one instance, the onset of unstable diabetic control was the earliest clinical feature of mental deterioration.
The Introduction of a Quality Assessment Scheme for Extra‐laboratory Blood Glucose Analysis
Authors: Hamilton A.D. , Allen K.R. , Waters A.K.
Published: July 2009

An external quality assessment scheme is described for on‐ward testing of blood glucose by nursing staff using the Glucometer II/Glucostix system. This involved the distribution of two concentrations of glucose solutions to the wards at 2‐week intervals. Initially, results were examined prior to the introduction of a formal training programme for use of the blood glucose meters when the hospital CV was 25 % (low glucose) and 19 % (high glucose). Some improvement was shown after 6 months, with CVs of 13 and 8 %, and a greater improvement after 12 months with CVs of 6 and 8 %, respectively. A ward report was designed to allow easy interpretation of performance by the participants in the scheme. The introduction of this report was well received and generated enthusiasm among the ward staff.
Proliferative Diabetic Retinopathy in a Patient with Maturity‐onset Diabetes of the Young (MODY)
Authors: Tymms D.J. , Reckless J.P.D.
Published: July 2009

Maturity‐onset diabetes of the young (MODY) has been described as being characteristically free from severe complications. This has led to speculation that the type of diabetes may be important in the pathogenesis of complications in diabetes. We report a case of classical MODY in which severe proliferative diabetic retinopathy developed. The retinopathy was detected shortly after the diagnosis of diabetes was made when the patient was 32 years old, and did not progress subsequently. No further complications developed during the subsequent 29 years in which normal postprandial plasma glucose levels were maintained with chlorpropamide therapy (mean 4.7, range 4.1–6.0 mmol l−1). This case demonstrates that severe retinopathy can occur in MODY and we suggest that in this patient there may have been a period of hyperglycaemia prior to diagnosis which was sufficient to lead to the microvascular complication.
The Effect of Improved Control on Blood Filtration Properties and Non‐enzymatic Glycosylation of Erythrocyte Proteins in Type 2 Diabetes
Authors: Yue D.K. , Capogreco C. , McLennan S.V. , Turtle J.R.
Published: July 2009

Abnormal blood flow in the microcirculation has been reported in diabetes and may be important in the pathogenesis of diabetic complications. The mechanism of this is not understood but non‐enzymatic glycosylation of erythrocyte membrane or haemoglobin causing reduced erythrocyte deformability and a secondary change in filtration properties of blood have been suggested as possible factors. The relationship of non‐enzymatic glycosylation of erythrocyte membrane and glycosylated haemoglobin to filtration time of blood was investigated during stabilization of diabetes with sulphonylurea therapy. Over an 8‐month period, glycosylated haemoglobin, non‐enzymatic glycosylation of erythrocyte membrane, and filtration time fell by 41%, 71%, and 53% of the initial value, respectively, but the rate of decline was slower for filtration time which did not change significantly until the last month. Due to the different time‐course of improvement, no relationship was found between filtration time and glycosylated haemoglobin or non‐enzymatic glycosylation of erythrocyte membrane whereas glycosylated haemoglobin and non‐enzymatic glycosylation of erythrocyte membrane correlated significantly (r = 0.49, p < 0.001). These results suggest that the abnormal filtration property of blood in diabetes is not a direct consequence of non‐enzymatic glycosylation, and suggest that the erythrocytes made in the hyperglycemic milieu are abnormally rigid. The filtration properties of blood are only improved when new generations of erythrocytes enter the circulation.
Dietary Fructose as a Natural Sweetener in Poorly Controlled Type 2 Diabetes: a 12‐month Crossover Study of Effects on Glucose, Lipoprotein and Apolipoprotein Metabolism
Authors: Osei Kwame , Bossetti B.
Published: July 2009

The metabolic effects of fructose incorporated in the normal diets of 13 poorly controlled, Type 2 diabetic patients were studied in a 6‐month, randomized, crossover study. Patients used 60 g day−1 of crystalline fructose in divided amounts as part of their isocaloric (1400–3900 kcal), weight‐maintaining diet. During fructose supplementation, the distribution of carbohydrate‐derived calories was 35 % complex and 15 % simple, the latter solely from fructose. This was compared with the patients' values on their usual diabetic diet (carbohydrate 50 % (mostly complex), fat 38 %, and protein 12 %). After 6 months of taking fructose, fasting serum glucose decreased from 12.6 ± 1.1 (± SE) to 9.8 ± 1.3 mmol I−1 (p < 0.02), while it was unchanged on normal diet (11.0 ± 0.1 vs 11.6 ± 0.9 mmol I−1, NS). Glycosylated haemoglobin was also reduced from 11.3 ± 0.4 to 9.9 ± 0.5 % (p < 0.05) on fructose, but unchanged on the control diet (10.4 ± 0.7 vs 11.2 ± 0.7 %, NS). No significant long‐term deleterious changes were observed in the fasting serum lipids, lipoproteins, and apolipoproteins A‐1 and B‐100. Fructose was well tolerated without significant effects on body weight, or lactic acid and uric acid levels.
Nicotinamide Increases C‐peptide Secretion in Patients with Recent Onset Type 1 Diabetes
Authors: Pozzilli P. , Visalli N. , Ghirlanda G. , Manna R. , Andreani D.
Published: July 2009

Nicotinamide, a poly‐(ADP‐ribose) synthetase inhibitor, has been shown in animal models to induce islet B‐cell regeneration. An open controlled trial was therefore carried out for 1 year in 36 patients with recent onset (<4 weeks symptoms) Type 1 diabetes. Twenty‐three patients were treated with nicotinamide (200 mg daily) in addition to insulin, and 13 control patients were treated with insulin alone. Metabolic and immunological variables at entry were similar in the two groups. A significant increase of stimulated plasma C‐peptide levels compared to diagnosis was observed only in the nicotinamide treated group (1.4±0.3 (±SE) μg I−1 at diagnosis vs 2.4±0.4 at 6 months, p < 0.04; and 3.0±0.5 at 1 year, p < 0.01). Patients receiving nicotinamide had lower glycosylated haemoglobin levels at 6 months and 1 year compared to the control group (p < 0.04 and p < 0.03, respectively) although insulin dose was lower. Small doses of nicotinamide may be successful in improving metabolic control in recent onset Type 1 diabetes, probably by increasing residual islet B‐cell function.
Raised Ankle/Brachial Pressure Index in Insulin‐treated Diabetic Patients
Authors: Goss D.E. , de Trafford J. , Roberts V.C. , Flynn M.D. , Edmonds M.E. , Watkins P.J.
Published: July 2009

The ankle/brachial blood pressure index (A/B PI) is important in the vascular laboratory assessment of peripheral vascular disease. However it is falsely elevated in diabetes, hence underestimating the true severity of disease. We have therefore examined the influence of diabetes on the A/B PI in 2092 patients, 538 with diabetes, all referred for evaluation of peripheral vascular disease. The prevalence of a raised A/B PI (≤1.5) in insulin‐treated patients (18.3%) was much higher (p<0.001) than that in both non‐insulin‐treated diabetic patients (4.5%) and patients with no diabetes (2.8%). Insulin‐treated patients with a duration of diabetes of >30 years had a higher prevalence of raised A/B PI than those with a duration of ≥9 years. No significant age effects were seen.
Ambulatory Blood Pressure and Heart Rate in Diabetic Patients: an Assessment of Autonomic Function
Authors: Hornung R.S. , Mahler R.F. , Raftery E.B.
Published: July 2009

In order to examine the physiological variation in blood pressure and heart rate that occurs during normal activities in patients with diabetes, 24‐h profiles were constructed from continuous ambulatory recordings. Isometric and dynamic tests were also performed. The patients were subdivided into 25 uncomplicated cases, 11 with peripheral neuropathy and 6 with autonomic neuropathy. These were compared with a ‘control’ group of 22 normal subjects. Abnormal 24‐h blood pressure profiles were found particularly in the patients with autonomic neuropathy. This group had attenuation or reversal of the usual diurnal rhythm, blood pressure often rising during the night and falling in the early morning. Diurnal heart rate variation was reduced in all three groups of patients. Blood pressure responses to both forms of exercise were also significantly reduced in the autonomic neuropathy group (maximum change in systolic blood pressure during isometric exercise was 10±4 mmHg vs 36±3 mmHg in the control group, p<0.003). Patients with peripheral neuropathy also had some impairment of exercise‐induced blood pressure changes, but to a lesser degree.
A Controlled Study of the Effect of Computer‐aided Analysis of Home Blood Glucose Monitoring on Blood Glucose Control
Authors: Morrish N.J. , Cohen D.L. , Hicks B. , Keen H.
Published: July 2009

A 6‐month study of the effects on blood glucose control of computer‐aided analysis of glucose self‐monitoring results was performed. Eighteen clinically insulin‐dependent patients were ranked in order of haemoglobin A1 and randomly allocated in consecutive pairs to either a conventional group, using diaries to record self‐monitoring meter‐read results, or a memory group using meters with inbuilt memories which were linked to a computer at each visit for the analysis of self‐monitoring results. There was a significant decline in haemoglobin A1 (p<0.001) and fructosamine (p=0.002) over the 6‐month period in the whole population but there was no difference between the study groups. The absolute or percentage changes in haemoglobin A1 and fructosamine did not correlate significantly with any of the patient characteristics examined. The memory system was popular with the patients. At present no benefit in terms of blood glucose control from such systems has been demonstrated.
Insulin‐induced Hypoglycaemia and Absorption of Injected Insulin in Diabetic Patients
Authors: Fernqvist‐Forbes E. , Gunnarsson R. , Linde B.
Published: July 2009

The effect of insulin‐induced hypoglycaemia (soluble insulin 1 mU kg−1min−1IV) on the absorption of125I‐Iabelled soluble insulin (10 U SC) from thigh was studied in 10 insulin‐treated Type 1 diabetic patients on a test and a control day. Disappearance of125I was followed by external gamma counting. Adipose tissue blood flow was measured concomitantly using the133Xe‐clearance technique. Arterial plasma levels of glucose, insulin, adrenaline and noradrenaline were determined intermittently. Hypoglycaemia occurred at a glucose level of 2.2 ± 0.1 (±SE) mmol I−1after 58 ± 6 min. Peak levels of adrenaline (6.44 ± 1.62 nmol I−1) and noradrenaline (2.29 ± 0.39 nmol I−1) were found 10 min later. During the 30‐min period after onset of hypoglycaemia, adipose tissue blood flow increased 132 ± 45% (p< 0.05) but the disappearance rate of 125I‐insulin was unchanged. Thus, insulin absorption was unaltered in connection with hypoglycaemia in Type 1 diabetic patients, in contrast to the depression previously reported in healthy subjects, despite similar increases in adipose tissue blood flow.
A Prospective Study of Symptomatic Hypoglycaemia in Childhood Diabetes
Authors: Macfarlane P.I. , Walters M. , Stutchfield P. , Smith C.S.
Published: July 2009

A prospective study of symptomatic hypoglycaemia was conducted in 47 children over a 14‐week period using a questionnaire completed at home for each episode of hypoglycaemia. Twenty‐nine children (62%) experienced 150 episodes during the study. The average incidence was once every 33 days (range 0–5.2 mo−1). Hypoglycaemia occurred more frequently in children with lowest haemoglobin A1 levels. Episodes were not randomly distributed in time; hypoglycaemia occurred significantly more frequently in the evening, in the early morning and around midday. The majority of episodes were judged to be mild but 2 children had nocturnal convulsions and glucagon was used on three occasions. Symptomatic nocturnal hypoglycaemia occurred one or more times in 30% of the children. Daytime episodes were manifested by tremor, feeling weak, dizziness, pallor, and other symptoms and signs. In 46% of cases the cause was not evident to parents or children, but 25% were related to physical activity.
Xiaoke Tea, a Chinese Herbal Treatment for Diabetes Mellitus
Authors: Hale P.J. , Horrocks P.M. , Wright A.D. , Fitzgerald M.G. , Nattrass M. , Bailey C.J.
Published: July 2009

Xiaoke tea, a traditional Chinese treatment for diabetes mellitus, lowered blood glucose concentrations in streptozotocin diabetic mice. To investigate Xiaoke clinically, a double‐blind crossover study was undertaken in 12 non‐insulin‐treated diabetic patients. Xiaoke tea and ordinary tea (infusion of 2.72 g, 4 times daily) were consumed in random order for 4 weeks. A standard breakfast meal was taken before and after each treatment period. Xiaoke did not significantly affect glycosylated haemoglobin, basal or post‐breakfast serum glucose and insulin concentrations, intermediary metabolite concentrations, triglyceride and cholesterol. No adverse side‐effects of Xiaoke were evident.
Normal Urinary Albumin Excretion in Recently Diagnosed Type 1 Diabetic Patients
Authors: Lind B. , Jensen T. , Feldt‐Rasmussen B. , Deckert T.
Published: July 2009

The urinary excretion of albumin and retinol binding protein were measured in 51 recently diagnosed Type 1 diabetic patients and 48 control subjects, matched for age and sex. The diabetic patients, admitted consecutively to the Steno Memorial Hospital, were all studied 3 to 6 months after the onset of diabetes. Urinary albumin excretion (median and 95% confidence interval) was similar in the diabetic patients and normal control subjects (8 (6–11) vs 8 (6–11) mg 24‐h−1, NS). Four diabetic patients had urinary albumin excretion in the microalbuminuric range of 30–300 mg 24‐h−1. There was no significant difference between the two groups in urinary excretion of retinol binding protein. The distribution among the individuals of both urinary proteins was positively skewed and similar in the two groups. In conclusion, no significant differences in the urinary excretion of albumin and retinol binding protein were found between recently diagnosed Type 1 diabetic patients and normal subjects.
Patterns of Hyperinsulinaemia in Type 1 Diabetic Patients With and Without Nephropathy
Authors: Pickup J.C. , Collins A.C.G. , Walker J.D. , Viberti G.C. , Pasic J.
Published: July 2009

The prevalence and patterns of insulinaemia in five groups of patients with Type 1 diabetes have been reinvestigated using a free insulin assay which minimizes in vitro redistribution of the free and antibody‐bound insulin components. In 18 diabetic patients managed by conventional insulin injection treatment and 19 patients treated by continuous subcutaneous insulin infusion (CSII), the mean 24‐h serum free insulin level exceeded a non‐diabetic reference range in 78% (injections) and 68% (CSII). Twenty‐four‐hour profiles showed that hyperinsulinaemia occurred in the basal state before meals and at night, but not immediately post‐prandially. The serum free insulin concentration at 0800 h, 1200 h, and 1600 h was significantly (p < 0.001) correlated with mean 24‐h free insulin in injection‐treated and CSII patients, and samples at one of these time‐points may thus provide a simple, single measure of integrated insulinaemia for population studies. There was no significant difference in 24‐h mean free insulin levels in 7 patients randomly crossed‐over between injection treatment and CSII, but the profiles had a more physiological pattern during CSII, with a mean post‐prandial serum free insulin level which was significantly higher on CSII than injections (mean ± SE = 37.2 ± 3.1 vs 26.9 ± 2.5 mU I‐1, p = 0.01). Fourteen diabetic patients with reagent strip‐positive proteinuria and a GFR of 32 ± 5.5 (±SE) ml min‐1 had significantly higher mean 24‐h serum free insulin levels than a pair‐matched group of diabetic patients without proteinuria (39.6 ± 5.3 vs 22.6 ± 1.8 mU I‐1, p = 0.008). As hyperinsulinaemia has been associated with an increased risk of atherosclerosis, the confirmation of significant hyperinsulinaemia in Type 1 diabetic patients on both conventional treatment and CSII is of interest; it is possible that accentuated hyperinsulinaemia in diabetic patients with nephropathy may contribute to the high frequency of cardiovascular disease in this group.
Employers' Attitudes to Diabetes
Authors: Robinson N. , Bush L. , Protopapa L. E. , Yateman N.A.
Published: July 2009

In order to examine the knowledge and attitude of employers to diabetes and diabetic employees, a questionnaire was sent to a random sample of approximately 2500 businesses and industries in eight different areas of the United Kingdom. Information was collected on the employment of people with diabetes, such as sickness absence, suitability of types of job for the diabetic person, the proportion of people with diabetes registered as disabled, and the provision of pension schemes. Only 1% of firms claimed that they would not consider a person with diabetes for employment within the firm. Nearly a third of employers did not know whether they employed anyone with diabetes. Over a quarter of the manufacturing industries reported some jobs that were unsuitable and 8% reported certain unfavourable job conditions for a diabetic employee such as shift work, working at heights, strenuous work, etc. A total of 7% of those firms with a diabetic employee reported that diabetic workers were more often absent from work due to sickness and 16% of firms employing a diabetic person did not allow paid time off for clinic visits. The attitude of the majority of employers seemed to indicate that diabetes in itself does not limit employment prospects since most people with diabetes have few problems arising from their condition and can make good employees in a range of occupations.
Plaster Casts in the Management of Advanced Ischaemic and Neuropathic Diabetic Foot Lesions
Authors: Borssén B. , Lithner F.
Published: July 2009

The outcome of plaster cast treatment of diabetic ulcerations at different sites of the feet in 33 patients was assessed in a prospective study. They were selected for the study because the previous conservative treatment had been unsuccessful. The mean age was 68 years and Type 1/Type 2 ratio was 4/29. Fifteen patients had lesions of grade 2 severity according to Wagner's classification, 9 patients' lesions were grade 3, and 9 patients had grade 4 lesions. The lesions healed in 19 patients (58%). All 10 patients (100%) with plantar lesions healed, while 7 (44%) of the patients with ischaemic lesions on the toes underwent lower leg amputation (p < 0.01). Other factors that were important in determining which patients underwent amputation included the presence of local pain (p < 0.001), and ankle/arm pressure index (<0.5 vs ≥ 0.5, p < 0.001). We conclude that plaster cast treatment is more useful in the treatment of advanced foot lesions than has previously been reported.
Seasonal Incidence of Diabetes Mellitus in Tropical Africa
Authors: McLarty D.G. , Yusafali A. , Swai A.B.M.
Published: July 2009

During a 6‐year period from 01 June 1981 to 30 May 1987, 1250 newly diagnosed African diabetic patients were registered at Muhimbili Medical Centre, Dar es Salaam, Tanzania. A seasonal pattern in the presentation of patients for both insulin‐requiring and non‐insulin‐requiring diabetic patients was observed (p < 0.001). The peak months of presentation were August through to November, with the greatest number of patients presenting in September (170 patients in 6 years) and the smallest number in June (55 patients). Similar patterns were found for month of onset of symptoms, with the peak month August (180 patients) and the trough month May (56 patients) (p < 0.001). A similar pattern of presentation was observed in Morogoro, a town in another region of Tanzania. Seasonality in the presentation of insulin‐requiring and non‐insulin‐requiring diabetes may therefore occur in tropical as well as temperate climates.
Pupillary Size in Children and Adolescents with Type 1 Diabetes
Authors: Clarke C.F. , Piesowicz A.T. , Spathis G.S.
Published: July 2009

Pupillary adaptation to darkness was studied in 63 children and adolescents with Type 1 diabetes using a simple portable pupillometer. Results were compared with those in a group of age‐related non‐diabetic children and expressed as the ratio of the pupil diameter to the iris diameter (pupil diameter %). In the diabetic patients the pupil diameter % was 61.1 ± 5.8 (44.4–71.9) % compared with 64.2 ± 4.1 (53.2–72.6) % in the control subjects (p< 0.001). Abnormal pupillary adaptation to darkness was found more commonly than abnormal heart rate variation in response to a variety of stimuli in the diabetic patients. Pupillary adaptation to darkness may be useful as an indicator of subclinical autonomic neuropathy in diabetic children.
An Acceptable Exercise Test to Study Microalbuminuria in Type 1 Diabetes
Authors: Watts G.F. , Morris R.W. , Mandalia S. , Williams I. , Polak A. , Shaw K.M.
Published: July 2009

A modified test for studying the response of urinary albumin excretion (UAV) to exercise in diabetic patients is described. It is designed to produce a standardized increase in pulse rate (by 90–110 %) rather than a standardized workload. Thirty‐three normotensive Type 1 diabetic patients with normal pre‐exerciseUAV(<10 μg min−1) on the day of the test were compared with 25 non‐diabetic subjects matched for age and sex. The patients developed a significantly greater increase in the medianUAV(p< 0.05) and systolic blood pressure (p< 0.01) during exercise, despite the use of lower workloads (p< 0.05). During exercise, the albumin excretion in the patients was not related to their heart rate, blood pressure, workload or fall in blood glucose; nor was it related to duration of diabetes, glycosylated haemoglobin or insulin dose. An exerciseUAV> 15 μg min−1was found in 10 of the 33 patients; it was significantly correlated (p< 0.01) with the frequency of previous overnight microalbuminuria (> 10 μg min−1), and was associated with a greater progression of microalbuminuria (p< 0.05) over a mean period of 24 months. Retinol‐binding protein excretion rate was also measured as an indicator of proximal tubular function and did not increase in either group.
The Effect of Aldose Reductase Inhibition on Erythrocyte Polyols and Galactitol Accumulation in Diabetic Patients
Authors: Airey C.M. , Price D.E. , Wales J.K. , Kemp J.V. , Perkins C.M.
Published: July 2009

Erythrocyte sorbitol level has previously been used as a measure of the efficacy of aldose reductase inhibitors, but its value is limited by fluctuations related to variations in blood glucose concentration. The aim of the study was to compare sorbitol content with the ability to accumulate galactitol during ex vivo incubation with galactose, of erythrocytes taken from diabetic patients following administration of a single 600 mg dose of the aldose reductase inhibitor, ponalrestat. Twelve patients were studied in a placebo‐controlled crossover trial. Blood glucose levels were not statistically different during the placebo and ponalrestat treatment periods except at 1 h after the dose was taken (10.6 ± 6.7 vs 7.7 ± 4.6 mmol I−1 (±SD), p < 0.05). Ponalrestat reduced erythrocyte sorbitol concentrations compared with placebo at 3, 5 and 7 h (0.82 ± 0.36, 0.69 ± 0.23, and 0.83 ± 0.35 mg I−1 vs 1.79 ± 0.67, 1.68 ± 0.65, and 1.57 ± 0.59 mg I−1 respectively, p < 0.005) and 24 h post‐dose (1.57 + 0.45 vs 2.01 + 0.73 mg I−1, p < 0.05). Ponalrestat also reduced erythrocyte galactitol accumulation at 3, 5 and 24 h post‐dose from 5.53 ± 2.41, 5.43 ± 1.89, and 5.42 ± 1.96 mg I−1 2‐h−1 to 1.47 ± 0.30, 1.76 ± 0.41, and 4.12 ± 0.72 mg I−1 2‐h−1 respectively, p< 0.01. Galactitol accumulation rate appeared to be a less variable parameter than erythrocyte sorbitol and was not influenced by fluctuations in blood glucose. After placebo the intra‐individual coefficient of variation in galactitol accumulation rate was 6.2 % and for erythrocyte sorbitol was 26.3 %. Thus a single 600 mg dose of ponalrestat inhibits erythrocyte aldose reductase in diabetic patients. Inhibition of galactitol accumulation appears to be a method of in vitro assessment of aldose reductase inhibitor efficacy which, unlike erythrocyte sorbitol, is independent of blood glucose levels.
Studies of the Entero‐insular Axis Following Pancreas Transplantation in Man: Neural or Hormonal Control?
Authors: Clark J.D.A. , Wheatley T. , Brons I.G.M. , Calne R.Y. , Bloom S.R.
Published: July 2009

To study the role of hormonal and neural factors in the control of the entero‐insular axis the insulin, C‐peptide, and glucose‐dependent insulinotropic peptide (GIP) responses to oral and intravenous glucose were investigated in 5 patients who had received a combined kidney and paratopic pancreas transplant, with physiological portal venous drainage. The incremental areas under the insulin and C‐peptide responses to oral glucose were significantly greater than the responses to intravenous glucose (insulin: patients 7983 ± 1937 (±SE) vs 3513 ± 2188 mU I−1 min, p < 0.002, control subjects 5505 ± 1035 vs 1066 ± 484 mU I−1 min, p < 0.004; C peptide: patients 440 ± 80 vs 144 ± 61 nmol I−1 min, p < 0.01, control subjects 200 ± 38 vs 63 ± 16 nmol I−1 min, p < 0.01). The incretin effects for insulin (patients 4.4 ± 1.4, control subjects 7.7 ± 1.8) and C‐peptide (patients 4.4 ± 0.9, control subjects 3.7 ± 0.9) and the GIP responses to oral and intravenous glucose were not significantly different between transplant patients and control subjects. As the incretin effect was preserved, despite a denervated pancreas, hormonal rather than neural factors may be more important in mediating increased insulin secretion after oral carbohydrate. The normal GIP response is compatible with its proposed role as an insulinotropic hormone.
Heart Rate Variability During Hypoglycaemia
Authors: Malpas S.C. , Maling T.J.B.
Published: July 2009

A diabetic patient with parasympathetic neuropathy underwent 24‐h ECG monitoring. During the 24 hours the patient had a hypoglycaemic event. Heart rate variability was greatly increased during this time, though heart rate was unaltered. The reasons for the sudden increase are unknown but may indicate a fruitful line for further research.
Apolipoprotein C Subtype Distribution in Type 2 Diabetes Mellitus
Authors: Gomez J. A. , del Pozo C. , Sorribas A. , Serrat J. , Gonzalez‐Sastre F. , de Leiva A.
Published: July 2009

Plasma lipid levels and apolipoprotein C (apo C) composition of VLDL were investigated in a group of Type 2 diabetic patients at first attendance at the outpatient clinic and before any therapeutic intervention. Patients were distributed into two groups of 26 individuals, normo‐and hyperlipidaemic, respectively, and compared with two matched control groups. Normolipidaemic diabetic patients had higher serum triglycerides, VLDL cholesterol, and lower HDL cholesterol than matched normolipidaemic control subjects. While hyperlipidaemic non‐diabetic individuals showed increased apo C II and decreased apo C III‐1 percentages when compared with normolipidaemic non‐diabetic individuals (12.1 ± 4.9 vs 8.5 ± 3.2% and 44.0 ± 6.7 vs 48.1 ± 7.0%, respectively, mean ± SD, both with p < 0.05), the relative distribution of apo C III isoforms and apo CII was similar in both normo‐ and hyperlipidaemic diabetic patients.
Ketone Bodies do not Give Falsely Positive Alcohol Tests
Authors: Slama G. , Bruzzo F. , Dupeyron J. P. , Lassechere M. , Dauchy F.
Published: July 2009

Ketosis, as observed in diabetic ketoacidosis or secondary to hypoglycaemia, may be associated with symptoms resembling those of acute alcoholism. It is thus essential to rule out the possibility that ketone bodies cross‐react with any method of ethanol determination. Two currently used methods for detecting ethanol in the expired air (Alcotest and a fuel cell electrode), and three methods for blood determination (the nitrochromic method, gas liquid chromatography, and the TDX‐REA method) were examined. No cross‐reaction was found in nine grossly ketotic diabetic subjects. In vitro 3‐hydroxybutyrate, acetoacetate or acetone, alone (30 mmol l‐1) or in association, did not cross‐react in the assays studied.
Effect of Oral Antidiabetic Drug Withdrawal in Type 2 Diabetes
Authors: Nobels F. , Van Gaal L. , Rillaerts E. , De Leeuw I.
Published: July 2009

Oral hypoglycaemic agents were withdrawn in 22 Type 2 diabetic patients to establish whether long‐term use of these products is really necessary. Discontinuation of the drugs resulted in significant increases of HbA1 (8.1 ± 1.1 to 11.3 ± 2.4%) and fasting (9.1 ± 2.1 to 13.6 ± 4.0 mmol l‐1) and postprandial (12.3 ± 3.0 to 18.7 ± 5.7 mmol l‐1) plasma glucose levels after 12 weeks (all p < 0.01). This was associated with a reduction of fasting (12.4 ± 6.2 to 8.0±3.4 mU l‐1) and postprandial (35.7 ± 13.2 to 19.3 ± 13.4 mU l‐1) serum insulin concentrations, and fasting (0.8 ± 0.4 to 0.5 ± 0.2 nmol l‐1) and postprandial (1.8 ± 0.6 to 1.0 ± 0.5 nmol l‐1) serum C‐peptide concentrations (all p < 0.01). Only one patient did not show metabolic deterioration after drug withdrawal. In multivariate analysis no significant correlations could be found between measures of baseline diabetic control and the deterioration after drug withdrawal.