bluuebunny/crossref_metadata_2025 huggingface dataset:
Glucokinase Gene Variations in Japanese-Americans With a Family History of NIDDM
Authors: Stone Lisa M , Kahn Steven E , Deeb Samir S , Fujimoto Wilfred Y , Porte Daniel
Published: March 2007

OBJECTIVE

To determine if sequence variants in the glucokinase (GCK) gene contribute to the high risk of impaired glucose metabolism in Japanese-Americans and whether the gene sequence differs between Japanese-Americans and Caucasians.

RESEARCH DESIGN AND METHODS

Forty-seven unrelated Japanese-Americans with one or more first-degree relatives with non-insulin-dependent diabetes mellitus (NIDDM) were selected, irrespective of glucose tolerance status. By World Health Organization criteria, 13 had normal glucose tolerance, 11 had impaired glucose tolerance, and 23 had NIDDM. Variations in the GCK gene were identified by single-strand conformation polymorphism analysis and sequenced using standard techniques.

RESULTS

Six variants of the GCK gene were identified in a total of 21 subjects: 1) a G→A substitution at nucleotide −30 in the β-cell-specific promoter; 2) an A→G substitution at nucleotide 244 in the 5'-untranslated region (5'-UTR) of exon 1a; 3) a C→G substitution at nucleotide 403 in the 5'-UTR of exon 1a; 4) a G→A variant 13 base pair (bp) 5' to the intron 3 exon 4 junction; 5) a silent substitution in the third base of codon 145 in exon 4; and 6) a C→T substitution 8 bp 3' to the exon 9 intron 9 junction. None of these variations would be expected to affect the structure of the GCK enzyme. While none of these variants were significantly associated with IGT or NIDDM, a nonsignificant increase in the β-cell promoter variant was observed in subjects with abnormal glucose tolerance. No uniform sequence differences in the GCK gene were identified between Japanese-American and Caucasian-American subjects.

CONCLUSIONS

Mutations affecting the amino acid sequence of GCK do not account for the increased incidence of impaired glucose metabolism in Japanese-Americans, and the gene sequence does not uniformly differ from that in Caucasians.
Slow Elimination of Glyburide in NIDDM Subjects
Authors: Jönsson Anders , Rydberg Tony , Ekberg Goran , Hallengren Bengt , Melander Arne
Published: March 2007

OBJECTIVE

To determine the terminal elimination half-life of glyburide in non-insulin-dependent diabetes mellitus (NIDDM) subjects after cessation of long-term treatment.

RESEARCH DESIGN AND METHODS

Ten NIDDM patients (5 of each sex, 36-72 years old, without hepatic or renal disease) taking a median glyburide dose of 14 mg/day, who were to start insulin therapy because of sulfonylurea failure, were studied. Serum glyburide concentrations, measured by a newly developed selective and sensitive liquid chromatographic method, were followed from 10 to 48 h after the last glyburide dose.

RESULTS

Serum glyburide levels declined in three different phases, with a terminal 7-phase between 18 and 48 h having a mean ± SD half-life of 15.0 ± 6.7 h. Two patients had half-lives over 20 h. The half-life values did not correlate with fasting blood glucose, age, body weight, body mass index, or creatinine levels. The latter agrees with the assumption that glyburide is completely eliminated by metabolic transformation. Although longer than previously observed, the current half-life values are in accordance with clinical experience that glyburide is a long-acting sulfonylurea.

CONCLUSIONS

The elimination of glyburide in NIDDM subjects is slower than previously reported. The long half-life adds support to the use of a once-daily dosage of glyburide. It also justifies increased caution when using this sulfonylurea.
Effect of Antecedent Hypoglycemia on Cognitive Function and on Glycemie Thresholds for Counterregulatory Hormone Secretion in Healthy Humans
Authors: Mellman Michael J , Davis Maris R , Brisman Michelle , Shamoon Harry
Published: March 2007

OBJECTIVE

To determine whether reduced hormonal, symtomatic, and/or cognitive responses to hypoglycemia are caused by an increase in the plasma glucose concentration required to stimulate these counterregulatory parameters after antecedent hypoglycemia.

RESEARCH DESIGN AND METHODS

We studied nine healthy volunteers during stepped hypoglycemia clamps (plasma glucose targets from 80 to 50 mg/dl in 10 mg/dl steps) on two separate days. The study was preceded either by a 2-h period of hypoglycemia (plasma glucose 58 ± 2 mg/dl) or a 2-h period of euglycemia (plasma glucose 94 ± 2 mg/dl) for 90 min.

RESULTS

The plasma glucose that triggered secretion of-plasma norepinephrine (NE) was lower after antecedent hypoglycemia (control = 74 ± 2 and experimental = 67 ± 2 mg/dl, respectively, P < 0.005). In contrast, a relatively higher plasma glucose stimulated secretion of other counterregulatory hormones after anteceden hypoglycemia: growth hormone (GH) (65 ± 2 to 72 ± 2 mg/dl, P < 0.01); glucagon (63 ± 2 to 70 ± 2 mg/dl, P < 0.01); and epinephrine (EPI) (68 ± 2 to 76 ± 2 mg/dl, P < 0.01) when comparing control days with experimental days. Hypoglycemic symptoms were first observed at a plasma glucose plateau of 59 ± 2 mg/dl. Motor function reflected by Digit Symbol Substitution deteriorated equally whether there had been antecedent hypoglycemia or euglycemia. Logical (immediate) memory deteriorated in the control study at a plasma glucose of 54 ± 2 mg/dl but remained unchanged at equivalent hypoglycemia in the experimental study (P / 0.03).

CONCLUSIONS

Our conclusions are as follows: 1) symptoms of moderate hypoglycemia occur at plasma glucose levels averaging ∼5-15 mg/dl lower than the plasma glucose concentrations required to trigger counterregulatory hormone release; 2) after acute antecedent hypoglycemia, glucagon, EPI, and GH secretion occur at higher plasma glucose concentrations and NE is released at lower plasma glucose concentrations; and 3) there may be CNS adaptation to prior hypoglycemia reflected in preservation of logical memory function at plasma glucose levels of ∼50 mg/dl. These findings suggest that thresholds for hormone secretion and for changes in cognitive function can be altered very acutely by foregoing hypoglycemia in healthy humans.
Suicides in Men With IPPM
Authors: Kyvik Kirsten O , Stenager Elsebeth N , Green Anders , Svendsen Anders
Published: March 2007

OBJECTIVE

To investigate the occurrence of suicide in men with insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS

A cohort of all Danish men born between 1949 and 1964 (including 1964) who were diagnosed with IDDM before age 20 (n = 1,682) was ascertained earlier. Follow-up from diagnosis to death or 1 January 1991 was based on record linkage with the Danish Civil Registration System and was supplemented with information from death certificates obtained from the Danish National Registry of Deaths. From published vital statistics, cause-specific standardized mortality ratios (SMRs), adjusted for age and calendar time, were calculated.

RESULTS

Among the 168 deaths recorded during follow-up, 15 took place in connection with the onset of IDDM and have been excluded. Of the remaining 153 deaths, 12 were officially classified as suicides (SMR 12/7.48 = 1.6, 0.05 < P < 0.1); as for the age-group of 20-24 years, SMR was 2.98, P < 0.05. Furthermore, all deaths officially classified as attributable to unknown causes (n = 28) and accidents (n = 22) were reviewed with respect to unrecognized suicides; as for deaths of unknown causes, three could be reclassified as probable suicides and two as possible suicides, whereas one of the deaths caused by accident could be reclassified as possible suicide.

CONCLUSIONS

Young men with IDDM may confer a higher risk of suicide than expected. Furthermore, suicide may represent an underestimated cause of death among patients with IDDM.
Clinical Evaluation of a Semipermeable Polymeric Membrane Dressing for the Treatment of Chronic Diabetic Foot Ulcers
Authors: Blackman John D , Senseng Daniel , Quinn Lauretta , Mazzone Theodore
Published: March 2007

OBJECTIVE

To evaluate the utility of a semipermeable polymeric membrane dressing for the treatment of chronic diabetic foot ulcers.

RESEARCH DESIGN AND METHODS

Nineteen subjects with either insulin- dependent diabetes mellitus (IDDM) or non-insulin-dependent diabetes mellitus (NIDDM) and foot ulcers were randomly assigned to the polymeric dressing or conventional wet-to-dry saline dressings. Subjects had foot ulcer site measurements performed every 3 weeks. The subjects using conventional therapy were allowed to cross over to polymeric dressing after 2 months.

RESULTS

At the end of 2 months, in the patients using the polymeric dressing, ulcer size was reduced to 35 ± 16% of baseline. The patients on conventional therapy had an ulcer size of 105 ± 28% of baseline (P < 0.03, polymeric vs. conventional). Patients initially treated with wet-to-dry saline were crossed over into the polymeric membrane treatment and demonstrated a decrease to 35 ± 11% of baseline size (P < 0.02) after an additional 2 months.

CONCLUSIONS

The semipermeable polymeric membrane dressing is a useful therapeutic option for treating uncomplicated chronic diabetic foot ulcers.
Community Screening for Diabetes: Low detection rate in a low-risk population
Authors: Newman William P , Nelson Rik , Scheer Kurt
Published: March 2007

OBJECTIVE

To evaluate glucose-based community screening for diabetes with regard to detection rate.

RESEARCH DESIGN AND METHODS

A retrospective analysis of a community-screening questionnaire data base that included a screening for blood glucose. Referred subjects had fasting glucose levels >6.4 mM (115 mg/dl) or postprandial levels >8.9 mM (160 mg/dl). An attempt was made to contact referred subjects and to ascertain whether follow-up was undertaken and current status. A random sample of subjects not meeting the glucose criteria (nonreferred) also was contacted in an analogous fashion to referred subjects.

RESULTS

In 2,016 questionnaires, glucose-based referral criteria were exhibited by 148 (7.3%) individuals, and subsequent evaluation data were available for 111. Of those 111 individuals, 37 (33%) knew they had diabetes before the screening, and 39 (36%) did not seek further evaluation. Of the remaining 35 subjects, 6 (13%) were told of their new diagnosis of diabetes, and 29 were told they did not have diabetes. Three of 50 nonreferred subjects knew of their diabetes before screening. Thirty percent (14 out of 47) of nonreferred subjects underwent subsequent evaluation, although they were not told to do so. A single new case of diabetes occurred in the nonreferred group.

CONCLUSIONS

Community screening for diabetes that is based on measured glucose is of low yield. The known problems of glucose-based screening, coupled with its low yield, make a glucose-based approach difficult to justify. These results indicate that glucose-based community screening should be done only under the careful supervision of a health professional who is trained both in glucose measurement instrumentation and in screening.
Development of a Miniaturized Glucose Monitoring System by Combining a Needle-Type Glucose Sensor With Microdialysis Sampling Method: Long-term subcutaneous tissue glucose monitoring in ambulatory diabetic patients
Authors: Hashiguchi Yasuhiro , Sakakida Michiharu , Nishida Kenro , Uemura Takero , Kajiwara Ken-Ichiro , Shichiri Motoaki
Published: March 2007

OBJECTIVE

To develop a reliable and practical glucose monitoring system by combining a needle-type glucose sensor with a microdialysis sampling technique for long-term subcutaneous tissue glucose measurements.

RESEARCH DESIGN AND METHODS

A microdialysis Cuprophan hollowfiber probe (inner diameter, 0.20 mm; length, 15 mm) was perfused with isotonic saline solution (120 μl/h) and glucose concentrations in the dialysate were measured by a needle-type glucose sensor extracorporeally. This system was tested both in vitro and in vivo. Subcutaneous tissue glucose concentrations were then monitored continuously in 5 healthy and 8 diabetic volunteers for 7 to 8 days. A hollow-fiber probe was inserted into the abdominal subcutaneous tissue.

RESULTS

This monitoring system achieved excellent results in vitro. Subcutaneous tissue glucose concentrations were measured in a wide range from 1.7 to >027.8 mM glucose, with a time delay of 6.9 ±1.2 min associated with a rise in glucose and 8.8 ±1.6 min with a fall in the glucose level (means ± SE). The overall correlation between subcutaneous tissue (Y) and blood (X) glucose concentration was Y = 1.08X ± 0.19 (r = 0.99). The subcutaneous tissue glucose concentration could be monitored precisely for 4 days without any in vivo calibrations and for 7 days by introducing in vivo calibrations.

CONCLUSIONS

Glycemic excursions could be monitored precisely in the subcutaneous tissue by this microdialysis sampling method with a needle-type glucose sensor in ambulatory diabetic patients.
Plasma Cholesteryl Ester Transfer Protein and Its Relationship to Plasma Lipoproteins and Apolipoprotein A-I-Containing Lipoproteins in IDDM Patients With Microalbuminuria and Clinical Nephropathy
Authors: Kahri Juhani , Groop Per-Henrik , Elliott Tom , Viberti Giancarlo , Taskinen Marja-Riitta
Published: March 2007

OBJECTIVE

To study the distribution of high-density lipoprotein (HDL) subclasses in insulindependent diabetes mellitus (IDDM) patients with nephropathy and factors involved in the regulation of HDL, including plasma cholesteryl ester transfer protein (CETP) and postheparin plasma lipoprotein lipase (LPL) and hepatic lipase (HL) activities.

RESEARCH DESIGN AND METHODS

Participants included 52 microalbuminuric IDDM patients (with a urinary albumin excretion rate [UAER] of 20–200 μg/min), 37 macroalbuminuric IDDM patients (UAER >200 μg/min), and 64 normoalbuminuric IDDM patients (UAER <20 μg/min). Groups were matched for age, body mass index, duration of diabetes, and glycemic control (HbA1).

RESULTS

Median concentrations of HDL and HDL2 cholesterol were 11.6 (P = 0.01) and 22.7% (P = 0.01) less in microalbuminuric patients and 5.1 and 15.5% less in macroalbuminuric patients compared with normoalbuminuric patients. No significant differences were observed in the concentrations of apoA-I, apoA-II (apolipoprotein) or LpA-I or LpA-I:A-II (lipoprotein) particles between the groups. HDL cholesterol: apoA-I + apoA-II ratio was significantly lower in micro- (19.7 ± 4.2 (± SD); P < 0.01) and macroalbuminuric patients (20.0 ± 3.7, P < 0.05) than in normoalbuminuric patients (22.1 ± 4.4). Postheparin plasma LPL:IIL ratio was lower in microalbuminuric patients compared with normoalbuminuric patients (1.65 vs. 1.05 [median], P < 0.01). Plasma CETP activity was higher in the macroalbuminuric patients than in micro- (P < 0.05) and normoalbuminuric patients (P < 0.05) but did not correlate with HDL, HDL2, or HDL, cholesterol. LPLHL ratio correlated positively with HDL cholesterol (r = 0.372, P < 0.001), HDL2 cholesterol (r = 0.413, P < 0.001) and with LpA-I particles (r = 0.355, P < 0.001) but not with LpA-I:A-II particles (r = –0.065, NS).

CONCLUSIONS

IDDM patients with micro- and macroalbuminuria show only trivial changes in concentrations of different HDL parameters, which cannot explain the excess risk of coronary heart disease in these patients. Data also indicate that elevation of CETP activity in IDDM patients with nephropathy is probably not responsible for the lowering of HDL cholesterol.
Fasting Plasma Glucose in Screening for NIDDM in the U. S. and Israel
Authors: Modan Michaela , Harris Maureen I
Published: March 2007

OBJECTIVE

To demonstrate the inadequacy of fasting plasma glucose for screening for NIDDM, even among groups at high risk for diabetes.

RESEARCH PESIGN AND METHODS

Representative samples of adults 40–69 years of age in the U. S. (n = 2,035) and Israel (n = 2,316) were selected. Fasting plasma glucose (FPG) was measured and a 2-h oral glucose tolerance test (OGTT) was administered. Subjects with undiagnosed NIDDM were identified using internationally accepted diagnostic criteria (FPG ≥7.8 mM or 2-h plasma glucose ≥11.1 mM).

RESULTS

Only 31–38% of subjects with undiagnosed NIDDM had fasting hyperglycemia (2:7.8 mM), and 36% in the U. S. and 19% in Israel had normoglycemia (<6.1 mM). Postchallenge glucose, diagnostic of diabetes, was associated with all fasting values, including values <5.0 mM. Based on sensitivity, specificity, and positive predictive value, no FPG level provided a satisfactory cutoff point to use in screening for undiagnosed NIDDM. Sensitivity at each FPG cutoff point varied little among groups classified by age, sex, race, blood pressure status, or body mass index (BMI) levels >23, but sensitivity was lower among those with BMI levels <23.

CONCLUSIONS

In the clinical setting, FPG is commonly used in screening for NIDDM. However, fasting values ≥7.8 mM are highly insensitive for detecting NIDDM. Lower FPG cutoff points that achieve acceptable sensitivity are accompanied by inadequately low specificity, require a high percentage of patients to be retested, and result in a low yield of diabetes among those screened. Clinicians and researchers who seek detection of undiagnosed NIDDM should use the OGTT, because FPG lacks adequate sensitivity and specificity for this purpose.
Relationship Between Autonomic Neuropathy, 24-h Blood Pressure Profile, and Nephropathy in Normotensive IDDM Patients
Authors: Spallone Vincenza , Gambardella Sergio , Maiello Maria R , Barini Angela , Frontoni Slmona , Menzinger Guido
Published: March 2007

OBJECTIVE

To evaluate the relationship between autonomic neuropathy, nephropathy, and 24-h blood pressure (BP) pattern in insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS

We studied 30 normotensive IDDM patients without overt nephropathy, divided into two groups and matched for age, duration of diabetes, and HbA1 according to the presence of cardiovascular autonomic neuropathy. We simultaneously measured 24-h BP and urinary albumin excretion rate (UAE) on urine collections timed overnight and at 2-h intervals during the day.

RESULTS

Mean day and night systolic and diastolic BP values did not significantly differ between the groups. Mean night albuminuria was significantly higher in patients with autonomic neuropathy than in those without (61.4 ± 104.6 [mean ± SD] vs. 16 ± 25.2 μg/min, P < 0.04). The percentages day-night changes in systolic BP, diastolic BP, and UAE were significantly lower in neuropathic patients (systolic BP: 2.4 ± 7.7 vs. 9.6 ± 4.2%, P < 0.001; diastolic BP: 8.4 ± 6.9 vs. 15.5 ± 5.4%, P < 0.002; UAE: – 8 ± 99.4 vs. 49.3 ± 29.4%, P < 0.02) and were inversely related to autonomic score, index of autonomic neuropathy degree (r = –0.54, P < 0.002; r = –0.58, P < 0.001; and r = –0.53, P < 0.005, respectively). In patients with autonomic neuropathy, 2-h day periods and day and night UAE were more strongly related, respectively, to mean 2-h day periods (r = 0.58, P < 0.0001), day systolic BP (r = 0.67, P < 0.04), and night systolic BP (r = 0.69, P < 0.04) than in patients without autonomic neuropathy (2-h day periods: r = 0.32, P < 0.001; day: r = 0.37, NS; night: r = 0.35, NS).

CONCLUSIONS

Autonomic neuropathy in IDDM patients is associated with reduced nocturnal falls in BP and UAE and with a stronger relationship of UAE to systolic BP. We suggest a pathogenetic role of autonomic neuropathy in the development of diabetic nephropathy through changes in nocturnal glomerular function and by enhanced kidney vulnerability to hemodynamic effects of BP.
Comparison of Acute Daytime and Nocturnal Insulinization on Diurnal Glucose Homeostasis in NIDDM
Authors: Puhakainen Ilpo , Taskinen Marja-Riitta , Yki-Järvinen Hannele
Published: March 2007

OBJECTIVE

The question of whether to use insulin in the evening or in the morning during combination therapy in patients with non-insulin-dependent diabetes mellitus (NIDDM) is controversial. We compared the acute effects of 12-h nocturnal or daytime insulin infusions on the 24-h glucose profile in 20 patients with NIDDM.

RESEARCH DESIGN AND METHODS

NIDDM patients were 56 ± 2 (mean ± SE) years of age and had a body mass index of 29.6 ±1.1 kg/m2; fasting plasma glucose concentration of 12.2 ± 0.5 mM; and fasting C-peptide concentration of 0.9 ± 0.2 nM. Each patient was studied twice. On one occasion, the patient received a 12-h intravenous infusion of insulin (mean 1.5 ± 0.1 1U/h) during the day, and on the other occasion an identical dose of insulin was infused during the night. Blood glucose, insulin, c-peptide, and free fatty acid concentrations were determined for 24 h.

RESULTS

The mean 24-h free insulin concentrations were similar in both studies (150 ± 12 vs. 162 ± 12 pM, daytime versus nocturnal insulin infusion). The mean 24-h free fatty acid concentration was 18% lower in the nocturnal than in the daytime (309 ± 30 vs. 376 ± 30 μM, P < 0.001) insulin infusion study. The mean 24-h C-peptide concentration was less suppressed if insulin was infused overnight than during the day (1.3 ± 0.2 vs. 1.1 ± 0.2 nM, P < 0.01). The mean 24-h plasma glucose concentrations were identical in both studies (11.1 ±0.6 vs. 11.4 ± 0.7 mM, daytime versus nocturnal insulin infusion). We also searched for factors predicting the decrease in the blood glucose concentration during the nocturnal insulin infusion. The best predictors were a high initial blood glucose concentration at 2200 and a low fasting C-peptide concentration. These factors explained, independent of each other, 50% of the rate of decrease in the plasma glucose concentration.

CONCLUSIONS

Despite better suppression of lipolysis and less suppression of endogenous insulin secretion by nocturnal than daytime insulinization, the hypoglycemic effect of these two treatments is similar.
Platelet Plasminogen Activator Inhibitor 1 in Patients With Type II Diabetes
Authors: Jokl Rudolf , Laimins Marta , Klein Richard L , Lyons Timothy J , Lopes-Virella Maria F , Colwell John A
Published: March 2007

OBJECTIVE

To compare platelet plasminogen activator inhibitor 1 (PAI-1) concentration in type 11 diabetic patients and healthy control subjects.

RESEARCH DESIGN AND METHODS

We studied a group of 12 diabetic patients whose disease was controlled by diet or sulfonylurea therapy and a group of 17 nondiabetic control subjects. All subjects were free of clinically advanced vascular disease. PAI-1 antigen concentrations were measured in 5 × 108 isolated platelets, which were lysed by 1% Triton X-100.

RESULTS

Mean platelet PAI-1 was significantly higher in diabetic patients (264 ± 83 ng/5 × 108 platelets) compared with control subjects (202 ±71 ng/5 × 108platelets) (P < 0.05). A significant independent positive correlation was found between platelet PAI-1 concentrations and fasting plasma specific insulin levels in the diabetic patients (r = 0.63, P = 0.03).

CONCLUSIONS

These findings suggest that 1) a higher platelet PAI-1 concentration may contribute to enhanced thrombosis in type II diabetes and 2) megakaryo-cyte PAI-1 synthesis may be under the control of insulin.
Fetal Hemoglobin in Diabetic Patients
Authors: Koskinen Leena K , Lahtela Jorma T , Koivula Timo A
Published: March 2007

OBJECTIVE

To determine the occurrence of elevated fetal hemoglobin (HbF) among the diabetic population and determine the clinical situation of importance.

RESEARCH DESIGN AND METHODS

A cross-sectional study was conducted. HbA1c. and HbF were measured with high-performance liquid chromatogra-phy in 1,104 consecutive diabetic patients attending our clinic for HbA1c determination. The expression of clinical correlations between the high and low HbF group was performed for adults (≥15 years). A nondiabetic control group (n = 258) with the same age and sex distribution was included.

RESULTS

HbF was elevated (>1.0% of total hemoglobin) in 7.5% of the total diabetic group. In the adult diabetic group, HbF was elevated in 6.5% of the patients, and in the control group, HbF was elevated in 1.9% (P < 0.01). In the insulin-treated adult group, HbF was elevated in 10.2% of the patients, and in the non-insulin-treated group, HbF was elevated in 3.8%. The mean HbA1c was 8.90 ± 2.00% among the patients and 5.52 ± 0.53% in the control subjects (P < 0.001). Patients with elevated HbF were younger (P < 0.02) and more often on insulin therapy (P < 0.001) or type I diabetic patients (P < 0.001). Sex, glycemic control, or duration of diabetes were not significantly different in the patients with high or low HbF. Correlation was not detected between the amount of HbF and HbA1c or age in the group of patients with elevated HbF. Hemoglobinopathies, anemias, or malignancies were not diagnosed from the patients with high HbF.

CONCLUSIONS

Level of HbF is increased (>1.0%) among 7.5% of unselected diabetic patients. In adult (≥15 years) diabetic patients, it is increased among 6.5%, which is 3.4 times more often than in the control population. Acute hematological conditions or malignancies do not explain the difference. Elevated HbF seems to be associated with type I diabetes and insulin treatment.
A Telephone-Delivered Intervention for Patients With NIDDM: Effect on coronary risk factors
Authors: Kirkman M Sue , Weinberger Morris , Landsman Pamela B , Samsa Gregory P , Shortliffe E Anne , Simel David L , Feussner John R
Published: March 2007

OBJECTIVE

To examine whether a telephone-delivered intervention (TDI), designed to improve glycemie control in patients with non-insulin-dependent diabetes mellitus (N1DDM), improved coronary risk factors in high-risk patients.

RESEARCH DESIGN AND METHODS

This randomized controlled trial involved 275 veterans with N1DDM followed in a general medical clinic. Intervention (TDI) patients were telephoned at least monthly by a nurse. Calls emphasized compliance with the medical regimen (diet, medications, and exercise), encouraged behavioral changes, and facilitated referrals to a dietitian or smoking cessation clinic. Control patients received no such calls. Baseline and 12-month follow-up measurements included fasting lipid profiles, weight, smoking status (self-reported; cessation verified by measurement of exhaled CO), adherence to diet and exercise (self-reported), appointments, and medications (hospital computerized data base).

RESULTS

After 12 months, equal numbers of obese patients in the two groups reported adhering to a diabetic diet and exercising, although more obese TDI patients had seen a dietitian (30 vs. 7%, P = 0.003). Weight loss was not seen in either group (—0.9 ± 5.3 vs. —0.1 ± 3.6 kg, P = 0.202). Hyperlipidemic TDI patients were more likely to see a dietitian (31 vs. 6%, P = 0.003) and receive lipid-lowering medications (22 vs. 9%, P = 0.096), but serum cholesterol reduction was similar between groups (–11.7 ± 33.4 vs. –4.3 ± 32.7 mg/dl, P = 0.270); comparable results were seen for high-density lipoprotein, low-density lipoprotein, and triglyceride levels. More TDI group smokers reported quitting (26 vs. 0%, P = 0.033), but the difference was not significant for CO-verified abstention (10 vs. 0%, P = 0.231).

CONCLUSIONS

The TDI improved self-reported adherence to regimens that might reduce coronary risk, but had little effect on objective measures of risk.
A Population Survey on the Prevalence of Diabetes in Kin-Hu, Kinmen
Authors: Chou Pesus , Liao Ming-Jen , Kuo Hsu-Sung , Hsiao Kwang-Jen , Tsai Shih-Tzer
Published: March 2007

OBJECTIVE

To investigate the prevalence of non-insulin-dependent-diabetes mellitus in Kin-Hu, Kinmen.

RESEARCH DESIGN AND METHODS

This is a community-based population survey. The target population are residents ≥30 years of age in Kin-Hu, Kinmen, according to the official household registry in 1990. Face to face interviews were conducted by the Yang-Ming Crusade in 1991 using a structured questionnaire. Fasting blood samples were drawn by public health nurses, and a 75-g oral glucose tolerance test was performed for definite diagnosis of diabetes.

RESULTS

; There were 4,097 eligible subjects (2,026 men and 2,071 women), and 3,236 had complete fasting plasma glucose data (1,536 men and 1,700 women). The response rate was 79% (76% for men and 82% for women). The age-specific response rates were 81% for the 30- to 39-year and 50- to 59-year age-groups, 84% for the 40- to 49-year age-group, and 69% for the ≥60-year age-group. The crude prevalence of diabetes in Kin-Hu was 6.5% (2.0% previous and 4.5% new). With the standard world population of Segi, the age-adjusted prevalence rate was 4.9% (4.5% for men and 5.4% for women). The prevalence rate of diabetes increased significantly with age. The prevalence of previously diagnosed diabetes accounted for less than one third of the total rate.

CONCLUSIONS

The population survey in Kin-Hu, Kinmen, had a high response rate of 79%. The crude prevalence rate of diabetes was 6.5%, and the age-adjusted prevalence rate was 4.9%. The low ratio of previously diagnosed to newly diagnosed diabetic cases may be due to lack of public awareness and medical services in this community.
Different Change in Lipoprotein(a) Levels From Lipid Levels of Other Lipoproteins With Improved Glycemie Control in Patients With NIDDM
Authors: Kikuchi Toru , Onuma Tomio , Shimura Michitaka , Tsutsui Masahiro , Boku Akitoshi , Matsui Jun , Takebe Kazuo
Published: March 2007

OBJECTIVE

To evaluate change both in lipoprotein(a) [Lp(a)] and lipid levels in other lipoproteins in non-insulin-dependent diabetes mellitus (NIDDM) after short-term improvement of glycemie control.

RESEARCH DESIGN AND METHODS

We compared Lp(a) levels in 210 NIDDM patients with those in 46 control subjects and evaluated the relationship between glycemie control and Lp(a) levels in diabetic patients. In addition, changes in Lp(a) levels and lipid levels were assessed after the improvement of glycemie control in 54 poorly controlled NIDDM patients.

RESULTS

In NIDDM, Lp(a) levels in all patients, 62 patients with HbA1c <6.0%, and 75 patients with HbA1c between 6.0 and 8.0%, were significantly higher than those in control subjects (19.1 [1.7-106.6], 19.2 [6.0-106.6], and 20.3 [2.7-75.3] vs. 15.4 [2.0-61.7] mg/dl, median [range], P < 0.05). Lp(a) levels in 73 patients with HbA1c of ≥8.0% (18.7 [1.7-58.8] mg/dl) were not significantly different from those in control subjects. After glycemie control, lipid levels in plasma and in other lipoproteins fell significantly, but Lp(a) did not change (from 18.3 [1.7-58.8] to 18.4 [6.6-95.3] mg/dl). Changes in lipid levels, including Lp(a), did not correlate with those in fasting plasma glucose or HbAlc.

CONCLUSIONS

These results suggest that elevated Lp(a) levels do not reflect poor glycemie control and that Lp(a) levels are independent of lipid levels in other lipoproteins after improved glycemie control in NIDDM.
Anti-Insulin Antibodies Are a Cause of Hypoglycemia Following Pancreas Transplantation
Authors: Tran Minou P , Larsen Jennifer L , Duckworth William C , Ruby Elizabeth I , Miller Suzanne A , Frisbie Kecia , Taylor Rodney J , Stratta Robert J
Published: March 2007

OBJECTIVE

Hypoglycemie symptoms have been reported by more than half of pancreas transplantation (PTX) recipients. To better understand the mechanism for the hypoglycemia documented in some of these patients, we studied the glucose and pancreatic hormone response to Sustacal in patients with and without hypoglycemia following PTX.

RESEARCH DESIGN AND METHODS

Twelve patients with established, repeated episodes of hypoglycemia following PTX (hypo) were case-matched to PTX recipients without hypoglycemie symptoms (control; n = 7). On the day of the study, fasting glucose, free and total immunoreactive insulin (IR1), C-peptide, proinsulin, and glucagon were drawn (time 0); Sustacal was administered; and glucose, free and total IRI, and C-peptide were assayed at 15,30,45, 75,120,150,180, and 240 min. Based on the glucose response to Sustacal, the hypo group was further divided into those whose glucose rose after Sustacal (hypo-high; n = 7) and those with no increase in glucose from baseline concentration (hypo-flat; n = 5).

RESULTS

Before the administration of Sustacal, the hypo-high group had a lower fasting free/total IRI (0.26 ± 0.06, mean ± SE) than the hypo-flat (0.51 ± 0.02) or control (0.52 ± 0.04) groups (both P < 0.05 compared with hypo-high). The glucose response to Sustacal was greatest in the hypo-high group as defined. Area under the curve (AUC) for total IRI following Sustacal was also greatest in the hypo-high group (P < 0.05 compared with both control and hypo-flat groups), but there was no significant difference in free IRI AUC following Sustacal between the three groups. Two individuals developed hypoglycemia during the Sustacal challenge, both in the hypo-high group.

CONCLUSIONS

The lower fasting free/total IRI ratio and greater increase in glucose and total IRI in response to Sustacal in the hypo-high group compared with either the hypo-flat or control groups are consistent with the presence of significant quantities of anti-insulin antibodies in the hypo-high group. Because anti-insulin antibodies are, in turn, an established cause of episodic hypoglycemia, this study provides the first data to support the hypothesis that significant quantities of anti-insulin antibodies are a cause of symptomatic hypoglycemia following PTX in some recipients.
Osteopenia, Neurological Dysfunction, and the Development of Charcot Neuroarthropathy
Authors: Young Matthew J , Marshall Andrew , Adams Judith E , Selby Peter L , Boulton Andrew JM
Published: March 2007

OBJECTIVE

To determine factors that might be associated with the development of Charcot neuroarthropathy.

RESEARCH DESIGN AND METHODS

This cross-sectional prevalence study examined neurological function and bone density in matched groups of neuropathic diabetic patients with and without radiological evidence of Charcot neuroarthropathy.

RESULTS

Patients with Charcot neuroarthropathy had a global impairment of neurological function that was significantly greater than that of otherwise matched non-Charcot neuropathic patients. All 17 Charcot patients had evidence of autonomic neuropathy compared with 10 of the control subjects (P = 0.03). The Charcot patients had evidence of reduced bone density in the lower limbs compared with the neuropathic control subjects (P = 0.009), but relatively preserved bone density in the spine (P = 0.4 vs. control subjects).

CONCLUSIONS

We conclude that minor trauma in diabetic patients with peripheral neuropathy might result in a fracture in those with a reduced bone density and thus trigger the development of Charcot neuroarthropathy.
A Comparison of Fish Oil or Corn Oil Supplements in Hyperlipidemic Subjects with NIDDM
Authors: Morgan Wanda A , Raskin Philip , Rosenstock Julio
Published: March 2007

OBJECTIVE

To examine the effects on blood lipids and glycemic control of fish oil and corn oil supplementation at two levels in subjects with hyperlipidemia and non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

Forty subjects (18 men and 22 women; aged 53.9 ± 7.0 years) with NIDDM and hyperlipidemia were randomly assigned to one of four treatment groups: 9 g of fish oil, 18 g of fish oil, 9 g of corn oil, or 18 g of corn oil daily supplementation for 12 weeks.

RESULTS

The level of oil supplements (9 g compared with 18 g) did not have a significant effect within each oil group on glycemic control and lipids. Significant differences (P < 0.05) in lipids were found when the 9-g and 18-g groups were combined. In subjects consuming fish oil, plasma very-low-density lipoprotein (VLDL) cholesterol (P = 0.0001), plasma triglyceride (TG) (P = 0.0001), and plasma VLDL TGs (P = 0.02 at 6 weeks and P = 0.0001 at 12 weeks) were significantly lowered compared with subjects consuming corn oil. Plasma VLDL cholesterol increased across time in the corn oil group (P = 0.04). Plasma low-density lipoprotein (LDL) cholesterol was temporarily increased (P = 0.008) in the fish oil group at 6 weeks, but the effect was no longer present at 12 weeks. No significant differences between fish oil–or corn oil-supplemented diets were found in total plasma cholesterol, high-density lipoprotein cholesterol, fasting plasma glucose, glycosylated HbA1c, weight, and blood pressure.

CONCLUSIONS

In this study, fish oil supplementation improved plasma VLDL cholesterol, VLDL TGs, and total TGs while having a transient deterioration in LDL cholesterol in subjects with NIDDM. Furthermore, fish oil supplementation had no significant deleterious effect on glycemic control.
Psychological Stress and the Onset of IDDM in Children: A case-control study
Authors: Thernlund Gunilla M , Dahlquist Gisela , Hansson Kjell , Ivarsson Sten A , Ludvigsson Johnny , Sjöblad Sture , Hägglöf Bruno
Published: March 2007

OBJECTIVE

The purpose of the study was to determine whether psychosocial stress during different life periods could be a risk factor in the etiology/pathogenesis of insulin-dependent diabetes mellitus (IDDM) in children.

RESEARCH DESIGN AND METHODS

In a population-based sample of 67 case patients 0–14 years of age and 61 matched healthy control subjects, life events during the entire lifespan before the onset of IDDM were recorded as well as measures of child behavior before onset, social support, and family function.

RESULTS

Negative life events occurring during the first 2 years of life, life events with difficult adaptation, child behavioral deviances, and a more chaotic family function were more common in the case group. A stepwise logistic regression indicated that negative life events in the first 2 years increased the risk of IDDM and that premorbid child behavior as well as dysfunctional hierarchical family pattern affect the risk.

CONCLUSIONS

Stress early in life may increase the risk for IDDM, presumably by affecting the autoimmune process. To confirm these results, it is necessary to make a truly prospective study.
Psychosocial Status of Children With Diabetes in the First 2 Years After Diagnosis
Authors: Grey Margaret , Cameron Mary Emily , Lipman Terri H , Thurber Frances W
Published: March 2007

OBJECTIVE

The purpose of this study was to determine the pattern of adjustment over time of a cohort of children with newly diagnosed diabetes compared with a cohort of peer-selected children without diabetes over the first 2 years after the diagnosis of insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS

Children (n = 89 with IDDM, n = 53 without IDDM) ages 8–14 years were studied with the Children's Depression Inventory, State-Trait Anxiety Inventory for Children, Child and Adolescent Adjustment Profile, Self-Perception Profile for Children, and a general health scale. Initial data were collected within 6 weeks of the diagnosis of IDDM and at 3, 6, 12, and 24 months thereafter.

RESULTS

There were no demographic differences between the two groups. Initially, children with diabetes were more depressed, more dependent, and more withdrawn than their peers. By 1 year postdiagnosis, there were no significant differences in psychosocial status between the two groups. By 2 years postdiagnosis, depression, dependency, and withdrawal were significantly higher in children with diabetes than in their peers without IDDM. Self-perceived competence remained similar between the two groups at all time points.

CONCLUSIONS

After an initial period of adjustment, children with IDDM have equivalent psychosocial status to children without IDDM, but by 2 years after diagnosis, they have experienced twice the amount of depression and adjustment problems as their peers. Interventions should be aimed at this critical period between 1 and 2 years postdiagnosis.
Improved Postprandial Metabolic Control After Subcutaneous Injection of a Short-Acting Insulin Analog in IDDM of Short Duration With Residual Pancreatic β-Cell Function
Authors: Pampanelli Simone , Torlone Elisabetta , Ialli Carlo , Sindaco Paola Del , Ciofetta Marco , Lepore Mauro , Bartocci Linda , Brunetti Paolo , Bolli Geremia B
Published: March 2007

OBJECTIVE

To compare postprandial metabolic control after subcutaneous injection of a short-acting insulin analog [Lys(B289),Pro(B29)] (Lispro) or human regular insulin (Humulin R U-100 [Hum-R]) in insulin-dependent diabetes mellitus (IDDM) of short duration with residual β-cell function.

RESEARCH DESIGN AND METHODS

Six IDDM patients (age 25 ± 2 years, diabetes duration 14 ± 2 months, HbA1c 6.4 ± 0.5%) with residual pancreatic β-cell function (fasting plasma C-peptide 0.19 ± 0.02 nmol/l) were studied on three different occasions. Postbreakfast plasma glucose was maintained at ∼ 7.1 mmol/l by means of intravenous insulin until either 1200 when 0.1 U/kg Hum-R was injected or until 1225 when 0.1 U/kg of either Hum-R or Lispro was injected subcutaneously. Lunch (mixed meal, 692 Kcal) was served at 1230 (0 min). Six nondiabetic control subjects were also studied.

RESULTS

After Lispro administration, the 120-min plasma glucose decreased more (6.1 ± 0.3 mmol/l) than after injection of Hum-R at −30 min (7.7 ± 0.3 mmol/l) or −5 min (9.9 ± 0.2 mmol/l). By the end of the study, plasma glucose was still lower after Lispro was injected (6.7 ± 0.3 mmol/l) than after Hum-R was injected at −30 min (7.6 ± 0.3 mmol/l) or −5 min (7.3 ± 0.2 mmol/l) (P < 0.05). Two IDDM patients required glucose to prevent hypoglycemia after being injected with Lispro, but four required glucose after being injected with Hum-R at −5 min (Lispro ∼ 27 mmol glucose infused between 90 and 240 min; Hum-R ∼ 80 mmol between 240 and 390 min). After Lispro, plasma insulin peaked earlier (at 30 min, 342 ± 29 pmol/l) than after Hum-R injection at −30 min (at 90 min, 198 ± 28 pmol/l) and was superimposable on that of nondiabetic subjects. In Hum-R injected at −5 min, plasma insulin peaked later (at 120 min) and subsequently remained > in the two other studies.

CONCLUSIONS

Despite the lack of a time interval between injection and meal, Lispro controls postprandial plasma glucose concentration better than Hum-R given 30 min before meals and, to an even greater extent, better than Hum-R given 5 min before meals. In addition, Lispro minimizes the risk of postprandial hypoglycemia, thus closely mimicking the postprandial glucose homeostasis of nondiabetic subjects. IDDM patients with residual pancreatic β-cell function are the ideal candidates for prandial use of Lispro because they can maintain near-normoglycemia longer after subcutaneous analog injection because of residual endogenous insulin secretion.
Steadily High IDDM Incidence Over 4 Years in Sardinia
Authors: Muntoni Sandro , Stabilini Liliana , Stabilini Marco , Mancosu Gabriella , Muntoni Sergio
Published: March 2007

OBJECTIVE

To verify whether the high incidence of insulin-dependent diabetes mellitus (IDDM) in Sardinia is an epidemic outbreak or a steady phenomenon.

RESEARCH DESIGN AND METHODS

All newly diagnosed cases of IDDM with onset in patients 0–29 years of age between 1 January 1989 and 31 December 1992 among residents in Sardinia were obtained from the Sardinian IDDM Incidence Registry. The local IDDM patient association (Associazione Diabete Infantile Giovanile) served as the secondary and independent source.

RESULTS

The completeness of ascertainment was 91%. The age-standardized mean annual incidence of IDDM (per 100,000) was 34.4 in the 0- to 14-year-old age-group and 26.2 in the entire 0- to 29-year-old range, respectively. Men-to-women ratios were 1.38 and 1.55, respectively. Seasonal variation in incidence was observed, with a peak in fall and winter and a nadir in summer.

CONCLUSIONS

Sardinia has a very high and steady IDDM incidence rate, which is up to fivefold that of other Italian regions and Mediterranean countries and approaches the Finnish top rate in the world. Interaction between the genetic peculiarity of Sardinians and still unidentified powerful environmental agents is likely to account for the phenomenon.
Hypomagnesemia in Type II Diabetes: Effect of a 3-Month Replacement Therapy
Authors: Eibl Nicole L , Kopp Hans-Peter , Nowak Helga R , Schnack Christoph J , Hopmeier Pierre G , Schernthaner Guntram
Published: March 2007

OBJECTIVE

To investigate the effects of long-term high-dose oral magnesium (Mg) therapy (30 mmol/day) in patients with type II diabetes. Low plasma magnesium levels have been reported in type II diabetes and are associated with insulin resistance and diabetic late complications.

RESEARCH DESIGN AND METHODS

Forty patients with type II diabetes and hypomagnesemia were observed in a randomized double-blind placebo-controlled trial for 3 months (body mass index: 28 ± 4 kg/m2; HbA1c: 7.4 ± 0.8%). Plasma and urine magnesium and metabolic control parameters were determined, and side effects were considered, especially with regard to patients' compliance.

RESULTS

A significant increase in plasma magnesium levels was observed after 3 months of treatment (Mg: 0.73 ± 0.8 vs. 0.81 ±0.1 mmol/1), reaching magnesium levels of the control group (0.88 ± 0.8 mmol/1; NS); metabolic control, however, was not altered (HbA1c: 7.2 ± 0.7 vs. 7.4 ± 0.9%). Six months after the end of the trial, plasma magnesium declined to pretreatment levels (Mg: 0.73 ± 0.07 mmol/1). The prevalence of side effects was high at the beginning and was reduced significantly during treatment.

CONCLUSIONS

We conclude that oral magnesium replacement therapy corrects hypomagnesemia after a minimum treatment period of 3 months. These observations might be important for the prevention of diabetic late complications.
The Independent Contributions of Diabetic Neuropathy and Yasculopatny in Foot Ulceration: How great are the risks?
Authors: McNeely Marguerite J , Boyko Edward J , Ahroni Jessie H , Stensel Victoria L , Reiber Gayle E , Smith Douglas G , Pecoraro Roger E
Published: March 2007

OBJECTIVE

To describe the relative contributions of neurological and vascular abnormalities to the overall risk of diabetic foot ulceration.

RESEARCH DESIGN AND METHODS

A case-control study of diabetic veterans from the Seattle Veterans Affairs Medical Center was conducted using data collected from 46 patients with diabetic foot ulcers and 322 control subjects. Neuropathy was determined by vibratory, monofilament, and tendon reflex testing. Macro-vascular disease was measured by ankle-arm blood pressure index, and cutaneous perfusion was measured by transcutaneous oxygen tension (TcPO2) on the dorsal foot. A multi variate logistic regression model was used to adjust for confounding variables and to calculate the odds ratios (ORs) for each independent risk factor.

RESULTS

Three variables were significant independent predictors of foot ulceration: absence of Achilles tendon reflexes (adjusted OR 6.48, 95% confidence interval [CI] 2.37–18.06), insensate to the 5.07 monofilament (adjusted OR 18.42, 95% CI 3.83–88.47), and TcPO2 <30 mmHg (adjusted OR 57.87, 95% CI 5.08–658.96). Absent vibratory sensation and low ankle-arm blood pressure index were not significant independent risk factors.

CONCLUSIONS

Both neuropathy and vasculopathy are strong independent risk factors for the development of diabetic foot ulcers. In our model, the strongest risk factor is impaired cutaneous oxygenation. However, in the clinical setting, sensory examination with a 5.07 monofilament probably remains the single most practical measure of risk assessment.