bluuebunny/crossref_metadata_2025 huggingface dataset:
A Population-based Study of Diabetes Mortality
Authors: Ochi James W , Melton L Joseph , Palumbo Pasquale J , Chu Chu-Pin
Published: March 2007

In a population-based investigation among the residents of Rochester, Minnesota, the diabetes mortality rate was 8.5 per 100,000 person-years with diabetes as the underlying cause of death, 31.5 per 100,000 person-years with diabetes as an underlying or contributory cause, and 82.7 per 100,000 person-years if all deaths among diabetic individuals were counted. Diabetes was not mentioned on the certificate in 62% of the 428 diabetic deaths during 1965–1974. When the clinical characteristics of the subgroup of mortality cases in 1969 were compared with those of the prevalence cases on 1 January 1970, it was found that mortality cases tended to be older, were more often on insulin therapy, and were more likely to have macro- and microvascular complications. Because mortality data are sometimes used to infer trends and characteristics for the diabetic population at large, it is important to recognize these biases.
Incidence and Management of Severe Hypoglycemia in 434 Adults with Insulin-dependent Diabetes Mellitus
Authors: Mühlhauser Ingrid , Berger Michael , Sonnenberg Gabriele , Koch Jutta , Jörgens Viktor , Schernthaner Guntram , Scholz Vera , Pädagogin Diplom
Published: March 2007

The risk of severe hypoglycemia associated with the particular therapeutic approach of two University hospitals was assessed in 96% of all patients with insulin-dependent diabetes mellitus (IDDM) who had been admitted during a period of almost 3 yr to the diabetic wards of two hospitals and who participated in a structured teaching and treatment program. During a mean follow-up period of 18 mo, 10% of the conventionally treated patients (N = 384; age 30 ± 13 yr; duration of diabetes 12 ± 9 yr) and 9% of the CSII-treated patients (N = 50, age 28 ± 7 yr, duration of diabetes 13 ± 7 yr, total follow-up period 1093 patient-mo) experienced at least one severe hypoglycemic episode per year, and a total of 123 severe hypoglycemic episodes occurred. In a subgroup of 169 conventionally treated patients, mean glycosylated hemoglobin values decreased from 10.5 ± 1.9% before participation in the program to 9.2 ± 2.0% (P < 0.001) 18 ± 4 mo thereafter. For the CSII-treated patients, glycosylated hemoglobin values were 9.7 ± 1.9% before initiation of pump therapy and remained at the upper normal range from 3 mo thereafter throughout the study. There was no relationship between glycosylated hemoglobin levels and the occurrence of severe hypoglycemic episodes. Fifty-three severe hypoglycemic episodes were treated with glucagon injections by the patients' relatives (all but one effectively), 30 were managed by assisting physicians, and 44 led to hospitalization. Thus, successful attempts to improve glycosylated hemoglobin values in an unselected group of patients with IDDM were not associated with an unduly high risk of severe hypoglycemia when compared with the scarce data from the literature.
Outpatient Management of Diabetes Mellitus with Patient Education to Increase Dietary Carbohydrate and Fiber
Authors: Stevens June , Burgess Mary B , Kaiser Donald L , Sheppa C Michael
Published: March 2007

The impact of patient education on dietary fiber intake, diabetes control, and serum lipids was examined in patients with non-insulin-dependent diabetes mellitus. Customary outpatient personnel and procedures were used to teach three diet plans: (1) the American Diabetes Association (ADA) diet, (2) the ADA diet modified to increase high-fiber, high-carbohydrate foods (IF), and (3) the IF diet supplemented with oat bran (IFOB). A control group was instructed on foot care to provide teaching visits. Fifty-two patients were recruited from an outpatient clinic and studied over a 6-wk period. Subjects were of low socioeconomic status and had completed a mean of 8.3 yr of education. Patients instructed to increase their intake of high-fiber foods reported a doubling of fiber intake and tolerated the diets well. Increased fiber and carbohydrate intake and decreased fat intake were associated with reductions in fasting plasma glucose levels. Increased fiber intake was also associated with reductions in total serum cholesterol and high-density lipoprotein cholesterol levels. Changes in fiber, carbohydrate, and fat intake were unrelated to changes in weight, serum insulin levels, or hemoglobin A1c levels over the study period.
High Prevalence of Maturity-onset Diabetes of the Young (MODY) Among Indians
Authors: Mohan Viswanathan , Ramachandran Ambady , Snehalatha Chamukuttan , Mohan Rema , Bharani Gopalan , Viswanathan Moopil
Published: March 2007

This article describes the high prevalence of maturity-onset diabetes in the young (MODY) in an Indian clinic population of diabetic patients. MODY appears to be more common among Indians than among Caucasians. Only 27% of MODY patients had definite autosomal-dominant inheritance. In 73% the mode of inheritance was not definite. Microvascular complications were common and macrovascular complications rare. The high prevalence of MODY in this diabetes clinic might suggest an ethnic variation in diabetes.
Effects of Exercise Training on Insulin Sensitivity in Adolescents with Type I Diabetes
Authors: Landt Kyle W , Campaigne Barbara N , James Frederick W , Sperling Mark A
Published: March 2007

We investigated the influence of a program of exercise training consisting of three weekly sessions, each 45 min long, for 12 wk, on indices of physical fitness, glycemic control, and insulin sensitivity in nine adolescents with type I diabetes; six age-matched adolescents with diabetes of equivalent duration served as nonexercised controls. All subjects were instructed not to change dialy insulin dose or caloric intake. In the exercised group, maximal oxygen uptake during graded cycle ergometry to volitional exhaustion increased by 9 ± 2.7% (P < 0.01) and lean body mass increased by 4 ± 1.8% (P < 0.05). Insulin sensitivity, assessed via the euglycemic clamp technique at insulin infusion rates of 100 mU/M2/min, showed an increase of insulin-mediated glucose disposal from 274 ± 33 to 338 ± 28 mg/M2/min, representing an increase in insulin sensitivity of 23 ± 5% (P < 0.01). None of these indices changed in the control group. Despite increased insulin sensitivity, glycohemoglobin levels remained at 12 ± 1% before and after the 12 wk of exercise training, indicating no improvement in overall glycemic control. No increase in hypoglycemic reactions was reported in either group. We conclude that exercise training may be a valuable adjunct in managing type I diabetes providing there is concomitant attention to diet and insulin. Exercise training alone, however, does not improve glycemic control, although it improves physical fitness and insulin sensitivity.
Professional Education in a Long-Term-Care Facility: Program Development in Diabetes
Authors: Wylie-Rosett Judith , Villeneuve Mary , Mazze Roger
Published: March 2007

To effect diabetes care in a 1000-bed chronic care institution, a program development approach to multidisciplinary staff education was implemented. Chart audit, staff interviews, and observations were used to evaluate care standards. Initial assessment revealed that none of the charts included a thorough evaluation of patients for skills, knowledge, and adherence related to care of diabetes. Additionally, it was found that the current diagnostic criteria for diabetes and urine testing procedures were not being used. An educational approach was implemented to teach current information about diabetes, to focus on multidisciplinary coordination of care, and to set goals for care on model care units. Postintervention assessments of the model care units were completed at 6 and 24 mo. There were substantial alterations in care, with more of the charts meeting the standard in each of the eight categories under investigation: diabetes diagnosis according to National Diabetes Data Group criteria, urine testing, capillary blood testing, rotation of insulin injection site, assessment of patients for adherence to regimen, assessment of patient skills and knowledge, and interdisciplinary coordination of care.
The Value of Cardiovascular Autonomic Function Tests: 10 Years Experience in Diabetes
Authors: Ewing David J , Martyn Christopher N , Young Robert J , Clarke Basil F
Published: March 2007

Five simple, noninvasive cardiovascular reflex tests have been used to assess autonomic function in one center over the past 10 yr. Seven hundred seventy-four diabetic subjects were tested for diagnostic and research purposes. In 543 subjects completing all five tests, abnormalities of heart rate tests occurred in 40%, while abnormal blood pressure tests occurred in < 20%. Their results were grouped as normal (39%), early (15%), definite (18%), and severe (22%) involvement. Six percent had an atypical pattern of results. Two hundred thirty-seven diabetic subjects had the tests repeated ≤3 mo apart: 26% worsened, 71% were unchanged, and only 3% improved. The worsening followed a sequential pattern with first heart rate and later additional blood pressure abnormalities. Comparison between a single test (heart rate response to deep breathing) and the full battery in 360 subjects showed that one test alone does not distinguish the degree or severity of autonomic damage. These tests provide a useful framework to assess autonomic neuropathy simply, quickly, and noninvasively.
Accuracy of Perceiving Blood Glucose in IDDM
Authors: Cox Daniel J , Clarke William L , Gonder-Frederick Linda , Pohl Stephen , Hoover Claudia , Snyder Andrea , Zimbelman Linda , Carter William R , Bobbitt Sharon , Pennebaker James
Published: March 2007

Type I (insulin-dependent) diabetic individuals and health professionals often assume that the symptoms of extremely low or high blood glucose (BG) levels can be recognized and, consequently, appropriate treatment decisions can be based on symptom perception. Because no research has documented the validity of these assumptions, this study tested the ability to perceive BG concentration. Nineteen type I adults, experienced in self-monitoring of BG (SMBG), estimated their BG 40–54 times just before measurement of actual BG. This procedure was repeated under two conditions: (1) in the hospital (hospital condition) while connected to an insulin/glucose infusion system that artificially manipulated BG, leaving subjects only symptomatic, or internal, cues and (2) in the natural environment (home condition), where both internal and external cues, e.g., food and insulin consumption, were available. Estimates significantly correlated with actual BG for 7 of 16 subjects in the hospital condition and for 18 of 19 subjects in the home condition. Believed ability to estimate BG did not predict documented ability in either condition. An evaluation of the treatment significance of estimation errors showed that the majority of errors were relatively benign. The most common error affecting clinical outcome was estimated euglycemia when actual BG was hypoglycemic or hyperglycemic.
Evaluation of Computer-based Diet Education in Persons with Diabetes Mellitus and Limited Educational Background
Authors: Wheeler Lawrence A , Wheeler Madelyn L , Ours Patricia , Swider Cynthia
Published: March 2007

A study was conducted to determine whether computer-based techniques for meal planning and diet education could be an effective supplement to diabetes diet counseling in a group of inner-city subjects with limited educational background. Sixteen individuals with diabetes mellitus who were newly referred to an inner-city outpatient diet clinic and who demonstrated ninth-grade reading ability were given computer-based nutritional education. They received meal planning information through use of individualized computer-planned menus and education about the diabetes diet by computer-assisted instruction (CAI) combined with an interactive videodisc system (VIDEO). Total contact time was 180 min of CAI/VIDEO, 50 min of dietitian/patient education, and 20 min of dietitian/patient computer time (the last function could have been performed by a clerk). At the end of 4 wk, the group performance was improved in Exchange Lists knowledge (P < 0.001), recognition of foods containing concentrated carbohydrate (P < 0.05), and reduction of reported fat intake (P < 0.05). In addition, average group weight declined by 4.6 lb (P < 0.005). No improvement was found in food-measuring skills or in calorie-consumption compliance during a standardized buffet lunch. It appears that computer-based techniques are an acceptable supplement to traditional methods of education in this patient group and can improve the effectiveness of diabetes education programs without a significant increase in dietitian time.
Peripheral Arterial Circulation in Individuals with Impaired Glucose Tolerance
Authors: Vaccaro Olga , Pauciullo Paolo , Rubba Paolo , Annuzzi Giovanni , Rivellese Angela A , Riccardi Gabriele , Mancini Mario
Published: March 2007

Employees of a telephone company in Naples (N = 1376) were screened by oral glucose tolerance test (OGTT, 75 g). All those with impaired glucose tolerance (IGT) (N = 69) plus 138 normoglycemic controls, matched by sex, age, and body mass index (BMI, kg/m2), were selected to participate in this study. All participants were retested by OGTT under the same conditions as the first test. The prevalence of signs of impaired peripheral arterial circulation (IPAC) were investigated by different methods: Rose questionnaire on intermittent claudication, digital pulse plethysmography (inclination time), and ankle blood pressure measurement (ankle/arm systolic blood pressure). Very few persons had symptoms of IPAC: 2 (3.1%) and 3 (2.4%), respectively, in IGT subjects and controls. No difference in the prevalence of abnormal vascular parameters was detected between IGT and normoglycemic individuals according to either digital pulse plethysmography (6.1% versus 8.8%, P = 0.36) or ankle blood pressure measurement (10.8% versus 9.6%, χ2 = 0.06, NS); similar results were obtained when the prevalence of abnormalities was evaluated according to both methods combined (16.9% versus 16.8%). The finding remained very much the same after controlling for the effect of smoking. Individuals with IGT at both OGTTs were compared with individuals with normoglycemia at both tests: once again no significant difference was detected between the two groups in the prevalence of abnormal vascular findings (22.6% versus 16.7%, χ2 = 0.66, NS). This suggests that IGT is not associated with increased prevalence of atherosclerotic peripheral arterial disease.
The Vibratory Perception Threshold in Young Diabetic Patients: Associations with Glycemia and Puberty
Authors: Sosenko Jay M , Boulton Andrew J M , Kubrusly Denise B , Weintraub Jagdish K , Skyler Jay S
Published: March 2007

The vibratory perception threshold, an indicator of sensory neuropathy, was measured in young type I diabetic patients (N = 55) and nondiabetic control subjects (N = 34) of similar age. Values were significantly higher in the diabetic patients (P < 0.01), and 20% had values > that of any control subject. This difference was most marked among those postpubertal and persisted with allowances for age and gender in an analysis of covariance. Although the vibratory perception threshold was not related to hemoglobin A1 in younger diabetic patients (Tanner stage < 5), there was a highly significant positive relationship in postpubertal patients (r = 0.72, P < 0.001). There were also associations of the vibratory perception threshold with age in diabetic and control subjects (r = 0.44 and r = 0.43, respectively, P < 0.01 for both) and with diabetes duration (r = 0.36, P < 0.01). These data indicate that vibratory perception threshold abnormalities occur early in the course of type I diabetes mellitus; however, they are more evident in those patients who are postpubertal. In addition, they suggest that the association between the vibratory perception threshold and glycemia may be modified by developmental factors.
Effects of Sorbinil Treatment on Erythrocytes and Platelets of Persons with Diabetes
Authors: Martyn C N , Matthews D M , Popp-Snijders C , Tucker J , Ewing D J , Clarke B F
Published: March 2007

Thirty-three diabetic subjects were given the aldose reductase inhibitor sorbinil (Pfizer, UK) for 3 wk. There was a significant fall in mean erythrocyte sorbitol concentration over this period. In all subjects erythrocyte sorbitol concentrations after treatment were within or below the range found in normal subjects. No changes in erythrocyte 2,3-diphosphoglycerate (2,3-DPG) or myo-inositol concentrations, plasma beta-thromboglobulin (β-TG) concentration, or P50—a measure of the oxygen affinity of hemoglobin—were observed. There was a high incidence of adverse reactions to the drug.
Perioperative Control of Blood Glucose in Diabetic Patients: A Two-Step Protocol
Authors: Meyers Elsie F , Alberts Doris , Gordon Mae O
Published: March 2007

Perioperative control of blood glucose in patients with diabetes has been difficult due to frequent occurrence of hypoglycemia or hyperglycemia. We developed a two-step protocol for management of insulin-treated patients during general anesthesia. Regular insulin was given intravenously before anesthetic induction according to the step I formula (initial): initial blood glucose − 150/10 = U. Regular insulin was then given during surgery according to the step II formula (hourly): blood glucose 150–250 mg/dl = 2 U; blood glucose > 250 mg/dl = 4 U. Fluid replacement of 5% dextrose with lactated Ringer's solution, 3 ml/kg estimated ideal body weight, was given hourly and additional lactated Ringer's solution was given as indicated. Thirty patients received preoperative (long-or intermediate-acting) insulin and were managed by the two-step protocol. Ten patients received preoperative (long- or intermediate-acting) insulin and were managed by a standard method used in the same institution. Thirty patients did not receive preoperative insulin and were managed by the two-step protocol. All patients underwent retinal surgery under general anesthesia. In comparing the two groups pretreated with insulin, patients treated by the standard method had significantly higher (mean) blood glucose levels (360.2 ± 100.4 mg/dl) than those treated with the two-step protocol (181.2 ± 50.8 mg/dl) (P = 0.0001) at the end of surgery. Of the two-step protocol patients, those pretreated with one-half the usual morning dose of long- or intermediate-acting insulin had lower (mean) blood glucose levels (225 ± 87 mg/dl) than patients not pretreated (310 ± 130.8 mg/dl) (P = 0.0069) the morning after surgery. Hypoglycemia was not evident. We conclude that use of the two-step protocol can provide a safe, effective method of perioperative control of blood glucose and that pretreatment by one-half the usual morning dose of long- or intermediate-acting insulin preoperatively is effective in improving control during the first 24 h postoperatively.
Glycemic Control with Closed-Loop Intraperitoneal Insulin in Type I Diabetes
Authors: LeBlanc Hervé , Chauvet Dominique , Lombrail Pierre , Robert Jean Jacques
Published: March 2007

Blood glucose levels were compared in eight type I diabetic subjects who were given closed-loop infusions of insulin by intraperitoneal (i.p.) and intravenous (i.v.) routes, in a cross-over randomized study. After a test meal, plasma glucose peaks were significantly higher with i.p. than with i.v. infusion (174 ± 22 versus 129 ± 29 mg/dl) and marked hypoglycemia occurred after 180 min in five of eight subjects. These observations appear to be the consequence of a 60-min lag in insulin rise with i.p. administration. Because of this difference in plasma glucose rise, twice as much insulin was administered i.p. than with i.v. Plasma insulin rose to similar values in both cases. Therefore, with present closed-loop systems, i.p. insulin infusion does not lead to better control of glucose levels than i.v. infusion and does not prevent hyperinsulinism. Adjustments of the artificial B-cell algorithms and the injection of a bolus dose must be tested so that the potential advantages of the i.p. route may be achieved.
A Randomized Study of the Effects of a Home Diabetes Education Program
Authors: Rettig Bryan A , Shrauger Dennis G , Recker Robert R , Gallagher Thomas F , Wiltse Hobart
Published: March 2007

Home health nurses provided individualized instruction in diabetes self-care within the home environment of 393 diabetic individuals. Each subject was randomly assigned to either the intervention (those receiving home teaching) or control (those not receiving home teaching) group. At 6 mo postenrollment, intervention subjects showed significantly greater self-care knowledge and skills than control subjects, although the actual differences between the two groups in terms of self-care skills were probably too small to have any practical meaning. The primary objective of the study, which was the reduction of the number of preventable diabetes-related hospitalizations (ketoacidosis, ketotic coma, nonketotic coma, insulin reaction, and diabetes out of control), was not achieved; no differences between the groups were noted after 12 mo of follow-up. Similarly, length of hospital stay, foot problems, emergency room and physician visits, and sick days were roughly equivalent in both groups during the follow-up year. These results suggest that, in the absence of concurrent changes in the health-care delivery system and strategies for influencing attitudes toward self-care, education alone is ineffective.
The Person and Diabetes in Psychosocial Context
Authors: Holmes David MacRae
Published: March 2007

This review spans life with diabetes from the first year through the succeeding period of relatively good health, into the phase when the patient needs to accommodate for more symptoms and impaired functioning. Focusing on autonomy, vulnerability to fears, and vocational choices, this article compares effects of diabetes on children and youths with effects on those with onset in later life. A concept of biopsychosocial homeostasis helps to explain: (1) why patients turn to a physician when they do; (2) how the physician may often save the patient time and money by helping that patient to change psychological and social components of well-being and functioning—and highlights the importance of these; (3) how to treat depressive disorder; (4) how to discuss worst fears and encourage patients to play with their unpleasant imaginings; and (5) how to reduce hypoglycemia. Repeated hypoglycemic episodes have the cumulative deleterious effect of undercutting the patient's and others' sense that the patient is dependable, with impaired performance and even serious occupational and marital repercussions. Educational tactics are suggested for the patient with IDDM who finds it harder to identify early levels of hypoglycemia; that patient must learn to respond to specific clues of mild hypoglycemia, stemming from defective thinking and emotional and sexual functioning. There is no substitute for a full history and an empathic understanding of the patient's imaginings, relationships, and circumstances.
Maintenance of Basal Insulin Secretion in Severe Non-Insulin-Dependent Diabetes
Authors: Kingston Michael E , Skoog Warren C
Published: March 2007

It has been postulated that glucose regulation is secondary to maintenance of normal basal insulin secretion. Serum glucose, insulin, and C-peptide levels were measured at fasting in 209 consecutive non-insulin-dependent diabetic patients and after glucose stimulation in 193 patients. The basal serum insulin C-peptide levels were not significantly different in control subjects (mean 22 ± 8.8 μU/ml) and in patients with varying severity of diabetes (mean 24 ± 9.6 μU/ml) except in the most severely diabetic group [fasting serum glucose >350 mg/dl (19.4 mmol/L), mean 19± 7 μU/ml]. In 39 patients who developed ketonuria without acidosis during follow-up, the mean basal serum insulin was 22 μU/ml during the episode of ketonuria, 21 μU/ml during the glucose tolerance test, and 25 μU/ml after glucose stimulation (statistically nonsignificant differences). Our data suggest that hyperglycemia compensates for β-cell impairment so that basal insulin secretion usually stays above the threshold for ketoacidosis unless there is marked β-cell impairment. Patients who fail to increase insulin in response to nutrient challenge are at risk of developing ketosis.
Comparison of Plasma Glucose, Serum Insulin, and C-Peptide Responses to Three Isocaloric Breakfasts in Non-Insulin-Dependent Diabetic Subjects
Authors: Colagiuri Stephen , Miller John J , Holliday Jenny L , Phelan Ellen
Published: March 2007

While differences in glucose and insulin responses to specific carbohydrate foods have been reported, few data are available for mixed meals incorporating such foods. This study compared the plasma glucose (PG), serum insulin (SI), and C-peptide (CP) responses tothree different isocaloric test breakfasts given in random order to eight insulin-treated non-insulin-dependent diabetes mellitus (NIDDM) patients. The test meals were selected from a hospital food exchange list and contained similar quantities of carbohydrate, protein, fat, and dietary fiber. The postprandial PG, SI, and CP responses to two of the test breakfasts (meal A: eggs, toasted wholemeal bread, orange juice, margarine, and milk; meal B: wheatflake biscuits, toasted wholemeal bread, milk, and margarine) were similar (meal A: 104.3 ±, 23.0 mg · h · dl−1, 5996 ± 1108 μU · min · ml−1, and 89.8 ± 25.4 pmol · min · ml−1, respectively; meal B: 104.9 ± 21.6 mg · h · dl∼l, 6268 ± 1161 μU · min · mi−1, and 99.8 ± 26.4 pmol · min · ml−1, respectively). Meal C, consisting of toasted muesli and skim milk, produced smaller glycemic and insulin responses (46.8 ± 8.8 mg · h · dl−1; P < .02, and 4369 ± 700 μU · min · ml−1; P < .05, respectively) than meals A and B and less endogenous insulin secretion (CP response 62.8 ± 19.9 pmol · min · ml−1; P < .05 compared with meal A, NS compared with meal B). The lower glycemic response after meal C could be explained by differences in method of food processing resulting in a decreased availability of starch to amylolytic enzymes, the higher content in meal C of sucrose, lactose, and fructose, which are associated with a low glycemic index, and by quantitative and qualitative differences in fiber. While food exchange lists are generally useful in planning diets for diabetic persons, some modification to current lists may be necessary to take into account the processing method and nature of the carboyhydrates in the food when considering the equivalence of individual food items.
Pruritus in Diabetes Mellitus: Investigation of Prevalence and Correlation With Diabetes Control
Authors: Neilly J B , Martin A , Simpson N , MacCuish A C
Published: March 2007

Three hundred diabetic and 100 nondiabetic hospital outpatients (both groups of comparable age and sex distribution) were assessed for the presence of generalized and localized pruritus. Pruritus vulvae was significantly more common in diabetic women (18.4%) thanin controls (5.6%) and was significantly associated with poor diabetes control (mean glycosylated hemoglobin level <12%). Other forms of localized pruritus were equally common in diabetic and nondiabetic patients, regardless of glycosylated hemoglobin levels. Generalized pruritus was present in 14 diabetic patients, but in 5 cases the symptom was ascribed to intercurrent illness or drug administration. Thus, generalized pruritus without apparent cause was present in only 8 diabetic patients (2.7%) and was not significantly more common than in nondiabetic patients. It is doubtful if diabetes mellitus per se should be regarded as a cause of generalized or localized pruritus, other than pruritus vulvae.
Behavioral Skills in Self-Monitoring of Blood Glucose: Relationship to Accuracy
Authors: Wing R R , Koeske R , New A , Lamparski D , Becker P
Published: March 2007

Sixty-two children and adolescents with IDDM were observed while performing self-monitoring of blood glucose (SMBG) to determine which of the behaviors involved in SMBG were most likely to be performed incorrectly and which errors had the greatest effect on the accuracy bf SMBG readings. Behaviors related to cleanliness and timing were performed most poorly; only 60% of the subjects correctly timed the first minute, and 30–33% correctly timed the second interval. The duration of SMBG and frequency of monitoring were not related to proper performance of the behaviors involved in SMBG. Accuracy of SMBG was assessed by comparing subjects' readings to laboratory values obtained immediately afterward. The behavior that had the greatest effect on the accuracy of SMBG readings was that concerning whether the blood was adequately wiped from the Chemstrip bG. This behavior should receive more emphasis in SMBG training programs. The systematic observation procedure used in this study may help to identify errors made by patients while performing SMBG and may serve as the basis for training programs to improve SMBG accuracy.
simple Solution to Problem of Biostator-Induced Insulin Aggregation
Authors: Harris M D , Davidson M B , Rosenberg C S
Published: March 2007

It has recently been reported that there is a significant loss of insulin immunoreactivity and bioavailability secondary to heat-induced insulin aggregation during prolonged insulin delivery by the Biostator. This artifact of Biostator insulin delivery system makes data generated by studies that use prolonged, continuous insulin infusions performed with the Biostator uninterpretable. We report the prevention of this problem by the addition of 20 ml heparinized whole blood to a 500-ml reservoir containing the insulin to be infused. The proposed solution is simple, economical, and without risk to the subject since his or her own blood can be used.
Altering Physicians' Practice Patterns—A Nationwide Educational Experiment: Evaluation of the Clinical Education Program of the American Diabetes Association
Authors: Mazze R , Deeb L , Palumbo P J
Published: March 2007

A comprehensive evaluation of the Clinical Education Program (CEP) of the American Diabetes Association on type II diabetes was undertaken in a cohort of 5640 primary-care physicians to determine whether practice patterns are affected by such continuing medical education programs. The educational and behavioral objectives were defined and the extent to which these objectives were met was evaluated by use of questionnaires completed by conference attendees both before and after they participated in the program and by in-office interviews 2 mo later with 288 of the primary-care physicians who had attended the conference. Prior to participation, approximately half of the primary-care physicians described diabetes practice patterns consistent with excellent care. The proportion who stated that they intended to improve their practice patterns increased significantly after the conference. Similarly, the majority of these same physicians knew the basic educational objectives before the conference, with a significant increase in the proportion of physicians knowing these objectives after the conference. The office interviews indicated that the changes noted in the proportion of physicians intending to carry out a practice at the end of the conference were sustained or actually increased in this cohort. Exceptions to this trend occurred in the area of use of glucosylated hemoglobin and perhaps in the area of periodic assessment of macrovascular circulation. Two interesting additional findings from the in-office interviews were that physicians prefer the conference format for learning and that distribution of printed material alone is not very effective in influencing knowledge and behavior in primary-care physicians. The CEP met its educational and behavioral objectives. Health care by primary-care physicians can be affected by the conference format, but impediments still exist in the translation of knowledge into behavior. These impediments must be explored further. A model for planning educational programs and assessing the need of the program, its implementation, and its impact is described. This model is applicable to all levels of learning experience.
Glycemic Control and Bone Age Are Independently Associated With Muscle Capillary Basement Membrane Width in Diabetic Children After Puberty
Authors: Rogers D G , White N H , Santiago J V , Miller J P , Weldon V V , Kilo C , Williamson J R
Published: March 2007

This study was undertaken to examine the possible relationships between muscle capillary basement membrane width (CBMW) and glycemic control, bone age, chronologic age, and duration of diabetes in young patients with insulin-dependent diabetes mellitus (IDDM) during different stages of pubertal development. We studied 49 males and 43 females (age, 7–20 yr) with IDDM for up to 16 yr for whom bone age and glycosylated hemoglobin (HbA1c) data were available at the time of right quadriceps muscle biopsy. Based on pubic hair Tanner stage, subjects were assigned to prepubertal (Tanner I), pubertal (Tanner II and III), and postpubertal (Tanner IV and V) groups. In 30 pubertal and prepubertal subjects, none of the variables studied was significantly correlated with CBMW. This is attributable in part to the small number of subjects in each group. In 62 postpubertal subjects, CBMW was correlated with age (r = .27, P = .03), bone age (r = .43, P = .0005), and postpubertal duration of diabetes (r = .38, P = .003) but not total duration of diabetes. In the postpubertal subjects, CBMW was correlated with HbA1c at the time of biopsy (r = .31, P = .01) but correlated more strongly with the mean of HbA1c values obtained during the 1- and 2-yr periods before biopsy (r = .37, P = .01, and r − .54, P = .03, respectively). An analysis of covariance revealed that the slopes for the regression of loge CBMW on HbA1c differed significantly (P = .02) among the three groups. This difference is due primarily to the negative relationship between loge CBMW and HbA1c in the prepubertal group in contrast to the positive relationship in the other two groups. Multiple regression analyses performed on data from the postpubertal group showed that bone age and glycemic control were independently associated with CBMW. These observations suggest that in children with IDDM, CBMW is influenced after puberty by the factors responsible for skeletal maturation (i.e., sex steroids) and also by the degree of hyperglycemia.
Bacteriuria and Autonomic Nerve Function in Diabetic Women
Authors: Sawers J S , Todd W A , Kellett H A , Miles R S , Allan P L , Ewing P J , Clarke B F
Published: March 2007

Significant bacteriuria (viable count ≥105/ml) was found on single testing in 10% of 400 consecutive diabetic women aged 15–65 yr routinely attending a diabetic clinic. Twenty patients with and 21 without significant bacteriuria were then randomly selected for measurement of cardiovascular autonomic reflexes, bladder ultrasound, and mictiography. There were no significant differences between these two groups in age, duration and type of diabetes, glycosylated hemoglobin, blood urea, and creatinine. Abnormalities of cardiovascular autonomic function were more common in the bacteriuric group (P < .01). Although the bacteriuric group voided a smaller volume of urine, none had evidence of increased residual bladder volume of urine on ultrasound. Diabetic women with cardiovascular autonomic neuropathy appear to be at increased risk of developing bacteriuria. However, age is probably the most important factor influencing the prevalence of bacteriuria in diabetic and in nondiabetic women.
Nutritional Risk of High-Carbohydrate, Guar Gum Dietary Supplementation in Non-Insulin-Dependent Diabetes Mellitus
Authors: Van Duyn M A S , Leo T A , McIvor M E , Behall K M , Michnowski J E , Mendeloff A I
Published: March 2007

Dietary supplementation with high-carbohydrate, guar gum fiber (HCF) is effective in acutely blunting postprandial blood glucose levels. We report the effect of such supplementation on the diet and nutritional status of a group of 16 subjects with non-insulin-dependent diabetes mellitus (NIDDM) who incorporated either HCF bars (35.7 g carbohydrate and 6.6 g guar gum/bar) or placebo bars (identical except for the absence of guar gum) into the diet for 6 mo as part of a double-blind, randomized clinical trial. The HCF subjects achieved mean daily intake of 4.8 ± 0.4 bars, constituting 51.2 ± 3.1% of total calories and providing 29.7 ± 2.6 g guar gum daily. Energy intakes and body weight did not change significantly in either group. Food consumption patterns and nutrient intakes did change, although not enough to impair the nutritional integrity of the diet because the bars themselves served as a source of nutrients. The bars were rich in thiamin, B6, folacin, phosphorus, iron, zinc, and copper, adequately replacing any decrease in nutrient intake as a result of foods being dropped from the diet. In fact, daily intakes of B6, folacin, and copper actually increased due to contributions from the bars. Nutrients in which the bars were poor (vitamins A, C and B12) resulted in suboptimal intakes (<66% RDA). Although no significant change in nutritional status of the HCF group occurred as determined by arm muscle area, arm fat area, hemoglobin, hematocrit, or serum albumin, transferrin, iron, ferritin, calcium, phosphate, B12, and magnesium levels, these indicators of nutritional status are rather insensitive. To ensure adequate nutrient intake and thus nutritional status with HCF diets, vitamin and mineral supplementation is probably advisable over the long term.
Effect of Computer-Based Learning on Diabetes Knowledge and Control
Authors: Wise P H , Dowlatshahi D C , Farrant S , Fromson S , Meadows K A
Published: March 2007

Two interactive computer-based systems have been evaluated: a teaching program with text and animated graphics and a multiple-choice knowledge-assessment program (KAP) with optional prescriptive feedback. One hundred seventy-four routine-attending insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) patients were allocated to active and control groups to determine the effect of these programs on knowledge and control after a 4- to 6-mo follow-up period. Interactive computer teaching (ICT) resulted in a significant knowledge increment in both IDDM and NIDDM patients (P < .05), together with a mean fall of 0.8 and 0.7%, respectively, in HbA1c (P < .05 and P > .1), but no changes were observed in respective control groups. The KAP with feedback also produced a significant knowledge increment in both IDDM and NIDDM patients (P < .05), of similar magnitude to the ICT program, and a mean fall in HbA1c of 1.2 and 1.3%, respectively (P < .05), with no changes in the corresponding control groups. Even when KAP was used without prescriptive feedback, smaller but significant mean falls in HbA1c of 0.7 and 0.8% (P < .05) were seen in IDDM and NIDDM patients, respectively, suggesting a motivational effect resulting from program participation. An inverse correlation was demonstrated between knowledge increment and final HbA1c in the ICT and KAP/feedback groups, which was significant for NIDDM patients (r = −.43, r = −.45; P < .05) but not for IDDM patients (r = − .2, r = .25;P=.1). Our studies confirm positive educational benefit of both computer-based programs, probably acting through enhancement of both knowledge and motivation.
Asymptomatic Bacteriuria and Hemoglobin A1
Authors: Schmitt J K , Fawcett C J , Gullickson G
Published: March 2007

We measured hemoglobin A1 (HbA1 and performed clean-catch urine cultures in 752 patients (411 men and 341 women) with non-insulin-dependent diabetes mellitus (NIDDM) attending an outpatient diabetes clinic. Prevalence of bacteriuria was significantly greater in diabetic women than in controls (9.1 vs. 5.0%, P < .001) but not in diabetic men. Risk of bacteriuria was not related to level of HbA1 at the time of urine culture. However, mean duration of diabetes mellitus was significantly greater in diabetic women with bacteriuria than in those without infection (9.9 ± 1.5 vs. 5.4 ± 0.4 yr, P < .025), and the prevalence of bacteriuria was significantly greater in patients with complications of long-standing diabetes mellitus than in those without complications (P < .005).
Dissociation of Insulin Absorption and Blood Flow During Massage of a Subcutaneous Injection Site
Authors: Linde B
Published: March 2007

Nine healthy volunteers with normal body weights were injected subcutaneously with 125I-labeled soluble human insulin (10 U) in one thigh and 133Xe in the contralateral thigh for the measurement of subcutaneous blood flow on 2 consecutive mornings. On one of the days, standardized massage of both injection sites was performed for 30 min starting 30 min after insulin injection. Serum insulin and plasma glucose were determined intermittently before, during, and after massage, and elimination of radioactivities was monitored continuously by external detectors. During massage, the first-order elimination rate constants of l25I increased approximately sixfold compared with the rise during control (0.19 ± 0.04 to 0.88 ± 0.15%/min during the last 15 min of the massage vs. 0.21 ± 0.03 to 0.32 ± 0.03%/min during control). Serum insulin increased from 13.8 ± 1.8 mU/L before massage to a maximal value of 56.4 ± 8.7 mU/L 10 min after massage (vs. 15.3 ± 3.0 and 19.7 ± 2.2 mU/L during control). Plasma glucose fell significantly faster on the massage day, from 10 min after massage onward. No significant alteration in the subcutaneous blood flow was found during or after massage. The results suggest that the pronounced enhancement of insulin absorption induced by massage of the injection site is mainly not blood flow mediated.
psychosocial Predictors of Self-Care Behaviors (Compliance) and Glycemic Control in Non-Insulin-Dependent Diabetes Mellitus
Authors: Wilson W , Ary D V , Biglan A , Glasgow R E , Toobert D J , Campbell D R
Published: March 2007

This study assessed potential psychosocial correlates of self-care behaviors (compliance) and of glycemic control in a community sample of 184 people diagnosed as having non-insulin-dependent (type II) diabetes mellitus. Four different diabetes self-care behaviors were studied (medication taking, glucose testing, diet, and exercise), and glycemic control was assessed by glycosylated hemoglobin analyses. Multiple measures were collected within each of several categories of psychosocial variables including knowledge, stress, depression, anxiety, diabetes-specific health beliefs, and social support. Findings indicate that ∼25% of the variance in self-care behaviors can be explained by psychosocial and demographic variables. In contrast, psychosocial variables were not significant predictors of level of glycemic control. The diabetes-specific psychosocial measures of health beliefs and social support were the most consistent and strongest predictors of self-care behavior across the different regimen areas studied. Possible reasons for these findings, limitations of the study, and directions for future research are discussed.
Obstructive Sleep Apnea: Its Relevance in the Care of Diabetic Patients
Authors: Boyer Suzanne , Kapur Vishesh
Published: March 2007

In Brief

Obstructive sleep apnea (OSA) is a common and frequently unrecognized disorder. It is often found in patients with obesity, diabetes, and cardiovascular disease, and there is growing evidence that sleep apnea is independently associated with increased cardiovascular morbidity. This article reviews the presentation, diagnosis, and treatment of OSA and its related health risks. It also discusses the proposed associations between OSA and diabetes and insulin resistance.
Clarifying the Role of Insulin in Type 2 Diabetes Management
Authors: White John R. , Davis Stephen N. , Cooppan Ramachandiran , Davidson Mayer B. , Mulcahy Kathryn , Manko Gary A. , Nelinson Donald ,   the Diabetes Consortium Medical Advisory Board
Published: March 2007

In Brief

The prevalence of type 2 diabetes has been increasing rapidly and with it has been resultant morbidity and mortality. Strict glycemic control reduces the progression of diabetic microvascular disease; however, most patients treated with sulfonylureas require additional insulin therapy. This article addresses common clinician concerns about prescribing insulin early in type 2 diabetes. It presents strategies for incorporating basal insulin therapy with glargine (Lantus) into a regimen that promotes compliance.
Empowerment and Self-Management of Diabetes
Authors: Funnell Martha M. , Anderson Robert M.
Published: March 2007

IN BRIEF

A gap currently exists between the promise and the reality of diabetes care. Practical interventions that facilitate collaborative relationships and foster patient-centered practices are the key to closing this gap.
Management of Diabetic Peripheral Neuropathy
Authors: Boulton Andrew J.M.
Published: March 2007

IN BRIEF

Diabetic peripheral neuropathy affects up to 50% of older type 2 diabetic patients. Whereas some patients may have extremely painful symptoms, others with a more marked neuropathic deficit may be asymptomatic. Diagnosis requires careful examination of the lower limbs. Management involves establishing that the neuropathy is caused by diabetes instead of more sinister causes and aiming for optimal glycemic control. Medications, usually tricyclic drugs or anticonvulsant agents, may be required. Patients with peripheral neuropathy must be considered at risk of insensate foot ulceration and must receive preventive education and podiatric care.
Erectile Dysfunction
Authors: Thethi Tina K. , Asafu-Adjaye Nana O. , Fonseca Vivian A.
Published: March 2007

IN BRIEF

Erectile dysfunction affects ∼ 30 million men in the United States to some extent. It may indicate the presence of a serious underlying medical condition, such as cardiovascular disease, diabetes, or depression. It compromises multiple aspects of a patient's life, including overall quality of life and interpersonal relationships.
Evidence for transferrin allele as a host‐level risk factor in naturally occurring equine respiratory disease: a preliminary study
Authors: NEWTON J. R. , WOOD J. L. N. , CHANTER N.
Published: March 2007

Reasons for performing study: Recurring respiratory infections can contribute to prolonged burdens of disease, especially in younger horses and better knowledge of factors and effective interventions, such as vaccines, should improve therapeutic and preventive strategies.

Objectives: To identify factors and infections associated with naturally occurring respiratory disease in recently weaned Welsh Mountain ponies maintained at pasture and to determine whether ponies vaccinated with an experimental inactivated bacterial vaccine had lower burdens of disease and infection compared to nonvaccinated controls. Transferrin allele, which may influence the ability of pathogenic bacteria to acquire iron, was examined specifically as a host‐level risk factor.

Methods: Twice weekly clinical evaluations and weekly microbiological samplings over a 10 week period were conducted in 29 ponies, of which 12 received an experimental bacterial vaccine, 12 received placebo and 5 were untreated. A multilevel modelling approach suitable for analysing longitudinal data containing repeated observations was used to identify factors associated with disease and to evaluate any effect from vaccination.

Results: Analyses demonstrated significant variation in clinical disease between ponies that possessed different alleles of iron binding transferrin protein but no significant effect from vaccination. Of the 29 ponies monitored, 14 possessing homozygote or non‐F2 heterozygote transferrin D alleles demonstrated significantly less clinical disease (P<0.001), whereas 14 possessing the F2 transferrin allele demonstrated significantly more clinical disease (P<0.001). These effects remained apparent even after the significant effects of tracheal bacterial isolates, clinical score the previous week and repeated observations from the same ponies were accounted for.

Conclusions and potential relevance: Results provide evidence for a potential genetic basis for variation in susceptibility to clinical equine respiratory disease of bacterial origin, although more work is required to corroborate this conclusion.