bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Comparison of Three Dietary Prescriptions in the Treatment of NIDDM
Authors: Milne Robyn M , Mann Jim I , Chisholm Alex W , Williams Sheila M
Published: March 2007

OBJECTIVE

To compare three sets of dietary guidelines for the treatment of non-insulin-dependent diabetes (NIDDM) in free-living individuals and to observe the effects on metabolic control over an 18-month period.

RESEARCH DESIGN AND METHODS

Seventy volunteer subjects with NIDDM were randomly assigned to one of three diets, a weight-management diet, a high-carbohydrate/fiber diet, or a modified-lipid diet and followed for 18 months. Nutrient intakes, weight, blood lipids, and glycemic control were measured.

RESULTS

In all diet groups, glycated hemoglobin (HbA1) fell significantly before diet intervention began, remaining lower throughout the study and at follow-up 9 months later. Low-density lipoprotein (LDL) cholesterol showed a sustained fall in all groups after diet intervention. Apart from transient changes in high-density lipoprotein (HDL) cholesterol and triglyceride (TG) in the diet groups with the higher carbohydrate intake, no lasting differences were found between the three diet groups.

CONCLUSIONS

In the long term, there were few differences in the outcome of the three dietary prescriptions. Even with intensive instruction, participants found it difficult to meet recommended nutrient intakes; however, specific dietary advice did result in an improvement in LDL cholesterol. Adverse changes in HDL cholesteroland TG because of diet intervention were transient. The significant improvement in glycemic control during the recruitment phase may have been the result of particpants' previous dietary knowledge and the increased attention that they received during the intervention.
A Comparison of Eating Behaviors in Newly Diagnosed NIDDM Patients and Case-Matched Control Subjects
Authors: Kenardy Justin , Mensch Melba , Bowen Kerry , Pearson Sallie-Anne
Published: March 2007

OBJECTIVE

To determine whether disordered eating may be problematic in non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

We contrasted the eating behaviors and attitudes in 50 newly diagnosed NIDDM patients with 50 age-, sex-, and weight-matched control subjects.

RESULTS

Although 14% of diabetic subjects versus 4% of nondiabetic subjects reported episodes of binge eating (P < 0.10), there was no difference between diabetic and nondiabetic subjects in the prevalence with which they met criteria for binge eating disorder. Diabetic patients with a history of binge eating were significantly heavier, had younger age at diagnosis, and had more problems with eating in response to situational and emotional cues than did diabetic patients who did not binge.

CONCLUSIONS

No support was found for greater prevalence of binge eating disorder in newly diagnosed NIDDM patients than in matched nondiabetic control subjects.
Impact of Obesity on Neuropathic Late Complications in NIDDM
Authors: Straub Rainer H , Thum Markus , Hollerbach Cathérine , Palitzsch Klaus-Dieter , Schölmerich Jürgen
Published: March 2007

OBJECTIVE

This cross-sectional study was aimed to investigate the isolated influence of obesity on peripheral sensorimotor and autonomic neuropathy in patients with long-term non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

Ninety-one long-term NIDDM patients with a mean duration of 13.6 ± 1.0 years and a mean age of 60.4 ± 1.0 years were divided into two groups according to their body mass index (BMI) (lean with a BMI < 26.5: n = 41, age = 58.6 ± 1.7 years, BMI = 23.7 ± 0.3 kg/m2; and obese with a BMI ≥ 26.5: n = 50, age = 61.9 ± 1.2 years, BMI = 30.5 ± 0.5 kg/m2). The two groups were not different in age, duration, gender, current parameters of glycemic control, number of smokers, cholesterol, triglycerides, and systolic and diastolic blood pressure. Neuropathic late complications were scrutinized by a standardized clinical examination that delivers a neuropathy score, pupillary autonomic neuropathy assessed by pupillometry, and cardiovascular autonomic neuropathy using a standardized test battery.

RESULTS

One-way analysis of variance revealed that obese patients had poor results in the clinical neuropathy test (overall score in obese vs. lean: 71.1 ± 2.9 vs. 80.6 ± 3.0 points, 2P = 0.0266; 100 points were absolutely normal). This was particularly true for the discrimination perception (obese vs. lean: 67.0 ± 4.0 vs. 81.7 ± 3.3 points, 2P = 0.0073) and the reflex status (obese vs. lean: 57.4 ± 4.0 vs. 71.8 ± 4.3 points, 2P = 0.0164). Furthermore, obese patients had a poor result in the respiratory sinus arrhythmia (RSA) test, one of six autonomic function tests (RSA: obese vs. lean in average RSA percentile: 36.9 ± 4.9 vs. 54.0 ± 5.9%, 2P = 0.0264).

CONCLUSIONS

Obesity influences sensorimotor and autonomic neuropathic late complications. The poor result in RSA in obesity may indicate an interrelation between pathogenesis of obesity and disorders of the respiratory and heart rhythm-generating control centers in the brain stem. Moreover, it could be due to intrathoracic fat deposits that alter lung mobility. Body mass control may be an important approach to reduce neuropathic complications. Beyond that, it seems necessary to control for body mass when comparing neuropathy in two groups of patients with NIDDM.
Rhinocerebral Mucormycosis in IDDM: Sequential magnetic resonance imaging of long-term survival with intensive therapy
Authors: Moll George W , Raila Frank A , Liu Gilbert C , Conerly A Wallace
Published: March 2007

OBJECTIVE

To describe the clinical course and the utility of computerized tomography (CT) and magnetic resonance imaging (MRI) in the successful management of an often fatal fungal infection in a 12-year-old patient with insulin-dependent diabetes mellitus (IDDM).

CASE

The patient was admitted to The University of Mississippi Medical Center (UMC) for the purpose of diabetic ketoacidosis (DKA) management and subsequent intensive therapy for mucormycosis according to nationally accepted standards of care. Strict diabetic control was instituted with frequent monitoring of blood glucose levels and interval assessment of HbA1c. Sequential MRI studies were obtained according to approved patient standards; the clinical and MRI course of the infection was charted.

RESULTS

The patient's DKA resolved within 12 h on intravenous fluid repletion and insulin therapy. His sinusitis/rhinitis noted on admission did not respond to intravenous antibiotic therapy and progressed with obvious left orbital involvement and left cranial nerve palsies by 72 h of hospitalization. CT and MRI were invaluable aids to the early diagnosis and design of appropriate surgical and antifungal management of this patient, who survived with minimal left cranial nerve palsies.

CONCLUSIONS

Our patient is among the youngest of IDDM patients reported to have survived rhinocerebral mucormycosis. His survival is attributed to early recognition of possible mucormycosis with diagnostic support of CT and MRI, surgical debridement and antifungal therapy, and intensive blood glucose control. Sequential MRI is invaluable to the design of therapy for this type of patient and shows the nearly 3-year recovery from mucormycosis.
Environmental Factors in Childhood IDDM: A population-based, case-control study
Authors: Verge Charles F , Howard Neville J , Irwig Les , Simpson Judy M , Mackerras Dorothy , Silink Martin
Published: March 2007

OBJECTIVE

To identify environmental factors involved in the etiology of insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS

An estimated 90% of all incident cases of IDDM in patients 0–14 years of age in New South Wales, Australia, were ascertained over 18 months. For each IDDM patient, two age- and sex-matched control subjects were randomly selected from the population. Past environmental exposures were determined with a questionnaire completed by the parents. Response rates were 92% for the IDDM patients (217 of 235) and 55% for the control subjects (258 of 470). The relative risk associated with each exposure was estimated with the odds ratio (OR) adjusted for confounding factors using multiple logistic regression.

RESULTS

The introduction of cow's milk-based infant formula into the diet before 3 months of age was associated with an increased risk (OR 1.52, 95% confidence interval [CI] 1.04–2.24). Exclusive breast-feeding for ≥3 months was associated with a protective effect (OR 0.66, 95% CI 0.45–0.97). High dietary intake of cow's milk protein in the 12 months before the onset of diabetic symptoms was also associated with an increased risk (OR 1.84, 95% CI 1.12–3.00). A recent infection (during the 3 months before onset of diabetic symptoms) was more common in the patients than the control subjects (OR 2.92, 95% CI 1.96–4.35), as was day care attendance before the age of 3 (OR 1.73, 95% CI 1.00–3.00). When two age-groups, defined by the median age at onset of diabetes, were compared, the associations with early infant-feeding were stronger among the younger group (<9.2 years), and associations with recent diet and recent infection were stronger among the older group (≥9.2 years).

CONCLUSIONS

These results indicate an increased risk of IDDM associated with early dietary exposure to cow's milk-containing formula, short duration of exclusive breast-feeding, high intake of cow's milk protein in the recent diet, recent infection, and early attendance at day care.
Hypoglycemia Unawareness in IDDM
Authors: Mokan Marian , Mitrakou Asimina , Veneman Thiemo , Ryan Christopher , Korytkowski Mary , Cryer Philip , Gerich John
Published: March 2007

OBJECTIVE

To assess the characteristics of patients with hypoglycemia unawareness (development of neuroglycopenia without appropriate prior autonomic warning symptoms) and its predisposing factors.

RESEARCH DESIGN AND METHODS

We studied 43 insulin-dependent diabetes mellitus patients who were objectively categorized as having or not having hypoglycemia using the stepped hypoglycemic clamp technique in which plasma glucose was clamped at plateaus of 4.3, 3.6, 3.0, and 2.3 mmol/l and a statistical criterion (onset of autonomic warning symptoms at a plasma glucose concentration 2 SD below normal) and examined their clinical characteristics and hormonal, symptomatic, and cognitive responses.

RESULTS

Eleven (26%) of the patients were classified as having hypoglycemia unawareness. Compared with the other patients, unaware patients had a lower HbA1c level (P < 0.01), a longer duration of diabetes (P < 0.01), and a history of more severe hypoglycemia (P < 0.003). During experimental hypoglycemia, counterregulatory hormone responses, neuroglycopenic symptoms, and cognitive dysfunction all began at lower plasma glucose concentrations in unaware patients (P < 0.01, 0.03, and 0.01, respectively). Moreover, although the magnitudes of their plasma catecholamine responses and autonomic symptoms were reduced (both, P < 0.01), the plasma catecholamine levels at which autonomic symptoms began was not altered. Finally, as seen from glucose infusion rates necessary to maintain identical plasma glucose levels, patients with hypoglycemia unawareness had increased sensitivity to insulin (P < 0.001).

CONCLUSIONS

Our results confirm an association between hypoglycemia unawareness and duration of diabetes, glycemic control, and occurrence of severe hypoglycemia, and in addition provide evidence that both autonomic and neuroglycopenic symptoms are affected and that insulin sensitivity is increased, but β-adrenergic sensitivity is not diminished.
The Prevalence of NIDDM and Associated Coronary Risk Factors in Mexico City
Authors: Posadas-Romero Carlos , Yamamoto-Kimura Liria , Lerman-Garber Israel , Zamora-Gonzalez José , Fajardo-Gutierrez Arturo , Velazquez Leora , Cardoso-Saldaña Guillermo
Published: March 2007

OBJECTIVE

To determine the prevalence of diabetes and associated coronary risk factors in the Mexico City population.

RESEARCH DESIGN AND METHODS

A sample of 805 adults was selected from Mexico City. The participants, 20–90 years of age and living in the city, were selected by the method of multistage cluster sampling with proportional allocation. Diabetes was diagnosed by previous history or if fasting blood glucose was ≥ 7.8 mmol/l (≥ 140 mg/dl).

RESULTS

The crude rate prevalence of NIDDM was 8.7%, with an age-adjusted rate of 10.6% for women and 6.0% for men. Age strongly influenced diabetes prevalence, with a χ2 of risk tendency of 39.1 (P < 0.00005). A significant proportion (5.9%) of younger individuals (35–44 years of age) was affected by the disease. Diabetes was associated with advanced age, had a greater impact in the low-income group, and showed increased odds ratio for hypertension, dyslipidemias, and myocardial infarction in men and women and for obesity only in women.

CONCLUSION

There is a high prevalence of NIDDM in Mexico City that also strikes a significant group of younger individuals. Associated coronary risk factors are also common and more prevalent in diabetic individuals. Current epidemiological data in Mexico and Mexican-Americans in the U.S. suggest that we may be on the ascending limb for diabetes and cardiovascular disease. There is a critical need for resources to be allocated to programs for primary and secondary prevention, which must be well structured and organized so that proper standards of care are followed to prevent progression of the disease.
Comparative Efficacy of a Once-Daily Controlled-Release Formulation of Glipizide and Immediate-Release Glipizide in Patients With NIDDM
Authors: Berelowitz Michael , Fischette Christine , Cefalu William , Schade David S , Sutfin Tamara , Kourides Ione A
Published: March 2007

OBJECTIVE

To compare the efficacy and safety of controlled-release glipizide (glipizide-GITS [gastrointestinal therapeutic system]) and immediate-release glipizide in patients with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

In a multicenter, open-label, randomized, two-way crossover study, 132 patients with NIDDM received daily doses of 5, 20, or 40 mg of either glipizide-GITS or immediate-release glipizide for 8 weeks followed by 8 weeks of the alternate formulation. Plasma glucose, serum insulin, C-peptide, and plasma glipizide levels were measured at fasting and post-Sustacal challenge at the end of 1 and 8 weeks of each treatment phase. HbA1c was measured at the end of weeks 7 and 8 of each treatment phase.

RESULTS

Both formulations of glipizide yielded similar mean HbA1c values. However, mean fasting plasma glucose (FPG) levels were significantly lower with glipizide-GITS treatment than with immediate-release glipizide at the end of week 1 (11.0 vs. 11.6 mmol/l; P < 0.01) and at the end of the 8-week treatment phase (10.9 vs. 11.7 mmol/l; P < 0.001). Fasting insulin and C-peptide levels were lower after 5 mg glipizide-GITS vs. immediate-release glipizide. Glucose responses to Sustacal were similar after both formulations of glipizide; however, serum insulin (P < 0.01) and C-peptide responses (P < 0.05) were lower with glipizide-GITS than with immediate-release glipizide treatment at the end of the 8-week treatment phase. Mean plasma glipizide concentrations were stable by the end of week 1, and the concentrations increased proportionately with dose. Once-daily Glipizide-GITS provided effective mean glipizide concentrations (> 50 ng/ml) 24 h after dosing, even at the lowest (5 mg) dose level. Both formulations were well tolerated.

CONCLUSIONS

Glipizide-GITS was significantly more effective than immediate-release glipizide in reducing FPG levels. Both formulations reduced postprandial plasma glucose levels equally; however, glipizide-GITS exerted its control in the presence of lower plasma glipizide concentrations in addition to significantly lower insulin and C-peptide levels. This suggests that glipizide-GITS improves insulin sensitivity.
The High—Monounsaturated Fat Diet as a Practical Alternative for NIPPM
Authors: Campbell Lesley V , Marmot Priscilla E , Dyer Jenny A , Borkman Mark , Storlien Len H
Published: March 2007

OBJECTIVE

To examine the dietary preferences of and metabolic effects in patients with non-insulin-dependent diabetes mellitus (NIDDM) of a home-prepared high-monounsamrated fat (HM) diet compared with the recommended high-carbohydrate (CHO) diet.

RESEARCH DESIGN AND METHODS

Ten men with mild NIDDM prepared HM and high-CHO diets at home alternately and in random order for 2 weeks each with a minimum 1-week washout. Before and after each diet, 24-h urine glucose, fasting lipids, fructosamine, and 6-h profiles of glucose, insulin, and triglycerides were measured. Dietary preferences were assessed by questionnaire.

RESULTS

In the HM diet, patients consumed 40% of energy intake as CHO and 38% as fat (21% monounsaturated) compared with 52 and 24%, respectively, in the high-CHO diet, with equal dietary fiber content. Body weight and total energy intake were similar in both. The HM diet resulted in significantly lower 24-h urinary glucose excretion, fasting triglyceride, and mean profile glucose levels. The fructosamine levels, the fasting total, low-density lipoprotein, and high-density lipoprotein cholesterol, and the prandial triglyceride concentrations did not differ significantly as a result of the diets. The two diets did not differ in ratings for overall acceptance, taste, cost, ease of preparation, variety, or satiety.

CONCLUSIONS

Prepared at home, the HM diet was, in the short-term, metabolically better in some aspects than the currently recommended diet for NIDDM. It also provided a palatable alternative.
Stroke in the Diabetic Patient
Authors: Beul David S H
Published: March 2007

A higher prevalence of stroke is found in the patient with both diagnosed and undiagnosed diabetes and glucose intolerance. Because of local cerebral acidosis caused by ischemia and hyperglycemia, morbidity and mortality from a stroke are increased. Most studies show that individuals with admission serum glucose >120 mg/dl (6.7 mM) have a higher morbidity and mortality from a stroke. The prevalence of cerebral infarcts, especially lacunar infarcts, is increased and the prevalence of subarachnoid hemorrhage, cerebral hemorrhage, and transient ischemie attacks are decreased in the diabetic patient. Age, race, hypertension, and the presence of diabetic nephropathy and coronary and peripheral vascular disease are risk factors for stroke in the diabetic patient, whereas obesity, smoking, hyperlipidemia, and glycemie control are not. Investigation and treatment of the diabetic patient with a stroke is discussed.
Treatment With an Oral Proteinase Inhibitor Slows Gastric Emptying and Acutely Reduces Glucose and Insulin Levels After a Liquid Meal in Type II Diabetic Patients
Authors: Schwartz Joyce G , Guan Difu , Green Gary M , Phillips William T
Published: March 2007

OBJECTIVE

To determine whether an oral trypsin/chymotrypsin inhibitor, POT II, will delay the rate of gastric emptying in recently diagnosed type II diabetic patients and improve their postprandial metabolic parameters.

RESEARCH DESIGN AND METHODS

Two gastric emptying studies were performedon each of six type II diabetic patients. During one study, the patient ingested a glucose/protein solution, and during the other study, the patientingested the same glucose/protein solution with the addition of 1.5 g ofPOT II, a putative stimulant of cholecystokinin (CCK) release. Each patient served as their own control subject. Each of the two oral solutions were administered to the patients in a counterbalanced order separated by at least 1 week.

RESULTS

Serum insulin, plasma glucose, plasma gastric inhibitory polypeptide (GIP) values, and the rate of gastric emptying were all significantly (P <0.05) decreased over the 2-h testing period when POT II was added tothe oral glucose/protein meal. The area under the curve above baseline for glucose with POT II was 75% of the glucose value without POT II. The areaunder the curve above baseline for insulin with POT II was 68% of the value without POT II. Plasma CCK was significantly increased by POT II 15 min postprandially.

CONCLUSIONS

A trypsin/chymotrypsin inhibitor, POT II, can delay therate of gastric emptying, and decrease postprandial plasma glucose levels, GIP levels, and serum insulin levels in type II diabetic patients diagnosed recently. Delay of gastric emptying in diabetic patients may provide a uniqueor adjunctive approach to the treatment of type II diabetes.
Effect of a High-Monounsaturated Fat Diet Enriched With Avocado in NIDDM Patients
Authors: Lerman-Garber Israel , Ichazo-Cerro Sagrario , Zamora-González José , Cardoso-Saldaña Guillermo , Posadas-Romero Carlos
Published: March 2007

OBJECTIVE

To assess the effects of two controlled diets, one rich in oleic acid obtained from avocado and olive oil and the other rich in complex carbohydrates, on fasting and postprandial serum lipids and glycemic control in 12 women with NIDDM.

RESEARCH DESIGN AND METHODS

A randomized crossover study was designed. During a 4-week baseline period, all patients received the isocaloric diets recommended by the American Diabetes Association. After this period the patients were randomly assigned to receive the two study diets alternately during two 4-week periods. One diet was high in monounsaturated fatty acids (HMUFA) and the other was high in complex carbohydrates (high-CHO). There also was a 4-week washout period in between the two 4-week periods during which the patients followed the American Diabetes Association's isocaloric diet. Blood samples were obtained before and after each dietary period.

RESULTS

Both diets had a minor hypocholesterolemic effect with no major changes in high-density lipoprotein cholesterol. The HMUFA diet was associated with a greater decrement in plasma triglycerides (20 vs. 7% in the high-CHO diet). Glycemic control was similar with both diets.

CONCLUSIONS

Partial replacement of complex digestible carbohydrates with monounsaturated fatty acids (avocado as one of its main sources) in the diet of patients with non-insulin-dependent diabetes mellitus improves the lipid profile favorably, mantains an adequate glycemic control, and offers a good management alternative.
A Case-Control Investigation of Perinatal Risk Factors for Childhood IDDM in Northern Ireland and Scotland
Authors: Patterson Christopher C , Carson Dennis J , Hadden David R , Waugh Norman R , Cole Susan K
Published: March 2007

OBJECTIVE

To identify perinatal risk factors for childhood insulin-dependent diabetes mellitus (IDDM) and determine if they differ between early-onset and lateonset disease.

RESEARCH DESIGN AND METHODS

We selected 258 diabetic children in Northern Ireland and 271 diabetic children in Scotland from population-based registers. For each diabetic child, five matched control subjects were drawn from the same population. All perinatal data were recorded routinely at birth. Odds ratios (ORs) were estimated for parental age, social class, breast-feeding, deprivation measures, and other perinatal variables.

RESULTS

Scottish data indicated an increased risk among children born to older mothers (OR = 2.43, 95% confidence interval [CI] 1.49–3.97 for mothers >35 years of age relative to those <25 years of age). Northern Ireland data showed no such effect. Only Northern Ireland data showed an excess risk in children of professional or managerial families (OR = 1.51, 95% CI 1.11–2.04). A small but nonsignificant reduction in risk among breast-fed children was observed only after adjustment for social class (OR = 0.76, 95% CI 0.54–1.07). Deprivation measures were associated with reductions in risk. Children delivered by cesarean section were at increased risk in both Northern Ireland (OR = 1.66,95% CI 1.10–2.50) and Scottish (OR = 1.70,95% CI 1.12–2.59) data. In Northern Ireland data only, children of first pregnancies were at increased risk (OR = 1.41, 95% CI 1.03–1.93). Both data sets indicated that a first pregnancy was a more important risk factor for early-onset disease than for late-onset disease.

CONCLUSIONS

Many reported risk factors are weak and show inconsistencies between studies. They may be secondary to more direct, as-yet-undiscovered risk factors. Although irrelevant in the majority of cases, the increased risk associated with delivery by cesarean section deserves further study.
Clinical Characteristics of Type II Diabetic Subjects Consuming High Versus Low Carbohydrate Diets in Mexico City and San Antonio, Texas
Authors: Gonzélez Clicerio , Stern Michael P , Mitchell Braxton D , Valdez Rodolfo A , Haffner Steven M , Pérez Beatriz Arredondo
Published: March 2007

OBJECTIVE

To compare the clinical status of type II diabetic subjects identified in two population-based surveys, one performed in Mexico City, Mexico and the other in San Antonio, Texas.

RESEARCH DESIGN AND METHODS

In a low income area of Mexico City, 3,517 age-eligible (35–64 years of age) individuals were randomly selected of whom 3,319 were interviewed at home and 2,198 were examined in a clinic (response rates 62.5%). In San Antonio, 2,357 similarly aged low-income Mexican Americans were randomly selected of whom 2,076 were interviewed at home and 1,511 were examined (response rate 64.1%). Oral glucose tolerance tests were performed at both sites and diabetes was diagnosed according to the World Health Organization (WHO) criteria. In Mexico City, 288 type II diabetic individuals were identified, and 255 were identified in San Antonio. The following variables were measured: height, weight, subscapular and triceps skinfolds, waist-to-hip circumference ratios (WHR), systolic and diastolic blood pressure (random 0 sphygmomanometer), fasting and 2-h postglucose load glucose and insulin concentrations, and fasting total-cholesterol, HDL-cholesterol, and triglyceride (TG) levels. A food frequency questionnaire was used to estimate total calories and the percentage of calories derived from protein, fat, and carbohydrate. Only type II diabetic patients were included in the analyses. Age-adjustment was performed by analysis of covariance for continuous variables and by the Mantel-Haenszel procedure for discrete variables.

RESULTS

The mean age, the percentage newly diagnosed cases, and the percentage of males were similar in both sites. The percentage of diabetic patients treated with oral agents was significantly higher in Mexico City (56.9 vs. 72.7% in San Antonio and Mexico City, respectively, P < 0.001), whereas the percentage treated with insulin was significantly higher in San Antonio (18.8 vs. 2.1% for San Antonio and Mexico City, respectively, P < 0.001). A significant difference was observed in the percentage of calories derived from carbohydrate (61.7–63.2 vs. 47.1–47.5% for Mexico City and San Antonio, respectively, P < 0.001) and fat (18.4–20.0 and 30.1–33.0% for Mexico City and San Antonio, respectively, P < 0.001). Body mass index (BMI)
NIDDM in Mexican-American Families: Heterogeneity by age of onset
Authors: Mitchell Braxton D , Kammerer Candace M , Reinhart Laurie J , Stern Michael P
Published: March 2007

OBJECTIVE

Heredity has long been known as a risk factor for non-insulindependent diabetes mellitus (NIDDM), but the mode of inheritance of NIDDM remains unclear. We examined the distribution of diabetes in 29 Mexican-American families ascertained on a diabetic proband.

RESEARCH DESIGN AND METHODS

Probands represented a random sample of diabetic Mexican Americans residing in low-income neighborhoods from San Antonio, TX. A total of 375 family members of these diabetic probands were examined, and diabetes was diagnosed according to the World Health Organization lasma glucose criteria.

RESULTS

The prevalence of diabetes decreased from 28.2% in first-degree relatives of the probands to 13.3% in second-degree relatives to 11.1% in third-degree relatives. When compared with Mexican Americans with no parental history of diabetes, this represents an excess of diabetes of 2.0-, 1.3-, and 1.1-fold in first-, second-, and thirddegree relatives, respectively. Five of the 29 probands (17%) had an age of diabetes onset <40 years. In the first-degree relatives of these early-onset probands, diabetes prevalence was 47.0% (16 of 34) compared with only 24.1% (34 of 141) in the first-degree relatives of the 24 late-onset probands. After adjustment for age, this excess represented a fivefold increase in the odds of diabetes among relatives of the early-onset probands compared with relatives of the late-onset probands (P < 0.001). Moreover, the 16 affected family member of the early-onset probands had a mean age of diabetes onset of 42.7 years compared with 49.9 years for the 34 affected members of the late-onset probands, although this difference was not statistically significant (P = 0.13).

CONCLUSIONS

NIDDM may be genetically heterogeneous in this Mexican- American population, with family members of early-onset diabetes patients being at higher risk for NIDDM than family members of late-onset diabetes patients.
Plasma Endothelin in NIDDM Patients With and Without Complications
Authors: Bertello Plerdomenico , Veglio Franco , Pinna Giuliano , Gurioli Lorenzo , Molino Paola , Alban Sandra , Chiandussi Livio
Published: March 2007

OBJECTIVE

To measure plasma endothelin 1 (ET-1) levels in uncomplicated non-insulin-dependent diabetes mellitus (NIDDM) and investigate whether ET levels may be related to angiopathy, blood pressure, metabolic control, or duration of illness.

RESEARCH DESIGN AND METHODS

Plasma levels of ET-1 were measured in 44 NIDDM patients, of whom 24 had uncomplicated diabetes, 20 had angiopathy, and 10 had hypertension. In 21 patients, the duration of illness was > 10 years, and in 23 the duration of illness was <10 years. Serum creatinine levels, microalbuminuria, and HbA1c were determined simultaneously. Thirty normotensive healthy (nondiabetic) individuals (20 men and 10 women) served as control subjects.

RESULTS

No significant statistical differences in plasma ET-1 levels were found among all diabetic patients, diabetic patients with and without angiopathy, diabetic patients with different durations of diabetes, and normal subjects. No significant correlation of plasma ET-1 with blood pressure, age, serum creatinine level, duration of diabetes, HbA1c, or diabetic complications was found.

CONCLUSIONS

Plasma ET-1 levels are similar in patients with NIDDM and healthy subjects and do not seem to act as a marker of diabetic complications.
Health-Insurance Coverage for Adults With Diabetes in the U. S. Population
Authors: Harris Maureen I , Cowie Catherine C , Eastman Richard
Published: March 2007

OBJECTIVE

To compare the extent and types of health insurance coverage for adults with diabetes to coverage for those without diabetes in the U. S. population.

RESEARCH DESIGN AND METHODS

Nationally representative samples of 2,405 adults with diabetes and 20,131 adults who were not known to have diabetes in the U. S. completed a questionnaire on current health insurance, including coverage through Medicare, private insurance, the military, and Medicaid and other public programs.

RESULTS

Among all adults with diabetes, 92.0% have some form of health insurance, including 86.5% of those 18–64 years of age and 98.8% of those ≥65 years of age. Approximately 41% are covered by more than one health insurance mechanism, but almost 600,000 people with diabetes do not have any form of health-care coverage. Little difference was found by type of diabetes in the proportion who have health insurance. Only small differences exist between people with diabetes and those without diabetes in the percentages covered and the types of health-care coverage. Government-funded programs are responsible for health-care coverage of 57.4% of adults with diabetes, including 26.4% of those 18–64 years of age and 96.0% of those >65 years of age. Private health insurance is held by 69.3% of diabetic people. Lack of private insurance appears to be attributable primarily to lower income.

CONCLUSIONS

Almost all patients with diabetes who are ≥65 years of age have health-care coverage, but 13.5% of those 18–64 years of age have no health insurance. Few differences exist in coverage between individuals with and without diabetes. However, the absence of insurance should have a substantially greater impact on the ability of patients with diabetes to obtain services necessary for care of their disease, compared with those without diabetes. Government-funded insurance mechanisms cover a large proportion of diabetic patients, which indicates a significant societal burden associated with diabetes. Any changes in government reimbursement and coverage policies could have a major impact on health care for patients with diabetes.
Food-Containing Hypocaloric Diets Are As Effective As Liquid-Supplement Diets for Obese Individuals With NIDDM
Authors: Anderson James W , Brinkman-Kaplan Valerie , Hamilton Carlene C , Logan Jo Ellen B , Collins Robert W , Gustafson Nancy J
Published: March 2007

OBJECTIVE

This study was designed to determine if food-containing hypocaloric diets are as effective as liquid-supplement diets in promoting weight loss for obese individuals with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

Forty NIDDM subjects with body mass indexes (BMIs) of 30–40 kg/m2 were randomized to one of two 800-kcal diets for 12 weeks. Group A received liquid supplement only, and group B received supplement plus an evening meal. Both groups received an intensive behavioral education program.

RESULTS

Weight loss and improvements in glycemic, blood lipid, and blood pressure parameters were similar for the two groups. Weight loss averaged 15.7 kg for the entire group. The need for insulin, anti-diabetes, and anti-hypertensive medication decreased significantly. No serious side effects were observed.

CONCLUSIONS

Both food-containing and supplement diets providing 800 kcal a day effectively promote weight loss for obese individuals with NIDDM.
A Retrospective Study of Glucose Metabolism in Mothers of Large Babies
Authors: Kurishita Masahiro , Nakashima Koji , Kozu Hiromu
Published: March 2007

OBJECTIVE

To evaluate retrospectively the glucose metabolism of women who gave birth to large babies.

RESEARCH DESIGN AND METHODS

Within the first 3 days of postpartum, HbA1c of the dense erythrocytes and glycated albumin were measured. The sample group was comprised of 59 women who gave birth to heavy-for-dates infants. Fifty-five women who had average-sized infants formed the control group. Both groups had normal results on screening for gestational diabetes mellitus (GDM) by 28 weeks of gestation. The dense erythrocyte fractionation was obtained by capillary centrifugation for measurement of stable HbA1c.

RESULTS

Mothers of heavy-for-dates infants had a significantly higher level of HbA1c of the dense erythrocytes (mean ± SD; 5.86 ± 0.68 vs. 5.50 ± 0.70%, P = 0.015) and a higher maternal body mass index (BMI) (mean ± SD; 26.5 ±2.9 vs. 24.1 ±2.3 kg/m2, P < 0.00001) than control mothers. Differences in the occurrence of high levels of HbA1c of the dense erythrocytes and maternal BMI were statistically significant (P < 0.01, P < 0.05) between the two groups, but no difference was noted in glycated albumin. There was no statistical correlation between high levels of HbA1c of the dense erythrocytes and maternal obesity.

CONCLUSIONS

High HbA1c levels of the dense erythrocytes and maternal obesity are independent factors that affect fetal oversize. Heavy-for-dates infants may be a consequence of maternal hyperglycemia in late pregnancy. This maternal hyperglycemia was not detected by the routine screening test for GDM.
CD5+ B-Cells at the Onset of Type I Diabetes and in the Prediabetic Period
Authors: Smerdon Rebecca A , Peakman Mark , Hussain Munther J , Sue Wong F , Watkins Peter J , Leslie R David G , Vergani Diego
Published: March 2007

OBJECTIVE

B-cells expressing CD5 are associated with the production of autoantibodies and are present at increased levels in several autoimmune diseases. The aim of this study was to investigate the relationship of these cells to the development of type I diabetes and the presence of organ and non-organ-specific autoantibodies.

RESEARCH DESIGN AND METHODS

We measured percentage levels of CD5+ B-cells in patients with recent-onset (n = 34) and long-standing (n = 21) type I diabetes and in a cohort of 18 identical twins of patients with type I diabetes studied prospectively, 8 of whom became diabetic (prediabetic twins) during the study; the rest remained nondiabetic after at least 7 years and are now unlikely to develop the disease. Forty-seven healthy individuals were studied as control subjects.

RESULTS

Percentage levels of total B-cells (CD20+) and the proportion expressing CD5 were increased in patients with recent-onset (P < 0.001 for both) but not long-standing type I diabetes compared with control subjects. Percentage levels of CD20+ B-cells were increased in prediabetic twins throughout the prediabetic period (P < 0.05), and there was an increased proportion of CD5-expressing B-cells that failed to reach statistical significance (P = 0.08). Percentage levels of CD20+ B-cells and the proportion expressing CD5 were normal throughout the study in twins remaining nondiabetic. No relationship between percentage levels of CD5+ B-cells and islet cell antibody, thyroid autoantibodies, or non-organ-specific autoantibodies was found.

CONCLUSIONS

These results show an increase in B-cell percentage levels at the diagnosis of type I diabetes, which is because of an expansion of the CD5+ subset. These changes are also evident in twins throughout the prediabetic period, which suggests that they are related to the processes that lead to diabetes.
Long-Term Improvement of Glycemic Control by Insulin Treatment in NIDDM Patients With Secondary Failure
Authors: Lindström Torbjörn , Eriksson Per , Olsson Anders G , Arnqvist Hans J
Published: March 2007

OBJECTIVE

To evaluate the long-term efficacy of insulin treatment of patients with non-insulin-dependent diabetes mellitus (NIDDM) and secondary failure to oral hypoglycemic agents.

RESEARCH DESIGN AND METHODS

Twenty one NIDDM patients with secondary failure were studied while they were still on oral agents. Then they were switched to insulin treatment, and after a median of 27 months, a long-term evaluation was conducted.

RESULTS

At the long-term evaluation, metabolic control was still markedly improved by insulin treatment, with reduction of HbA1c from 8.8 ± 0.2 (mean ± SE) to 6.9 ± 0.3% (P < 0.0001), lowering of very-low-density lipoprotein (VLDL) cholesterol concentration from 0.97 ± 0.3 to 0.69 ± 0.1 mM (P < 0.03), and lowering of total triglycerides from 2.8 ± 0.6 to 1.8 ± 0.3 mM (P < 0.005), mainly due to reduction of VLDL triglycerides. Body weight increased during the first year, but not thereafter (71.3 ± 2.5 kg during oral treatment, 78.9 ± 2.9 and 79.8 ± 3.2 kg after 12 and 36 months of insulin treatment, respectively). Blood pressure did not change. Fasting and postprandial insulin concentrations increased, and C-peptide concentrations were lowered.

CONCLUSIONS

Improvements of glycemic control and lipoprotein concentrations in patients with NIDDM and secondary failure persist also after insulin treatment for 2–3 years in spite of weight gain and hyperinsulinemia.
Biochemical and Molecular Studies of Mitochondrial Function in Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, and Deafness
Authors: Jackson Margaret J , Bindoff Laurence A , Weber Katharina , Wilson Jonathan N , Ince Paul , Alberti K George M M , Turnbull Douglass M
Published: March 2007

OBJECTIVE

To determine if diabetes insipidus, diabetes mellitus, optic atrophy, and deafness (DIDMOAD) combined with a cerebellar syndrome is associated with a systemic disorder of respiratory chain function as found in similar genetic syndromes.

CASE

A muscle biopsy was taken from a patient with DIDMOAD, and a mitochondrial fraction was prepared. Respiratory chain function was assessed by analysis of intermediary metabolites, histochemical analysis of muscle biopsy, measurement of the activity of individual respiratory chain complexes, oxidative flux through the respiratory chain, and cytochrome concentration and compared with a population with normal respiratory chain function. Mitochondrial DNA from skeletal muscle, brain, and pancreas was examined for major rearrangements and specific point mutations. Brain tissue was examined neuropathologically for abnormalities, particularly those previously described in association with DIDMOAD.

RESULTS

No abnormality was found in mitochondrial oxidation, individual complex activity, or cytochrome concentration. Histochemical analysis and electron microscopy showed no abnormality known to be associated with mitochondrial dysfunction. A single-base substitution at position 12308 of the mitochondrial genome was found, but no major rearrangement of mitochondrial DNA was demonstrated. Neuropathological examination revealed severe demyelination and gliosis in the optic nerves and loss of Purkinje cells associated with gliosis in the white matter in the cerebellum.

CONCLUSIONS

We have found no evidence that DIDMOAD is associated with a systemic abnormality of respiratory chain function. The mitochondrial DNA single-base substitution noted is likely to be a polymorphism rather than a pathogenic point mutation. We have confirmed that DIDMOAD may be associated with a neurodegenerative disorder, but the cause of this remains undetermined.
HLA-DQB1 Codon 57 and IDDM in Chinese Living in Taiwan
Authors: Chuang Lee-Ming , Jou Tzuu-Shuh , Hu Chung-Yi , Wu Huey-Peir , Tsai Wen-Yu , Lee Jing-Sheng , Hsieh Rhong-Phong , Chen Kuang-Ho , Tai Tong-Yuan , Lin Boniface J
Published: March 2007

OBJECTIVE

To study the human leukocyte antigen (HLA)-DQB1 genetic background in the Chinese population in Taiwan and its association with the low incidence of insulin-dependent diabetes mellitus (IDDM) in this population.

RESEARCH DESIGN AND METHODS

Forty-eight IDDM patients and 59 nondiabetic unrelated control subjects were recruited from the population in Taiwan. HLA-DQB1 exon 2 was enzymatically amplified by polymerase chain reaction. HLA-DQBl alleles were diagnosed by dot blotting and hybridization with 16 sequence-specific oligonucleotide probes.

RESULTS

DQB1*0201 and DQB1*0302 alleles were more frequent and DQB1*0301 and DQB1*0601 were less frequent in Chinese with IDDM than in control subjects. Genotypes for homozygous non-aspartic acid residue (NA/NA) at position 57 were positively associated with IDDM at a relative risk of 4.34 (P < 0.001), and those for homozygous aspartic acid (A/A) were negatively associatedwith IDDM at a relative risk of 0.14 (P < 0.001). Among the NA/A heterozygotes, only DQB1*0201/ DQB1*0303 was significantly increased in IDDM subjects.

CONCLUSIONS

The amino acid residue at position 57 of HLA-DQ β3-chain is significantly associated with the development or prevention of IDDM in Chinese subjects living in Taiwan. Other genetic and environmental factors may also play important roles in pathogenesis of IDDM.
Use of Focus Groups to Explore Nutrition Practices and Health Beliefs of Urban Caribbean Latinos With Diabetes
Authors: Quatromoni Paula A , Milbauer Marian , Posner Barbara M , Carballeira Nicolas Parkhurst , Brunt Melanie , Chipkin Stuart R
Published: March 2007

OBJECTIVE

Although Caribbean Latinos are two to three times more likely than non-Hispanic whites to develop diabetes, cultural influences on nutrition and health are poorly understood. To provide insight into important features of diabetes prevention and management, we conducted focus groups to explore nutrition practices and health beliefs.

RESEARCH DESIGN AND METHODS

Thirty low-income urban Caribbean Latinos with non-insulin-dependent diabetes mellitus (NIDDM) and four familymembers participated in four focus group interviews that were conducted in Boston and Cambridge, Massachusetts. Interviews were conducted in Spanish, were tape recorded, and were led and analyzed by Latino professionals from a community-based health organization.

RESULTS

Consistent themes described by participants were feelings of social isolation, little understanding of long-term consequences of diabetes, fatalism regarding the course of the disease, multiple barriers todiet and exercise interventions, skepticism regarding the value of preventive health behaviors, prevalent use of traditional nonmedicai remedies, and a clear need for culturally sensitive health-care providers and services.

CONCLUSIONS

The information from focus groups provides useful information for planning innovative intervention programs for chronic disease risk reduction that emphasize practical skills development, family/peer networks, empowerment techniques, and bilingual providers. We conclude that the focus group technique can be used effectively with low-income, urban minority populations to provide information on lifestyle behaviors and beliefs regarding chronic diseases that impact on health and nutritional status.
Premixed Insulin Preparations in Pen Syringes Maintain Glycemie Control and Are Preferred by Patients
Authors: Dunbar Jennifer M , Madden Patricia M , Gleeson Deirdre T , Fiad Tarek M , McKenna T Joseph
Published: March 2007

OBJECTIVE

To examine the impact on glycemie control of substituting a range of premixed insulins for the standard treatment with patient-mixed insulin combinations. In addition, a pen-type syringe was substituted for the conventional insulin syringe, and the patients' preference wasascertained at the end of the study.

RESEARCH DESIGN AND METHODS

Before the study, all patients had maintained a constant insulin dosage for 2 months. For the first month of the study, all patients were encouraged to make any adjustment in insulin dosage required to optimize control. Twenty-seven patients participated in the study. At the end of the first month, patients were randomized either to change to premixed insulins or to continue with self-mixed insulins for 2 months. At the end of the 2-month period, participants changed to the alternative regime for a further 2 months. Glycemie control was measured by assessment of glycosylated hemoglobin levels at the start of the study and aftereach 2-month period of the study. In addition, during the 1-month run-in period and during both 2-month study periods, a seven-point blood glucose profile was obtained extending from before breakfast to just before retiring for sleep.

RESULTS

Glycosylated hemoglobin levels were unchanged throughout the duration of the study. Similarly, there were no systematic changes inindividual seven-point blood glucose profiles. The frequency of hypoglycemie reactions was similar on patient-mixed and premixed insulin programs. However, 83% of patients expressed a preference for premixed insulins. A similar percentage regarded pen-type insulin syringes to be preferable to the conventional syringe.

CONCLUSIONS

Glycemie control was similar on patient-mixed and premixed insulins, and patients had a marked preference for premixed insulins delivered in a pen-type syringe over conventional insulin therapy. Premixed insulin delivered by a pen-type syringe promises to ease the burden of daily injections for many diabetic patients.