bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Sonographic Evaluation for Fetal Growth Delay and Congenital Malformations in Pregnancies Complicated by Insulin-Requiring Diabetes
Authors: Brown Zane A , Mills James L , Metzger Boyd E , Knopp Robert H , Simpson Joe Leigh , Jovanovic-Peterson Lois , Scheer Kenneth , Van Allen Margot I , Aarons Jerome H , Reed George F ,   National Institute of Child Health and Human Development Diabetes in Early Pregnancy Study
Published: March 2007

Objective

It has been reported that early fetal growth retardation may be a useful marker for congenital malformations in diabetic pregnancies. To test this hypothesis, diabetic and nondiabetic women were sonographically evaluated during the first trimester.

Research Desihn and Methods

Fetal crown-rump lengths were measured sonographically at least once during the first 15 wk of pregnancy in 329 nondiabetic and 312 diabetic women. Of these, 289 nondiabetic and 269 diabetic women had sonograms before 10 wk of gestation and 283 nondiabetic and 269 diabetic women had sonograms between 10 and 15 wk of gestation. Early fetal growth delay was defined as a sonographic gestational age of ≥6 days less than menstrual gestational age.

Results

The mean crown-rump lengths at 8 wk were 17.9 ± 4.6 mm in the diabetic and 18.7 ± 4.9 mm in the nondiabetic groups (P = 0.13). At 12 wk, the mean fetal crown-rump length was 58.5 ± 8.8 mm for diabetic subjects and 60.6 ± 8.7 mm for nondiabetic subjects (P = 0.04). Between 5 and 9 wk, 28 of 289 (9.7%) fetuses of nondiabetic subjects, 34 of 259 (13.1%) normal fetuses of diabetic subjects, and 2 of 10 (20%) malformed fetuses of diabetic subjects demonstrated growth delay (P = 0.31, normal vs. malformed diabetic). Between 10 and 15 wk of gestation, 28 of 283 (9.9%) fetuses of nondiabetic subjects, 32 of 256 (12.5%) normal fetuses of diabetic subjects, and 4 of 13 (30.8%) malformed fetuses of diabetic subjects demonstrated growth delay (P = 0.06, normal vs. malformed diabetic). Early fetal growth delay did not predict a reduced birth weight at term.

Conclusions

Among insulin-dependent diabetic subjects who were moderately well controlled at conception, statistically significant but mild early fetal growth delay was present but did not appear to be useful clinically in predicting congenital malformations. Recommendations that growth delay demonstrated on early ultrasound be used as a predictor of congenital malformation require careful reexamination.
Hypertriglyceridemia in Different Degrees of Glucose Intolerance in a Finnish Population-Based Study
Authors: Salomaa Veikko V , Tuomilehto Jaakko , Jauhiainen Matti , Korhonen Heikki J , Stengård Jari , Uusitupa Matti , Pitkanen Matti , Penttila Ilkka
Published: March 2007

Objective

To determine the prevalence of hypertriglyceridemia and the mean serum triglyceride concentrations in different degrees of glucose tolerance—non-insulin-dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT), and normal glucose tolerance (NGT). In addition, we analyzed the correlates of serum triglyceride concentration to explain why it is more prevalent in diabetic subjects.

Resarch Design and Methods

This study was a cross-sectional survey of 4000 people aged 45-64 yr randomly drawn from the population register of the Finnish population of the provinces of North Karelia and Kuopio in eastern Finland and Turku/Loimaa area in southwestern Finland and stratified by four 10-yr age- and sex groups. The final material comprised 96 subjects with NIDDM, 102 subjects with IGT, and 323 subjects with normal glucose tolerance classified on the basis of two 2-h oral glucose tolerance tests. The prevalence of hypertriglyceridemia by the glucose tolerance status and the variation in serum triglycerides associated with selected life-style and biochemical factors were executed as the main outcome measures.

Results

The prevalence of hypertriglyceridemia (≥ 2.3 mM) was 47.6% (95% confidence interval [CI] 32.5–62.7%) in NIDDM men, 21.9% (95% CI 7.6–36.2%) in IGT men, and 15.4% (95% CI 9.3–21.5%) in NGT. In women, hypertriglyceridemia was found in 51.9% (95% CI 38.6–65.2%) among those with NIDDM, 25.7% (95% CI 15.5–35.9%) among those with IGT, and 10.7% (95% CI 6.3–15.1%) in women with NGT. After adjusting for body mass index (BMI) and age, the difference in the prevalence of hypertriglyceridemia between the glucose tolerance groups remained significant in both men (P = 0.008) and women (P = 0.0001). High serum total cholesterol, high BMI, high waist-hip ratio, and low high-density lipoprotein (HDL) cholesterol were significantly associated with high serum triglycerides in all glucose tolerance groups. No synergistic effect between these parameters and glucose tolerance status was found. In multiple linear regression analyses, fasting plasma insulin, diabetes status, and serum uric acid were significant predictors of serum triglyceride concentration after taking into account age, BMI, and HDL and total cholesterol. The association between BMI and serum triglycerides in the regression analysis was significant only when plasma insulin was not included in the model.

Conclsions

Hypertriglyceridemia is common in subjects with NIDDM and IGT and is often associated with low HDL cholesterol, high total cholesterol, hyperinsulinemia, and elevated serum uric acid concentration.
Onset of NIDDM occurs at Least 4–7 yr Before Clinical Diagnosis
Authors: Harris Maureen I , Klein Ronald , Welborn Tim A , Knuiman Matthew W
Published: March 2007

Objective

To investigate duration of the period between diabetes onset and its clinical diagnosis.

Research Design and Methods

Two population-based groups of white patients with non-insulin-dependent diabetes (NIDDM) in the United States and Australia were studied. Prevalence of retinopathy and duration of diabetes subsequent to clinical diagnosis were determined for all subjects. Weighted linear regression was used to examine the relationship between diabetes duration and prevalence of retinopathy.

Results

Prevalence of retinopathy at clinical diagnosis of diabetes was estimated to be 20.8% in the U.S. and 9.9% in Australia and increased linearly with longer duration of diabetes. By extrapolating this linear relationship to the time when retinopathy prevalence was estimated to be zero, onset of detectable retinopathy was calculated to have occurred ∼ 4–7 yr before diagnosis of NIDDM. Because other data indicate that diabetes may be present for 5 yr before retinopathy becomes evident, onset of NIDDM may occur 9–12 yr before its clinical diagnosis.

Conclusions

These findings suggest that undiagnosed NIDDM is not a benign condition. Clinically significant morbidity is present at diagnosis and for years before diagnosis. During this preclinical period, treatment is not being offered for diabetes or its specific complications, despite the fact that reduction in hyperglycemia, hypertension, and cardiovascular risk factors is believed to benefit patients. Imprecise dating of diabetes onset also obscures investigations of the etiology of NIDDM and studies of the nature and importance of risk factors for diabetes complications.
Immediate HbA1c Results: Performance of new HbA1c system in pediatric outpatient population
Authors: Marrero David G , Vandagriff Julie L , Gibson Reid , Fineberg S Edwin , Fineberg Naomi S , Hiar Charles E , Crowley Lawrence E
Published: March 2007

OBJECTIVE

This study compared the performance of a new device that uses an IA to measure HbA1c in 9 min with a 1-μl capillary blood sample with AC and CE methods in both nondiabetic and diabetic pediatric patients.

RESEARCH DESIGN AND METHODS

Two hundred seven pediatric subjects (103 nondiabetic, 104 with insulin-dependent diabetes mellitus) had HbA1c measured with the IA method and compared with total GHb values determined by AC and HbA1 by the CE method with the same whole-blood capillary aliquot. Glucose values were also obtained from the same blood samples.

RESULTS

Correlations and regression analyses show excellent correspondence between the three assays. The correlation between the AC and CE methods is 0.98 (P < 0.001) with a slope of 1.615 ± 0.0125 and intercept of 4.00 ± 0.20. The correlation between the IA and AC methods is 0.99 (P < 0.001) with a slope of 0.608 ± 0.007 and intercept of 1.326 ± 0.066. The correlation between the IA and CE methods is 0.97 (P < 0.001), with a slope of 0.983 ± 0.018 and intercept of 1.122 ± 0.153. The average difference and average percentage difference between methods were also significant (P < 0.001), reflecting the differences in GHb components measured. There was a significant correlation (P < 0.001) between each method and glucose values (IA r = 0.72, AC r = 0.70, CE r = 0.73). Within-run precision for IA ranged from 1.7 to 3.5% and between-run precision 2.7 to 4.1%.

CONCLUSIONS

Study results suggest that the IA method gives extremely accurate and reliable values over the clinical range of interest. The instrument is small, portable, easy to use, and provides information within 9 min for both physicians and patients.
Smokers with IDDM Experience Excess Morbidity: The Colorado IDDM Registry
Authors: Gay Elizabeth C , Cai Yong , Gale Susan M , Baron Anna , Cruickshanks Karen J , Kostraba Jill N , Hamman Richard F
Published: March 2007

OBJECTIVE

To determine whether there is an association between smoking and the self-reported morbidity of people with IDDM and to evaluate the nature of a possible interaction between smoking and IDDM in increasing the risk of morbidity among smokers with IDDM.

RESEARCH DESIGN AND METHODS

Subjects were non-Hispanic whites aged 18–28 yr who participated in the Colorado IDDM Registry Follow-up Survey (case subjects, n = 24) or the 1985 NHIS (control subjects, n = 5876). Assessments of self-reported morbidity included any hospitalization in the past year; bed days, sick days, and limited-activity days in the past 2 wk; and ratings of poor health. The criteria outlined by Saracci were used to determine whether smoking was associated with greater morbidity among IDDM case compared to control subjects (smoking by IDDM interaction).

RESULTS

Age- and sex-adjusted ORs, estimated from logistic regression, showed that people with IDDM reported excess morbidity compared with control subjects, regardless of smoking status. Smokers with IDDM reported morbidity 3–10 times as often as nonsmoking control subjects and were 2–3 times more likely to report morbidity than nonsmokers with IDDM. The smoking by IDDM interaction was more than multiplicative for all morbidity measures. Fifty to 75% of excess morbidity in young smokers with IDDM over simple additive effects was related to the interaction between smoking and IDDM.

CONCLUSIONS

There was excess reported morbidity among people with IDDM who smoked, > that expected from the combined effects of smoking and IDDM. Smoking cessation in young people with IDDM may alleviate some of this excess, but more study is needed to determine whether smoking serves as an indicator of poor IDDM care practices or has a physiological impact that compounds the morbidity experienced by people with IDDM.
Factors Predicting Course of β-cell Function in IDDM
Authors: Schiffrin Alicia , Suissa Samy , Weitzner Gabriel , Poussier Philippe , Lalla Daniel
Published: March 2007

OBJECTIVE

The purpose of this study was to determine whether the severity o clinical presentation, sex, age, HLA type, and the presence of IAs and ICAs could predict the variation of residual insulin secretion as measured by the serum C-peptide response to a Sustacal meal.

RESEARCH DESIGN AND METHODS

A cohort of 151 newly diagnosed IDDM children (mean age 10.2 ± 4.6 yr) was followed prospectively for 3 yr. Thirty-five patients (12 males, 23 females) were still secreting C-peptide after 36 mo.

RESULTS

We found that age (P = 0.0001), sex (P = 0.003), presence of ICA (P = 0.006), severity of clinical presentation (P = 0.001), and symptom duration (P = 0.002) significantly predicted the rate of loss of C-peptide secretion. The risks of accelerated C-peptide disappearance decreased with increasing age, the risk ratios being 0.25 for the older group (> 12 yr) compared with the younger group (< 6 yr) and 0.50 for the intermediate group (6–12 yr) compared with the younger group. The risk for the presence of ICA was 1.7, and the risk for males was 1.7 also. There was a significant negative correlation between ICA titers and C-peptide at 18 and 24 mo after diagnosis (P = 0.04). There were no significant differences in HbA1 values between patients who secreted C-peptide and those who did not.

CONCLUSIONS

We conclude that younger age of onset, male sex, high titers of ICA, severe clinical presentation, and shorter symptom duration significantly predict accelerated rates of loss of C-peptide secretion.
Diabetes Mellitus and Macrovascular Complications: An epidemiological perspective
Authors: Donahue Richard P , Orchard Trevor J
Published: March 2007

It is clearly recognized that patients with NIDDM have an increased risk for CHD. Recent data indicate that persons with glucose concentrations in the nondiabetic range also may be at higher risk for CHD. These associations may not represent cause and effect, however. Emerging data suggest that hyperglycemia and CHD may both arise from hyperinsulinemia/insulin resistance. In support of this hypothesis are studies showing that NIDDM and CHD have many risk factors in common, including age, elevated blood pressure, dyslipidemia, adiposity, and a central pattern of fat distribution. Moreover, these risk factors are frequent concomitants of hyperinsulinemia, itself a risk factor for CHD and perhaps for NIDDM. Although the duration of NIDDM has been infrequently related to risk of CHD, the authors hypothesize that duration of hyperinsulinemia/insulin resistance would be a more sensitive marker for risk of CHD. The relation of IDDM to CHD is a different situation. The etiological process leading to IDDM, namely the destruction of β-cells in genetically predisposed persons, is not related to cardiovascular risk. However, IDDM patients still have an excess of CVD, the risk factors for which may vary according to the location of the diseases (e.g., LEAD vs. CHD). There is a strong relationship between proteinuria and CVD, which has led to a general theory of vascular complications in IDDM based on defective heparan sulfate metabolism (Steno hypothesis). Recent evidence challenges parts of this hypothesis, and the possibility is raised that a higher case-fatality rate in a subgroup of patients with both renal and CVD explains part of the renal connection, as does the general worsening of CVD risk factors.
Diabetic Nephropathy: Metabolic versus hemodynamic considerations
Authors: Hostetter Thomas H
Published: March 2007

Not all patients with diabetes develop clinically significant nephropathy and, for this reason, attention has begun to focus on the risk factors for development of this serious complication. These risk factors have not been quantified to the same degree as those factors associated with more common progressive vascular diseases, such as atherosclerosis. However, studies of pathogenesis and clinical and epidemiological surveys of diabetic nephropathy point to numerous risk categories. Glycemic control, genetic and familial predispositions, renal and glomerular enlargement, glomerular hyperfiltration, and capillary and systemic hypertension can be invoked as contributors to this disease process. This review focuses on hemodynamic alterations and their role in the development and progression of diabetic nephropathy. Increases in GFR, largely driven by increases in plasma flow and capillary pressure, appear in early IDDM and NIDDM. This abnormality of renal vascular control probably is derived from alterations in several vasoactive control systems. In addition, the elevations in capillary pressure may be damaging to the glomerular capillaries. Arterial hypertension is not necessarily present before clinical nephropathy appears; however, it is a usual concomitant of progressive diabetic renal disease. The strongest evidences for the roles of altered systemic and renal hemodynamics in the progression of diabetic renal disease are clinical and experimental studies demonstrating attenuation of the disease process by lowering systemic and capillary pressures with antihypertensive agents, and dietary and glycemic modifications. Thus, although multiple factors probably interact to determine risk for the development of diabetic nephropathy, hemodynamic forces are a particularly important contributor and are especially amenable to therapeutic intervention.
Development of Macrovascular Diseases in NIDDM Patients in Northern Taiwan: A 4-yr follow-up study
Authors: Fu Chen-Chung , Chang Chih-Jen , Tseng Chin-Hsiao , Chen Muh-Shy , Kao Chie-Shung , Wu Ta-Jen , Wu Huey-Peir , Chuang Lee-Ming , Chen Chien-Jen , Tai Tong-Yuan
Published: March 2007

Objective— To assess the development of macrovascular diseases and explore major associative factors in NIDDM.

Research Design and Methods— A total of 479 NIDDM patients ≥ 40 yr of age were recruited from four community primary care health centers of northern Taiwan in July 1986 for a cohort study with a 4-yr follow-up. No patient required insulin therapy within 1 yr of diagnosis nor had a history of diabetic ketoacidosis. All were able to participate independently in the activities of daily living. BP and ECG were measured, and a structured questionnaire was asked of each patient. Venous blood after overnight fasting was collected every year to measure cholesterol, HDL cholesterol, plasma glucose, and HbA1c.

Results— The duration of diabetes was associated with the development of stroke with a relative risk of 1.063 for every 1-yr increment (P = 0.07). As for HVDs, the significant risk factors were serum cholesterol and HbA1c. For every 1-mg/dl increase in mean total cholesterol level, the relative risk of developing HVD increased 1.016-fold (P = 0.04). For every 1% increase in HbA1c, the relative risk of developing HVD increased 1.170-fold (P = 0.01). With regard to leg VDs, sex and cigarette smoking were significant risk factors. Women diabetic subjects had a higher relative risk than men. Cigarette smoking was significantly associated with leg VD with a relative risk of 6.9 for smokers compared with nonsmokers. The most significant risk factor for LVD was the total cholesterol level. For every 1-mg/dl increase in mean serum cholesterol level, the relative risk of LVD increased 1.013-fold.

Conclusions— In the prevention of macrovascular diseases, effective intervention of the nondiabetic cardiovascular risk factors may be as important as or even more important than the good control of diabetes.
A Search for Malnutrition-Related Diabetes Mellitus Among Ethiopian Patients
Authors: Lester Frances T
Published: March 2007

Objective— To search for evidence of MRDM among Ethiopian patients.

Research Design and Methods— We reviewed the records from March 1976 to January 1991 of 1835 Ethiopian diabetic patients registered consecutively in the Diabetic Clinic of Yekatit 12 Hospital in Addis Ababa, Ethiopia.

Results— Of those aged 15–30 at onset, 41.3% had a BMI <19 kg/m2 at diagnosis, and 55% of the latter had a history of normal weight before the onset of symptoms. The frequency of KA was similar in the very thin patients and others of the same age-group, and only 1 patient required >1.5 IU insulin in 24 h. Pancreatic calcification was observed in only 4 middle-aged men with histories of alcohol abuse, and the very thin patients did not have other stigmata of malnutrition. Of the 1604 patients ≥18 yr of age at diagnosis, only 21 of 1116 who knew their previous weight had a BMI <19 kg/m2 before the onset of diabetic symptoms, and most of the 178 patients with a BMI <19 kg/m2 on treatment had been normal or even overweight. In regression analysis, the factors associated with weight loss before diagnosis were the duration of symptoms in type I diabetes patients and the need for insulin from diagnosis, poverty certification, and symptom duration in type II diabetes patients. Weight gain with treatment was related to female sex, the duration of symptoms, and the absence of tuberculosis in type I diabetes patients and related to an address/birthplace not in Addis Ababa in type II diabetes patients.

Conclusions— The undernutrition at presentation is probably caused by the untreated diabetic state and is reversible with treatment, even if the patient is poor and/or lives in a rural area. No convincing cases of MRDM fulfilling the published definition could be found.
Intensive Conventional Insulin Therapy for Type II Diabetes: Metabolic effects during a 6-mo outpatient trial
Authors: Henry Robert R , Gumbiner Barry , Ditzler Timothy , Wallace Penny , Lyon Rachel , Glauber Harry S
Published: March 2007

Objective— To determine whether tight glycemic control can be obtained using intensive conventional split-dose insulin therapy in the outpatient management of type II diabetes without development of unacceptable side effects.

Research Design and Methods— Fourteen type II diabetic subjects were treated with an intensive program of conventional insulin (subcutaneous NPH and regular insulin before breakfast and supper) for 6 mo. Insulin dose adjustments were based on an algorithm built on frequent CPG measurements (4–6 times/day). Patients were monitored biweekly as outpatients and admitted 1 day/mo for metabolic evaluation.

Results— Glycemic control was achieved by 1 mo (mean plasma glucose fell from 17.5 ± 0.9 to 7.7 ± 0.7 mM, P < 0.001) and remained in this range thereafter. Hypoglycemic events at 1 mo were infrequent (mean ± SE events per patient per month: 4.1 ± 0.3) and mild in nature, and progressively decreased to 1.3 ± 0.5 events/mo by 6 mo. After treatment, basal HGO fell 44% from 628 ± 44 to 350 ± 17 μmol·m−2·min−1 (P < 0.001), and maximal rates of glucose disposal measured by hyperinsulinemic euglycemic clamp (1800 pmol·m−2·min−1) improved from 1418 ± 156 to 1657 ± 128 μmol·m−2·min−1 (P < 0.05). The total dose of exogenous insulin required was 86 ± 13 U at 1 mo and 100 ± 24 U at 6 mo. During treatment, mean serum insulin levels increased from 308 ± 80 to 510 ± 102 pM (P < 0.05), while body weight increased from 93.5 ± 5.8 to 102.2 ± 6.8 kg (P < 0.001). Both pre- and posttreatment glucose disposal rates correlated with the total exogenous insulin dose required to achieve glycemic control (r = −0.75 and −0.78, both P < 0.005). Weight gain was inversely related to the pretreatment glucose disposal rate (r = −0.53, P < 0.05) and directly correlated with both mean day-long serum insulin level (r = 0.67, P < 0.01) and total exogenous insulin dose (r = 0.62, P < 0.02).

Conclusions— Intensive CIT, when combined with CBG measurements, can be used to rapidly improve glycemic control in type II diabetes without development of unacceptable hypoglycemia. This degree of metabolic improvement, however, requires large doses of exogenous insulin to overcome peripheral insulin resistance and results in greater hyperinsulinemia with progressive weight gain.
Insulin Resistance in the Pathogenesis of NIDDM in Pima Indians
Authors: Bogardus Clifton
Published: March 2007

NIDDM in Pima Indians is characterized by obesity, abnormal insulin secretion, insulin resistance, and excess hepatic glucose output. Cross-sectional studies, and, as yet incomplete longitudinal studies of nondiabetic and diabetic Pima Indians suggest that the natural history of the disease begins with insulin resistance and, subsequently, when insulin secretion fails, increasing hepatic glucose output occurs, resulting in increasing fasting hyperglycemia. The insulin resistance that precedes the development of fasting hyperglycemia is not due solely to obesity. Insulin resistance aggregates in families and the trimodel frequency distribution of insulin action in vivo suggests it may have genetic determinants.
Cardiovascular Disease Among American Indians and Alaska Natives
Authors: Welty Thomas K , Coulehan John L
Published: March 2007

Objective— To compare the regional differences in cardiovascular disease in AI/AN with the U.S. general population and determine the parity gap and preventable proportion of cardiovascular mortality.

Research Design and Methods— Age-adjusted cardiovascular disease mortality rates for 1981–1983 and hospital discharge rates for 1982–1984 reported by the IHS were compared with U.S. data for 1982 and 1983, respectively.

Results— Rates of ischemic heart disease and atherosclerosis were found to be generally low among AI/AN although those in the 25- to 44-yr age-group have higher death rates from cardiovascular disease than in the U.S. population. Although the mortality rate from cardiovascular disease in AI/AN is 19% lower than the rate for the general U.S. population, the parity gap in individual regions of the U.S. ranges from favorable to extremely unfavorable. There were also wide variations in the preventable gap theoretically possible by reduction of the three major risk factors.

Conclusions— Changing nutrition and exercise patterns and the increasing prevalence of diabetes in many Indian tribes may have adverse effects in the future, possibly increasing the prevalence of heart disease. Regional differences in the prevalence of some major cardiovascular risk factors (smoking, hypertension, hypercholesterolemia, and diabetes) are the probable explanation for these differences in cardiovascular morbidity and mortality rates. Prevention and treatment of these risk factors will have the greatest impact in attempts to reduce cardiovascular disease among AI/AN. In addition, moderation in the use of alcohol, or abstinence, may prevent sudden deaths resulting from acute intoxication.
Epidemiology of Lower-Extremity Amputations in the Indian Health Service, 1982–1987
Authors: Valway Sarah E , Linkins Robert W , Gohdes Dorothy M
Published: March 2007

OBJECTIVE— To describe the LEA experience among IHS diabetic patients.

RESEARCH DESIGN AND METHODS— A cross-sectional study of hospital discharges for nontraumatic LEAs from 1982 to 1987 in four IHS areas was conducted.

RESULTS— Incidence rates of first LEA in the study period increased with increasing age. Compared with nondiabetic subjects, diabetic patients had increased risks in each age-group, with those between the ages of 15 and 44 yr having a 158-fold increased risk. The average annual age-adjusted incidence rates of all LEAs among diabetic subjects in the Tucson (240.8/10,000) and Phoenix (203.1/10,000) IHS areas were substantially higher than the rates for the U.S. (73.1/10,000), Navajo (74.0/10,000), and the Oklahoma (87.3/10,000) IHS areas.

CONCLUSIONS— LEA rates varied in different IHS areas. Reasons for these findings need to be evaluated, but may include IHS area differences in preventive health-care practices or risk factors for LEA.
Effect of Meal Frequency on Blood Glucose, Insulin, and Free Fatty Acids in NIDDM Subjects
Authors: Bertelsen Jette , Christiansen Christian , Thomsen Claus , Poulsen Per L , Vestergaard Svend , Steinov Alice , Rasmussen Lars H , Rasmussen Ole , Hermansen Kjeld
Published: March 2007

Objective— We studied the effects of meal frequency on blood glucose, serum insulin, and FFAs in 12 NIDDM subjects.

Research Design and Methods— Subjects were assigned in random order to two 8-hr observation periods after an overnight fast. They received isocaloric diets with similar composition either as six small or as two large meals. At the end of each study period, an IVGTT was given.

Results— Two large meals induced an 84% greater maximum amplitude of glucose excursions than six small meals (6.1 ± 0.5 vs. 3.3 ± 0.5 mM, P < 0.005) and higher insulin responses (P < 0.03). The Kg response to an IVGTT did not differ in the two situations. The average FFA level was lowest in response to frequent meals (P < 0.02).

Conclusions— A higher meal frequency acutely subdues glucose excursions and reduces insulin and FFA levels during the daytime in older NIDDM subjects.
Autonomic Function in Neuropathic Diabetic Patients With Foot Ulceration
Authors: Gilmore James E , Allen Judith A , Hayes John R
Published: March 2007

Objective— The aim of this study was to compare peripheral autonomic function in neuropathic diabetic subjects with and without foot ulceration.

Research Design and Methods— Measurements were made on 57 diabetic subjects; 35 subjects had evidence of peripheral neuropathy, 14 of these had a history of foot ulceration, and 22 subjects had no evidence of peripheral neuropathy. No patient had peripheral vascular disease. Measurements were made of motor and sensory nerve conduction. Autonomic function was investigated by using standard cardiovascular reflex tests and by measuring blood flow variability in the foot. The vasoconstrictor responses to deep breathing and body cooling were measured by using venous occlusion plethysmography.

Results— Peripheral sympathetic function was significantly worse in the DU group. The vasoconstrictor response to deep breathing in the DU group was significantly smaller than the response in the DN group (15.3 ± 2.7 vs. 38 ± 4%, P < 0.001). The response to body cooling in the DU group was significantly smaller than the response in the DN group (6.2 ± 3.1 vs. 20.8 ± 3.5%, P < 0.01). Tests of cardiac autonomic function and measurements of motor and sensory nerve conduction were similar in both neuropathic groups.

Conclusions— Peripheral autonomic neuropathy is associated with the development of foot ulceration in diabetic subjects.
Prevalence of NIDDM and Impaired Glucose Tolerance in Aborigines and Malays in Malaysia and Their Relationship to Sociodemographic, Health, and Nutritional Factors
Authors: Ali Osman , Tan T T , Sakinah O , Khalid B A K , Wu L L , Ng M L
Published: March 2007

Objective— To determine the prevalence of diabetes mellitus and IGT in different ethnic groups living in the same physical environment and to find their relationship to nutritional status and dietary intake.

Research Design and Methods— The study was conducted among Malays and Orang Asli in six rural and urban locations in Malaysia. OGTTs were performed on 706 adult subjects ≥ 18 yr of age. WHO criteria were used for diagnosing diabetes mellitus and IGT.

Results— The overall prevalence of diabetes mellitus and IGT among Orang Asli was 0.3 and 4.4% compared with 4.7 and 11.3%, respectively, among Malays. This increased prevalence of glucose intolerance among Malays was associated with higher levels of social development. Among rural Malays, the crude prevalence of diabetes in a traditional village was 2.8% and in the land scheme was 6.7%, whereas urban Malays had a prevalence of 8.2%. In contrast, the prevalence of IGT (10.5–14.8%) was higher among rural Malays, compared with 9.6% among urban Malays. Ethnic group, ≥ 40 yr of age, an income > M$250, fewer daily activity, and obesity were associated with a higher prevalence of diabetes.

Conclusions— Diabetes mellitus and IGT, which were more common among Malays than Orang Asli, were associated with more affluent life-styles and modernization.
Prevalence of Microalbuminuria in Older-Onset Diabetes
Authors: Klein Ronald , Klein Barbara E K , Moss Scot E
Published: March 2007

OBJECTIVE

To examine the prevalence of microalbuminuria and the relationships of microalbuminuria to blood pressure and other risk factors.

RESEARCH DESIGN AND METHODS

Individuals diagnosed with diabetes at ≥30 yr of age either taking insulin (n = 435) or not taking insulin (n = 363), who were participants in the population-based Wisconsin Epidemiologic Study of Diabetic Retinopathy, were examined during 1984-1986. Random urine samples were collected and an agglutination inhibition test was used to determine the presence of microalbuminuria, which is defined as ≥0.03 g/L but <0.3 g/L.

RESULTS

The frequency of microalbuminuria was 29.2% in those individuals taking insulin and 22.0% in those not taking insulin. Microalbuminuria was significantly associated with the male sex, older age, higher systolic blood pressure, higher GHb, use of insulin, higher recent alcohol consumption, and a history of cardiovascular disease.

CONCLUSIONS

These findings suggest a relationship between controllable risk factors, blood pressure and GHb, and microalbuminuria in older-onset diabetic individuals.
Daily Vitamin E Supplements Improve Metabolic Control But Not Insulin Secretion in Elderly Type II Diabetic Patients
Authors: Paolisso Giuseppe , D'Amore Anna , Galzerano Domenico , Balbi Vinicio , Giugliano Dario , Varricchio Michele , D'Onofrio Felice
Published: March 2007

OBJECTIVE

To investigate the potential metabolic benefits deriving from daily vitamin E administration in type II diabetic patients.

RESEARCH DESIGN AND METHODS

Twenty-five type II diabetic patients were invited to randomly take placebo or vitamin E (d-α-tocopherol; 900 mg/day) along a similar 3-mo period in a double-blind, crossover procedure. A wash-out period of 30 days separated the two treatment periods. At the end of each treatment period blood samples were drawn for plasma metabolites determination, and an intravenous glucose tolerance test (25 g of glucose as bolus in 3 min) was performed. During this study oral hypoglycemic agents were not discontinued or changed in their dosage.

RESULTS

Chronic vitamin E administration reduced plasma glucose (8.3 ± 0.3 vs. 7.5 ± 0.2 mM, P > 0.05), triglycerides (2.27 ± 0.08 vs. 1.67 ± 0.09 mM, P < 0.02), free fatty acids (786 ± 116 vs. 483 ± 64 mM), total cholesterol (6.74 ± 0.09 vs. 5.50 ± 0.10 mM, P < 0.05), low-density lipoprotein cholesterol (4.73 ± 0.11 vs. 3.67 ± 0.07 mM, P < 0.04), and apoprotein B (1.7 ± 0.3 vs. 1.0 ± 0.1 g/L) levels but did not affect β-cell response to glucose. HbA1 levels (7.8 ± 0.3 vs. 7.1 ± 0.5%, P < 0.05) were also significantly lowered after chronic vitamin E administration.

CONCLUSIONS

Daily vitamin E supplements seem to produce a minimal but significant improvement in the metabolic control in type II diabetic patients. More studies are necessary before conclusions can be drawn about the safety of vitamin E during long-term administration.
Usual Dietary Fat Intake and Insulin Concentrations in Healthy Women Twins
Authors: Mayer Elizabeth J , Newman Beth , Quesenberry Charles P , Selby Joseph V
Published: March 2007

OBJECTIVE

To evaluate the associations between the usual intake of dietary fats and insulin concentrations. Insulin concentrations and insulin resistance have been positively related to risk for NIDDM, obesity, hypertension, dyslipidemia, and coronary heart disease, yet little is known of the environmental risk factors for relative hyperinsulinemia. Insulin resistance can be induced by high-fat feeding in laboratory animals; therefore, high-fat diets may increase risks for developing NIDDM.

RESEARCH DESIGN AND METHODS

Subjects included 544 nondiabetic women who participated in the second examination of the Kaiser Permanente Women Twins Study (1989-1990). Fasting and 2-h post 75-g glucose load insulin levels were determined. Dietary fat intake was assessed by a food frequency questionnaire. Generalized least-squares regression analyses for unpaired twin data were used to determine the relationship between dietary fat intake and insulin levels after adjustment for total calories, age, several behavioral variables, and in some models, percentage of body fat and waist-to-hip ratio. Associations of dietary fat intake with insulin levels were also evaluated within the subset of monozygotic twin pairs (n = 164 pairs) after removal of genetic influences by regression analysis of intrapair differences.

RESULTS

Among the 544 individual women, a 20 g/day increase in total dietary fat was associated with a higher fasting insulin level (9% [P < 0.001] before and 6% [P < 0.01] after adjustment for the obesity variables). Higher intakes of saturated fat, oleic acid, and linoleic acid were each positively related to higher fasting insulin values. The relation of dietary fat with fasting insulin was significantly attenuated among physically active women compared with those who were sedentary (P = 0.04), even after adjustment for obesity. Only saturated fat intake was significantly associated with 2-h postglucose load insulin level before (P = 0.04) but not after adjustment for obesity. Within identical twin pairs, total dietary fat was positively related to fasting insulin before (P = 0.03) but not after adjustment for obesity (P = 0.11).

CONCLUSIONS

High intake of total dietary fat is positively related to relative fasting hyperinsulinemia in nondiabetic women, particularly those who are sedentary. This effect appears to be partly mediated by the relation of dietary fat with obesity.
Effects on Blood Pressure, Glucose, and Lipid Levels of High-Monounsaturated Fat Diet Compared With a High-Carbohydrate Diet in NIDDM Subjects
Authors: Rasmussen Ole W , Thomsen Claus , Hansen Klavs W , Vesterlund Margit , Winther Eva , Hermansen Kjeld
Published: March 2007

OBJECTIVE

To compare the influence on blood pressure, glucose, and lipid levels of a diet rich in monounsaturated fatty acids with an isocaloric, highcarbohydrate diet in 15 NIDDM subjects.

RESEARCH DESIGN AND METHODS

A crossover design with diet interventions and wash-out periods of 3 wk was applied. The patients were randomly assigned to a 3-wk treatment with a high-carbohydrate diet containing 50% of energy as carbohydrate and 30% of energy as fat (10% of energy as monounsaturated fatty acids) or an isocaloric diet with 30% of energy as carbohydrate and 50% of energy as fat (30% of energy as monounsaturated fatty acids). On the last day of the two diets, 24-h ambulatory blood pressure was measured and day profiles of glucose, hormones, and lipids were performed to a test menu rich in carbohydrates.

RESULTS

The diet rich in monounsaturated fat reduced daytime systolic (131 ± 3 vs. 137 ± 3 mmHg, P < 0.04) and 24-h systolic blood pressure (126 ± 8 vs. 130 ± 10 mmHg, P < 0.03) as well as daytime diastolic (78 ± 2 vs. 84 ± 2 mmHg, P < 0.02) and diurnal diastolic blood pressure (75 ± 6 vs. 78 ± 5 mmHg, P < 0.03) as compared with the high-carbohydrate diet. Evidence of lowered blood glucose levels on the high-monounsaturated diet compared with the highcarbohydrate diet were found with lower fasting blood glucose (6.1 ± 0.3 vs. 6.8 ± 0.5 mM, P < 0.05), lower average blood glucose levels (7.4 ± 0.5 vs. 8.2 ± 0.6 mM, P < 0.04), and peak blood glucose responses (9.9 ± 0.6 vs. 11.3 ± 0.7 mM, P < 0.02). The two diets had the same impact on lipid levels.

CONCLUSIONS

A diet rich in monounsaturated fat has beneficial effects on blood pressure and glucose metabolism, whereas no adverse effects on lipid composition in NIDDM subjects is detected.
The Relationship of Physical Fitness to Lipid and Lipoprotein(a) Levels in Adolescents With IDDm
Authors: Austin Audrey , Warty Vijay , Janosky Janine , Arslanian Silva
Published: March 2007

OBJECTIVE

Increased physical activity and physical fitness are recommended therapeutic modalities in addition to insulin and diet in the management of children with IDDM. The aim of this study was to assess the fitness levels of adolescents with IDDM compared with healthy control subjects and to evaluate the relationship between physical fitness and metabolic control.

RESEARCH DESIGN AND METHODS

We studied 59 patients with IDDM, 28 boys and 31 girls, age 15.6 ± 2.5 yr, duration of diabetes 7.6 ± 3.5 yr, HbA1 10.6 ± 2.1% (mean ± SD), and compared them with 18 healthy, nondiabetic control subjects, 9 boys and 9 girls, matched for age, BMI, and Tanner stage. Physical fitness was measured by VO2max during progressive bicycle ergometry. HbA1 was used to determine glycemic control. Lipid profile included fasting total cholesterol, HDL, LDL, Lp(a), and TG levels.

RESULTS

Patients with IDDM had lower VO2max levels than control subjects (33.7 ± 7.0 vs. 41.0 ± 10.4 ml · kg−1 · min−1, P = 0.001). Males with IDDM had lower VO2max than male control subjects, but diabetic and control females showed no difference. In IDDM patients, VO2max correlated inversely with HbA1, insulin dose, cholesterol, LDL, TGs, and Lp(a), but did not correlate with HDL, which correlated inversely with BMI.

CONCLUSIONS

We conclude that the state of physical fitness is an important correlate of lipid levels and Lp(a) in adolescents with IDDM. We speculate that higher physical fitness levels in adolescents with IDDM may decrease the risk of CVD through modulating lipid levels.
Prevalence of Neuropathy in IDDM Patients in Piemonte, Italy
Authors: Veglio Massimo , Sivieri Roberto ,   The Neuropathy Study Group of the Italian Society for the Study of Diabetes, Piemonte Affiliate
Published: March 2007

OBJECTIVE

In view of the scarce data available in Italy, to assess the prevalence of neuropathy in various subgroups of IDDM patients living in the Piemonte region of Italy and to develop, based on existing guidelines, and test the practicality of a standardized assessment of diabetic neuropathy.

RESEARCH DESIGN AND METHODS

All IDDM patients (766) attending 23 outpatient clinics, evenly distributed in the region, were stratified into 3 age-groups (15–29, 30–44, and 45–59 yr) and into 3 groups of diabetes duration (1–7, 8–14, and ≥ 15 yr). A random sample of 467 patients was selected; 81% of whom participated in the studies (196 men and 183 women). The following data were collected: personal and clinical data, structured questionnaire (SQ), neurological examination (NE), vibration sensation (tuning fork) (VS), and two cardiovascular tests (CTs). Patients were classified as follows: stage 0, (no neuropathy) <2 abnormalities among SQ, NE, VS, and CT; stage 1, (asymptomatic neuropathy) > 1 abnormality among NE, VS, and CT; stage 2, (symptomatic neuropathy) abnormalities in SQ and in NE, and/or VS, and/or CT.

RESULTS

The prevalence rates were as follows: stage 0 = 71.5%, stage 1 = 7.2%, and stage 2 = 21.3% and all had a 95% CI. No difference was found between men and women. The prevalence of neuropathy (stages 1 and 2) was higher (P < 0.01) in groups of longer diabetes duration or older age.

CONCLUSIONS

Polyneuropathy is a frequent complication in a north Italian IDDM population. Our results suggest that IDDM patients > 30 yr of age, with diabetes of > 15 yr duration, and who complain of symptoms suggestive of neuropathy, should be promptly assessed for the presence of diabetic polyneuropathy.
Counting Diabetes in the Next Millennium: Application of capture-recapture technology
Authors: LaPorte Ronald E , McCarty Daniel , Bruno Graziella , Tajima Naoko , Baba Shigeaki
Published: March 2007

Monitoring diabetes is critical for our understanding of the etiology and natural history of disease and for public health actions. However, traditional methods for monitoring are either too expensive (e.g., IDDM registries, NIDDM-OGTT prevalence surveys) or too inaccurate (routinely collected data or passive surveillance) for broad accurate, national programs for monitoring the incidence and prevalence of disease. We suggest that one technology called capture-recapture would considerably increase our ability to “count” diabetes, both nationally and globally. Implementation of this approach could lead to accurate inter- and intracountry data on rates of disease. Moreover, such tracking of diabetes could serve as the model for the monitoring of all disease in the 21st century and beyond.
Glucose Tolerance During and After Pregnancy in Nondiabetic Women in an Urban Population in Tanzania
Authors: Lutale Janet K , Justesen Aafke , Swai Andrew B M , Alberti K George M M , McLarty Donald F
Published: March 2007

OBJECTIVE

It is generally accepted that glucose tolerance deteriorates during pregnancy in the developed world. Several small studies have suggested that this may not be the case in sub-Saharan Africa. This study was designed to investigate changes in glucose tolerance in nondiabetic African women during pregnancy in Dar es Salaam, Tanzania.

RESEARCH DESIGN AND METHODS

Women (n = 89) seen before the 14th wk of pregnancy without known diabetes were recruited: 58 had a 75-g OGTT in the 1st, 2nd, and 3rd trimesters and postpartum.

RESULTS

Mean FBG levels were 3.9, 3.5, 3.6, and 3.7 mM in the 1st, 2nd, and 3rd trimesters and postpartum period, respectively. Values were significantly lower in the 2nd and 3rd trimesters than in the 1st and 2nd trimesters compared with postpartum. Mean 2-h blood glucoses were 4.7, 4.4, 4.3, and 4.2 mM, respectively. The 1st trimester value was significantly higher than in the 3rd trimester and postpartum. Fifteen (26%) of the 58 women showed a decreased or unchanged 2-h blood glucose during the course of pregnancy, 5 (9%) showed an increase, and no clear pattern was seen in 38 (67%). Values for fasting glucose showed similar trends.

CONCLUSIONS

We conclude that women during pregnancy in an urban African setting show little change in glucose tolerance. This contrasts with women in both the developed world, where glucose tolerance worsens, and in a rural African environment, where glucose tends to improve.
Comparison of Six Commercial Techniques in the Measurement of Microalbuminuria in Diabetic Patients
Authors: Tiu Sau Cheung , Lee Shui Shan , Cheng Mei Wan
Published: March 2007

OBJECTIVE

To evaluate the advantages and drawbacks of six commercially available techniques in the measurement of microalbuminuria in diabetic patients.

RESEARCH DESIGN AND METHODS

Timed overnight urine samples from 75 patients in our diabetic clinic were tested with 2 qualitative tests (Micral-Test and Microbumintest) and assayed with 4 quantitative tests, which used different methodologies: double-antibody RIA, RID, IT, and NEPH. All tests were commercially available. The double-antibody RIA was taken as the golden standard. All urine samples were either negative or trace by Albustix (Ames, Elkhart, IN). Interobserver variation for the 2 qualitative tests was assessed by asking 12 experienced nurses to read the color changes on the dipsticks and the tablets simultaneously, using test solutions with albumin concentrations of 16, 32, and 64 mg/L.

RESULTS

The 75 urine samples contained 0–154.2 mg/L of albumin. Correlation coefficients of RID, NEPH, and IT with RIA were 0.970, 0.975, and 0.974, respectively. Intra-assay and interassay CVs ranged from 1.36–11.5%. Microbumintest had a higher sensitivity (100 vs. 75%), but lower specificity (82.5 vs. 87.3%) than Micral-Test. Considerable interobserver variation existed in the matching of colors for both tests. Discrepancies were especially significant with Microbumintest, with 8 of 12 nurses misreading the 32 mg/L level.

CONCLUSIONS

Correlations of the 3 quantitative methods with RIA were all >0.970. Choice of test may depend more on considerations such as time, space, number of specimens to be handled, and availability of instruments. Both qualitative tests showed a relatively low specificity. Positive tests must be confirmed with quantitative assays before microalbuminuria is diagnosed. Microbumintest had a higher sensitivity, but its unacceptably high interobserver variation and lower specificity were serious drawbacks.
Maternal Age and Birth Order of Young IDDM Patients: A study from southern India
Authors: Ramachandran Ambady , Snehalatha Chamukuttan , Joseph Annie , Viswanathan Vijay , Viswanathan Moopil
Published: March 2007

OBJECTIVE

To assess the effects of maternal age and birth order on the risk of IDDM in Asian Indians.

RESEARCH DESIGN AND METHODS

Data from a diabetes registry in Madras, India, was used to find IDDM patients diagnosed before 20 yr of age. A questionnaire was used to elicit clinical details of subjects.

RESULTS

Children with mothers ≤24 yr of age had a higher percentage of IDDM. Children with lower birth orders had a higher prevalence of IDDM.

CONCLUSIONS

The risk of IDDM in children is increased in children with lower birth orders, born of younger mothers.