bluuebunny/crossref_metadata_2025 huggingface dataset:
Improvement of Glycemic Control in Subjects With Poorly Controlled Type 2 Diabetes
Authors: Davies Melanie , Storms Fred , Shutler Simon , Bianchi-Biscay Monique , Gomis Ramon ,   for the AT.LANTUS Study Group
Published: March 2007

OBJECTIVE—Large prospective studies have demonstrated that optimum glycemic control is not routinely achieved in clinical practice. Barriers to optimal insulin therapy include hypoglycemia, weight gain, and suboptimal initiation and dose titration. This study compared two treatment algorithms for insulin glargine initiation and titration: algorithm 1 (investigator led) versus algorithm 2 (performed by study subjects).

RESEARCH DESIGN AND METHODS—A prospective, multicenter (n = 611), multinational (n = 59), open-label, 24-week randomized trial in 4,961 (algorithm 1, n = 2,493; algorithm 2, n = 2,468) suboptimally controlled type 2 diabetic subjects.

RESULTS—At baseline, mean diabetes duration was 12.3 ± 7.2 years, and 72% of subjects were pretreated with insulin. At end point, there was no significant difference in the incidence of severe hypoglycemia between algorithms 1 and 2 (0.9 vs. 1.1%). There was a significant reduction in HbA1c from 8.9 ± 1.3 to 7.8 ± 1.2%, with a greater decrease (P < 0.001) with algorithm 2 (−1.22%) versus algorithm 1 (−1.08%). Fasting blood glucose decreased from 170 to 110 mg/dl, with a greater decrease (P < 0.001) with algorithm 2 (−62 mg/dl) versus algorithm 1 (−57 mg/dl). Mean basal insulin dose increased from 22.9 ± 15.5 to 43.0 ± 25.5 IU, with a significant difference (P < 0.003) between algorithm 2 (21.6 IU) and algorithm 1 (18.7 IU).

CONCLUSIONS—Glargine is safe and effective in improving glycemic control in a large, diverse population with longstanding type 2 diabetes. A simple subject-administered titration algorithm conferred significantly improved glycemic control with a low incidence of severe hypoglycemia compared with physician-managed titration.
The Decline in Blood Glucose Levels Is Less With Intermittent High-Intensity Compared With Moderate Exercise in Individuals With Type 1 Diabetes
Authors: Guelfi Kym J. , Jones Timothy W. , Fournier Paul A.
Published: March 2007

OBJECTIVE—To compare the response of blood glucose levels to intermittent high-intensity exercise (IHE) and moderate-intensity exercise (MOD) in individuals with type 1 diabetes.

RESEARCH DESIGN AND METHODS—Seven healthy individuals with type 1 diabetes were tested on two separate occasions, during which either a 30-min MOD or IHE protocol was performed. MOD consisted of continuous exercise at 40% Vo2peak, while the IHE protocol involved a combination of continuous exercise at 40% Vo2peak interspersed with 4-s sprints performed every 2 min to simulate the activity patterns of team sports.

RESULTS—Both exercise protocols resulted in a decline in blood glucose levels. However, the decline was greater with MOD (−4.4 ± 1.2 mmol/l) compared with IHE (−2.9 ± 0.8 mmol/l; P < 0.05), despite the performance of a greater amount of total work with IHE (P < 0.05). During 60 min of recovery from exercise, glucose levels remained higher in IHE compared with MOD (P < 0.05). Furthermore, glucose levels remained stable during recovery from IHE, while they continued to decrease after MOD (P < 0.05). The stabilization of blood glucose levels with IHE was associated with elevated levels of lactate, catecholamines, and growth hormone during early recovery from exercise (P < 0.05). There were no differences in free insulin, glucagon, cortisol, or free fatty acids between MOD and IHE.

CONCLUSIONS—The decline in blood glucose levels is less with IHE compared with MOD during both exercise and recovery in individuals with type 1 diabetes.
Islet Transplantation Is Associated With an Improvement of Cardiovascular Function in Type 1 Diabetic Kidney Transplant Patients
Authors: Fiorina Paolo , Gremizzi Chiara , Maffi Paola , Caldara Rossana , Tavano Davide , Monti Lucilla , Socci Carlo , Folli Franco , Fazio Ferruccio , Astorri Ettore , Del Maschio Alessandro , Secchi Antonio
Published: March 2007

OBJECTIVE—Cardiovascular mortality and morbidity are major problems in type 1 diabetic patients with end-stage renal disease (ESRD). The aim of this study was to determine whether islet transplantation can improve cardiovascular function in these patients.

RESEARCH DESIGN AND METHODS—We assessed various markers of cardiac function at baseline and 3 years later in a population of 42 type 1 diabetic patients with ESRD who received a kidney transplant. Seventeen patients then received an islet transplant that had persistent function as defined by long-term C-peptide secretion (kidney-islet group). Twenty-five patients did not receive a functioning islet transplant (kidney-only group).

RESULTS—GHb levels were similar in the two groups, whereas the exogenous insulin requirement was lower in the kidney-islet group with persistent C-peptide secretion. Overall, cardiovascular parameters improved in the kidney-islet group, but not in the kidney-only group, with an improvement of ejection fraction (from 68.2 ± 3.5% at baseline to 74.9 ± 2.1% at 3 years posttransplantation, P < 0.05) and peak filling rate in end-diastolic volume (EDV) per second (from 3.87 ± 0.25 to 4.20 ± 0.37 EDV/s, P < 0.05). Time to peak filling rate remained stable in the kidney-islet group but worsened in the kidney-only group (P < 0.05). The kidney-islet group also showed a reduction of both QT dispersion (53.5 ± 4.9 to 44.6 ± 2.9 ms, P < 0.05) and corrected QT (QTc) dispersion (67.3 ± 8.3 to 57.2 ± 4.6 ms, P < 0.05) with higher erythrocytes Na+-K+-ATPase activity. In the kidney-islet group only, both atrial natriuretic peptide and brain natriuretic peptide levels decreased during the follow-up, with a stabilization of intima-media thickness.

CONCLUSIONS—Our study showed that type 1 diabetic ESRD patients receiving a kidney transplant and a functioning islet transplant showed an improvement of cardiovascular function for up to 3 years of follow-up compared with the kidney-only group, who experienced an early failure of the islet graft or did not receive an islet graft.
Dietary Glycemic Index, Glycemic Load, Fiber, Simple Sugars, and Insulin Resistance
Authors: Lau Cathrine , Færch Kristine , Glümer Charlotte , Tetens Inge , Pedersen Oluf , Carstensen Bendix , Jørgensen Torben , Borch-Johnsen Knut
Published: March 2007

OBJECTIVE—To examine the relationship between daily glycemic index, daily glycemic load, simple sugars, dietary fiber, and the prevalence of a measure of insulin resistance in 30- to 60-year-old nondiabetic Danish men and women.

RESEARCH DESIGN AND METHODS—The Inter99 study is a nonpharmacological intervention study. We used baseline data and examined cross-sectional associations between carbohydrate-related dietary factors and an estimate of insulin resistance in 5,675 subjects at 30–60 years. The dietary intake was estimated from a self-administered food frequency questionnaire, and insulin resistance was estimated using the homeostasis model assessment of insulin resistance (HOMA-IR). Multiple regressions were performed with HOMA-IR as the dependent variable and carbohydrate-related factors as explanatory variables. All models were adjusted for age, sex, smoking, physical activity, total energy intake, BMI, and waist circumference.

RESULTS—Intake of lactose was positively associated with HOMA-IR (P < 0.0001), whereas daily glycemic load and intake of glucose, fructose, dietary fiber, total carbohydrate, fruit, and vegetables were inversely associated with HOMA-IR (P < 0.05). Intake of dietary fiber explained the associations with daily glycemic load and total carbohydrate and attenuated the association with fruit and vegetables. No significant associations were observed for daily glycemic index or sucrose.

CONCLUSIONS—Habitual intake of diets with a high glycemic index and high glycemic load or diets with a high content of total carbohydrate including simple sugars was not associated with the probability of having insulin resistance. Furthermore, intake of dietary fiber was inversely associated with the probability of having insulin resistance.
No Evidence for Genetically Determined Alteration in Insulin Secretion or Sensitivity Predisposing to Type 1 Diabetes
Authors: Hawa Mohammed I. , Bonfanti Riccardo , Valeri Christina , Delli Castelli Michela , Beyan Huriya , Leslie R. David G.
Published: March 2007

OBJECTIVE— To determine whether inherited changes in insulin secretion or sensitivity could predispose to type 1 diabetes, we studied identical twins of type 1 diabetic patients.

RESEARCH DESIGN AND METHODS— We studied prospectively a consecutive series of 27 identical twins of patients with type 1 diabetes who were initially nondiabetic, as well as 14 control subjects, over a period of 18 years. Of these 27 twins, 15 remain nondiabetic (now estimated at low disease risk) and 12 developed diabetes (pre-diabetic twins). Subjects were tested when not diabetic on at least two occasions with an intravenous glucose tolerance test (IVGTT), and we estimated insulin secretion as first-phase insulin response (FPIR), glucose clearance (Kg), and insulin sensitivity both by homeostasis model assessment of insulin resistance (HOMA-IR) and relative to insulin response by the basal HOMA-IR–to–FPIR ratio.

RESULTS— Twins now at low risk and control subjects had similar fasting blood glucose and insulin levels, FPIR, Kg, HOMA-IR, and HOMA-IR–to–FPIR ratio. In contrast, pre-diabetic twins compared with control twins had higher fasting insulin levels (10.3 ± 6.0 vs. 4.6 ± 4.0 mIU/ml), lower FPIR (245 ± 129 vs. 796 ± 622 mIU · ml−1 · 10 min−1), lower Kg (1.5 ± 0.6 vs. 2.6 ± 0.8% per min), and higher HOMA-IR–to–FPIR ratio (0.007 ± 0.005 vs. 0.001 ± 0.0009) (all P < 0.01).

CONCLUSIONS— These observations in low-risk nondiabetic identical twins failed to identify a familial alteration in either insulin secretion or sensitivity predisposing to type 1 diabetes.
Is Physician Gender Associated With the Quality of Diabetes Care?
Authors: Kim Catherine , McEwen Laura N. , Gerzoff Robert B. , Marrero David G. , Mangione Carol M. , Selby Joseph V. , Herman William H.
Published: March 2007

OBJECTIVE—This study examines the association between physician gender and diabetes quality of care.

RESEARCH DESIGN AND METHODS—We examined the association between the gender of primary care physicians (n = 1,686) and the quality of diabetes care they provided to their patients participating in the Translating Research Into Action for Diabetes (TRIAD) study. Main outcome measures were diabetes processes of care including receipt of dilated retinal exams, urine microalbumin/protein testing, foot exams, lipid and HbA1c (A1C) testing, recommendation to take aspirin, and influenza vaccination over 1 year. Intermediate outcomes included blood pressure, A1C, LDL levels, and patient satisfaction. Hierarchical regression models accounted for clustering within provider groups and health plans and adjusted for patient age, gender, race, income, education, diabetes treatment and duration, and health status, along with physician age, years of practice, and specialty.

RESULTS—Compared with male physicians (n = 1,213), female physicians (n = 473) were younger, had more recently completed training, and were more often internists. Patients of female physicians (n = 4,585) were more often women and younger than patients of male physicians (n = 1,783). In adjusted analyses, patients of female physicians were slightly more likely to receive lipid measurements (predicted probability 1.09 [95% CI 1.02–1.15]) and A1C measurements (1.02 [1.00–1.05]) and were slightly more likely to have an LDL <130 mg/dl (1.05 [1.00–1.10]).

CONCLUSIONS— Patients of female physicians received similar quality of care compared with patients of male physicians.
Birth Weight and Parental BMI Predict Overweight in Children From Mothers With Gestational Diabetes
Authors: Schaefer-Graf Ute M. , Pawliczak Julia , Passow Doerte , Hartmann Reinhard , Rossi Rainer , Bührer Christoph , Harder Thomas , Plagemann Andreas , Vetter Klaus , Kordonouri Olga
Published: March 2007

OBJECTIVE—To investigate the growth of children from pregnancies with gestational diabetes mellitus (GDM) and its association with antenatal maternal, fetal, and recent anthropometric parameters of mother and father.

RESEARCH DESIGN AND METHODS—In 324 pregnancies of Caucasian women with GDM, BMI before pregnancy, maternal glycemic values, and measurements of the fetal abdominal circumference were recorded. The weight and height of infants were measured at birth and at follow-up at 5.4 years (range 2.5–8.5). In addition, somatic data from routine examinations at 6, 12, and 24 months and the BMI of parents at follow-up were obtained. BMI standard deviation scores (SDSs) were calculated based on age-correspondent data.

RESULTS—At all time points, BMI was significantly above average (+0.82 SDS at birth; +0.56 at 6, +0.35 at 12, and +0.32 at 24 months; and +0.66 at follow-up; P < 0.001). BMI at birth was related to BMI at follow-up (r = 0.27, P < 0.001). The rate of overweight at follow-up was 37% in children with birth BMI ≥90th percentile and 25% in those with normal BMI at birth (P < 0.05). Abdominal circumference of third trimester and postprandial glucose values were related to BMI at follow-up (r = 0.22 and r = 0.18, P < 0.01). Recent maternal, paternal, and birth BMI were independent predictors of BMI at follow-up (r = 0.42, P < 0.001). Sixty-nine percent of children of parents with BMI ≥30 kg/m2 were overweight at follow-up compared with 20% of those with parental BMI <30 kg/m2 (P < 0.001).

CONCLUSIONS—Children of mothers with GDM have a high rate of overweight that is associated both with intrauterine growth and parental obesity.
Changing the Definition of Impaired Fasting Glucose
Authors: Vaccaro Olga , Riccardi Gabriele
Published: March 2007

OBJECTIVE—This study evaluates the impact of lowering the diagnostic threshold for impaired fasting glucose (IFG) from 6.1 to 5.6 mmol/l as proposed by the American Diabetes Association (ADA) on the prevalence of the condition, classification of individuals, and risk definition.

RESEARCH DESIGN AND METHODS—A total of 1,285 employees of the Italian Telephone Company aged 35–59 years without known diabetes underwent an oral glucose tolerance test (OGTT). BMI, serum cholesterol, triglycerides, and blood pressure were measured. Medication use was recorded.

RESULTS—With the new ADA criterion, the proportion of people diagnosed with IFG increased from 3.2 to 9.7%. The newly proposed IFG category identified 41% of all subjects with impaired glucose tolerance (IGT) compared with 16.2% identified with the use of the World Health Organization criterion for IFG; the improvement in accuracy has been achieved at the cost of classifying more previously “normal” subjects as having IFG (from 2.3 to 7.3%). Both IFG and IGT were associated with an unfavorable risk profile for diabetes and cardiovascular disease, with a higher estimated risk for IGT than IFG.

CONCLUSIONS—Even with the revised diagnostic criterion, IFG and IGT identify distinct groups that have a different background risk. The cost/benefit of preventive measures tested in people with IGT may not apply to the new IFG category.
Insulin Resistance and Preeclampsia in Gestational Diabetes Mellitus
Authors: Montoro Martin N. , Kjos Siri L. , Chandler Mary , Peters Ruth K. , Xiang Anny H. , Buchanan Thomas A.
Published: March 2007

OBJECTIVE—To compare the degree of insulin resistance in women with gestational diabetes mellitus (GDM) who do and do not develop preeclampsia.

RESEARCH DESIGN AND METHODS—We conducted a prospective cohort study of initially normotensive women with GDM who underwent oral glucose tolerance tests (OGTTs), intravenous glucose tolerance tests (IVGTTs), and glucose clamp studies in the early third trimester (n = 150) and 15 months postpartum (n = 89). After delivery, the women were categorized as nonpreeclamptic or preeclamptic (systolic blood pressure [SBP] ≥140 mmHg, diastolic blood pressure [DBP] ≥90 mmHg, and at least >1+ proteinuria or >300 mg/24 h). Metabolic parameters between the groups were compared by χ2 or Fisher’s exact tests and ANOVA with P < 0.05 as significant.

RESULTS—A total of 29 women (19%) developed preeclampsia, which was mild in 21 and severe in 8 women. At entry, there were no differences in age, weight indexes, and glycemic measures between the nonpreeclamptic and preeclamptic groups. Those with preeclampsia were significantly taller (61.5 ± 2.4 vs. 60.1 ± 2.3 in, P = 0.003), were more often nulliparous (38 vs. 16%, P = 0.01), and had higher entry SBP (112 ± 10 vs. 103 ± 6.9 mmHg, P < 0.0001) and DBP (64 ± 9 vs. 59 ± 5 mmHg, P = 0.002). No significant differences between the groups were found in any measures of the OGTT glucose levels, insulin sensitivity index, glucose effectiveness, acute response to glucose, or disposition index, nor were there any differences found in the euglycemic clamp measures of basal or steady-state levels of glucose, insulin, free fatty acid, hepatic glucose output, peripheral glucose clearance, C-peptide, or glucagon. At 15 months postpartum, blood pressure levels remained significantly higher in the preeclamptic group (n = 19) compared with the nonpreeclamptic group (n = 70). No differences in any glycemic or insulin resistance measures were found.

CONCLUSIONS—Women with GDM were uniformly insulin resistant. Those who developed preeclampsia, when compared with those who remained nonpreeclamptic, were not more insulin resistant in either the third trimester or 15 months postpartum. However, women who developed preeclampsia had blood pressure levels that were significantly higher, although still in the normal range, than those of women who remained nonpreeclamptic.
Identifying Individuals at High Risk for Diabetes
Authors: Schmidt Maria Inês , Duncan Bruce B. , Bang Heejung , Pankow James S. , Ballantyne Christie M. , Golden Sherita H. , Folsom Aaron R. , Chambless Lloyd E. ,   for the Atherosclerosis Risk in Communities Investigators
Published: March 2007

OBJECTIVE—To develop and evaluate clinical rules to predict risk for diabetes in middle-aged adults.

RESEARCH DESIGN AND METHODS—The Atherosclerosis Risk in Communities is a cohort study conducted from 1987–1989 to 1996–1998. We studied 7,915 participants 45–64 years of age, free of diabetes at baseline, and ascertained 1,292 incident cases of diabetes by clinical diagnosis or oral glucose tolerance testing.

RESULTS—We derived risk functions to predict diabetes using logistic regression in a random half of the sample. Rules based on these risk functions were evaluated in the other half. A risk function based on waist, height, hypertension, blood pressure, family history of diabetes, ethnicity, and age was performed similarly to one based on fasting glucose (area under the receiver-operating characteristic curve [AUC] 0.71 and 0.74, respectively; P = 0.2). Risk functions composed of the clinical variables plus fasting glucose (AUC 0.78) and additionally including triglycerides and HDL cholesterol (AUC 0.80) performed better (P < 0.001). Evaluation of scores based on the metabolic syndrome as defined by the National Cholesterol Education Program or with slight variations showed AUCs of 0.75 and 0.78, respectively. Rules based on all these approaches, while identifying 20–56% of the sample as screen positive, achieved sensitivities of 40–87% and specificities of 50–86%.

CONCLUSIONS—Rules derived from clinical information, alone or combined with simple laboratory measures, can characterize degrees of diabetes risk in middle-aged adults, permitting preventive actions of appropriate intensity. Rules based on the metabolic syndrome are reasonable alternatives to rules derived from risk functions.
Influence of Glycemic Index/Load on Glycemic Response, Appetite, and Food Intake in Healthy Humans
Authors: Alfenas Rita C.G. , Mattes Richard D.
Published: March 2007

OBJECTIVE—High glycemic index (GI)/load (GL) diets reportedly enhance appetite and promote positive energy balance. Support for this hypothesis stems largely from acute feeding trials and longer-term studies lacking control over the macronutrient composition and palatability of test foods. This study evaluated the effects of consuming high- and low-GI/GL meals, matched on macronutrient composition and palatability, plasma glucose and insulin, appetite, and food intake.

RESEARCH DESIGN AND METHODS—Thirty-nine healthy adults consumed only low- or only high-GI foods ad libitum in the laboratory for 8 days in either high (three foods per meal)- or low (one food per meal)-variety conditions. Glucose and insulin concentrations as well as appetitive sensations were determined before and for 2 h following breakfast and lunch on days 1 and 8. Energy intake was monitored daily.

RESULTS—There were no significant differences in plasma glucose or insulin responses, appetitive ratings, or food intake between treatments.

CONCLUSIONS—These data indicate that the differential glycemic response of foods tested in isolation under fixed time are not preserved under conditions of chronic ad libitum consumption of mixed meals.
Diabetes Is Associated With Dramatically Decreased Survival in Female but Not Male Subjects With Cystic Fibrosis
Authors: Milla Carlos E. , Billings Joanne , Moran Antoinette
Published: March 2007

OBJECTIVE—Survival analysis was performed on a prospectively followed cohort of patients with cystic fibrosis (CF) to determine the impact of the development of diabetes on survival.

RESEARCH DESIGN AND METHODS—Clinical data were retrieved for patients diagnosed with CF-related diabetes (CFRD) at the Minnesota CF Center in 1987–2002. Kaplan-Meier survival analysis was performed to estimate median survival. Data were analyzed by Cox regression to evaluate the influence of clinical characteristics at the time of CFRD diagnosis on mortality.

RESULTS—Clinical information was reviewed from 1,081 CF patients. A total of 123 patients with CFRD with fasting hyperglycemia were identified (58 males). Median survival was 49.5 years for male subjects without diabetes, 47.4 years for male subjects with diabetes, 47.0 years for female subjects without diabetes, and 30.7 years for female subjects with diabetes. Only female sex and forced expiratory volume in 1 s at the time of CFRD diagnosis were significant predictors of the subsequent risk of death (P < 0.001). This strong association was not confounded by CFTR genotype, BMI, steroid use, respiratory pathogens, HbA1c, or pregnancy.

CONCLUSIONS—Female subjects with CFRD have a remarkably poorer prognosis compared with all male subjects with CF and female subjects with CF but without diabetes. The etiology of this sex difference is not clear. We speculate it might involve the interaction of female hormones and diabetes on promotion of a proinflammatory state or that androgens might protect male subjects from the catabolic effects of insulin deficiency. Alternatively, the appearance of frank diabetes in female subjects with CF may simply be a marker for some other biological difference that is not immediately apparent.
Autologous Transplantation of Granulocyte Colony–Stimulating Factor–Mobilized Peripheral Blood Mononuclear Cells Improves Critical Limb Ischemia in Diabetes
Authors: Huang Pingping , Li Shangzhu , Han Mingzhe , Xiao Zhijian , Yang Renchi , Han Zhong Chao
Published: March 2007

OBJECTIVE— To assess the application of autologous transplantation of granulocyte colony–stimulating factor (G-CSF)–mobilized peripheral blood mononuclear cells (PBMNCs) in the treatment of critical limb ischemia (CLI) of diabetic patients and to evaluate the safety, efficacy, and feasibility of this novel therapeutic approach.

RESEARCH DESIGN AND METHODS—Twenty-eight diabetic patients with CLI were enrolled and randomized to either the transplant group or the control group. In the transplant group, the patients received subcutaneous injections of recombinant human G-CSF (600 μg/day) for 5 days to mobilize stem/progenitor cells, and their PBMNCs were collected and transplanted by multiple intramuscular injections into ischemic limbs. All of the patients were followed up after at least 3 months.

RESULTS—At the end of the 3-month follow-up, the main manifestations, including lower limb pain and ulcers, were significantly improved in the patients of the transplant group. Their laser Doppler blood perfusion of lower limbs increased from 0.44 ± 0.11 to 0.57 ± 0.14 perfusion units (P < 0.001). Mean ankle-brachial pressure index increased from 0.50 ± 0.21 to 0.63 ± 0.25 (P < 0.001). A total of 14 of 18 limb ulcers (77.8%) of transplanted patients were completely healed after cell transplantation, whereas only 38.9% of limb ulcers (7 of 18) were healed in the control patients (P = 0.016 vs. the transplant group). No adverse effects specifically due to cell transplantation were observed, and no lower limb amputation occurred in the transplanted patients. In contrast, five control patients had to receive a lower limb amputation (P = 0.007, transplant vs. control group). Angiographic scores were significantly improved in the transplant group when compared with the control group (P = 0.003).

CONCLUSIONS—These results provide pilot evidence indicating that the autologous transplantation of G-CSF–mobilized PBMNCs represents a simple, safe, effective, and novel therapeutic approach for diabetic CLI.
The Role of Autoimmunity at Diagnosis of Type 1 Diabetes in the Development of Thyroid and Celiac Disease and Microvascular Complications
Authors: Glastras Sarah J. , Craig Maria E. , Verge Charles F. , Chan Albert K. , Cusumano Janine M. , Donaghue Kim C.
Published: March 2007

OBJECTIVE—The purpose of this study was to explore whether the presence of thyroid and endomysial autoantibodies at diagnosis of type 1 diabetes in children predicts development of thyroid and celiac disease, respectively, and whether diabetes-associated autoantibodies at diagnosis predict development of microvascular complications up to 13 years later.

RESEARCH DESIGN AND METHODS—Autoantibodies were measured at diagnosis of type 1 diabetes in 173 children aged 0–15 years and included thyroperoxidase antibody (TPOA), endomysial antibody (EMA), islet cell autoantibody, GAD antibody (GADA), and insulin autoantibody. Thyroid disease was defined as thyroid stimulating hormone level ≥5 μU/ml. Celiac disease was confirmed by small-bowel biopsy. Assessment of microvascular complications included stereoscopic fundal photography, pupillometry, thermal threshold, and albumin excretion rate (AER).

RESULTS—The incidence rates for thyroid and celiac disease were 0.9 and 0.7 per 100 patient-years, respectively. Within 13 years, 6 of 13 children with positive TPOA tests at diagnosis developed thyroid disease compared with 5 of 139 children with negative TPOA tests (P < 0.001). All four patients with positive EMA titers at diagnosis had biopsy-proven celiac disease. Five of 11 patients who developed thyroid disease and 4 of 8 who developed celiac disease had negative TPOA and EMA tests at diagnosis, respectively. Retinopathy was detected in 39% and elevated AER in 36%. The presence of diabetes-associated autoantibodies at diagnosis did not predict microvascular complications though GADA titer levels predicted pupillary abnormality.

CONCLUSIONS—Elevated TPOA and EMA levels at diagnosis of type 1 diabetes predict the development of thyroid and celiac disease, respectively. In children with negative antibody titers at diagnosis, screening at 2-year intervals is recommended.
Back to Basics in Diagnosing Diabetic Polyneuropathy With the Tuning Fork!
Authors: Meijer Jan-Willem G. , Smit Andries J. , Lefrandt Joop D. , van der Hoeven Johannes H. , Hoogenberg Klaas , Links Thera P.
Published: March 2007

OBJECTIVE—Several national and international scoring systems are used to diagnose diabetic polyneuropathy (PNP). The variety in these scores and the lack of data on validity and predictive value has led to a comparison and validation of the scores with clinical standards for PNP to determine the most powerful measurement for screening.

RESEARCH DESIGN AND METHODS—Three matched groups were selected: 24 diabetic patients with neuropathic foot ulcers, 24 diabetic patients without PNP or ulcers, and 21 control subjects without diabetes. In all participants the scores from the International Consensus on the Diabetic Foot (ICDF) and the Dutch Nederlandse Diabetes Federatie-Centraal Beleids Orgaan (NDF/CBO) were tested. The Diabetic Neuropathy Symptom score, the Diabetic Neuropathy Examination score, Heart Rate Variability, the Nerve Conduction Sum score, and a San Antonio Consensus sum score were obtained as clinical standards. Reproducibility was tested in a separate study (13 patients).

RESULTS—The construct validity and discriminative power of the ICDF and NDF/CBO scores were comparable, although monofilaments (NDF/CBO) scored lower. The predictive value was good for all scores, with the best results being obtained for the tuning fork (NDF/CBO). Reproducibility of the NDF/CBO scores (monofilaments and tuning fork) was high.

CONCLUSIONS—The characteristics of the scores of tests recommended by ICDF and NDF/CBO are comparable. The single use of the 128-Hz tuning fork produces results similar to the extended scores of the ICDF and much better than those of monofilaments on validation and for predictive value. For screening we therefore advise the use of the tuning fork alone.
The Metabolic Syndrome: Time for a Critical Appraisal
Authors: Kahn Richard , Buse John , Ferrannini Ele , Stern Michael
Published: March 2007

The term “metabolic syndrome” refers to a clustering of specific cardiovascular disease (CVD) risk factors whose underlying pathophysiology is thought to be related to insulin resistance. Since the term is widely used in research and clinical practice, we undertook an extensive review of the literature in relation to the syndrome’s definition, underlying pathogenesis, and association with CVD and to the goals and impact of treatment. While there is no question that certain CVD risk factors are prone to cluster, we found that the metabolic syndrome has been imprecisely defined, there is a lack of certainty regarding its pathogenesis, and there is considerable doubt regarding its value as a CVD risk marker. Our analysis indicates that too much critically important information is missing to warrant its designation as a “syndrome.” Until much needed research is completed, clinicians should evaluate and treat all CVD risk factors without regard to whether a patient meets the criteria for diagnosis of the “metabolic syndrome.”
The Diabetes Educator's Role in Teaching the Diabetic Patient
Authors: Dudley Jacqueline D
Published: March 2007

Diabetes educators have become a necessary cost-effective addition to the health care team whose efforts are directed toward the improvement of the total care provided to the diabetic patient. The role of the nurse educator in clinical practice and in hospital teams is a new approach to improving the quality of patient education. The nurse educator has specific responsibilities in the evaluation of each diabetic patient. An assessment of not only what that individual knows about his illness and where his educational needs lie but also of each person's readiness to learn. Whereas the physician's contact time with each diabetic patient is limited, the nurse educator has the time to spend with the patient and family. One must listen to what each individual has to say about his diabetes and other problems and to start the teaching-learning process. The nurse educator must be skilled in this teaching-learning process and have a good background and understanding of diabetes, including diabetes complications and problems. Very importantly, the educator must have the capability and the responsibility to evaluate the effectiveness of the teaching and learning that are done. This evaluation provides proof that better education of the diabetic patient does provide improvement in patient self-care through a better understanding of his illness. Proper care and management reduce the frequency of office visits, telephone calls, and hospitalization. Finally, the educator must interpret, for eah diabetic patient, the research being done, and, when possible, encourage diabetic patients to become involved themselves, for they are the ones who reap the benefits from diabetes research.
Virtually Continuous Euglycemia for 5 Yr in a Labile Juvenile-onset Diabetic Patient Under Noninvasive Closed-Loop Control
Authors: Bernstein Richard K
Published: March 2007

The author, diabetic for 33 yr, has used a novel technique for maintaining blood glucose (BG) in the 60–120 mg/dl range and HbA1c in the 3.95–6.4& range, thereby lowering serum triglycerides from 200+ to 29 mg/dl, cholestrol from 250+ to 130 mg/dl, and insulin dosage from 80 to 25 U/day. BG is patient-monitored six times a day with Dextrostix and Ames Eyetone reflectance colorimeter, modified for battery operation. BG levels over 115 mg/dl are corrected with Regular insulin, 0.5 U for every 15 mg/dl elevation above 100 mg/dl. BG levels below 85 are treated with one glucose tablet (Dextrosol) for every 15 mg/dl below 100 mg/dl. Usual preprandial split insulin doses are: 5 U Regular (R) + 5 U Ultralente (UL) about 50 min prebreakfast, 5R about 50 min prelunch, and 5R + 5UL about 50 min presupper. High protein diet limits carbohydrate to one bread exchange per meal, no simple sugars, no fruits. Caloric distribution is approximately 15& CHO, ≥ 45& PRO, ≤ 40& fat. This diet eliminates postprandial BG elevation without the large doses of R that might cause severe hypoglycemia when meals are slightly delayed. Snacks are contraindicated unless covered by additional R. Meals may be skipped or taken at any time provided R is withheld or times as appropriate. Psychological and physiologic improvements experienced by the author and other patients are described. The method is recommended to investigators as a means for testing long-term effects of euglycemia on sequellae of insulin-dependent DM in humans.
A Critical Evaluation of Methods of Monitoring Diabetic Control
Authors: Tattersall Robert , Walford Simon , Peacock Ian , Gale Edwin , Allison Simon
Published: March 2007

Patients with insulin-treated diabetes need to be actively involved in their own treatment. We have found that measurement of blood rather than urinary glucose by our diabetic patients leads to greater understanding and enthusiasm as well as to better control of blood glucose. Home blood glucose monitoring is complementary to rather than a substitute for measurement of hemoglobin A1. The latter provides an objective index of long-term control that is of more use to the doctor than to the patient. The former gives the patient information that enables him to master his own disease from day to day.
Feasibility of Blood Glucose Self-Monitoring in Unstable Insulin-dependent Diabetes
Authors: Barbosa Jose , Menth Lois , Schumacher Georgia , Johnson Sandra , Najarian John
Published: March 2007

We have studied the impact of home blood glucose measurements with the Ames Dextrostix/Eyetone system on the metabolic control of 17 insulin-dependent, ketosis-prone, unstable diabetic patients. Thirteen patients (69 patient-months) were enrolled in a comprehensive program designed to achieve excellent metabolic control and which included the daily use of the Eyetone meter. Eleven of these patients were diabetic kidney recipients on daily prednisone. The improvement of the metabolic control, as assessed by daily home blood glucose measurements, was highly significant (P < 0.001) in 11 patients (85%). The control was still inadequate, however, in at least seven patients. In four unstable diabetic patients who were given the meter for 4 mo but were not followed closely during this period, modest or no improvement in metabolic control was observed. The Eyetone meter proved highly precise and accurate in our patients' hands. Several patients achieved a coefficient of variation of less than 5 (in 10 consecutive determinations) and a correlation coefficient with the Beckman glucose analyzer of 0.96. We concluded that the metabolic control can be markedly improved in the most unstable diabetic patients with home blood glucose measurements, provided the patients receive adequate and frequent encouragement and diabetic teaching. Without the latter, at least in unstable diabetes, whether patients are compliant or not, the instrument may have little impact on control.
Self-Monitored Blood Glucose: The Essential Biofeedback Signal in the Diabetic Patient's Effort to Achieve Normoglycemia
Authors: Irsigler Karl , Bali-Taubald Christine
Published: March 2007

Seventeen pregnant diabetic women participated in a special outpatient program during which they learned to self-monitor blood glucose (BG) and to vary insulin dosage on the basis of the results. The Ames Eyetone reflectance meter and the Boehringer Reflomat were used for BG analysis. BG was self-monitored at least twice a day, with a 24-h profile once a week. The average mean BG from 220 wk of pregnancy was 101 mg/dl. No macrosomia has been seen in deliveries so far. Delivery has been later than is usual in our hospital. The number of necessary days of hospitalization was reduced by 45, as compared with a previous intensive outpatient program for pregnant diabetic women without self-monitoring. An important element of the program was a weekly group session in which individual experiences were shared and discussed in detail. Patients were enthusiastic about the program.
Discrepancies Between Glycosuria and Home Estimates of Blood Glucose in Insulin-treated Diabetes Mellitus
Authors: Ohlsen P , Danowski T S , Rosenblum D H , Mreiden T , Fisher E R , Sunder J H
Published: March 2007

Glycosuria can be a misleading indicator of blood or plasma glucose levels. Thus glycosuria may be present when blood glucose levels are within the normal fasting or postprandial range, and it may be absent when the blood glucose is distinctly above normal. In such patients the blood glucose must be measured, preferably by the patient, as a guide to insulin and other therapy. However, urine glucose tests are valid indicators in a minority of patients and are essential in all patients for the detection of acetone.
Effect of Blood Glucose Control on Retinal Vascular Permeability in Insulin-dependent Diabetes Mellitus
Authors: Bleicher S J , Lee T Y , Bernstein R , Schachter L , Temes R , Krupin T , Santiago J , Becker B , Waltman S R
Published: March 2007

Thirteen patients were instructed in a technique of self-management of insulin-dependent diabetes mellitus, using multiple home-monitored blood glucose determinations and multiple injections of regular insulin in conjunction with once-daily Ultra Lente insulin. Hemoglobin A1c and quantitative fluorescein fluorophotometry were used to assess blood glucose control and retinal permeability, respectively. In those patients achieving normal blood glucose control, retinal vascular leakage was statistically identical to that of a nondiabetic control population. In those patients less well controlled, retinal permeability did not differ statistically from values observed in a population of insulin-dependent diabetic patients under “standard” control. It is concluded that with “tight” control of blood sugar and normalized A1c hemoglobin, retinal permeability similarly is normalized.
Mineral and Vitamin Status on High-Fiber Diets: Long-Term Studies of Diabetic Patients
Authors: Anderson James W , Ferguson Susan K , Karounos Dennis , O'Malley Linda , Sieling Beverly , Chen Wen-Ju J
Published: March 2007

High-fiber diets have a beneficial impact on glucose metabolism of selected persons with diabetes mellitus. A major concern is the long-term effects of fiber intake on mineral and vitamin status. We measured serum concentrations of selected minerals and vitamins and also assessed three fat-soluble vitamins in 15 patients fed high-fiber diets for an average of 21 mo. Average values for serum calcium, phosphorus, alkaline phosphatase, iron-binding capacity, magnesium, and hemoglobin values were normal. Vitamin B12 and folic acid concentrations in serum were also normal. Indirect assessment suggested that these patients had adequate intakes of the fat-soluble vitamins A, D, and K. These preliminary observations suggest that high-fiber diets containing a wide variety of natural foods are well tolerated for up to 51 mo; we failed to detect evidence suggesting mineral or vitamin deficiency in these patients.
Parameters of Good Control in Diabetes Mellitus
Authors: Danowski T S , Ohlsen P , Fisher E R , Sunder J H
Published: March 2007

Optimal control of diabetes should achieve not only euglycemia and normal levels of glycosylated hemoglobin but also absence of the reversible concomitants of diabetes such as red cell rigidity, hyperlipidemia, increased capillary permeability, enlargement of the kidneys, proteinuria, etc. Unfortunately, in most patients consistent euglycemia cannot be assured even with two daily injections of insulin. However, self-measurement of blood glucose as a guide to insulin taken before each meal and at bedtime can, in selected patients, increase the frequency of normal glucose levels without undue hypoglycemia.
Normalization of Plasma Insulin Profiles in Diabetic Subjects with Programmed Insulin Delivery
Authors: Schade David S , Eaton R Philip , Spencer William
Published: March 2007

Normalization of plasma glucose concentration with subcutaneous injections of insulin has been difficult. With intravenous insulin delivery, normalization of plasma glucose concentration in adult-onset diabetic patients has been achieved when their plasma insulin concentration was normalized. In juvenile-onset diabetic subjects totally lacking endogenous insulin, the effect of normalization of the plasma insulin concentration has not yet been reported.

In the present studies, the plasma insulin profile was normalized in four brittle, insulin-dependent diabetic subjects throughout three meals (breakfast, lunch, and supper). Plasma free insulin concentration was assayed after precipitation of endogenous insulin antibodies with polyethylene glycol. Acute meal-related increases in plasma free insulin concentration were achieved with a programmable intravenous insulin delivery system.

When plasma insulin profiles were normalized in insulin-dependent diabetic subjects lacking endogenous insulin secretion, an improvement in meal-related glucose excursions was observed. However, complete normalization of plasma glucose concentration was not achieved, suggesting that factors other than plasma insulin concentration modulate carbohydrate homeostasis in brittle diabetes. These factors may include portal vein hypoinsulinemia during peripheral vein insulin infusion, stress hormone concentrations, and tissue insulin resistance.
Diabetic Complications and Their Prevention or Reversal
Authors: Danowski T S , Ohlsen P , Fisher E R
Published: March 2007

Patients with Type I, i.e., insulin-deficient diabetes, Type II or non-insulin-deficient diabetes, and impaired glucose tolerance or so-called chemical diabetes are variably predisposed to develop macroangiopathy, i.e., atherosclerosis, microangiopathy or basement membrane thickening, and neuropathy. Once these morphologic changes appear, they in all probability will remain irreversible even when precise regulation is attained. Hence prevention is the only realistic goal.
Relationships of Lipoprotein Lipids to Mild Fasting Hyperglycemia and Diabetes in Pregnancy
Authors: Knopp Robert H , Chapman Margaret , Bergelin Robert , Wahl Patricia W , Warth Maria R , Irvine Susan
Published: March 2007

The available data have been examined to determine if plasma lipids or lipoproteins are altered in pregnant subjects with adult-onset (type II) diabetes, gestational diabetes, or the hyperglycemic extreme of a randomly selected group of pregnant women attending a prepaid health plan. In each of these groups, a trend is observed toward an increase in total plasma and very low density lipoprotein triglycerides and a decrease in high density lipoprotein (HDL) cholesterol. These observations indicate that measurements of plasma triglyceride and HDL cholesterol may be valuable in identifying and quantifying the metabolic abnormality in gestational diabetes and in prognosticating fetal outcome.
Establishing Criteria for Gestational Diabetes
Authors: O'Sullivan John B
Published: March 2007

The general requirements for establishing diagnostic criteria with tests of glucose tolerance are discussed in relation to standards for gestational diabetes that are in current use. Data are presented to show that even when remissions of gestational diabetes occur with the progression of pregnancy, the risk of subsequent diabetes remains unaltered. The prognostic potential that fasting blood glucose levels has for the outcome of pregnancy is also considered. Finally the dependence of prevalence rates for gestational diabetes on the criteria selected and their substantial effect on assessment of screening methods is demonstrated.
Nutritional Requirements in Normal Pregnancy
Authors: Pitkin Roy M
Published: March 2007

Additional intakes of virtually all nutrients are needed for the support of pregnancy. Energy requirements average 300 kcal/day above nonpregnant needs, which should provide for a weight gain of 400 g/wk during the last two trimesters. Total protein intake of 1.3 g/kg/day is recommended for the adult gravida. Gestational needs for iron and perhaps for folacin cannot be met by the usual diet and supplementation is advised. Other nutrients, although needed in increased amounts, can be provided by a well-balanced diet.
Clinical Course of Myocardial Infarction Among Diabetic Patients
Authors: Czyżk Artur , Królewski Andrzej S , Szabłowska Sylvia , Alot Aleksandra , Kopczyński Jan
Published: March 2007

The clinical course of myocardial infarction (MI) was compared between 154 known diabetic (Ds) and nondiabetic (NDs) MI patients matched for age, sex, and hospital ward. In both groups similar numbers of cases with cardiac rupture, shock, pulmonary edema, and clinically observed arrhythmias were found. In contrast, Ds patients had significantly more frequent A-V and intraventricular conduction disorders than NDs (P < 0.02). Ds also died twice more often from MI (36%) than matched controls (18%). The excess case fatality rates from MI among Ds were limited to the period between the second and seventh day of hospitalization. The excessive fatality of Ds from MI resulted mainly from the high liability of insulin-dependent diabetic patients (IDDs), with the relative risk of over 4 in relation to NDs. Ds with arrhythmias and/or conduction disorders had a particularly poor prognosis for surviving, the relative risk exceeding 3. No ready explanation of this phenomenon is presently available.
Baby Food Exchanges and Feeding the Diabetic Infant
Authors: Benz Marian M , Kohler Elaine
Published: March 2007

Because of the dangers of hypoglycemia to the developing brain, the need to develop a lifelong positive attitude toward an eating pattern, the inherent communication difficulties, and the spontaneity of the very young, the diabetic infant presents a particular challenge to medical personnel. Baby and toddler foods in jar measurements and formula have been translated into the American Diabetes Association exchanges to help in teaching families with diabetic infants the effects of various foods on the infant's diabetes. The exchanges are taught as tools in maintaining metabolic balance rather than as a fixed diet. Caloric level is planned on the basis of diet history and the infant's current growth status. Flexibility of pattern and attitude is emphasized to minimize conflict over eating and to allow normal spontaneous activity without jeopardizing health.