bluuebunny/crossref_metadata_2025 huggingface dataset:
Unemployment and Diabetes
Authors: Robinson N. , Yateman N. A. , Protopapa L. E. , Bush L.
Published: July 2009

Unemployment was examined in a random sample of diabetic clinic attenders and a group of non‐diabetic control subjects aged 17–65 years, selected from eight different centres in Great Britain. Data on employment were obtained using a postal questionnaire and medical details were collected from diabetic clinic notes. Out of a 61 % response rate, 22 % of males and 12 % of females with diabetes were unemployed compared with 8 and 5 % of the control group (both p < 0.001). A greater percentage of people with diabetes were economically inactive, that is retired, unable to work, ill or housewives compared with the control group (29 vs 14 %, p < 0.001). Young people with diabetes (16–25 years) had the highest rates of unemployment. A matched pairs analysis confirmed that diabetic men had higher unemployment rates than their controls (14 vs 7 %, p < 0.001). Comparisons were made between unemployment rates for the eight geographical areas and published unemployment statistics; unemployment rates were significantly higher for men with diabetes except at one centre. A stepwise multiple logistic regression analysis indicated that variables which were predictive of unemployment were similar to those expected for people without diabetes. Unemployment is apparently a problem for the person with diabetes, especially for the young.
Corn Cures Can Damage Your Feet: An Important Lesson for Diabetic Patients
Authors: Foster A. , Edmonds M.E. , Das A.K. , Watkins P.J.
Published: July 2009

Seven diabetic patients rapidly developed severe foot ulceration and sepsis after application of corn cures. Four patients needed forefoot surgery. Corn cures should not be used by diabetic patients.
Hyperventilation or Hypoglycaemia?
Authors: Steel J.M. , Patrick A.W. , McGuire R. , Masterton G.
Published: July 2009

Two women with insulin‐treated diabetes who presented with hyperventilation in the setting of generalized anxiety disorder and panic disorder, respectively, are reported. The symptoms of hyperventilation and hypoglycaemia proved indistinguishable even after successful treatment with a behavioural approach including explanation, breathing retraining, and relaxation. With diabetic patients a cognitive strategy is complicated by conditioning to think in terms of diabetic control and an inability to safely reattribute symptoms to faulty breathing habit because of the risk of ignoring hypoglycaemia.
Within‐clinic Reagent Strip Lipid Measurement
Authors: Neil H.A.W. , Alberti K.G.M.M. , Cassidy D.M. , Laker M.F.
Published: July 2009

The agreement between the Reflotron dry chemistry analyser and laboratory methods for measurement of total cholesterol and triglycerides was assessed by studying the between‐method variability for individual samples. A paired comparison of replicate measurements from venous blood was made for 105 cholesterol and 90 triglyceride specimens. There was no significant mean difference between the two methods for cholesterol measurement (difference 0.02 mmol I−1, 95% CI −0.07 to 0.10 mmol I−1) but there were wide limits of agreement (±2SD) of −0.87 to 0.90 mmol I−1. Some of the differences in measurement were large enough to be clinically misleading and would result in inconsistencies in diagnostic assignment between the two methods. Both methods achieved relatively poor repeatability which limited the agreement possible (coefficient of repeatability, defined as 2SD of the differences, 0.59 mmol I−1 for the Reflotron and 0.38 mmol I−1 for the laboratory). The repeatability of triglyceride measurement was similar for the Reflotron and laboratory (coefficient of repeatability 0.24 mmol I−1 and 0.27 mmol I−1, respectively). However, there was a significant systematic difference between methods, with the Reflotron reading 0.30 mmol I−1 less than the laboratory method (95 % CI 0.26 to 0.35 mmol I−1) and the limits of agreement between the methods were −0.09 to 0.70 mmol I−1. It is important that clinicians recognize the limits of agreement between dry chemistry analysers and laboratory methods and take these into account when using them to screen for hyperlipidaemia or to monitor treatment of hyperlipidaemic diabetic patients.
Somatostatin Analogues in Diabetes Mellitus
Authors: Davies Dr.R. R. , Turner S. J. , Alberti K. G. M. M. , Johnston D. G.
Published: July 2009

Growth hormone (GH) has long been considered to have importance in diabetes. With poor control in Type 1 diabetes GH levels are high and may aggravate poor metabolic control. Pharmacological suppression of GH release at this stage might reverse the metabolic changes, with the possible added benefit of lower plasma insulin concentrations. Diabetic patients with life‐long GH deficiency rarely develop retinopathy, while pituitary ablation in patients with retinopathy often leads to improvement. Growth hormone release inhibiting factor, somatostatin, has a short plasma half‐life, and multiple effects on the endocrine system and on the gastrointestinal tract, making it unsuitable for clinical use as a GH suppressant. Long‐acting analogues have a long half‐life, but remain non‐specific in their effects. In Type 2 diabetes the analogue Octreotide suppresses insulin and glucagon release, leaving glucose levels either unchanged or somewhat elevated. Gastrointestinal side‐effects have been common, but may diminish with long‐term treatment. In Type 1 diabetes insulin requirement is decreased by Octreotide, but as in Type 2 diabetes GH suppression has been observed consistently only when the drug was given at bed‐time. The decrease in insulin requirement may reflect suppression of glucagon release and/or gut effects. Amelioration of the ‘dawn phenomenon’ has not proved possible, and hypoglycaemia has proved a particular problem with Octreotide given subcutaneously at night. The lack of effective GH suppression (particularly in patients with proliferative retinopathy), lack of specificity, and the gut and hypoglycaemic side‐effects, argue strongly against a clinical role for the current somatostatin analogues in diabetes mellitus.
A Cross‐sectional Analysis of Glucose Tolerance and Cardiovascular Disease in 67–year‐old Men
Authors: Ohlson L‐O. , Bjurö T. , Larsson B. , Eriksson H. , Svärdsudd K. , Welin L. , Wilhelmsen L.
Published: July 2009

The relationship between degree of glucose tolerance and cardiovascular disease has been studied in a cross‐sectional population survey of 644 men born in 1913, randomly sampled and examined at the age of 67. The cohort was divided into different groups according to current diagnostic criteria for diabetes and impaired glucose tolerance. An almost 2‐fold higher prevalence of hypertension, myocardial infarction, angina pectoris, and congestive heart failure was found in the group with impaired glucose tolerance compared to the group with a normal glucose tolerance. Fifty per cent of the men with impaired glucose tolerance were being treated with some drug for cardiovascular disease, usually diuretics for hypertension. Intermittent claudication showed a 2.5‐fold higher prevalence among the diabetic patients. A computerized 12‐lead exercise‐ECG test, with a unique accuracy in measuring ST‐segment changes, was performed in a subset of 135 men. This showed no association between ST‐segment depression and different degrees of glucose tolerance, even when accounting for confounding factors such as treatment withβ‐blocker agents or digoxin, pathological Q‐waves, and differences in maximal heart rate.
Activity of Enzymes of Glucose and Triglyceride Metabolism in Adipose and Muscle Tissue from Normal Pregnant Women at Term
Authors: Andersen O. , Falholt K. , Kühl C.
Published: July 2009

In order to further investigate insulin insensitivity in pregnancy, the activities of key enzymes in glycolysis and lipid metabolism were measured in adipose and muscle tissue biopsies from 20 normal pregnant women undergoing caesarean section at term, and 23 non‐pregnant women of similar age and body weight undergoing gynaecological surgery. The activity of pyruvate kinase was decreased in pregnant women in both adipose tissue (0.015 (0.009–0.024) (median and range) vs 0.020 (0.009–0.038) U g‐1 wet weight, p < 0.05) and muscle tissue (6.7 (3.6–10.9) vs 12.0 (2.8–16.2) U g‐1 wet weight, p < 0.001). The activity of hexokinase was decreased in adipose tissue only (0.045 (0.022–0.085) vs 0.057 (0.025–0.097) U g‐1 wet weight, p < 0.05), while the activity of phosphofructokinase was decreased in muscle tissue only (1.3 (0.7–2.6) vs 2.1 (0.3–4.5) U g‐1 wet weight, p < 0.01). Glucose‐6–phosphate dehydrogenase activity was increased in muscle tissue (0.30 (0.11–0.59) vs 0.17 (0.09–0.48) U g‐1 wet weight, p < 0.05), while the activity of hydroxyacyl‐CoA dehydrogenase was decreased in adipose tissue (0.5 (0.3–1.1) vs 1.0 (0.5–2.3) U g‐1 wet weight, p < 0.001) from the pregnant women. Similar results were found when enzyme activities were calculated per gram of protein, but with poorer reproducibility. The concentration of non‐esterified fatty acids was higher in both muscle (0.23 (0.11–0.35) vs 0.14 (0.07–0.31) μmol g‐1 wet weight) and adipose tissue (0.27 (0.17–0.43) vs 0.22 (0.15–0.59) μmol g‐1 wet weight) from pregnant women than in control subjects (p < 0.02), while the concentration of triglycerides was similar. The findings suggest that glycolysis is depressed at term in pregnancy in both adipose and muscle tissue and that the oxidation of fatty acids is decreased in adipose tissue from normal pregnant women.
Type 1 Diabetes and Driving Experience: an Eight‐year Cohort Study
Authors: Eadington D. W. , Frier B. M.
Published: July 2009

The driving habits of 250 drivers with Type 1 diabetes were reviewed 8 years after a previous assessment. At least 45 patients had died and 18 patients could not be traced. A postal questionnaire of the 187 survivors elicited a response from 89%. Fifty‐six patients (34%) still held an unrestricted driving licence, demonstrating that a significant proportion of diabetic drivers had not declared diabetes to the licensing authority and/or their motor insurer and continued to ignore the statutory regulations. Fewer patients held Heavy Goods Vehicle licences than 8 years previously. Twenty‐four patients had ceased driving as their driving skills had diminished with advancing age and ill health. This was a voluntary decision by all but two patients whose driving licences had been revoked. Thirty‐nine patients admitted to a total of 55 road traffic accidents since 1979; 9 accidents (16%) were attributed to hypoglycaemia. Although dependent on patients' honesty and the accuracy of recall, the disclosed accident rates of 4.9 per million miles driven for male drivers and 6.3 per million miles for female drivers are comparable to the accident rate of a non‐diabetic driving population of similar age.
A Study of Cell‐mediated Immunity in Type 1 Diabetes Using an Antigen Presentation Assay
Authors: D'Amore F. , Wolthers O. D.
Published: July 2009

The ability of macrophages to present a given antigen to homologous, immune T lymphocytes was studied in 21 patients with Type 1 diabetes and in 21 healthy control subjects. The patient group was heterogeneous with a broad range of age and duration of diabetes. An antigen presentation assay consisting of a co‐culture of antigen‐pulsed macrophages with autologous, immune T lymphocytes was used with purified protein derivative of tuberculin as antigen. Diabetic patients had responses similar to or higher than control subjects. Nevertheless diabetic patients had a tendency to higher T‐lymphocyte proliferation values with increasing age and duration of diabetes. Correlation analysis showed a marginally significant correlation (p= 0.05) between proliferation and age and a highly significant correlation (p< 0.01) between T‐lymphocyte proliferation and duration of diabetes.
Pneumomediastinum in Diabetic Ketoacidosis
Authors: Watson J. P. , Barnett A. H.
Published: July 2009

A 13‐year‐old girl was admitted with diabetic ketoacidosis. She was found to have a pneumomediastinum. This resolved spontaneously on correction of the metabolic disturbance. The condition is generally benign.
Employment Problems and Diabetes
Authors: Robinson N. , Yateman N.A. , Protopapa L.E. , Bush L.
Published: July 2009

A survey of employment problems in a random sample of diabetic patients and a group of control subjects aged 17–65 years was carried out in eight centres in the UK. Data were linked to information collected from patients' diabetic clinic notes relating to the presence and treatment of any diabetic complications and quality of diabetic control. Difficulties in obtaining employment because of diabetes were reported by 13 % of diabetic patients, and because of illness by 2% of control subjects (p < 0.001). Nine percent of diabetic patients and 2% of control subjects reported having to change their job because of their illness (p < 0.001), and 7 % of people with diabetes and 2% of people without diabetes reported losing a job because of their illness (p < 0.001). Diabetic shift workers were twice as likely as control subjects working shifts to experience problems with their job (18 vs 8%, p = 0.045). Reports of any sickness absence in the last 12 months were not significantly different for people with and without diabetes (49 vs 45%). Sickness absence in excess of 20 days in the last 12 months was more common among diabetic patients than control subjects (29 vs 16%, p < 0.001). People with diabetes are more likely to experience problems in obtaining employment and staying employed than people without diabetes.
Insulin Insensitivity in Offspring of Parents with Type 2 Diabetes Mellitus
Authors: Ho L.T. , Chang Z.Y. , Wang J.T. , Li S.H. , Liu Y.F. , Chen Y.‐D.I. , Reaven G.M.
Published: July 2009

Measurements were made of the plasma glucose and insulin responses to a 75 g oral glucose challenge in 50 Chinese born in Taiwan, divided into two groups on the basis of family history of Type 2 diabetes. Twenty‐five individuals (age 29 ± 5 (±SD) years) had 2 parents with normal oral glucose tolerance, whereas at least 1 parent had Type2 diabetes in the other 25 subjects (age 30 ± 6 years). In addition, in vivo insulin action was estimated by determining the steady‐state plasma glucose concentration during a 3‐h continuous infusion of glucose, insulin, and somatostatin. Steady‐state plasma glucose concentration was used as a measure of insulin‐induced glucose disposal. The 50 subjects were non‐obese, and of comparable gender distribution and body mass index. Plasma glucose and insulin concentrations in response to oral glucose were similar in the two groups. However, the steady‐state plasma glucose concentration was significantly (p < 0.01) higher in offspring with a family history of Type 2 diabetes when compared by two‐way analysis of variance (mean ± SE was 5.87 ± 0.27 vs 5.12 ± 0.32 mmol I−1). This difference was found despite a significantly (p < 0.01) higher steady‐state plasma insulin concentration during the infusion studies (0.705 ± 0.027 vs 0.643 ± 0.025 nmol I−1) in offspring of people with diabetes. The results support the view that resistance to insulin‐stimulated glucose uptake is present in offspring of diabetic parents.
Increased Urinary Excretion of Transferrin in Children with Type 1 Diabetes Mellitus
Authors: Martin P. , Walton C. , Chapman C. , Bodansky H.J. , Stickland M.H.
Published: July 2009

Urinary transferrin excretion was measured by radioimmunoassay in 74 children with Type 1 diabetes mellitus and in 40 normal children, and compared with urinary excretion of albumin, α‐1‐microglobulin, and N‐acetyl‐β‐D‐glucosaminidase. Urinary transferrin excretion was significantly elevated in diabetic (median (range) 186 (18–1671) mg mol‐creatinine−1) compared with normal (85 (27–668) mg mol‐creatinine−1) children (p < 0.001). Seventeen diabetic children had transferrin excretion above the 95th centile for normal children. In contrast there was no significant increase in urinary albumin excretion in the diabetic children although 8 had urinary albumin excretion which exceeded the 95th centile for normal children (6 of these 8 patients having coexistent urinary hyperexcretion of transferrin). Urinary transferrin excretion correlated significantly with urinary albumin excretion in both normal (rs = 0.62, p < 0.001) and diabetic (rs = 0.61, p < 0.001) children. The indices of proximal renal tubular function (urinary excretion of α‐1‐microglobulin and N‐acetyl‐β‐D‐glucosaminidase) correlated significantly with transferrin excretion in both diabetic (rs = 0.43 and rs = 0.41, p < 0.001) and normal (rs = 0.40, p < 0.02 and rs = 0.53, p < 0.001) children, but not with albumin excretion (rs = 0.20, p > 0.05 and rs = 0.22, p > 0.05). In addition urinary transferrin excretion significantly correlated with urinary glucose concentration (rs = 0.34, p < 0.007) in Type 1 diabetic children. The discrepancy in urinary excretion of transferrin and albumin may reflect impaired proximal renal tubular reabsorption of transferrin and/or altered glomerular basement membrane selectivity for the two proteins.
Metabolic Abnormalities in Obese Patients with Impaired Glucose Tolerance
Authors: Robertson D.A. , Singh B.M. , Baddeley R.M. , Nattrass M.
Published: July 2009

It is not clear whether the glucose tolerance test diagnosis of Impaired Glucose Tolerance introduced in the recent revisions of diagnostic criteria is associated with abnormalities of intermediary metabolism other than glucose. Intermediary metabolite concentrations have therefore been studied fasting and in response to oral glucose in 35 patients referred with morbid obesity accompanied by either normal glucose tolerance (18 patients) or Impaired Glucose Tolerance (17 patients). When fasting obese patients with Impaired Glucose Tolerance had significantly higher blood total ketone body concentrations, 0.24 (0.19‐0.30) vs 0.14 (0.12‐0.16) mmol I−1 (antilog of mean‐SE to mean+SE) (p < 0.05), and lower blood glycerol concentrations, 0.14 ± 0.01 vs 0.18 ± 0.01 mmol I−1 (mean ± SE) (p < 0.05), than obese patients with normal glucose tolerance. There were no significant differences in fasting insulin, 16 (15–18) vs 14 (12–15) mU I−1, or glucose levels, 5.3 ± 0.2 vs 5.1 ± 0.2 mmol I−1. After oral glucose there was an exaggerated rise in glucose, insulin, lactate, and pyruvate in patients with Impaired Glucose Tolerance.
Relationship Between Urinary Excretion of Sodium and Dopamine in Type 1 Diabetic Patients with and without Microalbuminuria
Authors: Patrick A.W. , Collier A. , Clarke B.F. , Jeffrey R.F. , Lee M.R.
Published: July 2009

The relationship between urinary sodium and dopamine excretion was investigated in 40 normal males and in 48 normotensive, Type 1 diabetic males, 11 with microalbuminuria and 37 with normal albumin excretion. In all three groups a significant correlation was demonstrated and the regression lines were similar. Thus, no evidence was found that a defect in dopamine mobilization contributes to the early renal pathophysiological changes of Type 1 diabetes.
Effect of Phase of Menstrual Cycle on Insulin Sensitivity, Peripheral Blood Flow and Cardiovascular Responses to Hyperinsulinaemia in Young Women with Type 1 Diabetes
Authors: Macdonald I.A. , Scott A.R. , Bowman C.A. , Jeffcoate W.J.
Published: July 2009

Disturbances of blood glucose control around the time of menstruation are often reported by women with Type 1 diabetes. To investigate the possibility that such changes may be due to alterations in insulin sensitivity or peripheral blood flow we have studied 9 women with Type 1 diabetes during the follicular and luteal phases of the menstrual cycle. Insulin sensitivity was assessed by the glucose clamp technique with insulin doses of 40 (low dose) and 100 (high dose) mU m−2 min−1. Glucose disposal rates were 2.5 ± 0.3 (mean ± SE) mg kg−1 min−1 during the follicular phase and 3.2 ± 0.3 mg kg−1 min−1 in the luteal phase with low dose insulin, and 5.9 ± 0.4 and 6.4 ± 0.6 mg kg−1 min−1, respectively, with high dose insulin. These differences were not statistically significant. Forearm blood flow, heart rate, and blood pressure were similar during both phases.
The Learning Needs in Diabetes of General Practitioners
Authors: Marsden P. , Grant J.
Published: July 2009

The aim of the study was to determine the learning needs of General Practitioners (GPs) in diabetes. A postal questionnaire was sent to all GPs in South East Thames Region (England). The level of interest in continuing professional education in diabetes is sufficient to merit production of tailored learning materials and opportunities. Eighty‐three percent of GPs would definitely or probably avail themselves of the opportunity even if they did have to pay. This percentage represents a figure of over 780 GPs. They are most keen to learn the clinical and other skills associated with diabetes and its management. A large number, 71%, requested education on retinal examination and adjustment of insulin, 56% on adjustment of tablet therapy, and 51% on the management of children with diabetes. Individual study materials, backed up by small group meetings and video material would be the most appreciated format. A course of study divided into half‐hourly periods adding up to a total of about 5 h might be the most widely acceptable format. GPs would most like to study with other GPs from local practices and with hospital staff. Group work might best be designed to incorporate both an experienced GP, if one were available, and a consultant. The materials themselves might also best be designed and written by such a partnership.
A Three‐year Evaluation of the Quality of Diabetes Care in the Norwich Community Care Scheme
Authors: Williams D.R.R. , Hospedales C.J. , Munroe C. , Greenwood R.H.
Published: July 2009

The care of patients with diabetes was assessed in eight general practices intending to establish mini‐clinics. Seven of these practices subsequently participated in a mini‐clinic scheme incorporating continuing education and audit. After 3 years further data were collected and compared with the baseline assessment. Seven other local practices which had not set up mini‐clinics were also studied. During the time between the baseline survey and the 3—year assessment the proportion of non‐insulin‐treated patients registered with the mini‐clinic practices and receiving regular review in general practice increased from 54 to 84%. The proportions of patients with a record of body weight, blood pressure, urinary glucose, urinary protein, blood glucose, HbA1, visual acuity, examination of the fundus through dilated pupils, examination of the feet, and a consultation with a dietitian within the previous year increased significantly and were higher in mini‐clinic than in comparison practices although, for a substantial number of patients in both groups of practices, these remained unrecorded. This study shows that organized and audited general practice mini‐clinics can improve the process of care for diabetic patients.
The Tuning Fork Revisited
Authors: Liniger C. , Albeanu A. , Bloise D. , Assal J. Ph.
Published: July 2009

The performance of the Rydel‐Seiffer graduated tuning fork was examined in healthy subjects and in various groups of diabetic patients in order to evaluate its efficacy for identifying patients whose loss of vibration sensation may expose them to the risk of foot injury. Vibration perception score measured with the tuning fork declined with age (p < 0.001) in the control subjects. It correlated well (r = −0.90, p < 0.001) with the thresholds obtained with an electromagnetic instrument (Vibrameter) in diabetic patients, in whom vibration perception score was impaired compared with control subjects (4.0 ± 1.8 (± SD) vs 5.4 ± 1.4, p < 0.001). Age‐related Rydel‐Seiffer tuning fork vibration sensation was impaired in 79% of 38 ulcerated feet of 26 patients. The tuning fork score was 4.0 in 95% of the ulcerated feet. We conclude that the Rydel‐Seiffer graduated tuning fork is a suitable tool for screening for sensation loss and that diabetic patients with a tuning‐fork score of 4.0 are vulnerable to ulceration.
A Study of the Effect of Diet on Glycosylated Haemoglobin and Albumin Levels and Glucose Tolerance in Normal Subjects
Authors: Ryle A. J. , Davie S. , Gould B. J. , Yudkin J. S.
Published: July 2009

As factors other than the degree of glucose tolerance or ambient blood glucose may determine glycosylated haemoglobin levels, we have investigated the effects of dietary glucose and soluble fibre supplementation on glucose tolerance, glycosylated haemoglobin and glycosylated albumin in non‐diabetic subjects. Eleven non‐diabetic subjects (7 M, 4 F; age 26.5 ± 6.5 (± SD) yr; BMI 21.6 ± 3.1 kg m−2) followed a high‐soluble‐fibre (5 g guar gum thrice daily)/low‐glucose diet, or a low‐soluble‐fibre/high‐glucose (500 ml glucose drink providing 100 g glucose per day) diet, each for 6 weeks, in randomized order. A 75 g oral glucose tolerance test was performed at recruitment and after each diet period, and fasting blood was assayed for glycosylated albumin by affinity chromatography, and glycosylated haemoglobin by four different methods. Adherence to guar and glucose supplementation was assessed at 89.5 ± 7.5% and 97.1 ± 3.5%, respectively. There was no significant effect of either diet on mean fasting, 1‐h or 2‐h plasma glucose concentration, or glycosylated haemoglobin levels by any assay. Glycosylated albumin was 1.71 ± 0.35% at entry, fell to 1.33 ± 0.30% (p < 0.01) with high‐fibre and rose to 1.95 ± 0.23% (p < 0.02) after a high‐glucose diet. Insulin, total‐ and HDL‐cholesterol and triglyceride levels were unaffected by either diet. A high‐glucose diet increases, and a high‐soluble‐fibre diet decreases, levels of glycosylated albumin without effects on glucose tolerance or glycosylated haemoglobin.
Familial Aggregation in Type 1 (Insulin‐dependent) Diabetes Mellitus: a Study from South India
Authors: Ramachandran A. , Snehalatha C. , Premila L. , Mohan V. , Viswanathan M.
Published: July 2009

An analysis of 617 Type 1 (insulin‐dependent) diabetic patients from 587 families was made. In 33 families (5.6%) there was more than one Type 1 diabetic patient. In 98 families (16.7%) positive family history of Type 2 (non‐insulin‐dependent) diabetes was present. There was a linear correlation between the age at diagnosis of the proband and that of the sibling (r = 0.73, p < 0.001) in the Type 1 multiplex families. The risk of Type 1 diabetes in relatives was found to be 2.7% by Li Mantel estimate, which is lower than that reported among Europeans. The cumulative risk was higher (p < 0.001) in the relatives of Type 1 diabetic patients with age at diagnosis 10 years.
Blood Hyperviscosity and Its Relationship to Progressive Renal Failure in Patients with Diabetic Nephropathy
Authors: Gordge M. P. , Patel A. , Faint R. W. , Rylance P. B. , Neild G. H.
Published: July 2009

Blood rheology was investigated in patients with diabetic nephropathy and progressive renal insufficiency, and compared with similar non‐diabetic patients and healthy control subjects. Plasma viscosity and whole blood viscosity at standardized haematocrit were elevated to a comparable degree in the two patient groups, but erythrocyte deformability was normal. In diabetic patients, the rate of progression of renal failure showed weak, but significant, correlations with plasma viscosity (rs = 0.50, p = 0.005), standardized whole blood viscosity (rs = 0.41, p = 0.021), plasma fibrinogen (rs = 0.46, p = 0.010), C reactive protein (rs = 0.40, p = 0.023), and proteinuria (rs = 0.52, p = 0.003). Both plasma viscosity and plasma fibrinogen correlated significantly with proteinuria (rs = 0.45, p = 0.012 and 0.40, p = 0.027, respectively). Rheological abnormality is probably a manifestation of increased acute phase proteins, but it remains to be determined whether these are the cause or the effect of the renal injury. Abnormal blood rheology may be a risk factor for the progression of renal failure in diabetic nephropathy.
A Nation‐wide Cross‐sectional Study of Urinary Albumin Excretion Rate, Arterial Blood Pressure and Blood Glucose Control in Danish Children with Type 1 Diabetes Mellitus
Authors: Mortensen H. B. , Marinelli K. , Nørgaard K. , Main K. , Kastrup K. W. , Ibsen K. K. , Villumsen J. , Parving H.‐H. ,   The Danish Study Group of Diabetes in Childhood
Published: July 2009

Nation‐wide screening for microalbuminuria in Denmark was performed in 22 paediatric departments treating children with Type 1 diabetes. Over a period of 6 months 1020 children ( 12 years) and adolescents (> 12 to 19 years) were screened (81% of total). Of these, 957 (94%) performed at least two timed overnight urine collections. In 209 non‐diabetic subjects the upper 95% limit for normal albumin excretion rate (AER) was 20 μg min−1. Mean overnight AER was significantly (p< 0.001) elevated in diabetic (3.0 x/divide; 2.3 (SD tolerance factor) μg min−1) and in non‐diabetic (2.5 x/ divide; 2.2 μg min−1) adolescents compared with diabetic (1.7 x/ divide; 2.1 μg min−1) and non‐diabetic (1.3 x/ divide; 2.2 μg min−1) children. In the diabetic patients AER was positively correlated with the body surface area and age. Among the patients with Type 1 diabetes, 4.3% (18 males and 23 females) had AER > 20 to 150 μg min−1(persistent microalbuminuria). A further 7 adolescents (0.7%) had overt proteinuria (> 150 μg min−1). Clinical data for the 41 diabetic patients with AER > 20 to 150 μg min−1were compared with those for 569 diabetic adolescents with AER 20 μg min−1and duration of diabetes more than 2 years. The group with AER > 20 to 150 μg min−1had significantly higher mean age (16.5 years) than the group with AER 20 μg min−1(15.0 years;p< 0.001). Females with AER > 20 to 150 μg min−1had significantly higher mean HbA1clevel (10.8 ± 1.9%) than those with AER 20 μg min−1(9.8 ± 1.9%,p< 0.03); they also had impaired linear growth (standard deviation score −0.25 vs + 0.16;p= 0.003). These associations were not found in males. Mean body mass index (BMI) was significantly increased in both females (22.2 ± 2.9 kg m−2) and males (20.8 ± 2.7 kg m−2) with AER > 20 to 150 μg min−1, compared with diabetic patients with AER 20 μg min−1(females 20.8 ± 3.0 kg m−2,p= 0.02; males 19.7 ± 2.4 kg m−2,p< 0.006). Mean blood pressure was significantly higher (94 ± 9 mmHg) in the group of diabetic patients with AER > 20 to 150 μg min−1than in the group with AER 20 μg min−1(87 ± 9 mmHg;p< 0.0001). No statistically significant differences in mean blood pressure or BMI were found between the diabetic patients and a control group of 663 non‐diabetic healthy children. The findings suggest that hormonal changes in puberty, poor blood glucose control (particularly in females), and elevated arterial blood pressure may be risk factors related to the increased prevalence of microalbuminuria in diabetic children.
Effects of Octreotide on Lipoproteins and Endothelial Function in Type 1 (Insulin‐dependent) Diabetic Patients
Authors: Nørgaard K. , Snorgaard O. , Jensen T. , Kirkegaard C.
Published: July 2009

Hypersecretion of growth hormone (GH) is a characteristic feature of Type 1 diabetic patients. In healthy subjects growth hormone is able to induce an increase in endothelial cell proteins such as fibrinogen and von Willebrand factor. Plasma concentrations of such proteins, which are markers of cardiovascular risk, are elevated in diabetic patients with microalbuminuria, suggesting endothelial cell dysfunction. In a randomized prospective study we therefore evaluated the possible effects of 1 year's treatment with a somatostatin analogue, octreotide, on lipoproteins and on endothelial function in Type 1 diabetes mellitus. Seven patients were allocated to treatment with a continuous subcutaneous infusion of 400 μg octreotide per day. Seven patients served as a control group. During treatment a decrease in plasma LDL‐cholesterol (2.62 (2.17–3.11) (median (range)) vs 2.00 (1.89–2.96) mmol l−1, p < 0.05) and serum apolipoprotein A‐I (1.47 (1.25–1.60) vs 1.23 (1.13–1.90) g l−1, p < 0.05) was observed in the treated group. Furthermore a probable reduction during treatment in plasma concentrations of von Willebrand factor (1.72 (0.84–3.04) vs 1.24 (0.94–1.82) U ml−1, p = 0.08) and fibrinogen (11.3 (7.3–25.3) vs 8.1 (7.5–11.8) μmol l−1, p = 0.06) was found, and after withdrawal of treatment an increase towards the initial levels was seen. The platelet count declined (326 (301–612) vs 217 (206–400) × 109 l−1, p < 0.01) during octreotide treatment and remained depressed 2 months after withdrawal.
Drug Treatment of Obesity in Type 2 Diabetes Mellitus
Authors: Carpenter M. A. , Bodansky H. J.
Published: July 2009

Obesity is a common problem in Type 2 diabetes mellitus, and reduction of weight in obese diabetic patients will lead to an improvement in glucose tolerance. Despite the importance of weight loss, obese diabetic patients often fail to lose weight with advice on dietary restriction. Frequent visits to see the dietician provide the best chance of successful weight loss, and should be an important part of the management of the overweight patient. If this line of treatment is unsuccessful, then drug therapy may be considered to assist the patient in adhering to the dietary restriction. Over the past decade, drug therapy for weight loss has fallen into disrepute in the wake of the abuse of amphetamines and thyroid hormones by both patients and doctors. For this reason, the only drug commonly used in the diabetic clinic to assist patients to lose weight is metformin because of its putative therapeutic effect on obesity. However, currently available anorectic agents have much less potential for abuse by patients than their predecessors, and new drugs are being developed in this field.
Microalbuminuria and Cardiovascular Risk Factors in Type 2 Diabetes Mellitus
Authors: Allawi J. , Jarrett R.J.
Published: July 2009

Prospective studies have shown that increased urinary albumin excretion is a risk factor for cardiovascular morbidity and mortality in patients with Type 2 diabetes mellitus, but the nature of the association remains unknown. Eighty‐five patients aged less than 65 years and not treated with insulin were studied. The overnight albumin excretion rate (AER) was measured in each patient and analysed in relation to several putative risk factors for cardiovascular disease. AER was used both as a continuous variable and after dividing patients into high‐risk (AER ≥ 10 μg min−1) and low‐risk (AER < 10 μg min−1) groups. By both methods of analysis AER was significantly correlated with both seated and supine diastolic blood pressure levels and with resting heart rate. Body mass index and waist—hip ratio appeared higher and HDL‐cholesterol lower in the at‐risk group, but differences were not statistically significant. The level of Factor VII was not significantly lower in the at‐risk group. Little of the cardiovascular risk associated with raised AER can be attributed to associations with conventional risk factors.
Insulin Management During Labour and Delivery in Mothers with Diabetes
Authors: Lean M.E.J. , Pearson D.W.M. , Sutherland H.W.
Published: July 2009

A standardized intravenous regimen has been assessed, in 25 insulin‐treated diabetic women, for insulin and dextrose therapy in labour and delivery. Adjustments to insulin infusion rate are determined by trends in blood glucose as well as by absolute concentration, in order to approach normoglycaemia. Blood glucose was 5.0 (SD 1.7) mmol I−1 on arrival in labour (or at 0800 h before planned delivery) and was maintained at 6.0 (SD 1.8) mmol I−1 with insulin 0–5 U h−1 for up to 29 h before delivery, when it was 6.3 (SD 2.1, range 3.0–9.0) mmol I−1 with insulin infusion rate 0–4 U h−1. Neonatal blood glucose (<2.0 mmol I−1 in 11 babies) correlated with both maternal HbA1c (rs = −0.47, p < 0.02) and maternal blood glucose at delivery (rs = −0.58, p < 0.01). During 12 months observation on the intravenous regimen, 339 measurements of blood glucose were made; 10 were < 3.0 mmol I−1, 242 were 3.0–8.0 mmol I−1, and 81 were >8.0 mmol I−1 (mean 6.5, range 2.7–13.5 mmol I−1). Insulin infusion rate ranged from 0 to 5 U h−1, with 139 rate adjustments. Only one mild clinical hypoglycaemic episode, responding to increased dextrose infusion, was recorded. This simple flexible regimen proved clinically reliable for both midwifery and medical staff.
A Chinese Family with Non‐insulin‐dependent Diabetes of Early Onset and Severe Diabetic Complications
Authors: Chan J.C.N. , Hawkins B.R. , Cockram C.S.
Published: July 2009

Non‐insulin‐dependent diabetes mellitus of early onset has recently been described in Caucasians as a distinct syndrome with a characteristic pedigree suggestive of inheritance of genetic determinants from both parents. It is characterized by absence of islet cell antibodies and the severity of its clinical course. We report a Chinese family pedigree of three generations in which this form of diabetes has affected the third generation. Some members of this pedigree had severe complications at presentation in their twenties.
Obesity, Weight Loss and Prognosis in Type 2 Diabetes
Authors: Lean M.E.J. , Powrie J.K. , Anderson A.S. , Garthwaite P.H.
Published: July 2009

Medical records were reviewed of all 263 Type 2 diabetic patients from the Aberdeen diabetic clinic who were known to have died in 1985 or 1986. Mean age was 65 years (interquartile range 57–75 years) at diagnosis and 72 (66–80) years for men, 75 (72–83) years for women, at death. Life expectancy at age 65 was 35% less than published figures for the general population. Analysis of survival in 233 patients who lived more than 1 year (189 overweight) using stepwise multiple regression indicated as significant (p < 0.05) adverse independent variables: age at diagnosis, presence of clinical ischaemic heart disease at diagnosis, plasma glucose at diagnosis; and as significant favourable variables: oral hypoglycaemic drug therapy, weight loss in the first year, and an interaction between weight loss and BMI for patients with BMI > 25 kg m−2. Changes in fashions over the years are likely to have biased these results towards including oral hypoglycaemic therapy and excluding the expected adverse effect of smoking. Mean weight loss at 1 year was 2.6 kg for those with BMI 25–30 kg m−2, 6.8 kg with BMI > 30 kg m−2, following standard dietetic advice. For the average patient each 1 kg weight loss was associated with 3–4 months prolonged survival.
An Unbiased Glucose Clamp Method Using a Variable Insulin Infusion: Its Application in Diabetic Adolescents
Authors: Matthews D.R. , Edge J.A. , Dunger D.B.
Published: July 2009

A simple, unbiased insulin‐varying glucose clamp program is described. The aim of the program was to utilize a continuously updated array of data to predict insulin requirements for normoglycaemia. In assessing Type 1 diabetes the quantity of insulin required for maintenance of basal euglycaemia can be more clinically informative than other clamp methods. We present a method which uses an iterative computer program to predict changes in insulin infusion rate required for glucose clamping. After initial parameter estimation, the program uses no fixed algorithm but makes predictions according to previous blood glucose responses to infusion rates. The program has flexible data entry, graphic display, and running statistics including mean infusion data, mean glucose levels, and their respective standard deviations. Data for 26 consecutive overnight clamp studies have been analysed. The median coefficient of variation of glucose values at the end of the clamp was 4.1% (range 1.4–12.0%). The mean bias during the last 2 h was 0.20 ± 0.24 mmol l−1. Cross‐correlation showed that insulin had its maximal effect on the rate of decline of glucose after 15 min, and the nadir of glucose occurred 45 min after a change in insulin infusion rate.
Development of Nephropathy in Diabetic Patients with a Single Kidney
Authors: Sampson M.J. , Drury P.L.
Published: July 2009

Six diabetic patients with either a nephrectomy or a congenitally single kidney, and who later developed diabetic nephropathy, are described. They represent about 3 % of our diabetic population with nephropathy, and are the only patients in our clinic population known to have single kidneys. A reduced renal mass may augment the renal glomerular hyperfiltration associated with diabetes mellitus and increase the risk of later developing nephropathy.
Effect of Ketones and Glucose on the Estimation of Urinary Creatinine: Implications for Microalbuminuria Screening
Authors: Watts G.F. , Pillay D.
Published: July 2009

The influence of acetoacetate, 3‐hydroxybutyrate, and glucose on the assay of urinary creatinine by Jaffé‐type and enzymatic methods was studied in vitro. Acetoacetate (≥ 5 mmol l−1) led to significant overestimation of low concentration urinary creatinine measured by an end‐point and a kinetic Jaffé reaction, but neither 3‐hydroxybutyrate nor glucose influenced these reactions. None of the metabolites interfered with an enzymatic creatininase assay. It is recommended that, when employing the urinary albumin/creatinine ratio to screen for microalbuminuria in diabetes mellitus, an enzymatic method be used to measure creatinine in Ketostix positive samples, particularly those that are dilute or obtained from patients with a low lean body mass.
Who Joins the BDA?
Authors: Robinson N.
Published: July 2009

A comparison of demographic and clinical characteristics was made between a random sample of members and non‐members of the British Diabetic Association (BDA) of working age (17–65 years) who responded to a questionnaire concerning their employment. There were large regional variations in BDA membership, but overall 27 % of responders were BDA members. Of the responders, BDA members were more likely to be women than men (30 vs 25 %, p = 0.04) and under rather than over the age of 36 years (38 vs 21 %, p < 0.001). A greater proportion of insulin‐treated patients with diabetes were BDA members compared with patients who were not treated with insulin (37 vs 13%, p < 0.001). Unemployment was significantly less amongst BDA members compared with non‐members (12 vs 20%, p < 0.001). Membership decreased with decreasing social status, with significantly more house‐owners being BDA members compared with those living in rented accommodation (31 vs 23 %, p < 0.001).
Effect of Initiation of Insulin Therapy on T‐lymphocyte Activation in Type 1 Diabetes
Authors: Peakman M. , Hussain M.J. , Millward B.A. , Leslie R.D.G. , Vergani D.
Published: July 2009

Levels of activated T‐lymphocytes are characteristically increased in recently diagnosed patients with Type 1 diabetes and remain elevated up to 6 months after diagnosis. To determine whether insulin treatment has a role in initiating or maintaining this activation 12 patients were studied at diagnosis and again 1,5, and 70 days after the start of insulin therapy. Levels of activated T‐lymphocytes were found to be elevated at diagnosis (9.7 ± 1.6 % (± SD)) before insulin treatment compared with normal control subjects (4.2 ± 1.1 %; p < 0.001). One day after starting insulin therapy, the level of activated T‐lymphocytes had not changed but by day 5 it had fallen significantly (7.6 ± 1.9 %; p < 0.05) compared with pre‐treatment levels. By day 70, activated T‐lymphocytes were returning towards the high levels found before treatment. Investigation of the phenotype of the activated T‐lymphocytes showed that there was an increase in the percentage of activated cells expressing the CD8 (suppressor/cytotoxic) phenotype at 70 days compared with pre‐treatment values (p < 0.02). These results show that elevated levels of activated T‐lymphocytes found in recently diagnosed Type 1 diabetes are not a result of insulin treatment. Treatment may, however, have a role in maintaining T‐lymphocyte activation and modifying the distribution of functional subsets of the activated cells.
The Role of Hyperglycaemia‐induced Alterations of Antithrombin III and Factor X Activation in the Thrombin Hyperactivity of Diabetes Mellitus
Authors: Ceriello A. , Quatraro A. , Marchi E. , Barbanti M. , Russo P. Dello , Lefebvre P. , Giugliano D.
Published: July 2009

Factor X concentration and factor X activation, antithrombin III anti‐Xa activity and plasma concentration, and fibrinopeptide A were measured in 20 diabetic patients and 20 normal subjects. Although factor X activation (81.3 ± 2.2 vs 97.3 ± 2.1 %, p < 0.01; mean ± SE) and antithrombin III activity (76.5 ± 2.2 vs 96.3 ± 1.8 %, p < 0.01) were reduced in the diabetic patients, fibrinopeptide A concentration was increased (3.7 ± 0.4 vs 1.7 ± 0.2 ng ml−1, p < 0.01). The ratio of factor X activation to antithrombin III anti‐factor Xa activity was increased in the diabetic patients (1.10 ± 0.01 vs 1.01 ± 0.02, p < 0.01). Induced hyperglycaemia was able to mimic all these abnormalities, without changing factor X or antithrombin III concentration. The results suggest that in vivo hyperglycaemia produces a decrease of factor X activation, but at the same time increases fibrinopeptide A formation due to a greater decrease of antithrombin III anti‐Xa activity.
Fatal Hypoglycaemia in Insulin‐treated Diabetes Mellitus: Clinical Features and Neuropathological Changes
Authors: Patrick A.W. , Campbell I.W.
Published: July 2009

Four insulin‐treated diabetic patients presented over a 2‐year period in hypoglycaemic coma and died secondary to this. At autopsy, there were widespread neuropathological changes, in all four cases consistent with hypoglycaemic damage. Abnormalities were also found in areas regarded as generally being spared in hypoglycaemic brain injury, particularly the brain stem, thalamus, globus pallidus, and cerebellum, and these lesions may relate to seizure activity and cardio‐respiratory depression secondary to the hypoglycaemia. Although more than one aetiological factor may be contributing, it is concluded that the neuropathological changes in diabetic patients dying in hypoglycaemic coma are extremely diverse.
Fasting Serum Insulin Concentration and Early Insulin Response as Risk Determinants for Developing Diabetes
Authors: Lundgren H. , Bengtsson C. , Blohmé G. , Lapidus L. , Waldenström J.
Published: July 2009

Among a cohort of 348 women aged 50 on entering a 12‐year prospective study, the incidence of diabetes was increased (17.1%) during follow‐up in those who initially had fasting glucose concentration above the upper quintile, a fasting serum insulin concentration above the upper quintile (14.9%), a disappearance rate of glucose below the lowest quintile in an IV glucose tolerance test (12.7%), or early insulin response below the lowest quintile (17.1%). The incidence in all women was 4.9%. By multivariate analysis, the highest risk was for high fasting serum insulin concentration. Obesity and treatment with antihypertensive drugs further increased the risk. An initial low early insulin response was not however a prerequisite for the development of manifest diabetes. Determination of fasting insulin concentration, especially in overweight hypertensive subjects, is of value in order to find out which subjects are at high risk of developing diabetes.