bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and Predictive Value of Islet Cell Antibodies and Insulin Autoantibodies in Women with Gestational Diabetes
Authors: Damm P. , Kühl C. , Buschard K. , Jakobsen B. K. , Svejgaard A. , Sodoyez‐Goffaux F. , Shattock M. , Bottazzo G. F. , Mølsted‐Pedersen L.
Published: July 2009

The objective of the present study was to investigate the predictive value of islet cell antibodies (ICA) and insulin autoantibodies (IAA) for development of diabetes in women with previous gestational diabetes (GDM). Two hundred and forty‐one previous diet‐treated GDM patients and 57 women without previous GDM were examined 2–11 years after the index pregnancy. In subgroups, plasma from the diagnostic OGTT during index pregnancy was analysed for ICA and IAA. Among the previous GDM patients, 3.7% had developed Type 1 diabetes and 13.7% Type 2 diabetes. Four (2.9%) of the 139 GDM patients tested for ICA were ICA‐positive and three of these had Type 1 diabetes at follow‐up, as well as three ICA‐negative patients. The sensitivity, specificity, and predictive value of ICA‐positivity for later development of diabetes were 50%, 99%, and 75%, respectively. None of the women was IAA‐positive during pregnancy. In conclusion, the majority of the patients with GDM did not show evidence of ongoing autoimmune destruction of the beta cells during the index pregnancy. However, ICA‐positive GDM patients had a high risk of developing Type 1 diabetes later in life.
Sequelae of Acute Hypoglycaemia on 24 hour Blood Pressure and Metabolic Parameters in Normal and Type 1 (Insulin‐dependent) Diabetic Individuals
Authors: Avogaro A. , Crepaldi C. , Miola M. , Penzo M. , Maran A. , Zanin L. , Rossi G. P. , Moretti M. , Palatini P. , Tiengo A.
Published: July 2009

This study was performed to assess possible delayed after‐effects of acute hypoglycaemia on blood pressure (BP) and heart rate (HR) over a 24‐h period. Eleven insulin‐dependent diabetic patients and 11 sex, age, and body mass index matched non‐diabetic subjects were studied. Blood pressure was measured using a non‐invasive ambulatory blood pressure monitor following acutely induced hypoglycaemia in the morning. No significant differences were observed in 24‐h systolic and diastolic BP and HR in either groups, between the day when hypoglycaemia was induced and the day when plasma glucose was kept normal. In diabetic patients, hypoglycaemia induced a temporary but significant fall in mean BP (‐7 ± 1 mmHg vs ‐2 ± 2; p < 0.05). Plasma glucose levels were significantly higher in insulin‐dependent diabetic patients following hypoglycaemia than in those observed during the reference test. This study demonstrates that acute hypoglycaemia in insulin‐dependent diabetic subjects does not cause significant alterations in 24‐h BP in either diabetic or normal subjects.
The Medical Management of Gestational Diabetes in Australia within a Solo Private Practice
Authors: Moses R. G.
Published: July 2009

This study reports the obstetric and fetal outcomes of 266 consecutive patients with gestational diabetes managed by a solo practitioner in private practice. Labour was spontaneous in 75.6% and 93.2% had a gestational age of delivery between 37 and 41 weeks. The elective Caesarean section rate of 14.7% was slightly higher than the rate for the overall obstetric population. Insulin therapy was required in 12.8% of the patients with a mean daily dose of 35.3 units. The rate of insulin use increased to 23.8% during 1993 when the criteria for its use was revised. This was associated with a significantly lower macrosomic rate of 3.6%. Overall there was a significant reduction in the number of babies weighing ≤ 2500 g and no increase in the number of babies weighing ≥ 4000 g. One patient only was admitted to hospital during this 30‐month period and there was 1 neonatal death. These results indicate that successful medical management of gestational diabetes, with obstetric and fetal results similar to the overall obstetric population, is possible outside of tertiary institutions and specialized clinics.
Spatial Clustering in Childhood Diabetes: Evidence of an Environmental Cause
Authors: Bodington M.J. , Muzulu S.I. , Burden A.C.
Published: July 2009

If environmental factors are important in the aetiology of insulin‐dependent (Type 1) diabetes mellitus, primary schooling would be more likely to be shared by cases in an epidemic year compared with controls. We have examined a case control study, comparing primary schools attended. Cases were identified from an established register with known accurate ascertainment and compared with controls taken from a central register of all children and date of birth, sex, and race matched. Parents were asked to complete a structured questionnaire which included questions relating to the child's schooling. There were 187 cases with at least a first matched control. Thirty‐two of the cases attended the same nursery or primary school as another case, 18 in the same academic year, compared with 12 controls attending the same school as another control (99% confidence interval (Cl) for the difference between proportions 0.0572–0.107). Of the cases diagnosed in 1986, 9 attended the same school as another case. Spatial clustering occurs in Type 1 diabetes. This is further evidence of an environmental factor contributing to the genesis of the disease.
More Uniform Diurnal Blood Glucose Control and a Reduction in Daily Insulin Dosage on Addition of Glibenclamide to Insulin in Type 1 Diabetes Mellitus: Role of Enhanced Insulin Sensitivity
Authors: McCoy S. , Kabadi M. , Kabadi U.M. , Birkenholz M.
Published: July 2009

Combination therapy with insulin and sulphonylurea has gained acceptance in management of subjects with Type 2 (non‐insulin‐dependent) diabetes mellitus. However, its role in management of Type 1 (insulin‐dependent) diabetes mellitus remains controversial. In this study, the effect of combination therapy with insulin and glibenclamide on metabolic control, daily insulin dosage, and insulin sensitivity was assessed in subjects with Type 1 diabetes mellitus. Ten men with Type 1 diabetes mellitus participated in a randomized, double‐blind, crossover, clinical trial with three treatment regimens, namely (1) insulin alone, (2) insulin and placebo, (3) insulin and glibenclamide, each lasting 3 months. Combination therapy induced: (1) reduction in daily insulin dosage; (2) more uniform blood glucose control as reflected by a lower average 24 h blood glucose level, a smaller difference between mean preprandial and 2 h postprandial blood glucose concentrations, decreased 24 h urine glucose excretion, and a decline in number of hypoglycaemic events; (3) improved insulin sensitivity as expressed by more rapid plasma glucose disappearance rate, without a significant alteration in fasting plasma glucagon and 1 h postprandial serum C‐peptide levels; when compared with treatment with either insulin alone or with insulin and placebo. Therefore, it is apparent that the addition of glibenclamide to insulin reduces daily insulin dosage and renders a greater uniformity to diurnal blood glucose control, most probably secondary to enhancement of insulin sensitivity.
The Effects of Repeated Daily Recombinant Human Insulin‐like Growth Factor I Administration in Adolescents with Type 1 Diabetes
Authors: Cheetham T.D. , Dunger D.B. , Clayton K. , Holly J.M.P. , Cwyfan‐Hughes S.
Published: July 2009

Reduced insulin‐like growth factor bioactivity has been linked to poor metabolic control and growth hormone hypersecretion in adolescents with Type 1 diabetes. The safety and efficacy of recombinant human insulin‐like growth factor I administered subcutaneously in a dose of 40 μg kg−1 for 28 days was studied in a group of 6 adolescent male subjects with Type 1 diabetes (aged 13.6–19.4 years, puberty stage 3–5). After a 4‐week run‐in period (week 4 to day 0) recombinant human insulin‐like growth factor I was administered for 4 weeks (day 0 to week +4) before a run‐out of a further 4 weeks duration (week +4 to +8). HbA1c levels were measured throughout the study and overnight profiles were undertaken to study levels of insulin‐like growth factor I, insulin‐like growth factor binding protein‐3, and growth hormone concentrations (week —1, day 0, and week +4). The injections were well tolerated and hypoglycaemia was not problematic at any stage of the study. Recombinant insulin‐like growth factor I administration appeared to lead to a sustained increase in insulin‐like growth factor I levels (week —1; 198 ± 16 ng ml−1, week +4; 422 ± 18 ng ml−1, mean ± SEM; p = 0.03). Insulin‐like growth factor binding protein‐3 concentrations (n = 6) increased in 5 subjects (week —1; 4.5 ± 0.3 μg ml−1, week +4; 5.1 ± 0.4 μg ml−1) and mean overnight growth hormone decreased (week −1; 14.0 ± 3.1 mU I−1, week +4; 7.6 ± 1.7 mU I−1) during the period of study but these differences were not statistically significant. HbA1c levels fell significantly at the time of rhIGF‐I administration (day 0; 10.4 ± 1.9% vs week +4; 9.4 ±1.9%; p = 0.03) despite a reduction in subcutaneous isophane insulin dose from 0.50 ± 0.02 U kg−1 to 0.41 ± 0.02 U kg−1 (p = 0.03). There was no significant change in biochemical and haematological indices, glomerular filtration rate or urinary albumin excretion. The restoration of IGF‐I levels in adolescents with Type 1 diabetes may have a beneficial impact on glycaemic control.
Diabetes, Impaired Glucose Tolerance and Cardiovascular Disease Risk Factors in the Asian Indian Bhatia Community Living in Tanzania and in the United Kingdom
Authors: Ramaiya K.L. , Denver E. , Yudkin John S.
Published: July 2009

A population‐based cross‐sectional survey was carried out to study potential environmental risk factors contributing to diabetes and cardiovascular risk in the same homogeneous group in the United Kingdom and in Dar es Salaam, Tanzania. In Dar es Salaam, 222 members of the Bhatia community aged 15 years and over were studied. In the UK, 180 randomly selected subjects aged 15 years and over participated. Age, sex, and body mass index adjusted mean levels of fasting glucose (5.5 mmol l−1 vs 5.1 mmol l−1 (p< 0.001)) and 2 h glucose (6.8 mmol l−1 vs 6.0 mmol l−1 (p < 0.001)) were significantly higher in Tanzanian subjects than in UK subjects. Mean levels of serum triglycerides (1.5 mmol l−1 vs 1.3 mmol l−1 (p < 0.05)) and systolic blood pressure (135 mmHg vs 127 mmHg (p<0.05)) were significantly higher in subjects in the UK. The age and sex adjusted prevalence of impaired glucose tolerance (28.4 % vs. 11.4 % (p < 0.001)), newly diagnosed diabetes (8.6 % vs 1.5 % (p < 0.01)), hypercholesterolaemia (9.9 % vs 1.5 % (p < 0.001)), and smoking (12.1 % vs 3.9 % (p < 0.01)) were significantly higher in subjects in Tanzania compared to subjects in the UK. The prevalence of known diabetes, hypertriglyceridaemia, hypertension, and obesity did not show significant differences between subjects in Tanzania and those in the UK. Within the same homogeneous community with the same likely genetic predisposition, there are substantial geographical differences in cardiovascular risk factors, the causes of which remain to be determined.
A Study of Spermatozoal Motility in Type 1 Diabetes Mellitus
Authors: Niven M.J. , Hitman G.A. , Badenoch D.F.
Published: July 2009

The aim of the study was to examine an aspect of male fertility in patients with Type 1 diabetes mellitus (n = 17) compared to healthy control subjects (n = 16) using parameters of sperm motility, measured using a computerized image analysis system (the Hamilton Thorn Research HTM‐2030 Motility Analyzer), as indicators of potential fertility. Within the diabetic group no correlations were found between sperm motility and age, age of onset of diabetes, duration of diabetes or glycated haemoglobin. When the diabetic and control groups were compared, track speed, path velocity, progressive velocity, and lateral head displacement were not significantly different, whereas linearity and linear index, measures of straightness of swimming, were significantly greater in the diabetic subjects (59.2% vs 69.8%, p = 0.0005 and 76.4% vs 83.6%, p= 0.0016, respectively). We conclude that diabetic men, in the absence of complications, do not appear to be at a disadvantage in terms of sperm motility compared to healthy individuals.
Trends in Mortality of Childhood‐onset Insulin‐dependent Diabetes Mellitus in Leicestershire: 1940–1991
Authors: McNally P.G. , Hearnshaw J.R. , Raymond N.T. , Botha J.L. , Burden M.L. , Burden A.C. , Burton P.R. , Swift P.G.F.
Published: July 2009

The relative risk of death by calendar date of diagnosis was investigated in a population‐based incident cohort of 845 (463 males:382 females) IDDM diagnosed in Leicestershire before the age of 17 years between 1940 and 1989. The mortality status of 844 (99.9 %) patients was determined as of the 31 December 1991, representing 14 346 person‐years of risk. Trends in relative risk of death were investigated using Cox proportional hazards modelling for within cohort comparisons and age/sex and calendar time adjusted standardized mortality ratios (SMR) using generalized linear modelling for external comparisons. Median age at diagnosis was 10 years (range 3 months to 16 years); median duration of diabetes 15 years (range 1–51 years). Forty‐four patients had died (5.2 %; median age at death 31 years, range 11–51 years). A further four patients died at presentation (within 24 h) from ketoacidosis and are excluded from all analyses. Calendar date of diagnosis was found to be an important predictor of mortality. Adjusting for attained age there was evidence of a decline in relative risk of death with calendar date of diagnosis of 3.4 % (95 % CI, 0.005–6.9 %) per annum, equivalent to a 32 % fall per decade (95 % CI, 5–51 %), or 84 % (95 % CI, 21–97) from 1940 to 1989. The data are consistent with a large fall in mortality between the 1940s and 1950s representing over 50 % of the total reduction in mortality between 1940 and 1991. Neither sex nor age at diagnosis were significant predictors of mortality. Over the study period 1940–89 the SMR (male and female combined) fell from 981 (541–1556) to 238 (60–953) relative to the general population. This population‐based study shows that the prognosis for Type 1 (insulin‐dependent) diabetes mellitus has improved markedly over the period 1940–1991.
Self‐reported Weight Loss Among Adults with Diabetes: Results From a National Health Survey
Authors: Will J.
Published: July 2009

Although weight reduction can have a favourable effect on glucose control among persons with diabetes mellitus (DM), no national data have been used to describe weight loss among persons with DM. To address this gap, national survey data were used to assess self‐reported weight loss among persons from the USA with and without DM and to identify how other factors might interact with DM to increase the risk of weight loss. Data from the 1989 United States National Health Interview Survey were analysed for 2185 persons with DM and 18304 persons without DM. Fifty‐five percent of persons with DM reported they were attempting weight loss compared with only 43 % of persons without DM. Among those who attempted weight loss, one‐quarter of persons with DM lost at least 15 lb (approximately 5.6 kg) during the prior year compared with only 16 % of persons without DM. After multivariate adjustment for demographic variables, health care utilization, cigarette smoking, and degree of overweight, persons with DM were 1.7 times more likely to have lost 15 lb than were persons without DM. Among persons with DM, having been hospitalised twice and having consulted a dietitian or nutritionist during the prior year were both related to intentional weight loss. Further research is needed to clarify the roles of health status and medical resources in weight loss effort and success.
Short Administration of Metformin Improves Insulin Sensitivity in Android Obese Subjects with Impaired Glucose Tolerance
Authors: Scheen A.J. , Letiexhe M.R. , Lefèbvre P.J.
Published: July 2009

In a double‐blind, randomized, cross‐over study, the metabolic effects of a short treatment with metformin (2 times 850 mg day−1 for 2 days and 850 mg 1 h before evaluation) were compared to those of placebo in 15 obese subjects (BMI: 33.2 ± 0.9 kg m−2), with abdominal distribution of adipose tissue and impaired glucose tolerance. An intravenous glucose tolerance test (0.3 g glucose kg−1) was performed after each period of treatment. Areas under the curve (AUC0–180 min) were calculated for plasma glucose, insulin, and C‐peptide levels. Glucose tolerance was estimated by the coefficient of glucose assimilation (KG). Insulin sensitivity (SI) and glucose effectiveness (SG) indices were calculated using Bergman's minimal model. Insulin secretion rate (ISR) was determined by deconvolution of plasma C‐peptide levels and insulin metabolic clearance rate (MCR) was estimated by dividing AUC ISR by AUC insulin. Fasting plasma insulin levels were reduced after metformin (89.3 ± 15.9 vs 112.4 ± 24.3 pmol I−1; p = 0.04). AUC glucose, KG and SG were similar in both tests. However, AUC insulin was reduced (39.7 ± 6.5 vs 51.8 ± 10.4 nmol min I−1; p = 0.02), while SI (6.98 ± 1.14 vs 4.61 ± 0.42 10−5 min−1 pmol−1 I; p = 0.03) and insulin MCR (715 ± 116 vs 617 ± 94 ml min−1 m−2; p = 0.03) were increased after metformin. The demonstration that metformin rapidly improves insulin sensitivity should encourage further research to evaluate the long‐term effects of metformin in android obese subjects with impaired oral glucose tolerance.
Characterization of the Insulin‐antagonistic Effect of Growth Hormone in Insulin‐dependent Diabetes Mellitus
Authors: Fowelin J. , Attvall S. , Von Schenck H. , Smith U. , Lager I.
Published: July 2009

To characterize its insulin‐antagonistic effect, growth hormone (GH) was infused at variable rates (24, 12 or 6 ***mU kg−1 min−1) for 1 h in 7 IDDM patients. Saline infusion was used as control (C) and all patients participated in all studies. The effect of insulin was measured with the euglycaemic clamp technique for 6 h combined with d–(3–3H)–glucose to evaluate glucose turnover. The insulin levels during the clamps were similar in all studies (23 ± 3 ***mU I−1). The infusions produced peak GH levels of (24 rate = 24) 157 ± 11, (12 rate = 12) 76 ± 7, and (6 rate = 6) 45 ± 8 ***mU 1−1 (mean ± SEM). The insulin‐antagonistic effect of GH on glucose uptake was seen after 2 h and was at a maximum 4 to 5 h after the start of the GH infusion (difference in glucose infusion rate between C and 24 was 1.7 ± 0.4 mg kg−1 min−1p < 0.01). The resistance was due to a less pronounced effect of insulin to both inhibit rate of appearance and to stimulate rate of disappearance. Infusion of GH at 12 mU kg−1 min−1 induced a less pronounced insulin resistance both with regards to maximal effect (glucose infusion rate C ‐ GH 1.4 ± 0.5 mg kg−1 min−1p < 0.05) and duration (3 h). At 6 ***mU kg−1 min−1a clear GH‐induced insulin‐antagonistic effect was only seen during the third hour of the clamp (glucose infusion rate C‐GH 1.3 ± 0.5 mg kg−1 min−1p < 0.05). GH infusion impaired the effect of insulin to lower both the levels of free fatty acids (NEFA) and glycerol between 2 and 5 h after the start of the infusion (NEFA, C:110 ± 29, 24:303 ± 95, p < 0.05: glycerol, C:32 ± 4, 24:50 ± 7 μmol I−1p < 0.05).

The present study therefore demonstrates that the insulin‐antagonistic effect of GH in IDDM is related to the plasma levels both with regard to duration and response. The results also indicate that GH impairs the effect of insulin on lipolysis in IDDM after physiological peaks.
Prospective Study of Autonomic Nerve Function in Type 1 and Type 2 Diabetic Patients: 24 Hour Heart Rate Variation and Plasma Motilin Levels Disturbed in Parasympathetic Neuropathy
Authors: Nilsson H. , Sundkvist G. , Bergström B. , Lilja B. , Juul‐Möller S. , Carlsson J.
Published: July 2009

To clarify the impact of autonomic neuropathy in diabetic patients, we have conducted a prospective study of 58 Type 1 and 51 Type 2 diabetic patients (investigated at baseline, after 4, and after 7 years). In Type 1 diabetic patients, the sympathetic nerve function (orthostatic acceleration and brake indices) and in Type 2 patients, parasympathetic nerve function (R‐R interval variation; E/I ratio) deteriorated during 7 years of prospective observation. Symptoms of autonomic neuropathy were associated with signs of autonomic neuropathy (low brake indices) in Type 1 but not in Type 2 diabetic patients. In the latest assessment 24 h ECG recording was performed and blood samples assayed for neuropeptide Y (NPY) and motilin were obtained. Type 1 diabetic patients with parasympathetic neuropathy (abnormal E/I ratio) showed significantly lower SD value (less variation in the R‐R intervals; 29 [17] vs 50 [16], [mean {interquartile range}]; p = 0.001) and higher postprandial plasma motilin values (70 [20] pmol I−1 vs 50 [15] pmol I−1; p< 0.01) than patients with normal parasympathetic nerve function. In Type 2 diabetic patients, sympathetic neuropathy (low brake indices) was associated with an increased frequency of ventricular extra systolic beats during 24 h ECG recording (rs = 0.65; p<0.01). Postprandial plasma NPY levels were not associated with disturbed autonomic nerve function.
Effect of Treatment with an Aldosereductase Inhibitor on Symptomatic Carpal Tunnel Syndrome in Type 2 Diabetes
Authors: Monge L. , De Mattei M. , Dani F. , Sciarretta A. , Carta Q.
Published: July 2009

The aim of this study was to test the efficacy of the aldose‐reductase inhibitor Tolrestat in the treatment of carpal tunnel syndrome in Type 2 diabetic patients. Seventeen patients were treated with Tolrestat (200 mg daily for 12 months) clinical and neurophysiological evaluations were performed at baseline, 6 and 12 months; symptoms and blood glucose control were assessed at baseline, 2, 6, and 12 months. Thirteen Type 2 diabetic patients suffering from symptomatic carpal tunnel syndrome served as controls. Neurophysiological studies showed improvement in the sensory conduction velocity of the median nerve between forefinger and wrist (baseline 37.5 ± 4.3 vs 6 months 41.3 ± 5.7 ms−1, p < 0.0005 and baseline vs 12 months 41.4 ± 8.2 ms−1, p < 0.005) but not between wrist and elbow. The terminal latency index of the median nerve was unchanged. Paraesthesiae and pain improved in terms of intensity and frequency. Blood glucose control was not significantly changed. We conclude that treatment of this case series with Tolrestat appears to produce beneficial effect on the outcome of carpal tunnel syndrome in diabetic patients.
Symptoms, Hormones, and Glucose Fluxes During a Gradual Hypoglycaemia Induced by Intraperitoneal vs Venous Insulin Infusion in Type I Diabetes
Authors: Selam J. L. , Medlej R. , M'bemba J. , Chevalier A. , Guyon F. , Ashworth L. , Slama G.
Published: July 2009

Intraperitoneal (IP) insulin infusion with programmable implantable pumps is associated with a reduction in hypoglycaemic events when compared to intensive diabetes management with subcutaneous insulin in patients with Type 1 diabetes mellitus. The mechanism may involve more physiological insulin kinetics, lower peripheral insulin levels or a specific hepatic action of portal insulin on hypoglycaemic counter regulation. To investigate the latter two hypotheses, we performed two hypoglycaemic clamps (controlled blood glucose decrement to 2.2 mmol l−1) in random order in 12 Type 1 diabetic patients. Insulin was infused either IP or IV for 150 min, at rates chosen to generate similar peripheral insulin levels (1 mU/kg−1 min−1 IV or 2 mU/kg−1 min−1 IP, n = 6) to evaluate direct hepatic action, or at similar rates (1 mU/kg−1 min−1 IV and IP, n = 6) to evaluate IP indirect effects via lower peripheral insulinaemia. Hepatic glucose production and glucose utilization were measured by [6, 6 2H] glucose dilution technique. Glucose production was lower (1.7 ± 0.4 vs 0.5 ± 0.4 mg kg−1min−1, p < 0.05), and utilization was similar at the end of the matched‐insulinaemia IV and IP clamps, respectively. By contrast, glucose production was higher (1.7 ± 0.5 IV vs 2.7 ± 0.3 IP mg kg−1 min−1, p < 0.01) and glucose utilization lower (4.4 ± 1.0 IV vs 3.3 ± 0.2 IP mg kg−1 min−1, p < 0.05) with IP delivery at the end of the matched‐dose clamps. Counterregulatory hormones and hypoglycaemic symptoms increased similarly in all clamps. In summary, IP insulin, when compared to IV insulin at similar delivery rates, but not at similar insulinaemia, is associated with a less negative glucose balance (glucose production‐glucose utilization) during hypoglycaemia. Such a mechanism may play a role in the reduced hypoglycaemic risk seen with IP implantable pumps.
Pakistan National Diabetes Survey: Prevalence of Glucose Intolerance and Associated Factors in Shikarpur, Sindh Province
Authors: Shera A. S. , Rafique G. , Khwaja I. A. , Ara J. , Baqai S. , King H.
Published: July 2009

The prevalence of diabetes mellitus and impaired glucose tolerance (IGT) and their relationship to age and obesity was estimated in the rural town of Shikarpur in Sindh Province, Pakistan by a population‐based survey in 1994. Oral glucose tolerance tests were performed in a stratified random sample of 967 adults (387 men, 580 women) aged 25 years and above. The diagnoses of diabetes and IGT were made on the basis of WHO criteria. The response rate was 71% for men and 80% for women. The prevalence of diabetes was 16.2% (9.0% known, 7.2% newly diagnosed) in men, and 11.7% (6.3% known, 5.3% newly diagnosed) in women. The prevalence rose with age to a peak of 30% and 21% in 65–74 year‐old men and women respectively. IGT was detected in 8.2% of men and 14.3% of women. Thus, total glucose intolerance (diabetes and IGT combined) was present in 25% of subjects examined. These results indicate that glucose intolerance in South Asians can no longer be regarded as a problem confined to migrant communities. Of the 72 subjects previously known to have diabetes, none was using insulin treatment, but 57 (79%) took oral hypoglycaemic agents. Central obesity and positive family history were strongly associated with diabetes, as was prevalence of hypertension. The association with central obesity was greater for women than for men, and suggests important, modifiable risk factor(s) related to lifestyle.
Diabetes Mellitus in Egypt: Risk Factors and Prevalence
Authors: Herman W. H. , Ali M. A. , Aubert R. E. , Engelgau M. M. , Kenny S. J. , Gunter E. W. , Malarcher A. M. , Brechner R. J. , Wetterhall S. F. , DeStefano F. , Thompson T. J. , Smith P. J. , Badran A. , Sous E. S. , Habib M. , Hegazy M. , abd el Shakour S. , Ibrahim A. S. , el Moneim el Behairy A.
Published: July 2009

Major sociodemographic changes have occurred in Egypt to promote the development of noncommunicable diseases. We have performed a cross‐sectional, population‐based survey of persons ≥ 20 years of age in Cairo and surrounding rural villages to describe the prevalence of diabetes risk factors, diagnosed diabetes, previously undiagnosed diabetes, and impaired glucose tolerance by age, sex, rural and urban residence, and socioeconomic status (SES). In the survey, we identified 6052 eligible households: 76% of household respondents completed a household examination and 72% of selected household respondents subsequently completed a medical examination. Exercise was assessed by questionnaire; adiposity by measurement of height, weight, and girths; and diabetes by history and 2‐h 75 g oral glucose tolerance test. In rural areas, 52% of persons ≥ 20 years of age were sedentary, 16% were obese, and 4.9% had diabetes. In lower SES urban areas, 73% were sedentary, 37% were obese, and 13.5% had diabetes. In higher SES urban areas, 89% were sedentary, 49% were obese, and 20% had diabetes. The combined prevalence of diagnosed and undiagnosed diabetes in the Egyptian population ≥ 20 years of age was estimated to be 9.3%. Approximately half the diabetes was diagnosed and the other half was previously undiagnosed. The prevalence of diabetes in Egypt is high, and the gradient in risk factors and disease from rural to urban areas and in urban areas from lower to higher SES suggest that diabetes is a major, emerging clinical and public health problem in Egypt.
Does Psychological Stress Cause Diabetes?
Authors: Wales J.K.
Published: July 2009

Many patients believe that their diabetes has been caused by stress or an adverse life event. Whereas there is strong evidence that psychological stress is related to a deterioration in glycaemic control in established diabetes, there is much less evidence that psychological stress can cause diabetes in humans de novo. It seems more likely that psychological stress produces a deterioration in glycaemia in the non‐symptomatic patient which in turn makes diabetic symptoms and the diagnosis evident. The pathogenic mechanisms which have been suggested to relate psychological stress to diabetes are described and reviewed.
The Emotional World of the Diabetic Patient
Authors: Ivinson M.H.L.
Published: July 2009

An assessment of the emotional world of the diabetic patient is proposed as a means of augmenting the clinician's understanding and treatment of his/her patients. The importance of considering the patient's unconscious as well as overt means of communicating is emphasised. The defence mechanisms of denial, displacement and intellectualization are described and examples of their application in clinical work are explored. Equipped with a greater understanding of the intra‐psychic world of the individual the clinician is more likely to remain attuned to the patient and thereby to facilitate an exploration of the factors that are perpetuating poor diabetic control.
Final Adult Height and its Relationship to Blood Glucose Control and Microvascular Complications in IDDM
Authors: Penfold J. , Chase H.P. , Marshall G. , Walravens C.F. , Walravens P.A. , Garg S.K.
Published: July 2009

The effect of longitudinal blood glucose control on final adult height was evaluated in 181 subjects (94 women and 87 men) with IDDM. Diabetes onset was at a median age of 6.9 years with an interquartile range of 4.7 years. Longitudinal glycated haemoglobin values were determined over a mean period of 6.6 ± 2.6 years during their growth phase. Serial eye and joint examinations and urinary albumin excretion rates were performed with final assessment being carried out at a mean age of 21.1 ± 3.0 years. The mean adult height standard deviation score of the whole group was −0.22 ± 1.15 and was reduced compared to the mean height of the general population and to the mean height of the subjects' parents and siblings. There was an inverse correlation with mean longitudinal glycated haemoglobin and final adult height (p<0.01). There was also an inverse relationship between adult height and the severity of eye, kidney, and joint complications, but when controlled by glycated haemoglobin, this relationship only remained significant for eye complications. Final adult height is reduced in subjects with early onset IDDM who remain in poor blood glucose control during their growth period.
Frequency, Severity and Symptomatology of Hypoglycaemia: a Comparative Trial of Human and Porcine Insulins in Type 1 Diabetic Patients
Authors: MacLeod K.M. , Gold A.E. , Frier B.M.
Published: July 2009

A randomized, double‐blind, cross‐over trial was performed to compare the frequency, severity, and symptomatology of hypoglycaemia during treatment with porcine and human insulins. Forty patients with Type 1 diabetes (20 newly diagnosed and 20 with diabetes of 5–20 years duration) were treated with human and porcine insulins for consecutive 3‐month periods, in random order. Episodes of hypoglycaemia were recorded prospectively with self‐reporting of the presence and intensity of symptoms using a standardized scoring technique. Serial measurements of glycated haemoglobin and review of home blood glucose tests confirmed that similar glycaemic control was achieved with each insulin species. On comparison of the treatment periods with human and porcine insulins, no differences were demonstrated in the total frequency of symptomatic hypoglycaemia (3.10 vs 3.06 episodes patient−1 3‐months−1; p = 0.94), the frequency of severe hypoglycaemia (0.1 vs 0.2 episodes patient−1 3‐months−1; p = 0.44), the occurrence of asymptomatic biochemical hypoglycaemia (0.75 vs 0.68 episodes patient−1 3‐months−1; p = 0.81), and the capillary blood glucose concentration at the onset of hypoglycaemic symptoms (2.6 ± 0.2 vs 2.4 ± 0.3 mmol I−1; p = 0.40), with all results being expressed for human vs porcine treatment periods, respectively. The symptoms of hypoglycaemia did not differ during the treatment periods with each insulin species. In conclusion, treatment with human insulin had no effect upon the symptomatic response to hypoglycaemia, did not increase the total frequency of hypoglycaemia, and did not emerge as a significant risk factor for severe hypoglycaemia in these patients.
A Longitudinal Study of Biomedical and Psychosocial Predictors of Multiple Hospitalizations Among Young People with Insulin‐dependent Diabetes Mellitus
Authors: Kovacs M. , Charron‐Prochownik D. , Obrosky D.S.
Published: July 2009

The aim of the present study was to estimate the cumulative probability of multiple diabetes‐related hospitalizations and identify associated risk factors in a sample of 92 school‐age children, newly diagnosed with insulin‐dependent (Type 1) diabetes mellitus, who were followed longitudinally for up to 14 years (mean: 9 years). ‘Multiple hospitalizations’ as a variable was defined as three or more admissions. Altogether 26 young patients (28%) had multiple admissions (with a total of 158 hospitalizations), yielding an estimated cumulative probability for this outcome of 0.33 by 10 years after onset of diabetes. Multivariate longitudinal analyses revealed that at any given point in time, four variables significantly increased the risk of multiple admissions: higher levels of glycosylated haemoglobin reflecting poorer metabolic control, higher levels of externalizing symptoms reflecting greater behaviour problems, younger age at diagnosis, and lower socio‐economic status. According to the results ofpost hocanalyses, however, the aforementioned risk factors do not appear to be specific to multiple hospitalizations, and can serve to identify groups that are generally vulnerable to readmissions.
Hydroxyproline Excretion is Increased in Diabetes Mellitus and Related to the Presence of Microalbuminuria
Authors: Selby P.L. , Shearing P.A. , Marshall S.M.
Published: July 2009

Increased fracture frequency and low bone mass have each been reported in patients with diabetes. To see if these were related to increased bone resorption we have measured the urinary excretion of hydroxyproline in 73 patients with Type 1 (insulin‐dependent) diabetes, 67 patients with Type 2 (non‐insulin‐dependent) diabetes, and 75 control subjects. Hydroxyproline excretion was increased in both types of diabetes: Type 1: 21 (10–36) (median (IQR) μmol mmol creatinine−1; Type 2: 25 (13–43) μmol mmol creatinine−1; control: 10 (6–22) μmol mmol creatinine−1 (p < 0.0001 and < 0.0002, respectively). Hydroxyproline excretion was not related to age, duration of diabetes or blood glucose control. Neither was it different in patients with or without retinopathy, neuropathy and macrovascular disease. However it was higher in patients with microalbuminuria at 35 (20–53) μmol mmol creatinine−1 than in those with normal protein excretion (25(13–37) μmol mmol creatinine−1 p = 0.03) or those with established proteinuria (18(8–26) μmol mmol creatinine−1 p = 0.001). We conclude that there is evidence of increased bone resorption in diabetes and that this is related to alterations in renal function.
Microalbuminuria as Identified by a Spot Morning Urine Specimen in Non‐insulin‐treated Diabetes: an Eight‐year Follow‐up Study
Authors: Beatty O.L. , Ritchie C.M. , Bell P.M. , Hadden D.R. , Kennedy L. , Atkinson A.B.
Published: July 2009

This study followed up a cohort of patients with microalbuminuria identified on a spot morning urine sample 8 years earlier and aimed to determine if a spot morning urinary albumin concentration was able to identify patients with non‐insulin treated diabetes at increased risk of mortality and progression to nephropathy.

In 1984, 47 of 216 patients chosen by random selection from our teaching hospital‐based diabetes clinic were identified as having microalbuminuria (urinary albumin concentration 35–300 μg ml−1). Subjects were compared with an age‐matched control group from the 1984 cohort who did not have microalbuminuria. Eight years later, 22 of 47 (46.8 %) patients with microalbuminuria had died compared to 10 of 47 (21.3 %) patients without albuminuria (p < 0.05). The majority of deaths were from cardiovascular disease (53.1 %). Logistic regression showed microalbuminuria to be an independent predictor of mortality, not influenced by age, duration of diabetes, blood pressure, glycosylated haemoglobin or creatinine at the initial examination. Eight years later, in the group with initial microalbuminuria, eight still had microalbuminuria and five patients had developed nephropathy. In the group without albuminuria in 1984, only one patient had progressed to microalbuminuria and no patients to nephropathy. In conclusion, a spot urinary albumin concentration is of value in identifying patients with an increased risk of mortality or progression to nephropathy, and is simple to obtain at a clinic.
Multiple Cerebral Haematomata and Peripheral Nerve Palsies Associated with a Case of Juvenile Diabetic Ketoacidosis
Authors: Atkin S.L. , Coady A.M. , Horton D. , Sutaria N. , Sellars L. , Walton C.
Published: July 2009

A 15‐year‐old girl presented de novo in diabetic ketoacidosis having been comatose for 24 h (day 1). A CT scan and lumbar puncture performed on admission were normal and her conscious level slowly improved over several days. On day 7 she had central neurological signs of bilateral knee clonus and an extensor plantar response. In addition, she had developed lower motor neurological signs of an ulnar nerve palsy of the left forearm, and ulnar, median, and radial nerve palsies of the right forearm. Magnetic resonance imaging (MRI), performed on day 12, showed multiple small cerebral haematomata with appearances at least several days of age. The scattered lesions were localized particularly to the parieto‐occipital region, with sparing of the basal ganglia and without cerebral oedema, a novel feature not previously described in juvenile ketoacidosis. Four months later there was minimal residual disability of her right arm. The clinical findings together with the MRI images suggested that the peripheral nerve and central lesions were temporally related, suggesting a common aetiology. However, it is likely that MRI showed cerebral lesions which may have been missed by the conventional CT scanning performed initially.
A Computerized Health Screening and Follow‐up System in Diabetes Mellitus
Authors: Azzopardi J. , Fenech F.F. , Junoussov Z. , Mazovetsky A. , Olchanski V.
Published: July 2009

A computerized population health problem targeting program for diabetes mellitus and other common non‐communicable disease was tested at St Luke's Hospital, Malta. The program utilizes a patient questionnaire by dialogue with a computer lasting about 20 min. The system evaluates and targets health problems that are followed up through the database. During a period of 10 months, two groups of people were screened using the system, consisting of 128 recently diagnosed diabetic patients presenting consecutively and 320 people from the general population. The age distributions of the two groups were similar. The system indicated 27 % of the control group as being within the Diabetes Risk Group; 5 % of this control group were confirmed to have diabetes. Eighty‐two percent of newly referred diabetic patients were detected, giving false positive results in 23 % and a false negative result in 18 % of cases. The classification rules in the system were tuned to the population of Moscow, Russia. We have since adjusted these to better suit the Maltese population. The adjusted rules now indicate 20 % of the general population as being within the risk group and have correctly detected 84 % of the diabetic people, giving a false positive result in 15 % and a false negative result in 16 % of cases.
BOOK REVIEWS
Authors: Fisher B. M. , McDermott Jane
Published: July 2009

Book reviewed in this article:

Key Facts in Diabetes by K. Tim Moriarty

Care of People with Diabetes by Trisha Dunning
Nitric Oxide as a Potential Bridge Between the Metabolic and Vascular Hypotheses of Diabetic Neuropathy
Authors: Stevens M.J.
Published: July 2009

Both metabolic and vascular factors have been invoked in the pathogenesis of diabetic neuropathy but their interrelationships are poorly understood. Both aldose reductase inhibitors and vasodilators improve nerve conduction velocity, nerve blood flow, and (Na+, K+)‐ATPase activity in the streptozotocin diabetic rat, implying a metabolic‐vascular interaction. Nitric oxide may be the ‘bridge’ linking these divergent hypotheses of diabetic neuropathy. We propose a model for the pathogenesis of neuropathy invoking metabolic defects both at a vascular and neurochemical level. Early after the induction of experimental diabetes, metabolic defects may lead to a decrease in synthesis of nitric oxide in either the vascular endothelium or the sympathetic ganglia leading to decreased nerve blood flow. In addition, nitric oxide may be involved in more distal defects of somatic nerve metabolism which impair the activity of the nerve Na/K‐ATPase by a mechanism involving phosphoinositide signaling and diacyl glycerol and may therefore affect nerve conduction velocity independently of ischaemia. Improved understanding of the effects of hyperglycaemia on nitric oxide metabolism, may provide important clues elucidating the mechanisms underlying the pathogenesis of diabetic neuropathy.
Catecholamines and Diabetic Autonomic Neuropathy
Authors: Hilsted J.
Published: July 2009

In diabetic patients with autonomic neuropathy plasma noradrenaline concentration, used as an index of sympathetic nervous activity, is low. This decrease is, however, only found in patients with a long duration of diabetes with clinically severe autonomic neuropathy. This apparent insensitivity of plasma catecholamine measurements is not due to changes in the clearance of catecholamines in diabetic autonomic neuropathy. The physiological responses to infused adrenaline and to noradrenaline are enhanced, for noradrenaline mainly cardiovascular responses. Adrenoceptors (alpha and beta adrenoceptors) are not altered in circulating blood cells in diabetic autonomic neuropathy. Thus, a generalized up‐regulation of adrenoceptors does not occur in diabetic autonomic neuropathy.
Diabetic Neuropathy and the Microcirculation
Authors: Flynn M.D. , Tooke J.E.
Published: July 2009

There is a close relationship between the abnormal microcirculation in diabetic sbjects and diabetic neuropathy. Neurogenic factors play a prominent role in the regulation of the microcirculation. In diabetic neuropathy, damage to these mechanisms results in a profound haemodynamic disturbance with increased arteriovenous shunting, abnormal postural regulation of blood flow, and abnormal inflammatory responses to tissue injury. Abnormal neurogenic regulation of microvascular haemodynamics may contribute to the development of microangiopathy manifest as increased basement thickening and both are undoubtedly implicated in the pathogenesis of diabetic foot ulceration. In turn it is now recognized that microvascular abnormalities may contribute to the ischaemic aetiology of diabetic neuropathy.
Does Abnormal QT Interval Prolongation Reflect Autonomic Dysfunction in Diabetic Patients? QTc Interval Measure Versus Standardized Tests in Diabetic Autonomic Neuropathy
Authors: Veglio M. , Chinaglia A. , Borra M. , Perin P. Cavallo
Published: July 2009

The question as to whether the QTc interval correlates with five cardiovascular tests (deep breathing test, 30/15 ratio test, lying to standing test, cough test, and postural blood pressure test) for the diagnosis of diabetic autonomic neuropathy (DAN) was investigated in 168 (38 Type 1, 130 Type 2) consecutive outpatients (mean age 54.9 ± 11.2 years). QT interval was measured on an ECG recorded at rest and QTc calculated according to Bazett's formula. The percentage of patients with a QTc greater than 0.440 s was: absent DAN = 11% (n = 7), probable DAN = 7% (n = 4), definite DAN = 23% (n = 12) (p < 0.05), and the mean (± SD) QTc values were 0.403 ± 0.028 s, 0.405 ± 0.023 s, and 0.421 ± 0.026 s, respectively. A significant correlation between QTc duration and DAN score of autonomic cardiovascular test results (r = 0.34, p < 0.0001) was observed. The calculated specificity, sensitivity, positive and negative predictive values were 89%, 15%, 70% and 37%, respectively. In conclusion, QTc can be considered as an additional specific test in the assessment of diabetic autonomic neuropathy, but cannot replace the standard battery of cardiovascular tests.
Is ACE Inhibition with Lisinopril Helpful in Diabetic Neuropathy?
Authors: Reja A. , Tesfaye S. , Harris N.D. , Ward J.D.
Published: July 2009

Thirteen diabetic patients with hypertension (mean diastolic blood pressure 96.2 ± 1.1 mmHg) were included in a study to assess the effects of lisinopril (20 mg day−1) on measures of nerve function. Patients had nerve conduction velocity (NCV), temperature discrimination threshold (TDT), and vibration perception threshold (VPT) measurements. At the end of 12 weeks of treatment with lisinopril, there was a significant improvement in median motor NCV (mean change ± SEM 2.7 ± 0.6 m s−1, p < 0.0001), median sensory NCV (2.1 ± 0.9 m s−1, p = 0.03), peroneal motor NCV (1.0 ± 0.4 m s−1, p = 0.03), and sural sensory NCV (1.9 ± 0.7 m s−1 p = 0.01) values. There were also significant improvements in warm TDT and VPT. Diastolic BP decreased significantly, but there was no significant change in HbA1. Double blind controlled studies are now needed to confirm the effect of lisinopril on measures of nerve function.
Good Blood Glucose Control Characterizes Patients Without Retinopathy After Long Diabetes Duration
Authors: Kullberg C.E. , Arnqvist H.J.
Published: July 2009

The importance of blood glucose control for the avoidance of retinopathy was assessed by monitoring glycated haemoglobin for 5 years or more in Type 1 (insulin‐dependent) diabetic patients diagnosed before an age of 31 years, and with a diabetes duration of 20 years or more. They were followed up for an average of 9.4 years with 3.3 measurements per year. Of the 213 included patients, 16 had no retinopathy, 126 had background retinopathy (including 8 with macula oedema) and 71 had proliferative retinopathy. Patients without retinopathy had a mean HbA1c ± SEM for the whole follow‐up period of 6.3 ± 0.19 %, the 117 patients with background retinopathy but not macula oedema 7.0 ± 0.08%; Mann‐Whitney test vs group without retinopathy p = 0.003, macula oedema 7.9 ± 0.31%; p = 0.001, and proliferative retinopathy 7.4 ± 0.09; p < 0.001. The mean duration was 31 years, without significant differences between the groups. In conclusion, these results suggests that good blood glucose control is of major importance to prevent or postpone diabetic retinopathy also after long duration of diabetes, and that no patient with high HbA1c levels for several years is protected from retinopathic lesions.