bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of γ‐Linolenic Acid on Human Diabetic Peripheral Neuropathy: A Double‐blind Placebo‐controlled Trial
Authors: Jamal G.A. , Carmichael H.
Published: July 2009

Twenty‐two patients with distal diabetic polyneuropathy confirmed both clinically and by objective nerve function studies, completed a double‐blind, placebo‐controlled study to assess the effect of dietary supplementation with γ‐linolenic acid on their neuropathy. Patients received either 360 mg γ‐linolenic acid (12 patients) or indistinguishable placebo capsules (10 patients) for 6 months. All patients were assessed at the beginning and end of the study period by neuropathy symptom and sign scoring, motor and sensory nerve conduction studies, and thermal threshold measurements. When compared with the placebo group, patients on γ‐linolenic acid showed statistically significant improvement in neuropathy symptom scores (p< 0.001), median nerve motor conduction velocity (p< 0.01) and compound muscle action potential amplitude (p< 0.01), peroneal nerve motor conduction velocity (p< 0.05) and compound muscle action potential amplitude (p< 0.05), median (p< 0.01) and sural (p< 0.001) sensory nerve action potential amplitude and ankle heat threshold (p< 0.001) and cold threshold (p< 0.01) values. γ‐Linolenic acid therapy might have a useful role in the prevention and treatment of distal diabetic polyneuropathy.
How Effective is Cushioned Therapeutic Footwear in Protecting Diabetic Feet? A Clinical Study
Authors: Chantelau E. , Kushner T. , Spraul M.
Published: July 2009

Therapeutic footwear with cushioned insoles was supplied to 50 diabetic patients with severe peripheral neuropathy and/or peripheral vascular disease (age 59(SD 12) years, known duration of diabetes 17(7) years), 36 of whom had a history of foot ulceration. A follow‐up examination was carried out 25(14) months later, except in 8 patients who died from conditions unrelated to their foot lesions, and 1 patient who died from sepsis due to upper limb amputation. Among the surviving 41 patients, intercurrent foot lesions during follow‐up occurred in significantly fewer (42 %) of the 26 who had worn the shoes regularly than of the 15 who had worn the shoes irregularly (87 %, p < 0.01). At follow‐up, only 15 % of the 41 patients were being treated for foot‐lesions, compared with 78 % of these 41 patients before cushioned shoes were provided. It is concluded that the availability of therapeutic shoes with cushioned insoles for diabetic patients at risk of foot lesions decreases the morbidity due to the diabetic foot syndrome.
Measures of Psychological Well‐being and Treatment Satisfaction Developed from the Responses of People with Tablet‐treated Diabetes
Authors: Bradley C. , Lewis K.S.
Published: July 2009

Psychological outcome measures of Well‐being and Treatment Satisfaction have been designed and developed for people with tablet‐treated Type 2 diabetes. The Well‐being scale includes three six‐item sub‐scales to measure Depression, Anxiety, and Positive Well‐being. A prime consideration when selecting items for the psychological well‐being measures was to minimize the confounding of diabetic symptomatology with the somatic symptoms of depression and anxiety. Cronbach's alpha indicated that each of the Well‐being sub‐scales and the Treatment Satisfaction scale was internally reliable (alphas ranged from 0.70 to 0.88) and evidence for construct validity was provided by predicted associations with other variables collected at the time of the study. For example, lower Well‐being scores were associated with being overweight (Depression: p < 0.05; Anxiety: p < 0.001) while greater Satisfaction with Treatment was associated with lower HbA1 levels (p < 0.001) and lower percent ideal body weight (p < 0.01). These scales should prove particularly useful where measures of quality of life are required to complement metabolic variables when evaluating new treatments, education programmes, and other interventions, or in the routine auditing of established methods of treatment.
The Effect of Ambient Temperature on Glucose Tolerance
Authors: Akanji A. O. , Oputa R. N.
Published: July 2009

Standard (75 g) oral glucose tolerance tests were performed at two different ambient temperatures (23 and 33°C) in random order in 16 (eight obese) diabetic and 16 (eight obese) non‐diabetic Nigerian subjects. Consistently higher plasma glucose values were found 120 min post‐glucose ingestion at 33°C, with mean differences of 0.5 (SE 0.3) and 4.5 (SE 1.5) mmol l−1 in the non‐diabetic and diabetic subjects, respectively. This caused reclassification of two of the non‐diabetic subjects as Impaired Glucose Tolerance at 33°C, applying the WHO criteria. The difference was consistently greater (p < 0.01) in the non‐obese subjects (non‐diabetic 0.8 (0.4), diabetic 6.9 (2.8) mmol l−1) than in the obese (non‐diabetic 0.2 (0.4), diabetic 2.1 (0.9) mmol l−1). In the diabetic subjects, a negative correlation (r = −0.50, p < 0.01) was established between the difference and the body mass index. This variability in responses to ambient temperature between the obese and non‐obese subjects could be due to a variable influence of heat on arm blood flow consequent on differences in amounts of subcutaneous fat. The ambient temperature for the conduct of the oral glucose tolerance test is important.
Public Awareness of the Symptoms of Diabetes Mellitus
Authors: Jackson D. M. A. , Wills R. , Davies J. , Meadows K. , Singh B. M. , Wise P. H.
Published: July 2009

A cross‐sectional survey by standard questionnaire was conducted to determine the public's knowledge (n = 480) of diabetes and diabetes symptoms. Four hundred and sixty‐two (96%) subjects had heard of diabetes, 350 (73%) could give a rudimentary definition of diabetes, but 231 (48%) were unable to name any symptom and only 20 (4%) knew of thirst and polyuria in combination. The public's knowledge of diabetes symptoms is poor. This may possibly contribute to delayed presentation of Type 2 diabetes.
Patients with Type 1 Diabetes Adapt Acutely to Sustained Mild Hypoglycaemia
Authors: Kerr D. , Macdonald I. A. , Tattersall R. B.
Published: July 2009

The relationship between awareness of, and the catecholamine response to, sustained mild hypoglycaemia was examined in six well‐controlled Type 1 diabetic patients (age 24–41 years, HbA1 < 10.0%) using a hyperinsulinaemic clamp. Blood glucose was maintained at 2.8 mmol I−1 for 90 min with a euglycaemic (4.5 mmol I−1) clamp as a control. After 40 min at a blood glucose of 2.8 mmol I−1, symptom score had increased from 0.2 ± 0.2 (± SE) to 3.0 ± 0.8 (p < 0.01), cognitive function (measured by reaction time) deteriorated by 55 ± 20 ms, and four patients ‘felt hypoglycaemic’. This was associated with a rise in plasma adrenaline from 0.48 to 1.30 nmol I−1 (p < 0.01). However when hypoglycaemia was prolonged to 90 min, symptom score decreased to 1.8 ± 0.2, none ‘felt hypoglycaemic’, and reaction time improved by 30 ± 12 ms, despite a progressive rise in plasma adrenaline to 1.62 nmol I−1. Thus, despite high levels of adrenaline, diabetic patients develop reduced symptoms and no longer ‘feel hypoglycaemic’ during sustained mild hypoglycaemia.
The Relationship Between Stress and the Development of Diabetic Complications
Authors: Lloyd C. E. , Robinson N. , Stevens L. K. , Fuller J. H.
Published: July 2009

Using the Life Events and Difficulties Schedule of Brown and Harris, the relationship between preceding stress and the onset of diabetic complications and premature death was investigated prospectively in a random sample of 130 patients with diabetes, aged 35–59 years. The presence of stress, assessed as severe life‐events and severe long‐term difficulties, was not significantly associated with premature death or the onset of macrovascular disease over the relatively short period of follow‐up (4 years). Those who commenced anti‐hypertensive therapy during the follow‐up period were significantly more likely to have experienced five or more severe life‐events during the previous 5 years (40 vs 6%, p < 0.01), and also to have experienced one or more severe long‐term difficulties during the same time period (60 vs 28%, p < 0.05). A multiple Cox regression analysis showed that the effects of stress were independent of other factors such as baseline blood pressure, type of diabetes, sex, and ethnic group.
A Protocol for Screening for Diabetic Retinopathy in Europe
Authors:   Retinopathy Working Party
Published: July 2009

Diabetic eye complications, and particularly diabetic retinopathy, are the major cause of blindness in the working age groups of industrialized countries. Laser photocoagulation has been proven to reduce blindness due to retinopathy by at least 60 % but even more patients would benefit if treatment were delivered at an early enough stage. High‐risk retinopathy, though, may not cause visual symptoms, and when the latter occur it is often too late to reverse them. Hence, a screening programme for diabetic retinopathy should aim at detecting patients at risk when they can still be effectively treated. This can be achieved by regularly checking the patients' eyes. The screening programme's target, as defined by the joint World Health Organization/International Diabetes Federation Saint Vincent Declaration Working Group, is to reduce diabetes‐related blindness by one‐third or more in the next 5 years. The number of individuals to be screened is high, 30000 per million total population per year, but available data indicate that this is feasible and that the initial investments in professional and material resources are more than justified by the reduction of preventable blindness and of the financial burdens that go with it. Indeed, prevention of the major cause of blindness in the working age group should rate the same priority as other widely deployed programmes, such as those to screen for cancer, neonatal hypothyroidism, and phenylketonuria. The concerted action of government health departments, patients' and professional associations will be vital for the successful implementation of this programme. The texts of this document (a protocol for the screening of diabetic retinopathy and cataract), Appendix 1 (information leaflet for the patients), and Appendix 2 (data collection card) were approved by 57 specialists, representing 30 diabetic and ophthalmic societies from 21 European countries, and endorsed for translation into all European languages and distribution at the appropriate levels.
Activation of Coagulation in Diabetes Mellitus in Relation to the Presence of Vascular Complications
Authors: Ford I. , Singh T.P. , Kitchen S. , Makris M. , Ward J.D. , Preston F.E.
Published: July 2009

To examine the relationship between diabetic vascular disease and haemostasis, a set of sensitive assays has been used to assess in vivo activation of coagulation in 62 diabetic patients (41 Type 1 and 21 Type 2), aged 19–68 years, who had been screened for the presence of complications. Fibrinopeptide A, an index of thrombin activity, was significantly increased in diabetic patients compared with control subjects (p<0.05), in both plasma (with complications mean 8.04 ± 11.87 (± SD); without complications 7.21 ± 10.13; control subjects 2.11 ± 1.40 μg l−1) and urine (with complications mean 1.48 ± 0.74; without complications 1.35 ± 0.62; control subjects 0.98 ± 0.39 μg l−1). Activated factor VII (VIIa ratio 1.21 ± 0.39; 1.13 ± 0.23; 1.01 ± 0.11) and fibrinogen (3.15 ± 0.59; 3.11 ± 0.69; 2.70 ± 0.57 g I−1) were also elevated in diabetic patients with and without complications (VIIa p<0.05, fibrinogen p<0.01). The only difference between Type 1 and Type 2 patients was in fibrin degradation products (Type 1 0.28 ± 0.18; Type 2 0.40 ± 0.18 mg I−1, p<0.01). Plasma levels of fibrin degradation products were elevated in diabetic patients (p<0.05 vs control subjects), and correlated with age (r=0.44, p<0.01) but were unrelated to the presence of complications. There were no significant differences in any coagulation variables between diabetic patients with and without complications. HbA1 was correlated with fibrin degradation products only (r=0.30, p<0.05), and there were no correlations with current blood glucose concentration. Our results show activation of the coagulation system in diabetes which precedes the appearance of clinically detectable complications and suggests early vascular damage.
The Effects of Diet and Insulin Therapy on Coagulation Factor VII, Blood Viscosity, and Platelet Release Proteins in Diabetic Patients with Secondary Sulphonylurea Failure
Authors: Jennings A. M. , Ford I. , Murdoch S. , Greaves M. , Preston F. E. , Ward J. D.
Published: July 2009

The effect of intensified dietary measures and subsequently insulin therapy upon haemorheological measures were studied in Type 2 diabetic patients with secondary sulphonylurea failure. Coagulation factors VIIc and VIIIc, fibrinogen, plasma viscosity, whole blood viscosity, β‐thromboglobulin, platelet factor 4, von Willebrand factor, and euglobulin clot lysis time were measured at baseline, after 3 months intensified dietary therapy and after 4 months insulin therapy. During intensified dietary therapy there was a significant fall in serum cholesterol (p < 0.05) and a small decrease in weight, but no significant change in blood glucose control. Factor VIIc levels fell significantly (1.22 (SE 0.07) vs 1.42 (0.08) u ml−1, p < 0.01), and plasma viscosity and whole blood viscosity (23 s−1) also improved (both p < 0.05). Insulin therapy was instituted with either continuous subcutaneous insulin therapy or twice daily injections of soluble and isophane (NPH) insulin. During this period glycosylated haemoglobin improved (mean (SE) 49.5 (1.4) vs 65.0 (2.1) mmol‐HMF mol‐Hb−1 p < 0.001; normal range 29–39 mmol‐HMF mol‐Hb−1) as did serum triglyceride (p < 0.01), but weight increased (p < 0.001). The only haemorheological changes with insulin were increased levels of the platelet release proteins β‐thromboglobulin (37 (3) vs 28 (2) μg l−1 p < 0.01) and platelet factor 4 (median 7.5 (range 3.0–18.0) vs 4.5 (2.0–10.5) μg l−1, p < 0.01).
Prevalence and Incidence of Diabetes in a Swedish Community 1972–1987
Authors: Andersson D. K. G. , Svärdsudd K. , Tibblin G.
Published: July 2009

The prevalence and incidence of diabetes mellitus were studied from 1972 to 1987 in Laxå, a rural community with 8500 inhabitants located in mid‐Sweden. Data were collected from clinical records at the primary health care centre in Laxå, from departments of internal medicine and paediatrics and from a general practitioner's office in the area. In addition, a case finding procedure involving 85 % of the residents aged 35–79 years was performed in 1983–1987. The age‐standardized prevalence of diabetes rose significantly (p < 0.001) from 26 per 1000 in 1972 to 43 per 1000 in 1987. The largest rise in prevalence for males occurred in the age group 45–54 years and for females in the age group 65–74 years. The age‐standardized mean annual incidence of diabetes was 3.46 per 1000 population. A small (non‐significant) increase in incidence of Type 2 diabetes over time was seen in men which may in part be an effect of the case finding strategy. The overall incidence rates thus appeared to be rather stable while the prevalences tended to increase, probably mainly due to earlier detection of diabetic individuals in recent years, leaving a larger number of patients with a longer duration of diabetes to be cared for in the future.
Prevalence of Diabetes and Obesity in the Adult Population of the Seychelles
Authors: Tappy L. , Bovet P. , Shamlaye C.
Published: July 2009

The prevalence of diabetes and obesity were assessed in an age‐ and sex‐stratified sample of 1078 individuals living in Mahé, The Republic of Seychelles. Presence or absence of diabetes mellitus was assessed by measuring glucose concentration in fasting venous blood. Prevalence of obesity (standardized for age) was elevated five‐fold in women compared with men (20.9 vs 4.2 %). In women, it increased from 8.9 % at age 25–34 years to 29.4 % at age 35–44 years and plateaued thereafter, whereas it did not change with age in men. Prevalence of diabetes (standardized for age) was 3.4 % for men and 4.6 % for women. It increased markedly with age, from 0.0 and 0.8 % at age 25–34 years to 8.8 and 13.4 % at age 55–64 years in men and women, respectively. A strong association of diabetes with excess body weight was observed. Most cases of diabetes can be attributed to Type 2 (non‐insulin‐dependent) diabetes. Fifty‐five percent of diabetic individuals were unaware of their disease at the time of the survey.
Initiation of Insulin Treatment after 70 Years of Age: Patient Status 2 Years Later
Authors: Elgrably F. , Costagliola D. , Chwalow A.J. , Varenne P. , Slama G. , Tchobroutsky G.
Published: July 2009

The present study assessed 106 diabetic patients 2 years after beginning insulin treatment at or after 70 years of age. Ten patients (9%) had had the therapy discontinued after 2–4 months, 26 (25%) had died of causes unrelated to insulin therapy, 12 (11%) were lost to follow‐up, and 58 (55%) were still alive and insulin treated. Fifty‐one were at home and seven institutionalized for reasons unrelated to insulin therapy. Of these 58 patients, 50 were available for further study. Except for frequency of travel, which had decreased, lifestyle either improved or did not change. Patients' preceptions of the goals of treatment were more appropriate to a younger population of patients, who are less vulnerable to hypoglycaemic reactions. Mean fasting blood glucose was considered by the medical staff to be too low in 42% of cases. Adding insulin to the treatment of the elderly did not negatively affect their lifestyle, and indeed, insulin therapy appeared to create or strengthen the patients' existing social support network. Educational interventions must attempt to extend the effect of the specialized unit outside the hospital, to families, visiting nurses as well as general practitioners.
Outcome of Pregnancy in Diabetic Patients in Dar es Salaam, Tanzania
Authors: Lutale J. K. , Justesen A. , Lema R. S. M. , Swai A. B. M. , McLarty D. G.
Published: July 2009

Between 1 June 1986 and 31 August 1987 all 47 pregnant diabetic Tanzanian women attending Muhimbili Medical Centre, Dar es Salaam were seen and managed by a small team of interested physicians and obstetricians. Of the 50 pregnancies there were 44 (88%) live births, five (10%) perinatal deaths, and one (2%) spontaneous abortion. One child was born with a serious congenital abnormality. All five perinatal deaths were seen in women who presented late in pregnancy (three) or had poor blood glucose control (two). In 10 (36%) of the 28 pregnancies in the 25 patients with insulin‐requiring diabetes, insulin requirements decreased > 8 U during the course of pregnancy. The present study suggests that with close supervision of the pregnant diabetic patient in Africa perinatal mortality rates approaching those seen in developed countries can be achieved, despite the lack of home blood glucose monitoring. Rates could be further reduced if medical services were more widely available, and if all patients were educated on the importance of early presentation in pregnancy.
The Cost of Hospitalization for the Late Complications of Diabetes in the United States
Authors: Jacobs J. , Sena M. , Fox N.
Published: July 2009

Estimates of the cost of diabetes should take into account the development of complications. Patient records identified from the 1987 National Hospital Discharge Survey were used to evaluate the risk of hospitalization due to late complications. Hospitalization for diabetic nephropathy reached a peak of 6.74/1000 between the ages of 45 and 54 years, compared to 0.14 to 1.80/1000 in controls. Diabetic patients ≥ 45 years of age were 46 times more likely to be hospitalized due to neuropathy. The risk of cardiovascular complications is high, with a greater incidence of arterial than venous disorders. Diabetic patients were 22 times more likely to be admitted for skin ulcers/gangrene, 15 times more likely due to peripheral vascular disease, and 10 times due to atherosclerosis. The risk of cerebrovascular accident and heart disease was 6 to 10 times greater in diabetic patients. Seventy‐five per cent of diabetic cardiovascular disorders are myocardial infarction or chronic ischaemia. Hospitalization from renal complications occurs at younger ages than in the general population. Ophthalmic complications increase with age. Diabetic complications account for 2% of the total hospital admissions in the US in 1987. The total cost of the treatment of late diabetic complications was estimated at $5091 million (cardiovascular 74%; renal diseases 10%; nephropathy 3.6%; ophthalmic disorders 1.5%; other unspecified diseases 10%).
Hyperglycaemia, Hypoglycaemia, and Blood Glucose Control in Diabetes: Symptom Perceptions and Treatment Strategies
Authors: Polonsky William H. , Davis C.L. , Jacobson A.M. , Anderson B.J.
Published: July 2009

Recent research has suggested that patients with Type 1 diabetes who are in chronically poor blood glucose control perceive hyperglycaemia differently from those who are in good control. To extend these observations 181 insulin‐treated patients with Type 1 or Type 2 diabetes were studied. Patients completed a self‐report questionnaire which included items concerning feelings about high and low blood glucose levels and strategies for maintaining blood glucose control. Glycosylated haemoglobin levels were also measured. We hypothesized that level of blood glucose control would: (1) be associated with perceptions of hyperglycaemia and treatment strategies for managing hyperglycaemia and (2) not be associated with perceptions and strategies concerning hypoglycaemia. In comparison with those in ‘acceptable’ or ‘poor’ blood glucose control, those in ‘good’ control perceived symptoms of hyperglycaemia at lower blood glucose levels (p < 0.001) and felt physically best at lower blood glucose levels (p < 0.001). They also began treatment for hyperglycaemia at lower glucose levels (p < 0.05), set lower minimal (p < 0.001) and maximal (p < 0.001) glucose levels as treatment goals, and tested their blood glucose levels more frequently (p < 0.05). Among Type 1 diabetic patients, those in ‘good’ control reported experiencing hypoglycaemia at lower glucose levels than those in ‘acceptable’ or ‘poor’ control (p < 0.05). No differences in treatment strategies of hypoglycaemic symptoms were apparent. This study suggests an influence of patients' perceptions of symptoms and treatment in self‐care of diabetes.
Mortality of All Incident Cases of Diabetes Mellitus in Sweden Diagnosed 1983–1987 at Age 15–34 Years
Authors: Nyström L. , Östman J. , Wall S. , Wibell L. ,   The Diabetes Incidence Study in Sweden (DISS) Group
Published: July 2009

From 1983 all incident cases of diabetes in the age group 15–34 years in Sweden have been recorded prospectively. The aim of the present study was to assess the mortality pattern of cases reported for 1983–87 and followed until the end of 1987. Eighteen deaths were identified by linkage to the national death register. When comparing the mortality in the cohort with Swedish males and females in general, an excess mortality was found in all the groups studied. It is, however, less pronounced if the analysis is restricted to those with Type 1 diabetes (standardized mortality ratio (SMR) and 95% confidence interval=2.1; 0.8, 4.6), Type 2 diabetes (SMR=4.8; 1.3, 12.3) or Type 1 + Type 2 (SMR=2.7; 1.3, 5.0). Eight (44%) of the deaths were in patients with secondary diabetes, a diagnosis that applied to less than 3% of the cohort. Alcohol abuse was prevalent in six cases and suspected in another two. Hypoglycaemia was established as a cause of death in only one case but could not be excluded in a further six. Only one death was associated with ketoacidosis. No valid support for an increased risk of the ‘dead in bed’ syndrome was found. We suggest that diabetes was decisively important for the death in two cases and less important in 10. In the remaining six cases the existing documentation precludes a proper judgement.
The Use of Low Glycaemic Index Foods Improves Metabolic Control of Diabetic Patients over Five Weeks
Authors: Fontvieille A.M. , Rizkalla S.W. , Penfornis A. , Acosta M. , Bornet F.R.J. , Slama G.
Published: July 2009

The aim of the present study was to determine whether any benefit might occur from lowering the glycaemic index of diet in the medium term in diabetic patients. Eighteen well‐controlled diabetic patients (12 Type 1 and 6 Type 2 non‐insulin‐treated), were assigned to either a high mean glycaemic index or low mean glycaemic index diet for 5 weeks each in a random order using a cross‐over design. The two diets were equivalent in terms of nutrient content and total and soluble fibre content. The glycaemic indices were 64 ± 2 (mean ± SD) % and 38 ± 5% for the two diets. The high glycaemic index diet was enriched in bread and potato and the low glycaemic index diet in pasta, rice, and legumes. At the end of the study periods, the following variables were improved on the low compared to the high glycaemic index diet: fructosamine (3.9 ± 0.9 vs 3.4 ± 0.4 mmol I−1, p < 0.05); fasting blood glucose (10.8 ± 2.8 vs 9.6 ± 2.7 mmol I−1, p < 0.02); 2‐h postprandial blood glucose (11.6 ± 2.9 vs 10.3 ± 2.5 mmol I−1 p < 0.02); mean daily blood glucose (12.0 ± 2.5 vs 10.4 ± 2.7 mmol I−1, p < 0.02); serum triglycerides (1.5 ± 0.9 vs 1.2 ± 0.6 mmol I−1, p < 0.05). No significant differences were found in body weight, HbA1C, insulin binding to erythrocytes, insulin and drug requirements, and other circulating lipids (cholesterol, HDL‐cholesterol, phospholipids, Apolipoprotein A1, Apolipoprotein B). Thus the inclusion of low glycaemic index foods in the diet of diabetic patients may be an additional measure which slightly but favourably influences carbohydrate and lipid metabolism, requires only small changes in nutritional habits and has no known deleterious effects.
Beneficial Effect of a Low Glycaemic Index Diet in Type 2 Diabetes
Authors: Wolever T.M.S. , Jenkins D.J.A. , Vuksan V. , Jenkins A.L. , Buckley G.C. , Wong G.S. , Josse R.G.
Published: July 2009

Low glycaemic index foods produce low blood glucose and insulin responses in normal subjects, and improve blood glucose control in Type 1 and well‐controlled Type 2 diabetic patients. We studied the effects of a low glycaemic index diet in 15 Type 2 diabetic patients with a mean fasting blood glucose of 9.5 mmol I−1 using a randomized, crossover design. Patients were given pre‐weighed diets (59% energy as carbohydrate, 21% fat, and 24g 1000‐kcal−1 dietary fibre) for two 2‐week periods, with a diet glycaemic index of 60 during one period and 87 during the other. On the low glycaemic index diet, the blood glucose response after a representative breakfast was 29% less than on the high glycaemic index diet (874 ± 108 (± SE) vs ± 204 ± 112 mmol min I−1; p < 0.001), the percentage reduction being almost identical to the 28% difference predicted from the meal glycaemic index values. After the 2‐week low glycaemic index diet, fasting serum fructosamine and cholesterol levels were significantly less than after the high glycaemic index diet (3.17 ± 0.12 vs 3.28 ± 0.16 mmol I−1 p < 0.05, and 5.5 ± 0.4 vs 5.9 ± 0.5 mmol I−1, p < 0.02, respectively. Urinary C‐peptide excretion, as an index of insulin secretion, was 30% lower on the low than the high glycaemic index diet (2.05 ± 0.30 vs 2.93 ± 0.49 nmol mmol‐creatinine−1; p < 0.02), urinary urea was reduced by 19% (347 ± 27 vs 402 ± 39 mmol 24‐h−1; p < 0.025), consistent with enhanced colonic fermentation. These results suggest that low glycaemic index starchy foods may be beneficial in the treatment of Type 2 diabetes.
Evaluation of Type 1 Diabetes in Black African‐heritage Populations: No Time for Further Neglect
Authors: Tull E.S. , Makame M.H. ,   Diabetes Epidemiology Research International Group
Published: July 2009

Heritage studies involving populations that share a common genetic background but reside in different geographic areas have provided important insights into the aetiology of Type 1 diabetes. While Type 1 diabetes heritage research has focused on Iberian, Arab, Italian, Indian (Asian), and Oriental groups, little attention has been paid to the evaluation of the disease in populations with black African ancestry. Epidemiological data on the occurrence of Type 1 diabetes in New World black populations have thus far been limited to a few studies conducted mainly in African‐Americans. Moreover, much of the available data is not population‐based and are of limited value for making generalizations about the black populations studied. Despite the limitations, there is evidence that these populations may be important for studying the aetiology and natural history of Type 1 diabetes. Increased research in this area is warranted and should be based on population‐based cohorts.
An Audit of the Management and Outcome of Hospital Inpatients With Diabetes: Resource Planning Implications for the Diabetes Care Team
Authors: Masson E.A. , MacFarlane I.A. , Power E. , Wallymahmed M.
Published: July 2009

In order to assess the outcome of hospitalized diabetic patients in an urban health district the notes of a cohort identified from a survey of all inpatients on a single day in spring 1990 were reviewed. One hundred and ten cases were reviewed (8.4% of all inpatients); median age 73 years (range 26–99), 59 female. Fifty‐five percent were medical patients (general or geriatric) and 16% were general surgical. Six remained inpatients after 6 months. Sixteen died, of whom 10 had macrovascular disease. Median length of stay was 22 days (2–300), significantly above the district average in all specialties (< 10 days). Of 15 patients with foot problems, 5 died and 3 had major amputations. Only 23% of all patients had documented evidence of screening for diabetic complications. The discharge diagnoses failed to acknowledge diabetes in 54 cases (including 10 deaths). Only 10% had formal advice from the diabetes team and subsequent audit revealed that metabolic management was commonly suboptimal in non‐physician units. These data suggest that inpatient diabetes is costly and carries a high mortality. The incidence is substantially underestimated by conventional episode statistics. The evidence from this cohort of diabetic inpatients suggests that improved communication and recognition of the importance of diabetes could usefully contribute to the quality of care achieved.
Diabetes Self Help Facilitated by Local Diabetes Research: The Coventry Asian Diabetes Support Group
Authors: Simmons D.
Published: July 2009

Diabetic South Asians know less about the nature of diabetes than Europeans. In view of the difficulties in communicating with diabetic South Asians in a clinical environment, a ‘self help group’ was established. The group was initially resourced by the Coventry Diabetes Study, became independent after 2 years and has met monthly for 4 years. Meetings are led and organized by local diabetic South Asians and include invited speakers and discussions. All meetings are held in one of the South Asian languages, particularly Punjabi. Attendance has ranged from 15 to 50, almost exclusively from the surveyed diabetic population of one electoral ward. Those with a high glycated haemoglobin (HbA1 > 9.5%) were assessed 12 months after invitation to the group, 44% (22/51) of whom attended at least twice. Those living over 1 mile from the meeting place and those speaking a minority language were least likely to attend. Those who attended the group had a greater drop in HbA1 and increase in ‘knowledge score’ than those not attending (both p < 0.01). The continued existence of the group illustrates the ability of local health workers to facilitate and empower local communities to become more responsible for their own health.
Prescribed Versus Unrestricted Carbohydrate Diets in Children with Type 1 Diabetes
Authors: Price K.J. , Lang J.D. , Eiser C. , Tripp J.H.
Published: July 2009

The diets of 53 children over 8 years of age with diabetes mellitus were examined by 24 h recall. Thirty‐seven had been on prescribed carbohydrate diets while 16 had been on an unrestricted carboydrate diet since diagnosis. The mean intakes of energy (prescribed 9.1 MJ, unrestricted 9.0 MJ, p = 0.66), carbohydrate (prescribed 259 g, unrestricted 251 g, p = 0.64), fat (prescribed 99.8 g, unrestricted 98.2 g, p = 0.84) and fibre (prescribed 29.2 g, unrestricted 31.0 g, p = 0.42) were not significantly different between the two groups. Both groups showed similar distribution of carbohydrate through the day and considerable day to day variation in their carbohydrate intake (coefficient of variation, prescribed 14.5%, unrestricted 14.1%, p = 0.87). Those on prescribed diet had a mean carbohydrate intake which exceeded their prescription by 36%. Both groups had above average fibre intake suggesting that qualitative advice was being followed. There were no significant differences between the two groups in metabolic control (HbA1 prescribed 12.4%, unrestricted 11.9%, p = 0.23), body mass index (prescribed 19.8 kg m−2, unrestricted 20.4 kg m−2) or insulin dosage (prescribed 1 unit kg−1 day−1, unrestricted 0.9 units kg−1 day−1). This study has shown no differences between prescribed and unrestricted carbohydrate diets. Qualitative, rather than quantitative advice may be more appropriate in the management of Type 1 diabetic children.
Alternative Medicine: Potential Dangers for the Diabetic Foot
Authors: Ewins D.L. , Bakker K. , Young M.J. , Boulton A.J.M.
Published: July 2009

Two patients with non‐insulin‐dependent diabetes mellitus and previously undiagnosed peripheral neuropathy consulted separate practitioners in alternative medicine with symptoms of painful cold feet. They both received the traditional Chinese therapy of moxibustion and subsequently developed painless ulceration at the sites of treatment on the feet and legs. These cases re‐emphasize the dangers of trauma to the neuropathic limb in patients with diabetes.
Persisting Mortality in Diabetic Ketoacidosis
Authors: Basu A. , Close C.F. , Jenkins D. , Krentz A.J. , Nattrass M. , Wright A.D.
Published: July 2009

An overall hospital mortality rate of 3.9% was found in 929 episodes of diabetic ketoacidosis treated in single centre over a 21‐year period. The mortality rate in the first half of the survey (4.4%) was not significantly different from that in the second half of the survey (3.4%). Six deaths in patients under 50 years of age occurred in the first half, but only one death under 50 years occurred in the second half of the survey. The number of deaths from a metabolic cause where no other illness was identified also fell from nine (43% of deaths) in the first half to five (33% of deaths) in the second half of the study (not significant). The remaining deaths were due to concurrent illness, mainly myocardial infarction and serious infections. Many of the residual deaths occurred in elderly patients with such medical illness in addition to the ketoacidosis. It may, therefore, prove difficult to reduce mortality further in diabetic ketoacidosis.
Diet Treatment of Newly Presenting Type 2 Diabetes Improves Insulin Secretory Capacity, but Has No Effect on Insulin Sensitivity
Authors: Hosker J.P. , Kumar S. , Gordon C. , Bhatnagar D. , France M. , Boulton A.J.M.
Published: July 2009

Fifteen newly diagnosed obese Type 2 diabetic subjects were treated with diet alone for 3 months with a median 1.5 kg weight loss. Each had a Continuous Infusion of Glucose with Model Assessment (CIGMA) test, at diagnosis and at 3 months, measuring insulin and C‐peptide responses, and deriving mathematically modelled measures of beta‐cell function and insulin sensitivity. Median fasting glucoses were 9.6 mmol l−1 at diagnosis and 8.5 mmol l−1 at 3 months (NS). Median fasting insulin was 9.3 mU l−1 at diagnosis and 11.7 mU l−1 at 3 months (NS). Median fasting C‐peptide was 0.58 nmol l−1 at diagnosis and 0.64 nmol l−1 at 3 months (p < 0.05). Median achieved plasma insulin increased from 13.8 mU l−1 at diagnosis to 17 mU l−1 at 3 months (p < 0.02); median achieved plasma C‐peptide increased from 0.72 nmol l−1 at diagnosis to 0.81 nmol l−1 at 3 months (p < 0.002). Modelled beta‐cell function rose from median 26 % at diagnosis to 37 % at 3 months (p < 0.02). Modelled insulin sensitivity showed no significant change (median 0.31 at diagnosis, 0.27 at 3 months, NS). Elevation of achieved C‐peptide was positively correlated with weight loss (Rs = 0.53, p < 0.05), but not with change in fasting glucose. Diet treatment of newly diagnosed Type 2 diabetes, with modest weight loss, results primarily in improvement of insulin secretory capacity, rather than insulin sensitivity.
Emphysematous Pyelonephritis: A Case Report and Review of the Literature
Authors: Pappas S. , Peppas Th. A. , Sotiropoulos A. , Katsadoros D.
Published: July 2009

Emphysematous pyelonephritis is a rare and life‐threatening suppurative infection of renal parenchymal and perirenal tissues, characterized by spontaneous gas production. Although uncommon (76 cases in the literature), it occurs almost exclusively in diabetic patients (87 % of the cases). We describe a recent case of a diabetic woman with emphysematous pyelonephritis due to E. coli, successfully managed with unilateral nephrectomy. Symptoms, diagnostic approach and management are discussed and related to the previously reported series.
Absorption of Radiolabeled Soluble Insulin in Type 1 (Insulin‐dependent) Diabetes: Influence of Subcutaneous Blood Flow and Anthropometry
Authors: Vora J.P. , Burch A. , Peters J.R. , Owens D.R.
Published: July 2009

The rate of absorption of soluble insulin, and its relationships with subcutaneous blood flow (SCBF) and patients' anthropometry, were investigated in 12 male Type 1 (insulin‐dependent) diabetic patients of less than 10 yr disease duration (age range: 23–29 yr; body mass index (BMI): 22.2–30.8 kg m−2). Simultaneous assessment of the absorption of 125I‐labelled soluble insulin and SCBF (99mTechnetium clearance) were performed, on separate study days, for the anterior abdominal wall, anterior mid‐thigh, and the upper arm injection sites. Absorption of 125I soluble insulin, including during the lag‐phase, was determined by the two‐ and three‐parameters biexponential models description of residual radioactivity levels at the injection site. Anthropometric measurements utilized were: BMI, ultrasonic measurement of the subcutaneous adipose tissue layer, and caliper skinfold thickness at anterior abdominal wall, biceps, triceps, anterior mid‐thigh and subscapular sites. Rate‐constants for absorption of soluble insulin were positively correlated with SCBF (Spearman rank coefficient (rs) = 0.33‐0.55; p < 0.01‐0.001). An inverse relationship was observed between the duration of the lag‐phase and SCBF (rs = −0.28‐ −0.54; p < 0.05‐0.001). Patients' degree of adiposity was inversely correlated with the rate of soluble insulin absorption (rs = −0.24‐ −0.28; p < 0.05) and SCBF (rs = −0.28‐ −0.43; p < 0.05‐0.001). Consequently, faster absorption of soluble insulin, with shorter lag‐phase duration, was noted for the abdominal and thigh sites for non‐obese (BMI > 25 kg m−2) than obese patients (BMK 27.5 kg m−2) (p < 0.05–0.01). In Type 1 (insulin‐dependent) diabetic patients, the rate of absorption of soluble insulin, including during the lag‐phase, is positively correlated with subcutaneous blood flow. Increasing adiposity prolongs the duration of the early lag‐phase and reduces the rate of absorption of soluble insulin and subcutaneous blood flow.
Is Serum Anhydroglucitol an Alternative to the Oral Glucose Tolerance Test for Diabetes Screening?
Authors: Robertson D.A. , Alberti K.G.M.M. , Dowse G.K. , Zimmet P. , Tuomilehto J. , Gareeboo H. ,   for the Mauritius Noncommunicable Diseases Study Group
Published: July 2009

The oral glucose tolerance test is inconvenient for diabetes screening. In clinical studies a reduced serum anhydroglucitol level has proved to be a sensitive and specific test for diabetes. A new minicolumn enzymatic method which is simple and robust makes use in population screening feasible. The aim of our study was to assess the usefulness of a single measurement of anhydroglucitol to screen for diabetes and impaired glucose tolerance. Assays were performed on samples taken from 227 Mauritian Chinese subjects at the time of glucose tolerance testing. Subjects had normal glucose tolerance (n = 82), impaired glucose tolerance (n = 76), newly diagnosed diabetes (n = 38), and known diabetes (n = 31). Anhydroglucitol concentrations (mean ± SD) were similar for normal and impaired glucose tolerance subjects (23.7 ± 8.2 vs 23.4 ± 8.6 mg l‐1). Although the differences between normal and newly diagnosed diabetes (15.0 ± 11.0 mg l‐1) and known diabetic subjects (11.8 ± 10.6 mg l‐1) were significant (p < 0.001), diagnostic sensitivity and specificity were poor. We conclude that measurement of serum anhydroglucitol is not suitable for screening for the diagnoses of impaired glucose tolerance and diabetes.
Evidence for an Increase in the Prevalence of Known Diabetes in a Sample of an Urban Population in Greece
Authors: Katsilambros N. , Aliferis K. , Darviri Ch. , Tsapogas P. , Alexiou Z. , Tritos N. , Arvanitis M.
Published: July 2009

It is accepted that the prevalence of known diabetes mellitus has increased in some countries, although the available data are incomplete and sometimes anecdotal. In 1974 a sample of the urban population (n = 21410) in a suburb of Athens (Greece) was evaluated for the prevalence of known diabetes mellitus. The study was repeated 17 years later in the same area under the same conditions and methodology on 12 836 randomly selected inhabitants (both sexes, all ages). Visiting nurses contacted the inhabitants at home and filled in a questionnaire. The results show a clear increase in diabetes prevalence of the population as a whole (standardized rates: 1974:2.4 % (95 % confidence intervals 2.2‐2.6 %) 1990: 3.1 (2.8‐3.4 %)). Standardization was done on the basis of data obtained from the same census. The changes were statistically significant in the 50–59, 60–69, and 70–79 age groups (1974: 5.87, 10.98, and 11.41 %; 1990: 7.70, 13.68, and 19.52 %, respectively). Thus, the prevalence of known diabetes mellitus has considerably increased during the last 17 years in a sample of urban Greek population.
An Audit of Cushioned Diabetic Footwear: Relation to Patient Compliance
Authors: Chantelau E. , Haage P.
Published: July 2009

The recurrence rate of neuropathic foot ulcers is reported in 51 diabetic patients regularly attending a diabetic foot clinic. All of the patients were provided with protective footwear reducing peak plantar pressure at the forefoot area by 50% (versus normal shoes), and were followed up for up to 4 years. Compliance with this footwear was recorded by assessing the daily time of wearing protective or normal shoes, and compliance with foot care was recorded from the entries in the patients charts. The results of this observational study demonstrate that wearing protective shoes for > 60% of the daytime significantly (p = 0.0002) reduced the ulcer relapse rate by > 50% in comparison with shorter wearing times for these shoes. In addition, patients without ulcer relapses had foot care significantly more frequently than patients with relapse (p < 0.05). It is concluded that cushioned protective footwear in association with frequent foot care is essential in the prevention of neuropathic diabetic foot ulcer recurrence.
Human Insulin and Hypoglycaemia: A Literature Survey
Authors: Jørgensen L. Nellemann , Dejgaard A. , Pramming S.K.
Published: July 2009

Thirty‐nine clinical studies and 12 epidemiological reports comparing human insulin and porcine insulin were reviewed. Twenty‐five studies (encompassing 338 subjects) showed identical symptoms and physiological response to acute hypoglycaemia overall. Fifteen studies (encompassing more than 1253 patients) showed identical incidence of hypoglycaemia overall and similar symptoms with the two types of insulin. Twelve epidemiological studies showed identical incidence of hypoglycaemia overall with the two types of insulin. Thus, the overwhelming evidence from a large number of studies including a large number of patients suggests that: (1) human and porcine insulin do not provoke different hormonal responses to hypoglycaemia; (2) they do not cause different symptoms of hypoglycaemia; (3) the incidence of severe hypoglycaemia with human insulin does not differ from that of porcine insulin.
Is Hyperinsulinaemia a Central Characteristic of a Chronic Cardiovascular Risk Factor Clustering Syndrome? Mixed Findings in Asian Indian, Creole and Chinese Mauritians
Authors: Zimmet P. , Collins V.R. , Dowse G.K. , Alberti K.G.M.M. , Tuomilehto J. , Knight L.T. , Gareeboo H. , Chitson P. , Fareed D. ,   For the Mauritius Noncommunicable Disease Study Group
Published: July 2009

The aim of the study was to investigate whether the constellation of cardiovascular disease risk factors, described as Insulin Resistance Syndrome, exists in the multi‐ethnic population of Mauritius, and to assess whether hyperinsulinaemia is the key feature of this syndrome. A sample of 5080 Mauritian subjects (aged 25–74 years) was examined in a non‐communicable diseases survey in 1987. Survey procedure included an oral glucose tolerance test, and anthropometric, blood pressure, plasma lipids and serum insulin measurements. Abnormal glucose tolerance (diabetes and impaired glucose tolerance), general obesity, upper‐body obesity, hypertension, low HDL‐cholesterol, and hypertriglyceridaemia were defined as risk factor conditions. Mean values for a series of risk factor variables were compared between reference subjects (no risk factors) and those with a risk factor condition (either one condition only, or in combination with one or more others). Prevalence estimates for each risk factor condition in combination with three or more other conditions were three to four times greater than expected by chance, and levels of risk factors for subjects with more than one risk factor condition were further away from the reference levels than for those with just one condition. Fasting and 2‐h serum insulin levels were elevated for each condition when in combination with others, or to a lesser extent when isolated. However, this was not the case for isolated hypertension where insulin levels were not elevated. When adjusted for age, sex, and body mass index, insulin levels were only significantly elevated in subjects with upper‐body obesity if in association with general obesity. A clustering of cardiovascular risk factors was therefore found in Mauritius. However, insulin levels although high for most conditions were not high in hypertension.