bluuebunny/crossref_metadata_2025 huggingface dataset:
Insulin Sensitivity Is Not Impaired In Mexican-American Women Without a Family History Of Diabetes
Authors: Bonora Enzo , Gulli Giovanni , Bonadonna Riccardo , Prato Stefano Del , Solini Anna , DeFronzo Ralph A.
Published: March 2007

OBJECTIVE

The purpose of this research was to compare insulin sensitivity in Mexican-Americans and non-Hispanic whites without a family history of diabetes to establish whether insulin resistance is a defect intrinsically related to subjects of Mexican origin.

RESEARCH DESIGN AND METHODS

In study A, we compared insulin sensitivity in 12 Mexican-American and 12 non-Hispanic white women with normal glucose tolerance and no family history of diabetes. In study B, we compared insulin sensitivity in two groups of normal glucose-tolerant Mexican-Americans, nine with a positive (FHD+) and nine with a negative (FHD−) family history of diabetes. In both studies, the groups were closely matched for age, total body fat content, and fat topography. Insulin sensitivity was assessed with the euglycemic insulin clamp (20 mU·min−1·m2 surface area) which was performed in combination with tritiated glucose infusion and indirect calorimetry. Total fat mass and fat-free mass (FFM) were assessed by a tritiated water dilution technique, and regional fat distribution was evaluated by anthropometry and magnetic resonance imaging.

RESULTS

During a 4-h euglycemic insulin clamp (study A), rates (mg·min−1·kg FFM−1) of total (6.32 ± 0.64 vs. 6.62 ± 0.81), oxidative (3.54 ± 0.24 vs. 3.51 ± 0.19), and nonoxidative (2.78 ± 0.48 vs. 3.11 ± 0.75) glucose utilization were similar in Mexican-Americans and non-Hispanic whites; hepatic glucose production (0.33 ± 0.13 vs. 0.35 ± 0.13) was suppressed similarly in both groups. During a 2-h euglycemic insulin clamp (study B), Mexican-Americans with FHD+ had lower rates of insulin-mediated total (3.55 ± 0.39 vs. 5.93 ± 0.59, P < 0.001), oxidative (3.31 ± 0.25 vs. 4.32 ± 0.17, P < 0.01), and nonoxidative (0.24 ± 0.28 vs. 1.61 ± 0.49, P < 0.01) glucose disposal than subjects with FHD− suppression of hepatic glucose production (0.24 ± 0.14 vs. 0.18 ± 0.12) was similar in both groups.

CONCLUSIONS

These results indicate that in the absence of a family history of non-insulin-dependent diabetes mellitus, Mexican-American women are not less sensitive to insulin than non-Hispanic white women.
Similar Insulin Sensitivity in NIDDM Patients With Normo- and Microalbuminuria
Authors: Nielsen Søren , Schmitz Ole , Ørskov Hans , Mogensen Carl Erik
Published: March 2007

OBJECTIVE

To investigate whether insulin resistance and microalbuminuria are associated in non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

Insulin sensitivity was assessed using a hyperinsulinemic euglycemic clamp in 11 normoalbuminuric and 9 microalbuminuric NIDDM patients matched for sex, age, body composition, glycemic control, diabetes duration, and therapy.

RESULTS

Isotopically determined glucose disposal was similar in normo- and microalbuminuric patients in the basal state (mean ± SD; 3.30 ± 1.01 vs. 3.46 ± 0.82 mg·kg lean body mass [LBM]−1 · min−1; NS) and during hyperinsulinemia (7.16 ± 2.65 vs. 6.63 ± 2.88 mg·kg LBM−1 · min−1;NS). No difference was observed in nonoxidative glucose disposal or lipid oxidation. Endogenous glucose production was equally suppressed by insulin (−0.08 ± 0.99 vs. 0.30 ± 1.12 mg·kg−1 LBM·min−1; NS). Glucose oxidation tended to be lower in the normoalbuminuric patients in the basal state (1.16 ± 0.37 vs. 1.41 ± 0.36 mg·kg LBM· min−1) and during hyperinsulinemia (2.35 ± 0.72 vs. 2.90 ± 0.77 mg·kg LBM· min−1; both P < 0.15). Urinary albumin excretion rate correlated with the insulin-stimulated glucose oxidation rate (r = 0.59, P = 0.0064), and a similar trend was seen in the basal state (r = 0.42, P = 0.063). Protein oxidation was higher in normoalbuminuric patients (1.6 ± 0.5 vs. 1.0 ± 0.4 mg·kg LBM · min−1; P = 0.017) and correlated inversely with albuminuria (r = −0.70, P = 0.0007). Serum growth hormone increased during insulin infusion; however, the increase was significantly greater in microalbuminuric patients. Plasma lipoproteins, maximal aerobic capacity, and 24-h ambulatory blood pressure were similar in the two groups.

CONCLUSIONS

Basal and insulin-stimulated glucose uptakes are comparable in carefully matched normo- and microalbuminuric NIDDM patients, and glucose oxidation may be positively related to albuminuria. The inverse relation between protein oxidation and albuminuria may be due to higher growth hormone levels during daily life perturbations in glucose in microalbuminuric patients.
Factors Determining the Blood Pressure Response to Enalapril and Nifedipine in Hypertension Associated With NIDDM
Authors: Chan Juliana C N , Nicholls M Gary , Cheung Chi-Keung , Law Lap-Kay , Swaminathan Ramasmyiyer , Cockram Clive S
Published: March 2007

OBJECTIVE

To examine the factors that determine the blood pressure response to enalapril and nifedipine monotherapy in the treatment of hypertension associated with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

After a 6-week placebo baseline period, 102 hypertensive NIDDM patients were randomly assigned, double-blindly, to treatment with nifedipine retard (slow release) (n = 52) or enalapril (n = 50). The daily dosage of enalapril was increased, if required, from 10 to 20 to 40 mg and that of nifedipine from 40 to 60 to 80 mg at 4-week intervals during the 12-week titration period. Blood pressure, 24-h urinary albumin excretion (UAE), biochemical data, and serum angiotensin-converting enzyme (ACE) activity were measured at weeks −6, −4, 0, 4, 8, and 12. At week 0, venous blood was also sampled for baseline plasma atrial natriuretic peptide, renin, aldosterone, and serum insulin concentrations.

RESULTS

At week 12, the mean daily dose of enalapril was 35 ± 11.4 mg, and 27 (57%) patients were receiving the maximum daily dose of 40 mg. In the nifedipine group, the mean daily drug dose was 50 ± 12.9 mg, and 4 (8%) were receiving the maximum daily dose of 80 mg. Despite a dose-dependent fall in the serum ACE activity in the enalapril group, the mean arterial pressure (MAP) was reduced by only 8 mmHg throughout the 12-week titration period compared to a decline of 15, 18, and 19 mmHg at weeks 0, 4, and 12, respectively, in the nifedipine group (P = 0.01 between groups). In the enalapril group, changes in MAP between weeks 0 and 12 correlated significantly with baseline plasma glucose (r = 0.45, P = 0.001) and aldosterone concentrations (r = −0.32, P = 0.02) and UAE (r = 0.3, P = 0.04). There was no statistically significant correlation between the changes in MAP and baseline plasma renin concentration. On multivariate analysis, the baseline renal function, glycemic control, and plasma aldosterone and serum insulin concentrations were all independently related to the changes in blood pressure in the enalapril-treated patients. No such statistical associations were observed in the nifedipine group.

CONCLUSIONS

In hypertensive NIDDM patients, the activity of the renin-angiotensin-aldosterone system, the level of serum insulin, glycemic control, renal function, and proteinuria may be important determinants of the blood pressure response to ACE inhibition. Good glycemic control may optimize the antihypertensive efficacy of concomitant ACE inhibitor therapy.
An Assessment of the Association Between Functional Edentulism, Obesity, and NIDDM
Authors: Cleary Thomas J , Hutton John E
Published: March 2007

OBJECTIVE

To assess the association between a measure of extensive tooth loss (functional edentulism) and obesity with non-insulin-dependent diabetes mellitus (NIDDM) in a racially heterogeneous sample.

RESEARCH DESIGN AND METHODS

A cross-sectional survey (370 subjects) was performed by reviewing the medical and dental records of dependently or independently living individuals who were treated as inpatients and/or outpatients at a Department of Veterans Affairs facility. Frequencies and descriptive measures were derived; univariate and multiple logistic regression analyses were conducted to test for associations, confounding, effect modification, and interaction using functional edentulism and obesity as the independent variables and NIDDM as the dependent measure.

RESULTS

Functionally edentulous individuals were at significantly greater risk for NIDDM (estimated odds ratio [] = 4.06), than the obese ( = 3.29). These relationships were not confounded by age or race in this sample. Obesity did confound functional edentulism in the multivariable model, suggesting that they act independently on the outcome variable (NIDDM).

CONCLUSIONS

Dentist-assessed functional edentulism and physician-diagnosed obesity were significantly associated with NIDDM in this sample of predominantly older men. This finding ought to be considered by primary care providers in formulating dietary strategies in order to facilitate the realization of their therapeutic goals.
Abnormal Albuminuria as a Predictor of Mortality and Renal Impairment in Chinese Patients With NIDDM
Authors: Chan Juliana C N , Cheung Chi-Keung , Cheung Margaret Y F , Swaminathan Ramasmyiyer , Critchley Julian A J H , Cockram Clive S
Published: March 2007

OBJECTIVE

Microalbuminuria predicts mortality in non-insulin-dependent diabetes mellitus (NIDDM), but its association with deterioration of renal function remains more controversial than in insulin-dependent diabetes mellitus (IDDM). Using albumin-to-creatinine ratios (ACRs) in random spot urine samples is a convenient method for evaluating albuminuria. We studied prospectively the predictive values of albuminuria in NIDDM when assessed by this urine measurement.

RESEARCH DESIGN AND METHODS

Between 1991 and 1992, we restudied the clinical and biochemical status of 403 Chinese NIDDM patients recruited in 1989 after a follow-up period of 26.6 ± 3.2 months (mean ± SD). Spot urine ACR was measured on two occasions and microalbuminuria was defined as a mean ACR between 5.6 and 38 mg/mmol.

RESULTS

From the original cohort, 29 patients had died mostly because of cardiovascular events with or without renal failure. The overall relative risk of death in patients with abnormal albuminuria was 7.1 (P < 0.001) (microalbuminuria: 3.7, P = 0.04; macroalbuminuria: 11, P < 0.001). On multivariate analysis, the independent predictive factors for mortality were plasma creatinine (wald = 12.1, P < 0.001) and glucose concentrations (wald = 10.4, P < 0.001) in the normo- and microalbuminuric patients (n = 11) and age (wald = 4.4, P = 0.03) and plasma creatinine (wald = 8.2, P < 0.01) in the macroalbuminuric group (n = 18). In the survivors (n = 374), baseline spot urine ACR was independently associated with 2-year spot urine ACR in the normo- (P < 0.001), micro- (P < 0.01), and macroalbuminuric groups (P = 0.01). In addition, baseline spot urine ACR was independently related to 2-year plasma creatinine (P = 0.01) in the macroalbuminuric group. The rates of change of the reciprocal of plasma creatinine (Δ [Cr]−1) were −27.3 ± 62.5, −43.4 ± 68.6, and −108.8 ± 98.81·μmol−1·months−1 in the normo-, micro-, and macroalbuminuric groups, respectively (P < 0.001). The Δ [Cr]−1 was independently and inversely related to the baseline spot urine ACR (P < 0.001) and 2-year systolic blood pressure (P < 0.001).

CONCLUSIONS

Abnormal albuminuria as indicated by a random spot urine ACR > 5.6 mg/mmol predicts increased mortality and is associated with the progression of albuminuria and deterioration of renal function in Chinese NIDDM patients.
Features of Syndrome X in First-Degree Relatives of NIDDM Patients
Authors: Stewart Murray W , Humphriss David B , Berrish Taher S , Barriocanal Luis A , Trajano Laura R , Alberti K George M M , Walker Mark
Published: March 2007

OBJECTIVE

To determine whether the features of syndrome × are more common in first-degree relatives of non-insulin-dependent diabetes mellitus (NIDDM) patients than in control subjects with no family history of diabetes.

RESEARCH DESIGN AND METHODS

A total of 154 first-degree relatives from 60 families with two or more NIDDM patients and 154 age- and sex-matched control subjects were studied. All subjects underwent a 75-g oral glucose tolerance test and baseline lipid blood and anthropometric measures. The features of syndrome × that were studied were obesity, hypertension, dyslipidemia (high triglyceride levels and low high-density lipoprotein [HDL] cholesterol concentrations), impaired glucose tolerance (World Health Organization criteria), and insulin resistance (as assessed by the homeostasis model assessment).

RESULTS

Relatives were heavier than control subjects (body mass index 27.5 ± 5.2 vs. 25.2 ± 4.6 kg/m2, respectively [mean ± SD], P < 0.0002), had lower HDL cholesterol concentrations (1.2 ± 0.3 vs. 1.4 ± 0.4 mmol/l, P < 0.001), were more insulin-resistant (2.3 [0.7−7.6] vs. 1.6 [0.5−5.1], geometric mean [95% confidence intervals], P < 0.0001), and had more individuals classified as having impaired glucose tolerance (28 of 154 [18%] vs. 7 of 154 [7%], χ 2, P < 0.001). The differences in insulin resistance and HDL cholesterol concentrations between the groups were independent of obesity.

CONCLUSIONS

Features of syndrome X occur more frequently in relatives of NIDDM patients than in control subjects with no family history of diabetes.
Dietary Factors Determining Diabetes and Impaired Glucose Tolerance: A 20-year follow-up of the Finnish and Dutch cohorts of the Seven Countries Study
Authors: Feskens Edith J , Virtanen Suvi M , Räsänen Leena , Tuomilehto Jaakko , Stengård Jari , Pekkanen Juha , Nissinen Aulikki , Kromhout Daan
Published: March 2007

OBJECTIVE

To investigate the role of diet as a predictor of glucose intolerance and non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

At the 30-year follow-up survey of the Dutch and Finnish cohorts of the Seven Countries Study, in 1989/1990, men were examined according to a standardized protocol including a 2-h oral glucose tolerance test. Information on habitual food consumption was obtained using the cross-check dietary history method. Those 338 men in whom information on habitual diet was also available 20 years earlier were included in this study. Subjects known as having diabetes in 1989/1990 were excluded from the analyses.

RESULTS

Adjusting for age and cohort, the intake of total, saturated, and monounsaturated fatty acids and dietary cholesterol 20 years before diagnosis was higher in men with newly diagnosed diabetes in the survey than in men with normal or impaired glucose tolerance. After adjustment for cohort, age, past body mass index, and past energy intake, the past intake of total fat was positively associated with 2-h postload glucose level (P < 0.05). An independent inverse association with the past intake of vitamin C was observed (P < 0.05). These associations were independent of changes in the intake of fat and vitamin C during the 20-year follow-up. An increase in the consumption of vegetables and legumes, potatoes, and fish during the 20-year follow-up was inversely related with 2-h glucose level (P < 0.05).

CONCLUSIONS

Although the regression coefficients were in general not very large, these results indicate that a high intake of fat, especially that of saturated fatty acids, contributes to the risk of glucose intolerance and NIDDM. Foods such as fish, potatoes, vegetables, and legumes may have a protective effect. In addition, the observed inverse association between vitamin C and glucose intolerance suggests that antioxidants may also play a role in the development of derangements in glucose metabolism.
Effect of Chronic Intermittent Intravenous Insulin Therapy on Antihypertensive Medication Requirements in IDDM Subjects With Hypertension and Nephropathy
Authors: Aoki Thomas T , Grecu Eugen O , Prendergast Joseph J , Arcangeli Michael A , Meisenheimer Ronald
Published: March 2007

OBJECTIVE

The prevalence of systemic hypertension is increased in patients with diabetes. In this prospective, randomized, crossover clinical trial, we assessed antihypertensive effects of chronic intermittent intravenous insulin therapy (CIIIT) on insulin-dependent diabetes mellitus (IDDM) subjects with hypertension and nephropathy by monitoring the amount of antihypertensive medication (AHM) required to maintain blood pressure (BP) ≤ 140/90 mmHg.

RESEARCH DESIGN AND METHODS

After a stabilization period, 26 hypertensive IDDM subjects were randomly assigned to a control or treatment phase for 3 months and then crossed over into the opposite phase for another 3 months. Addition of CIIIT during the treatment phase was the only procedural difference between the control and treatment phases.

RESULTS

The AHM dosage requirements for maintenance of the baseline BP levels decreased significantly (46% P < 0.0001) and linearly over time (P < 0.0058) during the treatment phase, while remaining essentially unchanged during the control phase.

CONCLUSIONS

Our data suggest that CIIIT markedly improves BP control, as evidenced by the significantly reduced AHM dosage requirements in subjects with IDDM and hypertension, possibly through an improvement in vascular reactivity.
The Jamaican Diabetes Survey: A protocol for the Caribbean
Authors: Ragoobirsingh Dalip , Lewis-Fuller Eva , Morrison Errol Y St A
Published: March 2007

OBJECTIVE

This study was designed to investigate the point prevalence of diabetes in Jamaica.

RESEARCH DESIGN AND METHODS

A two-stage stratified random sampling design was used, and individuals aged 15 years and over were interviewed. Nonresponse was documented and factored into the final analysis of the survey data. The overall response rate obtained was 57.9%. All subjects with fasting blood glucose (FBG) > 6.1 mmol/1 (110 mg/dl) were brought back for an abbreviated glucose tolerance test. The data was analyzed using Epi 5, an advanced statistical program designed specifically for use with epidemiological data.

RESULTS

The 2,109 subjects who participated were the basis for estimates of diabetes and IGT prevalence. Among those with previously diagnosed diabetes, diet therapy alone, oral hypoglycemic agents plus diet therapy, insulin therapy, and lack of treatment were reported.

CONCLUSIONS

By the World Health Organization (WHO) criteria, Jamaica has a point prevalence of diabetes of 17.9% in the 15-and-over age-group.
Increasing Incidence of IDDM in Austrian Children: A nationwide study 1979–1993
Authors: Schober Edith , Schneider Ursula , Waldhör Thomas , Tuomilehto Jaako ,   Austrian Diabetes Incidence Study Group
Published: March 2007

OBJECTIVE

A nationwide population-based study was conducted to assess the insulin-dependent diabetes mellitus (IDDM) incidence in childhood over a 15-year period (1979–1993).

RESEARCH DESIGN AND METHODS

A questionnaire was sent to all Austrian pediatric departments and diabetologists. The secondary data source was based on patient organization lists and hospital administration data. The data from 1979-1987 were collected retrospectively, while from 1988 to 1993 the registration of cases was performed prospectively in the same network. Estimates of probability of ascertainment were calculated according to the capture-recapture method.

RESULTS

The achieved ascertainment was 94%. The overall annual incidence was 7.9/100,000 person-years in children 0–14 years old. During the observation period, the incidence rose by 2.4% annually.

CONCLUSIONS

The incidence of childhood IDDM in Austria, a European country with an intermediate risk for IDDM, showed a proportionally similar increase to that of Northern European countries over the past decade. The increase seems to be continuous, following mainly a linear trend with superimposed sudden outbreaks indicating environmental causative factors.
Hyperinsulinemia in Nondiabetic Asian Subjects Using Specific Assays for Insulin, Intact Proinsulin, and Des-31, 32-Proinsulin
Authors: Nagi Dinesh K , Ali Vidya Mohamed , Walji Shahenaz , Jain Sachin K , Yudkin John S
Published: March 2007

OBJECTIVE

To investigate the contributions of intact proinsulin and of des-31,32-proinsulin to fasting concentrations of insulin-like molecules in nondiabetic subjects from two ethnic groups (Asian and white) and to see whether Asian subjects are hyperinsulinemic compared with white subjects using highly specific assays for insulin.

RESEARCH DESIGN AND METHODS

We investigated subjects with normal glucose tolerance (NGT) (82 Asian and 67 white) and impaired glucose tolerance (IGT) (16 Asian and 13 white), diagnosed by using standard World Health Organization criteria. Highly specific monoclonal antibody-based assays were used to measure insulin, intact proinsulin, and des-31, 32-proinsulin. An index of insulin secretion was derived as a ratio of incremental insulin to incremental glucose concentrations from 0 to 30 min during an oral glucose tolerance test.

RESULTS

Asian subjects with NGT, despite being significantly thinner than whites (BMI 24.4 ± 3.5 vs. 25.7 ± 3.7 kg/m2, P = 0.04), had a more central distribution of obesity (subscapsular-to-triceps skinfold ratios 1.36 ± 0.69 vs. 1.17 ± 0.41, P = 0.047). Asian subjects with NGT showed significant hyperinsulinemia 2 h after oral glucose load (plasma insulin median 274 pmol/l [range 26–1,505] vs. 186 pmol/l [27–720], P < 0.005) compared with whites. Asian subjects with NGT also had significantly higher insulin increments (P < 0.02) compared with white subjects and significantly higher fasting concentrations of intact proinsulin (median 2.7 pmol/l [range 0.9–14.1] vs. 2.1 [0.8-7.9], P < 0.02) but not of des-31, 32-proinsulin. The ratio of proinsulin-like molecules to the total sum of three insulin-like molecules, however, was similar between Asian and white subjects with NGT and IGT.

CONCLUSIONS

These results indicate that when specific assays for insulin are used, Asian subjects show postglucose load hyperinsulinemia and fasting hyperproinsulinemia compared with white subjects, suggesting increased insulin secretion and/or the presence of underlying insulin resistance in this ethnic group. The contribution of proinsulin-like molecules to total insulin-like molecules was similar between Asian and white subjects with NGT and IGT, and there was no contribution to hyperinsulinemia in Asian subjects.
Islet Cell Antibodies at Diagnosis, But Not Leanness, Relate to a Better Cardiovascular Risk Factor Profile 5 Years After Diagnosis of NIDDM
Authors: Gottsäter Anders , Ahmed Mubarik , Lilja Bo , Fernlund Per , Sundkvist Göran
Published: March 2007

OBJECTIVE

To evaluate the relationship between islet cell antibodies (ICAs) and the cardiovascular risk profile 5 years after clinical diagnosis of NIDDM.

RESEARCH DESIGN AND METHODS

Five years after clinical diagnosis, we evaluated blood pressure (BP) and lipids in 17 NIDDM patients with ICA at diagnosis (age 60 ± 4 years) and 133 NIDDM patients without ICA at diagnosis (age 61 ± 1 year). Urinary albumin excretion was evaluated in a subset of 12 NIDDM patients with ICA at diagnosis (age 60 ± 4 years) and 82 NIDDM patients without ICA at diagnosis (age 61 ± 1 year).

RESULTS

NIDDM patients without ICA showed higher BP (140/86 ± 2/1 mmHg vs. 128/79 ± 3/2 mmHg; P < 0.05), total cholesterol (6.10 ± 0.11 vs. 5.09 ± 0.29 mmol/l; P < 0.01), LDL-to-HDL ratio (3.85 ± 0.14 vs. 2.49 ± 0.18; P < 0.001), and triglycerides (2.58 ± 0.24 vs. 0.90 ± 0.06 mmol/l; P < 0.001), lower HDL cholesterol (1.08 ± 0.03 vs. 1.40 ± 0.08 mmol/l; P < 0.001), and higher urinary albumin excretion (0.16 ± 0.06 vs. 0.01 ± 0.01 g/24 h; P < 0.05) than NIDDM patients with ICA. Among NIDDM patients without ICA, no differences concerning BP or lipids were found between obese and nonobese patients.

CONCLUSIONS

ICA at diagnosis of NIDDM is a marker of more favorable cardiovascular risk profile 5 years after clinical diagnosis.
A 5-year (1989–1993) Prospective Study of the Incidence of IDDM in Rome and the Lazio Region in the Age-Group 0–14 years
Authors: Sebastiani L , Visalli N , Adorisio E , Suppa M A , Buzzetti R , De Cicco A L , Giovannini C , Comerci M D , Negri M , Pozzilli P
Published: March 2007

OBJECTIVE

To provide data on the incidence of IDDM in Rome and the Lazio region evaluated prospectively from 1989 to 1993 for a total of > 5 million subjects younger than 15 years.

RESEARCH DESIGN AND METHODS

All patients with newly discovered IDDM diagnosed between 1 January 1989 and 31 December 1993 among residents in Rome and its region were recorded. Primary ascertainment was based in diabetes clinics and specialized hospitals in the region, whereas the secondary independent source was taken from the archives of the region where patients are registered to obtain exemption from paying for medications.

RESULTS

We identified 330 new patients with a degree of ascertainment of 85%. Overall the incidence rate of the disease was 7.9 per 100,000 per year (95% CI 7.1–8.8). The incidence was higher in the 5- to 9-year-old age-group (10.4 per 100,000) and in winter (36.2%). The cumulative risk for the disease is on the order of 1.18 per 1,000 subjects < 15 years of age. No significant differences in incidence were observed between boys and girls. There were 14 instances of coma at diagnosis (4.3%), but hyperglycemia without ketonuria was diagnosed in 35% of patients, suggesting an early diagnosis.

DISCUSSION

Compared with the other continental Italian regions for which data are available for a single year, the IDDM incidence rate in Rome is similar. We conclude that the IDDM incidence rate in Rome and its region is comparable to that in other Southern European countries and remained stable over the 5-year observation period.
An Economic Analysis of Captopril in the Treatment of Diabetic Nephropathy
Authors: Rodby Roger A , Firth Louise M , Lewis Edmund J ,   The Collaborative Study Group
Published: March 2007

OBJECTIVE

The results of a recent clinical trial. The Effect of ACE inhibition on Diabetic Nephropathy, demonstrated that captopril reduced the rate of renal failure, end-stage renal disease (ESRD), and death in patients with IDDM and nephropathy. The purpose of this study was to determine the cost-benefitand cost-effectiveness of captopril as a therapy in patients with IDDM as well as the potential savings for all patients with diabetes and nephropathy.

RESEARCH DESIGN AND METHODS

We used the results from a randomized, placebo-controlled trial comparing captopril (207 patients) with placebo (202 patients), whose purpose was to determine whether captopril has kidney-protecting properties independent of its effect on blood pressure in diabetic nephropathy to develop a model of medical treatment for patients before progression to ESRD. To model the course of illness after progression to ESRD and to extend the model to patients with NIDDM, we used data from the U.S. Renal Data System and published literature. Medical resource cost data were based predominantly upon Medicare reimbursement levels, published wholesale drug prices, and surveying health care providers. The economic model uses a payer perspective to estimate direct cost. The cost to society (indirect cost) associated with lost patient productivity due to ESRD was also estimated. Using this information, we predicted the costs incurred annually and over a lifetime if patients with IDDM and NIDDM and overt nephropathy were treated with either placebo or captopril. We also constructed a model of the overall prevalence of diabetic nephropathy to estimate the aggregate savings in total U.S. health care expenditures.

RESULTS

Treatment with captopril resulted in an absolute direct cost savings or benefit of $32,550 per patient with IDDM over the course of a lifetime compared to treatment with placebo. For patients with NIDDM, the direct cost savings totaled $9,900 per patient. Absolute savings were found for indirect costs as well: $84,390 per patient with IDDM and $45,730 per patient with NIDDM. If captopril therapy were initiated in 1995 for patients with either IDDM or NIDDM and nephropathy, the aggregate health care cost savings (i.e. direct cost savings alone) would be $189 million a year for the year 1999 and $475 million a year in 2004, the present value of cumulative health care cost savings for these 10 years would be $2.4 billion.

CONCLUSIONS

The use of captopril in diabetic nephropathy will provide significant savings in health care costs; in addition, it will result in savings in indirect cost, which reflects the broader societal benefit.
Deranged platelet calcium homeostasis in diabetic patients with end-stage renal failure: A possible link to increased cardiovascular mortality?
Authors: Vicari Aurelio M , Taglietti Maria V , Pellegatta Fabio , Spotti Donatella , Melandri Marco , Galli Laura , Ronchi Paola , Folli Franco
Published: March 2007

OBJECTIVE

Platelet hyperfunction is a typical feature of the prothrombotic state that frequently complicates the natural history of diabetes. In uremia, a bleeding diathesis is present, which principally involves the primary phase of hemostasis. Thus, in patients with uremia of diabetic origin, the infrequent coexistence of two opposite alterations of hemostasis takes place. In patients with uremia, an increased incidence of cardiovascular events and related mortality is observed. This phenomenon is greatly amplified in uremia of diabetic origin. Calcium homeostasis is a critical aspect of platelet function, which has recently become available in human diseases. The aim of this study was to evaluate calcium homeostasis in platelets from patients with uremia of diabetic and nondiabetic origin.

RESEARCH DESIGN AND METHODS

We evaluated, by means of Fura 2, the intracellular concentration of ionized calcium ([Ca2+]i) in platelets from 18 patients with uremia of diabetic origin, 12 patients with uremia of nondiabetic origin and 16 healthy control subjects [Ca2+]i was evaluated in resting conditions and after stimulation with 0.05, 0.1, 0.5 U/ml thrombin.

RESULTS

Platelets from uremic patients with diabetes had higher resting [Ca2+]i than both control subjects (P = 0.01) and uremic patients without diabetes (P = 0.001). Similarly, after stimulation with thrombin, the absolute increase of [Ca2+]i was higher (P < 0.05) in platelets from uremic patients with diabetes compared with both control subjects and uremic patients without diabetes. The relative increase of [Ca2+]i was higher (P < 0.05) than normal in platelets from uremic patients after weak or intermediate strength thrombin. No correlation were present between [Ca2+]i values and other clinical and laboratory variables potentially associated with platelet hyperfunction.

CONCLUSIONS

Diabetes and uremia in combination further deteriorate the abnormal platelet calcium homeostasis observed in uremia.
A Population-Based Study of the Prevalence of Diabetes and Impaired Glucose Tolerance in Adults in Northern Sudan
Authors: Elbagir Murtada N , Eltom Mohammed A , Elmahadi Elmahadi MA , Kadam Ibrahim MS , Berne Christian
Published: March 2007

OBJECTIVE

To study the prevalence of glucose intolerance in adult urban and rural populations in the northern parts of Sudan.

RESEARCH DESIGN AND METHODS

A sample of 1,284 subjects aged ≥25 years was selected using a multistage cluster method and underwent a 75-g oral glucose tolerance test.

RESULTS

The crude prevalence was 3.4% (men, 3.5%; women, 3.4%) for diabetes and 2.9% (men, 2.2%; women, 3.3%) for impaired glucose tolerance (IGT). The highest crude prevalence was in the northern parts of Sudan (5.5%) and the lowest in the western desert-like parts (0.9%). Diabetes and IGT rates were not different between the urban and rural populations. New cases (2.2%) were almost twice as prevalent as previously known cases (1.3%). Family history of diabetes, obesity, and advanced age were associated with higher rates of diabetes.

CONCLUSION

The results showed a high prevalence of diabetes in the adult population of Sudan, with a wide difference among the different areas. The high ratio of newly discovered to previously known diabetic cases may reflect poor public awareness and medical services. These findings will certainly have far-reaching implications for diabetes care delivery in this country.
Smoking Is Independently Associated With High Plasma Insulin Levels in Nondiabetic Men
Authors: Rönnemaa Tapani , Rönnemaa Elina M , Puukka Pauli , Pyörälä Kalevi , Laakso Markku
Published: March 2007

OBJECTIVE

Studies using the euglycemic clamp technique or the insulin suppression test in relatively small numbers of subjects have suggested that smoking may cause insulin resistance. Our aim was to study the association between smoking status and fasting plasma insulin in a large nondiabetic male population.

RESEARCH DESIGN AND METHODS

A total of 616 nondiabetic men aged 45–64 years were taken from a population register. Fasting plasma insulin and blood pressure were measured, and smoking history and medication were evaluated by interview.

RESULTS

Age- and BMI-adjusted insulin levels were significantly higher in smokers and ex-smokers than in nonsmokers (92.4, 86.4, and 78.6 pmol/l, respectively; P = 0.009). In every BMI-tertile, smokers and ex-smokers had higher plasma insulin than nonsmokers. After adjustment for factors potentially affecting insulin sensitivity (hypertension, systolic or diastolic blood pressure, use of β-blockers and/or diuretics, use of vasodilating antihypertensive drugs, physical exercise, alcohol use, parental history of NIDDM, coronary heart disease, and previous myocardial infarction), insulin concentrations were still highest in smokers (91.2 pmol/l), intermediate in ex-smokers (86.8 pmol/l), and lowest in nonsmokers (78.9 pmol/l, P = 0.008 between groups).

CONCLUSIONS

Our results show that chronic smoking is associated with high age- and BMI-adjusted plasma insulin levels, independent of other factors known to influence insulin sensitivity. The effect of smoking may be partially reversible after quitting.
Increase in Circulating Products of Lipid Peroxidation in Smokers With IDDM
Authors: Zoppini Giacomo , Targher Giovanni , Monauni Tiziano , Faccini Giovanni , Pasqualini Elena , Martinelli Carlo , Zenari Maria L , Muggeo Michele
Published: March 2007

OBJECTIVE

To measure plasma malondialdehyde (MDA) concentration, a product of lipid peroxidation, both in IDDM patients and in healthy control subjects and to examine whether smoking has a negative impact on the plasma MDA levels in diabetic patients.

RESEARCH DESIGN AND METHODS

Plasma total MDA concentration (as a thiobarbituric acid adduct by high-performance liquid chromatography) was measured in 56 young IDDM patients and in a group of 32 age-, sex-, BMI-, and smoking habit-matched healthy subjects.

RESULTS

Plasma MDA concentration in IDDM patients was significantly higher than that in healthy control subjects (mean ± SE: 0.95 ± 0.03 vs. 0.54 ± 0.03 μmol/l; P < 0.0001). After stratification by smoking status, it was seen that diabetic smokers had values of age, BMI, serum lipids, blood pressure, metabolic control, and diabetes duration and its chronic complications superimposable on those of their nonsmoking counterparts. Nevertheless, plasma MDA concentration was significantly higher in IDDM patients who smoked than in IDDM patients who didn't smoke (1.03 ± 0.4 vs. 0.87 ± 0.03 μmol/l; P = 0.002), without any sex difference with regard to MDA levels.

CONCLUSIONS

These data show an increase in circulating products of lipid peroxidation in young diabetic smokers, thus further supporting the clinical importance of discouraging the initiation of smoking as well as promoting its cessation in people with IDDM.
Reduced Decrease of Peripheral Vascular Resistance During Exercise in Young Type I Diabetic Patients
Authors: Matthys Dirk , Craen Margaretha , De Wolf Daniel , Walle Johan Vande , Verhaaren Henri
Published: March 2007

OBJECTIVE

In normal subjects, peripheral vascular resistance decreases during dynamic exercise. We studied blood pressure and peripheral vascular resistance responses to dynamic exercise in young normotensive type I diabetic patients.

RESEARCH DESIGN AND METHODS

Thirty adolescent diabetic patients (9–19 years of age) underwent a maximal exercise test on a cycle ergometer. In a subset of 14 patients, cardiac output was measured by a CO2 rebreathing method and peripheral vascular resistance was calculated. Twenty-four normal individuals, age and sex matched, served as control subjects.

RESULTS

Diastolic blood pressure was significantly higher in diabetic patients at intermediate workload (77 ± 2 vs. 71 ± 1 mmHg) and peak exercise (86 ± 2 vs. 73 ± 2 mmHg). Peripheral vascular resistance was significantly higher in diabetic patients at intermediate workload (17.0 ± 1.1 vs. 12.6 ± 0.5 mmHg·l−1 · min−1 · m−2) and peak exercise (16.3 ± 1.3 vs. 11.4 ± 0.5 mmHg ·l−1 · min−1 · m−2). There were no significant correlations with the patient's age, diabetes duration, or diabetes control.

CONCLUSIONS

We observed the decrease of vasodilator response during dynamic exercise in normotensive young type I diabetic patients.
A Twofold Excess Mortality Among Black Compared With White IDDM Patients in Allegheny County, Pennsylvania
Authors: Tull Eugene S , Barinas Emma ,   The Pittsburgh Deri Mortality Study Group
Published: March 2007

OBJECTIVE

To examine the long-term mortality experience of blacks who develop IDDM in childhood.

RESEARCH DESIGN AND METHODS

The 11–25-year mortality status of individuals with IDDM who participated in the Diabetes Epidemiology Research International (DERI) Mortality Study was verified as of 1 January 1990 for 1,008 (94%) of the 1,076 individuals in the study. Life-table analysis was performed, and race-specific rates were determined for the final sample.

RESULTS

Among black patients, 14.9% died compared with 6.6% of the white patients after a maximum of 25 years of follow-up. African-Americans experienced an age-adjusted mortality rate that was over twice that of whites for the entire period (9.4 vs. 3.8 per 1,000 person-years, respectively; P < 0.05) and at each 5-year interval of follow-up. Among blacks, the mortality rate for females (15.9/1,000 person-years) was 8.4 times (P < 0.05) that of males (1.9/1,000 person-years). In contrast, this sex difference was not seen among whites. Acute complications of diabetes accounted for 40% of the mortality in the black patients, while only 23% of the white patients died from acute causes.

CONCLUSIONS

The data suggest that some of the excess mortality in black IDDM patients may be preventable.
Costs of diabetes in Texas, 1992
Authors: Warner David C , McCandless Roy R , De Nino Louis A , Cornell John E , Pugh Jacqueline A , Marsh Genevieve M
Published: March 2007

OBJECTIVE

To estimate direct and indirect costs of diabetes in Texas in 1992.

RESEARCH DESIGN AND METHODS

For most direct medical costs, we relied on third party and provider billing databases, including Medicare, Medicaid, VA facilities, public hospitals, and others. The researchers identified people with diabetes in the respective databases, located all records of their care, and sorted records as clearly, probably, or probably not attributable to diabetes on the basis of principal diagnoses. In most cases, costs were valued as allowable or paid charges. Some medical costs, such as private insurance, were estimated from national data and state surveys. Indirect costs included current short- and long-term disability costs and the discounted present value of future costs of mortality. Disability estimates relied on National Health Interview Survey (NHIS) data and U.S. Department of Labor wage data applied to Texas. Mortality estimates were based on death certificates.

RESULTS

Total costs clearly or probably attributable to diabetes among Texans in 1992 were estimated at $4.0 billion. Direct medical costs were ∼ $1.6 billion. Indirect costs were estimated at $2.4 billion. the largest direct costs were paid by Medicare. Most indirect costs were from long-term disability.

CONCLUSIONS

This study demonstrates methods for conducting cost of illness studies at the state level. In a state like Texas, with a large and growing Mexican-American population, estimation of current and future economic costs of diabetes is vital for development of strategies to minimize social and economic consequences of diabetes.
Mitochondrial Aldehyde Dehydrogenase in Diabetes Associated With Mitochondrial tRNALeu(UUR) Mutation at Position 3243
Authors: Suzuki Yoshihiko , Muramatsu Taro , Taniyama Matsuo , Atsumi Yoshihito , Suematsu Makoto , Kawaguchi Ryuji , Higuchi Susumu , Asahina Takayuki , Murata Chisato , Handa Michiko , Matsuoka Kempei
Published: March 2007

OBJECTIVE

To ascertain why alcohol is prone to manifest unpleasant effects in diabetes associated with mitochondrial tRNALeu(UUR) mutation at position 3243 (DM-Mt3243), we investigated the genotype of aldehyde dehydrogenase (ALDH) 2 and alcohol dehydrogenase 2 (ADH2) in DM-Mt3243.

RESEARCH DESIGN AND METHODS

Nineteen unrelated patients with DM-Mt3243 were included in the study (12 men and 7 women). They were recruited from ∼700 diabetic patients at three different institutes, without prior information of alcohol habit. ALDH2, ADH2, and 3243 mutation were genotyped by polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) methods. There were 461 unrelated Japanese individuals and 170 non-3243 mutant NIDDM patients enrolled as control subjects.

RESULTS

In the DM-Mt3243 group, 15 (79%) patients had inactive ALDH2 and 18 (95%) had atypical ADH2. The frequency of the inactive ALDH2 genotype was higher than that in the normal control subjects (P < 0.002) and that in the NIDDM control subjects (P < 0.003). However, the frequencies of ADH2 genotype in the DM-Mt3243 group, the normal control subjects, and the NIDDM control subjects were not different.

CONCLUSIONS

Inactive ALDH2 genotype was frequently observed in DM-Mt3243. It suggests that DM-Mt3243 is associated with ALDH2 inactivity. We speculate the trait of acetaldehyde accumulation on ALDH2 inactivity may favor mitochondrial DNA abnormalities, thereby worsening ATP production and impairing insulin secretion. In addition, the interaction of ALDH1 and ALDH2 may alter the retinoid metabolism in the pancreas, thereby influencing insulin secretion and precipitating diabetes. Thus, this association of ALDH2 genotype with DM-Mt3243 provides insight into the etiology of diabetes in the mitochondrial diseases.
Raised Serum Sialic Acid Concentration in NIDDM Patients With and Without Diabetic Nephropathy
Authors: Chen Jian-Wen , Gall Mari-Anne , Yokoyama Hiroki , Jensen Jan S , Deckert Marja , Parving Hans-Henrik
Published: March 2007

OBJECTIVE

Raised serum sialic acid concentration is a strong predictor of cardiovascular mortality in the general white population. A progressive increase in cardiovascular morbidity and mortality takes place in relation to increasing albuminuria in NIDDM patients. Therefore, we investigated the potential association between serum sialic acid and micro- and macroangiopathy in NIDDM patients.

RESEARCH DESIGN AND METHODS

We studied a prevalence cohort of all white NIDDM patients < 76 years of age attending a diabetic clinic during 1 year. Of the patients, 319 had normoalbuminuria, 148 had microalbuminuria, and 75 had macroalbuminuria (diabetic nephropathy was in 47 of 75 patients); 66 nondiabetic age- and sex-matched subjects acted as a control group. Blood samples were taken for measurements of sialic acid, lipids, creatinine, and HbA1c. Retinopathy was assessed by funduscopy. The prevalence of cardiovascular disease was based on Minnesota-coded electrocardiograms and the World Health Organization cardiovascular questionnaire.

RESULTS

A progressive raise in serum sialic acid was demonstrated with an increasing urinary albumin excretion rate: [median (range)] 2.02 (1.55–2.63); 2.42 (1.47–6.48); 2.67 (1.57–5.86), and 2.95 (1.52–7.86) mmol/l in nondiabetic subjects, NIDDM patients with normoalbuminuria, microalbuminuria, and diabetic nephropathy, respectively (P < 0.05 or less for differences between groups). Multiple linear regression analysis showed that serum cholesterol concentration, serum HDL cholesterol concentration, BMI, albuminuria, smoking, and cardiovascular disease correlate independently with logarithmic (10) serum sialic acid concentration.

CONCLUSIONS

Our study revealed a progressive raise in serum sialic acid with increasing urinary albumin excretion rate in NIDDM patients. Furthermore, several modifiable cardiovascular risk factors were associated with serum sialic acid.
The Effect of Metformin on Adipose Tissue Metabolism and Peripheral Blood Flow in Subjects With NIDDM
Authors: Jansson Per-Anders E , Gudbjörnsdóttir H Soffia , Andersson Ove K , Lönnroth Peter N
Published: March 2007

OBJECTIVE

To examine the effect of metformin on net lactate and glycerol release in NIDDM subjects, we used abdominal subcutaneous microdialysis combined with 133Xe clearance. Skeletal muscle blood flow (MBF) was assessed simultaneously both before and after metformin treatment.

RESEARCH DESIGN AND METHODS

Nine male patients with NIDDM (age 53 ± 2 years [mean ± SE]; BMI 30.2 ± 1.4 kg/m2; body fat 23.0 ± 2.6 kg; diabetes duration 4.6 ± 1.5 years; six of nine receiving sulfonylurea treatment) were recruited into an open study. They were studied after an overnight fast, both before and after 1 week of additional treatment with 500 mg metformin three times daily. Nine weight- and age-matched nondiabetic subjects served as a control group.

RESULTS

Postabsorptive net subcutaneous lactate release increased (149 ± 50 vs. 475 ± 127 nmol · 100 g1 · min−1, P < 0.05) whereas plasma lactate was unchanged after metformin treatment in the NIDDM patients. The net decrease of glycerol release 90 min after an oral glucose tolerance test was more pronounced (110 ± 30 vs. 199 ± 20 nmol · 100 g−1 · min−1, P < 0.05) after metformin treatment. Both adipose tissue blood flow (ATBF) (1.5 ± 0.1 vs. 2.3 ± 0.2 ml · 100 g−1 · min−1, P < 0.01) and MBF (3.2 ± 0.4 vs. 4.2 ± 0.5 ml · 100 ml−1 · min−1, P < 0.05) increased after metformin treatment.

CONCLUSIONS

In this open study, postabsorptive net lactate release in abdominal subcutaneous adipose tissue was clearly increased in NIDDM patients after metformin treatment. Basal ATBF as well as MBF was improved after metformin treatment. Whether this reflects enhanced metabolic control or is a drug-specific effect remains to be established.