bluuebunny/crossref_metadata_2025 huggingface dataset:
Insulin-Resistant Diabetes with Insulin Receptor Autoantibodies in a Male Patient Without Acanghosis Nigricans
Authors: Baldwin David , Winston Evonne , Hoshizaki Robert J , Garland John T , Baldwin David , Holcomb Henry H , Flier Jeffrey S , Rubenstein Arthur
Published: March 2007

A 51-yr-old, nonobese, male patient presented with hyperglycemia and a recent 40-pound weight loss. Severe insulin resistance was documented in studies in which high amounts of insulin were infused using the Biostator GCIIS. Diabetic control was finally achieved with subcutaneous injections of 470 U of insulin per day. Positive laboratory findings included a mild pancytopenia, elevated erythrocyte sedimentation rate, decreased C3 and properdin, and increased IgA. Antinuclear or other autoantibodies were not present. Insulin antibody levels were within the range usually present in insulin-treated diabetic patients. Acanthosis nigricans was not present. Incubation of the patient's serum with IM-9 lymphoblastoid cells revealed that an insulin receptor antibody was present in a serum dilution of 1:80. Insulin-resistant diabetes mediated by insulin receptor antibodies may present in patients with immunologic findings but without overt dermatologic stigmata.
Salvage of Extremities with Ischemic Necrosis in Diabetic Patients by Infrapopliteal Arterial Bypass
Authors: Reichle Frederick A , Rankin Kevin P , Shuman Charles R
Published: March 2007

Initial and long-term limb salvage can be achieved by infrapopliteal bypass in diabetic patients with ischemic necrosis of the distal extremity. Mortality is low in all groups, and mortality of subsequent amputation apparently is not affected by the previous bypass. An adequate arteriogram and consideration of distal bypass are frequently indicated in the diabetic patients in whom ischemic necrosis is present. Limb salvage may be feasible even in those diabetic patients in whom popliteal artery is not patent on preoperative arteriogram by bypasses to anterior tibial, posterior tibial, or peroneal artery.
Glycated Hemoglobin and Related Factors in Diabetic Children and Adolescents Under 18 Years of Age: a Belgian Experience
Authors: Dorchy Harry , Roggemans Marie-Paule , Willems Dominique
Published: March 2007

OBJECTIVE

To determine, in an unselected population of diabetic children and adolescents < 18 years of age, which HbA1c levels can be achieved, and to examine the relationships with insulin regimen, insulin dose, sex, diabetes duration, BM1, and frequency of home blood glucose monitoring (HBGM) and outpatient clinic attendance.

RESEARCH DESIGN AND METHODS

A total of 144 unselected subjects (73 boys and 71 girls) aged 11.8 ± 3.7 years (mean ± SD) were included in the study over a 6-month period. They had diabetes durations ranging from 5 months to 15 years (4.0 ± 3.0). They were followed by the same pediatric diabetologist and the same nurse. The yearly frequency of visits was 8.9 ± 2.0, and the monthly frequency of HBGM was 111 ± 27. Of the patients, 129 were treated with two daily insulin injections of an individualized mixture of rapid- and intermediate-acting insulins, and 15 adolescents were treated with four injections using the basal-bolus regimen. The patients were divided into two subgroups according to diabetes duration: ≤ 2 years (n = 53) and > 2 years (n = 91), i.e., outside the honeymoon period. HbA1c was measured by a high-pressure liquid chromatography method (normal values 3.9–5.5%).

RESULTS

The mean ± SD HbA1c level in the 144 children and adolescents was 6.6 ± 1.2% using our method. In 62% of the patients, it was possible to obtain an HbA1c level under the normal mean value plus 5 SD. HbA1c was not related to sex, number of insulin injections, or age, i.e., it was not poorer at adolescence. The mean daily insulin dose was 0.9 U/kg body wt, being lower during the first 2 years of diabetes and reaching 1 U at adolescence. HbA1c levels were lower during the first 2 years of diabetes (6.2 ± 1.0%) than afterwards (6.9 ± 1.2%), but the frequencies of outpatient visits and HBGM were higher. After 2 years, HbA1c was negatively correlated with the frequency of HBGM. The yearly incidence rate of severe hypoglycemic episodes was 0.2. After the age of 13 years, BM1 was significantly higher in girls and in adolescents on four daily injections.

CONCLUSIONS

In nearly two-thirds of diabetic children and adolescents, it is possible to obtain HbA1c levels under the normal mean plus 5 SD, which is considered satisfactory and close to that of the adult cohort of the Diabetes Control and Complications Trial (DCCT) with intensive treatment. There is no difference between the children on only two daily insulin injections and the adolescents on four injections. After 2 years of diabetes, increased frequency of HBGM helps reduce HbA1c levels, taking into account the “intensive” education of the patients and their families. Adolescent girls on four injections must pay attention to the risk of becoming overweight.
Severe Antibody-Mediated Human Insulin Resistance: Successful Treatment With the Insulin Analog Lispro: A case report
Authors: Lahtela Jorma T , Knip Mikael , Paul Robert , Antonen Jaakko , Salmi Jorma
Published: March 2007

OBJECTIVE

To evaluate the efficacy of the insulin analog lispro (Lys B28, Pro B29) in severe insulin resistance caused by human insulin antibodies.

CASE:

A 27-year-old man with a history of diabetes treated with human insulin for 3 years developed severe immunological insulin resistance caused by human insulin antibodies. Throughout follow-up (12 months) the insulin analog lispro was administered with an infusion pump as the only insulin therapy. The insulin dose decreased from an average of 300 U/day to 58 U/day, HbA1c decreased from 12.6 to 7.4%, and human insulin antibodies decreased from 8,057 to 1,860 nU/ml. Hypoglycemic episodes during early morning disappeared.

CONCLUSIONS

The insulin analog lispro might be suitable for the treatment of diabetic patients with substantially increased insulin antibody levels Apparently, the structural difference between the lispro and human insulin molecules prevented lispro from binding to the human insulin antibodies in this patient and consequently was nonimmunogenic.
A Randomized Controlled Trial of Weight Reduction and Exercise for Diabetes Management in Older African-American Subjects
Authors: Agurs-Collins Tanya D , Kumanyika Shiriki K , Have Thomas R Ten , Adams-Campbell Lucile L
Published: March 2007

OBJECTIVE

To evaluate a weight loss and exercise program designed to improve diabetes management in older African-Americans.

RESEARCH DESIGN AND METHODS

Overweight African-Americans (n = 64) ages 55–79 years with NIDDM were randomized to either an intervention (12 weekly group sessions, 1 individual session, and 6 biweekly group sessions) or usual care (1 class and 2 informational mailings). Clinical and behavioral variables were assessed at 0, 3, and 6 months of treatment.

RESULTS

Significant net differences in the intervention versus usual care were observed for weight (−2.0 kg, P = 0.006), physical activity, and dietary intake of fat, saturated fat, cholesterol, and nutrition knowledge at 3 months (all P < 0.05) and for weight at 6 months (−2.4 kg; P = 0.006) and mean HbA1c values at 3 and 6 months (respectively, −1.6 and −2.4%, both P < 0.01). After the adjustment for changes in weight and activity, the intervention participants were ∼ twice as likely to have a one unit decrease in HbA1c value as those in usual care. Blood pressure increase sin usual care participants resulted in net differences (intervention minus control) at 3 and 6 months of −3.3 (P = 0.09) and −4.0 (P = 0.05) mmHg diastolic, respectively, and −8.4 (P = 0.06) and −5.9 (P > 0.10) mmHg systolic, respectively. Blood lipid profiles improved more in intervention than usual care participants, but not significantly.

CONCLUSIONS

The intervention program was effective in improving glycemic and blood pressure control. The decrease in HbA1c values was generally independent of the relatively modest changes in dietary intake, weight, and activity and may reflect indirect program effects on other aspects of self-care.
Thyroid Peroxidase Autoantibodies Predict Poor Metabolic Control and Need for Thyroid Treatment in Pregnant IDDM Women
Authors: Fernandez-Soto Luisa , Gonzalez Amalia , Lobón Jose Antonio , Lopez Jose Antonio , Peterson Charles M , Escobar-Jiménez Fernando
Published: March 2007

OBJECTIVE

To study whether the presence of antithyroid peroxidase antibodies (TPO-Abs) before gestation in IDDM affects thyroid function and metabolic control during pregnancy and early postpartum as well as neonatal outcome.

RESEARCH DESIGN AND METHODS

A prospective study at an outpatient endocrine-obstetric unit was carried out in 20 pregnant IDDM women. Free T4 (thyroxine), thyroid-stimulating hormone (TSH), TPO-Abs, and HbA1c were assayed before gestation; during the first, second, and third trimester of pregnancy; and 3 months postpartum.

RESULTS

HbA1c was significantly higher in TPO-Ab+ women than in those who were TPO-Ab− during the second (P < 0.01) and third (P < 0.05) trimesters. HbA1c levels significantly decreased in TPO-Ab− patients when the second (P < 0.01) and third (P < 0.05) trimesters were compared with before the pregnancy and the first trimester. There was a significant increase in the dosage of insulin for TPO-Ab+ versus TPO-Ab− patients during the second (P < 0.05) and third (P < 0.01) trimesters and 3 months postpartum (P < 0.05). TSH was significantly increased in the second (P < 0.001) and third (P < 0.05) trimesters and 3 months postpartum (P < 0.01) when compared with TPO-Ab− patients; 7.6% of the TPO-Ab− group and 29% in the TPO-Ab+ group presented postpartum thyroid dysfunction, and 42% of the TPO-Ab+ women required thyroid treatment.

CONCLUSIONS

Pregnant women with IDDM who have a positive test for TPO-Abs before gestation have poorer glucose control and a high prevalence of hypothyroidism. Therefore we recommend that prepregnant IDDM patients be screened for anti-TPO-Abs. Those with a positive result should be followed with serial monitoring of free T4 and TSH levels during each trimester as well as the postpartum period.
Increased Macrosomia and Perinatal Morbidity Independent of Maternal Obesity and Advanced Age in Korean Women With GDM
Authors: Jang Hak C , Cho Nam H , Min Yong-Ki , Han In K , Jung Kyu B , Metzger Boyd E
Published: March 2007

OBJECTIVE

To examine the impact of gestational diabetes mellitus(GDM) on perinatal outcome in a setting where influences of maternal age and obesity would be minimal.

RESEARCH DESIGN AND METHODS

A case-control study was done to compare the outcome of pregnancy in 65 women with GDM and 153 women with normal carbohydrate metabolism matched for age, height, and prepregnancy weight.

RESULTS

The frequencies of preeclampsia and primary cesarean sections were higher and delivery was earlier in pregnancies complicated by GDM. Birth weight, symmetry index, and chest circumference were greater, and macrosomia and need for phototherapy were more common in offspring of mothers with GDM. Cord-serum C-peptide and insulin concentrations were higher in the infants of mothers with GDM and were strongly correlated with birth weight and symmetry index. However, maternal age, prepregnancy weight, and prepregnancy BMI were not correlated with birth weight. Postprandial glucose levels during the first 2 weeks after diagnosis of GDM had associations with the infants' birth weight, symmetry index, and cord insulin concentration in the diet-treated patients with GDM.

CONCLUSIONS

Antepartum maternal glucose metabolism was significantly associated with fetal hyperinsulinemia and excessive fetal growth in relatively nonobese Korean women. These findings support a direct role for metabolic factors in the adverse outcomes in pregnancies complicated by GDM.
Metformin Enhances Clearance of Chylomicrons and Chylomicron Remnants in Nondiabetic Mildly Overweight Glucose-Intolerant Subjects
Authors: Grosskopf Itamar , Ringel Yehuda , Charach Gideon , Maharshak Nitsan , Mor Ronit , Iaina Adrian , Weintraub Moshe
Published: March 2007

OBJECTIVE

To assess the effect of metformin on the metabolism of intestinally derived lipoproteins in nondiabetic individuals who were mildly overweight and glucose intolerant.

RESEARCH DESIGN AND METHODS

A total of nine subjects with a BMI ≥ 25 kg/m2 and fasting serum glucose ≤ 6.1 mmol/l and who were glucose intolerant were studied. The subjects underwent a vitamin A fat-loading test before and after a 3-month treatment with 850 mg metformin twice a day. The metabolic behavior of the postprandial lipoproteins was compared with that found in a group of 19 healthy normolipidemic individuals who participated in a previous study.

RESULTS

Mean total plasma, chylomicron fraction, and nonchylomicron fraction retinyl palmitate (RP) pretreatment levels were 3.4-fold, 3.59-fold, and 3-fold higher, respectively, in the study group than in the normolipidemic group and were reduced by 50, 56, and 32%, respectively, after 3 months of metformin treatment. The decrease of chylomicron levels after treatment was positively correlated to the fasting triglyceride values before treatment (r = 0.73, P = 0.039) and to the serum insulin level at 120 min of standard glucose loading before treatment (r = 0.91, P = 0.002).

CONCLUSIONS

Metformin was shown to be beneficial in the clearance of postprandial lipoproteins in nondiabetic individuals who were mildly overweight and glucose intolerant.
Gender Differences in Hospitalizations for IDDM Among Adolescents in California, 1991: Implications for prevention
Authors: Cohn Barbara A , Cirillo Piera M , Wingard Deborah L , Austin Donald F , Roffers Steven D
Published: March 2007

OBJECTIVE

Describe gender differences in hospitalizations for IDDM to investigate the need for gender-specific interventions to reduce diabetes-related morbidity.

RESEARCH DESIGN AND METHODS

Analyses were based on hospital discharges with any mention of IDDM (n = 2,889) and the subset of these for IDDM as a principal diagnosis (n = 2,270) in California children, ages 0–18 years during 1991. Pregnancy-related hospitalizations were excluded.

RESULTS

Females had more diabetes hospitalizations among discharges with any mention of diabetes, among discharges with diabetes as a principal diagnosis, and among discharges with diabetic ketoacidosis as a principal diagnosis. For diabetes as a principal diagnosis, females had 40% more hospitalizations, 44% more repeated hospitalizations, 23% more individuals hospitalized, and significantly higher rates of hospitalizations for ages 10–14 years (50 vs. 38 per 100,000) and for ages 15–18 years (68 vs. 29 per 100,000). Gender differences occurred primarily in adolescents, were independent of complicating conditions at the time of hospitalization, and were observed for diabetic ketoacidosis alone.

CONCLUSIONS

Adolescent females had more diabetes hospitalizations than did males. The underlying cause may be biological or behavioral. Management protocols tailored for young women may be required to reduce hospitalizations for IDDM among females.
The Role of Viscous Soluble Fiber in the Metabolic Control of Diabetes: A review with special emphasis on cereals rich in β-glucan
Authors: Würsch Pierre , Pi-Sunyer F Xavier
Published: March 2007

Recent recommendations for the dietary management of diabetes mellitus state that diet needs to be individualized so that there is improved glucose and lipid control in the patient. In a majority of individuals with diabetes, this is best done with a diet that is low in fat and high in carbohydrate, particularly that of cereal origin. However, symptoms of hyper- and hypoglycemia must be averted. Most cereal products, however, tend to have a high glycemic index. Cereals such as Prowashonupana barley or fractions of oat bran are particularly high in the soluble fiber β-glucan, which when taken with a meal increases the viscosity of the meal bolus once it has reached the small intestine, where the absorption of nutrients occurs. This high viscosity delays absorption. A 50% reduction in glycemic peak can be achieved with a concentration of 10% β-glucan in a cereal food. A significant lowering of plasma LDL cholesterol concentrations can also be anticipated with the daily consumption of ≥3 g of (β-glucan. Diabetic individuals can benefit from diets that are high in (β-glucan, which, as a component of oats and barley, can be incorporated into breakfast cereals and other products.
Nonfasting Plasma Glucose is a Better Marker of Diabetic Control Than Fasting Plasma Glucose in Type 2 Diabetes
Authors: Avignon A , Radauceanu A , Monnier L
Published: March 2007

OBJECTIVE

To evaluate the relative value of plasma glucose (PG) at different time points in assessing glucose control of type 2 diabetic patients.

RESEARCH DESIGN AND METHODS

Glycemic profiles, i.e., PG at prebreakfast (8:00 A.M.), prelunch (11:00 A.M.), postlunch (2:00 P.M.), and extended postlunch (5:00 P.M.) times over the same day, were obtained in 66 type 2 diabetic patients on an ambulatory basis. The different time points of PG were compared with a measurement of HbA1c made in a reference laboratory.

RESULTS

Extended postlunch PG was lower than prebreakfast PG (104 ± 21 vs. 133 ± 35 mg/dl, P < 0.02) in patients demonstrating good diabetic control (HbA1c ≤ 7.0%), was not different from prebreakfast PG (149 ± 47 vs. 166 ± 26 mg/dl, NS) in patients demonstrating fair diabetic control (7.0% < HbA1c ≤ 8.5%), and was higher than prebreakfast PG (221 ± 62 vs. 199 ± 49 mg/dl, P ≤ 0.01) in those demonstrating poor diabetic control (HbA1c ≤ 8.5%). Prebreakfast, prelunch, postlunch, and extended postlunch PG values were all significantly correlated with HbA1c. Multiple linear regression analysis demonstrated that postlunch PG and extended postlunch PG correlated significantly and independently with HbA1c, but that prebreakfast PG and prelunch PG did not. Moreover, postlunch PG and extended postlunch PG demonstrated better sensitivity, specificity, and positive predictive value in predicting poor glycemic control than did prebreakfast PG or prelunch PG.

CONCLUSIONS

In type 2 diabetes, postlunch PG and extended postlunch PG are better predictors of glycemic control than fasting plasma glucose (FPG). We therefore suggest that they be more widely used to supplement, or substitute for, FPG in evaluating the metabolic control of type 2 diabetic patients.
Evaluation of the Impact of Podiatrist Care in the Primary Prevention of Foot Problems in Diabetic Subjects
Authors: Rönnemaa Tapani , Hämäläinen Helena , Toikka Tuula , Liukkonen Irmeli
Published: March 2007

OBJECTIVE

To evaluate the influence of podiatrist activities on the outpatient care of diabetic patients in terms of knowledge of diabetic foot care, self-care, and minor foot problems.

RESEARCH DESIGN AND METHODS

There were 733 patients, aged 10–79 years, identified from the national diabetes register. Patients without recent visits to a podiatrist and without an obvious need for foot care were randomized into a podiatric care group (education and primary prevention measures, n = 267) and a control group (written instructions only, n = 263). The patients were examined by an independent study podiatrist at baseline and after 1 year.

RESULTS

Patients in the podiatrist group had greater improvement in knowledge of diabetic foot care (P = 0.004) and self-care (P < 0.001) scores compared with control subjects. The prevalence of callosities in regions other than the calcaneal region decreased more (P = 0.009) in the podiatrist group (from 54.5 to 39.5%) than in the control group (from 51.3 to 48.2%), and the size of the callosities decreased more (P < 0.001) in the podiatrist group than in the control group. Reduction in the prevalence of callosities was associated with younger age (< 50 years).

CONCLUSIONS

Education and primary preventive measures provided individually by a podiatrist result in significant improvements in knowledge and foot self-care scores and in improvements in the prevalence of some minor foot problems. Long-term studies are needed to evaluate whether the intervention of podiatrists starting at an early phase would lead to a reduction in major foot problems.
The Cost to Health Plans of Poor Glycemic Control
Authors: Gilmer Todd P , O'Connor Patrick J , Manning Willard G , Rush William A
Published: March 2007

OBJECTIVE

We tested the hypothesis that level of glycemic control is related to medical care costs in adults with diabetes.

RESEARCH DESIGN AND METHODS

Regression analysis was used to estimate the relationship between glycemic control and medical care charges for 3,017 adults with diabetes who were continuously enrolled in a large health maintenance organization (HMO) over a 4-year period. Diagnosis of diabetes was ascertained from diagnostic and pharmaceutical databases using a method with an estimated sensitivity of 0.91 and an estimated specificity of 0.99. Charges for care included defined outpatient and inpatient services. Patients who disenrolled or who died during the 4-year period were excluded from the main analysis.

RESULTS

Charges for medical care for patients with diabetes from 1993 to 1995 were closely related to HbA1c level in 1992 before and after adjustment for age, sex, coronary heart disease, and hypertension. Standardized 3-year estimates of charges ranged from $10,439 for patients without comorbid conditions to $44,417 for those with heart disease and hypertension. Medical care charges increased significantly for every 1% increase above HbA1c of 7%. For a person with an HbA1c value of 6%, successive 1% increases in HbA1c resulted in cumulative increases in charges of ∼ 4, 10, 20, and 30%. The increase in charges accelerated as the HbA1c value increased. For patients with diabetes only, or with diabetes plus other chronic conditions, the rate of increase in charges with HbA1c was consistent.

CONCLUSIONS

HbA1c provides useful information to providers and patients regarding both health status and future medical care charges. Economic data suggest that clinicians should assign high importance to low HbA1c results and aggressively maintain the HbA1c status of patients who have low HbA1c values. For economic as well as clinical reasons, it may be beneficial to lower HbA1c when it is > 8% and to reduce cardiovascular risk factors. The medical charge data suggest that investment in clinical systems to improve diabetes care may benefit both payers and patients.
Comparison of Diabetes Diagnostic Categories in the U.S. Population According to 1997 American Diabetes Association and 1980–1985 World Health Organization Diagnostic Criteria
Authors: Harris Maureen I , Eastman Richard C , Cowie Catherine C , Flegal Katherine M , Eberhardt Mark S
Published: March 2007

OBJECTIVE

To compare the 1997 American Diabetes Association (ADA) and the 1980–1985 World Health Organization (WHO) diagnostic criteria in categorization of the diabetes diagnostic status of adults in the U.S.

RESEARCH DESIGN AND METHODS

Analyses are based on a probability sample of the U.S. population age 40–74 years in the 1988–1994 Third National Health and Nutrition Examination Survey (NHANES III). People with diabetes diagnosed before the survey were identified by questionnaire. For 2,844 people without diagnosed diabetes, fasting plasma glucose was obtained after an overnight 9 to < 24-h fast, HbA1c was measured, and a 2-h oral glucose tolerance test was administered.

RESULTS

Prevalence of diagnosed diabetes in this age-group is 7.9%. Prevalence of undiagnosed diabetes is 4.4% by ADA criteria and 6.4% by WHO criteria. The net change of −2.0% occurs because 1.0% are classified as having undiagnosed diabetes by ADA criteria but have impaired or normal glucose tolerance by WHO criteria, and 3.0% are classified as having impaired fasting glucose or normal fasting glucose by ADA criteria but have undiagnosed diabetes by WHO criteria. Prevalence of impaired fasting glucose is 10.1% (ADA), compared with 15.6% for impaired glucose tolerance (WHO). For those with undiagnosed diabetes by ADA criteria, 62.1% are above the normal range for HbA1c compared with 47.1% by WHO criteria. Mean HbA1c is 7.07% for undiagnosed diabetes by ADA criteria and 6.58% by WHO criteria.

CONCLUSIONS

The number of people with undiagnosed diabetes by ADA criteria is lower than that by WHO criteria. However, those individuals classified by ADA criteria are more hyperglycemic, with higher HbA1c values and a greater proportion of values above the normal range. This fact, together with the simplicity of obtaining a fasting plasma glucose value, may result in the detection of a greater proportion of people with undiagnosed diabetes in clinical practice using the new ADA diagnostic criteria.
Effects of Trp64Arg Mutation in the β3-Adrenergic Receptor Gene on Weight Loss, Body Fat Distribution, Glycemic Control, and Insulin Resistance in Obese Type 2 Diabetic Patients
Authors: Sakane Naoki , Yoshida Toshihide , Umekawa Tsunekazu , Kogure Akinori , Takakura Yasuto , Kondo Motoharu
Published: March 2007

OBJECTIVE

To investigate the effects of Trp64Arg mutation in the β3-adrenergic receptor gene on weight loss, body fat distribution, glycemic control, and insulin resistance in obese type 2 diabetic patients.

RESEARCH DESIGN AND METHODS

We measured body weight, waist-to-hip ratio (WHR), adjusted resting metabolic rate, fasting blood glucose, fasting serum insulin levels, insulin resistance index (fasting glucose × fasting insulin/22.5), and HbA1c levels before and after 12 weeks of obesity treatment in 61 obese women with type 2 diabetes. The Mval polymorphism of the β3-adrenergic receptor gene was determined by polymerase chain reaction-restriction fragment length polymorphism analysis.

RESULTS

Of obese type 2 diabetic patients, those with the mutation (n = 24) had a higher WHR (P < 0.001), a lower adjusted metabolic rate, and higher blood glucose levels, serum insulin levels, insulin resistance index (P < 0.001), and HbA1c levels (P = 0.016). Furthermore, patients with the mutation had smaller decreases in body weight, WHR, insulin resistance index, and HbA1c levels after the weight-loss program compared with patients without the mutation (n = 37), even though food intake, exercise, and serum thyroid hormone levels were similar in both groups.

CONCLUSIONS

These present findings show that the Trp64Arg allele of the β3-adrenergic receptor gene may predict difficulty in losing body weight, lowering WHR, and improving glycemic control and insulin resistance in obese patients with type 2 diabetes.
Gait Abnormalities in Diabetic Neuropathy
Authors: Katoulis Evangelos C , Ebdon-Parry Mark , Lanshammar Hakan , Vileikyte Loreta , Kulkarni Jarne , Boulton Andrew J M
Published: March 2007

OBJECTIVE

To investigate the effect of peripheral neuropathy on gait in diabetic patients.

RESEARCH DESIGN AND METHODS

Gait analysis was performed in the following groups matched for age, sex, and BMI: 20 normal healthy control subjects (NC), 20 non-neuropathic diabetic control subjects (DC), 20 neuropathic diabetic subjects (DN), and 20 neuropathic diabetic subjects with a history of foot ulceration (DNU). All subjects with orthopedic foot problems were excluded from the study. The following gait parameters were investigated: 1) walking speed; 2) stance phase duration; 3) joint angles and moment arms for the ankle, knee, and hip joints in both sagittal and frontal planes; 4) the components of the ground reaction force (GRF) vector; and 5) the ankle, knee, and hip joint moments originating from the GRF vector in both planes.

RESULTS

There were no statistical differences in any of the parameters studied between the NC and DC groups. Walking speed was significantly slower in the DNU group compared with the two control groups (P < 0.02). The maximum knee joint angle was smaller in the sagittal plane for the DNU group compared with the DC group values (P < 0.05). The maximum value of the vertical component of GRF was found to be higher (P < 0.03) in the two control groups compared with the DNU group. The maximum value of the anteroposterior forces was also found to be higher (P < 0.001) in the DC group compared with the DNU group. The maximum frontal plane ankle joint moment was significantly higher (P < 0.05) in the DN compared with the NC group.

CONCLUSIONS

Diabetic subjects with peripheral neuropathy demonstrate alterations in some gait parameters during walking. These alterations could facilitate foot injuries, thus contributing to frequent foot ulceration.
Effects of Oral Erythromycin on Fasting and Postprandial Antroduodenal Motility in Patients With Type I Diabetes, Measured With an Ambulatory Manometric Technique
Authors: Samsom Melvin , Jebbink Rik J A , Akkermans Louis M A , Bravenboer B , Van Berge-Henegouwen Gerard P , Smout Andre J P M
Published: March 2007

OBJECTIVE

The aim of this double-blind crossover study was to evaluate the effects of oral erythromycin (250 mg t.i.d.) on fasting and postprandial gastrointestinal motility and gastrointestinal symptoms in patients with type I diabetes.

RESEARCH DESIGN AND METHODS

Antroduodenal motility was recorded with an ambulatory manometric technique for a 20-h period, including a high-caloric high-fat dinner and a low-caloric low-fat breakfast and a long fasting period, after 2 weeks erythromycin and placebo treatment in 12 patients with type I diabetes. During the manometric study, plasma glucose concentrations were assessed by frequent self-testing. Gastrointestinal symptoms were scored daily to assess the severity of the symptoms (range 0–3).

RESULTS

Oral erythromycin decreased the migrating motor complex cycle length from 118.9 ± 46.0 to 86.2 ± 25.3 min (P = 0.03) by shortening phase II from 68.7 ± 23.5 to 48.5 ± 19.4 min (P < 0.05). The total number of duodenal phase III increased from 48 to 62 (P = 0.075). However, the degree of antral participation to duodenal phase III did not increase. Erythromycin significantly decreased the duration of the postprandial period after dinner (from 417.0 ± 137.9 to 348.8 ± 93.8 min, P = 0.04). During this shorter postprandial period, the number of antral contractions (P < 0.01) and the antral motility index increased (P < 0.03), and early phase III activity at the level of the duodenum was abolished. In diabetic patients with antral hypomotility, after dinner, the mean symptom score improved significantly, from 2.07 ± 0.86 to 1.52 ± 0.63 (P = 0.018).

CONCLUSIONS

This ambulatory antroduodenal manometric study showed that oral erythromycin (250 mg t.i.d.) improves both fasting and postprandial antroduodenal motor activity after a high-caloric meal in patients with type I diabetes. Furthermore, in diabetic subjects with postprandial antral hypomotility, erythromycin reduces dyspeptic symptoms.
The Role of Footwear in the Prevention of Foot Lesions in Patients With NIDDM: Conventional wisdom or evidence-based practice?
Authors: Litzelman Debra K , Marriott Deanna J , Vinicor Frank
Published: March 2007

OBJECTIVE

To conduct a prospective evaluation of footwear characteristics as predictors of diabetic foot wounds.

RESEARCH DESIGN AND METHODS

A total of 352 patients with NIDDM enrolled in a randomized controlled trial aimed at preventing diabetic foot lesions in an academic general medicine practice were studied. Foot wounds (n = 63) were modeled univariately and multivariably using generalized estimating equations. The dependent variable was a wound classified as a 1.2 or greater according to the Seattle Wound Classification System, indicating at least a superficial or healing minor lesion with no functional interruption of the protective cutaneous barrier. Independent variables included detailed measures of style and material of patients' indoor and outdoor shoes, appropriate length and width, sock fibers, whether the patient had bought new shoes in the past 6 months, and if the patient had been recommended for special shoes. Modeling controlled for intervention status and physiological measures (baseline wound, monofilament abnormalities, and serum HDL level).

RESULTS

Initial screening (P < 0.20) suggested that a recommendation for special shoes, shoe length, and shoe width were indicative of wounds at follow-up (odds ratios [ORs] 2.19, 1.84, 1.86, respectively), while having bought shoes in the past 6 months was associated with no wound at follow-up (OR 0.60). The final multivariable model included only the recommendation for special shoes (OR 2.19; 95% CI 1.07–4.49).

CONCLUSIONS

Many variables commonly cited as protective measures in footwear for diabetic patients were not prospectively predictive when controlling for physiological risk factors. Rigorous analyses are needed to examine the many assumptions regarding footwear recommendations for diabetic patients.
Fasting Plasma Glucose as a Screening Test for Diabetes and Its Relationship With Cardiovascular Risk Factors in Hong Kong Chinese
Authors: Ko Gary TC , Chan Juliana CN , Lau Edith , Woo Jean , Cockram Clive S
Published: March 2007

OBJECTIVE

To evaluate the use of fasting plasma glucose (FPG) in the diagnosis of diabetes and the relationship between FPG and various cardiovascular risk factors in a community-based Hong Kong Chinese population.

RESEARCH DESIGN AND METHODS

The results of 1,470 oral glucose tolerance tests from a prevalence survey for glucose intolerance and lipid abnormality in a Hong Kong Chinese working population were examined. Our previous report showed that an FPG of 5.7 mmol/l corresponded to a 2-h plasma glucose (PG) of 11.1 mmol/l, and we used this value as a cutoff value and examined the relationship between FPG and various cardiovascular risk factors in nondiabetic subjects.

RESULTS

An FPG cutoff value of 7.8 mmol/l gave a sensitivity of 20.0% and a specificity of 100% in the diagnosis of diabetes (defined as 2-h PG ≥ 11.1 mmol/l). We divided the non-diabetic subjects (FPG < 7.8 mmol/l and 2-h PG < 11.1 mmol/l) into two groups: subjects with FPG < 5.7 mmol/l and those with FPG ≥ 5.7 mmol/l and < 7.8 mmol/l. Subjects in the latter group were older, had higher blood pressure, BMI, waist-to-hip ratio, 2-h PG, fasting and 2-h insulin, fasting serum triglyceride, VLDL cholesterol, apolipoprotein B, and urinary albumin concentrations, as well as lower plasma HDL cholesterol and HDL2 cholesterol concentrations.

CONCLUSIONS

These findings suggest that an FPG cutoff value of 7.8 mmol/l, as recommended by the World Health Organization, was too high when applied to Chinese populations. As in the case of hyperlipidemia, plasma glucose concentration should be viewed as a continuum in terms of its relationship with cardiovascular risk.
Cumulative Incidence of Childhood-Onset IDDM is Unaffected by Pertussis Immunization
Authors: Heijbel Harald , Chen Robert T , Dahlquist Gisela
Published: March 2007

OBJECTIVE

To identify a possible effect of pertussis vaccination in infancy on the risk for developing human IDDM.

RESEARCH DESIGN AND METHODS

A comparison was made of the cumulative incidence of IDDM in children age 0–12 years between two birth cohorts born before pertussis vaccination and two birth cohorts born after pertussis vaccination had been excluded from the Swedish national immunization program. The Swedish Childhood Diabetes registry was used to identify cases of IDDM. Yearly nurse reports on administered vaccines were used to determine coverage for diphtheria/tetanus/pertussis (DTP) and diphtheria/tetanus (DT) vaccines. Pertussis vaccine coverage was estimated based on number of doses of vaccine made available on license.

RESULTS

No difference in cumulative incidence rate of IDDM up to the age of 12 years was found when the birth cohorts for 1978 and 1979 with high DTP vaccination coverage were compared with the cohorts of 1980 and 1981 with low pertussis vaccination coverage.

CONCLUSIONS

The comparison of the cumulative incidence of IDDM, up to the age of 12 years, in birth cohorts with high and low exposure to pertussis vaccine does not support the hypothesis that pertussis could induce autoimmunity to the β-cell that may lead to IDDM.
The Prevalence of NIDDM and Associated Risk Factors in Native Canadians
Authors: Harris Stewart B , Gittelsohn Joel , Hanley Anthony , Barnie Annette , Wolever Thomas M S , Gao Joe , Logan Alexander , Zinman Bernard
Published: March 2007

OBJECTIVE

To determine the true prevalence of impaired glucose tolerance (IGT), NIDDM, and associated risk factors by age and sex in an isolated native community.

RESEARCH DESIGN AND METHODS

A community-wide prevalence survey using a 75-g oral glucose tolerance test (OGTT) was undertaken in the remote native reserve of Sandy Lake, Ontario, Canada. Measurements for obesity included waist-to-hip circumference, BMI, and percentage body fat.

RESULTS

A total of 728 individuals were enrolled, representing a community participation rate of 72%. The overall crude prevalence of NIDDM was 17.2% (18.1% females and 16.0% males) and increased to 26.1% overall (28.0% females and 24.2% males) when age-standardized. The prevalence of IGT was higher in females compared with males (age-standardized prevalence of 19.8 vs. 7.1%, respectively). Females had a higher prevalence of obesity, IGT, and NIDDM occurring at younger ages. Measures of obesity and fasting insulin levels were significantly associated with NIDDM in the 18–49 age-group.

CONCLUSIONS

The prevalence rates of NIDDM in this study population are the highest reported to date in a Canadian native population and among the highest reported in the world. Females appear to be at much higher risk of developing obesity, IGT, and NIDDM and at a younger age. Due to the high prevalence rates of IGT and NIDDM in this young population, there is urgent need to develop culturally appropriate community-based public health intervention programs before the long-term complications of diabetes have a devastating effect on the residents.
Total Radical-Trapping Antioxidant Parameter in NIDDM Patients
Authors: Ceriello Antonio , Bortolotti Nadia , Falleti Edmondo , Taboga Claudio , Tonutti Laura , Crescentini Adriana , Motz Enrico , Lizzio Sebastiano , Russo Assunta , Bartoli Ettore
Published: March 2007

OBJECTIVE

The existence of an oxidative stress in diabetes is still debated. This is largely due to the lack of good tools to assay the level of oxidative stress. The use of total radical-trapping antioxidant parameter (TRAP) has recently been proposed to explore the antioxidant property of a plasma sample. TRAP may be either directly measured by a fluorescence-based method (TRAPm) or calculated (TRAPc) by a mathematical formula, taking into account the serum levels of four natural antioxidants: protein-bound SH (thiol) groups, uric acid, vitamin E, and vitamin C. The difference between TRAPm and TRAPc is due to antioxidants, which are still unidentified, and to the possible synergism among the antioxidants.

RESEARCH DESIGN AND METHODS

In this study, we evaluated malondialdehyde (MDA), TRAPm, TRAPc, protein-bound SH groups, uric acid, vitamin E, and vitamin C in 40 NIDDM patients and 40 matched normal control subjects.

RESULTS

TRAPm and TRAPc were significantly lower in diabetic patients. A good correlation between TRAPm and TRAPc was found in both NIDDM patients (r = 0.68, P < 0.0001) and control subjects (r = 0.74, P < 0.0001). Protein-bound SH groups and uric acid were significantly lower in diabetic subjects, while MDA and vitamin E level were significantly higher. After correction for serum triglycerides (MDA) and cholesterol (vitamin E), MDA lost significance, while vitamin E did not. Vitamin C was not different in the two groups.

CONCLUSIONS

These data show decreased TRAP levels in NIDDM patients, suggesting the existence of lower antioxidant defenses in diabetes. The decrease appears to be due to various antioxidants, some of them not yet clearly defined. TRAP may represent a more reliable estimation of serum antioxidant capacity than the measurement of each known antioxidants. The correlation found between TRAPm and TRAPc values suggests that TRAPc, easier to measure than TRAPm, might be adequately reliable for routine assessment of oxidative stress in diabetic patients.
The Classification of Diabetes by Clinical and C-Peptide Criteria: A prospective population-based study
Authors: Service F John , Rizza Robert A , Zimmerman Bruce R , Dyck Peter J , O'Brien Peter C , Melton L Joseph
Published: March 2007

OBJECTIVE

To evaluate both the concordance in the classification of diabetes by clinical and C-peptide criteria and, prospectively, the consistency of the classification by C-peptide.

RESEARCH DESIGN AND METHODS

Individuals with diabetes who were enlisted in the prospective epidemiological study of diabetic neuropathy (Rochester Diabetic Neuropathy Study [RDNS]) were classified clinically by National Diabetes Data Group (NDDG) criteria to IDDM and NIDDM at entry to the study. In addition, C-peptide response to 1 mg glucagon was measured at entry for the classification to IDDM (basal C-peptide, < 0.17 pmol/ml; increment above basal, < 0.07 pmol/ml) and NIDDM (all other responses) and for concordance with the clinical classification made. The consistency of the C-peptide response was assessed every 2 years for up to 8 years.

RESULTS

Among 346 individuals with diabetes, 84 were classified as IDDM and 262 as NIDDM by clinical algorithm. COncordance with the C-peptide response occurred in 89% of the patients and remained consistent during 8 years of follow-up. Among the 37 patients with discordant clinical and C-peptide classification, those considered clinically to have NIDDM had a consistent IDDM C-peptide response during follow-up, and most of those considered to have IDDM clinically eventually showed an IDDM C-peptide response during follow-up.

CONCLUSIONS

Clinical criteria for the classification of diabetes are highly correlated with the assessment of insulin secretory reserve. A small number of individuals considered to have NIDDM clinically or by C-peptide have or develop an IDDM peptide response.
Incidence of Distal Symmetric (Sensory) Neuropathy in NIDDM: The San Luis Valley Diabetes Study
Authors: Sands M L , Shetterly S M , Franklin G M , Hamman R F
Published: March 2007

OBJECTIVE

To determine the incidence and risk factors for distal symmetric sensory neuropathy (DSN) in people with NIDDM.

RESEARCH DESIGN AND METHODS

Prospective follow-up was conducted from 1988 to 1992 on 231 people free of DSN during the baseline period 1984–1988 (mean follow-up, 4.7 years). Subjects with incident DSN (n = 66) were defined by any two of three criteria: 1) bilateral paresthesia in legs or feet; 2) bilateral decreased or absent ankle reflexes; and/or 3) bilateral decreased or absent cold temperature discrimination in feet. Of all 66 cases, 42 had one positive follow-up visit; 14 cases had 2 positive follow-up visits.

RESULTS

The overall incidence rate of DSN was 6.1 per 100 person-years (95% CI, 4.7–7.8). The rate for Hispanics (n = 164) and non-Hispanic whites (n = 67), adjusted for age, sex, and NIDDM duration, was 5.3 per 100 person-years (95% CI, 3.9–7.0) and 5.0 per 100 person-years (95% CI, 2.8–8.1), respectively. Adjusting for age and sex, higher glycohemoglobin level and lower C-peptide secretion were associated with increased DSN but were no longer predictive after accounting for duration of diabetes. Logistic regression models found significantly increased risk of DSN for insulin treatment, current smoking, and history of myocardial infarction. Duration was related to DSN incidence until insulin treatment was included. Other risk factors, including height, weight, family history of diabetes, peripheral vascular disease, hypertension, urinary albumin, protein:creatinine ratio, retinopathy, and alcohol use, were not significantly related to incident DSN.

CONCLUSIONS

Hispanic and non-Hispanic whites with NIDDM have similar risks of DSN. Current cigarette smoking and a history of myocardial infarction may represent independent risk factors for DSN in addition to glycemic control.
Solitary Pancreas Transplantation: Experience with 62 consecutive cases
Authors: Stratta Robert J , Weide Lamont G , Sindhi Rakesh , Sudan Debra , Jerius John T , Larsen Jennifer L , Cushing Kathleen , Grune Martin T , Radio Stanley J
Published: March 2007

OBJECTIVE

To determine the safety and efficacy of solitary pancreas transplantation in the treatment of IDDM.

RESEARCH DESIGN AND METHODS

A single-center retrospective case series of 62 consecutive solitary pancreas transplants (20 sequential pancreas after kidney, 42 pancreas transplants alone) performed in 57 adult IDDM patients was studied. Indications for solitary pancreas transplantation were 1) the presence of two or more overt diabetic complications and/or 2) glucose hyperlability with hypoglycemic unawareness and impaired quality of life. The recipient group consisted of 31 men and 26 women with a mean age of 38 years (range 25–62) and a mean duration of diabetes of 26 years (range 14–52). Mean pretransplant glycohemoglobin level was 9.9 ± 2.6%. Organ acceptance was restricted to ideal donors and man-dated a minimum of a two-antigen match (mean human leukocyte antigen ABDR match 2.7). The mean cold ischemia time was 16.6 h. Whole-organ pancreas transplantation was performed with bladder drainage by the duodenal segment technique. All patients were managed with either triple or quadruple immunosuppression. Monitoring included prospective urine cytology as well as cystoscopic transduodenal needle biopsies.

RESULTS

The mean length of initial hospital stay was 18 days, and mean hospital charges were $106,341. The incidences of rejection, infection, and surgical complications were 70, 55, and 47%, respectively. Overall patient and graft survival rates were 86 and 52%, respectively, with a mean follow-up of 28 months. All patients with functioning grafts had excellent metabolic control (mean glycohemoglobin level 5.1%) and achieved good rehabilitation.

CONCLUSIONS

Despite morbidity, solitary pancreas transplantation can be performed with improving success, can enhance quality of life, and can offer an opportunity to arrest secondary diabetic complications.
Dual Hormonal Replacement With Insulin and Recombinant Human Insulin-Like Growth Factor I in IDDM: Effects on glycemic control, IGF-I levels, and safety profile
Authors: Quattrin Teresa , Thrailkill Kathryn , Baker Lester , Litton Jean , Dwigun Karen , Rearson Melissa , Poppenheimer Mary , Giltinan David , Gesundheit Neil , Martha Paul , Jr
Published: March 2007

OBJECTIVE

To examine if dual replacement with insulin and rhIGF-I, recombinant human insulin-like growth factor I (rhIGF-I) may be safe and result in improved metabolic control and reduced insulin usage.

RESEARCH DESIGN AND METHODS

Forty-three patients with IDDM were randomized to receive a daily injection of rhIGF-I (80 mcg/kg s.c.) or placebo while on conventional insulin therapy for 4 weeks. Insulin was adjusted in the attempt to achieve predetermined goal glycemic values. Free and total IGF-I, four daily blood glucoses, and HbA1c were measured.

RESULTS

Before randomization, placebo and rhIGF-I groups exhibited low plasma levels of free and total IGF-I, which increased toward normal levels during the treatment period only in the rhIGF group. The regression curve obtained from the average of daily blood glucose measurements indicated that the glycemic profile, overlapping in the lead-in period, exhibited a downward trend in the rhIGF-I group during the treatment period. Mean blood glucose level during the last 10 days of treatment was lower in the rhIGF-I groups (174 ± 37 vs. 194 ± 32 mg/dl). HbA1c level was reduced by more than one-half percent more in the rhIGF-I group (−1.85%) than in the control group (−1.3%). The dose of regular insulin was significantly lower in the rhIGF-I group (0.2 ± 0.1 vs. 0.28 ± 0.1 U · kg−1 · 10 days−1 in the placebo group; P < 0.05).

CONCLUSIONS

rhIGF-I in combination with conventional insulin treatment ameliorated the low plasma total and free IGF-I levels and was well tolerated in IDDM. There was a trend toward improved glycemic control, while the regular insulin dose was significantly decreased.