bluuebunny/crossref_metadata_2025 huggingface dataset:
Aging per se does not influence postprandial glucose levels in type 2 diabetes
Authors: Magata Yumiko , Oba Kenzo , Inuzuka Yuki , Nakano Hiroshi
Published: August 2005

Background:  It is well known that postprandial glucose increases with aging in non‐diabetic subjects. The question we addressed is whether elderly type 2 diabetic patients with definite fasting hyperglycemia (≥ 126 mg/dL) also display increased postprandial hyperglycemia relative to their younger counterparts.

Methods:  Diurnal plasma glucose profiles were measured in 162 overt type 2 diabetic patients treated by diet alone (diet group) or with sulfonylureas as monotherapy (SU group). Plasma glucose concentrations were measured at 08.00 hours (before breakfast), 10.00, 12.00 (before lunch), 14.00, 18.00 (before dinner), 20.00, 24.00, 03.00, 06.00 and 08.00 hours the next morning. The postprandial glucose area under the curve (AUC) from 08.00 to 24.00 hours was calculated above the baseline level equal to the 08.00‐hours plasma glucose value, and the relationships with clinical variables, including age, were assessed.

Results:  There were no differences in diurnal plasma glucose profiles between the middle‐aged (< 65 years) and elderly (≥ 65 years) groups either the diet group or the SU group. Univariate analysis showed that the postprandial glucose area under the curve was related to the 08:00‐hours plasma glucose value (R = 0.583, P < 0.001) in the diet alone group and to the duration of diabetes (R = 0.220, P < 0.05), SU dose (R = 0.330, P = 0.001) and urine CPR (R = −0.229, P < 0.05) in the SU group. In multivariate analysis, postprandial glucose area under the curve was only related to 08.00 hours plasma glucose value in the diet group (R2 of the model = 0.340, P < 0.001) and to the SU dose in SU group (R2 of the model = 0.145, P < 0.001).

Conclusion:  These results suggest that aging, per se, does not influence postprandial glucose levels in overt type 2 diabetic patients.
Influence of living alone on emotional well‐being in community‐dwelling elderly persons
Authors: Kawamoto Ryuichi , Yoshida Osamu , Oka Yuichiro , Kodama Akihiro
Published: August 2005

Background:  Elderly persons living alone might be an at‐risk group for high levels of mortality and morbidity, making high demands on health and social services. However, the effect of living alone on the physical and mental health of the elderly has not been sufficiently investigated. This study investigated the relationship between living alone and well‐being, and determined the characteristics, physical health status, mental health status, social support and health needs of community‐dwelling elderly people who are living alone.

Methods:  The study subjects were 877 persons living with others and 86 persons living alone at the baseline. The final outcome regarding emotional well‐being was based on four criteria: the subjects’ perceptions regarding the statements, ‘I feel I am as good as other people’, ‘I am hopeful about the future’, ‘I am happy’ and ‘I enjoy life. Stepwise multiple regression analysis was performed for findings regarding subjects’ emotional well‐being.

Results:  The mean age ± standard deviation was 72 ± 5.4 years, and 461 subjects (47.9%) were men. Significantly independent explanatory variables included financial status (β, 0.070; P = 0.028), participation in community events (β, 0.138; P < 0.001), everyday alcohol use (β, 0.103; P = 0.001) and self‐rated health (β, 0.153; P < 0.001). Living alone did not remain in the final model, however, when testing its interaction with confounding factors, the interactions between living alone and work activity status (F = 5.41; P = 0.0120) and prescription medication use (F = 5.77; P = 0.017) were significant independent explanatory variables.

Conclusion:  The interactions between living alone and work activity status and prescription medication influence the emotional well‐being of elderly subjects.
Molecular mechanisms underlying inflammatory lung diseases in the elderly: Development of a novel therapeutic strategy for acute lung injury and pulmonary fibrosis
Authors: Nagase Takahide , Aoki‐Nagase Tomoko , Yamaguchi Yasuhiro , Yamamoto Hiroshi , Ouchi Yasuyoshi
Published: August 2005

In the elderly, inflammatory lung diseases, including acute lung injury and pulmonary fibrosis, are significant in terms of both mortality and difficulty in management. Acute respiratory distress syndrome (ARDS) is an acute lung injury and the mortality rate for ARDS ranges from 40 to 70% despite intensive care. Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal disorder of the lung parenchyma. No useful drugs are currently available to treat IPF. However, molecular mechanisms underlying these lung diseases are little understood and the development of a novel therapeutic strategy is urgently needed. Platelet‐activating factor (PAF) and metabolites of arachidonic acid, i.e. eicosanoids, are lipid mediators that have various biological effects. A key enzyme for the production of these inflammatory mediators, including eicosanoids and PAF, is phospholipase A2. In particular, cytosolic PLA2 (cPLA2) is especially important. The purpose of this article is to report novel findings regarding the role of PAF and cPLA2 in lung inflammatory diseases, especially, acute lung injury and pulmonary fibrosis. To address this question, we used mutant mice, i.e. PAFR transgenic mice, PAFR gene‐disrupted mice and cPLA2 gene‐disrupted mice. We have shown that PAF and eicosanoids, downstream mediators of cPLA2, may be involved in the pathogenesis of ARDS and IPF, which are important diseases in the elderly. Although there exist extreme differences in clinical features between ARDS and IPF, both diseases are fatal disorders for which no useful drugs are currently available. On the basis of recent reports using mutant mice, cPLA2 might be a potential target to intervene in the development of pulmonary fibrosis and acute lung injury in the elderly.
Relationships among impairment, disability, handicap, burden of care, economic expenses, event‐related potentials and regional cerebral blood flow in Parkinson's disease
Authors: Takeda Yoshiko , Kuroiwa Yoshiyuki , Watabe Setsuko , Gokita Kazue , Chuman Taeko , Wang Lihong , Li Mei , Toda Hiroyuki , Kamitani Toshiaki , Omoto Shu , Ikegami Tadashi , Matsubara Sho , Suzuki Yume
Published: August 2005

Background:  Relationships between impairment, disability and handicap in neurological diseases such as stroke and spinal cord injury have been studied using the framework of the international classification of impairment, disability and handicap, defined by World Health Organization. Those relationships in Parkinson's disease have rarely been studied on a statistical basis.

Methods:  In order to identify relationships between impairment, disability, handicap, burden of care, economic expenses and neurophysiological dysfunction in patients with Parkinson's disease, we made quantitative evaluations of these parameters in 24 patients and 14 care‐givers. Impairment was measured by symptomatic assessment for motor and autonomic impairments and neuropsychological assessment using the revised version of Hasegawa's dementia scale, the mini‐mental state examination, and the self‐rating depression scale. Disability was measured by Hoehn and Yahr scale, Barthel index, and the comprehensive activities of daily living index for the elderly. Handicap was measured by the Craig handicap assessment and reporting technique. Scores for burdens of care on principal care‐givers had physical and psychosocial aspects. Neurophysiological dysfunction was studied by measuring visual event‐related potentials and regional cerebral blood flow.

Results:  Motor and cognitive impairments, disability and handicap significantly correlated to each other. In particular, disability and handicap were strongly correlated. The burden of care on care‐givers, economic expenses, visual event‐related potentials and regional cerebral blood flow were significantly correlated with impairment, disability and handicap.

Conclusion:  Further investigations are anticipated to confirm practical values of symptomatic, neuropsychological, electrophysiological and neuroimaging evaluations to predict burden of care on families and economic expenses for patients with Parkinson's disease.
Species pool size and invasibility of island communities: a null model of sampling effects
Authors: Herben Tomáš
Published: August 2005

The success of alien species on oceanic islands is considered to be one of the classic observed patterns in ecology. Explanations for this pattern are based on lower species richness on islands and the lower resistance of species‐poor communities to invaders, but this argument needs re‐examination. The important difference between islands and mainland is in the size of species pools, not in local species richness; invasibility of islands should therefore be addressed in terms of differences in species pools. Here I examine whether differences in species pools can affect invasibility in a lottery model with pools of identical native and exotic species. While in a neutral model with all species identical, invasibility does not depend on the species pool, a model with non‐zero variation in population growth rates predicts higher invasibility of communities of smaller pools. This is because of species sampling; drawing species from larger pools increases the probability that an assemblage will include fast growing species. Such assemblages are more likely to exclude random invaders. This constitutes a mechanism through which smaller species pools (such as those of isolated islands) can directly underlie differences in invasibility.
Intraspecific application of the mid‐domain effect model: spatial and temporal nest distributions of green turtles, Chelonia mydas, at Tortuguero, Costa Rica
Authors: Tiwari Manjula , Bjorndal Karen A. , Bolten Alan B. , Bolker Benjamin M.
Published: August 2005

The mid‐domain effect (MDE) model was developed to evaluate patterns of species richness. We applied the MDE model to intraspecific distribution patterns – the spatial and temporal nest distributions of green turtles, Chelonia mydas, at Tortuguero, Costa Rica, from 1972 to 2000. Spatial and temporal distributions of green turtle nests at Tortuguero did not exhibit significant annual variation over this time period. The spatial and temporal distribution of nests largely conformed to the predictions of the MDE model, although the spatial model has a better fit. Environmental factors that may cause deviations from the MDE model are discussed. The model also indirectly provided a first estimate of the mean spatial nesting range of individual green turtles at Tortuguero: 10.1 km (SD 8.7 km). The MDE model provides insight into intraspecific as well as interspecific distribution patterns.
Neutral drift and polymorphism in gene‐for‐gene systems
Authors: Salathé Marcel , Scherer Almut , Bonhoeffer Sebastian
Published: August 2005

Pathogens are a main driving force of the evolution of plants and animals. Being resistant to diseases confers a high selective advantage to hosts, yet many host–pathogen systems show a remarkable degree of polymorphism of host resistance and pathogen virulence. The most common explanation of this phenomenon is that both resistance and virulence genes are costly and that there is selection against those genes when they are unnecessary. Here, we use stochastic multi‐locus simulations to show that the origin and the maintenance of genetic polymorphism in plant–pathogen systems can be explained without costs. In multi‐locus gene‐for‐gene systems, temporal domination of a super pathogen can cause polymorphism in resistance through neutral drift. With an increasing number of susceptible alleles in the host population, pathogen types other than the super race are able to cause infections and invade the population, leading to higher pathogen diversity and in turn to higher host diversity.
Running to stand still: adaptation and the response of plants to rapid climate change
Authors: Jump Alistair S. , Peñuelas Josep
Published: August 2005

Climate is a potent selective force in natural populations, yet the importance of adaptation in the response of plant species to past climate change has been questioned. As many species are unlikely to migrate fast enough to track the rapidly changing climate of the future, adaptation must play an increasingly important role in their response. In this paper we review recent work that has documented climate‐related genetic diversity within populations or on the microgeographical scale. We then describe studies that have looked at the potential evolutionary responses of plant populations to future climate change. We argue that in fragmented landscapes, rapid climate change has the potential to overwhelm the capacity for adaptation in many plant populations and dramatically alter their genetic composition. The consequences are likely to include unpredictable changes in the presence and abundance of species within communities and a reduction in their ability to resist and recover from further environmental perturbations, such as pest and disease outbreaks and extreme climatic events. Overall, a range‐wide increase in extinction risk is likely to result. We call for further research into understanding the causes and consequences of the maintenance and loss of climate‐related genetic diversity within populations.
And the beak shall inherit – evolution in response to invasion
Authors: Carroll Scott P. , Loye Jenella E. , Dingle Hugh , Mathieson Michael , Famula Thomas R. , Zalucki Myron P.
Published: August 2005

The increased demographic performance of biological invaders may often depend on their escape from specifically adapted enemies. Here we report that native taxa in colonized regions may swiftly evolve to exploit such emancipated exotic species because of selection caused by invaders. A native Australian true bug has expanded it host range to include a vine imported from tropical America that has become a serious environmental weed. Based on field comparisons and historical museum specimens, we show that over the past 30–40 years, seed feeding soapberry bugs have evolved 5–10% longer mouthparts, better suited to attack the forest‐invading balloon vines, which have large fruits. Laboratory experiments show that these differences are genetically based, and result in a near‐doubling of the rate at which seeds are attacked. Thus a native biota that initially permits invasion may rapidly respond in ways that ultimately facilitate control.
Prospective study on the role of the CT scan in patients with an acute abdomen
Authors: Salem T. A. , Molloy R. G. , O'Dwyer P. J.
Published: August 2005

Objectives  Recent reports indicate that early CT scan (within 24 h) increases diagnostic accuracy, reduces hospital stay and mortality in patients with an acute abdomen. The aim of this study was to assess the surgeons' use of CT in patients with an acute abdomen and the impact of this on diagnostic accuracy and mortality.

Patients and methods  Patients older than 25 years admitted as an emergency with acute abdominal pain were prospectively evaluated.

Results  Two hundred and eleven patients fulfilled the inclusion criteria including 129 women and 82 men with a mean age of 62.4 years (range 27–92 years). The correct diagnosis on admission was made in 99 (47%) patients. CT was performed in 81 (38%), including 24 who had the scan performed within 24 h of admission. The sensitivity, specificity and accuracy of CT were 86%, 79% and 84%. CT was considered to have changed clinical management in 40 patients. Fifteen patients died, and one death may have been prevented by an early CT. Five had a delay in diagnosis of a serious condition; all could have been prevented by early CT.

Conclusion  Selective use of CT increases diagnostic accuracy and improves the management of patients with an acute abdomen. Clinical trials are necessary to assess outcome following selective vs routine use of CT in this group of patients.
Staged mucosal advancement flap for the treatment of complex anal fistulas: pretreatment with noncutting Setons and in case of recurrent multiple abscesses a diverting stoma
Authors: Van Der Hagen S. J. , Baeten C. G. , Soeters P. B. , Beets‐Tan R. G. , Russel M. G. V. M. , Van Gemert W. G.
Published: August 2005

Objective  To assess the efficacy of a staged strategy for the treatment of complex perianal fistula.

Methods  Between January 1999 and April 2003 all consecutive patients with complex perianal fistulas were treated according to a staged strategy. Fistula tracks originating from the middle third or upper part of the anal sphincter were included. Patients were examined for recurrent fistulas and complaints of incontinence and soiling. Initial treatment consisted of a noncutting seton with or without a diverting stoma. Definitive surgical treatment consisted of an advancement flap or fistulotomy.

Results  Thirty patients were included (median age; 42 years, range 22–68 years). Seven had Crohn's disease without signs of rectal and anal involvement other than the fistula. At a median follow up of 22 months (range 8–52 months) in 29 (97%) patients, the wounds had healed completely; 7 (22%) patients subsequently developed a recurrent fistula and minor soiling occurred in 7 (23%) patients.

Conclusion  Initial treatment with a seton with and without a diverting stoma minimizing inflammatory activity at the fistula site before definitive surgical treatment gave good results in this difficult group of patients.
Colovesical fistula – Is a surgical approach always justified?
Authors: Solkar M. H. , Forshaw M. J. , Sankararajah D. , Stewart M. , Parker M. C.
Published: August 2005

Objective  There is a tendency to over investigate patients with colovesical fistula and to advise surgical intervention as the sole course of action. Most patients are elderly and operative intervention often carries a high morbidity and mortality.

Patients and methods  A retrospective study of 50 patients diagnosed with a colovesical fistula over a 12‐year period was undertaken at our institution. The notes of all these patients were reviewed using a standardized proforma to look at the referral pattern, symtomatology, investigation, treatment and outcomes.

Results  Data analysis showed the median age of these patients to be 70 years with 92% having either pneumaturia or faecaluria or both as a symptom. There was no significant difference in disease‐specific mortality in patients with benign colovesical fistula undergoing surgical intervention and patients treated conservatively. There was not a single documented case of septicaemia despite untreated colovesical fistula being present for a cumulative total of 3254 weeks. There was no statistically significant decline in the renal function due to the disease.

Conclusion  We suggest that fewer investigations be performed for the diagnosis of colovesical fistula and conservative management offered to patients with benign pathology.
Phylogeny of nereidids (Polychaeta, Nereididae) with paragnaths
Authors: Bakken Torkild , Wilson Robin S.
Published: August 2005

A phylogenetic analysis was conducted of the Nereidinae — those members of the Nereididae (Polychaeta) with pharyngeal paragnaths. We had two objectives: to test the monophyly of currently accepted genera, subgenera and informal subgeneric groupings within the Nereidinae, and, if warranted, to propose a more natural classification of the Nereidinae. Parsimony analyses were undertaken, including 52 terminal taxa from all genera and informal groupings from the large heterogeneous generaNereis,Ceratonereis,NeanthesandPerinereis. Analyses of a character set of 52 informative characters yielded more than 10 000 equally parsimonious trees with a length of 176 steps (consistency index [CI] = 0.34, retention index [RI] = 0.66). Reweighting three times resulted in 445 most parsimonious trees with length 54.62 (CI = 0.59, RI = 0.79). Many characters widely used in nereidid systematics were found to exhibit high levels of homoplasy. The most parsimonious trees could not be rooted such that the selected ingroup, ‘Nereididae with paragnaths’, was monophyletic, causing us to reject the monophyly of the Nereidinae as currently defined. The following genera were well supported by the parsimony analyses and are newly diagnosed:Alitta,Ceratonereis,Pseudonereis,Simplisetia,SolomononereisandUnanereis.Alitta succinea,Pseudonereis cortezi,Pseudonereis noodtiandPseudonereis pseudonoodtiare proposed as new combinations. The parsimony analysis supported the monophyly of neitherComposetia,Neanthes,NereisandPerinereisnor of any new groupings of remaining species presently placed in those genera. It is these poorly supported genera that comprise most species of Nereididae.
Phylogenetic relationships of spatangoid sea urchins (Echinoidea): taxon sampling density and congruence between morphological and molecular estimates
Authors: Stockley Bruce , Smith Andrew B. , Littlewood Tim , Lessios Harilaos A. , Mackenzie‐Dodds Jacqueline A.
Published: August 2005

A phylogeny for 21 species of spatangoid sea urchins is constructed using data from three genes and results compared with morphology‐based phylogenies derived for the same taxa and for a much larger sample of 88 Recent and fossil taxa. Different data sets and methods of analysis generate different phylogenetic hypotheses, although congruence tests show that all molecular approaches produce trees that are congruent with each other. By contrast, the trees generated from morphological data differ significantly according to taxon sampling density and only those with dense sampling (aftera posterioriweighting) are congruent with molecular estimates. With limited taxon sampling, secondary reversals in deep‐water taxa are interpreted as plesiomorphies, pulling them to a basal position. The addition of fossil taxa with their unique character combinations reveals hidden homoplasy and generates a phylogeny that is compatible with molecular estimates. As homoplasy levels were found to be broadly similar across different anatomical structures in the echinoid test, no one suite of morphological characters can be considered to provide more reliable phylogenetic information. Some traditional groupings are supported, including the grouping of Loveniidae, Brissidae and Spatangidae within the Micrasterina, but the Asterostomatidae is shown to be polyphyletic with members scattered amongst at least five different clades. As these are mostly deep‐sea taxa, this finding implies multiple independent invasions into the deep sea.
Cladistic analysis of the fire ants of the Solenopsis saevissima species‐group (Hymenoptera: Formicidae)
Authors: Pitts James P. , McHugh Joseph V. , Ross Kenneth G.
Published: August 2005

Results are presented from a phylogenetic study of the fire ants comprising the Solenopsis saevissima species‐group (Hymenoptera: Formicidae). Six most‐parsimonious trees were identified following a cladistic analysis utilizing 18 taxa and 36 morphological characters derived from three castes and two developmental stages. A strict consensus tree recovered the following relationships: (S. daguerrei ((S. electra, S. pusilignis) (S. saevissima (S. pythia (S. interrupta, S. ‘undescribed species’, S. weyrauchi (S. richteri, S. invicta (S. megergates (S. quinquecuspis, S. macdonaghi)))))))). This phylogenetic hypothesis implies trends in fire ant evolution towards both polygyny (multiple egg‐laying queens per colony) and large major worker size. The phylogeny also provides a test of Emery's Rule, which is not supported in its strictest sense because the social parasite S. daguerrei is not the sister species to its host species. A modified version of Emery's Rule is supported, because the social parasite is the sister species to a larger clade containing its hosts, as well as nonhosts.
The comparison of venous plasma glucose and whole blood capillary glucose in diagnoses of Type 2 diabetes: a population‐based screening study
Authors: Sandbæk A. , Lauritzen T. , Borch‐Johnsen K. , Mai K. , Christiansen J. S.
Published: August 2005

Aim  To evaluate the degree of concordance between venous plasma glucose (PG) and capillary whole blood glucose (BG) in diagnosing Type 2 diabetes and to compare the prevalence of confirmed and unconfirmed Type 2 diabetes.

Methods  All 40‐ to 69‐year olds without known diabetes listed with five general practices were invited for screening (2051 persons). People identified by screening as being at high risk for having diabetes (random BG (rBG) ≥ 4.5 mmol/l or HbA1c≥ 5.9%) were examined using BG and PG. The main outcome measures were confirmed diabetes cases (one diabetic glucose value plus symptoms or two diabetic glucose values on two different days) and unconfirmed diabetes (one diabetic glucose value on the first day of testing).

Results  One thousand and twenty‐eight (50%) accepted screening. Diabetes was confirmed by BG or PG in 22 patients (1.8%), and in 14 of these by both BG and PG. Four patients in whom diabetes was confirmed only by BG had unconfirmed diabetes by PG. Three of four people in whom diabetes was confirmed only by PG had unconfirmed diabetes according to BG. The prevalence of unconfirmed diabetes was 3.3% and the prevalence of confirmed diabetes 2.1%.

Conclusion  Confirmed diabetes can be diagnosed by either BG or PG. BG seems more convenient than PG for use in general practice. The prevalence of confirmed diabetes was lower than the prevalence of unconfirmed diabetes.
Improved glycaemic control—an unintended benefit of a nurse‐led cardiovascular risk reduction clinic
Authors: Woodward A. , Wallymahmed M. , Wilding J. , Gill G.
Published: August 2005

Aims  One hundred and ten patients with Type 2 diabetes were referred into a nurse‐led cardiovascular risk reduction clinic. The primary aim of the clinic was to optimize blood pressure (BP) control and address cardiovascular risk factors.

Methods  Those attending outpatient clinics were referred into a nurse‐led cardiovascular risk reduction clinic if BP was above 140/85 mmHg. There was no intervention strategy designed in the nurse clinic protocol to improve glycaemic control.

Results  Following attendance at the clinic, there was a significant improvement in HbA1c noted when patients were reviewed 9 months later. HbA1c improved from 8.7 ± 1.6 to 8.1% ± 1.6% (P < 0.001) in the whole cohort. Further analysis showed that, after excluding those who had received intervention to improve glycaemic control from another source, during the same period there remained a significant improvement in the non‐intervention group of patients.

Conclusion  Frequent regular contact and health education in a nurse‐led clinic to reduce cardiovascular risk may improve HbA1c in the absence of any specific intervention to improve glycaemic control.
Telomere shortening occurs in Asian Indian Type 2 diabetic patients
Authors: Adaikalakoteswari A. , Balasubramanyam M. , Mohan V.
Published: August 2005

Aim  Telomere shortening has been reported in several diseases including atherosclerosis and Type 1 diabetes. Asian Indians have an increased predilection for Type 2 diabetes and premature coronary artery disease. The aim of this study was to determine whether telomeric shortening occurs in Asian Indian Type 2 diabetic patients.

Methods  Using Southern‐blot analysis we determined mean terminal restriction fragment (TRF) length, a measure of average telomere size, in leucocyte DNA. Type 2 diabetic patients without any diabetes‐related complications (n = 40) and age‐ and sex‐matched control non‐diabetic subjects (n = 40) were selected from the Chennai Urban Rural Epidemiology Study (CURES). Plasma level of malondialdehyde (MDA), a marker of lipid peroxidation, was measured by TBARS (thiobarbituric acid reactive substances) using a fluorescence method.

Results  Mean (± SE) TRF lengths of the Type 2 diabetic patients (6.01 ± 0.2 kb) were significantly shorter than those of the control subjects (9.11 ± 0.6 kb) (P = 0.0001). Among the biochemical parameters, only levels of TBARS showed a negative correlation with shortened telomeres in the diabetic subjects (r = −0.36; P = 0.02). However, telomere lengths were negatively correlated with insulin resistance (HOMA‐IR) (r = −0.4; P = 0.01) and age (r = −0.3; P = 0.058) and positively correlated with HDL levels (r = 0.4; P = 0.01) in the control subjects. Multiple linear regression (MLR) analysis revealed diabetes to be significantly (P < 0.0001) associated with shortening of TRF lengths.

Conclusions  Telomere shortening occurs in Asian Indian Type 2 diabetic patients.
Large‐scale studies of the Leu72Met polymorphism of the ghrelin gene in relation to the metabolic syndrome and associated quantitative traits
Authors: Bing C. , Ambye L. , Fenger M. , Jørgensen T. , Borch‐Johnsen K. , Madsbad S. , Urhammer S. A.
Published: August 2005

Aim  Recently, low‐frequency polymorphisms in the coding region of the ghrelin gene were suggested to be involved in the aetiology of obesity and to modulate glucose‐induced insulin secretion in different ethnic study groups. The objective of the present large study was to investigate whether the Leu72Met polymorphism of the ghrelin gene associates with features of the metabolic syndrome (MS) in the Danish population.

Methods  The variant was examined, using PCR‐RFLP, in the DanMONICA cohort, a population‐based sample of 2413 subjects. The metabolic syndrome was defined using the National Cholesterol Education Program‐Adult Treatment Panel III (NCEP‐ATPIII) criteria.

Results  The allelic frequency of the Met72 allele was 8.6%[6.3–10.9%] in the MS group and 7.8%[7.0–8.6%] among subjects classified as not having the MS (NS). Similarly, there were no significant differences across the three groups of genotypes with respect to any of the examined variables, including BMI, waist circumference, fasting serum lipids, plasma glucose, serum insulin and HOMA estimates of insulin resistance and insulin secretion

Conclusion  In conclusion, the Leu72Met polymorphism of the ghrelin gene is not associated with the metabolic syndrome or related quantitative traits in the Danish population.
Health‐economic comparison of continuous subcutaneous insulin infusion with multiple daily injection for the treatment of Type 1 diabetes in the UK
Authors: Roze S. , Valentine W. J. , Zakrzewska K. E. , Palmer A. J.
Published: August 2005

Objectives  The aim of this study was to project the long‐term costs and outcomes of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) in patients with Type 1 diabetes in the UK.

Methods  The CORE Diabetes Model is a peer‐reviewed, validated model which employs standard Markov/Monte Carlo simulation techniques to describe the long‐term incidence and progression of diabetes‐related complications. It was used to simulate disease progression in a cohort of patients with baseline characteristics taken from published UK studies (mean age 26 years, duration of diabetes 12 years, mean HbA1c 8.68%). Direct costs for 2003 were calculated from a third‐party payer perspective. Discount rates of 3.0% per annum were applied to costs and clinical outcomes.

Results  Treatment with CSII was associated with an improvement in mean quality adjusted life expectancy (QALE) of 0.76 ± 0.19 years compared with MDI (12.03 ± 0.15 vs. 11.27 ± 0.14 years). Mean direct lifetime costs were £19 407 ± 1727 higher with CSII treatment compared with MDI (£80 511 ± 1257 vs. £61 104 ± 1249). This produced an incremental cost‐effectiveness ratio (ICER) of £25 648 per quality‐adjusted life year (QALY) gained with CSII vs. MDI. The results were most sensitive to variation in hypoglycaemia rates and altering improvements in HbA1c associated with CSII therapy compared with MDI.

Conclusions  Improvements in glycaemic control associated with CSII over MDI led to improved QALE owing to reduced incidence of diabetes‐related complications. CSII was associated with an ICER of £25 648 per QALY gained vs. MDI, representing good value for money by current standards in the UK.

Diabet. Med. (2005)
Relationship of non‐alcoholic hepatic steatosis to cortisol secretion in diet‐controlled Type 2 diabetic patients
Authors: Targher G. , Bertolini L. , Zoppini G. , Zenari L. , Falezza G.
Published: August 2005

Aims  To examine the association of non‐alcoholic hepatic steatosis (HS) with the activity of the hypothalamo‐pituitary‐adrenal (HPA) axis in Type 2 diabetic individuals.

Methods  The activity of the HPA axis, as measured by 24‐h urinary free cortisol (UFC) excretion and serum cortisol levels after 1.0 mg dexamethasone, was measured in 40 diet‐controlled, predominantly overweight, Type 2 diabetic patients with non‐alcoholic HS and in 40 diabetic patients without HS who were comparable for age, sex and body mass index (BMI).

Results  Subjects with non‐alcoholic HS had significantly higher 24‐h UFC excretion (191 ± 4 vs. 102 ± 3 nmol/24 h; P < 0.001) and post‐dexamethasone cortisol concentrations (29.1 ± 2 vs. 14.4 ± 1 nmol/l; P < 0.001) than those without HS. Patients with HS had significantly higher values for HOMA insulin resistance score, plasma triglycerides and liver enzymes. Age, sex, BMI, waist–hip ratio (WHR), diabetes duration, HbA1c, LDL‐cholesterol and blood pressure values were not different between the groups. The differences in urinary and serum cortisol concentrations between the groups remained significant after adjustment for age, sex, BMI, WHR, HOMA insulin resistance score, plasma triglycerides, HbA1c and liver enzymes. In multiple logistic regression analyses, 24‐h UFC or serum cortisol concentrations (P < 0.05 and P = 0.02, respectively), along with age and HOMA insulin resistance, predicted the presence of HS, independently of potential confounders.

Conclusions  These results demonstrate that non‐alcoholic HS is closely associated with a subtle, chronic overactivity of the HPA axis in diet‐controlled Type 2 diabetic individuals.
British South Asians aged 13–16 years have higher fasting glucose and insulin levels than Europeans
Authors: Whincup P. H. , Gilg J. A. , Owen C. G. , Odoki K. , Alberti K. G. M. M. , Cook D. G.
Published: August 2005

Aim  To examine whether plasma glucose, insulin resistance and markers of adiposity differed between British adolescents of South Asian and European origin.

Methods  School‐based cross‐sectional study (1998–2000), in which detailed measurements of adiposity, fasting plasma glucose and serum insulin were made in 90 South Asian and 1248 European pupils (overall 69% response rate).

Results  Compared with Europeans, South Asian subjects had higher mean fasting insulin levels (percentage mean difference 17.2%, 95% confidence interval 7.2–26.1%, P = 0.001), a higher mean fasting glucose (mean difference 0.19 mmol/l, 95% confidence interval 0.08–0.29 mmol/l, P = 0.0005) and a higher prevalence of impaired fasting glucose (≥ 6.1 mmol/l) (5.6% vs. 1.5%, odds ratio 3.9, 95% confidence interval 1.4–10.9, P = 0.004). Although South Asian children tended to have slightly higher indices of adiposity than Europeans (other than body mass index), the differences in glucose and insulin levels persisted after adjustment for adiposity and for pubertal status.

Conclusions  The predisposition to Type 2 diabetes observed in South Asian adults is apparent before adult life. Establishing the contributions of the childhood and fetal environments and of genetic factors to the development of these ethnic differences is an important priority. Prevention of Type 2 diabetes in British South Asians needs to begin before adult life.
Antecedent hypoglycaemia attenuates vascular endothelial growth factor response to subsequent hypoglycaemia in healthy men
Authors: Merl V. , Peters A. , Oltmanns K. M. , Kern W. , Hubold C. , Fehm H. L. , Born J. , Schultes B.
Published: August 2005

Aim  The plasma concentration of vascular endothelial growth factor (VEGF) has recently been shown to increase sharply in response to hypoglycaemia and, thus, has been proposed as having a role in hypoglycaemia counter‐regulation. Many counter‐regulatory hormones show a reduced response after antecedent hypoglycaemia. We therefore investigated whether this decrease in responsiveness with repetitive hypoglycaemia also pertains to VEGF.

Methods  Three hypoglycaemic clamp experiments were performed on two consecutive days in 15 healthy men. VEGF response was assessed during the first and last hypoglycaemic period.

Results  As expected, plasma VEGF concentrations rose markedly during the clamps (P < 0.001). The increase was distinctly blunted during the third (+13 ± 8 pg/ml) as compared with the first (+54 ± 18 pg/ml) hypoglycaemic clamp (P = 0.046).

Conclusion  This data confirms that circulating VEGF concentrations increase acutely during hypoglycaemia. Like the counter‐regulatory hormones, the hypoglycaemia‐induced rise in VEGF is attenuated after antecedent hypoglycaemia. The origin of increased systemic VEGF concentration during hypoglycaemia and its physiological role remains to be defined.
Genetic polymorphisms in peroxisome proliferator‐activated receptor γ are associated with Type 2 diabetes mellitus and obesity in the Korean population
Authors: Moon M. K. , Cho Y. M. , Jung H. S. , Park Y. J. , Yoon K. H. , Sung Y. A. , Park B. L. , Lee H. K. , Park K. S. , Shin H. D.
Published: August 2005

Aims  We examined whether the common polymorphisms of the peroxisome proliferator‐activated receptor‐γ (PPARγ) gene are associated with Type 2 diabetes or obesity in the Korean population.

Methods  We genotyped two common PPARγ polymorphisms (Pro12Ala and 161C > T) and examined their association with the clinical phenotypes found in 684 patients with Type 2 diabetes mellitus and 291 non‐diabetic control subjects.

Results  The 12Ala allele was less frequent in the Type 2 diabetic patients than in the non‐diabetic control subjects (0.036 vs. 0.053, P = 0.024). The allele frequencies of the 161C > T polymorphism did not differ between the control and Type 2 diabetic group (0.158 vs. 0.173). In the non‐diabetic controls, those with the T allele had lower BMI and fasting serum triglyceride (TG) concentrations than those with the C/C homozygote (22.7 ± 2.9 vs. 23.8 ± 3.2 kg/m2, P = 0.002; 1.45 ± 0.81 vs. 1.65 ± 0.83 mmol/l, P = 0.03, respectively). The 12Ala‐161T haplotype was associated with a decreased risk for Type 2 diabetes (OR = 0.47, P = 0.009), whereas the 12Pro‐161T haplotype was associated with lower BMI and lower fasting serum TG (22.5 ± 2.8 vs. 23.7 ± 3.2 kg/m2, P = 0.004; 1.41 ± 0.87 vs. 1.64 ± 0.79 mmol/l, P = 0.02, respectively).

Conclusions  The PPARγ 12Ala allele was associated with a reduced risk of Type 2 diabetes, whereas the PPARγ 161T allele was associated with lower BMI and fasting serum TG concentrations in the Korean subjects. The subjects with 12Ala‐161T haplotypes had a reduced risk of Type 2 diabetes.
Diabetes and hypertension in pregnancy in a rural community of Bangladesh: a population‐based study
Authors: Sayeed M. A. , Mahtab H. , Khanam P. A. , Begum R. , Banu A. , Azad Khan A. K.
Published: August 2005

Aims  Gestational diabetes mellitus (GDM) is associated with increased infant mortality. Diabetes and infant mortality is higher in Bangladesh but the prevalence of diabetes and hypertension in pregnancy is not known. Thus, this study addressed the prevalence of diabetes and hypertension in pregnancy.

Methods  We selected 10 villages randomly in a union council of Nandail subdistrict. Following a population census (n = 14 382: male/female = 7476/6906) on demography and marital status, we interviewed 2205 married women (18–44 years) for detection of pregnancy. Of a total of 172 pregnancies, we investigated 147 with a gestational age of 24–28 weeks for obstetrical history, clinical examination and blood pressure (BP). Fasting (FBG) and 2‐h blood glucose (2hBG) were assessed by Hemocue cuvette. WHO diagnostic criteria were used.

Results  The overall prevalence (95% CI) of diabetes was 6.8% (1.88–9.32) and 8.2% (3.74–12.64) according to FBG and 2hBG, respectively. The crude prevalence of systolic and diastolic hypertension was 6.8 and 5.4%, respectively. The median (interquartile range) values for age, BMI and FBG of the participants were 25.0 (21.0–30.0) years, 19.5 (18.2–21.2) and 3.9 (3.6–4.3), respectively. The history of abortion, neonatal death and stillbirth was found in 19.9, 11.4 and 9.6%, respectively. The prevalence of GDM was higher among those with the history of stillbirth (15.4 vs. 6.0%) and neonatal death (11.8 vs. 6.2%) than those without.

Conclusion  The prevalence of GDM in rural Bangladesh is comparable with any other population with higher prevalence of GDM. Increased morbidity and mortality among mothers and newborns in Bangladesh may, in part, be because of increased prevalence of GDM.
Low serum concentration of sulfatide and presence of sulfated lactosylceramid are associated with Type 2 diabetes. The Skaraborg Project
Authors: Buschard K. , Fredman P. , Bøg‐Hansen E. , Blomqvist M. , Hedner J. , Råstam L. , Lindblad U.
Published: August 2005

Aims  The glycosphingolipid sulfatide (sulfated galactosyl‐ceramide) increases exocytosis of β‐cell secretory granules, activates KATP‐channels and is thereby able to influence insulin secretion through its presence in the islets. A closely related compound, sulfated lactosylceramide (sulf‐lac‐cer), is present in the islets during fetal and neonatal life when, as in Type 2 diabetes, insulin is secreted autonomically without the usual first phase response to glucose. The aim was to examine whether serum concentrations of these glycolipids are associated with Type 2 diabetes.

Methods  A case–control study, comprising 286 women and 283 men, was designed using a population‐based sample of patients with Type 2 diabetes and a population survey.

Results  Low serum concentrations of sulfatide were associated with Type 2 diabetes, independent of traditional risk factors for diabetes in a sex‐specific analysis: odds ratio (OR) 2.1 (95% confidence interval 1.1, 3.9) in men, and 2.3 (1.2, 4.3) in women, comparing the lowest and the highest tertiles. Type 2 diabetes was also associated with detectable amounts of sulf‐lac‐cer in serum: OR 1.7 (0.9, 3.4) in men, and 7.6 (3.8, 15.2) in women. After adjustment for confounding from other diabetes risk factors, these associations remained basically unchanged. The connections between sulfatide and Type 2 diabetes, and sulf‐lac‐cer and Type 2 diabetes were independent of each other. Insulin resistance (HOMA‐IR) was negatively correlated with sulfatide concentration and positively correlated with sulf‐lac‐cer (both P < 0.0001, independently).

Conclusions  We report a new, robust and highly significant independent association between Type 2 diabetes and serum concentrations of sulfatide in both sexes, and sulf‐lac‐cer in females. The associations were also independent of other known diabetes risk factors.
Comparison of processes and intermediate outcomes between South Asian and European patients with diabetes in Blackburn, north‐west England
Authors: McElduff P. , Edwards R. , Burns J. A. , Young R. J. , Heller R. , Long B. , Jones G. , New J. P.
Published: August 2005

Background  Diabetes and its complications are more prevalent among South Asians than people of European origin and there is some evidence that patients of South Asian origin with diabetes receive poorer quality care.

Methods  Longitudinal study of patients with diabetes in Blackburn, UK. Processes of care indicators [measurement of blood pressure (BP), cholesterol and glycosolated haemoglobin (HbA1c)] and values of these intermediate outcomes were extracted for all patients registered on a diabetes information system for the period 1995–2001. Differences in processes of care indicators and intermediate outcomes between ethnic groups were estimated after adjusting for the potential confounding factors of sex, age and socioeconomic status (SES). Generalized estimating equations were used to model trends and to test for differences in trends over time.

Results  Process of care was similar in South Asian and European patients. Mean BP and cholesterol concentration fell during the study period. South Asians had a higher level of HbA1c throughout the study period. South Asians had lower levels of BP and cholesterol in 1995 but the differences diminished or were abolished over time. SES did not explain differences between ethnic groups. Analyses stratified by baseline levels of intermediate outcomes (above or within target) demonstrated improvements among above target patients were greater among European patients.

Conclusions  Processes of care indicators are similar in diabetic patients of South Asian and European origin, irrespective of SES. However, there are worrying differences in improvements over time in the intermediate outcomes, and glycaemic control remained poorer among patients of South Asian origin patients throughout.
Long‐term influences of body‐weight changes, independent of the attained weight, on risk of impaired glucose tolerance and Type 2 diabetes
Authors: Black E. , Holst C. , Astrup A. , Toubro S. , Echwald S. , Pedersen O. , Sørensen T. I. A.
Published: August 2005

Aim  To investigate if weight gain during adulthood has effects on the risk of developing impaired glucose tolerance (IGT) or Type 2 diabetes beyond effect of attained weight.

Research design and methods  Data were obtained from a longitudinal study of two cohorts: one of juvenile‐onset obese (n = 248) and one of randomly selected control (n = 320) men, weighed at average ages of 20, 33, 44 and 51 years, respectively.

Results  For any given BMI, the risk of IGT was higher the greater the weight gain since age 20 (odds ratio of 1.10 per unit kg/m2 of BMI gain, confidence interval 1.03–1.17, P = 0.004), and weight gain during both the early and later ages contributed to the increased risk. Obese men, maintaining weight since age 20, had lower risk of IGT than non‐obese men who became similarly obese by age 51. The risk of Type 2 diabetes increased by weight gain in early adult life, but not by more recent weight gain in the later periods, probably because of the development of Type 2 diabetes leading to weight loss.

Conclusions  Independent of attained level of body weight in middle‐aged men, weight gain is associated with increased risk of IGT, and is greater in those not overweight in childhood.
The presence of allele D of angiotensin‐converting enzyme polymorphism is associated with diabetic nephropathy in patients with less than 10 years duration of Type 2 diabetes
Authors: Canani L. H. , Costa L. A. , Crispim D. , Gonçalves dos Santos K. , Roisenberg I. , Lisbôa H. R. K. , Sarturi Tres G. , Maia A. L. , Gross J. L.
Published: August 2005

Aim  To investigate the association between angiotensin‐converting enzyme gene I/D polymorphism and diabetic nephropathy (DN) in patients with Type 2 diabetes mellitus (DM) taking into consideration the known duration of DM.

Methods  Cross‐sectional study with 982 patients categorized according to urinary albumin excretion (UAE) into normoalbuminuria (UAE < 20 µg/min or < 17 mg/l, 24‐h timed urine or spot random sterile urine, respectively), incipient DN (UAE 20–199 µg/min or 17–174 mg/l) and overt DN (UAE > 200 µg/min or > 174 mg/l or dialysis). Patients were further grouped regarding presence of the D allele (DD/ID vs. II) and DM duration (≤ 10 years or > 10 years).

Results  Incipient DN was diagnosed in 17.3% (n = 170), and 20.7% (n = 203) had overt DN (macroalbuminuria, n = 129; dialysis, n = 74). Genotype distribution (DD/ID/II) was similar in patients with incipient (49/92/29) or overt DN (77/89/37) if compared with patients without DN (181/308/120, P = 0.172). In patients with DM ≤ 10 years, having the D allele (DD/ID) resulted in an odds ratio (OR) of 2.66 (95% CI: 1.12–6.58, P = 0.015) for incipient DN, and 3.19 (95% CI: 1.18–9.30, P = 0.012) for overt DN. In patients with longer DM duration, the D allele did not increase the risk for incipient (OR 0.68, 95% CI 0.36–1.29, P = 0.206) or overt DN (OR 0.67, 95% CI 0.39–1.17, P = 0.138).

Conclusion  The DD/ID genotypes were associated with incipient or overt DN in patients with DM ≤ 10 years.