bluuebunny/crossref_metadata_2025 huggingface dataset:
Increasing Incidence of Hypoglycemic Coma in Children With IDDM
Authors: Egger Matthias , Gschwend Sylvia , Smith George Davey , Zuppinger Klaus
Published: March 2007

Objective

To examine the incidence of hypoglycemic coma in children with insulin-dependent diabetes mellitus (IDDM) over 8 yr from 1981 to 1988 and to investigate the importance of residual β-cell function of HbA1 levels and other variables as risk factors for hypoglycemic coma.

Research Design and Methods

The study consisted of 155 children with IDDM aged < 16 yr at study entry. Mean age at onset of diabetes was 7.9 yr (range 1.1–15.6 yr). We made a prospective assessment of hypoglycemic coma episodes, with a standardized questionnaire, over a total observation time of 816.6 person-yr. Three monthly clinical and laboratory examinations, which included determinations of C-peptide and HbA1 levels, were conducted. We compared children with hypoglycemic coma (cases) with children without hypoglycemic coma (controls) in a case-control analysis matched for diabetes duration. Yearly incidence of hypoglycemic coma, calculated as the number of subjects having an attack in 1 yr divided by the cumulative number of person-years for that year, was measured. Univariate and multivariate odds ratios were calculated from logistic regression.

Results

Over the first 4 yr, the average yearly incidence was 4.4/100 person-yr compared with 7.4/100 person-yr during the later 4 yr (P < 0.0001). This tendency was accompanied by intensification of insulin treatment with an increase in the mean number of daily injections and a decrease in mean HbA1 levels. In the case-control analysis, absent residual β-cell function was the most important risk factor for hypoglycemic coma (adjusted odds ratio 7.8, 95% confidence intervals 2.0–31.2), followed by near-normal HbA1 levels (adjusted odds ratio 4.5, 95% confidence intervals 1.9–10.5).

Conclusions

In this group of children, improvement of glycemic control apparently led to an increase in the incidence of severe hypoglycemia. In children with recurrent hypoglycemic coma and undetectable C-peptide levels, it may be safer to aim for somewhat less tight glycemic control.
Quality Assurance for Blood Glucose Monitoring in Health-Care Facilities
Authors: Walker Elizabeth A , Paduano Darlene J , Shamoon Harry
Published: March 2007

Objective

To describe the practice of quality assurance (QA) for capillary blood glucose monitoring (CBGM) in health-care facilities.

Research Design and Methods

Descriptive survey data were collected from a purposive sample of 378 health-care providers, who use CBGM and direct CBGM QA programs, from acute- and chronic-care facilities in 47 states. Subjects completed a 36-item multiple-choice survey about QA practices for CBGM by providers.

Results

Only 53.4% of respondents reported a multidisciplinary advisory group to assist in decision making for the CBGM program. Almost one-third reported no clinical laboratory involvement in their QA program. Over 70% of respondents reported inclusion of all clinical areas in the CBGM program. Comparison of results of the same patient sample by laboratory reference method and CBGM system was done routinely by only 43.6% of respondents. Scheduled proficiency testing was reported by 33.4%. Only 5.8% of respondents reported the coexistence of a CBGM advisory group, full participation of the laboratory, and quarterly proficiency testing. Over 50% of respondents reported a patient charge for CBGM.

Conclusions

When survey results are compared with regulatory and accreditation standards, it is evident that a wide gap exists. Resources to bridge this gap may be scarce in many facilities. Further research is needed to determine minimal QA standards for CBGM that provide for optimal patient outcomes.
Visceral Afferent Neuropathy in Diabetic Gastroparesis
Authors: Rathmann Wolfgang , Enck Paul , Frieling Thomas , Gries F Arnold
Published: March 2007

Objective

To determine whether a lack of symptoms in diabetic patients with gastrointestinal motility disorders is associated with visceral afferent neuropathy.

Research Design and Methods

We investigated cerebral evoked potentials (EPs) after esophageal stimulation in 10 patients with motor dysfunction of the gastrointestinal tract and in 10 healthy control subjects. All patients had insulin-dependent diabetes mellitus (5 men, 5 women, age range 31–60 yr, diabetes duration 8–36 yr, 10 of 10 with polyneuropathy, 6 of 10 with cardiac autonomic neuropathy). Their esophageal and gastric motor disorders had been diagnosed by scintigraphy, and gastrointestinal stenosis had been excluded by gastroscopy. Only 2 patients had severe symptoms, whereas 6 patients complained of minor discomfort (distension, bloating), and 2 patients were symptom free.

Results

EPs were recorded after electrical stimulation of the esophagus (32 cm from the incisors) at intensity just above the perception threshold. All control subjects exhibited regular EPs at 0.1 ms/30 mA stimulation intensity. In 6 diabetic patients, no EPs were detected at 0.1 and 0.3 ms/30 mA, and the perception thresholds were significantly elevated. In 4 patients with normal perception threshold, EPs of regular shape but decreased amplitude were recorded. These patients had mild or severe gastroparetic complaints.

Conclusions

These data show for the first time an association between a lack of symptoms in diabetic gastrointestinal motility disorders and visceral afferent neuropathy.
Symptoms of Acute Insulin-Induced Hypoglycemia in Humans With and Without IDDM: Factor-Analysis Approach
Authors: Hepburn David A , Deary Ian J , Frier Brian M , Patrick Alan W , Quinn John D , Fisher B Miles
Published: March 2007

Objective

This study allocated the symptoms identified during acute hypoglycemia objectively to the autonomic or neuroglycopenic groups of symptoms by the use of factor analysis.

Research Design and Methods

Twenty-five nondiabetic subjects, 14 newly diagnosed insulin-dependent diabetic patients, and 16 insulin-dependent diabetic patients with diabetes > 4 yr duration were studied. Acute hypoglycemia was induced with insulin (2.5 mU·kg−1 body wt·min−1 i.v.), and symptoms of hypoglycemia were recorded with a seven-point scale at regular time points throughout the studies. Factor analysis of the symptom scores at the time of the acute autonomic reaction with principal component analysis followed by Varimax rotation was used to separate those symptoms that might belong to neuroglycopenic and autonomic groups.

Results

Hypoglycemia was induced to a mean ± SE plasma glucose nadir of 1.3 ± 0.1 mM in nondiabetic subjects, to 2.0 ± 0.3 mM in newly diagnosed diabetic patients, and 1.4 ± 0.2 mM in patients with diabetes of > 4 yr duration. The most frequently reported autonomic symptoms were sweating, trembling, and warmness, and the most frequently reported neuroglycopenic symptoms were inability to concentrate, weakness, and drowsiness. Neuroglycopenic symptoms were reported more commonly at the onset of hypoglycemia, which was identified by the development of symptoms. Factor analysis grouped trembling, anxiety, sweating, warmness, and nausea together, and this grouping was labeled an autonomic factor. A second factor was identified that included dizziness, confusion, tiredness, difficulty in speaking, shivering, drowsiness, and inability to concentrate, which was labeled a neuroglycopenic factor.

Conclusions

This study demonstrated the high frequency with which neuroglycopenic symptoms occur at the onset of hypoglycemia and the symptoms that could be used by an individual patient as a warning of the development of acute hypoglycemia, although the rapid reduction of plasma glucose is faster than experienced by the ambulant diabetic patient. Factor analysis assisted with the allocation of symptoms to either the autonomic or neuroglycopenic groupings, but the allocation of some symptoms remained undefined, and care must be taken when assessing symptoms such as hunger, weakness, blurred vision, and drowsiness when comparing the frequency of autonomic versus neuroglycopenic symptoms. To reduce the confusion resulting from the use of different symptom questionnaires in studies of hypoglycemia, a sample questionnaire is presented, the development of which was assisted by our analysis.
Relationship Between Prevalence of Impaired Glucose Tolerance and NIDDM in a Population
Authors: Dowse Gary K , Zimmet Paul Z , King Hilary
Published: March 2007

Objective

To study the relationship between the prevalence of impaired glucose tolerance (IGT) and non-insulin-dependent diabetes mellitus (NIDDM) across populations of the Pacific Ocean region to assess whether variability in those two proportions followed some predictable pattern related to modernization of life-style and risk factor levels.

Research Design and Methods

Prevalence estimates from studies with 75-g oral glucose loads and World Health Organization criteria were age standardized.

Results

The linear correlation between IGT and NIDDM prevalence was poor (0.22 in men and 0.24 in women), although it was improved when the outlying data of Micronesian Nauruans and Australian Aborigines were excluded (r = 0.65, P < 0.01 in men and r = 0.54, P < 0.01 in women). However, an epidemicity index calculated as the percentage of total glucose intolerance (TGI) made up by IGT (i.e., IGT/TGI) had the strongest correlation with NIDDM prevalence (r = −0.81, P < 0.001 in men and r = −0.77, P < 0.001 in women) and also explained more of its variance, with no population having undue influence on the relationship. When IGT/TGI was plotted against NIDDM prevalence for the genetically homogeneous rural (relatively traditional) and urban (modernized) segments of five Pacific island populations, there was a clear tendency for IGT/TGI to decline as the prevalence of NIDDM increased in association with worsening risk factor levels. However, longitudinal data for the high prevalence population of Nauru demonstrated that at least in a stabilizing epidemic, changes in the prevalence of IGT and NIDDM may not be easily predictable.

Conclusions

The epidemicity index may be useful as an indicator of the potential for higher future NIDDM prevalence in whole populations. Populations will probably equilibrate at a certain NIDDM prevalence dependent on the strength of their genetic susceptibility to the disease and their degree of exposure to adverse environmental risk factors, including modern diet, physical inactivity, and obesity.
Multicenter Survey of Diabetic Pregnancy in France
Authors:   Gestation and Diabetes in France Study Group
Published: March 2007

Objective

To describe the medical care and outcome of diabetic pregnancy and gestational diabetes in France and study their associations with glycemic control.

Research Design and Methods

We performed a multicenter prospective survey with systematic collection of clinical and biological data (HbA1c analysis in a central laboratory) at five successive examinations and consecutive recruitment of women at any stage of pregnancy in 46 specialized centers from all parts of France. Pregnancies were followed to the end. There were 483 single pregnancies (232 women with insulin-dependent diabetes mellitus [IDDM], 78 with non-insulin-dependent diabetes mellitus [NIDDM], and 173 with gestational diabetes mellitus [GDM]), and 11 twin births (8 IDDM, 3 GDM).

Results

We observed 30 abortions (6%), 8 perinatal deaths (1.8%, 4 IDDM, 4 GDM), and 13 congenital malformations (3%). In the 11 twin pregnancies, there were 7 congenital malformations. Premature births and cesarean sections were found very frequently (42 and 61% IDDM, 29 and 55% NIDDM, 22 and 32% GDM, respectively). In the three groups, birth weight adjusted for gestational age was much > national reference values. HbA1c levels during the first trimester were significantly higher in women who aborted (mean ± SE 7.1 ± 0.4 vs. 5.6 ± 0.1%, P < 0.001) and those who gave birth to malformed infants (6.8 ± 0.4 vs. 5.9 ± 0.1%, P < 0.05).

Conclusions

Perinatal mortality was slightly higher in diabetic women than the general population (1.8 vs. 1.2%), but the prematurity rate was much higher, possibly due to an interventionist policy in some centers. Fetal loss and congenital malformations were associated with poor glycemic control.
Metabolic Implications of Body Fat Distribution
Authors: Björntorp Per
Published: March 2007

Insulin resistance is the cornerstone for the development of non-insulin-dependent diabetes mellitus (NIDDM). Free fatty acids (FFAs) cause insulin resistance in muscle and liver and increase hepatic gluconeogenesis and lipoprotein production and perhaps decrease hepatic clearance of insulin. It is suggested that the depressing effect of insulin on circulating FFA concentration is dependent on the fraction derived from visceral adipocytes, which have a low responsiveness to the antilipolytic effect of insulin. Elevated secretion of cortisol and/or testosterone induces insulin resistance in muscle. This also seems to be the case for low testosterone concentrations in men. In addition, cortisol increases hepatic gluconeogenesis. Cortisol and testosterone have “permissive” effect on adipose lipolysis and therefore amplify lipolytic stimulation; FFA, cortisol, and testosterone thus have powerful combined effects, resulting in insulin resistance and increased hepatic gluconeogenesis. All these factors promoting insulin resistance are active in abdominal visceral obesity, which is closely associated with insulin resistance, NIDDM, and the “ metabolic syndrome.” In addition, the endocrine aberrations may provide a cause for visceral fat accumulation, probably due to regional differences in steroid-hormone-receptor density. In addition to the increased activity along the adrenocorticosteroid axis, there also seem to be signs of increased activity from the central sympathetic nervous system. These are the established endocrine consequences of hypothalamic arousal in the defeat and defense reactions. There is some evidence that suggests an increased prevalence of psychosocial stress factors is associated with visceral distribution of body fat. Therefore, it is hypothesized that such factors might provide a background not only to a defense reaction and primary hypertension, suggested previously, but also to a defeat reaction, which contributes to an endocrine aberration leading to metabolic aberrations and visceral fat accumulation, which in turn leads to disease.
Reproducibility of Glucose and Insulin Responses to Mixed Meal in Type II Diabetic Patients
Authors: Le Floch Jean-Pierre , Baudin Eric , Escuyer Philippe , Wirquin Evelyne , Yomtov Bernard , Perlemuter Léon
Published: March 2007

Objective

The reproducibility of glucose and insulin responses to a mixed meal were studied in 24 consecutive non-insulin-dependent (type II) diabetic patients, the diet of which matched the tested diet. Patients received their usual treatment throughout the study.

Research Design and Methods

A standardized diet was followed for 3 days, and responses were measured on the 2nd and 3rd days. Glucose and insulin responses were studied after lunches with the 180-min positive area under the curve, and were analyzed with paired ttest and Pearson's linear regression.

Results

Glucose responses did not vary (217 ± 50 vs. 217 ± 38 min × mM, NS) and were significantly correlated (r = 0.64, P <0.01). Insulin responses did not vary (35,224 ± 5768 vs. 35,305 ± 7779 min ' pM, NS) and were strongly correlated (r = 0.83, P <0.001).

Conclusions

These results suggest that glucose and insulin responses to a test meal are reproducible in type II diabetic patients.
An Overview of Role of Matrix Components
Authors: Brown David M , Charonis Aristidis S , Furcht Leo T , Klein David J , Mauer S Michael , Steffes Michael W , Tsilibary Photini-Effie
Published: March 2007

The glomerular filtration barrier consists of complex matrix constituents interposed between the glomerular endothelial and epithelial cells, which constitute the lining of the glomerular capillaries. The matrix components include collagen and noncollagenous molecules such as laminin and proteoglycans. This review describes herein the metabolic consequences of diabetes mellitus to which increased permeability of the filtration barrier may be attributed by altering matrix molecules.
Plasma Catecholamine Responses to Hypoglycemia in Children and Adolescents With IDDM
Authors: Hoffman Robert P , Singer-Granick Carol , Drash Allan L , Becker Dorothy J
Published: March 2007

Objective

The goal of this study was to assess whether children and adolescents with insulin-dependent diabetes mellitus (IDDM) have decreased catecholamine responses to insulin-induced hypoglycemia as has been reported in adults and to explore the pathogenesis of the decreased response in terms of possible relationships to autonomic neuropathy or hyperinsulinism.

Research Design and Methods

A before-and-after trial on the effects of 3 days of intensive insulin therapy was conducted on 60 subjects with IDDM (age 15.4 ± 2.6 yr, duration of diabetes 7.8 ± 3.5 yr). The control group consisted of 5 children with non-growth hormone-deficient short stature (age 14.8 ± 3.2 yr). Hypoglycemia was induced with an intravenous insulin bolus (0.15–0.75 U/kg) after insulin withdrawal and 3 days of intensive insulin therapy in diabetic subjects on an inpatient basis to assess the role of hyperinsulinism in suppressing the catecholamine response to hypoglycemia. Control subjects were studied once and received an insulin bolus of 0.1 µU/kg. Autonomic neuropathy was assessed by computerized assessment of the basal R-R variation during inspiration and expiration and the pancreatic polypeptide response to hypoglycemia.

Results

Basal plasma catecholamine levels were lower in diabetic subjects after intensive insulin therapy than in control subjects (P = 0.008). The peak and incremental catecholamine responses after insulin withdrawal and intensive insulin therapy in IDDM subjects were significantly decreased compared with control subjects (P < 0.001). Peak catecholamine responses to hypoglycemia in IDDM were decreased after intensive insulin therapy (P = 0.002). This was particularly true in those with plasma glucose nadir levels of < 2.2 mmol (P < 0.001). The diminished catecholamine responses were primarily due to decreased peak epinephrine responses after intensive insulin therapy compared with insulin withdrawal (P = 0.011). There were no significant correlations between the catecholamine response to hypoglycemia and age, duration of diabetes, pancreatic polypeptide, or R-R interval.

Conclusions

These results suggest that children and adolescents with IDDM after insulin withdrawal have diminished catecholamine response to hypoglycemia compared with control subjects and indicate that short-term intensive insulin therapy diminishes this response further. Thus, hyperinsulinism may play a role in suppressing the catecholamine response to hypoglycemia. There is no evidence for a clinical or subclinical role of autonomic neuropathy to explain the altered catecholamine responses.
Na+ Transport in Hypertension
Authors: Hilton Philip J
Published: March 2007

Several different lines of argument lead to the conclusion that the Na+ ion is important in hypertension. These include dietary and epidemiological studies, studies on the isolated cells and tissues of hypertensive subjects, and the association of the genetic predisposition to hypertension with abnormalities of cellular Na+ handling. In isolated cells, the most convincing abnormalities have been shown in the Na+ pump, where there is also evidence of a circulating inhibitor of the pump in essential hypertension, although the nature of the agent is still uncertain. The genetic association between essential hypertension and Na+ transport is best represented by alterations in Na(+)-Li+ countertransport in hypertensive subjects and their near relatives, although interpretation is rendered more complex by the influence of nongenetic factors on this system. The demonstrated differences between hypertensive and nonhypertensive subjects in the cellular handling of Na+ have not been integrated into a totally convincing explanation of the ultimate mechanism of the condition. Attention has focused on the possible mechanisms whereby an increase in intracellular Na+ may increase the concentration of cytosolic Ca2+ in the vascular smooth muscle, which is presumed to be a necessary precondition to a chronically elevated peripheral vascular resistance.
Hypertension in Obesity and NIDDM: Role of Insulin and Sympathetic Nervous System
Authors: Daly Patricia A , Landsberg Lewis
Published: March 2007

An important link exists between obesity, noninsulin-dependent diabetes mellitus (NIDDM), and hypertension. Most patients with NIDDM are obese; the incidence of hypertension in obesity and NIDDM is substantial, approaching 50% in some studies. Furthermore, hypertension is known to contribute to the increased cardiovascular morbidity and mortality in patients with obesity and NIDDM. Despite the obvious clinical importance, the pathogenesis of hypertension in obesity and NIDDM remains poorly understood. Recent studies have identified hyperinsulinemia and insulin resistance as important threads that tie hypertension, obesity, and NIDDM together. The hypothesis is developed that insulin-mediated sympathetic stimulation contributes to blood pressure elevation in both obesity and NIDDM. Recruited as a mechanism to limit weight gain and restore energy balance, insulin resistance and sympathetic stimulation increase blood pressure by enhancing renal Na+ reabsorption and stimulating the cardiovascular system. In this article, we review the evidence on which this hypothesis is based.
Improvement of Insulin-Induced Glucose Disposal in Obese Patients With NIDDM After 1-Wk Treatment With d-Fenfluramine
Authors: Scheen André J , Paolisso Giuseppe , Salvatore Teresa , Lefèbvre Pierre J
Published: March 2007

Objective

To study the short-term effects of the serotoninergic anorectic drug d-fenfluramine on insulininduced glucose disposal.

Research Design and Methods

A randomized double-blind placebocontrolled crossover trial with 1-wk treatment periods (2 × 15 mg/day d-fenfluramine) was conducted. Twenty obese subjects, 10 with normal oral glucose tolerance and 10 with non-insulin-dependent diabetes mellitus (NIDDM), were all treated with a weight-maintaining diet. Euglycemic-hyperinsulinemic glucose clamps with measurement of glucose kinetics with D-[3-3H]glucose were performed at either two (patients without NIDDM, 0.05 and 0.10 U · kg−1 · h−1) or three (patients with NIDDM, 0.05, 0.10, and 0.50 U · kg−1 · h−1) insulin delivery rates.

Results

In the n·ndiabetic subjects, no significant changes in any metabolic or hormonal parameter were measured in the basal state or during the clamp despite a slight reduction in body weight (−1.2 ± 0.5 kg, P < 0.05). In the diabetic patients, no significant changes in body weight or basal plasma insulin levels were observed, but fasting blood glucose levels (8.0 ± 0.8 vs. 9.4 ± 1.1 mM, P < 0.005) and plasma free fatty acid concentrations (1150 ± 227 vs. 1640 ± 184 µM, P < 0.05) were significantly reduced after d-fenfluramine compared with placebo. During the clamp, insulin metabolic clearance rate (MCR) was similar after both placebo and d-fenfluramine; endogenous (hepatic) glucose production was similarly and almost completely suppressed, whereas glucose disposal was remarkably enhanced after cMenfluramine (average increase of glucose MCR 35 ± 12%, P < 0.02).

Conclusions

Whatever the mechanism(s) involved, a 1-wk treatment with d-fenfluramine induces better blood glucose control and improves insulin sensitivity in obese patients with NIDDM independent of significant weight reduction; this last effect is not present in obese subjects with normal oral glucose tolerance.
Differential Effect of Diabetes Education on Self-Regulation and Life-Style Behaviors
Authors: Rubin Richard R , Peyrot Mark , Saudek Christopher D
Published: March 2007

Objective

To examine the effect of diabetes education on self-regulation and life-style behaviors.

Research Design and Methods

Participants in an outpatient diabetes education program completed a protocol measuring several self-care behaviors and glycemic control at entry (n = 165) and 6 (n = 124) and 12 (n = 89) mo after the program.

Results

Improvement was noted at 6 mo for most self-care behaviors and glycemic control. At 12 mo, lower glycosylated hemoglobin levels were maintained (P < 0.001) without increases in perceived hypoglycemia. Improvement was not maintained for those self-care behaviors that require change in life-style, i.e., diet and exercise. However, self-care behaviors that allow patients to self-regulate their glycemic control—self-monitoring of blood glucose and insulin dose self-adjustment—were improved at 12 mo over preprogram levels (P < 0.001). Frequency of insulin self-adjustment continued to increase during the period between follow-ups.

Conclusions

The findings suggest that diabetes education is effective in promoting self-regulation behaviors, although it has less effect on traditional regimen behaviors such as diet and exercise.
Evolution of Glomerular Filtration Rate in Proteinuric NIDDM Patients
Authors: Friedman Rogério , Gross Jorge .L
Published: March 2007

Objective

To evaluate, by means of a precise method, the rate of decline of glomerular filtration rate in proteinuric non-insulin-dependent diabetic (NIDDM) patients.

Research Degisn and Methods

The study was comprised of seven NIDDM patients who visited an outpatient clinic and had a 24-h urinary protein excretion rate ≥500 mg in the absence of heart failure, urinary tract infection, or other nephropathies.

Results

Glomerular filtration rate (51Cr-labeled EDTA, single-injection protocol) and 24-h proteinuria (turbidimetric method) were assessed at periodic intervals (2–6 mo). Correlation of the measurements with time (Pearson's r, with Student's t test used to assess the significance, α = 0.05) was used to evaluate the trend of evolution of glomerular filtration rate. Renal biopsies were performed in four patients. In three of four patients, renal histopathology was consistent with the diagnosis of diabetic nephropathy (in the 4th patient measurements were not satisfactory). Neither glomerular filtration rate nor proteinuria correlated significantly with time, except in one patient who had multiple myeloma.

Conclusions

The decline of glomerular filtration rate in proteinuric NIDDM patients is different from that observed in insulin-dependent diabetic patients, which is probably much slower.
Effect of Aldose Reductase Inhibition on Resistance to Ischemic Conduction Block in Diabetic Subjects
Authors: Price David E , Alani Shakir M , Wales John K
Published: March 2007

Objective

To study the effect of aldose reductase inhibition with ponalrestat on resistance to ischemic conduction block (RICB) in diabetic subjects.

Research Design And Methods

Twenty-one healthy diabetic subjects without neuropathy were studied. Subjects were randomized to take either a double-blind trial of 600 mg ponalrestat or placebo once daily for 6 wk. The median nerve action potential (MNAP) and conduction velocity (NCV), before and after 20 min of forearm ischemia, were measured at the start and finish of the study.

Results

RICB (MNAP remaining after ischemia) decreased from 39.5 to 29.4% in the ponalrestat-treated group (P < 0.05) and increased from 48.1 ± 10.2 to 49.5 ± 6.5% in the placebo-treated group. MNAP and NCV were unchanged in both groups.

Conclusions

Aldose reductase inhibition with ponalrestat partly reverses RICB in diabetes, perhaps by improving nerve hypoxia or reducing nerve energy substrates.
Drug Treatment of Hypertension in Patients With Diabetes Mellitus
Authors: Stein Peter P , Black Henry R
Published: March 2007

Patients with diabetes mellitus have an increased prevalence of hypertension and its vascular consequences, including coronary and cerebrovascular disease. Drug treatment of hypertension in diabetic subjects is fraught with potential difficulties, including the altered efficacy of medications, the increased risk of side effects, and the possibility of worsening glycemic control and increasing serum lipid levels. Despite these difficulties, treatment is an important part of reducing morbidity and mortality from vascular events. Antihypertensive therapy may also have the potential to prevent or retard the development of diabetic nephropathy. In this article, we discuss the efficacy and metabolic and nonmetabolic side effects of the various classes of antihypertensive agents in patients with diabetes mellitus and suggest a stepped-care approach to the drug treatment of patients with hypertension and diabetes.
Calcium Metabolism in Hypertension and Allied Metabolic Disorders
Authors: Resnick Lawrence M
Published: March 2007

Data suggest a critical role for Ca metabolism in the pathophysiology of hypertensive disease. Intracellularly, all hypertension displays elevated cytosolic free-Ca2+ and suppressed free-Mg2+ levels. Extracellularly, however, heterogeneous defects in Ca and Mg metabolism are observed. This apparent divergence may be explained by considering all hypertension as the expression, in varying degrees, of two underlying Ca-related mechanisms: one (salt sensitive, low renin, Ca2+-antagonist sensitive) dependent on inappropriate cellular Ca2+ uptake from the extracellular space and the other (salt insensitive, renin dependent, Ca2+-antagonist insensitive) dependent on increased cellular Ca2+ release from intracellular sites. Recent work highlights the role of 1,25-dihydroxyvitamin D3 and the newly described parathyroid hypertensive factor in volume-dependent low-renin forms of hypertension. Altered cellular ion handling may also explain metabolic and clinical correlates of hypertension, e.g., peripheral insulin resistance, hyperinsulinemia, obesity, and non-insulin-dependent diabetes mellitus (NIDDM). Thus, all subjects with NIDDM, whether hypertensive or not, display the same elevated cytosolic free-Ca2+ and suppressed free-Mg2+ levels observed in hypertension. Furthermore, adiposity, the level of blood pressure, and fasting and postglucose hyperinsulinemia are all closely and quantitatively related to intracellular free-Ca2+, free-Mg2+, and pH levels. This suggests a broader hypothesis, in which hypertension, obesity, insulin resistance, and NIDDM, each usually considered a distinct clinical entity, represent different clinical expressions of a common defect in cellular ion handling, hence explaining their frequent clinical coexistence in the general population.
Hypoglycemia Due to Surreptitious Injection of Insulin: Identification of Insulin Species by High-Performance Liquid Chromatography
Authors: Given Burce D , Ostrega Diane M , Polonsky Kenneth S , Baldwin David , Kelley Richard I , Rubenstein Arthur H
Published: March 2007

Objective

To identify the circulating species of insulin after separation by high-performance liquid chromatography (HPLC) in patients with factitious hypoglycemia.

Research Design and Methods

In three of four patients presented, the diagnosis of surreptitious insulin injection was made by documenting the presence of animal insulin in the circulation after separation of the circulating insulin forms by HPLC.

Results

Animal insulin was identified.

Conclusions

Thus, the identification of the circulating form of insulin in the circulation by HPLC may be a useful adjunct in the diagnosis of factitious hypoglycemia if animal insulin has been injected and if the simultaneously measured concentrations of insulin and C-peptide are inconclusive.
Kinetics of Zinc Status in Children With IDDM
Authors: Nakamura Toshiro , Higashi Akimasa , Nishiyama Soroku , Fujimoto Shigehiro , Matsuda Ichiro
Published: March 2007

Objective

To ascertain zinc deficiency in patients with insulin-dependent diabetes mellitus (IDDM) and evaluate the relationship between zinc clearance and body height velocity.

Research Design and Methods

Six boys and 11 girls with IDDM and zincuria and glycosuria were studied. Study quality and specific descriptive information concerning relationship and outcome measurement were assessed.

Results

The values of total-body zinc clearance in IDDM patients were higher than in the control subjects (24.6 ± 1.8 vs. 15.1 ± 0.6 ml · kg−1.h−1, P < 0.01). There was a negative correlation between body zinc clearance values and height velocity in IDDM patients.

Conclusions

Patients with IDDM have a secondary zinc deficiency, and normal growth may be stunted.
Clinic Attendance and Glycemic Control: Study of Contrasting Groups of Patients With IDDM
Authors: Jacobson Alan M , Adler Andrew G , Derby Laura , Anderson Barbara J , Wolfsdorf Joseph I
Published: March 2007

Objective

To assess factors associated with attendance at a specialized clinic for diabetes care.

Research Design and Methods

Adults with insulin-dependent diabetes mellitus (IDDM) in poor (HbA1 ≥ to 12%) versus good (HbA1 ≤ 10%) control and with no known complications comprised the study group.

Results

Infrequent attenders were in worse glycemic control than regular attenders (χ 2 = 6.60, P ≤ 0.01) and held health beliefs that downplayed the importance of getting advice from physicians (P ≤ 0.002) or providing opinions to physicians about what might be done to improve their health (P ≤ 0.001).

Conclusions

Because infrequent attenders are more likely to be in poor glycemic control and thus at greater risk for diabetic complications, engaging them in regularly supervised treatment has important personal and public health implications. Additional studies are needed to understand why some diabetic patients limit their contact with medical providers and to develop more effective strategies for reversing this process. Initial findings from this study suggest that patient beliefs about the doctor-patient relationship may influence clinic attendance.
Diabetes Mellitus in Mexico
Authors: Zarate Arturo
Published: March 2007

Diabetes in Mexico is a public health problem with considerable medical, social, and economic consequences. Although detailed data on the prevalence of diabetes and its complications are not available, health services utilization data of the Social Security organization (Instituto Mexicano del Seguro Social) indicate increasing use of primary and tertiary care for diabetes over a recent 10-yr period. A health interview survey conducted in 1988 indicated that, in different areas, from 3.5 to 12.7% of people aged ≥ 65 yr are believed to have diabetes, and that rates are higher in many of the states bordering the United States. Diabetes ranks among the leading 10 causes of death throughout the country. Although the ranking varies from state to state and the diagnosis may not appear on the death certificate when death results from a complication of the disease, in 1983 diabetes was the leading cause of death in Mexico and the first or second leading cause in many of the states bordering the U.S. Gestational diabetes contributes to perinatal mortality, and in view of the high birth rates, represents an important facet of the disease in Mexico. The impact of specific complications of diabetes on morbidity and mortality in Mexico are not well delineated. The relative frequency and impact of insulin-dependent and non-insulin-dependent diabetes in Mexico are not known.
Pathogenesis of NIDDM in Pima Indians
Authors: Bogardus Clifton , Lillioja Stephen , Bennett Peter H
Published: March 2007

The Pima Indians of Arizona have the highest reported prevalence and incidence of non-insulin-dependent diabetes mellitus (NIDDM) of any population in the world. A cross-sectional and longitudinal study was begun in 1982 to determine the metabolic characteristic(s) that is (are) predictive of the development of NIDDM and to document the sequence of metabolic events that occur with the transition from normal to impaired glucose tolerance and then to diabetes. Preliminary analyses suggest that insulin resistance is a primary abnormality predisposing Pima Indians to develop impaired glucose tolerance, and that the development of diabetes occurs with subsequent pancreatic failure.
Reported Practice Behaviors for Medical Care of Patients With Diabetes Mellitus by Primary-Care Physicians in Pennsylvania
Authors: Jacques CHM , Jones Robert L , Houts Peter , Bauer Laurence C , Dwyer Kathleen M , Lynch James C , Maria Casale Toni San
Published: March 2007

Objective

To compare the American Diabetes Association standards for the medical care of diabetic patients with reported care patterns.

Research Design and Methods

These standards were compared with reported care patterns obtained from a stratified random telephone survey of general practitioners, family physicians, and general internists in Pennsylvania. A total of 610 physicians completed the survey for a response rate of 73%.

Results

All primary-care physicians reported measurement of glycosylated hemoglobin, routine referrals to eye doctors, and patient self-monitoring of blood glucose < recommended. Nearly all physicians performed foot exams, but the exams were infrequent for many of the physicians. Significant and independent differences (P < 0.05) were noted between different groups of physicians. Older physicians and general practitioners reported patterns of care most different from the recommended standards for referral to eye doctors, measurement of glycosylated hemoglobin, and use of patient self-monitoring of blood glucose. General practitioners reported the lowest frequency of foot exams.

Conclusions

Educational programs on diabetes for primary-care physicians should focus on reported behaviors most different from recommended standards and may need to target subgroups of physicians to achieve a more uniform level of care for all diabetic patients.
Evaluation of Metabolic Effects of Substitution of Complex Carbohydrates for Saturated Fat in Individuals with Obesity and NIDDM
Authors: Howard Barbara V , Abbott William GH , Swinburn Boyd A
Published: March 2007

Dietary recommendations for diabetic patients now generally include the reduction of total and saturated fat and an increase in complex carbohydrates. We conducted two series of studies on individuals with obesity and/or non-insulin-dependent diabetes mellitus (NIDDM) to assess the effects of this dietary recommendation on both lipoproteins and their metabolism as well as on insulin secretion and action and energy expenditure. Both series compared a diet high in saturated fat with a diet high in complex carbohydrates and fiber. Calories and proportion of protein were constant. In the first set of studies, we sought to examine the effect of replacement of saturated fat with complex carbohydrate in a regimen with conventional foods that would closely approximate foods expected to be used and recommended to diabetic patients. In the second regimen, we examined a more extreme difference between carbohydrate content and fat content using a dietary change that would approximate the contrasts between traditional diets of Native Americans or other cultures and a modern westernized diet. The effects on lipoproteins included consistent decreases in total and low-density lipoprotein (LDL) cholesterol (av 10%), minimum to no change in high-density lipoprotein cholesterol, and insignificant changes in total or very-low-density lipoprotein (VLDL) triglycerides or 24-h triglyceride profiles. Changes in total and LDL cholesterol required 3-4 wk to reach equilibrium. Metabolic studies used to elucidate the reasons for the decrease in LDL cholesterol confirmed no stimulation of VLDL triglyceride or apolipoprotein B (apoB) production on the high-carbohydrate diet. The decrease in LDL appeared to be due to decreases in mechanisms that convert VLDL to LDL and increased activity of LDL apoB clearance. There were no changes in fasting and 2- or 24-h glucose profiles or in fasting and 2-h insulin concentrations in individuals consuming a diet of 30% fat and 55% carbohydrate. However, in the study with traditional foods, where dietary carbohydrate was 70% and fat only 15%, there was an improvement in glucose tolerance. It was accompanied by an improvement in glucose-mediated glucose disposal and insulin secretion. Finally, with a whole-body calorimeter, we found no difference between the high-fat and high-carbohydrate diets in terms of 24-h energy expenditure. In individuals having a wide range of obesity and glucose tolerance, substitution of complex carbohydrates for saturated fat has beneficial effects of lowering LDL cholesterol and possibly improving glucose tolerance and insulin secretion but without having any adverse effects on lipoprotein metabolism or energy expenditure.
Benefits and Limitations of Very-Low-Calorie Diet Therapy in Obese NIDDM
Authors: Henry Robert R , Gumbiner Barry
Published: March 2007

Weight reduction is one of the most effective therapies for obese non-insulin-dependent diabetes mellitus (NIDDM), but the success rate with conventional diets has been disappointing. The development of very-low-calorie diets (VLCDs) over the last two decades has provided an alternative approach to the treatment of uncomplicated obesity and is increasingly being used to treat obese NIDDM. This review focuses on the role of VLCDs in the treatment of obese NIDDM, the mechanisms underlying their efficacy, and the controversies surrounding their use. VLCDs provide 400–800 cal/day of high-quality protein and carbohydrate fortified with vitamins, minerals, and trace elements. Weight loss is initially very rapid, followed by steady reduction at a rate of 1–3 kg/wk. Metabolic benefits occur quickly with only modest weight reduction, suggesting that caloric restriction plays a more critical role. Multiple mechanisms account for improved glycemic control, including reduced hepatic glucose output, increased insulin action in the liver and peripheral tissues, and enhanced insulin secretion. VLCDs have the added benefit of rapid improvement in concomitant medical problems, particularly hypertension and hyperlipidemia, that could otherwise accelerate the development of some diabetic complications. Numerous controversies surround VLCD therapy, the most critical of which is its safety. However, recent studies indicate that VLCDs are safe for use by obese NIDDM patients in a medical setting closely supervised by an experienced physician. Contraindications to the diet, side effects, and recommended management are reviewed, as well as the role of adjunctive treatments, including behavioral modification and exercise. We present the perspective that, in most cases, the numerous metabolic benefits derived from VLCD therapy by the obese NIDDM patient outweigh its risks. Furthermore, recent data suggest that VLCD therapy may provide long-term benefits to the obese diabetic patient, despite weight regain.
Plasma Glucose and Insulin Response to Macronutrients in Nondiabetic and NIDDM Subjects
Authors: Nuttall Frank Q , Gannon Mary C
Published: March 2007

Information on the metabolic response in people with non-insulin-dependent diabetes mellitus (NIDDM) to ingested individual macronutrients is limited. Available information is reviewed herein. The major absorbed products of carbohydrate-containing foods are glucose, fructose, and galactose. The quantitative effect of these on the plasma glucose and insulin response is different for each. In addition, available data indicate that the glucose and particularly the insulin response is different from that in nondiabetic people. The quantitative effect of dietary proteins and fats on the circulating glucose and insulin concentrations in nondiabetic and NIDDM subjects also has been reviewed. Neither has a significant effect on the glucose concentration. Protein stimulates insulin secretion, and this is relatively more prominent in people with NIDDM. A strong synergistic interaction with glucose on insulin secretion is present, but this is absent in nondiabetic people. Ingested fat does not independently stimulate insulin secretion. However, when ingested with carbohydrate, it may have a considerable effect on the plasma glucose and/or insulin response to that carbohydrate, and the responses are different in nondiabetic and NIDDM subjects. This is probably not due to altered carbohydrate absorption. Intestinal hormones undoubtedly are playing a large role in the insulin secretory response in all of these studies, but this remains to be completely elucidated. Overall, the data indicate that the metabolic response to various foods determined in people with NIDDM may be different than that in nondiabetic people. In our opinion, much more information is required before dietary recommendations for NIDDM subjects can be made based on solid scientific data.
Accuracy of a Filter Paper Method for Measuring Glycosylated Hemoglobin
Authors: Gay Elizabeth C , Cruickshanks Karen J , Chase H Peter , Klingensmith Georgeanne , Hamman Richard F
Published: March 2007

Objective

–To compare glycosylated hemoglobin (GH) results obtained by filter paper fingerstick collection and mailed for assay by affinity chromatography with results from a venous sample assayed by ion-exchange chromatography (HbA1) in a local laboratory.

Research Design and Methods

–Fifty-eight volunteer subjects with insulin-dependent diabetes mellitus (IDDM), aged 5-24 yr, included patients at a referral-based IDDM clinic and subjects in an ongoing research study. We obtained two blood samples from each subject. One was collected by fingerstick onto filter paper, the other by venipuncture into a vacutainer. We sent filter paper samples to the Diabetes Research Laboratory (Univ. of Missouri, Columbia, MO) for analysis. Vacutainer samples were sent to the Clinical Chemistry Department of the Clinical Laboratory, University of Colorado Health Sciences Center.

Results

–Results were highly correlated (r = 0.89, P = 0.0001). Fifty-nine percent were classified identically when results were normalized to SD units and grouped to suggest levels of clinical concern.

Conclusions

–The filter paper method is a convenient, accurate measure of glycosylated hemoglobin in young people with IDDM. It should be considered a credible alternative research and clinical tool.
Effect of Soya and Cellulose Fibers on Postprandial Glycemic Response in Type II Diabetic Patients
Authors: Librenti Maria C , Cocchi Massimo , Orsi Emanuela , Pozza Guido , Micossi Piero
Published: March 2007

Objective

We studied the effect on serum glucose and insulin of a preprandial ingestion of 7 g of soya fibers or of an equal amount of purified cellulose on eight non-insulin-dependent (type II) diabetic patients.

Research Design and Methods

Four tests were conducted in each patient in random order. In the first study, soya or cellulose was ingested before a standard breakfast, and postprandial glucose and insulin curves were determined. In the second study, intestinal absorption was investigated by means of a standard D-xylose absorption excretion test after the ingestion of soya or cellulose.

Results

Insulin profiles did not differ between the two treatments. The glycemic profiles after soya ingestion were lower than those after cellulose ingestion. The area under the glucose curve and glucose peaks were significantly higher after cellulose ingestion (area under the curve 20.2 ± 3.88 vs. 15.57 ± 4.42 mM × min, P = .05; glucose peaks 4.97 ± 0.76 vs. 3.77 ± 0.77 mM, P < 0.02). The xylose tests were in the normal range, indicating that there was no interference with exose absorption, and no statistical difference was found between cellulose and soya treatment.

Conclusions

It is concluded that soya fiber compared with purified cellulose has a favorable effect on the rise of postprandial glycemia in type II diabetic patients; moreover, the use of soya fibers did not carry any untoward side effect.