bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Plasma Non‐esterified Fatty Acids During Exercise in Type 2 Diabetes Mellitus
Authors: Berrish T.S. , Elliott C. , Cooper B.G. , Reed J.W. , Orskov H. , Alberti K.G.M.M. , Walker M.
Published: July 2009

Elevated fasting plasma non‐esterified fatty acid (NEFA) levels have been reported in Type 2 diabetes. We examined whether such changes persist during low‐grade exercise and influence carbohydrate metabolism. Eight Type 2 diabetic patients with moderate glycaemic control and eight healthy controls received the anti‐lipolytic agent, acipimox, or placebo on separate occasions before exercising for 45 min at 35 % pre‐determined Vo2max. Fasting plasma NEFA levels were similar (0.40 ± 0.06 (SEM) and 0.45 ± 0.05 mmol l−1; healthy and Type 2 diabetic subjects) following placebo, and increased to comparable levels with exercise (0.73 ± 0.07 and 0.73 ± 0.10 mmol l−1). Acipimox lowered basal NEFA levels (0.14 ± 0.03 and 0.28 ± 0.04 mmol I−1; both p < 0.05 vs placebo), and prevented the rise with exercise. Blood glucose (p < 0.001) and serum insulin (p < 0.01) levels were higher in the Type 2 diabetic patients (vs controls) for both treatments. Whole body lipid oxidation increased from baseline to a comparable degree with exercise following placebo (3.2 ± 0.3 and 2.8 ± 0.3 mg kg−1 min−1; healthy and Type 2 diabetic subjects, both p < 0.02). Although less marked, the same was also observed following acipimox (2.0 ± 0.4 and 2.1 ± 0.5 mg kg−1 min−1; both p < 0.05). Carbohydrate oxidation increased with exercise in both subject groups, but with no significant difference between the treatments. Thus, the metabolic response to low‐grade exercise was normal in Type 2 diabetic patients with moderate glycaemic control, but occurred against a background of hyperinsulinaemia. Plasma NEFA do not exert a major regulatory effect on carbohydrate metabolism during low‐grade exercise.
Growth Hormone Levels in Patients with Type 1 Diabetes are Age Related
Authors: Wurzburger M.I. , Prelevic G.M. , Sonksen P.H. , Balint‐Peric L.
Published: July 2009

Possible effects of age on the growth hormone (GH) levels in Type 1 diabetes were examined. The study was performed in 71 patients with Type 1 diabetes (40 C‐peptide negative (CpN), without residual beta cell activity; 31 C‐peptide positive (CpP), with preserved beta cell activity) and 11 healthy subjects. The patients and controls were divided into three age groups (A = 21–30; B = 31–40; C = 41–50 years). Blood glucose and growth hormone (GH) were measured at hourly intervals during 24 h in all subjects in hospital conditions. GH levels decreased significantly with age in patients with Type 1 diabetes (mean 24‐h GH group A: 7.3 ± 1.0, group B:5.3 ± 0.6, group C:3.7 ± 0.4 mU 1−1; A vs C: p = 0.0007; B vs C: p = 0.03). In all age groups GH levels were significantly higher in CpN than either in CpP diabetic patients or controls (group A CpN: 8.3 ± 1.2, CpP: 4.7 ± 1.0, controls: 2.2 ± 0.3 mU 1−1; p < 0.001; group B CpN: 7.3 ± 0.8, CpP: 3.2 ± 0.5, controls: 1.6 ± 1.0 mU 1−1; p < 0.0002; group C CpN: 5.2 ± 0.5, CpP: 2.5 ± 0.4, controls: 1.4 ± 0.4 mU 1−1; p < 0.001). Mean GH levels were significantly higher in C‐peptide positive patients than in controls in all age groups (p < 0.001). GH levels decreased with age in patients with diabetes and controls, but the decrease was significant only in patients with diabetes (A vs C CpN: p = 0.018, CpP: p = 0.026). We conclude that age is a factor in addition to residual beta cell activity, which influences the magnitude of GH hypersecretion in Type 1 diabetes.
A Model for Early Diagnosis of Type 2 Diabetes Mellitus in Primary Health Care
Authors: Andersson D.K.G. , Lundblad E. , Svärdsudd K.
Published: July 2009

The aim of the study was to determine the feasibility of conducting a case‐finding programme for Type 2 diabetes mellitus in primary health care and to see whether random urinary glucose or random capillary blood glucose testing is the most suitable instrument for the early detection of Type 2 diabetes. Residents in the community of Laxå aged 35–64 years were subjected to testing during 1983–1987; those aged 65–79 were included from July 1985 and onwards. The urinary glucose testing was considered positive if a urinary dipstick was not unequivocally negative. The random blood glucose test was regarded as positive when 8.0 mmol I−1. A diagnosis of Type 2 diabetes made within a follow‐up period of 3 years from the initial examination was regarded as a positive outcome. Random blood glucose testing was performed on 3268 persons which was close to 85 % of the eligible population. Urinary glucose tests were missing in 67 subjects. The random blood glucose test was positive in 220 persons and the urinalysis in 42 persons. A total of 234 individuals had a positive test, out of which 66 new diabetic cases were found. Sixty‐four of these were detected by the random blood glucose testing and 20 by the urinalysis. The sensitivity for the random blood glucose and urinary glucose testing was 73 and 23 %, the specificity was 95 and 99 %, the positive predictive value 29 and 48 %, and the negative predictive value 99 and 98 %, respectively. Random blood glucose testing is superior to urinary glucose testing in case finding for Type 2 diabetes and is well suited for use as a screening instrument in a primary health care setting.
Long‐term Use of Intramuscular Insulin Therapy in a Type I Diabetic Patient with Subcutaneous Insulin Resistance
Authors: Brossard J.H. , Havrankova J. , Rioux D. , Bertrand S. , D'Amour P.
Published: July 2009

We studied a 26‐year‐old Type 1 diabetic patient who experienced recurrent episodes of ketoacidosis and who was unresponsive to subcutaneous insulin, but normally responsive to intravenous insulin as demonstrated by insulin challenge test. Attempts at intravenous and intraperitoneal insulin administration were complicated by recurrent septicaemia. We therefore investigated the hypoglycaemic effect of intramuscular insulin administration in this patient. After intramuscular injection of NPH and Ultralente human insulin (0.1 U kg−1), the lowest plasma glucose levels occurred 1 and 7h later, respectively; the hypoglycaemic effect lasted approximately 2 and 12 h, respectively. We based insulin therapy on intramuscular NPH as a fast‐acting insulin and Ultralente as an intermediate‐acting insulin using four injections a day. During the next 24 months, the patient was hospitalized for 4 weeks versus 56 weeks in the 20 months preceding intramuscular insulin administration, and was able to resume full‐time work. HbA1c decreased from 11.7 % to 8.7 % (normal range: 4.2–5.9 %). Thus, long‐term intramuscular insulin therapy is a feasible alternative to intravenous or intraperitoneal insulin in patients with well‐demonstrated resistance to subcutaneous insulin.
Frequency and Symptoms of Hypoglycaemia Experienced by Patients with Type 2 Diabetes Treated with Insulin
Authors: Hepburn D.A. , MacLeod K.M. , Pell A.C.H. , Scougal I.J. , Frier B.M.
Published: July 2009

This study ascertained the prevalence of severe hypoglycaemia and loss of awareness of hypoglycaemia in patients with Type 2 diabetes treated with insulin. One hundred and four sequentially selected Type 2 diabetic patients were compared with 104 patients with Type 1 diabetes who were matched for duration of insulin therapy. The patients were interviewed using a standardized questionnaire. During treatment with insulin, 18 Type 2 patients had experienced fewer than two episodes of hypoglycaemia, while 86 had experienced two or more episodes; 80 (93%) reported normal awareness, six (7%) reported partial awareness, and none had absent awareness of hypoglycaemia. All 86 Type 1 diabetic patients matched to the 86 Type 2 patients had experienced multiple episodes of hypoglycaemia; 71 (83%) had normal awareness, 14 (16%) had partial awareness and one patient (1%) reported absent awareness of hypoglycaemia. The Type 1 patients who had altered awareness of hypoglycaemia had longer duration of diabetes and insulin therapy (normal awareness: 5 (1–17) years (median (range)) vs partial awareness: 9 (3–18) years, p < 0.01). Similarly, Type 2 patients with altered awareness had longer duration of diabetes (normal awareness: 11 (2–25) years vs partial awareness: 19 (8–24) years, p < 0.02) and had received insulin for longer (normal awareness: 3 (1–18) years vs partial awareness: 12 (6–17) years, p < 0.001). Severe hypoglycaemia in the preceding year had occurred with a similar prevalence in the Type 2 patients (9 (10%)) and Type 1 patients (14 (16%)), but was more frequent in those patients with partial awareness both in Type 1 patients (normal awareness: 3 (4%) vs partial awareness: 11 (73%), p < 0.001) and in Type 2 patients (normal awareness: 3 (4%) vs partial awareness: 6 (100%), p < 0.001). Although the symptoms of hypoglycaemia were idiosyncratic in individual Type 2 patients, the range and prevalence of specific symptoms were similar to those described by the patients with Type 1 diabetes.
Frequency and Morbidity of Severe Hypoglycaemia in Insulin‐treated Diabetic Patients
Authors: MacLeod K.M. , Hepburn D.A. , Frier B.M.
Published: July 2009

To estimate the frequency and morbidity of insulin‐induced hypoglycaemia, a retrospective survey was undertaken of the frequency of severe hypoglycaemia in 600 randomly selected patients with insulin‐treated diabetes who were attending a large diabetic outpatient clinic in a teaching hospital. The resulting morbidity (hypoglycaemia‐related injuries, convulsions, and road traffic accidents) was ascertained in 302 patients. One hundred and seventy‐five (29.2%) of the 600 patients reported a total of 964 episodes of severe hypoglycaemia in the preceding year, giving an overall frequency for the group of 1.60 episodes patient−1 year−1. The frequency of severe hypoglycaemia which was documented in 544 Type 1 (ketosis prone) diabetic patients was double that observed in a subgroup of 56 Type 2 diabetic patients who were being treated with insulin (1.70 vs 0.73 episodes patient−1 year−1). In the subset of 302 patients, those who had experienced severe hypoglycaemia had greater morbidity associated with an estimated rate of injury of 0.04 injuries person−1 year−1. Twenty (6.6%) patients reported a total of 37 convulsions associated with hypoglycaemia, 5 of which had occurred in the preceding year (0.02 convulsions person−1 year−1). Five patients reported road traffic accidents in the preceding year which had been caused by hypoglycaemia. The only reliable predictors of severe hypoglycaemia were a history of previous severe hypoglycaemia (p < 0.001), a history of hypoglycaemia‐related injury (p < 0.001) or convulsion (p < 0.001), and the duration of insulin therapy (p < 0.001). Those patients with a history of severe hypoglycaemia had been treated with insulin for longer (17.4 vs 14.3 years, p < 0.02) and tended to have a lower mean glycated haemoglobin concentration. This study confirmed that severe hypoglycaemia is common and demonstrated that it is associated with significant morbidity in a conventionally treated, insulin‐requiring, diabetic population. The multifactorial aetiology of severe hypoglycaemia confounds attempts to predict the individual patient ‘at risk’.
Sudden Death and Human Insulin: Is There a Link?
Authors: Borch‐Johnsen K. , Helweg‐Larsen K.
Published: July 2009

Case reports from the United Kingdom (UK) in 1989 have suggested that the introduction of human insulin in 1985 was associated with an increased risk of sudden death in insulin‐treated diabetic patients. If human insulin increases the risk of sudden death, the number of these should have increased during the period where human insulin was introduced. We therefore identified all cases of sudden death in Denmark in younger insulin‐treated diabetic patients, age at death below 50 years. During this period the consumption of human insulin went from 0.2% to 70% of the total consumption in Denmark. The total number of cases fulfilling the inclusion criteria was 226, and the annual number of sudden deaths did not change during the study period (p= 0.14). The number of deaths due to hypoglycaemia and cases with unexplained cause of death also remained constant (test for trend:p= 0.44). Chronic alcohol abuse or acute alcohol intoxication was found in 50% of the 135 patients dying from hypoglycaemia, ketoacidosis or unknown cause of death (including found dead in bed), while this was the case in only 16% of the remaining 91 cases dying from other natural causes. We conclude that introduction of human insulin in Denmark was not followed by an increase in sudden deaths among younger insulin‐treated diabetic patients.
A Novel Device for the Rapid In‐clinic Measurement of Haemoglobin A1c
Authors: Pope R.M. , Apps J.M. , Page M.D. , Allen K. , Bodansky H.J.
Published: July 2009

In order to evaluate a novel technique for measuring haemoglobin A1c using a cassette‐based immunoassay method we have undertaken a laboratory evaluation using 48 patient samples and a separate within‐clinic prospective study of 59 diabetic patients. Individuals were recruited from general (48 patients), paediatric (19 patients), obstetric (24 patients), and general practice (15 patients) diabetic clinics. Agreement was evaluated between HbA1c results obtained using the new method (AMES DCA 2000) and an established laboratory assay (DIAMAT HPLC system). The mean differences between the two results (AMES DCA 2000‐DIAMAT) (95% confidence intervals) were: laboratory −0.69% (‐1.42 to 0.04%); paediatric clinic −0.93% (‐1.93 to 0.07%); obstetric clinic −0.29% (‐1.09 to 0.51%), and general practice clinic −0.77% (‐1.3 to −0.24%). For the AMES DCA 2000, the coefficient of variation for HbA1c of 5.2% was 1.6% and for HbA1c of 13%, 2.4%. This instrument was used without difficulty by four different operators. Intra‐assay coefficient of variation for each operator was < 3.4%. In 9/18 patients where a specific assessment of clinical utility was made, knowledge of the HbA1c result at the time of consultation lead to a change in treatment. Methodology of this type may be used successfully within a diabetic clinic setting in both primary care and hospital environments.
Diabetes in the Elderly: An Under‐diagnosed Condition
Authors: Simmons D. , Williams D.R.R.
Published: July 2009

The proportion of the population aged 65 years and over is increasing. The Coventry Diabetes Study was able to investigate the prevalence of diagnosed and undiagnosed diabetes among elderly (aged ≥ 65 years) Europeans (n = 1600) and South Asians (n = 288) in Foleshill, Coventry. The total prevalence of diabetes was higher in South Asians than Europeans among males (30.7 (95% CI 24.0–37.9)% vs 7.7 (95% CI 5.8–10.0)%, respectively) and females (24.0 (95% CI 17.5–32.4)% vs 12.5 (95% CI 10.6–14.8)%, respectively). The proportion with diagnosed diabetes was higher among South Asians than Europeans (55% vs 33%, p < 0.001), possibly because of their earlier onset. These findings suggest that detection of diabetes in elderly Europeans in urban areas may be inadequate.
Outpatient Treatment of Unilateral Diabetic Foot Ulcers with ‘Half Shoes’
Authors: Chantelau E. , Breuer U. , Leisch A.C. , Tanudjaja T. , Reuter M.
Published: July 2009

The impact half‘of shoes’ in the treatment of neuropathic forefoot ulcers was studied in two groups of diabetic patients, who were treated either by standard treatment alone (retrospective controls, n = 22), or by standard treatment plus‘half shoes’ (cases, n = 26). The groups were matched for sex, age, type, and duration of diabetes and ulcer grading. The‘half‐shoe’ cases’ vs controls’ median overall healing time was 70 vs 118 days, the median difference being 48 (95% CI: −5 to 82) days (NS). In the case group, hospitalization was required in 1/26 (4%) of patients, vs 9/22 (41%) of the control patients (chi‐square, p < 0.01). The home nursing service was required in 23% of the cases vs 18% of the controls (NS). It is concluded that the use of half‐shoes, in conjunction with standard treatment provided by a specialized diabetic foot clinic, may reduce the overall healing time and does reduce the hospitalization rate. This has implications for a rational strategy of treating unilateral diabetic neuropathic foot ulcers.
Ethnic Differences in the Incidence of Lower Extremity Amputation Secondary to Diabetes Mellitus
Authors: Gujral J.S. , McNally P.G. , O'Malley B.P. , Burden A.C.
Published: July 2009

Patients of Asian ethnic origin with diabetes mellitus living in the United Kingdom (UK) have been shown to have a higher prevalence of coronary heart disease and renal disease. Little is known about the incidence of lower extremity amputation in this racial group. The incidence of lower extremity amputation was estimated for patients of Asian ethnic origin and White Caucasians with diabetes mellitus in the county of Leicestershire from 1980 to 1985. The age and sex‐adjusted incidence rate of lower extremity amputation for the estimated population of patients with diabetes mellitus in patients of Asian ethnic origin was 3.4 (95% CI, 1.1–10.7) cases per 10000 patients year−1, compared to 14.2 (12.6–15.9) in White Caucasians. Similarly, a lower incidence rate of lower extremity amputation was recorded in patients of Asian ethnic origin without diabetes mellitus (0.4 (0.2‐0.6) vs 1.5 (1.4 to 1.6) cases per 10000 persons year−1). These findings contrast markedly with the high rates of coronary heart disease and renal disease previously reported in patients of Asian ethnic origin residing in the UK.
Ketoacidosis in Diabetic Pregnancy
Authors: Kilvert J.A. , Nicholson H.O. , Wright A.D.
Published: July 2009

A study was carried out to determine the incidence of maternal ketoacidosis in 635 insulin‐treated diabetic pregnancies managed in a combined antenatal/diabetic clinic between 1971 and 1990. A total of 11 episodes occurred, representing 1.73% of diabetic pregnancies of which 9 were in the antenatal period. Overall fetal loss including spontaneous abortion was 22%, but there was only one fetal death in the seven episodes of ketoacidosis in the second and third trimesters. Ketoacidosis is an infrequent occurrence in diabetic pregnancy managed in a combined clinic and is not associated with a high fetal loss after the first trimester.
Coming of Age with Diabetes: Patients' Views of a Clinic for Under‐25 year olds
Authors: Eiser C. , Flynn M. , Green E. , Havermans T. , Kirby R. , Sandeman D. , Tooke J.E.
Published: July 2009

This study is both an evaluation of patients' perceptions of a diabetes clinic for under‐25 year olds, and an assessment of experiences in transferring from a paediatric clinic. Sixty‐nine patients with Type 1 diabetes (74% of the total clinic), including 41 females, completed evaluations of the clinic and recall of experiences in transfer. Mean age on transferring clinic was 15.9 (range 12–20) years. Paediatricians were perceived to emphasise family and social life, school or work progress; adult physicians tended to stress the risk of long‐term complications, importance of exercise and need to maintain strict levels of glycaemic control. Our data suggest that transition to adult care can generally be achieved non‐traumatically, but patients may perceive some difficulty because of different emphases and treatment advice favoured by paediatricians and adult physicians.
Hyperglycaemic Progression in Subjects with Impaired Glucose Tolerance: Association with Decline in Beta Cell Function
Authors: Cook J.T.E. , Page R.C.L. , Levy J.C. , Hammersley M.S. , Walravens E.K.N. , Turner R.C.
Published: July 2009

Impaired glucose tolerance is associated with an increased risk of Type 2 diabetes. This prospective cohort study has examined the variables associated with hyperglycaemic progression in order to elucidate the aetiology of this deterioration. The 5 mg glucose‐kg ideal body weight‐min−1 continuous infusion of glucose with model assessment (CIGMA) test was used to quantitate glucose tolerance, beta cell function, and insulin sensitivity. Twenty‐two Caucasian subjects who had impaired glucose tolerance identified on two separate tests underwent repeat testing after a median period of 24 months. At follow‐up, 2 of the 22 subjects (9%) had Type 2 diabetes, 18 (82%) had impaired glucose tolerance, and 2 (9%) were normoglycaemic. The fasting and achieved (60‐min) glucose levels were significantly higher at follow‐up (mean ± SD) (5.7 ± 0.8 vs 5.5 ± 0.5 mmol l−1, p = 0.029 and 10.0 ± 0.9 vs 9.6 ± 0.6 mmol l−1, p = 0.021, respectively), and beta cell function was significantly lower (median and interquartile range): 75% (50–93%) vs 90% (70–135%), p = 0.009. The changes in fasting plasma glucose were found to correlate with change in body mass index (rs = 0.46, p = 0.03). We conclude that impaired glucose tolerance is associated with decline in beta cell function, and denotes substantial risk of hyperglycaemic progression. Randomized controlled trials are warranted to determine whether exercise programmes, dietary advice, and attentive follow‐up and effective preventive strategies for subjects with impaired glucose tolerance.
A Comparison of Different Methods of Assessing Free Radical Activity in Type 2 Diabetes and Peripheral Vascular Disease
Authors: MacRury S.M. , Gordon D. , Wilson R. , Bradley H. , Gemmell C.G. , Paterson J.R. , Rumleyd A.G. , MacCuish A.C.
Published: July 2009

Increased free radical activity in diabetes mellitus may contribute to the higher prevalence and mortality from macrovascular disease in diabetic patients. To investigate this, levels of plasma antioxidants (superoxide dismutase, caeruloplasmin, plasma, and lysate thiol), diene conjugates, lipid peroxides, and chemiluminescence were measured in diabetic and non‐diabetic patients with peripheral vascular disease compared with healthy control subjects. Caeruloplasmin, diene conjugate ratio, and lipid peroxides were significantly increased in patients with vascular disease but there was no difference between diabetic and non‐diabetic patients. Conjugated diene ratio correlated with caeruloplasmin (r = 0.40, p < 0.02) and inversely with superoxide dismutase level (r = −0.36, p < 0.05) but there was no significant correlation between other antioxidants and diene conjugates, lipid peroxides or chemiluminescence. The relationship between different indirect measurements of free radical activity is variable but there appears to be no additive effect of diabetes on the increased free radical activity associated with vascular disease.
Calcium Metabolism in Diabetes Mellitus: Effect of Improved Blood Glucose Control
Authors: Thalassinos N.C. , Hadjiyanni P. , Tzanela M. , Alevizaki C. , Philokiprou D.
Published: July 2009

Reduced bone mass occurring with increased frequency in diabetes mellitus has been attributed to poor blood glucose control but the pathogenetic mechanisms remain unknown. To evaluate the role of calcium metabolism, 59 patients with diabetes and normal renal function (22 Type 1, 37 Type 2) were studied. In all patients plasma calcium (Ca), serum phosphate (PO4), serum parathyroid hormone (PTH), and 24‐h urinary calcium (uCa) were determined under both poor and improved control (for at least 7 days) as ascertained by four blood glucose determinations daily. Improvement of blood glucose control (p = 0.001) was associated with reduction of uCa both in Type 1 (6.9 ± 1 vs 4.9 ± 0.9 mmol day−1, mean ± SEM, p = 0.02) and in Type 2 patients (4.2 ± 0.4 vs 3.2 ± 0.4 mmol day−1, mean ± SEM, p = 0.002). Considerably more Type 1 patients (10 out of 22) had PTH values below the detection limit (1.5 pmol l−1) during poor than during improved control (2 out of 22). Comparison between the two types of diabetes showed that in Type 1 under poor control, Ca and PTH were lower (p = 0.03), while uCa was higher (p = 0.003), and after improved control, only uCa continued to be higher (p = 0.035). These findings suggest that increased uCa excretion in association witih ‘functional hypoparathyroidism’ (especially in Type 1 diabetes) is observed during poor blood glucose control, and may be one of the factors leading to reduced bone mass in diabetes mellitus.
The Effect of Acarbose on Blood Glucose Profiles of Type 2 Diabetic Patients Receiving Insulin Therapy
Authors: Hotta N. , Kakuta H. , Koh N. , Sakakibara F. , Haga T. , Sano T. , Okuyama M. , Sakamoto N.
Published: July 2009

Nine patients with Type 2 diabetes receiving insulin therapy were treated with acarbose 100 mg thrice daily for 1 week to investigate the effect of acarbose on blood glucose control. Daily blood glucose profiles contained fewer excursions during acarbose administration and low levels were maintained. The M‐value, an indicator of blood glucose fluctuation, decreased significantly from a run‐in period value of 37.6 ± 8.7 (SEM) to 16.7 ± 4.0 during the acarbose period (p < 0.05) and rose again to 28.9 ± 6.7 (p ≧ 0.05) in the follow‐up period. The 24‐h urinary glucose excretion similarly decreased during acarbose administration. As expected, no decrease in HbA1c was observed due to the short treatment period. The 24‐h urinary C‐peptide excretions and serum lipids were not influenced by acarbose therapy. Frequent episodes of clinical hypoglycaemia were experienced while on acarbose therapy, indicating a decrease in insulin requirements. Adverse events such as flatulence and abdominal distention were observed in six out of nine cases. Symptoms were generally mild and well tolerated, only one patient dropped out because of diarrhoea and abdominal pain. We conclude that acarbose could usefully be administered to Type 2 diabetic patients treated with insulin to improve blood glucose control and reduce insulin requirement if the appropriate selection criteria were met.
Hyperinsulinaemia is Associated with Stimulation of Cholesterol Synthesis in Both Type 1 and Type 2 Diabetes
Authors: Stinson J.C. , Owens D. , Collins P. , Johnson A. , Tomkin G.H.
Published: July 2009

The effect of hyperinsulinaemia and hyperglycaemia on cholesterol synthesis was examined in lymphocytes from diabetic subjects. The first part of the study involved the provocation of hyperinsulinaemia by consumption of a carbohydrate‐rich meal, in obese patients with Type 2 diabetes mellitus. Cholesterol synthesis was measured before and 4 h after completing the meal. Results were compared to groups of obese non‐diabetic patients and to control subjects. Analysis of the three groups demonstrated that the percentage change in cholesterol synthesis was directly proportional to the percentage rise in serum insulin (r = 0.49, p < 0.05). This physiological study demonstrated that postprandial hyperinsulinaemia promoted cholesterol synthesis; however, we could not estimate the effect of the meal on cholesterologenesis. To study hyperinsulinaemia in isolation, we examined the effects of varying insulin infusion rates for 4 h at either low or high levels of serum glucose using the glucose clamp technique in young Type 1 diabetic patients. Cholesterol synthesis in lymphocytes was again measured before and after the study period. Hyperinsulinaemia stimulated cholesterol synthesis (+28.6%, p < 0.05) but hyperglycaemia alone did not exhibit this effect (‐1.7% NS). The combination of hyperinsulinaemia and hyperglycaemia produced the greatest increase in cholesterol synthesis (+ 51.4%, p < 0.05) but this increase was not significantly different from hyperinsulinaemia alone. The percentage increase in serum insulin levels was again proportional to the percentage change in cholesterol synthesis (r = 0.46, p < 0.05).
Possible Link Between a Low Prevalence of Cardiovascular Disease and Mild Dyslipidaemia: a Study in Japanese Patients with Type 2 Diabetes
Authors: Aizawa T. , Kobayashi M. , Sato Y. , Tozuka M. , Ishihara F. , Okada N. , Shigematsu S. , Komatsu M. , Hiramatsu K. , Yamauchi K. , Komiya I. , Yamada T. , Kanai M. , Honda Z. , Yoshizawa K.
Published: July 2009

In 98 Japanese patients with Type 2 diabetes mellitus, serum total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL‐C), free fatty acid (FFA), and apolipoproteins (apo) A‐I, A‐II, B, C‐II, C‐III, and E were determined. The data were compared with those in 47 normolipidaemic normal controls. The total cholesterol value of the diabetic patients was also compared to that of a general population (n = 2227). The diabetic patients were separated into those with cardiovascular disease (n = 20) and without it (n = 78) and a comparison of clinical characteristics and dyslipidaemia was also performed. The diabetic patients had slightly but significantly higher FFA, LDL‐C, apo B, C‐II, C‐III, E, and B/A‐I, and lower apo A‐I and A‐II compared to the normal controls. The total cholesterol level of the diabetic patients (5.17 ± 0.96 mmol−1) was not significantly higher than that of the general population (5.12 ± 0.91 mmol−1). By multivariate stepwise discriminant analyses, only total cholesterol significantly discriminated the patients with and without cardiovascular disease. In Japanese patients with Type 2 diabetes, a diabetic population with a very low prevalence of cardiovascular disease, high total cholesterol ís a risk factor for developing cardiovascular disease. Nevertheless, a markedly low prevalence of cardiovascular disease in Japanese with Type 2 diabetes compared to Caucasian counterparts may partly be due to the mildness of dyslipidaemia.
Perimenstrual Symptoms in Women with Diabetes Mellitus and the Relationship to Diabetic Control
Authors: Cawood E.H.H. , Bancroft J. , Steel J.M.
Published: July 2009

Four hundred and six insulin‐dependent diabetic women completed a Menstrual Health Questionnaire published in Balance. Sixty‐seven percent of women experienced changes in blood glucose levels or glycosuria premenstrually and 70% during the menstrual phase. Changes were more common in women who regarded themselves as suffering from premenstrual syndrome. Those experiencing premenstrual craving for sweet foods tended to have higher blood glucose levels or more glycosuria at those times. This may be a consequence of some women indulging their craving. Premenstrual symptoms were not caused by hypoglycaemia. When compared with age‐matched non‐diabetic women responding to a similar questionnaire, the diabetic women had a later menarche and, among those not on steroidal contraceptives, were more likely to report very irregular menstrual cycles. Among those regarding themselves as sufferers of premenstrual syndrome, diabetic women had less severe premenstrual symptoms than non‐diabetic women. When women from these two self‐designated diabetes mellitus syndrome suffering groups were matched for severity of premenstrual depression, differences still persisted in the severity of some symptoms perimenstrually, raising the possibility that in some way diabetes may alter women's experience of menstrual cycle‐related symptoms.
Prognosis of Acute Myocardial Infarction in Diabetic and Non‐diabetic Patients
Authors: Karlson B.W. , Herlitz J. , Hjalmarson Å.
Published: July 2009

We evaluated the prognosis of 858 patients with acute myocardial infarction (MI), of whom 97 (11%) had a history of diabetes mellitus. Among patients with diabetes the 1‐year mortality rate was 41% versus 26% for non‐diabetic patients (p < 0.01), and the 1‐year reinfarction rates were 23% and 14%, respectively (p = 0.05). Diabetic patients with a history of hypertension had a similar mortality rate as comapred with diabetic patients without hypertension. In a multivariate analysis including age and history of cardiovascular disease, diabetes did not significantly contribute to death or reinfarction. Among diabetic patients the only independent risk factor for death was age. The place and mode of death appeared similar in the two groups. Patients with and without a history of diabetes had a similar infarct size. We conclude that diabetic patients with acute myocardial infarction have a very poor prognosis. Within 1 year nearly half of them are dead and one‐quarter develop reinfarction. The mode of death appeared to be similar in diabetic patients as compared with non‐diabetic patients.
Are the Social Relationships of Young Insulin‐dependent Diabetic Patients Affected by Their Condition?
Authors: Lloyd C.E. , Robinson N. , Andrews B. , Elston M.A. , Fuller J.H.
Published: July 2009

In order to compare the social relationships of young adults with Type 1 diabetes with those of healthy controls, 80 young people aged 16–25 years were interviewed in‐depth with a semi‐structured questionnaire. Results demonstrated that subjects with diabetes had an equally high commitment to social arenas, but were significantly more likely to be socially isolated and were less likely to have very close relationships. Subjects had more attitudinal constraints with regard to having close relationships, and were more likely to report a fear of intimacy. They were less likely to have children, and many voiced their concerns regarding the impact their diabetes might have on both marriage and future parenthood. This study suggests that young adults with diabetes have more negative social experiences which may affect their feelings with regard to having close relationships. The absence of supportive relationships may impact on diabetes management; however this has yet to be fully ascertained in a young adult population.
Glucose Profiles in Children Two Years After the Onset of Type 1 Diabetes
Authors: Simell T. , Simell O. , Lammia E‐M. , Kaprio E.A. , Hakulinen A. , Hakalax J. , Mäenpää J.
Published: July 2009

The relationship of 24‐h glucose profiles to age, haemoglobin A1c (HbA1c), and C‐peptide concentration was analysed in consecutive, unselected children who had developed Type 1 diabetes 2 years earlier. Seventy‐seven children in four age groups (age 2–4 years, n = 9; 5–8 years, n = 14; 9–12 years, n = 26; and 13–17 years, n = 28) were studied. Each child was hospitalized for 2 days for the investigations. Mean blood glucose concentration was 9.7 ± 4.1 (SD) mmol l−1 in children aged 2–4 years; 10.7 ± 4.0 mmol l−1 in those aged 5–8 years; 11.3 ± 3.4 mmol l−1 in those aged 9–12 years; and 9.8 ± 3.3 mmol l−1 in those aged 13–17 years. Results were > 7.0 mmol l−1 in 69% (range 56–76%) and > 10 mmol l−1 in 49% (39–57%) of the measurements. Values decreased by 30% (21–43%) between 10 pm and 3 am. The nadir of the mean profiles of the groups was always at 3 am. Glucose concentration was < 3.0 mmol l−1 in 25% (14–50%), < 2.5 mmol l−1 in 9.6% (0–21%), and < 2.0 mmol l−1 in 2.7% (0–4.2%) of the children at 3 am; hypoglycaemia was most common in those aged 5–8 years. Of the four profile characteristics used, mean blood glucose predicted HbA1c (R2 = 24.7%, p < 0.00005, multiple linear regression analysis), and slightly more in combination with age (R2 = 32.0%, p < 0.00005). The means, AUCs and coefficients of variation of the glucose profiles were not different in C‐peptide positive and C‐peptide negative children of the age groups (p = NS, two‐way ANOVA). We conclude that glucose profiles frequently uncover otherwise poorly recognizable disturbances of metabolic contol in children with diabetes.
Action Profile of the Rapid Acting Insulin Analogue: Human Insulin B28Asp
Authors: Heinemann L. , Heise T. , Jorgensen L.N. , Starke A.A.R.
Published: July 2009

The time‐action profile of the human insulin analogue B28Asp, which displays faster absorption rates from subcutaneous tissue compared to soluble human insulin, was studied under euglycaemic glucose clamp conditions (blood glucose 5.0 mmol l−1) in 14 healthy male volunteers. Subcutaneous injection of 0.15 U kg−1 body weight (range 9.5–14.3 U) of the insulin analogue or soluble human insulin resulted in half‐maximal glucose infusion rates (after subtraction of mean baseline glucose infusion rates) that were reached significantly earlier after injection of B28Asp (45 ± 11 (SD) min) as compared to human insulin (58 ± 25 min, p < 0.05). Forty‐five and 60 min after injection of human insulin, glucose infusion rates had increased by 3.4 ± 1.8 and 4.8 ± 2.3 mg min−1 kg−1 above baseline glucose infusion rates, reflecting 30 ± 15 and 42 ± 17% of maximal action of 10.6 ± 2.7 mg min−1 kg−1. Following the injection of B28Asp, glucose infusion rates increased by 6.3 ± 2.7 after 45 min and by 7.9 ± 2.8 mg min−1 kg−1 after 60 min above baseline glucose infusion rates, reflecting 64 ± 28% and 81 ± 26% of maximal action of human soluble insulin (p < 0.001). Peak glucose infusion rates after injection of B28Asp were significantly higher and were reached earlier than after subcutaneous injection of soluble human insulin (p < 0.05 and p < 0.001). The human insulin analogue B28Asp showed a significantly faster onset of action as compared to soluble human insulin.
Bacteriuria, Bacterial Virulence and Host Factors in Diabetic Patients
Authors: Brauner A. , Flodin U. , Hylander B. , Östenson C.‐G.
Published: July 2009

The prevalence of bacteriuria as well as bacterial virulence and host factors were studied in 514 diabetic outpatients and 405 nondiabetic controls. The prevalence of bacteriuria was not significantly higher in diabetic women (15/239, 6.3 %) than in age‐matched nondiabetic women (8/236, 3.4 %). In diabetic and nondiabetic men, the prevalence was also similar but lower than in women. E. coli was found in 55 % of urine cultures with significant growth from diabetic patients, while in 91 % of positive cultures from nondiabetic controls. Most E. coli strains lacked ability of P‐fimbriae‐mediated adhesion and aerobactin‐mediated iron uptake, indicating low bacterial virulence. Long‐term metabolic control (HbA1c), prevalence of retinopathy, neuropathy and previous foot ulcers were similar in bacteriuric and nonbacteriuric diabetic patients, matched according to gender, age, and duration of diabetes. Renal function was also similar, though the frequency of proteinuria and elevated blood pressure tended to be higher in the bacteriuric than in the noninfected group. Eight‐three percent of the bacteriuric patients reported previous urinary tract infections but only 61 % of nonbacteriuric patients (p = 0.07). As compared to non‐diabetic women, diabetic women reported significantly more previous urinary tract infections (p < 0.01). In conclusion, the prevalence of bacteriuria in diabetic outpatients was not significantly higher than in non‐diabetic outpatients or healthy volunteers. No studied host factor was clearly associated with bacteriuria in diabetic patients, although proteinuria and hypertension tended to be more common. The infecting E. coli strains were of low virulence.
The Performance of Three Measures of Health Status in an Outpatient Diabetes Population
Authors: Bardsley M.J. , Astell S. , McCallum A. , Home P.D.
Published: July 2009

Both the late complications of diabetes and the means used to prevent them have a significant impact on the lives of people with the condition. Measuring quality of life is therefore important in assessing clinical need and evaluating the success of management. Three approaches to measuring health status were therefore compared in 284 randomly selected out‐patients attending a hospital diabetes service. The measures used were the Nottingham Health Profile (NHP), four categories of an anglicized version of the Sickness Impact Profile (the Functional Limitations Profile (FLP)), and a scale of Positive Well‐being (PWB). The results were found to be independent of questionnaire order and place of completion. The distributions of scores on the NHP and FLP scales were highly skewed, with a majority of cases scoring zero. NHP and FLP scores were related (p < 0.001) to age, but not otherwise to type of diabetes. Patients with angina, circulatory problems, and neuropathy scored significantly higher (up to p < 0.001) on several dimensions/ categories of the NHP and FLP, but not the PWB scale. Severe visual impairment (worse than 6/36) was only related (p < 0.005) to NHP ‘Mobility’ and FLP ‘Ambulation’ and ‘Home management’. Validation of scores by interview gave satisfactory results on all dimensions of the NHP except ‘Energy’, and all FLP categories except ‘Recreations and pastimes’. No statistically significant association was observed between the PWB and the interviewer's assessments, but it did correlate (up to tau = 0.45, p < 0.001) with some social and psychological dimensions/categories of the NHP/FLP. In conclusion the PWB scale is independent of physical disability. The NHP and FLP provide a useful assessment of general health in diabetes, but are biased towards identifying the minority of patients who have already developed more severe health problems.
Mortality Among Type 2 Diabetic Individuals and Associated Risk Factors: The Three City Study
Authors: Sprafka J.M. , Pankow J. , McGovern P.C. , French L.R.
Published: July 2009

The 10 year mortality experience was determined in a population‐based cohort of 540 Type 2 diabetic individuals. The association between potential risk factors and all causes mortality was examined. Diabetes was not mentioned anywhere on the death certificate in 46% of 274 decedents. Diseases of the circulatory system (ICD9‐390–459) accounted for the majority (62%) of deaths in this cohort. Ten‐year survival was poorer than expected for both men and women compared to the age‐ and sex‐matched Minnesota population. Standardized mortality ratios for selected causes of death indicated excess for cardiovascular disease (ICD9‐390–459), coronary heart disease (ICD9 410–414) and cerebrovascular disease. Baseline variables associated with all causes of mortality included age and a history of macrovascular disease. These findings indicate that mortality data significantly underestimate the magnitude of diabetes and that individuals with diabetes have poorer survival than non‐diabetic individuals.
Glycaemic Responses in Type 2 Diabetic Patients to Various Mixed Meals Taken at Home
Authors: Harnden K.E. , Judd P.A. , Hockaday T.D.R.
Published: July 2009

Eight Type 2 diabetic patients ate and prepared five different meals at home, taking each meal on two separate occasions. They measured their blood glucose just before eating and 30, 60, 120, and 180 min after the meal. The meals varied in energy and dietary fibre content and in the ratio (by energy) of carbohydrate to fat. Total energy content of the meals had little effect on the postprandial glycaemic responses nor were the responses reduced by meals with high dietary fibre content. The ratio of carbohydrate to fat did not significantly affect postprandial glycaemic responses when meals were low in fibre. However, postprandial glycaemic responses were significantly greater in the meal with a high ratio of carbohydrate to fat, high in fibre and low in energy compared with those after the equicaloric meal low in carbohydrate to fat ratio and low in fibre (area under the curve 683 ± 131 vs 306 ± 55 mmol ***I−1 min−1, p<0.05). Fat intake of 35% of energy may be compatible with improved postprandial blood glucose concentrations. Many meal combinations need to be studied in order to provide reliable information for diabetic patients. The method outlined proved reproducible (within patient coefficient of variation 13%), easy to perform and inexpensive.
Energy Expenditure in Lean and Obese Diabetic Patients Using the Doubly Labelled Water Method
Authors: Chong P.K.K. , Jung R.T. , Rennie M.J. , Scrimgeour C.M.
Published: July 2009

Obesity is a common problem among Type 2 diabetic patients. To investigate the role of energy expenditure in the maintenance of obesity in diabetic subjects, total energy output was measured during weight stability in 23 diabetic patients: 8 lean, 5 overweight, and 10 obese. Free living total energy expenditure was measured over 14 days using doubly labelled water method, resting metabolic rate by indirect calorimetry, and urinary energy losses were assessed. Total energy output was higher in the obese (13.66 ± SD 3.18 MJ 24 h−1) than normal weight patients (10.84 ± 2.02 MJ 24 h−1; p < 0.05); 11.96 ± 2.51 MJ 24 h−1 in the overweight. None of the lean but four of the obese had total energy output > 16 MJ 24 h−1. Urinary energy losses accounted for only 0.6% of total energy output in lean, 2.8% in overweight, and 3.1% in obese. Resting metabolic rate was significantly higher in obese (7.47 ± 1.69 MJ 24 h−1) compared to lean (5.87 ± 1.07; p < 0.05) and resting metabolic rate correlated with lean body mass (r = 0.8, p < 0.001). Thermogenesis plus physical activity was substantial and not lower in the obese (5.77 versus lean 4.97 MJ 24 h−1). The mean ratio of total energy expenditure to resting metabolic rate was in the moderate exercise category and similar in lean (1.87) and obese (1.80). Resting metabolic rate, total energy expenditure, and thermogenesis and physical activity were similar in all three groups when corrected for differences in lean body mass. In conclusion, high energy intake and not reduced energy expenditure is the major cause of the maintenance of obesity in diabetic patients. Overall there was no evidence of an energy deficit in the obese. This work emphasized the need for increased patient nutritional education to control energy intake.
Metabolic and Clinical Characteristics of South Asians and Europeans in Coventry
Authors: Simmons D. , Powell M.J.
Published: July 2009

A house to house survey in Foleshill, Coventry, compared risk factors for Type 2 diabetes and ischaemic heart disease (IHD) among adult United Kingdom Europeans (n = 5508, 64% screened) and South Asians (n = 4395, 84% screened). Those with a high glucose and a randomized 10% of others had a glucose tolerance test while those with previously diagnosed diabetes (104 Europeans, 223 South Asians) were re‐interviewed in more detail. By the age of 29 years, South Asians had higher 2 h glucose 5.4 ± 1.0 vs 4.84 ± 1.2 mmol l−1, p < 0.005) and insulin (45.6 vs 23.8 mU l−1, p < 0.001) concentrations and in males, a higher cholesterol concentration (5.1 ± 0.9 vs 4.6 ± 1.2 mmol l−1, p < 0.05). South Asians with known Type 2 diabetes had an earlier age at diagnosis (48 ± 11 vs 57 ± 14 years, p < 0.001), a lower body mass index in the past (29.0 ± 4.8 vs 32.1 ± 6.9 kg m−2, p < 0.001) and currently (27.1 ± 3.7 vs 29.1 ± 6.4 kg m−2, p< 0.001), were more likely to present with acute symptoms, were less likely to attend the hospital clinic (14% vs 31%, p < 0.001), and were less likely to be treated with diet alone (14% vs 21%) or with insulin (9% vs 16%) than Europeans. Glycaemic control was similar in the two ethnic groups. These findings suggest an earlier onset of the disease processes involved in diabetes in South Asians. Important ethnic differences in patterns of care exist that make clinical comparisons difficult.
Insulin Treatment, Time‐zones and Air Travel: a Survey of Current Advice from British Diabetic Clinics
Authors: Gill G.V. , Redmond S.
Published: July 2009

To investigate current advice given to insulin‐treated diabetic patients undertaking international flights crossing time‐zones, we have conducted a survey of UK physicians running diabetic clinics. Consultants were asked to give the general advice they would give to travellers on twice‐daily short‐ and intermediate‐acting insulins in four different flight situations: westward London to New York (morning and evening departures) and eastward Manchester to Singapore (morning and evening departures). Response rate was poor (37%). Six percent of replies were unhelpful (e.g. ‘pring the BDA’, ‘carry on as usual’), and 14% liable to cause hypoglycaemia. Thirteen percent advocated change to a ‘basal‐bolus' system of insulin administration. The rest used variants of additional insulin for westward flights and reduced flights eastward. There was great variation in advice, and many regimens were excessively complicated. We recommend simple individualized advice, without attempts at over‐zealous glycaemic control during travel. Local arrival and departure times may fit in easily with insulin and meals at standard times before and after flying, and little or no dosage alteration may be needed.