bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Delayed Gastric Emptying in Diabetic Patients With Autonomic Neuropathy by a New Magnetic Resonance Imaging Technique and Radio-Opaque Markers
Authors: Lehmann Roger , Borovicka Jan , Kunz Patrik , Crelier Gerard , Boesiger Peter , Fried Michael , Schwizer Werner , Spinas Giatgen A
Published: March 2007

OBJECTIVE

Our objective was to validate a new noninvasive magnetic resonance imaging (MRI) technique for diagnosis of delayed gastric emptying by using radio-opaque markers (ROMs) in diabetic patients with and without cardiovascular autonomic (CAN) and peripheral sensomotoric neuropathy (PSN).

RESEARCH DESIGN AND METHODS

Fifteen diabetic outpatients were recruited, eight with CAN and PSN (group A, age 28–61 years, mean diabetes duration 27 years) and seven without CAN (group B, age 28–60 years, mean diabetes duration 16 years). Gastric emptying and motility were assessed with ROMs and MRI in random order. After an overnight fast either a test meal (451 kcal) containing a capsule with 10 ROMs is eaten and a supine plain abdominal × ray is taken after 6 h or 500 ml intralipid 10% (550 kcal) is swallowed for the MRI study, using a 1.5 Tesla Gyroscan ACS II (Philips, Eindohoven, The Netherlands). Computer-assisted segmentation of images was used to measure gastric emptying (T1/2, min) over 125 min, contraction frequency (F, min−1), mean contraction amplitude (CA, % basal), and velocity (V, cm/s). Blood glucose was kept constant at 5.0–8.0 mmol/l.

RESULTS

In group A, 6.1 ± 1.36 ROMs (mean ± SE) were retained in the stomach after 6 h and 0 ROM in group B, indicating a significant delay of gastric emptying in patients with CAN. The MRI study revealed a significantly longer gastric emptying (P < 0.005) in group A (T1/2 = 124 ± 10 min) as compared with group B (T1/2 = 85 ± 18 min). There was no difference in F, CA, and V between the two groups: F 2.9 ± 0.07 and 2.7 ± 0.1 (min−1), CA 26.8 ± 1.2 and 29.6 ± 1.6 (% basal), V 0.43 ± 0.02 and 0.40 ± 0.02 (cm/s), respectively.

CONCLUSIONS

MRI offers the possibility of visualizing and examining exactly the mechanisms responsible for gastric emptying and is characterized by a high specificity but a lower sensitivity as compared with ROMs, which proved to be an ideal screening test for diagnosis of gastroparesis in clinical practice.
Relationship of Locus of Control to Physical Activity Among People With and Without Diabetes
Authors: Gregg Edward W , Kriska Andrea M , Narayan KM Venkat , Knowler William C
Published: March 2007

OBJECTIVE

To examine the relationship between locus of control (LOC) (internal and external) and physical activity in Pima Indians and to determine whether this relationship is affected by the presence of diabetes.

RESEARCH DESIGN AND METHODS

A population-based sample of 580 Pima Indians was recruited from an ongoing research study. LOC was measured on a 1–40 modified Rotter scale, and past year total physical activity (leisure and work physical activity levels combined) was measured by interviewer-administered questionnaire.

RESULTS

Among both men and women without diabetes, individuals with an internal LOC (score 1–16) were significantly (P < 0.01) more active than those with an external (score 17–40) LOC (70 vs. 30 median metabolic equivalent [MET] hours per week for men: 12 vs. 5 median MET hours per week for women). Controlled for age and BMI, an internal LOC was significantly associated with a higher level of physical activity among men (P = 0.04) and women (P = 0.001) without diabetes, but not among those with diabetes.

CONCLUSIONS

Nondiabetic Pima Indians with an internal LOC are more physically active than those with an external LOC. Enhancing perceptions of internal control may influence physical activity and thus have implications for diabetes prevention.
Lipid Levels in Former Gestational Diabetic Mothers
Authors: Meyers-Seifer Cynthia H , Vohr Betty R
Published: March 2007

OBJECTIVE

To investigate lipid levels in former gestational diabetic mothers, 5–6 years postpartum, and to evaluate the relationship of these values to glucose, insulin, BMI, and blood pressure.

RESEARCH DESIGN AND METHODS

The subjects studied were 56 former gestational diabetic mothers and 48 control mothers 5–6 years postpartum. Two hours after a 50-g carbohydrate meal, total cholesterol (TC), triglycerides (TG), HDL and LDL cholesterol, glucose, and insulin were measured and compared between the two groups (analysis of variance). BMI and blood pressure were also evaluated. The risk of finding an abnormal metabolic, anthropometric, or hemodynamic parameter in either group was assessed (X2 analysis and Fisher's exact test). Correlation coefficients were assessed between the lipids versus insulin, glucose, BMI, and blood pressure.

RESULTS

Mean TC, TG, LDL cholesterol, glucose, and systolic blood pressure were significantly higher in the gestational diabetic mothers than in the control mothers. In addition, there was greater likelihood of finding an abnormal TC ≥ 5.17 mmol/l, LDL cholesterol ≥ 4.14 mmol/l, and systolic blood pressure > 140 mmHg in gestational diabetic mothers. Triglycerides correlated with BMI, insulin, systolic and diastolic blood pressure, and HDL cholesterol correlated inversely with insulin in gestational diabetic mothers.

CONCLUSIONS

We conclude that at 5–6 years postpartum, former gestational diabetic mothers demonstrate changes in lipid levels that differ from control mothers and that specific lipids correlate with cardiovascular risk factors. Further study is needed to evaluate gestational diabetic mothers for the development of cardiovascular risk factors including insulin resistance.
Prevalence of Self-Reported Erectile Dysfunction in People With Long-Term IDDM
Authors: Klein Ronald , Klein Barbara E K , Lee Kristine E , Moss Scot E , Cruickshanks Karen J
Published: March 2007

OBJECTIVE

The purpose of this report is to examine the prevalence of erectile dysfunction and relationships to other characteristics in men with younger-onset diabetes.

RESEARCH DESIGN AND METHODS

In a population-based cohort study in southern Wisconsin, prevalence of erectile dysfunction was measured based on self reports in men who were 21 years of age or older, were <30 years of age at diagnosis of diabetes, had 10 or more years of diabetes, and were taking insulin (n = 365).

RESULTS

Of the study group, 20% reported a history of erectile dysfunction. The prevalence of erectile dysfunction increased with increasing age (from 1.1% in those 21–30 years of age to 47.1% in those 43 years of age or older, P for trend < 0.0001) and with increasing duration of diabetes (P for trend < 0.0001). Erectile dysfunction was associated with presence of severe diabetic retinopathy, a history of peripheral neuropathy, amputation, cardiovascular disease, a higher glycosylated hemoglobin, use of antihypertensive medications, and higher BMI.

CONCLUSIONS

These data suggest that tighter glycemic control and careful selection of antihypertensive medications might prove beneficial.
Plasma Fibrinogen in NIDDM: The Rotterdam Study
Authors: Missov Rossen M , Stolk Ronald P , van der Bom Johanna G , Hofman Albert , Bots Michiel L , Pols Huibert A P , Grobbee Diederick E
Published: March 2007

OBJECTIVE

To compare plasma fibrinogen levels across groups of subjects with and without NIDDM with respect to diabetes therapy and to evaluate the influence of metabolic control and other selected factors.

RESEARCH DESIGN AND METHODS

In a cross-sectional study, plasma fibrinogen was measured in 2,971 elderly subjects aged 55 years and older (mean age 70.8 years). This was part of the baseline examination of the Rotterdam Study, a population-based study of chronic diseases in the elderly.

RESULTS

Plasma fibrinogen levels did not differ among subjects with and without NIDDM (2.84 vs. 2.81 g/l, P = 0.5). After adjustment for age, sex, smoking, BMI, and waist-to-hip ratio, the plasma fibrinogen levels were higher in subjects receiving insulin therapy. In those without diabetes (n = 2,640), with diabetes but not taking antidiabetes medication (n = 196), taking oral medication (n = 99), and taking insulin (n = 36), the age- and sex-adjusted fibrinogen levels were 2.82 (SE 0.01), 2.79 (0.05), 2.79 (0.07), and 3.23 (0.11) g/l, respectively (P < 0.005). Adjustment for leukocyte count or serum creatinine level did not affect the observed association, while adjustment for fructosamine decreased the differences.

CONCLUSIONS

Plasma fibrinogen levels are elevated in insulin-treated NIDDM patients, which may reflect worse metabolic control in this subgroup.
Risk Factors for Diabetes and Cardiovascular Disease in Young Australian Aborigines: A 5-year follow-up study
Authors: Braun Braun , Zimmermann Michael B , Kretchmer Norman , Spargo Randolph M , Smith Richard M , Gracey Michael
Published: March 2007

OBJECTIVE

To test the hypothesis that hyperinsulinemia and glucose intolerance are present at an early age in australian aborigines and can be used to predict the eventual development of NIDDM.

RESEARCH DESIGN AND METHODS

Baseline anthropometric, pubertal stage, and blood pressure data were collected for 100 Australian aboriginal children and adolescents in 1989. Plasma concentrations of glucose, insulin, C-peptide, triglycerides, and LDL, HDL, and total cholesterol were measured before and during an oral glucose tolerance test. All measurements were repeated in 74 individuals from the original study population in 1994. Results were compared among hyperinsulinemic and normoinsulinemic subjects, and subjects with normal or abnormal glucose tolerance.

RESULTS

The percentage of subjects who were overweight increased from 2.7% at baseline to 17.6% 5 years later. At a mean age of 18.5 years, 8.1% of the population had impaired glucose tolerance (IGT), 2.7% had diabetes, and 21.6% had elevated cholesterol concentrations in plasma. Dyslipidemia was particularly prevalent among male subjects in the population: 34.4% had elevated plasma cholesterol and 21.9% had elevated LDL cholesterol values. Of the eight subjects who had diabetes or IGT in 1994, four were classified as hyperinsulinemic in 1989 and four were not.

CONCLUSIONS

The major finding of this study is the high prevalence of risk factors for NIDDM and cardiovascular disease in this population of aboriginal children and adolescents. Abnormalities of carbohydrate and lipid metabolism were well established by late in the second decade of life. Although many subjects had high insulin levels and there was evidence of insulin resistance in the population, hyperinsulinemia did not predict the development of abnormal glucose tolerance 5 years later.
Glucose and Amino Acid Turnover in Untreated Gestational Diabetes
Authors: Zimmer Dawn M , Golichowski Alan M , Karn Cheryl A , Brechtel Ginger , Baron Alain D , Denne Scott C
Published: March 2007

OBJECTIVE

Although gestational diabetes affects as many as 3% of all pregnant women, specific aspects of glucose and protein metabolism in this population have not been clearly delineated. We tested the hypothesis that gestational diabetes mellitus (GDM) results in increased glucose production and proteolysis during fasting.

RESEARCH DESIGN AND METHODS

Using tracer isotope infusions, the rate of appearance (Ra) of glucose, leucine, phenylalanine and tyrosine, phenylalanine hydroxylation, leucine oxidation, and urea nitrogen excretion were determined after an overnight fast in 10 GDM subjects, within 2 weeks of diagnosis and before initiation of treatment, and in a matched control group of nine healthy nondiabetic pregnant women.

RESULTS

Fasting glucose Ra was similar in GDM patients and control subjects (GDM, 12.8 ± 1.1 vs. control subjects, 12.8 ± 0.9 μumol · kg−1 . min−1). Leucine and phenylalanine Ra (reflecting proteolysis) also were not different between GDM patients and control subjects (GDM leucine Ra, 128 ± 14 vs. control subjects, 124 ± 5; phenylalanine Ra GDM, 35 ± 4 vs. control subjects, 40 ± 2 μumol · kg−1 · h−1). Furthermore, leucine oxidation and phenylalanine hydroxylation were not increased in GDM subjects, urea nitrogen excretion was actually lower in GDM patients. However, fasting insulin concentrations were significantly elevated in GDM subjects (GDM, 165 ± 35 vs. control subjects, 30 ± 5 pmol/l; P < 0.01).

CONCLUSIONS

Hepatic glucose release and whole-body proteolysis in GDM patients were remarkably similar to matched pregnant control subjects. This was achieved with insulin concentrations three- to fivefold higher than normal, suggesting significant insulin resistance for both glucose and protein metabolism in GDM.
Influence of Smoking on the Survival Rate of Diabetic Patients Requiring Hemodialysis
Authors: Biesenbach Glorg , Zazgornik Jan
Published: March 2007

OBJECTIVE

To study the influence of cigarette smoking on the survival rate of diabetic patients on hemodialysis.

RESEARCH DESIGN AND METHODS

We evaluated 1- and 5-year survival rates and the mean values of HbA1c, serum lipids, fibrinogen, and blood pressure. We compared the prevalence of vascular damage at the beginning of dialysis therapy and the endpoint of the study, as well as the causes of death in 22 diabetic patients who smoked (> 10 cigarettes/day) and 30 nonsmoking diabetic patients.

RESULTS

There were no differences with respect to HbA1c, cholesterol, and triglycerides. In contrast, diabetic patients with tobacco consumption had significantly (P < 0.05) higher levels of fibrinogen (428 ± 98 vs. 378 ± 76 mg/dl) and higher systolic blood pressures (154 ± 12 vs. 146 ± 13 mm Hg) than the nonsmoking group. The 1- and 5-year survival rates of the smoking patients were 68 and 9%, respectively, and in the nonsmoking subjects, 80 and 37%, respectively (P < 0.05). The prevalence of vascular damage was similar in both groups, but at the endpoint of the study, the incidence of myocardial infarctions was significantly higher (P < 0.005) in the smoking patients (77 vs. 13%). Cardiovascular events were the most frequent cause of death in both patient groups but more frequently in the smoking subjects (80 vs. 63%).

CONCLUSIONS

Hemodialyzed diabetic cigarette smokers show higher fibrinogen and systolic blood pressure values, a higher incidence of myocardial infarctions, and their 5-year survival rate is significantly decreased when compared with nonsmoking patients on hemodialysis.
The Dense LDL Phenotype: Association with plasma lipoprotein levels, visceral obesity, and hyperinsulinemia in men
Authors: Tchernof André , Lamarche Benoît , Prud'homme Denis , Nadeau André , Moorjani Sital , Labrie Fernand , Lupien Paul J , Després Jean-Pierre
Published: March 2007

OBJECTIVE

To investigate the potential relationship between the cluster of metabolic abnormalities found in visceral obesity and the small dense LDL phenotype.

RESEARCH DESIGN AND METHODS

We have estimated LDL peak particle size by nondenaturing 2–16% gradient gel electrophoresis in a sample of 79 men. Glucose tolerance and fasting plasma insulin and lipoprotein levels were also measured.

RESULTS

The LDL particle score, calculated from migration, distances and relative band intensities and reflecting the proportion of small dense LDL particles, was positively correlated with plasma triglyceride (TG) (r = 0.60, P < 0.0001) and negatively correlated with HDL cholesterol (r = −0.56, P < 0.0001) levels. Although the LDL particle score was not associated with variations in plasma LDL cholesterol or LDL apolipoprotein (apo) B concentrations, it was significantly correlated with the LDL apo B–to–LDL cholesterol ratio (r = 0.60, P < 0.0001). Fasting plasma insulin and visceral adipose tissue (AT) areas measured by computed tomography were weakly but significantly correlated with the LDL particle score (r = 0.23 and 0.29, respectively, P < 0.05). LDL peak particle size showed similar but inverse correlations with anthropometric and metabolic variables. Subjects classified as having small dense LDL particles (by comparing subjects in the highest tertile versus those in the lowest tertile of the LDL particle score distribution) were characterized by increased plasma TG, reduced HDL cholesterol, higher fasting insulin levels, and elevated visceral AT accumulation. However, multiple regression analyses revealed that visceral AT accumulation was not an independent predictor of the dense LDL phenotype after inclusion of TG and HDL cholesterol levels and lipoprotein ratios in the model.

CONCLUSIONS

It thus appears that the high TG–low HDL cholesterol dyslipidemia frequently found in visceral obesity and in a hyperinsulinemic state is a strong correlate of the small dense LDL phenotype. Although associated with the dense LDL phenotype, visceral obesity and hyperinsulinemia were not independent predictors of an increased proportion of small dense LDL particles after controlling for TG and HDL cholesterol levels.
Bromocriptine (Ergoset) Reduces Body Weight and Improves Glucose Tolerance in Obese Subjects
Authors: Cincotta Anthony H , Meier Albert H
Published: March 2007

OBJECTIVE

A double-blind placebo controlled study investigated long-term effects of Ergoset, a new quick release formulation of bromocriptine, on body weight, body fat, and glucose tolerance in a group (n = 17) of obese subjects who were instructed to follow a moderate hypocaloric diet.

RESEARCH DESIGN AND METHODS

Obese individuals (> 25% body fat for men and > 30% body fat for women) were instructed to follow a calorie-restricted diet (70% of weight maintaining based on study entry weight) and were randomized to daily treatment with Ergoset (1.6–2.4 mg/day) or placebo at 0800 over an 18-week treatment period. Oral glucose tolerance tests were performed on subjects before initiation and again at termination of treatment. Body weight and body fat (determined by skinfold measurements) were quantified every 2 weeks during the course of treatment.

RESULTS

Ergoset treatment for 18 weeks significantly reduced body weight and body fat versus placebo (6.3 ± 1.5 and 5.4 ± 1.1 kg vs. 0.9 ± 1.0 and 1.5 ± 0.6 kg. respectively, P < 0.01). Ergoset, but not placebo, also improved glucose tolerance (P < 0.02); the stimulated area under the oral glucose tolerance curve was reduced by 46% (from 121 ± 23 to 64 ± 32 mg · h−1 · dl−1), while the stimulated area under the insulin curve was reduced by 30%.

CONCLUSIONS

When combined with instruction to follow a moderate hypocaloric diet, Ergoset, but not placebo, improves glucose tolerance and promotes significant weight and body fat loss in obese subjects over an 18- week treatment period.
Rapid HLA-DQB1 Genotyping for Four Alleles in the Assessment of Risk for IDDM in the Finnish Population
Authors: Ilonen Jorma , Reijonen Helena , Herva Elja , Sjöroos Minna , Iitiä Antti , Lövgren Timo , Veijola Riitta , Knip Mikael , Åkerblom Hans K ,   The Childhood Diabetes in Finland (DIME) Study Group
Published: March 2007

OBJECTIVE

To study the effectiveness of MHC genotyping in the assessment of risk for IDDM based on the identification of alleles that are significantly associated with risk for IDDM (DQB1 *0302 and *0201) and protection from it (DQB1 *0602/*0603 and *0301).

RESEARCH DESIGN AND METHODS

A long series of 649 index cases of IDDM, together with their healthy siblings and 756 healthy blood donors, was collected in Finland. The samples were analyzed using a large-scale assay procedure that was developed for rapid screening purposes. The method utilizes time-resolved fluorometry to detect the hybridization of lanthanide-labeled allele-specific oligonucleotide probes with amplified gene product.

RESULTS

A total of 61.9% of IDDM index cases had high risk (DQB1 *0201/*0302) or moderate risk (DQB1 *0302/x [x meaning DQB1 *0302 or a nondefined allele]) genotypes compared with 14.3% of the reference population. In patients and control subjects, the frequencies of low risk genotypes were 28.0 and 22.1%, respectively, and those of decreased risk genotypes, 10.0 and 63.6%. The relative risk of a *0201/*0302 genotype was 53.5 (31.1–92.8) compared with the decreased risk genotypes (63.6% of controls). The graded risk estimation was equally efficient in assessing the risk of IDDM in siblings of child with IDDM.

CONCLUSION

The near-automatic typing procedure developed is attractive for large-scale screening projects, such as diabetes prevention and intervention trials.
Erythrocyte Sodium-Hydrogen Exchange and Microalbuminuria in Type I Diabetes
Authors: Giampietro Ottavio , Matteucci Elena , Pedrinelli Roberto
Published: March 2007

OBJECTIVE

To evaluate the relationship between sodium-hydrogen (Na+/H+) exchange and microalbuminuria (an abnormal urinary albumin/creatinine ratio in morning collections) in IDDM patients.

RESEARCH DESIGN AND METHODS

Amiloride-sensitive H+ efflux from cells acid loaded at pH 6.5 (defined as erythrocyte Na+/H+ exchange) was measured in normotensive IDDM patients with microalbuminuria and normal renal function (n = 16, serum creatinine < 106.1 μmol/l) and compared with both matched uncomplicated normoalbuminuric diabetic subjects and normal subjects (n = 16 each).

RESULTS

Erythrocyte Na+/H+ exchange was elevated to a similar extent in diabetic patients with and without microalbuminuria. Blood pressure and lipids were normal in both diabetic groups. Daily insulin requirement, blood glucose, and glycated hemoglobin were higher and retinopathy more frequent in microalbuminuric patients.

CONCLUSIONS

The abnormal erythrocyte Na+/H+ exchange of type I diabetic patients was unrelated to microalbuminuria and could not be ascribed to hypertension or dyslipidemia. Furthermore, the degree of metabolic control seemed to influence the progression of diabetic nephropathy, but not the abnormal antiport activity. The data imply that Na+/H+ exchange is an unlikely marker of nephropathy in type I diabetic patients.
Diabetes Mellitus and Its Vascular Complications in Japanese Migrants on the Island of Hawaii
Authors: Kawate Ryoso , Yamakido Michio , Nishimoto Yukio , Bennett Peter H , Hamman Richard F , Knowler William C
Published: March 2007

Japanese migrants and their offspring on the island of Hawaii and Japanese living in Hiroshima were examined for diabetes mellitus and its vascular complications. the same methods and investigators were used in both locations. Death certificates of Japanese and Caucasians dying on the island during the past 26 yr were analyzed. Diabetes, defined as a venous serum glucose concentration of at least 200 mg/dl 2 h after a 50-g oral glucose load, was significantly more common in the Hawaiian Japanese than in the Hiroshima Japanese subjects. This suggests that diabetes is more prevalent in Japanese in Hawaii than in Japan, although lack of knowledge about the total population of Japanese migrants in Hawaii makes this generalization uncertain. The proportion of deaths attributed to diabetes was much higher in Japanese migrants and their offspring in Hawaii than in Japan. During the 1950s, the proportional death rate from diabetes was about half as large in Japanese Hawaiians as in Caucasian Hawaiians, but it increased to become 1.6 times the Caucasian rate during the 1970s. A nutritional study revealed that the total caloric intake was similar in Japanese in Hawaii and Hiroshima, although the estimated level of physical activity was less in the Hawaiian subjects. Consumption of animal fat and simple carbohydrates (sucrose and fructose) were at least twice as high in Hawaiian as in Hiroshima Japanese. Conversely, Hiroshima Japanese consumed about twice the amount of complex carbohydrate as the Hawaiian Japanese. These observations support the hypothesis that a high fat, high simple carbohydrate, low complex carbohydrate diet and/or reduced levels of physical activity increase risk of diabetes. The proportion of deaths attributed to ischemic heart disease was higher in both diabetic and nondiabetic Japanese Hawaiians than in diabetic subjects in Japan. The rates were similar for Japanese and Caucasians in Hawaii. There was no evidence of an environmental influence on the development of microangiopathy (retinopathy) in diabetes, as the prevalence of diabetic retinopathy (stratified for diabetes duration) was similar in Japanese subjects in Hawaii and in Japan, and it was similar to previous reports from England. On the other hand, diabetes alone did not appear to account for the greater prevalence of macroangiopathy in Hawaiian Japanese than in Hiroshima. Thus environmental factors, possibly including diet, appear to be involved in the development of macrovascular complications of diabetes.
The WHO Multinational Study of Vascular Disease in Diabetes: 2. Macrovascular Disease Prevalence
Authors: Keen H , Jarrett R J
Published: March 2007

14 national groups have collaborated under WHO auspices to select, from local defined populations of individuals with clinical diabetes, groups of approximately 500 within the age range 35–55 yr stratified by age, sex, and known duration of diabetes. In each center, the selected patients were submitted to a standardized study protocol, which included systematic inquiry (WHO questionnaire) for the presence of symptoms of angina pectoris, history of myocardial infarction, presence of intermittent claudication, and cigarette smoking history. Examination included standard biometry, blood pressure measurement, 12-lead (centrally Minnesota coded) electrocardiography, and central laboratory measurement of serum cholesterol and creatine. Ophthalmoscopic and urinary examinations were also included. The prevalence of arterial disease symptoms and electrocardiographic abnormalities show very large variation between countries, the lowest rates generally being found in the Oriental samples and the highest in the European. “Risk factors” for arterial disease (blood pressure, serum cholesterol, and cigarette smoking) also vary widely between diabetic groups. Although data are not yet complete, these differences appear unlikely to explain the variation in the atherosclerotic morbidity observed. Diabetic women were at least as vulnerable to arterial disease as diabetic men. A high prevalence of nonspecific abnormalities of the repolarization phase of the ECG was found, even in groups where ischemic abnormalities were rare. The origin of these is uncertain; they may represent variable local changes or possibly diabetic cardiomyopathy. This preliminary report confirms and quantifies previous indications that the impact of atherosclerotic disease on persons with diabetes varies considerably between national groups, in broad terms, running parallel with the variations in prevalence in the populations in general and suggesting that cultural and/or ethnic factors are more important determinants of atherosclerosis in diabetic individuals than is the diabetic state per se.
Dietary Cyanide and Tropical Malnutrition Diabetes
Authors: McMillan D E , Geevarghese P J
Published: March 2007

Two categories of diabetes are recognized in the temperate zone—ketosis-prone diabetes requiring insulin and diabetes not requiring insulin. Another unique type of diabetes occurs in the tropics. It has two forms, both different from either form of temperate zone diabetes. Type J and pancreatic diabetes are both characterized by youth onset, antecedent malnutrition, substantial insulin requirement, and resistance to ketosis. In the tropical countries where they are found, both forms are associated with specific dietary practices, including a nutritionally marginal protein intake. The close association with low protein intake distinguishes this form of diabetes from that occurring in North America, Europe, and Oceania. The geographic distribution of malnutrition diabetes, in addition to being limited to the tropics, coincides regularly with the consumption of tapioca (cassava) or other foods that contain cyanide-yielding substances. Ingested cyanide is normally detoxified, principally, by conversion to thiocyanate. This detoxification requires sulfur, derived principally from amino acid sources. Studies in the rat indicate a remarkable ability to detoxify ingested cyanide, a reduction in urinary thiocyanate excretion when protein intake is lowered (especially during growth), production of marked hyperglycemia by either oral or parenteral cyanide, and the development of cyanosis and epidermal changes when there is prolonged exposure to cyanide. Both the association of malnutrition diabetes with food cyanogens and our laboratory observations support a role for cyanide in its pathogenesis.
A Multidisciplinary, Comprehensive, Ambulatory Treatment Scheme for Diabetes Mellitus in Children
Authors: Laron Zvi , Galatzer Avinoam , Amir Shoshana , Gil Ruth , Karp Moshe , Mimouni Marc
Published: March 2007

A study has been carried out on 262 children with juvenile diabetes and their parents, treated up to 10 yr on an ambulatory basis by a multidisciplinary team composed of pediatric endocrinologist, nurse, dietitian, psychologist, and social worker. Comparison of the findings with those of a study performed before inception of the Counselling Center for Juvenile Diabetics revealed the following positive influences: the degree of control attained was both higher and sustained with greater regularity; there were fewer complications with no episodes of coma, brittle diabetes, or severe ketoacidosis and almost no need for hospitalization; the attitude of the affected child, his parents, and his teachers was found to be considerably improved; there was better understanding of the nature of the disease and its requirements; the child's motivation to maintain the diabetic regimen was greater and conflicts within the family circle were markedly reduced; the child's self-concept was much higher; and both scholastic achievements and social adjustment were greater. We concluded that psychological stability is a basic factor in the control of diabetes, and the value of the multidisciplinary approach in the treatment of this chronic disease is indicated.
Factors in the Survival of Patients with Insulin-Requiring Diabetes for 50 Years
Authors: Cochran Harry A , Marble Alexander , Galloway John A
Published: March 2007

Ninety-seven diabetic patients who had taken insulin for 50 yr and longer were surveyed by questionnaire to identify factors that might explain their unusual longevity. The analysis suggested that the long survival of this group was related to the following: maintenance of normal or near normal body weight, regular contact with a personal physician, periodic blood glucose determinations, frequent urine testing, regular exercise, and longevity of the parents and grandparents. The results support the conclusion that careful management of diabetes favors longevity.
Accelerated Insulin Degradation: An Alternate Mechanism for Insulin Resistance
Authors: Kitabchi Abbas E , Stentz Frankie B , Cole Cindy , Duckworth William C
Published: March 2007

We have examined insulin and glucagon degrading activities of muscle and fat tissues in 11 subjects (4 lean controls, 3 insulin-resistant obese subjects, 2 non-insulin-dependent diabetic subjects, and 2 insulin-treated diabetic subjects) and correlated degrading activity with (1) basal insulin level and (2) state of insulin resistance. We found hyperinsulinemia and insulin resistance to be significantly correlated with accelerated insulin and glucagon degrading activity. Weight reduction in an insulin-resistant obese patients results in parallel reduction in both basal insulin level and insulin–glucagon degrading activity. These data are consistent with the hypothesis that an alternative mechanism for insulin resistance may be an accelerated insulin degradation at the level of target tissues.
Symmetrization of the Blood Glucose Measurement Scale and Its Applications
Authors: Kovatchev Boris P , Cox Daniel J , Gonder-Frederick Linda A , Clarke William
Published: March 2007

OBJECTIVE

To introduce a data transformation that enhances the power of blood glucose data analyses.

RESEARCH DESIGN AND METHODS

In the standard blood glucose scale, hypoglycemia (blood glucose, <3.9 mmol/l) and hyperglycemia (blood glucose, >10 mmol/l) have very different ranges, and euglycemia is not central in the entire blood glucose range (1.1–33.3 mmol/l). Consequently, the scale is not symmetric and its clinical center (blood glucose, 6–7 mmol/l) is distant from its numerical center (blood glucose, 17 mmol/l). As a result, when blood glucose readings are analyzed, the assumptions of many parametric statistics are routinely violated. We propose a logarithmic data transformation that matches the clinical and numerical center of the blood glucose scale, thus making the transformed data symmetric.

RESULTS

The transformation normalized 203 out of 205 data samples containing 13,584 blood glucose readings of 127 type 1 diabetic individuals. An example illustrates that the mean and standard deviation based on transformed, rather than on raw, data better described subject's blood glucose distribution. Based on transformed data: 1) the low blood glucose index predicted the occurrence of severe hypoglycemia, while the raw blood glucose data (and glycosylated hemoglobin levels) did not; 2) the high blood glucose index correlated with the subjects' glycosylated hemoglobin (r = 0.63, P <0.001); and 3) the low plus high blood glucose index was more sensitive than the raw data to a treatment (blood glucose awareness training) designed to reduce the range of blood glucose fluctuations.

CONCLUSIONS

Using symmetrized, instead of raw, blood glucose data strengthens the existing data analysis procedures and allows for the development of new statistical techniques. It is proposed that raw blood glucose data should be routinely transformed to a symmetric distribution before using parametric statistics.
Altered Hierarchy of Protective Responses Against Severe Hypoglycemia in Normal Aging in Healthy Men
Authors: Matyka Krystyna , Evans Mark , Lomas Jill , Cranston Iain , Macdonald Ian , Amiel Stephane A
Published: March 2007

OBJECTIVE

To investigate the effect of normal aging on the protective responses against hypoglycemia, in view of the fact that type II diabetes is primarily a disease of aging, and its treatment is associated with risk of hypoglycemia with cognitive impairment.

RESEARCH DESIGN AND METHODS

Plasma glucose was lowered stepwise from 5 to 2.4 mmol/l and restored by manipulation of an infusion of 20% glucose during 220-min intravenous infusion of 1.5 mU · kg−1 · min−1 soluble insulin in 14 men; 7 were aged 60–70 years and the other 7 were 22–26 years. Changes in neurohumoral responses, subjective awareness, and choice reaction time were assessed.

RESULTS

Hormonal responses were similar in the two groups, but symptoms began earlier in the younger men (at a plasma glucose of 3.6 ± 0.1 vs. 3.0 ± 0.2 mmol/l, P = 0.02) and were more intense (P = 0.03). Four-choice reaction time, a measure of psychomotor coordination, deteriorated earlier in the older men (at a plasma glucose of 3.0 ± 0.1 vs. 2.6 ± 0.1 mmol/l, P = 0.07) and to a greater degree. The difference between the glucose level for subjective awareness of hypoglycemia and the onset of cognitive dysfunction was lost in the older men (0.0 ± 0.2 vs. 0.8 ± 0.1 mmol/l, P < 0.007).

CONCLUSIONS

Older men are prone to more severe cognitive impairment during hypoglycemia than younger men and are less likely to experience prior warning symptoms if blood glucose falls. This effect of normal aging may contribute to the risk of severe hypoglycemia in older diabetic patients treated with sulfonylureas and insulin.
Stable Glomerular Filtration Rate in Normotensive IDDM Patients With Stable Microalbuminuria: A 5-year prospective study
Authors: Mathiesen Elisabeth R , Feldt-Rasmussen Bo , Hommel Eva , Deckert Torsten , Parving Hans-Henrik
Published: March 2007

OBJECTIVE

To investigate the long-term course of glomerular filtration rate (GFR) in IDDM patients with microalbuminuria in order to identify patients with stable or declining kidney function over a 5-year study.

RESEARCH DESIGN AND METHODS

Forty normotensive (129 ± 11/80 ± 8 mmHg) IDDM patients with persistent microalbuminuria (mean urinary albumin excretion [UAE] 84 mg/24 h [range 30–300]) were followed prospectively for 5 years of clinical examinations that included the measurement of GFR (51Cr-labeled EDTA clearance) at least once a year. The mean GFR at baseline was 120 ± 18 ml · min−1 · 1.73 m−2.

RESULTS

Using multiple regression analysis, the rate of decline in GFR was independently correlated to onset of diabetic nephropathy (P < 0.001) and systolic blood pressure (sBP) at baseline (P < 0.05). Increase in UAE was correlated to the mean HbA1c during the observation period. Out of 40 patients, 14 progressed to diabetic nephropathy (UAE > 300 mg/24 h). These patients had a significant reduction in GFR (mean −2.2 ± 3.8 ml · min−1 · year−1; P = 0.05), while GFR remained stable in the remaining 26 patients with nonprogressive microalbuminuria (change in GFR 0.5 ± 2.1 ml · min−1 · year−1; NS). The difference in the rate of decline of GFR was significant (mean 2.7 ml · min−1 · year−1; P < 0.05).

CONCLUSIONS

Normotensive IDDM patients with nonprogressive microalbuminuria have a stable GFR. Progression of UAE to diabetic nephropathy heralds a progressive loss of kidney function. Efforts should be made to prevent the progression from microalbuminuria to diabetic nephropathy in every IDDM patient with microalbuminuria.
Pathogenetic Mechanisms of Impaired Glucose Tolerance and Type II Diabetes in African-Americans: The significance of insulin secretion, insulin sensitivity, and glucose effectiveness
Authors: Osei Kwame , Gaillard Trudy , Schuster Dara P
Published: March 2007

OBJECTIVE

To examine the significance of alterations in insulin sensitivity index (S1), glucose effectiveness (Sg), and β-cell function in the pathogenesis of type II diabetes in African-Americans with varying degrees of glucose intolerance.

RESEARCH DESIGN AND METHODS

A total of 154 African-Americans residing in Franklin County, Ohio, were studied. There were 101 subjects with normal glucose tolerance (NGT), 36 with impaired glucose tolerance (IGT), and 17 with type II diabetes. An oral glucose tolerance test (OGTT) was performed on each subject. S1 and Sg were measured by insulin-modified, frequently sampled intravenous glucose tolerance test (FSIGT).

RESULTS

The mean fasting and postprandial serum glucose levels were significantly greater in the diabetic groups when compared with the IGT and NGT groups. In contrast, while fasting serum insulin and C-peptide levels tended to be greater in the type II diabetic and IGT groups, the postprandial responses were blunted at 30 min in the IGT and type II diabetic groups when compared with the NGT group. The mean acute first-phase insulin release after intravenous glucose was blunted also in the IGT and type II diabetic groups when compared with the NGT group. The S1 was significantly lower in the IGT (1.51 ± 0.19) and type II diabetic (0.61 ± 0.15) groups when compared with the NGT group (2.94 ± 0.20 × 10−4 · min−1 · μU−1 · ml−1). The Sg was not significantly different in the NGT (2.90 ± 0.20), IGT (2.47 ± 0.19), and the type II diabetic (2.35 ± 0.15 × 10−2/min) groups. The glucose effectiveness at theoretical zero insulin concentration (GEZI) followed similar patterns as the Sg. Furthermore, the basal insulin effect (BIE) was significantly lower in the IGT and type II diabetic groups compared with the NGT group. In addition, the glucose decay constant (Kg) was significantly lower (P < 0.001) in the IGT (1.21 ± 0.13) and the type II diabetic (1.07 ± 0.12) groups when compared with the NGT group (2.03 ± 0.10% per minute).

CONCLUSIONS

Our present study demonstrates that African-American patients with IGT and mild type II diabetes have significant reduction in β-cell function, insulin sensitivity, and BEI but have normal and intact Sg and GEZI when compared with NGT subjects. We conclude the following: 1) a reduction in Sg does not appear to play a significant role in the pathogenetic mechanism of IGT and type II diabetes in African-American patients, and 2) the intact Sg in the IGT and type II diabetic groups could serve as a compensatory mechanism for hyperglycemia in African-Americans.
Personal-Model Beliefs and Social-Environmental Barriers Related to Diabetes Self-Management
Authors: Glasgow Russell E , Hampson Sarah E , Strycker Lisa A , Ruggiero Laurie
Published: March 2007

OBJECTIVE

The specific aims of the present study were to report on the level of personal beliefs and social and environmental barriers across different regimen areas and patient subgroups and on the relationship of personal models and perceived barriers to the level of self-management.

RESEARCH DESIGN AND METHODS

This study focused on several issues related to personal models (representations of illness) and perceived barriers to diabetes self-management among a large heterogeneous survey sample of 2,056 adults throughout the U.S.

RESULTS

Respondents felt that diabetes was a serious disease and that their self-management activities will control their diabetes and reduce the likelihood of long-term complications. Most frequently reported barriers were related to dietary adherence, followed by exercise and glucose testing barriers. Both personal models and barriers significantly predicted level of self-management in all three regimen areas studied (diet, exercise, and glucose testing) after controlling for the influence of demographic and medical history factors. Regimen-specific models and barriers proved to be stronger predictors than more global measures. Differences on personal models and barriers were observed among different patient groups (e.g., age, health insurance, and insulin-taking status). Possible reasons for these differences and implications for intervention and future research are discussed.

CONCLUSIONS

Both the personal-model and barriers scales had good internal consistency and predicted variance in each of the self-management variables after controlling for demographic and medical history factors. These brief self-report personal-model scales demonstrated good internal reliability and were as predictive of self-management as the lengthier interview-based measures in previous studies. The assessment of the treatment effectiveness component of personal models may be sufficient for most clinical purposes.
Efficacy, Safety, and Dose-Response Characteristics of Glipizide Gastrointestinal Therapeutic System on Glycemic Control and Insulin Secretion in NIDDM: Results of two multicenter, randomized, placebo-controlled clinical trials
Authors: Simonson Donald C , Kourides Ione A , Feinglos Mark , Shamoon Harry , Fischette Christine T ,   The Glipizide Gastrointestinal Therapeutic System Study Group
Published: March 2007

OBJECTIVE

To investigate the efficacy, safety, and dose-response characteristics of an extended-release preparation of glipizide using the gastrointestinal therapeutic system (GITS) on plasma glucose, glycosylated hemoglobin (HbA1c), and insulin secretion to a liquid-mixed meal in NIDDM patients.

RESEARCH DESIGN AND METHODS

Two prospective, randomized, double-blind, placebo-controlled, multicenter clinical trials were performed in 22 sites and 347 patients with NIDDM (aged 59 ± 0.6 years; BMI, 29 ± 0.3 kg/m2; known diabetes duration, 8 ± 0.4 years) were studied. Each clinical trial had a duration of 16 weeks with a 1-week washout, 3-week single-blind placebo phase, 4-week titration to a fixed dose, and 8-week maintenance phase at the assigned dose. In the first trial, once-daily doses of 5, 20, 40, or 60 mg glipizide GITS were compared with placebo in 143 patients. In the second trial, doses of 5, 10, 15, or 20 mg of glipizide GITS were compared with placebo in 204 patients. HbA1c, fasting plasma glucose (FPG), insulin, C-peptide, and glipizide levels were determined at regular intervals throughout the study. Postprandial plasma glucose (PPG), insulin, and C-peptide also were determined at 1 and 2 h after a mixed meal (Sustacal).

RESULTS

All doses of glipizide GITS in both trials produced significant reductions from placebo in FPG (range −57 to −74 mg/dl) and HbA1c (range −1.50 to −1.82%). Pharmacodynamic analysis indicated a significant relationship between plasma glipizide concentration and reduction in FPG and HbA1c over a dose range of 5–60 mg, with maximal efficacy achieved at a dose of 20 mg for FPG and at 5 mg for HbA1c. PPG levels were significantly lower, and both postprandial insulin and C-peptide levels significantly higher in patients treated with glipizide GITS compared with placebo. The percent reduction in FPG was comparable across patients with diverse demographic and clinical characteristics, including those with entry FPG ≥ 250 mg/dl, resulting in greater absolute decreases in FPG and HbA1c in patients with the most severe hyperglycemia. Despite the forced titration to a randomly assigned dose, only 11 patients in both studies discontinued therapy because of hypoglycemia. Glipizide GITS did not alter lipids levels or produce weight gain.

CONCLUSIONS

The once-daily glipizide GITS 1) lowered HbA1c, FPG, and PPG over a dose range of 5–60 mg, 2) was maximally effective at 5 mg (using HbA1c) or 20 mg (using FPG) based on pharmacokinetic and pharmacodynamic relationships, 3) maintained its effectiveness in poorly controlled patients (those with entry FPG ≥ 250 mg/dl), 4) was safe and well tolerated in a wide variety of patients with NIDDM, and 5) did not produce weight gain or adversely affect lipids.
Utility of Untimed Urinary Albumin Measurements in Assessing Albuminuria in Black NIDDM Subjects
Authors: Chaiken Rochelle L , Khawaja Raheela , Bard Mara , Eckert-Norton Margaret , Banerji Mary Ann , Lebovitz Harold E
Published: March 2007

OBJECTIVE

To determine the usefulness of an untimed morning urine specimen in screening a black NIDDM population attending an urban diabetes clinic for microalbuminuria.

RESEARCH DESIGN AND METHODS

Untimed morning specimens were provided by 218 black NIDDM subjects. Of the 218 subjects, 123 also provided 24-h urine specimens. The 24-h specimens were assayed for albumin excretion rate (AER) in milligrams per 24 h, and the albumin-to-creatinine ratio (A-to-C) in micrograms per milligram was determined on the untimed morning urine specimen.

RESULTS

Correlation between the A-to-C ratio and the 24-h AER was 0.96 (P = 0.0001). In the range of clinical proteinuria, r was 0.92 (P = 0.003, n = 7). In the range of microalbuminuria, r was 0.55 (P = 0.005, n = 26), and in the normal range, r was 0.59 (P ≤ 0.0001, n = 90). Analysis of the untimed urine specimens from 218 black NIDDM subjects showed that 171 had A-to-C < 30 μg/mg, 38 had A-to-C 30–300 μg/mg, and 9 had A-to-C > 300 μg/mg. Data were grouped according to duration of NIDDM and the presence or absence of hypertension. None of the newly diagnosed NIDDM patients (< 1 year) (n = 40) had microalbuminuria. The frequency of microalbuminuria and clinical proteinuria increased with 1) duration of NIDDM 5–10 years (odds ratio [OR], 3.39; 95% CI 1.17–9.82),2) duration of NIDDM > 10 years (OR, 11.03; 95% CI 4.16–29.25), and 3) presence of hypertension (OR, 2.59; 95% CI I.20–5.61).

CONCLUSIONS

The A-to-C ratio obtained from an untimed morning urine specimen correlates with the AER from a 24-h collection. In black subjects with newly diagnosed NIDDM, microalbuminuria is not present to a significant degree. Duration of NIDDM > 5 years is associated with increased prevalence of microalbuminuria, and hypertension is associated with microalbuminuria and clinical proteinuria in this population.