bluuebunny/crossref_metadata_2025 huggingface dataset:
Cutaneous Complications of Chronic Continuous Subcutaneous Insulin Infusion Therapy
Authors: Pietri Angel , Raskin Philip
Published: March 2007

The cutaneous complications that can develop with continuous subcutaneous insulin infusion constitutes a significant concern when using this innovative and highly effective form of treatment for type I diabetes. These complications are twofold, the first being infection with abscess formation at the infusion needle site. Proper hygiene and frequent changing of the infusion site are helpful and effective measures. The second complication is the development of local allergic skin reactions, again at the infusion needle site, even with highly purified pork insulin. These may subside after several weeks on their own but switching insulin preparations also may be helpful.
Use of the Artificial B-Cell (Biostator) in Improving Insulin Therapy in Unstable Insulin-dependent Diabetes
Authors: Ratzmann Klaus Peter , Bruns Waldemar , Schulz Bernd , Zander Eckhard
Published: March 2007

The present study was designed to improve the conventional subcutaneous insulin treatment of labile insulin-dependent diabetic patients by means of the artificial B-cell (Biostator) during a combination of conventional treatment and a glucose-controlled insulin infusion. Eleven patients with no residual B-cell function and poor metabolic control were studied. All patients were treated as effectively as possible by conventional methods using a combination of regular and intermediate insulin under clinical conditions. In order to determine the inadequacy of previous insulin treatment, all patients were connected to the Biostator, and the profile of daily physical activity was simulated using a bicycle ergometer. Metabolic control was compared during a 6-day period before and after a 30–50-h connection to the artificial B-cell. Using a preselected blood glucose level of 80 mg/dl (4.44 mmol/L), the additional insulin requirement amounted to 45.5 ± 11.1 U/24 h (N = 6). The day after connection to the artificial B-cell, the patients received a new insulin regimen according to the additional insulin delivery determined by the Biostator. No better metabolic control was achieved and frequent hypoglycemic episodes occurred in this group. Another group (N = 5) was therefore studied at a preselected blood glucose level of 130 mg/dl (7.22 mmol/L). The mean additional insulin delivery by the Biostator was lower (17.2 ± 2.1 U/24 h; P < 0.05) and all patients were significantly better equilibrated after the new insulin regimen derived from data given by the Biostator. The ratio of short-acting to intermediate-acting insulin was 3:1; 40% of the total dosage was given in the morning. This study demonstrates that using the Biostator in addition to subcutaneous insulin allows determination of the amount of additional regular insulin that should be administered to improve glycemic control in labile diabetes.
Myocardial Infarction Site and Mortality in Diabetes
Authors: Weitzman Simon , Wagner Galen S , Heiss Gerardo , Haney Thomas L , Slome Cecil
Published: March 2007

Survival after a first myocardial infarction (MI) was examined in 54 diabetic and 270 nondiabetic subjects according to anatomic site of MI. Complete survival status information was obtained during a 12-yr follow-up. Compared with nondiabetic subjects, diabetics had a higher proportion of anterior site of MI below the age of 60 in both sexes. A significantly higher mortality was experienced in both sexes by patients with anterior MIs compared with other infarction sites (47% vs. 13% respectively, over 12 yr of follow-up). This excess fatality was differentially distributed by diabetic status. The 60-day mortality following admission with an anterior MI was significantly higher in diabetic (55%) than in nondiabetic subjects (31%). No differences in 60-day survival were found between diabetic and nondiabetic subjects with other infarction sites. Thus, anterior size and diabetic status each convey an increased risk of early postinfarct mortality. The findings from this study suggest that the presence of both is synergistic with regard to the 60-day mortality rate.
Transient Anterior Electrocardiographic Changes Simulating Acute Anterior Myocardial Infarction in Diabetic Ketoacidosis
Authors: Fuller Peter J , Colman Peter G , Harper Richard W , Stockigt Jan R
Published: March 2007

In two patients with severe diabetic ketoacidosis, electrocardiography showed transient anterior changes suggestive of acute transmural infarction without subsequent evidence of myocardial necrosis. While the mechanism of these and other temporary electrocardiographic changes in diabetic ketoacidosis remains unclear, appreciation of their transient nature is essential if misdiagnosis of myocardial infarction and possible inappropriate delay in intravenous fluid administration are to be avoided. When electrocardiographic abnormalities are present early in diabetic ketoacidosis, the full 12-lead electrocardiogram should be repeated after adequate resuscitation.
Insulin Resistance Developing in Children with IDDM
Authors: Cuttler Leona , Ehrlich Robert M
Published: March 2007

In a review of the 1000 children with insulin-dependent diabetes mellitus (IDDM) followed at The Hospital for Sick Children, Toronto, between 1970 and 1980, insulin resistance (IR) was noted in 3 after initial sensitivity to exogenous insulin. One was an otherwise typical patient with IDDM. One had cystic fibrosis and is the first such patient with IR to be reported. These two had high insulin antibody titers and responded dramatically to sulfated insulin. The third patient had hyperthyroidism. Although she also had a high anti-insulin antibody titer, IR was controlled only when she was given propylthiouracil. She is the first reported child with IR and hyperthyroidism. The literature on IR in children with IDDM is reviewed. With our 3 patients included, a total of 29 children have been reported. Their meanage is 12.9 yr, 72% are female, and 41% had associated illnesses. Insulin antibodies were elevated in 71% of those in whom measurement was attempted. Of those whose outcome is reported, 67% improved, 21% continued to have IR, and 12% died.
Light Touch Thresholds in Diabetic Patients
Authors: McBride Magelende R , Mistretta Charlotte M
Published: March 2007

To determine whether touch acuity is altered in individuals with maturity-onset diabetes, tactile thresholds on the pad of the index finger of 32 diabetic and 27 nondiabetic subjects were compared. A set of modified Von Frey hairs was used to present touch stimuli in a forced-choice tracking procedure that controls for subject response bias. The mean tactile threshold of diabetic patients was significantly higher than that of nondiabetic subjects, although the difference between the two groups is small. Within the diabetic group, decreased tactile acuity was associated with a longer duration of disease diagnosis, presence of insulin therapy, and low-digit temperature. However, reported presence or absence of peripheral sensory symptoms (tingling, numbness, etc.) in diabetic patients did not relate to touch thresholds. The small but significant increase in touch threshold that was observed in diabetic individuals may provide an early indication of sensory neuropathy. Further use of threshold determinations will contribute to our understanding of sensory changes that accompany diabetes.
Improvement of the Plasma Lipoprotein Pattern After Institution of Insulin Treatment in Diabetes Mellitus
Authors: Agardh Carl-David , Nilsson-Ehle Peter , Scherstén Bengt
Published: March 2007

Plasma lipids and lipoproteins were studied in 26 nonobese diabetic patients, either newly diagnosed or unsatisfactorily controlled by oral antidiabetic treatment. Measurements were performed before and 3-4 mo after the institution of insulin treatment. In a subgroup of seven patients, the activities of lipoprotein lipase (LPL) and hepatic lipase (HL) in postheparin plasma and the elimination rate of exogenous triglyceride were also monitored. After beginning insulin treatment, diabetic control was improved as demonstrated by decreasing levels of HbAx. Mean plasma cholesterol and triglyceride levels decreased by about 10% (P < 0.01) and 40% (P < 0.05), respectively. The decrease in plasma cholesterol was largely accounted for by a fall in LDL cholesterol levels (−8%, P < 0.05), while plasma HDL cholesterol concentrations increased by about 12% (P < 0.01). The elimination rate of exogenous triglycerides increased significantly. There was a suggestive, but not significant, increase in LPL activity while the HL activity remained unchanged. It is concluded that the improved diabetic control after institution of insulin treatment results in a significant improvement of the plasma lipoprotein profile. Since the improvement of the lipoprotein pattern is not strictly correlated to the amelioration of indices reflecting glucose transport, we suggest that the plasma lipoprotein pattern may provide an additional tool for monitoring the degree of control in diabetes mellitus.
The Effect of Continuous Subcutaneous Insulin Infusion on Endogenous Insulin Secretion in Type I Diabetes
Authors: Pietri Angel , Alford Marilyn , Raskin Philip
Published: March 2007

In an attempt to elucidate possible mechanisms for the success of continuous subcutaneous insulin infusion (CSII), we evaluated the C-peptide response to a standard breakfast in seven type I diabetic patients while they were on conventional insulin treatment and again after 4 wk of near-normal glycemia achieved with CSII. While on conventional therapy their 24-h mean blood glucose level was 211 ± 12 mg/dl and their glycosylated hemoglobin level was 10.6 ± 0.6%. After 4 wk of CSII their 24-h mean blood glucose level fell to 95 ± 7 mg/dl and their glycosylated hemoglobin level fell to 6.5 ± 0.4%. Plasma C-peptide levels were undetectable in all seven patients both while on conventional therapy and after 4 wk of CSII. We conclude that the success of CSII is related to an improved method of insulin delivery and not to either the selection of type I diabetic patients who have some residual insulin secretory capacity or to some change in endogenous insulin secretion produced by the treatment itself.
Increased Incidence of Type I Diabetes in Children of Older Mothers
Authors: Flood Thomas M , Brink Stuart J , Gleason Ray E
Published: March 2007

Analysis of chart data in a large series of patients with juvenile-onset, type I diabetes shows a highly significant (P < 0.001) increased incidence in the children born to older mothers. Diabetes was also much more frequent in the late-birth-order siblings, and this appears to be an alternative expression of advanced maternal age. This observation suggests that there may be a subset of children who eventually develop type I diabetes and are at increased risk by virtue of being born to older mothers
Urine C-Peptide After Recovery from Diabetic Ketoacidosis: An Index of Insulin Dependency
Authors: Matsuda Ayako , Kuzuya Takeshi
Published: March 2007

C-peptide immunoreactivity (CPR) in 24-h urine was assayed in 13 diabetic patients during and after recovery from ketoacidosis. In 10 patients who remained insulin-dependent on discharge and in the subsequent follow-up period, urine CPR was low (18 μg/day or less), while in three patients who were ultimately controlled by diet or sulfonylureas, urine CPR was normal (59–92 μg/day, normal value 74 ± 26 μg/day). In the latter group, urine CPR in one patient assayed during ketoacidosis was 6 μg/day and, in another patient, it was 22 μg/day on the 3rd day of the admission. This may imply that in the latter group, B-cell function was decompensated in ketoacidosis, but was restored after recovery. Clinical courses suggested that these patients were not in the remission phase of IDDM, but belonged to NIDDM. Among other groups of diabetic patients, urine CPR in those treated with diet or sulfonylureas was 72 ± 30 μg/day and always higher than 20 μg/day. The prevalence of urine CPR less than 20 μg/day was more frequent in those with younger onset of diabetes, higher insulin dosage, unstable diabetes, or previous history of ketoacidosis among insulin-treated patients. We suggest that urine CPR less than 20 μg/day is an index of insulin dependency, although in a state of extreme decompensation of B-cells such as in ketoacidosis, urine CPR can be decreased low even in NIDDM.
Urinary Excretion of Total Proteins, Albumin, and β2-Microglobulin During Rest and Exercise in Diabetic Adolescents With and Without Retinopathy
Authors: Poortmans Jacques , Dorchy Harry , Toussaint Daniel
Published: March 2007

To determine whether protein excretion during exercise is an earlier sign of renal dysfunction in diabetic adolescents than the basal measurements, urinary creatinine, total proteins, albumin, and β2-microglobulin were studied before, immediately after, and 30 min after exercise until exhaustion on a bicycle ergometer in a group of 21 adolescent diabetic boys (Albustix negative) and in a comparable control group. Among the 21 diabetic subjects, 11 had an incipient retinopathy diagnosed by fluorescein angiography. Urinary output of creatinine was similar in diabetic and in nondiabetic groups, and did not vary during exercise. At rest, the urinary output of total proteins, albumin, and β2-microglobulin was signify cantly higher in diabetic subjects than in controls. These data suggest that the subclinical proteinuria of diabetes is of mixed origin, being both glomerular and tubular. An exercise test leading to exhaustion did not give any additional information other than the basal excretion. There was no difference between diabetic subjects with early retinal vascular changes and those free from all retinopathy.
Incidence of Diabetes Mellitus by Clinical Type
Authors: Melton L Joseph , Palumbo Pasquale J , Chu Chu-Pin
Published: March 2007

The incidence of diabetes mellitus by clinical type was determined for the community of Rochester, Minnesota, 1945–69. Overall adjusted incidence rates per 100,000 person-years were 8.4 for IDDM, 80.1 for obese NIDDM, 45.6 for nonobese NIDDM, and 3.6 for secondary diabetes, using our definitions. Strict use of National Diabetes Data Group criteria would have reduced the apparent incidence of all diabetes by about 20% through the deletion of NIDDM cases. The National Diabetes Data Group classification improved the clinical homogeneity of IDDM patients compared with “juvenile-onset” diabetes but had little effect on NIDDM relative to “maturity-onset” diabetes, since essentially the same patients were included in both groups. Separation of NIDDM into obese and nonobese subcategories accomplished little in the way of defining two more homogeneous subgroups.
Diabetes in the National TV News: 1971–1981
Authors: Pichert James W
Published: March 2007

Millions of Americans get virtually all their current events information from the national nightly television news programs. The purpose of this study was to learn what diabetes-related information had been broadcast over the last 11 years by the network news programs. Another objective was to learn how that coverage compared with that given other chronic diseases. The Vanderbilt Television News Archives (VTNA) has videotaped every ABC, NBC, and CBS nightly newscast since mid-1968. The contents of each telecast have been catalogued and indexed. Indexes were searched for every segment that had anything to do with diabetes from 1971 through 1981. In the last 11 years there have been 32 diabetes-related news segments. More than a third were about the controversial attempt to ban saccharin. Because each network may carry essentially the same story, the number of nonoverlapping reports was 20. The total time of the diabetes-related segments was 70 minutes. The topics covered by the news reports included oral agents (5 reports), artificial sweeteners (12), biosynthetic human insulin (BHI) (7), and an assortment of unique items. The 32 diabetes-related segments compare with 23 about arthritis, 215 about heart diseases, and 925 dealing with cancer. A compilation of the nonoverlapping segments has been shown to health professionals, who felt the stories were generally accurate. Diabetes is not portrayed as a killer. Therefore, diabetes seems less serious, and therefore less newsworthy, than heart disease or cancer.
Exercise in Insulin-dependent Diabetes Mellitus: The Effect of Continuous Insulin Infusion Using the Subcutaneous, Intravenous, and Intraperitoneal Sites
Authors: Gooch Brent R , Abumrad Naji N , Robinson Ronald P , Petrik Mark , Campbell Doug , Crofford Oscar B
Published: March 2007

The metabolic response to exercise in insulin-dependent diabetic (IDD) man was assessed during continuous insulin infusion using the subcutaneous (CSII), intravenous (CIVII),and intraperitoneal (CIPII) routes. During the basal period, plasma glucose levels were higher with CIPII (153 ± 17 mg/dl) than with CSII (117 ± 13 mg/dl) or CIVII (118 ± 17 mg/dl). Basal free insulin concentrations were similar for CSII (12.3 ± 10 μU/ml) and CIVII (12.4 ± 1.4 μU/ml) but lower in CIPII (8.5 ± 1.0 (μU/ml, P < 0.05). Exercise on a stationary bicycle at 75 W for 60 min produced a decline of plasma glucose in each protocol that was significant only during CIVII (55 ± 11 mg/dl, P < 0.01). Insulin levels remained unchanged throughout the study period in all protocols. In normals, insulin values decreased during exercise and remained below basal levels through the recovery period (P < 0.05), while plasma glucose remained unchanged. Plasma glucagon and epinephrine levels were similar in all protocols and remained unchanged with exercise, while plasma norepinephrine tended to be higher than normal in all diabetic subjects. Significant differences between normal and diabetic subjects (P < 0.05) were observed for blood ketone bodies, while blood lactate, glycerol, and plasma FFA were similar. Normalization of intermediarymetabolites occurred only with CIVII. Continuous insulin infusion provides near-normal glycemic and metabolic control before, during and following exercise in IDD man. However, to produce normal blood concentrations of intermediary metabolites during exercise, the insulin infusion rate may be excessive in terms of its hypoglycemic effect. CSII appears tobe a safe, accessible, and adequate method for treating diabetic man during exercise.
Evaluation of Two Methods of Self Blood Glucose Monitoring by Trained Insulin-dependent Diabetic Adolescents Outside the Hospital
Authors: Schiffrin Alicia , Desrosiers Micheline , Belmonte Mimi
Published: March 2007

We studied the accuracy of the Chemstrip bG and Glucometer systems in the self-monitoring of blood glucose by trained adolescents. The determinations were done at home with simultaneous collection of whole blood into capillary tubes (Sarstedt) which were later analyzed by a glucose-Oxidase analyzer (Beckman Instruments). In both cases, there was an excellent correlation between laboratory concen-trations and Chemstrip bG (r = 0.96, P < 0.001) and Glucometer (r = 0.96, P < 0.001). Comparisonsmade at 8 mo remained with the same degree of accuracy. There was a trend toward greater deviation with higher plasma glucose values. Well-trained patients can achieve sufficientaccuracy to permit the use of either of the methods tested with similar results.
Characteristics of Adolescents with Poorly Controlled Diabetes Referred to a Tertiary Care Center
Authors: Orr Donald P , Golden Michael P , Myers Gayle , Marrero David G
Published: March 2007

The medical and psychosocial findings concerning 15 adolescents with poorly controlled diabetes referred to a tertiary center are reviewed. While referring physicians usuallyattributed poor metabolic control to an unusual idiosyncratic pathophysiologic aspect of diabetes, all patients were managed by conventional treatment regimens. Psychosocial problems, including excessive school absence, depression, and social isolation were frequent in this population, and in eight families emotional factors appeared to contribute to thedevelopment and persistence of poor metabolic control. Eight patients accepted psychosocial intervention consisting of individual, family, and/or group counseling. Not one ofthe patients has been hospitalized for ketoacidosis in the subsequent 12–18-mo period, and their psychosocial functioning as adolescents is improved. Hemoglobin A1c levels remained elevated. Psychosocial factors in adolescents experiencing poor metabolic control should be addressed.
Diet and the Diabetic Patient
Authors: Nuttall Frank Q
Published: March 2007

At the present time, our knowledge regarding the metabolic consequences of various dietary regimens is incomplete and in need of further research. In addition, the composition of a diet for diabetic persons that will result in the best blood glucose control is uncertain and controversial. Whether dietary changes can significantly delay or prevent thelong-term complications of diabetes also is not known. Thus, the insistence that certain foods be avoided by the diabetic person or that a specified diet be adhered to rigidly cannot be defended scientifically. In view of the above limitations in our knowledge, perhaps the best approach should be to allow diabetic persons to select their own diet and daily meal plan, as long as the nutrient content is adequate. A diabetic person being treated with insulin or a hypoglycemic drug will have to comply with a dietary regimen consistent in carbohydrate content and time of meal ingestion. This continues to be of vital importance in the management plan. Nevertheless, an insulin or drug regimen usually can be designed to accommodate the individual's usual eating habits and food preferences. Such a flexible approach to diet management should lead to better patient compliance and overall management of the diabetic patient.
The Effect of Strict Control with the Artificial β-Cell on Plasma Lipid Levels in Insulin-Dependent Diabetes
Authors: Vlachokosta Fredericka V , Asmal A Cader , Ganda Om P , Aoki Thomas T
Published: March 2007

The artificial β-cell can establish normoglycemia within 2 h in an indifferently controlled diabetic patient. In the present study, the temporal relationship between the achievement of normoglycemia and its effect on plasma lipid concentrations has been examined in 12 insulin-dependent diabetic patients regulated by the artificial β-cell for 7 days. The fasting values (mean ± SEM) of blood glucose (BG), triglycerides (TG), total cholesterol (T-chol), HDL-cholesterol (HDL), and the calculated LDL/HDL ratio (obtained while participants were on single or split insulin regimens) were 385 ± 42 mg/dl, 148 ± 24 mg/dl, 219 ± 22 mg/dl, 39 ± 3.6 mg/dl, and 3.8 ± 1.04, respectively. Within 12 h of establishing normoglycemia TG levels fell to 87 ± 10 mg/dl (P < 0.001), T-chol to 196 ± 15 mg/dl (P < 0.005), and HDL to 37 ± 3 mg/dl (P = NS). The LDL/HDL ratio remained unchanged. After 7 days on the artificial β-cell, the corresponding values were: 73 ± 5 mg/dl (P < 0.001), 169 ± 9 mg/dl (P < 0.001), 41 ± 2.6 mg/dl (P = NS), and 2.6 ± 0.56 (P < 0.05). Twenty-four hours after discontinuation of artificial β-cell therapy, the TG and T-chol concentrations reverted to baseline. These findings underscore the rapidity and effectiveness with which strict control can improve plasma lipid profiles.
Importance of Timing of Preprandial Subcutaneous Insulin Administration in the Management of Diabetes Mellitus
Authors: Dimitriadis George D , Gerich John E
Published: March 2007

Since little is known regarding the appropriate time for preprandial insulin administration, we compared the effects of 30-min subcutaneous insulin infusions started 60 min, 30 min, and immediately before meal ingestion on postprandial plasma glucose and insulin profiles in eight subjects with insulin-dependent diabetes mellitus. Of these three regimens, administration of insulin 60 min before meal ingestion provided plasma glucose and insulin profiles closest to normal and permitted less insulin to be used. Our results suggest that adjustments in the timing as well as in the amount of insulin administered preprandially may be used in the management of diabetes and that prolonging the interval between administration of insulin and meal ingestion may reduce insulin requirements and thus decrease the hyperinsulinemia usually associated with insulin therapy.
Abnormal Glucose Tolerance in Patients with Chronic Glomerulonephritis Without Renal Failure
Authors: Kaneshige Hideaki , Endoh Masayuki , Tomino Yasuhiko , Nomoto Yasuo , Sakai Hideto
Published: March 2007

An oral glucose tolerance test and an assay of insulin receptor activity were performed in patients with chronic glomerulonephritis (CGN) to elucidate the aberration of glucose metabolism in such patients. Ninety of 123 patients with CGN without renal failure showed abnormal glucose tolerance, including 72.6% with IgA nephropathy, 81% with benign recurrent hematuria, 87% with chronic proliferative glomerulonephritis, 100% with membranoproliferative glomerulonephritis, and 80.0% with membranous nephropathy. Insulin responses in CGN patients during oral glucose tolerance tests showed lower levels of basal insulin and significantly higher levels after 90, 120, and 180 min compared with those of normal controls. The binding of radiolabeled insulin to blood mononuclear cells in 22 CGN patients with abnormal glucose tolerance was significantly (P = 0.0023) decreased in comparison with 5 normal controls. However, plasma obtained from such patients showed no significant (P = 0.4761) inhibition of the binding of insulin to normal mononuclear cells. It was concluded that glucose tolerance capacity was impaired in 80.4% of patients with CGN without renal failure. Such impairment of glucose metabolism might be due to decreased activity of insulin receptors on cells in CGN patients.
Problems of Mothers in Management of Children with Diabetes
Authors: Banion Carolyn Robinson , Miles Margaret Shandor , Carter Melba C
Published: March 2007

This study was designed to determine which aspects of diabetic management were perceived by mothers of children with diabetes to be the most problematic. A secondary purpose was to explore how age and sex of the child, age at diagnosis, illness duration, marital status, and socioeconomic status of the mother were related to the mother's perception of problematic aspects of care. The 84 subjects in this study were asked to complete the Diabetic Management Concern Questionnaire, which measures concern about 11 dimensions of diabetes management, along with a personal-situational information sheet. Results indicated that the three dimensions classified by mothers as most problematic were future concerns, hypoglycemia, and diabetic control. The younger the child, the greater the maternal concern about hypoglycemic reactions and availability of help/support. The younger the child was at diagnosis, the more the mother was concerned with hypoglycemic reactions. A shorter duration of illness was related to concern about insulin injections. Subjects with lower socioeconomic status were concerned about finances, the availability of help/support, and the psychological stigma of diabetes. Single mothers were also concerned about financial aspects of management. There were no differences in concerns between mothers of boys and girls. Implications of the findings for clinical practice are presented.
The Presence of Retinopathy in Patients with Secondary Diabetes Following Pancreatectomy or Chronic Pancreatitis
Authors: Tiengo Antonio , Segato Tatiana , Briani Giustina , Setti Antonio , Prato Stefano Del , Devidé Antonio , Padovan Domenico , Virgili Flavio , Crepaldi Gaetano
Published: March 2007

The incidence of diabetic retinopathy was evaluated by means of fluorescein angiography in 54 patients with diabetes secondary to chronic pancreatitis or to pancreatectomy. Thirty-one percent of the patients had background retinopathy; none had proliferative retinopathy. The percentage of patients with retinopathy was the same in groups with or without a family history of diabetes. There was no correlation between the degree of metabolic control, the levels of C-peptide, glucagon, growth hormone, and the presence of retinopathy. Retinopathy was correlated with the duration of diabetes. In conclusion, diabetes caused by pancreatitis or pancreatectomy has a significant prevalence of retinopathy, which has more benign characteristics and slower evolution than the retinopathy in patients with primary diabetes.
Lipoprotein Composition in Individuals with Impaired Glucose Tolerance
Authors: Capaldo Brunella , Tutino Loredana , Patti Lidia , Vaccaro Olga , Rivellese Angela , Riccardi Gabriele
Published: March 2007

The relationship between impaired glucose tolerance (IGT) and blood lipid levels was examined in 65 IGT individuals and in two control groups: control group I, composed of age-, sex-, and body weight-matched controls, and control group II, including normal subjects matched for sex and age but with normal body mass index. IGT individuals were found to have significantly higher total triglyceride (Tg) values compared with normal weight controls (P < 0.001), while no difference was found between IGT and control group I. Total cholesterol levels were similar in IGT and each of the control groups. No significant correlation was found between serum lipoproteins and blood glucose levels either fasting or after load.
Anti-insulin Antibody Titers Do Not Influence Control or Insulin Requirements in Early Pregnancy
Authors: Jovanovic Lois G , Mills James L , Peterson Charles M
Published: March 2007

IgG antibodies (AB) to insulin have been reported to influence insulin requirements and control in patients who have taken insulin for prolonged periods of time. Nineteen pregnant type I diabetic patients (C-peptide < 0.03 pmol/ml) were studied in their fifth week of gestation after the establishment of normoglycemia. Mean age was 27.5 yr and duration of diabetes, 14.2 yr (range: 1–23 yr). IgG AB to beef and pork insulin were measured. IgG AB to insulin were encountered in all diabetic patients (range: 103–6736 μU/ml). None of the nondiabetic pregnant controls in their fifth week of gestation (N = 17) had detectable (>50 μU/ml) AB levels. The antibody titer did not affect the insulin requirement (P > 0.2, NS) or ability to achieve normoglycemia. AB levels were correlated with years of treatment with conventional insulin preparations (r = 0.73; P < 0.001). At 5 wk postmenstruation the mean AB level in the patients with less than 10 yr duration of diabetes (N = 7) was 727 μU/ml and mean insulin requirement was 0.7 U/kg/24 h. In the group of patients with greater than 10 yr duration of diabetes (N = 12) the mean antibody titer was 3716 μU/ml and the insulin requirement was also 0.7 U/kg/24 h. IgG AB to insulin increase with increasing duration of treatment with beef/pork insulin. IgG AB do not affect the insulin requirement or the ability to achieve normoglycemia during early pregnancy.
Needle and Catheter Colonization in Pregnant Diabetic Patients Using the Continuous Subcutaneous Insulin Infusion Pump
Authors: Rivera-Alsina Manuel E , Willis Shelly
Published: March 2007

The incidence of bacterial colonization and risk of infection associated with the use of continuous insulin infusion pump (CIIP) was examined in 11 pregnant diabetic patients. All patients received instruction on specific aspects of CIIP and needle insertion technique according to the protocol used in our institution. A total of 220 cultures was performed on the subcutaneous needle and connective tubing. There was no clinical evidence of infection. In conclusion, the risk of infectious cutaneous complications in the pregnant diabetic patient using CIIP is not increased over the nonpregnant diabetic population.
Obesity Does Not Modulate Insulin Secretion in Indian Patients with Non-insulin-dependent Diabetes in the Young
Authors: Jialal I , Joubert S M
Published: March 2007

The insulin response to a 100-g oral glucose load was studied in 40 obese (percent desirable weight ≥ 120%) and 40 nonobese (< 120%) age- and sex-matched Indian patients with non-insulin-dependent diabetes in the young. There were no significant differences between the obese and nonobese patients with respect to their insulin and glucose responses. Thus, it appears that obesity does not exert a significant modulating effect on insulin secretion in patients with fasting hyperglycemia.
Comparison of Chemstrip uG, Clinitest, and Diastix Urine Test Methods in Diabetic Children
Authors: Sobel Douglas O , Balsam Marion
Published: March 2007

The new urine test, Chemstrip uG, was compared with Clinitest and Diastix methods by pediatric diabetic patients and by health care professionals. With the children testing all urine samples (N = 108), accuracy for Chemstrip uG and Clinitest was similar and superior to that of Diastix. When the children tested specimens containing up to only 2.2% glucose (N = 75), all test methods were shown to have generally similar accuracies. The diabetic children, however, preferred Chemstrip uG (P < 0.02). It is concluded that Chemstrip uG is a clinically useful and acceptable method for self-monitoring of urine glucose in diabetic children.
Use of Tactile Techniques for Self-Monitoring of Blood Glucose in Visually Impaired Patients with Diabetes Mellitus
Authors: Prior Jerilynn C , Alojado Nenita C , Hunt John A , Begg Iain S
Published: March 2007

Twenty-eight patients with type I diabetes mellitus, legally blind as a result of proliferative retinopathy, were recruited into a program designed to teach and evaluate tactile methods for self-monitoring of blood glucose (SMBG). Vision ranged from “blind” to “able to read large print.” Techniques with wipe-off strips (Chemstrip bG or BM Test BG, Boehringer-Mannheim, Canada Ltd., Dorval, Quebec, Canada) use the opposite hand as a guide, operation of timing devices by touch, and special methods forlabeling and storing strips. Methods with wash-off strips (Dextrostix, Ames Division, Miles Laboratories, Rexdale, Ontario, Canada) employ the fingers as a guide in directing thewash water. The accuracy of tactile methods was documented. Clinical parameters of glucose control improved in patients with adequate data after 6 mo of tactile SMBG. Glycosylated hemoglobin in 17 patients decreased from 11.3 ± 2.1% to 9.4 ± 1.5% (P = 0.005). Patients experienced significantly fewer reactions and low blood sugar readings as well as lowering of mean blood glucose values from158 ± 56 to 141 ± 51 (P = 0.025).
An Epidemiologic Model for Diabetes Mellitus: Incidence, Prevalence, and Mortality
Authors: Herman William H , Sinnock Pomeroy , Brenner Eric , Brimberry Jerry L , Langford Dorothy , Nakashima Allyn , Sepe Stephen J , Teutsch Steven M , Mazze Roger S
Published: March 2007

An epidemiologic model is developed to describe the incidence, prevalence, and mortality of diabetes. Available data are reviewed, analyzed, and applied to the model. The model provides a framework for understanding diabetes on a population basis, and is useful inidentifying needs and facilitating health care planning.
Evaluation of a Self-Calibrating Blood Glucose Monitor
Authors: Rayman G , Spencer P D , Tillyer C R , Wise P H
Published: March 2007

A new reflectance blood glucose meter designed for hospital use, the Reflocheck (Boehringer-Mannheim, West Germany), was evaluated. The instrument showed excellent correlationwith a routine laboratory method (r = 0.996), and the coefficients of variation at high, medium, and low glucose levels were less than 4%.
Correlation of Serum Lipids with Diabetes Control in Sulfonylurea-treated Diabetic Patients
Authors: Huupponen Risto K , Viikari Jorma S , Saarimaa Heikki
Published: March 2007

The relationships between fasting blood glucose, glycosylated hemoglobin A1, and several lipid parameters were studied in 67 non-insulin-dependent diabetic patients (19 men, 48 women) being treated with tolbutamide, chlorpropamide, or glibenclamide. All patients were over 60 yr of age with a mean age of 76.4 ± 6.7 yr (±SD). There were positive associations between fasting blood glucose and serum cholesterol, LDL cholesterol, and serum triglycerides. A strong association between total cholesterol and triglycerides was also evident. Diabetes control and HDL cholesterol did not correlate with each other. A weak inverse correlation existed between fasting blood glucose and the HDL cholesterol/total cholesterol ratio. HDL cholesterol concentrations were low in the diet-and drug-treated diabetic patients. No deleterious sulfonylurea effects on cholesterol, LDL cholesterol, and triglyceride concentrations or HDL cholesterol/total cholesterol ratio were noted.
The Use of a County Hospital Emergency Room by Diabetic Patients
Authors: Murphy Catherine C , Faulkenberry Esther H , Rumpel John D , Wheeler Frances C
Published: March 2007

The use of a county hospital emergency room (ER) by diabetic patients was investigated by comparing ER visits for diabetes to a sample to total ER visits over a period of 1 yr. The major problems of ER use by diabetic patients were an excessive number of visits for diabetes complications, a high rate of hospital admissions from the ER, and the high cost of ER use. Approximately 20% of visits for diabetic patients were attributed to preventable complications of diabetes. The rate of hospital admissions from the ER was over four times greater for the diabetic patients than for the random sample. The median cost of an ER visit was nearly three times higher for diabetic patients than for the random sample. These problems may be best resolved through improved access to primary care and educational services that can assist the person with diabetes in self-management and prevention of the acute complications of the disease.
Assessment of a New Blood Glucose Strip: Comparison of Visidex, Visidex II, and Chemstrip bG with Glucose Analyzer Determination of Blood Glucose
Authors: Canfield Michael E , Kemp Stephen F , Hoff Charles
Published: March 2007

Chemical test strips for estimating blood glucose are reliable, rapid, and convenient when properly used. Ames (Miles Laboratories, Elkhart, Indiana) has recently introduced a new product, Visidex II, which does not require water for development. This study compares the Visidex II with its predecessor Visidex, an established test strip, the Bio-Dynamics Chemstrip bG (Boehringer-Mannheim, Indianapolis, Indiana), and plasma glucose as measured by standard laboratory methods. Determination of blood glucose by visual inspection by all chemical test strips gave an estimation of true plasma glucose, and was reliable in predicting those values that were hypo- and hyperglycemic, although Chemstrip bG tended to underestimate in the hypo- and euglycemic ranges. Visidex II is more convenient to use than Visidex and is equally reliable in estimating true plasma glucose. In addition, strips from 20 patient samples were read daily for 7 days. Reacted Chemstrip bG test strips began to deteriorate within 24 h, and showed a 27% decline in estimations by day 3. Reacted Visidex II strips were stable for 1 day, but then rapidly declined to 50% of the original estimation by day 4.
The Cardiovascular Risk Profile of Adolescents with Insulin-dependent Diabetes Mellitus
Authors: Cruickshanks Karen J , Orchard Trevor J , Becker Dorothy J
Published: March 2007

Cardiovascular risk factors including blood pressure, lipoprotein concentrations, physical activity, and diet were assessed in 149 diabetic adolescents and 45 nondiabetic siblings. All diabetic subjects had had insulin-dependent diabetes mellitus (IDDM) for a minimum of 2 yr and were currently attending the Children's Hospital of Pittsburgh Diabetes Clinic. For both boys and girls, cardiovascular risk profiles were mildly disturbed among diabetic subjects compared with nondiabetic siblings. These disturbances included higher systolic (P = 0.002) and diastolic (P = 0.024) blood pressures and higher HDL3 cholesterol concentrations. The diabetic girls showed higher total cholesterol concentrations during adolescence in contrast to the usual fall seen in nondiabetic adolescents (and evidenced in the siblings studied). In addition, the diabetic girls' mean pulse rate was 12 bpm higher than that of the sibling girls, a finding not seen in the boys. Multiple linear regression analyses showed that neither glycemic control (worse in diabetic girls), diet, nor physical activity were important explanatory variables for any of the lipoprotein or blood pressure measures. These results suggest that the cardiovascular risk profile of diabetic girls may be relatively more disturbed than that of diabetic boys. This difference could not be explained by the slightly higher glycosylated hemoglobin levels in the girls. The loss of the sex differential in the risk for cardiovascular disease experienced by adults with IDDM may partly relate to these adolescent risk factor differences.
Autonomic Neuropathy in Diabetes Mellitus: A Follow-up Study
Authors: Sundkvist Göran , Lilja Bo
Published: March 2007

To evaluate the development of autonomic neuropathy, 23 patients with a moderate (group A) and 18 patients with a long (group B) duration of diabetes and without symptoms of autonomic neuropathy were re-investigated 6 yr after the initial studies. Autonomic nerve function was evaluated from heart reactions to deep breathing (E/I ratio) and to a rapid 90° tilt (acceleration and brake indices). Symptoms of autonomic neuropathy (SAN) developed in 18 patients (nine in each group) who showed a low mean E/I ratio and brake index in both studies. In group A, but not in group B, patients with SAN showed a decrease in the acceleration index and most SAN patients (8/9) in group A had an abnormal acceleration index in the follow-up study. We conclude that in both groups SAN developed rapidly and was preceded by decreases in E/I ratio and brake index.
Attitudes of Diabetic Men After Implantation of a Semi-Rigid Penile Prosthesis
Authors: Peterson Hugh R , Best James D , Berger Richard , Reenan Andrew , Porte Daniel , Halter Jeffrey B , Pfeifer Michael A
Published: March 2007

Erectile impotence is a common and distressing problem in diabetic men. In order to examine the impact of a penile prosthesis on the quality of life of the recipients, we mailed a questionnaire to all patients (N = 49) who received a semi-rigid (Small-Carrion) prosthesis at the Seattle VAMC from 1976 to 1981. Fourteen patients with diabetes and 23 without diabetes returned the questionnaire. Direct comparisons showed no statistically significant differences between the responses of the two groups. Based on a scale of 1–7 (1 = worst, 4 = no change, 7 = best), the general effect of the operation on the quality of life of the recipients was 5.7 ± 0.3 (X¯ ± SEM); the quality of intercourse was 5.1 ± 0.3; the patient's perception of his partner's response to the prosthesis was 5.2 ± 0.3; and the patient's perception of postoperative changes in his relationship with his partner was 5.6 ± 0.3. Eighty-three percent of the patients were satisfied with the performance of the prosthesis. Most of the patients (86%) felt that their preoperative expectations had been fulfilled and would elect to have the procedure if they had it to do over again. However, five patients (14%) stated that they would not elect the operation again because their partners did not appreciate the operation (N = 2); the operation produced severe, prolonged pain (N = 1); or the patient's expectations had not been fulfilled (N = 2). Preoperative counseling should be used to foster realistic patient and partner expectations. This operation, which appears to improve the quality of life for most diabetic patients with erectile impotence, should be considered a part of standard care and not as a cosmetic procedure or extraordinary care.
Effects of Antithyroid Drug Therapy on Blood Glucose, Serum Insulin, and Insulin Binding to Red Blood Cells in Hyperthyroid Patients of Different Ages
Authors: Komiya Ichiro , Yamada Takashi , Sato Akira , Koizumi Yoichi , Aoki Takeshi
Published: March 2007

The mechanism of glucose intolerance in thyrotoxicosis was investigated in 119 patients with Graves's disease with careful consideration of the age-related deterioration of glucose tolerance. Before and after treatment of thyrotoxicosis with antithyroid drug, changes of blood glucose (BG) and serum immunoreactive insulin (IRI) in response to 50 g oral glucose tolerance test (OGTT) and insulin binding to red blood cell (RBC) were evaluated. In control subjects, the ΣIRI/ΣBG ratio after 50-g OGTT decreased progressively with age without significant change in absolute ΣIRI value, suggesting the occurrence of age-related insulin resistance. Glucose intolerance was much more apparent in hyperthyroid patients because of age-related relative decrease of insulin secretion. Such a decrease of insulin secretion was not found in age-matched postgastrectomy patients with a similar degree of hyperglycemia, however. Maximal binding of labeled insulin and number of insulin receptors of RBC were decreased in old patients but binding affinity was unchanged. Elevation of BG was partially suppressed when serum thyroxine (T4) and triiodothyronine (T3) were reduced to moderately supernormal levels, whereas ΣBG, ΣIRI, ΣIRI/ΣBG ratio, and insulin binding to RBC were all returned to normal when normal serum thyroid hormone concentration was maintained. Our data indicate that insufficient insulin secretion and reduced insulin action at the target cell are responsible, at least in large part, for age-related glucose intolerance in hyperthyroid patients.
Neonatal Mortality in Infants of Diabetic Mothers
Authors: McFarland Kay F , Hemaya Ezzat
Published: March 2007

To assess the effects of an educational program emphasizing detection and tight control of maternal glucose levels during pregnancy, the management and outcome of all pregnancies complicated by diabetes mellitus delivered at a county hospital during two time periods, 1978–1980 and 1981–1983, are compared. The prevalence of diabetes during pregnancy was 1.4% between 1978 and 1980 and 2.6% between 1981 and 1983 (P < 0.01). The perinatal death rate decreased for infants of diabetic mothers from 100 per thousand deliveries in 1978–1980 to 32 per thousand in 1981–1983 (P < 0.02). The perinatal death rate for infants of mothers with gestational diabetes was nearly the same as the perinatal death rate for all neonates born in the state in 1981–1983. Congenital anomalies followed by stillbirths were the most frequent causes of perinatal death.
Continuous Subcutaneous Insulin Infusion in Adults: Glycemic Advantage is Predicted by Venous Plasma C-Peptide Concentrations
Authors: Rodger N W , Dupre J , Canny C L B , Brown W F
Published: March 2007

Continuous subcutaneous insulin infusion (CSII) has been compared with conventional insulin injection treatment (CIT) supplemented by self-monitoring of capillary blood glucose (SMBG) in 18 nonobese adults with insulin-dependent diabetes mellitus (IDDM). Mean daily insulin dosage and rates of hypoglycemia were similar during CSII (duration of treatment 36 ± 2 wk mean ± SE) and CIT (31 ± 1.6 wk). On the basis of fasting C-peptide concentrations and postintravenous glucagon increments of < 0.1 pmol/ml, subjects were classified C-peptide negative (CP NEG) (N = 11), or C-peptide positive (CP POS) (N = 7). Relative to CIT, CP NEG subjects on CSII had significant decreases in premeal/bedtime and postmeal plasma glucose concentrations and glycosylated hemoglobin (percent of total). CP POS patients during each of CSII and CIT showed glycemic responses equivalent to those of CP NEG patients on CSII. In neither group could results be explained on the basis of improved beta cell function. Thus, therapeutic advantage of CSII was not apparent in IDDM adults retaining significant C-peptide activity.