bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Thromboxane Synthesis Inhibitor Triflusal on Renal Hemodynamics in Microalbuminuric Diabetic Patients
Authors: Esmatjes Enric , Conget Jesus I , Gaya Joan , Fernandez Maria R , Ferrer Jorge P , Rivera Francisca , Vilardell Enric
Published: March 2007

Triflusal (2-acetoxy-4-trifluormethylbenzoic acid) is a platelet-antiaggregant drug that selectively inhibits thromboxane synthesis with little effect on prostacyclin production. In this study, we evaluated the effect of 5- day administration of 900 mg/day triflusal on glomerular filtration rate (GFR), renal plasma flow (RPF), urinary albumin excretion (UAE), thromboxane B2 (TXB2), 6-ketoprostaglandin F1α (PGF1α), and PGE2 in nine normotensive insulin-dependent diabetic patients with UAE between 30 and 103 fxg/min. Plasma TXB, and plasma renin activity (PRA) were also determined. After administration of triflusal, we observed a reduction in microalbuminuria (59 ± 25 vs. 33 ± 22 μg/min, P < 0.01), an increase in RPF (648 ± 119 vs. 722 ± 134 ml· min−1 · 1.73 m−2, P < 0.01), and a reduction in filtration fraction (0.24 ± 0.04 vs. 0.20 ± 0.03, P < 0.01). Triflusal produced a significant reduction in both plasma TXB2 (130 ± 39 vs. 52 ± 32 pg/ml, P < 0.02) and urine TXB2 (523 ± 249 vs. 312 ± 11 pg/min, P < 0.02), without changes in PRA and UAE of 6-keto-PGF1α and PGE2. Metabolic control and arterial blood pressure did not change during the study. These results suggest that platelet-antiaggregant therapy can reduce microalbuminuria in diabetic patients. This effect could be mediated by a reduction in the transglomerular hydraulic pressure through a vasodilation of efferent arterioles secondary to renal thromboxane synthesis inhibition.
Chronic Diabetic Complications and Tissue Glycosylation: Relevant Concern for Diabetes-Prone Black Population
Authors: Vlassara Helen
Published: March 2007

A significant segment of the Black population is affected by chronic diabetes, and most of them are subjected to severe cardiovascular, renal, and neurological complications that shorten survival and diminish quality of life. One of the important pathogenetic mechanisms under intensive investigation is advanced tissue glycosylation. Tissue and cell surface proteins modified nonenzymatically by glucose are shown to be highly active in protein cross-linking and have been implicated in tissue damage. Such protein-glucose interactions, called advanced glycosylation end products (AGEs), are processed by macrophages through a high-affinity receptor. Coupling of AGE proteins to their AGE receptors results in their degradation and removal and, simultaneously, in synthesis and secretion of pluripotential cytokines such as tumor necrosis factor and interleukin 1. This suggests that AGE may act normally as a signal for growth-promoting factor secretion in a coordinated replacement process during tissue remodeling. In chronic diabetes, however, where accelerated accumulation of tissue AGE occurs, a disturbance of this balance may lead to several pathological, lytic, and/or proliferative responses like those in the vasculopathy of diabetes. Progress has been made with the discovery of aminoguanidine HCI, an AGE inhibitor, which has prevented significant pathology in short-term diabetic animal studies.
Abnormal Glucose Tolerance and Hypertension
Authors: Reaven Peter D , Barrett-Connor Elizabeth L , Browner Deirdre K
Published: March 2007

To quantify the association of abnormal glucose tolerance with hypertension and postural hypotension, 2480 men and women aged 50-89 yr from a defined population were evaluated by oral glucose tolerance and measurements of supine, seated, and standing blood pressure. In both sexes, adults with impaired glucose tolerance or non-insulin-dependent diabetes mellitus (NIDDM) had increased mean blood pressure compared with those with normal glucose tolerance. These differences were both statistically (P < 0.05) and clinically (3-12 mmHg) significant and were independent of age, obesity, and the use of antihypertensive medication. Age-adjusted rates of systolic hypertension and isolated systolic hypertension were also higher in subjects with impaired glucose tolerance or NIDDM compared with those with normal glucose tolerance.
Psychological Characteristics of Adults With IDDM: Comparison of Patients in Poor and Good Glycemic Control
Authors: Jacobson Alan M , Adler Andrew G , Wolfsdorf Joseph I , Anderson Barbara , Derby Laura
Published: March 2007

This study was conducted to evaluate selected psychosocial characteristics of contrasting groups of patients with insulin-dependent diabetes mellitus (IDDM), i.e., patients with persistently poor versus good glycemic control. Patients with chronic poor control reported feeling physically best at higher blood glucose levels than patients with good control. They also reported a higher threshold for physical symptoms caused by hyperglycemia without any difference in threshold for hypoglycemic symptoms. No differences between groups were found in level of diabetes knowledge, self-esteem, or psychiatric symptomatology. This study suggests that poorly controlled adult patients have underlying perceptions of hyperglycemic symptoms and physical well-being that distinguish them from patients with well-controlled diabetes. The design of this study does not allow for determination of the causal direction in this relationship. Although these patient reports about glycemic and physical symptoms may be post hoc justifications or unreliable beliefs, they also may be accurate perceptions of physical symptom experiences and therefore could influence their self-care activities with resulting chronic problems in glycemic control. Further research is needed to assess the validity of these observations and their possible role in long-term regulation of glycemia.
Hyperphosphaturia and Hypermagnesuria in Children With IDDM
Authors: Ponder Stephen W , Brouhard Ben H , Travis Luther B
Published: March 2007

Urinary excretion of calcium, inorganic phosphorus, magnesium, glucose, and creatinine was measured in first-void spot urine samples collected 4 days apart in 220 insulin-dependent diabetic (IDDM) children (mean age 11.9 yr) attending a summer camp. A single control urine sample was obtained from 33 healthy nondiabetic siblings (mean age 11.2 yr). Mean ± SD urinary calciumcreatinine ratios (UCa/cr) did not significantly differ between IDDM and control subjects (0.14 ± 0.09 vs. 0.12 ± 0.09, respectively, P = 0.156). Mean urinary magnesium-creatinine ratios (UMg/Cr) were elevated in IDDM compared with control subjects (0.15 ± 0.06 vs. 0.08 ± 0.03, respectively, P = 0.0001). Similarly, mean urinary phosphorus-creatinine ratios (UP/cr) were significantly increased over those in control subjects (1.12 ± 0.33 vs. 0.40 ± 0.22, respectively, P = 0.0001). Uca/cr′ UMg/Cr′, and Up/Cr were correlated with increasing mean urine glucose content (P = 0.0001). No correlations were found when Uca/cr′ UMg/Cr′, or Up/Cr were compared with patient age, duration of diabetes, glycosylated hemoglobin, or insulin dosage. Urine losses of phosphorus and magnesium were present even when glycemic control was considered good by several methods (glycosylated hemoglobin, short-term glycemic index, or urinary glucose content). Glomerular hyperfiltration was unable to account for increased urinary mineral content. In conclusion, the data indicate that urinary excretion of phosphorus and magnesium is elevated in children with IDDM, regardless of glycemic control. In the presence of glucosuria, this loss is further enhanced. Urinary calcium excretion is significantly higher only during periods of glucosuria. The data suggest that children with IDDM could be at risk for mineral deficiencies in the absence of intensive insulin management.
Incidence and Significance of Islet Cell Antibodies in Women With Previous Gestational Diabetes
Authors: Catalano Patrick M , Tyzbir Elaine D , Sims Ethan A H
Published: March 2007

Islet cell antibodies (ICAs) are markers for patients at risk for insulin-dependent diabetes and are associated with progressive β-cell destruction. This prospective study was performed to estimate the incidence of these antibodies in 187 women with previous gestational diabetes. With a specific protein A monoclonal antibody (MoAb) assay, the incidence of ICAs was only 1.6% (3 of 187). Oral and intravenous glucose tolerance tests were performed in these 3 women and compared with 6 women with previous gestational diabetes without ICAs and 5 control women. Glucose tolerance was impaired only in the 3 women with ICAs, who also had an increase (P < 0.03) in fasting plasma glucose and a decrease (P < 0.03) in early first-phase insulin response. We conclude that the more specific MoAb method indicates a lower incidence of ICA in women with a history of gestational diabetes than previously reported and that a decreased first-phase insulin response is associated with the presence of ICAs, suggesting progressive islet cell damage.
Evidence for Elevated Glucose Threshold in Patients With Impaired Glucose Tolerance and Symptoms of Hypoglycemia During OGTT
Authors: Chalew Stuart A , Mersey James H , Kowarski A Avinoam
Published: March 2007

We evaluated the relationship between hypoglycemic symptoms, glucose nadir levels, and hormone changes in patients with impaired glucose tolerance (IGT) after an oral glucose tolerance test (OGTT). The peak counterregulatory hormone response was determined at the glucose nadir identified by continuous glucose monitoring. Eight patients with IGT who had symptoms and signs typical of hypoglycemia at the glucose nadir were compared with completely asymptomatic subjects (5 IGT patients and 13 patients who had normal glucose tolerance [NGT]). The mean glucose nadir of symptomatic IGT patients was 3.50 ± 0.46 mM, which was not statistically different from the mean of asymptomatic NGT patients (4.10 ± 0.56 mM) but was significantly lower than that for asymptomatic IGT patients (5.10 ± 0.81 mM, P < 0.001). Seven of 8 symptomatic IGT patients had glucose levels that never fell below the range of glucose nadirs for asymptomatic NGT patients. However, the symptomatic IGT group had significantly higher levels of growth hormone, cortisol, epinephrine, and norepinephrine than the asymptomatic groups in response to the nadir. We conclude that patients with IGT are capable of experiencing signs and symptoms of hypoglycemia at physiological glucose levels during OGTT with reflex stimulation of counterregulatory hormone release. This may indicate that symptomatic IGT patients have a higher glucose threshold for eliciting characteristic hypoglycemic symptom episodes than individuals with NGT.
Factors Associated With Avoidance of Severe Complications After 25 Yr of IDDM: Pittsburgh Epidemiology of Diabetes Complications Study I
Authors: Orchard Trevor J , Dorman Janice S , Maser Raelene E , Becker Dorothy J , Ellis Demetrius , LaPorte Ronald E , Kuller Lewis H , Wolfson Sidney K , Drash Allan L
Published: March 2007

To identify characteristics associated with long-term avoidance of insulin-dependent diabetes mellitus (IDDM) complications, subjects taking part in an epidemiologic natural history study of childhood-onset IDDM, with a duration of disease ≥25 yr, were studied. Nineteen percent of 175 subjects had avoided overt nephropathy, definite cardiovascular and peripheral vascular disease, clinical neuropathy, and proliferative retinopathy. Approximately half of the nonrenal complications occurred in the absence of renal disease. Subjects free of these advanced complications were characterized by a longer duration of disease (P < 0.05), better lipid profile and blood pressure (P < 0.01), and considerably lower glycosylated hemoglobin levels (P < 0.001). Health-related behaviors, including recent medical contact, regular glucose monitoring, physical activity in youth, and avoidance of cigarette smoking, did not relate to complication status, although regular (at least weekly) alcohol consumption was more prevalent (P < 0.05) in those without complications. We conclude that a lower mean glycosylated hemoglobin level is strongly related to the avoidance of all IDDM complications.
Acquired Partial Corticosterone Methyl Oxidase Type II Defect in Diabetes Mellitus: Case of Hyperreninemic Hypoaldosteronism
Authors: Braithwaite Susan S , Barbato Anthony L , Emanuele Mary Ann
Published: March 2007

The aim of this study was to investigate the pathogenesis of hypoaldosteronism in diabetes. Endogenous elevation of plasma renin activity and exogenous corticotropin were used to study steroidogenesis. Observations were made over 12 yr on the evolution and treatment of hyperkalemia in a diabetic subject. In 1977, potassium, baseline cortisol, aldosterone, and renin activity were normal; renin activity increased normally with posture; and cortisol responded normally to ACTH infusion. Nine yr later, persistent hyperkalemia was documented. Upright renin activity was elevated to 5.26 ng · L−1 · s−1, with concomitant elevation of 18-hydroxycorticosterone (18-OHB) and a low-normal aldosterone level. One hour after administration of 0.25 mg i.m. cosyntropin, cortisol increased normally, aldosterone increased from 220 to 360 pM, and 18-OHB increased from 3700 to 4800 pM. During treatment with fludrocortisone, fludrocortisone with furosemide, and furosemide alone, improvement of hyperkalemia was noted. Endogenous hyperreninemia and basal elevations of 18-OHB, accompanied by limited aldosterone responsiveness to renin and ACTH, suggest the presence of a partial corticosterone methyl oxidase type II defect. Evolution of hyperkalemia between 1977 and 1986 suggests this defect was acquired.
Intravenous Insulin Infusion to Simulate Subcutaneous Absorption: Bioavailability and Metabolic Sequelae
Authors: Watanabe Richard M , Vølund Aage , Bergman Richard N
Published: March 2007

Objective

To determine the bioavailability and bioactivity of subcutaneously injected insulin.

Research Design and Methods

A randomized block design with six male mongrel dogs as subjects. In protocol 1, purified pork insulin was infused intravenously to simulate the pattern of appearance in the blood that would have been expected from subcutaneous injection. Three intravenous doses (0.05, 0.10, and 0.15 U/kg) were infused on separate days in a pattern (0-300 min) designed to ~ simulate the absorption rate of subcutaneously injected insulin. In protocol 2, interscapular subcutaneous injections of pork insulin at 0.10 U/kg were made.

Results

Integrated insulin, decrement in plasma glucose, and maximal glucose clearance for subcutaneous injection experiments were similar to intravenous infusion of equal dose (P > 0.10) but significantly different from low-dose infusions (P < 0.025). Similar results were observed for hepatic glucose output and glucose uptake. Hypoglycemia elicited counterregulatory responses that appeared to be under a threshold differentiated at a plasma glucose of ~ 3 mM. Integrated insulin was plotted against insulin dose to create dose-response curves for intravenous data. The curve was then used to predict the actual appearance rate of insulin in plasma for subcutaneous injection. The estimated bioavailability of subcutaneous insulin was 103.0 ± 10.5% of the injected dose.

Conclusions

We concluded that, in dogs, insulin delivered subcutaneously in the interscapular area is not significantly degraded before absorption, resulting in metabolic effects equal to intravenous insulin infusion of equivalent dose.
Relationship Between Normal Oral Glucose Tolerance Test in Women at Risk for Gestational Diabetes and Large for Gestational Age Infants
Authors: Phillipou George
Published: March 2007

Objective

To determine whether the glycemic status of pregnant women with a normal 3-h 100-g oral glucose tolerance test (OGTT) is related to outcome with respect to large for gestational age (LGA) infants.

Research Design and Methods

A prospective study of 2631 women was conducted. One hundred seventy-six women had an OGTT based either on a 1-h 50-g OGTT (n = 105) or clinical risk factors (n = 71). Thirty-three women were diagnosed as having gestational diabetes mellitus.

Results

Negligible discriminatory capacity for the variables with respect to prediction of LGA infants was indicated by the areas under the receiver operating characteristic (ROC) curves for fasting blood glucose, 2-h OGTT blood glucose, and the OGTT response curve area for women with a normal OGTT (n = 143). However, a statistically significant increased incidence of LGA infants was established for both the OGTT-positive and normal OGTT groups (P < 0.0001). Multiparity, a maternal weight > 70 kg, and birth of a male infant were other factors associated with a significantly increased frequency of LGA infants.

Conclusions

The results may be interpreted as either indicating a role for confounding variables, i.e., maternal weight, multiparity, and birth of a male infant, or the imprecision of the OGTT in assessing physiologically important changes in maternal hyperglycemia.
Relationship of Metabolic Control and Body Weight to Hypercholesterolemia in NIDDM Patients With Apolipoprotein E4
Authors: Eto Masaaki , Watanabe Kiyoshi , Makino Isao
Published: March 2007

Objective

We previously reported that non-insulindependent diabetes mellitus (NIDDM) patients with apolipoprotein E4 (apoE4) are more susceptible to hypercholesterolemia. The purpose of this study was to clarify whether metabolic control or body weight is related to hypercholesterolemia in NIDDM patients with apoE4.

Research Design and Methods

Two hundred forty NIDDM patients with apoE4 or apoE3/3 who had either hypercholesterolemia or normolipidemia were studied. ApoE phenotypes were determined by isoelectric focusing method.

Results

The apoE4- carrying NIDDM patients with hypercholesterolemia (n = 39) showed significantly higher fasting plasma glucose (8.4 vs. 7.2 mM, P < 0.05), HbA, (9.3 vs. 8.1%, P < 0.05), and percentage of ideal body weight values (116 vs. 102%, P < 0.01) than the apoE4-carrying NIDDM patients with normolipidemia (n – 26), whereas there was no significant difference in their levels between the apoE3/3-carrying NIDDM patients with hypercholesterolemia (n = 47) and normolipidemia (n = 128).

Conclusions

In addition to our previous finding, this study indicates that hypercholesterolemia in apoE4-carrying NIDDM patients may be more closely related to poor metabolic control and increased percentage of ideal body weight.
Macrovascular Complications in Mexican Americans With Type II Diabetes
Authors: Haffner Steven M , Mitchell Braxton D , Stern Michael P , Hazuda Helen P
Published: March 2007

Mexican Americans have a threefold greater prevalence of non-insulin-dependent (type II) diabetes mellitus than non-Hispanic whites in the San Antonio Heart Study, a population-based study of diabetes. In addition, Mexican-American diabetic subjects (n = 365) have greater fasting glycemia than non-Hispanic white diabetic subjects (P < 0.001). Despite these findings, and despite a higher prevalence of microvascular complications among Mexican Americans, there does not appear to be a marked difference in prevalence of macrovascular complications between Mexican-American and non-Hispanic white diabetic subjects. Mexican-American diabetic subjects have only a moderate excess of peripheral vascular disease (as judged by ankle-arm blood pressure ratios) relative to non-Hispanic white diabetic subjects (sex-adjusted Mantel-Haenszel odds ratio 1.84, 95% confidence interval 0.75–4.49). Mexican-American diabetic subjects actually reported fewer myocardial infarctions than non-Hispanic white diabetic subjects (sex-adjusted Mantel-Haenszel odds ratio 0.73, 95% confidence interval 0.31–1.71). Duration was not associated with either peripheral vascular disease or myocardial infarction. Severity of glycemia was only mildly associated with presence of peripheral vascular disease and negatively associated with self-reported myocardial infarction. This latter finding may represent a survival bias in that more severe diabetic subjects have already died and are not ascertained in a prevalence study. The absence of an ethnic difference in the prevalence of macrovascular disease contrasts with our previous reports from the San Antonio Heart Study, in which the prevalence of both retinopathy and proteinuria was observed to be higher in Mexican-American diabetic subjects. (ABSTRACT TRUNCATED AT 250 WORDS)
Prevalence Rates for Diabetes Mellitus in Puerto Rico
Authors: Haddock Lillian , Conty Isis Torres de
Published: March 2007

The aim of this study was to analyze prevalence data for diabetes mellitus obtained from a household interview of a random sample of the general population by the Department of Health of the Commonwealth of Puerto Rico for the years 1975–1986. Details of the prevalence rate by sex and age were analyzed for the years 1981, 1984, 1985, and 1986 and for the urban and rural population in 1985. The mean prevalence rate of known cases of diabetes showed a tendency to increase from 3.1% in 1975 to 5.1% in 1986. Prevalence rates adjusted for age and sex showed an increase in the mean prevalence for 1986 compared with that of 1981. The prevalence rate was significantly higher for the rural population for the age-group 45–64 yr old and for the urban population for the age-group ≥ 65 yr. The prevalence rate compares with that of Mexican Americans and Puerto Ricans in the New York City area. On the basis of the prevalence data, ∼ 90% of the diabetic population is non-insulin dependent and 10% are insulin dependent. Major risk factors thought to explain the increased prevalence of non-insulin-dependent diabetes are increasing longevity of the Puerto Rican population, genetic predisposition, obesity, and changes in life-styles. In conclusion, Puerto Ricans, as other Hispanic Americans, have a higher prevalence of diabetes than the white American population.
Diabetes in pregnancy in Mexican Americans
Authors: Hollingsworth Dorothy R , Vaucher Yvonne , Yamamoto Thomas R
Published: March 2007

Diabetes in pregnant Mexican-American women is a serious and expensive health problem. At the University of California, San Diego Medical Center, 44% of pregnant women are Mexican American. In the Diabetes in Pregnancy Clinic, only 7% of women with insulin-dependent diabetes are in this ethnic group compared with 66% of non-insulin-dependent diabetic patients and 51% of those with gestational diabetes mellitus (GDM). GDM is the most common complication of pregnancy in Mexican Americans with a prevalence approximately three times higher than that of whites (4.5 vs. 1.5%). Mexican-American obese GDM subjects had more frequent cesarean sections and were more likely to have complications of premature rupture of membranes and preterm labor (NS). Polycythemia and sepsis also occurred more often in their infants. Anthropometric measurements in infants of both lean and obese GDM subjects differed from those of infants of mothers without GDM. Infants of lean mothers with GDM were heavier and longer than those of lean mothers without GDM. In addition, they had increased waist-hip ratio and triceps and subscapular skin folds. Infants of obese mothers with GDM were heavier than those of lean mothers with GDM. Moreover, they were longer (P < 0.04); had a higher body mass index (P < 0.04); and larger waist and hip circumferences (P < 0.03) and buccal (P < 0.01), subscapular (P < 0.01), and sum of skin-fold measurements (P < 0.03). Our observations indicate that pregnant diabetic Mexican-American women have predominantly GDM and non-insulin-dependent diabetes. They represent a major public health problem because of increased maternal and neonatal morbidity.
Randomized Trial Comparing Continuous Subcutaneous Insulin Infusion and Conventional Insulin Therapy in Type II Diabetic Patients Poorly Controlled With Sulfonylureas
Authors: Jennings Adrian M , Lewis Kathryn S , Murdoch Susan , Talbot John F , Bradley Clare , Ward John D
Published: March 2007

Objective

To compare the effects of continuous subcutaneous insulin infusion (CSII) and conventional insulin therapy (CIT) in patients with poorly controlled sulfonylurea-treated diabetes mellitus.

Resarch Design and Methods

Twenty-five patients aged 40–65 yr and poorly controlled with sulfonylureas and without severe diabetic complications comprised the study group. Five patients left the study (3 achieved satisfactory glycemic control without insulin, 1 defaulted, 1 developed ketonuria). Ten patients were treated with CSII and 10 with CIT. Outpatient treatment consisted of CIT (twice-daily injections of regular and NPH insulin) or CSII (basal infusion and prandial boluses of regular insulin).

Results

Glycosylated hemoglobin improved with both methods of insulin delivery (P < 0.01), but 8 of 10 CSII-treated patients achieved satisfactory glycemic control (HbA1 < 50 mmol hydroxymethylfurfural/mol Hb), whereas only 3 of 10 CIT-treated patients achieved this (P < 0.05). Weight gain, insulin dosage, and prevalence of hypoglycemia were similar in the two groups. Retinal deterioration occurred in one CSII-treated patient and three CIT-treated patients, but there were no episodes of infusion site infection or metabolic decompensation. Patients' satisfaction with treatment improved during insulin therapy (P < 0.02), and significant changes in beliefs about diabetes and its treatment were observed in CSII-treated patients (P < 0.05).

Concusions

Glycemic control improved with both methods of insulin treated patients achieved satisfactory glycemic control (HbA1 < 50 mmol hydroxymethylfurfural?mol Hb), whereas only 3 of 10 CIT-treated patients achieved this CSII. Patients' satisfaction with treatment improved during insulin therapy.
Dietary Therapy in Diabetes Mellitus: Is There a Single Best Diet?
Authors: Grundy Scott M
Published: March 2007

The ideal diet for diabetic patients remains to be determined. Recommendations generally call for low-fat high-carbohydrate diets. The primary purpose of this recommendation is to reduce the risk for coronary heart disease, a major killer of diabetic patients. Some investigators also suggest that high-carbohydrate diets also improve glucose tolerance, even in patients with non-insulin-dependent diabetes mellitus (NIDDM). Another potential advantage of a low-fat diet (high percentage of carbohydrate) is that it may promote weight reduction. High-fat diets are thought by many investigators to stimulate weight gain. Thus, in obese NIDDM patients a trial of a low-fat weight-reduction diet may be worthwhile. However, if after an adequate trial of this diet, weight reduction is not achieved, this suggests that the patient is consuming large quantities of carbohydrates. The continued feeding of a high-carbohydrate diet to a persistently obese patient with NIDDM may have several untoward effects. For example, it can heighten hyperglycemia, raise plasma triglycerides, and lower high-density lipoproteins. In such dietary failures, it may be better to replace carbohydrate with fat to avoid these responses. Ideally, the fat should not raise the serum cholesterol level, and hence it should be unsaturated. Monounsaturated fatty acids seem preferable to polyunsaturated fatty acids, because polyunsaturates may increase the risk for cancer or promote the oxidation of low-density lipoprotein, another potentially atherogenic change. Many NIDDM patients, particularly obese patients in the earlier stages of diabetes, tolerate weight-maintenance high-carbohydrate diets without deterioration of glucose tolerance. However, as their insulin reserve declines, high-carbohydrate diets may further raise glucose levels, and a lower-carbohydrate diet seems preferable. The same may be true for nonobese patients with NIDDM; the predominant defect in many of these patients is a deficient secretion of insulin. Replacement of carbohydrates by monounsaturated fatty acids in the latter two groups of patients may be advantageous. In summary, the best dietary approach in obese patients with NIDDM, who are relatively early in the course of their disease, is to attempt weight reduction with a lowfat diet. However, if this diet should fail, it probably would be better to reduce carbohydrate intake and replace some of it with monounsaturates. Likewise, in more advanced NIDDM, with deficiency of insulin secretion, high-carbohydrate diets probably should be avoided, because they accentuate hyperglycemia. Therefore, the ideal diet for diabetic patients may depend on the presence or absence of obesity, the response to a weight-reduction diet, and the stage of progression of β-cell dysfunction.
Normalization of Composition of Triglyceride-Rich Lipoprotein Subfractions in Diabetic Subjects During Insulin Infusion With Programmable Implantable Medication System
Authors: Georgopoulos Angeliki , Saudek Christopher D
Published: March 2007

Objective

–To investigate whether long-term improved glycemic control by intraperitoneal insulin infusion normalizes the compositional abnormalities of triglyceride (TG)-rich lipoproteins in insulin-dependent diabetes mellitus (IDDM).

Research Design and Methods

–Seven subjects were studied before and 12–14 mo after initiation of treatment with the programmable implantable medication system (PIMS). Plasma TG levels were measured, and the composition of three TG-rich lipoprotein subfractions (Svedberg flotation [Sf] >400, 100–400, and 20–100) were analyzed before and every 1.5 h for 7.5 h after ingestion of corn oil.

Results

–PIMS significantly improved glycemic control, as measured by mean blood glucose (P < 0.02), and HbA1 (P <0.001, paired t test) levels. Weight loss was also observed during PIMS treatment. Significant changes occurred in the composition of TG-rich lipoprotein subfractions during PIMS treatment in both the fasting (P < 0.002) and the postprandial (P < 0.0001) state. Most changes were in the direction of nondiabetic values. PIMS treatment reduced the total cholesterol enrichment in IDDM subjects in all three subfractions in the postprandial state and the very-low-density lipoprotein subfractions (Sf 100–400 and 20–100) in the fasting state. Multivariate analysis showed that the compositional changes were affected by improved glycemic control, as assessed by both mean blood glucose and HbA1, whereas the very-low-density lipoprotein compositional changes were by both the improved glycemic control and body weight.

Conclusions

–In IDDM subjects during PIMS treatment, there was normalization of most abnormalities in the composition of fasting and postprandial TG-rich lipoproteins, including enrichment in total cholesterol, which is considered atherogenic.
Relationship of Self-efficacy and Binging to Adherence to Diabetes Regimen Among Adolescents
Authors: Littlefield Christine H , Craven John L , Rodin Gary M , Daneman Denis , Murray Michael A , Rydall Anne C
Published: March 2007

Objective

–To test the hypothesis that poorer adherence to diabetes care is related to four variables associated with self-concept in adolescents with diabetes: self-esteem, self-efficacy, depression, and binging behavior. In addition, we expected adolescent females to be less adherent to diabetes care.

Research Design and Methods

–We recruited 193 consecutive patients (aged 13–18 yr) with insulin-dependent diabetes mellitus during their regular quarterly visit to a diabetes clinic in a large urban hospital. Participants completed the Rosenberg Self-Esteem Scale, the Children's Depression Inventory, an assessment of the frequency of binging in the past 3 mo, and parallel forms of an adherence scale and a self-efficacy scale that were developed for use in this study.

Results

–Adolescents who reported lower adherence tended to report lower self-esteem (r = 0.45, P < 0.001) and self-efficacy (r = 0.57, P < 0.001), more depressive symptoms (r = −0.50, P < 0.001), more binging (r = −0.36, P < 0.001), and had higher HbA1c (r = −0.24, P < 0.001) than those with higher adherence scores. Together, the psychological variables accounted for 50% of the variance in adherence. There was no sex difference in reported binging, but, as expected, adolescent females reported less adherence overall (F[7,184] = 2.5, P = 0.018).

Conclusions

–Treatment adherence in adolescents with insulin-dependent diabetes mellitus is associated with behavioral and psychological variables. These findings suggest that specific behavioral and cognitive interventions could be used to improve adherence in those individuals who lack confidence in their ability to perform diabetes-related tasks.
Relationship of Postload Plasma Glucose to Mortality With 19-Yr Follow-Up. Comparison of one versus two plasma glucose measurements in the Chicago Peoples Gas Company Study
Authors: Vaccaro Olga , Ruth Karen J , Stamler Jeremiah
Published: March 2007

OBJECTIVE

To explore the relationship of one versus two postload plasma glucose measurements to 19-yr mortality in men in the Chicago Peoples Gas Company Study.

RESEARCH DESIGN AND METHODS

One-hour postload plasma glucose was measured twice (1.4 yr apart, 1965–1967) for 873 nondiabetic men 34–65 yr of age. Serum cholesterol, blood pressure, height, and weight were measured. Data on smoking habits were obtained. Mortality follow-up was complete through July 1986, 19 yr after second glucose load.

RESULTS

In prospective analyses, with each of three glucose values—first, second, and mean of first and second—coronary, cardiovascular, and all-cause age-adjusted mortality rates were higher in quintiles 3, 4, and 5 compared with quintile 1, with a significant linear trend. Multivariate analyses with glycemia as a continuous variable confirmed a positive independent association between plasma glucose and mortality endpoints with first measurement and mean of two values but not with second. With dichotomization of plasma glucose (≥ 11.2 mM [≥ 200 mg/dl]) for 30 men hyperglycemic both times, CHD and CVD death rates were significantly higher (odds ratios 2.3–2.7) compared with those for 758 men consistently nonhyperglycemic. In contrast, for those hyperglycemic once only, death rates were not significantly higher. Results of multivariate analyses were consistent with these findings.

CONCLUSIONS

These data indicate a significant relationship of asymptomatic hyperglycemia on repeat examinations to coronary and cardiovascular mortality independent of other factors measured in the study.
C-peptide Response to Meal Challenge in Nondiabetic and Diabetic Adults Living in Wadena, Minnesota
Authors: Bushhouse Sally A , Goetz Frederick C , Jacobs David R , Bender Alan P , French L Ronald , Oestreich Patricia G , Geisser Mindy S
Published: March 2007

OBJECTIVE

The goal of the study was to provide cross-sectional descriptive data on the response of C-peptide to a vigorous meal stimulus in a population-based sample of nondiabetic adults compared with a population-based sample of adults with NIDDM. Available information is scanty, especially in subjects > 50 yr old.

RESEARCH DESIGN AND METHODS

The group under study included 377 adults without previously known diabetes randomly chosen from the population of the city of Wadena, Minnesota, almost all of northern European background, and 88 adults with known diabetes. PCP was measured 90 min after ingestion of 480 ml liquid meal Ensure-Plus, which includes 95 g dextrose, 26 g protein, and 25 g fat. C-peptide also was measured in a 260-min urine collection after the meal challenge. Novo antibody M1221 was used for C-peptide assay throughout the study. Participants whose medical record indicated insulin-dependent diabetes with a history of acetone production were excluded from analyses.

RESULTS

The distribution of UCP and PCP in this group of subjects appears very broad. Both the highest and lowest values for C-peptide were observed in individuals with diabetic glucose tolerance. The mean and median values in the nondiabetic group are higher than in previously published reports. After statistical adjustment for age, sex, BMI, and concomitant plasma glucose, participants with IGT produced significantly more C-peptide than the group with NGT (3.48 vs. 2.96 nM PCP, P < 0.05). Participants with diabetic glucose tolerance and who were not taking insulin produced as much or more C-peptide than either the NGT or IGT groups, depending on the statistical model used for adjusting for plasma glucose. Diabetic participants who were taking insulin produced significantly lower amounts of C-peptide than any of the non-insulin-taking groups (∼ 30% of the C-peptide produced by the non-insulin-taking diabetic participants). A decline in PCP production with increasing years since diagnosis (5.7%/yr) was observed exclusively in the insulin-taking NIDDM participants. Effect modification by glucose tolerance classification was observed on the relationship between plasma glucose and PCP: PCP increased with increasing plasma glucose in NGT and IGT groups, but a nonsignificant negative relationship was exhibited in diabetic participants.

CONCLUSIONS

The data suggest that two forms of NIDDM may exist, crudely distinguished by the clinical decision to use insulin to control blood glucose levels. The insulin-taking diabetic individuals may experience a greater likelihood of pancreatic failure, whereas non-insulin-taking diabetic individuals probably experience stable pancreatic function over the course of their disease. Longitudinal observation of the Wadena cohort will provide more insight into this possibility.
Prevalence of Eating Disorder Symptoms in Preadolescent and Adolescent Girls With IDDM
Authors: Striegel-Moore Ruth H , Nicholson Timothy J , Tamborlane William V
Published: March 2007

OBJECTIVE

To assess attitudinal and behavioral symptoms of eating disorders in preadolescent and adolescent girls with IDDM and a matched sample of nondiabetic subjects, and to explore the relationship between the perceived impact of IDDM and eating disorder symptoms.

RESEARCH DESIGN AND METHODS

All eligible IDDM patients (girls, age 8–18 yr) from the case register of the Yale Children's Diabetes Clinic were recruited for this study. Of 49 eligible patients, 46 participated in the study. Control subjects were recruited among students in several local schools; 46 girls, individually age and race-matched with IDDM patients, and group-matched by father's socioeconomic status, were included in this study. All subjects participated in an investigator-based clinical interview (EDE) and completed a self-report measure of eating-related psychopathology (EDI). IDDM subjects completed the DQOL measure to determine the perceived impact of diabetes on patients' lives.

RESULTS

IDDM patients reported significantly more regular consumption of meals and snacks than did nondiabetic subjects. No group differences were found on measures of symptoms of eating disorders: both groups reported minimal levels of symptoms. Among adolescent IDDM patients, eating disorder symptoms were related significantly to patients' dissatisfaction with the illness and its impact on their lives.

CONCLUSIONS

It appears that when applying stringent diagnostic procedures and matching criteria, IDDM girls do not evidence an elevated prevalence of eating disorder symptoms. However, those IDDM patients who did report symptoms may be a high-risk group for the development of an eating disorder and should be followed prospectively.
Microalbuminuria Immunoassay Based on Antibodies Covalently Conjugated to Eupergit C-Coated Beads
Authors: Solomon Beka , Fleminger Gideon , Schwartz Fidi , Doolman Ram , Sela Ben-Ami
Published: March 2007

OBJECTIVE

To develop a reliable, simple, and sensitive assay for microalbuminuria, based on covalent attachment of anti-HSA to oxirane-bearing polymethylmethacrylate beads (Eupergit CB6200).

RESEARCH DESIGN AND METHODS

Anti-HSA antibodies were coupled to CB6200 beads by reaction of their amino groups with the oxirane groups of the matrix. The capability of the beads to bind HSA from standard solutions or urine was evaluated and compared with the state of the art ELISA test.

RESULTS

The new bead immunoassay is sensitive and linear in the range of 1–25 mg/L, which is considered the low microalbuminuria range. When HSA levels in urine were tested, the intra- and interassay CV values ranged between 2.7 and 3.9% and between 5.6 and 6.6%, respectively. The long-term storage stability of the antibodies covalently bound on the beads was higher than of the same antibodies adsorbed on ELISA plates. After 16 wk of storage, the CV was about 7.3% with the bead assay, compared with 14% obtained for the ELISA test under the same experimental conditions.

CONCLUSIONS

A new procedure for microalbuminuria assay was developed, with Eupergit CB6200 beads as a solid support for covalent binding of the first antibody. Accuracy, sensitivity, reproducibility, and precision of the bead immunoassay were similar to those of commonly used immunoassays, as exemplified by the analysis of HSA in 53 clinical urine samples. The bead assay retains a low degree of variability over long storage periods, and the beads may be reapplied after a simple acid-washing procedure.
Glucose Turnover in Type I Diabetic Subjects During Exercise: Effect of selective and nonselective β-blockade and insulin withdrawal
Authors: Benn Jonathan J , Brown Philip M , Beckwith Lucy J , Farebrother Martin , Sönksen Peter H
Published: March 2007

OBJECTIVE

To assess the effect of selective β1-blockade (atenolol and betaxolol) and nonselective β-blockade (propranolol) on glucose turnover in subjects with insulin-dependent (type I) diabetes mellitus during moderate exercise.

RESEARCH DESIGN AND METHODS

Five subjects with type I diabetes were infused with insulin and then exercised for 1 h, after pretreatment with each of the three drugs or saline and, on a separate day, after withdrawal of insulin. Glucose turnover was measured using tritiated glucose.

RESULTS

Plasma glucose, initially 9.2 ± 0.5 mmol/L (mean ± SE) when insulin infused and 14.0 ± 0.8 when insulin was withdrawn, fell on exercise by 3.4 ± 1.1 mmol/L (P < 0.05) saline, 4.0 ± 0.8 mmol/L (P < 0.01) with betaxolol, 3.8 ± 0.7 mmol/L (P < 0.01) with atenolol, 5.0 ± 0.6 mmol/L (P < 0.005) with propranolol, and 1.7 ± 1.0 mmol/L (NS) when insulin was withdrawn. Propranolol, but not the other β-blockers, caused a significantly greater fall in glucose on exercise than during the control study. Glucose appearance rate (Ra) was similar basally and rose to an almost identical level in all five groups during exercise. Glucose disappearance rate (Rd) rose similarly during exercise, except after propranolol when the rise was significantly greater with saline (P < 0.01). Failure of glucose to change significantly during exercise when insulin had been withdrawn was associated with the smallest rise in Rd and the highest nonesterified fatty acid concentrations. Propranolol and betaxolol, but not atenolol, reduced nonesterified fatty acids.

CONCLUSIONS

We conclude that the greater fall in glucose on exercise after β-blocking drugs is probably largely a direct effect of β2-blockade on muscle, increasing the exercise-induced rise in Rd glucose. This offers support to the use of β1-specific drugs, where β-blockade is necessary in type I diabetes.
Diabetic Retinopathy: A clinical overview
Authors: Davis Matthew D
Published: March 2007

After an introductory summary, this review presents a description of the natural course of diabetic retinopathy, then briefly considers selected pathogenetic and epidemiological concepts, and concludes with a discussion of current treatment.
Effect of Treatment With Capsaicin on Daily Activities of Patients With Painful Diabetic Neuropathy
Authors:   Capsaicin Study Group
Published: March 2007

Objective

— To establish the effects of topically applied capsaicin on daily activities in patients with painful diabetic neuropathy.

Research Design and Methods

— Investigators at 12 sites enrolled 277 men and women with painful peripheral polyneuropathy and/or radiculopathy in an 8-wk double-blind vehicle-controlled study with parallel randomized treatment assignments. Participants were unresponsive or intolerant to conventional therapy and were experiencing pain that interfered with functional activities and/or sleep. Either 0.075% capsaicin cream or vehicle cream was applied to the painful areas 4 times/day. A visual analogue scale of pain intensity and baseline measurements of the pain's interference with the ability to walk, work, participate in recreational activities, use shoes and socks, sleep, and eat were recorded at onset and at 2-wk intervals. A physician's global evaluation scale assessed changes in pain status from baseline.

Results

— Statistically significant differences are percentage of patients with improvement in favor of capsaicin versus vehicle: 69.5 vs 53.4% with clinical improvement in pain status (P = 0.012), 26.1 vs. 14.6% with improvement in walking (P = 0.029), 18.3 vs. 9.2% with improvement in working (P = 0.019), 29.5 vs. 20.3% with improvement in sleeping (P = 0.036), and 22.8 vs. 12.1% with improvement in participating in recreational activities (P = 0.037).

Conclusions

— The results from this study suggest that topical 0.075% capsaicin is effective for reducing pain in patients with painful diabetic neuropathy with subsequent improvement in daily activities, enhancing the quality of the patient's life.
Dietary protein intake is not correlated with clinical proteinuria in NIDDM
Authors: Jameel Nauman , Pugh Jacqueline A , Mitchell Braxton D , Stern Michael P
Published: March 2007

Objective

— To determine whether dietary protein intake is correlated with clinical proteinuria in subjects with non-insulin-dependent diabetes mellitus (NIDDM).

Research Design And Methods

— Cross-sectional analysis of data obtained from the San Antonio Heart Study, a population-based survey of diabetes and cardiovascular risk factors. Subjects were enrolled in two phases: phase 1 between 1979 and 1982 and phase 2 between 1984 and 1988. This study was based on 376 NIDDM subjects who had both urinalysis and complete dietary protein intake information available. Dietary protein intake was measured by 24-h dietary recall in phase 1 and by food-frequency questionnaire in phase 2. An early-morning spot urine was obtained from study subjects. Clinical proteinuria was defined as ≥ 1 on Ames Albustix test.

Results

— In phase 1, the subjects with negative or trace proteinuria had a mean protein intake of 79.9 g/day compared with 72.1 g/day for subjects with ≥ 1 proteinuria. In phase 2, the mean protein intake was 72.2 g/day in the negative/trace group and 65.3 g/day in the ≥ 1 proteinuria group. In multivariate analysis, adjusting for age, sex, ethnicity, systolic blood pressure, and 2-h blood glucose, we were again unable to detect a significant correlation between dietary protein intake and clinical proteinuria.

Conclusions

— These data do not support the hypothesis that high-protein intake is a risk factor for clinical proteinuria in NIDDM subjects. Therefore, any recommendation for protein restriction in the diets of NIDDM subjects, before the development of NIDDM-related nephropathy, must be made with caution.