bluuebunny/crossref_metadata_2025 huggingface dataset:
The Prevalence, Detection, and Epidemiological Correlates of Peripheral Vascular Disease: A Comparison of Diabetic and Non‐diabetic Subjects in an English Community
Authors: Walters D.P. , Gatling W. , Mullee M.A. , Hill R.D.
Published: July 2009

A cross‐sectional study was performed to investigate the distribution, methods of detection, and potential risk factors for peripheral vascular disease in a diabetic population with comparison to an age and sex matched non‐diabetic group. The population came from a geographically defined area consisting of 10 general practices (total list size 97 034) and covered rural and urban districts of East Dorset. Peripheral vascular disease was defined as an ankle/brachial Doppler pressure ratio of 0.9 or less. Of the diabetic subjects reviewed, 864 were classified as having Type 2 diabetes and 213 Type 1 diabetes. The prevalence of peripheral vascular disease in Type 1 diabetes was 8.7% (95% CI 4.9–12.5) and in Type 2 diabetes 23.5% (95% CI 20.5–26.5), which after adjusting for age was not significantly different (odds ratio 1.5, 95% CI 0.8–2.7, p = 0.18). There was no difference in the frequency of symptomatic peripheral vascular disease or the site of occlusion between diabetic and non‐diabetic subjects with peripheral vascular disease. Age, cerebrovascular disease, coronary artery disease, glucose, body mass index, and cholesterol in Type 2 diabetes and age and proteinuria in Type 1 diabetes were significant predictors of peripheral vascular disease. In the non‐diabetic group, age and cigarettes smoked were significant variables. These findings suggest that clinical features of peripheral vascular disease in diabetic and non‐diabetic subjects are similar but risk determinants may be different.
The Effect of Weight‐bearing Pressure on the Plantar Circulation in Diabetes Mellitus
Authors: Proano E. , Määttänen H. , Perbeck L. , Solders G. , Turan I.
Published: July 2009

Patients with diabetic neuropathy are prone to ulceration on the sole of the foot, especially in areas with high weight‐bearing pressure. The relationship between weight‐bearing pressure and nutritive skin circulation in the plantar region was studied. Gait analysis was performed with the EMED Gait Analysis System and the skin circulation was measured by fluorescein flowmetry in ten neuropathic diabetic patients and in eight healthy controls. The critical plantar foot pressure above which nutritional blood flow in the skin was arrested was 3 N cm−2or more in both diabetic and control subjects. Below 3 N cm−2the blood flow was independent of weight‐bearing pressure both in diabetic and control subjects (correlation coefficientr= −0.01 and −0.19, respectively). Thus, our results indicate that the nutritional blood flow in the plantar region is not decreased in patients with diabetic neuropathy.
Effect of Chronic ACE Inhibition on Glucose Tolerance and Insulin Sensitivity in Hypertensive Type 2 Diabetic Patients
Authors: Seghieri G. , Yin W. , Boni C. , Sanna G. , Anichini R. , Bartolomei G. , Ferrannini E.
Published: July 2009

The question, of whether long‐term treatment of essential hypertension with angiotensin‐converting enzyme (ACE) inhibitors is capable of modifying glucose tolerance or insulin sensitivity in Type 2 (non‐insulin dependent) diabetes, is still unsolved. We studied 14 moderately overweight Type 2 diabetic patients with essential hypertension in stable metabolic control after a run‐in period and again after 3 months of antihypertensive treatment with the ACE inhibitor, Captopril. Glucose tolerance was tested with a 75‐g oral glucose load and insulin sensitivity was measured by the insulin suppression test, while dietary and drug treatment of the diabetes remained constant. In the whole group, mean blood pressure (MBP) fell progressively over 3 months from a baseline value of 123 ± 3 mmHg to a final value of 115 ± 2 mmHg (p < 0.005); in six patients, the change in MBP was < 5 mmHg (non‐responders), thus giving a clinical response rate of ˜60%. After treatment, fasting plasma glucose, insulin, free fatty acid (FFA), potassium, and glycated haemoglobin concentrations were unchanged from baseline. During the oral glucose tolerance test, the incremental glucose area‐under‐curve was 0.75 ± 0.05 mol 120 min I−1 before and 0.76 ± 0.06 mol 120 min I−1 after treatment (p = ns). Endogenous insulin response and suppression of plasma FFA levels were superimposable on the two occasions. During the insulin suppression test, steady‐state plasma glucose levels were 14.4 ± 1.3 vs 14.2 ±1.1 mmol I−1 before and after chronic ACE inhibition, respectively, at comparable hyperinsulinaemic plateaux (291 ± 21 vs 287 ± 14 pmol I−1). Neither endogenous (oral glucose) nor exogenous (insulin suppression test) insulin caused any change in plasma potassium concentrations. This resistance to the hypokalemic action of insulin was not affected by Captopril. The eight blood pressure responders, or the seven patients with less fasting hyperglycaemia, had similar baseline characteristics as the whole group, and likewise showed no significant treatment‐related change in glucose tolerance or insulin sensitivity.

We conclude that chronic ACE inhibition does not change glucose tolerance, endogenous insulin response, and sensitivity of glucose disposal, lipolysis, and potassium metabolism to insulin in stable Type 2 diabetic patients whose glycaemic control by other means (diet and/or drugs) is held constant.
Foot Infections in Diabetes are Rarely Due to a Single Microorganism
Authors: Hunt I.A.
Published: July 2009

The purpose of this study was to investigate the frequency with which multiple organisms can be isolated from severe foot infections in diabetic patients with carefully planned techniques of collection and processing of specimens. One hundred and seventy‐seven organisms were isolated from 52 patient admissions (mean 3.4 per infection) at a district hospital. This was compared to a mean of 2.1 organisms per lesion at a local university hospital and 2.3 at a smaller community hospital. Staphylococcus aureus was isolated in about half of all lesions at the three hospitals, while anaerobic organisms were isolated from 30 at the district hospital, 10 at the university hospital, and 4 at the community hospital. This study concludes that, firstly, proper techniques for collection, transportation and examination of culture specimens are important in the isolation of multiple organisms from foot infections in diabetes, and secondly, Staphylococcus aureus is often absent while anaerobic organisms are common.
The Effect of a City‐wide Mass Media Campaign on the Public Awareness of Diabetes
Authors: Penn N.D. , Stevenson C. , McMahon C. , Bodansky H.J.
Published: July 2009

The aim of this study was to determine whether a mass media campaign about diabetes would increase public awareness and knowledge of diabetes, leading to an increased rate of detection of previously undiagnosed cases. A telephone questionnaire was administered to two groups of randomly selected members of the public before and after a 1‐week mass media campaign. Cases of newly diagnosed diabetes were monitored by general practitioners. The median knowledge score rose from 5 (range 0–10) before the campaign to 6 (0–10) afterwards, p < 0.001. The knowledge score for a control group, questioned post‐campaign only, was also 6 (1–10). The increase in the median knowledge score was mainly as a result of more people being able to define diabetes and give two presenting symptoms. This increased awareness did not however result in an increase in detection of new cases.
A Proposal for Continuing Audit of Diabetes Services
Authors: Williams D.R.R. ,   P.D. Home and Members of a Working Group of the Research Unit of the Royal College of Physicians and British Diabetic Association
Published: July 2009

A working group was established in order to suggest the process and outcome variables most appropriate for the continuing audit of diabetes services. The proposed audit is being piloted in hospitals in selected United Kingdom Health Districts. The main process and outcome measures suggested are: waiting and consultation times; missed or cancelled appointments; information given to patients and the primary care team; knowledge of diabetes and risks of smoking; recording of key examinations and investigations, i.e. levels of glycosylated haemoglobin (or equivalent), serum cholesterol, body mass index, blood pressure, albumin excretion rate, presence and extent of retinopathy, history of coronary artery, cerebrovascular or peripheral vascular disease; history of severe hypoglycaemia; presence of foot problems; psychological well‐being; patient satisfaction; admission rates and hospital bed days for hyperglycaemic and other diabetes related emergencies.
Evidence for Reversibility of Defective Counterregulation in a Patient with Insulinoma
Authors: Maran A. , Taylor J. , Macdonald I. A. , Amiel S. A.
Published: July 2009

To investigate her unheralded neuroglycopenia, a 45‐year‐old woman was studied before and 3 months after removal of her insulinoma. Hypoglycaemia was induced and reversed by glucose infusion during 4‐h insulin infusions (1.5 mU kg−1 min−1). Postoperatively, the low preoperative adrenaline, noradrenaline, growth hormone, and Cortisol responses increased by 490, 152, 64, and 178%, respectively, and started at higher glucose levels (2.7 vs 1.9 mmol I−1 for adrenaline), with a four‐fold increase in autonomic symptoms and more profound psychomotor dysfunction. We conclude that the syndrome of recurrent severe hypoglycaemia with defective warning symptoms and hormonal responses, in this case induced by an insulin‐secreting tumour, is reversible, perhaps by the removal of the hypoglycaemia, a finding which may be relevant to other patients with recurrent severe hypoglycaemia.
Autonomic Function Testing in Diabetic Subjects Using Sequential Measurements
Authors: Lawrence G.P. , Home P.D. , Murray A.
Published: July 2009

The repeatability of commonly used electrocardiographic (ECG) related autonomic function tests was investigated in 25 diabetic subjects, mean age 44 (range 18–67) years and mean duration of diabetes 10 (<1–35) years. Tests were based on deep breathing, the Valsalva manoeuvre, relaxed normal breathing, and standing up from a lying position. All tests were repeated twice at each session, with two sessions separated by a mean of 5 (range 3–8) months. ECG and respiratory data were recorded for subsequent analysis. Maximum (max) and minimum (min) RR intervals and instantaneous heart rate (HR) were determined. The mean and repeatability data (within‐subject standard deviation) for 21 different test results were calculated, and included deep breathing sitting (max‐min)RR 226 ± 39 ms and (max‐min)HR 19.3 ± 3.2 beats min−1, Valsalva manoeuvre 1.74 ± 0.18, and lying‐to‐standing RR ratio 1.19 ± 0.07. The within‐subject repeatability to between‐subject variability ratios consistently demonstrated that it is better to perform the deep breathing test sitting (with the smaller mean ratio of 0.37) rather than supine (0.46), with the use of three respiratory cycles rather than a single cycle (0.33 compared with 0.50 for (max‐min)RR). A significant (p=0.037) relationship was found between variability in heart rate changes and variability in air volume breathed during the deep breathing test.
High Prevalence of Gestational Diabetes in Women from Ethnic Minority Groups
Authors: Dornhorst A. , Paterson C.M. , Nicholls J.S.D. , Wadsworth J. , Chiu D.C. , Elkeles R.S. , Johnston D.G. , Beard R.W.
Published: July 2009

The influence of ethnic origin, body mass index, and parity on the frequency of gestational diabetes was assessed in 11205 consecutive women attending a multiracial antenatal clinic in London, where all women were screened for gestational diabetes. Logistic regression was used to model the relationship between gestational diabetes and ethnic origin, age, body mass index (BMI), and parity. Results were presented as adjusted odds ratios, where the reference categories are White women, age < 25 years, BMI < 27, and parity < 3. Ethnic origin was the dominant influence on the prevalence of gestational diabetes. Women from ethnic groups other than White had a higher frequency of gestational diabetes than White women (2.9% vs 0.4%, p < 0.001). Compared to White women the relative risk of gestational diabetes in the other ethnic groups was: Black 3.1 (95% confidence limits 1.8–5.5), South East Asian 7.6 (4.1–14.1), Indian 11.3 (6.8–18.8), and miscellaneous 5.9 (3.5–9.9). Increasing age was an independent risk factor. The relative risk was higher in women ≥ 35 years in all ethnic groups other than in South East Asian women. Obesity (BMI ≥ 27) was a further independent risk factor in all ethnic groups except in the Indian and South East Asian women. Parity ≥ 3 increased the relative risk of gestational diabetes in the White, Black, and South East Asian women only. Age and obesity were factors of particular importance in Black women in whom the risk was 4.1 fold greater in those ≥ 35 years compared with women ≥ 35 years, and 5.0 fold higher if the BMI was ≥ 27 compared with ≥ 27. Ethnic origin has a major influence on the prevalence of gestational diabetes and the importance of other risk factors varies between ethnic groups. These findings have important implications for the screening of women in pregnancy.
Morning versus Bedtime Isophane Insulin in Type 2 (Non‐insulin dependent) Diabetes Mellitus
Authors: Seigler D.E. , Olsson G.M. , Skyler J.S.
Published: July 2009

Morning versus bedtime administration of NPH insulin was compared in 12 subjects with Type 2 diabetes and overt fasting hyperglycaemia. Subjects were studied at baseline (diet alone) and after 2 months on each of the two insulin programmes in a random crossover design, in which dosage was increased until at least one daily preprandial blood glucose was consistently in the range of 3.9 to 6.0 mmol l‐1. Mean (± SEM) daily total insulin dosage was equivalent for the morning (0.36 ± 0.03 units kg−1) and for the bedtime (0.37 ± 0.03 units kg−1) insulin administration schedules. Glycaemic control was improved on both insulin regimens, but was better on bedtime than morning insulin. Fasting plasma glucose (mmol I−1) was 12.0 ± 0.7 (baseline), 8.6 ± 0.7 (morning), and 4.6 ± 0.3 (bedtime), respectively. Mean 24 h plasma glucose (mmol I−1) was 13.3 ± 1.3, 9.0 ±0.7, and 7.8 ± 0.7. Glycated haemoglobin (%) was 7.65 ± 0.35, 6.23 ± 0.26, and 5.81 ± 0.32. The improvement of basal glycaemia is a consequence of increased basal metabolic clearance of glucose (baseline, 47.6 ± 3.1 ml m−2 min‐1; morning 63.5 ± 5.4, bedtime 103.5 ± 7.1). There was no change in hepatic glucose output.

it is concluded that bedtime administration of intermediate acting insulin results in increased basal insulinaemia, leading to improved basal glycaemia and consequent improved overall metabolic control, compared to morning insulin administration. Therefore, bedtime may be the preferable timing of insulin therapy for patients with Type 2 diabetes and overt fasting hyperglycaemia.
A Community Survey of Diabetes in the Elderly
Authors: Dornan T.L. , Peck G.M. , Dow J.D.C. , Tattersall R.B.
Published: July 2009

All 98 elderly patients who were known to have diabetes on the lists of two inner‐city general practices were interviewed and examined in their own homes. They were characterized in terms of their prevalence of vascular complications, metabolic control, perceived health (measured by the Nottingham Health Profile), frequency of hospital and general practice contacts and use of domiciliary ‘support services’ and compared to 98 control subjects with an identical age/gender distribution. Mean haemoglobin A1 in the diabetic patients was 9.9 ± 2.5%, few of them had suffered severe hyperglycaemia (10%) or hypoglycaemia (5%) and they were little more obese than controls (mean body mass index 26.2 ± 4.2 vs 24.6 ± 4.1 kg m−2; 95% confidence interval for the difference 0.4–2.8; p<0.01). All complications were more prevalent in diabetic patients and the difference was statistically significant for visual impairment, strokes, impaired mental test scores, absent vibration sense, and absent leg pulses. Cataract was more common than retinopathy as a cause of visual disability. Diabetic patients perceived their health to be much worse than controls and were more often depressed. No measure of perceived health correlated with haemoglobin A1. We conclude that care of the diabetic elderly should not be too narrowly focused on ‘metabolic’ goals.
Does the Prepubertal Duration of Diabetes Influence the Onset of Microvascular Complications?
Authors: McNally P.G. , Raymond N.T. , Swift P.G.F. , Hearnshaw J.R. , Burden A.C.
Published: July 2009

This study investigated the relationship between the development of diabetic retinopathy and pubertal status at onset of diabetes in 521 Type 1 diabetic patients diagnosed between 1950 and 1985. Pubertal status was based on age at onset (girls ≧ 11 years and boys ≧ 12 years). Retinopathy (all forms) developed in 112 patients (21.5%; 65 background and 47 proliferative retinopathy). For subjects diagnosed in either the prepubertal or postpuberal period, a similar proportion survived without developing retinopathy for any given duration of diabetes (X2 = 0.3822, p = 0.54). However, if only the postpubertal duration of diabetes is considered, then the proportion of patients surviving without retinopathy was significantly less for those diagnosed in the prepubertal period (X2 = 14.2, p = 0.002). This study suggests that the prepubertal duration of diabetes is an important phase and that the years prior to puberty do contribute to the risk of developing microvascular injury.
Prevalence of QT Prolongation in a Type 1 Diabetic Population and Its Association with Autonomic Neuropathy
Authors: Sivieri R. , Veglio M. , Chinaglia A. , Scaglione P. , Cavallo‐Perin P. ,   For the Neuropathy Study Group of the Italian Society for the Study of Diabetes, Piemonte affiliate
Published: July 2009

The prevalence of QT prolongation in a large random sample of Type 1 diabetic patients in Piemonte, Italy and its association with autonomic neuropathy were assessed. Three hundred and seventy‐nine Type 1 diabetic patients (age 15–59) with (94, DAN+) and without (280, DAN‐) autonomic neuropathy and 118 non‐diabetic control subjects participated in the study. QT interval was measured on an ECG recorded at rest and QTc calculated according to Bazett's formula. QTc was greater than 0.440 s in 7.6% (95% CI 2.9–12.3) of control subjects, 25.6% (21.0–30.0) of diabetic patients, 30.8% (21.5–40.1) of DAN+, 23.9% (18.9–28.9) of DAN‐. QTc was greater than 0.460 s (mean + 2SD of QTc in control subjects) in 11.7% (8.5–14.9) of diabetic patients, 18.1% (10.3–25.9) of DAN+, 9.6% (6.2–13.0) of DAN‐. QT was above the 95% upper limit for the control subjects in the plot of measured QT against RR interval in 21.4% (17.3–25.5) of diabetic patients, 26.6% (17.7–35.5) of DAN+, 19.3% (14.7–23.9) of DAN‐. No correlation was found between QT interval and age or disease duration. The prevalence of QT prolongation was higher in diabetic patients than in control subjects and in DAN+ than in DAN‐.
The Toxic Effects of Serum from Patients with Type 1 Diabetes Mellitus on Mouse Neuroblastoma Cells: A New Mechanism for Development of Diabetic Autonomic Neuropathy
Authors: Pittenger G.L. , Liuy D. , Vinik A.I.
Published: July 2009

The pathogenesis of diabetic neuropathy is incompletely understood. The possibility that humoral neurotoxic factors contribute as a cause of diabetic neuropathy was tested by application of serum from patients with Type 1 and Type 2 diabetes to mouse neuroblastoma cells, which have the characteristics of adrenergic neurons in culture. Serum from patients with Type 1 diabetes and somatic neuropathy significantly inhibited both proliferation and differentiation of neuroblastoma cells, while serum from patients with Type 1 diabetes but no symptoms of neuropathy and patients with Type 2 diabetes and neuropathy had no effect on proliferation, and serum from Type 2 patients only marginally inhibited differentiation. The effects of Type 1 diabetic serum could be reversed by pre‐absorption of the serum to neuroblastoma cells, and were independent of glucose levels. Immunoglobulins precipitated from the sera mimicked the effects of whole sera. These results suggest that Type 1 diabetes mellitus causes a change in serum composition, possibly related to autoimmunity, that is capable of contributing to adrenergic autonomic neuropathy in diabetic patients.
Physiological, Symptomatic and Hormonal Responses to Acute Hypoglycaemia in Type 1 Diabetic Patients with Autonomic Neuropathy
Authors: Hepburn D.A. , MacLeod K.M. , Frier B.M.
Published: July 2009

The effects of peripheral autonomic neuropathy on the symptomatic, physiological, and hormonal responses to acute insulin‐induced hypoglycaemia were studied in two groups of patients with Type 1 diabetes, matched for age, duration of diabetes, and prevailing glycaemic control. A group of eight patients who gave a history of normal awareness of hypoglycaemia and had normal cardiovascular autonomic function tests were compared to a group of six patients who had symptoms of autonomic dysfunction and gross abnormalities of cardiovascular autonomic function tests. An additional two patients with autonomic neuropathy who also had hypoglycaemia unawareness were studied. Acute hypoglycaemia was induced by intravenous infusion of insulin (2.5 ***mU kg−1 min−1) and the onset of the acute autonomic reaction (R) was identified objectively by the sudden rise in heart rate and onset of sweating. Cognitive function and hypoglycaemia symptom scores were estimated serially, and plasma counterregulatory hormones were measured. Acute autonomic activation was observed to occur in all subjects in response to hypoglycaemia and commenced at similar venous plasma glucose concentrations in both groups (neuropathic patients: 1.6 ± 0.2 mmol I−1 vs non‐neuropathic patients 1.6 ± 0.2 mmol I−1, p = 0.9,). In the neuropathic patients plasma adrenaline responses were significantly lower at all time points from time R until time R + 30 min (MANOVA for repeated measures, F = 19.4, p < 0.001). The total autonomic symptom score at R was slightly lower in the neuropathic patients (12 (8–12) median (range)) but was not significantly different from the non‐neuropathic patients (14 (10–26), p = 0.10), and the total neuroglycopenic symptom scores were very similar (neuropathic group: 11 (6–21) vs non‐neuropathic group: 11.5 (6–22), p = 0.95). Although some of the autonomic responses were lower, but not significantly so, in the patients with autonomic neuropathy this study suggests that peripheral autonomic neuropathy is not the principal cause of hypoglycaemia unawareness in patients with Type 1 diabetes.
Education and Employment for Young People with Diabetes
Authors: Robinson N. , Stevens L.K. , Protopapa L.E.
Published: July 2009

Educational achievements and employment experiences were examined using a postal questionnaire in a random sample of diabetic clinic attenders and non‐diabetic control subjects aged 16–21 years, selected from 13 different centres in Great Britain. A response rate of 63% and 42% for diabetic and control subjects, respectively, was obtained. The diabetic group experienced a significantly greater number of health difficulties and problems at school (compared with their control group (21% vs 11%, p = 0.01) and there was a significant difference in perceived useful careers advice obtained at school for the two groups (5% vs 59%, p < 0.0001, diabetic and control groups, respectively). There was no difference in the number of General Certificates of Secondary Education (GCSEs) and Advanced (A) level qualifications obtained between the two groups. Of the young people who had left school, diabetic adolescents were significantly more likely to report having lost their jobs than their non‐diabetic counterparts (19% vs 6%, p = 0.002). The diabetic group were also more likely to report that they were unable to do the job they wanted compared with the non‐diabetic group (28% vs 16%, p = 0.005) and were more likely to report shift work problems (41% vs 12%, p = 0.04). With the increasing rate of unemployment it is important that youngsters with diabetes obtain specific diabetes‐orientated vocational guidance in order to plan their careers and provision should be made for this in educational establishments.
A Prospective Study of Sensory Function in Patients with Type 2 Diabetes
Authors: Sosenko JM , Kato M. , Soto R. , Bild DE
Published: July 2009

Sensory function was prospectively examined in 201 Type 2 diabetic patients over a 2‐year period. Quantitative sensory testing for vibration, cool, warm, and pressure perception at the hallux was performed at baseline, 1‐month, 1‐year, and 2‐year visits. There were statistically significant increments of thresholds for all sensory modalities from the baseline visit to the 1‐year visit (p < 0.001) and from the 1‐year visit to the 2‐year visit (p < 0.001). Thirty percent of 77 subjects considered to be at low risk for foot ulceration at baseline progressed to a higher risk category at the 2‐year visit. There were no significant differences in mean glycosylated haemoglobin, height, sex distribution, age, or diabetes duration when patients who had a faster progression of insensitivity were compared with patients who had a slower progression. There was a high degree of autocorrelation between baseline and 2‐year visits for all sensory modalities (r = 0.83 to r = 0.88, p < 0.001 for all). Also, changes in sensory thresholds from the baseline to 2‐year visits for one modality tended to correlate with other modalities (r = 0.36 to r = 0.70, p < 0.001 for all). These data indicate that an appreciable proportion of Type 2 diabetic patients are at risk for a marked rate of decline of sensory function, and suggest a need for at least yearly quantitative sensory testing.
Overt Diabetic Neuropathy: Repair of Axo‐glial Dysjunction and Axonal Atrophy by Aldose Reductase Inhibition and its Correlation to Improvement in Nerve Conduction Velocity
Authors: Sima A.A.F. , Prashar A. , Nathaniel V. , Bril V. , Werb M.R. , Greene D.A.
Published: July 2009

Clinically overt diabetic neuropathy is characterized by neuroanatomical changes of the node of Ranvier and myelinated axons, and by decreased nerve conduction velocity. Sural nerve biopsies were obtained from 16 neuropathic diabetic patients participating in a 12‐month randomized, placebo‐controlled, double‐blind clinical trial of the aldose reductase inhibitor sorbinil. One sural nerve biopsy was obtained at baseline and a second biopsy at the termination of the trial. Ten sorbinil‐treated patients showed significant improvement in axo‐glial dysjunction, a characteristic lesion of the node of Ranvier. Axonal atrophy assessed by three independent morphometric techniques also exhibited significant recovery in the sorbinil‐treated patients. No change was demonstrated in any of these structural parameters in six placebo‐treated patients. The improvement in sural nerve conduction velocity in sorbinil‐treated patients correlated with the product of the quantitative improvements in axo‐glial dysjunction and axonal atrophy. We conclude that the activated polyol‐pathway plays a sustaining role in nerve fibre damage in diabetic neuropathy, and that structural lesions such as axo‐glial dysjunction and axonal atrophy which are reversible following intervention with an aldose reductase inhibitor, constitute the morphological basis for nerve conduction slowing in overt diabetic neuropathy.
Insulin Insensitivity is Associated with a Decrease in Postprandial Thermogenesis in Normal Pregnancy
Authors: Robinson S. , Viira J. , Learner J. , Chan S.‐P. , Anyaoku V. , Beard R.W. , Johnston D.G.
Published: July 2009

Insulin sensitivity and postprandial thermogenesis were investigated at various stages of pregnancy to assess if changes in insulin sensitivity contribute to energy conservation during pregnancy. Cross‐sectional and longitudinal studies were undertaken. Sixteen control non‐pregnant women were compared with 10 women in the second trimester (2nd) and thirteen women in the third trimester (3rd) of uncomplicated pregnancy. Six women were studied at all three time points. The slope of plasma glucose decline following a bolus of intravenous insulin was used as an index of insulin sensitivity. Resting energy expenditure was measured with continuous indirect calorimetry. Postprandial thermogenesis was measured as the change in energy expenditure for the 2 h after a mixed meal. Results are expressed as mean ± SEM or median (interquartile range). Insulin sensitivity was lower as pregnancy progressed (non‐pregnant control 181 (177–205) vs 2nd 111 (100–112) vs 3rd 96 (80–109) μmol l−1 min−1, p < 0.001). Fasting insulin levels were significantly higher in the third trimester but not in the second trimester (non‐pregnant control 1.9 (1.5–6.0) vs 2nd 3.1 (2.8–5.2) vs 3rd 8.6 (4.8–9.7) mU l−1, p < 0.05). Meal stimulated insulin levels were higher in the second and third trimesters compared to non‐pregnant women (insulin area over 2 h, postmeal, non‐pregnant control 78 ± 10 vs 2nd 92 ± 14 vs 3rd 145 ± 14 mU l−1 h−1, p < 0.005). Postprandial thermogenesis was lowest in the third trimester (non‐pregnant control 103 ± 5 vs 2nd 74 ± 8 vs 3rd 48 ± 8 kJ, p < 0.01). In pregnancy insulin sensitivity correlated positively with postprandial thermogenesis (r = +0.57 p < 0.02). Insulin insensitivity is present in the second trimester and increases in the third trimester of normal pregnancy. Postprandial thermogenesis is reduced in pregnancy and correlates positively with insulin sensitivity. Insulin insensitivity may play an important physiological role in limiting the energy demands of pregnancy.
Use of Fructosamine and Glycated Haemoglobin to Verify Self Blood Glucose Monitoring Data in Diabetic Pregnancy
Authors: Parfitt V.J , Clark J.D.A. , Turner G. M. , Hartog M.
Published: July 2009

Relationships between fructosamine and HbA1, and mean blood glucose over the previous 1–8 weeks, determined from self blood glucose monitoring with memory meters, were studied prospectively throughout 16 pregnancies in Type 1 diabetic women. Fructosamine correlated best (Spearman rank) with mean blood glucose over the previous 2 weeks in the first and second trimesters (0.5) and over the previous 1 week in the third trimester (0.39). HbA1 correlated best with mean blood glucose over the previous 8 weeks in the first and second trimesters (0.56), but over the previous 2 weeks in the third trimester (0.524) probably because of increased erythropoeisis in late pregnancy. From Deming regression models, 95% prediction intervals for mean blood glucose for fructosamine and HbA1 values were calculated, showing that fructosamine predicted levels of mean blood glucose more precisely than HbA1. These intervals can be used to estimate an individual pregnant diabetic woman's mean blood glucose from her fructosamine or HbA1 results and to verify self blood glucose monitoring data. In well‐controlled diabetic pregnancy, both fructosamine and HbA1 reliably indicated trends in blood glucose but fructosamine estimated blood glucose levels more precisely.
Diabetes Education: An Asian Perspective
Authors: Wilson E. , Wardle E.V. , Chandel P. , Walford S.
Published: July 2009

Asian diabetic patients often lack knowledge about diabetes and self‐management of the disease due to difficulties in communication. The introduction of a diabetes education programme specifically for Asian patients has resolved many of the communication problems, provided education which Asian patients could understand, and raised awareness of diabetes within the Asian community. Forty‐eight percent of Asian patients were unable to read, while only 26 % spoke and 20 % read English, emphasizing the need for education in Asian languages using oral and visual teaching methods. Cultural differences were identified such as the use of alternative therapy to supplement treatment (33 %) and the large number of vegetarians (61%). Public awareness of diabetes in the Asian community was increased by providing health education at social venues. The provision of diabetes education designed for the needs of Asian patients is essential to improve the quality of life and life expectancy of these patients.
Use of Insulin for 50 Years or More in North Canterbury, New Zealand
Authors: Lunt H. , Brown L.J. , Lake W.P. , Hegan K.L.
Published: July 2009

Previous reviews of diabetic subjects using insulin for 50 years or more have been based on clinic populations or on individuals receiving medals to mark this achievement. We interviewed all 11 subjects who had been on insulin for 50 years or more, identified from a population‐based register of insulin users in North Canterbury, New Zealand. Seven of the 11 subjects had required treatment for micro‐ or macrovascular disease, but the functional level of the majority of survivors was nevertheless high. Diabetes had a major social impact on only one of the subjects interviewed.
Smoking in Diabetic Teenagers
Authors: Shaw N.J. , McClure R.J. , Kerr S. , Lawton K. , Smith C.S.
Published: July 2009

The prevalence of smoking amongst a group of 77 diabetic teenagers aged 11–18 years attending two paediatric clinics was determined using a questionnaire and urine cotinine assay. Five individuals were identified as definite smokers with two further individuals being probable smokers, all of whom were aged 15 years or more. This low prevalence (9%) is in contrast to a 48% prevalence in a young adult diabetic clinic. Many diabetic teenagers appear to acquire a regular smoking habit after leaving the paediatric clinic so it is important that health education is targeted at this group.
Insulin Deficiency Rather Than Hyperinsulinaemia in Newly Diagnosed Type 2 Diabetes Mellitus
Authors: Davies M.J. , Metcalfe J. , Gray I.P. , Day J.L. , Hales C.N.
Published: July 2009

This paper reports beta cell function as assessed during OGTT using specific IRMAs for insulin, intact and 32/33 split proinsulin in subjects with newly diagnosed Type 2 diabetes matched to normal controls. The relationships between insulin and the proinsulins to risk factors for cardiovascular disease were also examined. Similar fasting insulin concentrations but lower 30‐min post‐glucose‐load insulin concentrations were found in diabetic subjects (mean ± SEM 143 ± 12 pmol−1 vs 304 ± 19 (p < 0.001). Subjects with diabetes had increased fasting intact (10.6 ± 1.1 pmol−1 vs 3.3 ± 0.2, p < 0.001) and 32/33 split proinsulin concentrations (8.1 ± 0.9 pmol−1 vs 2.2 ± 0.3, p < 0.0001). Beta cell dysfunction, as expressed by a reduction in the 30‐min insulin to glucose ratio (9.4 ± 1 vs 34.8 ± 2.3, p < 0.0001) and an increase in the fasting percentage of total proinsulin‐like to total insulin‐like molecules (24.5 ± 9% vs 11.6 ± 5, p < 0.001), was present in subjects with diabetes. In diabetic subjects beta cell dysfunction and insulin deficiency increased relative to the degree of fasting hyperglycaemia. It seems clear that beta cell dysfunction and insulin deficiency are major features of Type 2 diabetes. Only the fasting concentration of 32/33 split proinsulin positively correlated with both the waist/hip ratio (r = 0.36, p < 0.001), diastolic blood pressure (r = 0.23, p < 0.01) in addition to plasma triglyceride concentration (r = 0.46, p < 0.001). It is questionable whether hyperinsulinaemia plays a pathogenic role in cardiovascular disease in subjects with glucose intolerance.
Plasma Concentrations of Islet Amyloid Polypeptide After Glucagon Administration in Type 2 Diabetic Patients and Non‐diabetic Subjects
Authors: van Jaarsveld B.C. , Hackeng W.H.L. , Lips C.J.M. , Erkelens D.W.
Published: July 2009

Islet amyloid polypeptide (IAPP) is the main constituent of pancreatic islet amyloid, observed in the pancreases from patients with Type 2 diabetes mellitus. IAPP is synthesized by the pancreatic β‐cells. In order to study the secretion characteristics of IAPP in Type 2 diabetes mellitus, plasma IAPP was measured during a provocation test with glucagon in 33 Type 2 diabetic patients and 18 non‐diabetic subjects. The median fasting IAPP level was 5.7 (range 1.1–13.1) pmol l−1 in the 27 patients treated with oral hypoglycaemic agents and 2.7 (1.9–5.9) in the 6 patients on insulin. In the non‐diabetic group fasting IAPP was 5.7 (2.2–10.1). Six minutes after glucagon administration median IAPP rose to 9.4 (1.7–31.0) and 6.1 (5.1–10.2) in the respective diabetic groups, and to 16.8 (4.0–41.0) in the non‐diabetic subjects (p 0.05). The correlation coefficient between change in IAPP and change in C‐peptide was 0.68 in the diabetic group. We conclude that intravenous administration of glucagon stimulates IAPP release from the β‐cell. This provocation test is easy to perform and can be used on a large scale in the study of IAPP secretion in Type 2 diabetes mellitus.
High Prevalence of Diabetes in Chronic Leg Ulcer Patients: a Cross‐sectional Population Study
Authors: Nelzén O. , Bergqvist D. , Lindhagen A.
Published: July 2009

In a cross‐sectional survey, designed to detect all patients with current chronic leg ulcers, 27% of the patients had diabetes mellitus. The outcome for the 104 examined diabetic patients has been evaluated and compared with the 278 nondiabetic patients. The purpose was to establish the prevalence of leg ulcers among diabetic patients and to assess potential causes. The point prevalence was calculated by extrapolating the leg ulcer frequency to the total diabetic population in the studied area. The point prevalence for active leg ulcers (including foot ulcers) in diabetic patients was 3.5% (95% CI 2.8–4.2). Ulcers above the malleoli were almost as common as foot ulcers. Peripheral vascular disease was present in 67% of all ulcerated legs in patients with diabetes compared to 42% in nondiabetic patients (p < 0.001). In 72% of foot ulcers in diabetic patients arterial impairment was judged to be a contributing aetiological factor and in nondiabetic patients 45% (p < 0.001). Ulcers solely attributed to possible neuropathy were less common (15%). Ulcers with multifactorial causes were common above the malleoli. This survey has given the size of the problem and indicates macroangiopathy to be the dominating factor responsible for slow or nonhealing ulcers in diabetic patients. Objective assessment of arterial circulation is mandatory and signs of arterial impairment require consultation with a vascular surgeon.
A Simple Economic Evaluation Model for Selecting Diabetes Health Care Strategies
Authors: Gagliardino J.J. , Olivera E.M. , Barragàn H. , Puppo R.A.
Published: July 2009

The aim of this work was to develop a simple model to evaluate the health care cost of diabetes in order to help decision‐makers in selecting strategies for the prevention, control, and treatment of the disease. The model assesses the cost of full coverage of health care of diabetic patients free of chronic complications and in comparison with those of the treatment of acute and chronic complications. For that purpose, standardized cost figures were obtained from both annual control and treatment of uncomplicated diabetic patients and the treatment of one episode of ketoacidosis, acute myocardial infarction, and amputation of two toes. The treatment/prevention cost ratio obtained showed that prevention of a single episode of any of these late‐complication‐related events would provide enough funds to cover either the total or partial annual cost of control and treatment of several uncomplicated diabetic patients. These facts would favour the allocation of funds in such a way as to allow adequate control and treatment of diabetic patients to keep them free of the chronic complications of the disease. This would be a wise investment of funds, which would result in a reduction in the socioeconomic cost of the disease and in a better quality of life for the diabetic patients and their families.
Diabetes Mellitus and Employment: Survey of a New Zealand Workforce
Authors: Baker J. , Scragg R. , Metcalf P. , Dryson E.
Published: July 2009

A cross‐sectional survey of a 5670 multiracial New Zealand workforce aged >40 years was used to determine the health status of people with diabetes mellitus in employment. One hundred and two workers (73 men, 29 women) had known diabetes mellitus (prevalence of 1.8%) of whom 91 individuals (89.2%) had Type 2 diabetes. Mean age of diabetic workers was 51.1 ± 5.6 (SD) years and median duration of disease was 5.0 (range 0–51) years. Most subjects were asymptomatic, although only 31.4% of diabetic workers had fasting glucose concentrations and 35.5% had fructosamine concentrations within the mean ± 2SD range of a matched control group. Moreover, 22.5% of diabetic participants had fasting hypertriglyceridaemia and 21.6% had microalbuminuria. Ethnicity (non‐European vs European) and lack of insulin therapy were the most important predictors of poor glycaemic control. We advocate more aggressive therapy with insulin and with culturally sensitive education programmes to avert long‐term macrovascular complications.
Diabetes Mellitus and Employment: Is there Discrimination in the Workplace?
Authors: Baker J. , Scragg R. , Metcalf P. , Dryson E.
Published: July 2009

The employment record of 102 diabetic workers (73 men, 29 women), identified in a cross‐sectional survey of 5670 middle‐aged people in a New Zealand workforce, was studied for evidence of discrimination in the workplace. Compared with 403 matched controls (292 men, 111 women), diabetic workers showed no significant differences in socioeconomic status, educational attainment, or distribution between occupational groups. Similarly, mean duration of current employment (12.3 vs 12.4 years), mean number of jobs in the past 5 years (1.25 vs 1.34 jobs), frequency of sickness absence, and mean number of hours worked each week (43.5 vs 43.3h) did not differ significantly between diabetic and non‐diabetic groups. We found no significant differences in work stress, even among those diabetic individuals with poor blood glucose control. There was no convincing evidence across a broad spectrum of industry that diabetic workers did suffer discrimination in the workplace.
A Single Visit Diabetes Complication Assessment Service: a Complement to Diabetes Management at the Primary Care Level
Authors: McGill M. , Molyneaux L.M. , Yue D.K. , Turtle J.R.
Published: July 2009

Modern diabetes management emphasizes the early detection and prompt treatment of diabetic complications. However it is difficult to organize comprehensive screening at the primary care level. To address this problem we established a complication assessment service whereby all the major diabetes‐specific complications were assessed in a single 3 h visit. A report with results and recommendations was sent to the general practitioner (GP). Being philosophically a complication‐specific service, no attempt was made to intervene with metabolic management. This paper describes our experience with the first 743 patients of whom 92% had been referred from GPs. Of the diabetes‐specific complications, 22% of patients had one, 5% had two, and 1% had three major complications. Many of the patients were unaware of the presence of these complications. One hundred and three people had attended the service on more than one occasion with an average time between visits of 1.7 years. The results demonstrated that GPs were very good at following a recommendation to refer a patient for ophthalmic assessment (85% of cases) and improving hypertension but were less successful in treating hyperlipidaemia. This service has proven to be an excellent forum for the collection of data and the teaching of health professionals. It is a move away from the traditional format of hospital‐based clinics providing comprehensive diabetes management.
Monitoring the Targets of the St Vincent Declaration and the Implementation of Quality Management in Diabetes Care: the DiabCare Initiative
Authors: Piwernetz K. , Home P.D. , Snorgaard O. , Antsiferov M. , Staehr‐Johansen K. , Krans M. ,   DiabCare Monitoring Group of the St Vincent Declaration Steering Committee
Published: July 2009

The St Vincent Declaration, a joint initiative on diabetes care and research of the World Health Organization (Europe) and the International Diabetes Federation (Europe), includes 5‐year targets for improvement in diabetes outcomes as a central tenet. Accordingly, the establishment of state of the art monitoring and control systems is urged as a basis for the implementation of quality management. As a prerequisite for both targets, a diabetes dataset (fields and definitions) has been agreed to allow common monitoring of diabetes throughout Europe. This dataset has been further developed as the foundation stone of DiabCare, an initiative for continuous quality development in diabetes care. In a formal consensus process using the Delphi method, over 130 European diabetologists from 21 countries contributed to the development of this dataset, which includes fields covering true patient outcomes, intermediate metabolic outcomes, markers of diabetes tissue damage, risk factors, pregnancy, and life‐style. The tools for documentation of the quality of health status have been developed in three formats for use in different health care settings. These tools, the DiabCare Diabetes Dataset, the DiabCare Basic Information Sheet, and the DiabCare Computer Program, are designed to allow local feedback‐driven improvement in the quality of care, but are also the subject of communication protocols to compare performance between centres, regions, and countries. Whether implemented with or without the benefits of modern information technology, these initiatives can be the basis for both monitoring the targets of the St Vincent Declaration and for implementation of continuing quality development in diabetes care.