bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship of Body Fat Distribution Pattern to Atherogenic Risk Factors in NIDDM: Preliminary Results
Authors: Gaal Luc Van , Rillaerts Eddy , Creten Wouter , Leeuw Ivo De
Published: March 2007

Because recent knowledge indicates that the distribution of fat deposits in men may be a better predictor of cardiovascular disease than the degree of obesity alone, some risk factors for atherosclerosis were evaluated in 51 middle-aged men with non-insulin-dependent diabetes mellitus. Abdominal adiposity (waist/hip ratio, WHR) was related to parameters of metabolic control, lipid parameters, and known vascular complications in three different groups. In groups with abdominal obesity, mean annual hemoglobin A1 was significantly (P < .01) higher than in patients without an abdominal fat distribution. Atherogenic index was significantly increased in the group with the highest WHR and highdensity lipoprotein cholesterol (HDL-chol) levels were significantly decreased in both groups with upper-body fat distribution. The frequency of peripheral vascular disease, coronary ischemic heart disease, and hypertension was most prominent in diabetic subjects with an abdominal fat mass distribution. A highly significant (P < .001) correlation was present between WHR and HDL-chol and WHR and the total-cholesterol/ HDL-chol ratio; this significant correlation remains after correction for body mass index. A similar correlation could be found between WHR and systolic and diastolic blood pressures. These results demonstrate an association of excess abdominal fat, even without manifest obesity, with worse diabetes metabolic control, cardiovascular complications, and blood lipid levels actually considered to play an important role in atherogenesis.
Randomized Controlled Trial of Topical Hyperbaric Oxygen for Treatment of Diabetic Foot Ulcers
Authors: Leslie Camilo A , Sapico Francisco L , Ginunas Virginia J , Adkins Rodney H
Published: March 2007

The effect of 2 wk of topical hyperbaric oxygen (THO) treatment on the healing of diabetic foot ulcers without associated gangrene was evaluated in a prospective, controlled, and randomized manner in 28 patients. There were 12 patients in the THO group (group 1) and 16 in the control group (group 2). Clinical management of the two patient groups was similar except for THO treatment in the group 1 patients. Clinical parameters, including age, sex, baseline fasting serum glucose levels, duration of diabetes mellitus, duration of foot ulcers, presence of peripheral neuropathy or arterial insufficiency, and evidence of osteomyelitis as determined by radiographs and/or radionuclide scans, were comparable in both groups of patients. No statistical differences (Student's t test) were seen in the number of microorganisms isolated from curettage cultures of the base of the ulcer at days 0, 7, and 14 of the study between groups 1 and 2. In contrast to previous studies, there was a paucity of anaerobic microorganisms isolated from these foot ulcers without associated gangrenous changes. Ulcer areas were estimated by multiplying the maximum width by the maximum length in millimeters at days 0, 7, and 14. Analysis of variance and Student's t test revealed progressive significant reductions in the ulcer areas in both groups when days 0, 7, and 14 were compared and in ulcer depths in both groups when days 0 and 14 were compared. However, such ulcer size changes did not differ statistically between the control and THO groups. A trend toward slower healing was observed in the From the THO group. Healing of diabetic foot ulcers was not accelerated by THO in this study.
Effect of Hematocrit Concentration on Blood Glucose Value Determined on Glucometer II
Authors: Barreau Peter B , Buttery Joseph E
Published: March 2007

Nineteen patient blood samples each with modified hematocrit concentrations of ∼20, 30, 40, 50, and 60%, were assayed for their glucose concentration by the Glucometer II. Blood removal from the test strip was by the one- and two-blot techniques. The reference method was the Yellow Springs Instruments (YSI) blood glucose analyzer. Glucometer II results were falsely high for the single blot (13–59%, mean 33%) and double blot (12–41%, mean 19%) at 20% hematocrit and falsely low at 60% hematocrit for the single blot (22–44%, mean 37%) and the double blot (26–49%, mean 43%). At 40- 50% hematocrit, Glucometer II and YSI results agreed only for the one-blot technique.
Dietary Fiber in Management of Diabetes
Authors: Vinik Aaron I , Jenkins David J A
Published: March 2007

Current evidence suggests that high-fiber diets, especially of the soluble variety, and soluble fiber supplements may offer some improvement in carbohydrate metabolism, lower total cholesterol and low-density lipoprotein (LDL) cholesterol, and have other beneficial effects in patients with non-insulindependent diabetes mellitus (NIDDM). Diets enriched with wheat bran and guar gum induce 10–20% reductions in serum cholesterol and LDL in both normoand hypercholesterolemic subjects and have the ability to blunt the hypertriglyceridemic effects of diets high in carbohydrate and low in fiber. In insulin-dependent diabetes mellitus (IDDM) the situation is less clear, but a decrement of the circadian glucose profile has been shown. Americans, in general, consume too little fiber. With the need to restrict fat and reduce protein, an increase in carbohydrates is mandatory. A practical goal would be to establish the present level of fiber intake (15–30 g/day) and to gradually increase it. An intake of up to 40 g of fiber per day or 25 g/1000 kcal of food intake appears beneficial; in many individuals on weight-reducing diets higher levels may be unacceptable because of gastrointestinal side effects. The level of maximum benefit has not been determined. Fiber supplementation appears beneficial only if given with a diet comprising approximately half of the calories as carbohydrate. Foods should be selected with moderate to high amounts of dietary fiber from a wide variety of choices to include both soluble and insoluble types of fiber. Insufficient data are available on the long-term safety of high-fiber supplements. People at risk for deficiencies, such as postmenopausal women, the elderly, or growing children, may require supplements of calcium and trace minerals. People with upper gastrointestinal dysfunction are at risk of bezoar formation and cautioned against a diet high in fiber of the leafy vegetable type. Careful attention must be paid to insulin dose because hypoglycemia can result if there is a radical change in fiber intake and insulin dose is not reduced appropriately. Care must be exercised in the use of “novel” fibers, including the wood celluloses, because little is known of their safety and efficacy.
Diet Therapy for Minority Patients With Diabetes
Authors: Gohdes Dorothy
Published: March 2007

The opinions expressed in this paper are those of the author and do not necessarily reflect the views of the Indian Health Service Diet therapy for minority diabetic patients must be directed to NIDDM, the most prominent form of diabetes in minority populations. Diet programs must be tailored to the cultural framework, and traditional foods with desirable characteristics can be encouraged. To teach patients about diet, educators must use educational techniques appropriate to culture and literacy of the patient and family. Single-concept messages such as “eat less fat” or “eat less food” promote learning and minimize failure. Nutrition information can be divided into sequenced manageable steps that can then be individualized to the patient's setting. No single set of exchange lists will suffice for all minority groups, nor are exchange lists themselves appropriate for all situations. To meet the needs of minority patients, nutrition educators must use a variety of tools and techniques relating to the foods of a particular ethnic group. Sound education strategies and simplified materials for NIDDM patients should also be employed.
Effect of Fat-Free Diet on Insulin Requirements in Type I Diabetes Controlled With Artificial β-Cell
Authors: Dunn Fredrick L , Carroll Patricia B
Published: March 2007

We investigated the effect of eliminating calories derived from fat sources on postprandial and basal insulin requirements in five patients with type I (insulindependent) diabetes mellitus. The patients were studied on a metabolic ward on two solid-food diets with similar quantities of carbohydrate and protein with or without the addition of fat. Diet A was isocaloric (weight maintenance) with calories distributed as 45% carbohydrate, 15% protein, and 40% fat. Diet B contained the same carbohydrate and protein content as diet A but was virtually fat free and therefore hypocaloric (1233 ± 106 vs. 1830 ± 99 cal, mean ± SE). The diets were given as five equal meals each day on consecutive days. Insulin requirements and blood glucose measurements were determined by use of the artificial p-cell. During the study, mean (± SE) preprandial blood glucose levels were maintained at 85 ± 11 mg/dl, and peak postprandial blood glucose levels were <180 mg/dl. The elimination of fat calories had no effect on total (68.9 ± 10.3 vs. 69.3 ± 4.9 U /day), postprandial (9.8 ± 3.8 vs. 10.3 ± 3.7 U/meal), or basal (1.9 ± 0.2 vs. 1.8 ± 0.2 U/h) insulin requirements. Thus, despite a hypocaloric diet, no change in insulin requirements was noted when fat-derived calories were deleted from the diet. We conclude that fat-derived calories do not alter short-term basal or postprandial insulin requirements in type I diabetes.
Primary Prevention of Diabetes Mellitus
Authors: Zimmet Paul Z
Published: March 2007

Two-thirds of all deaths in developed countries are caused by the major noncommunicable diseases, e.g., cardiovascular disease, cancer, and non-insulindependent diabetes mellitus (NIDDM). There is increasing evidence that these diseases are a consequence of life-style change, and they have a number of risk factors in common. Primary prevention of both insulin-dependent diabetes mellitus (IDDM) and NIDDM has become increasingly important because of their significant morbidity and mortality and the human and economic costs associated with diabetes and its complications. Prevention of the two major forms of diabetes, IDDM and NIDDM, are quite separate issues. The former appears to be an autoimmune disorder, whereas the latter should be considered along with other life-style-related noncommunicable diseases. The primary prevention of NIDDM appears to offer the greatest promise of success. The uncertainty that still exists as to the role of obesity and other risk factors in the development of NIDDM gives support to a multiple-risk-factor intervention approach (through a healthy life-style strategy) for NIDDM prevention.
Glucagon-Stimulated and Postprandial Plasma C-Peptide Values as Measures of Insulin Secretory Capacity
Authors: Koskinen Pertti J , Viikari Jorma SA , Irjala Kerttu MA
Published: March 2007

Basal, postprandial (2 h after breakfast), and glucagonstimulated plasma C-peptide concentrations were determined in a group of 36 adult diabetic patients. Basal and postprandial C-peptide values were measured on consecutive days to estimate the degree of variation of C-peptide secretion. In a subgroup of 15 diabetic patients treated chronically with diet and oral hypoglycemic agents (sulfonylureas or a combination of sulfonylureas and metformin), we studied whether administration of sulfonylureas immediately before breakfast had any effect on postprandial C-peptide values. Absolute differences between two consecutive fasting C-peptide concentrations in insulin-requiring patients were <0.1 nM in all but 1 patient, in whom the difference was 0.18 nM. In subjects treated with oral hypoglycemic agents the median difference was 0.12 nM (range 0-0.38 nM). Absolute differences between two consecutive postprandial C-peptide concentrations were all <0.1 nM in insulin-requiring patients. No significant difference was found between postprandial C-peptide concentrations with or without preceding administration of oral hypoglycemic agents (medians 1.35 and 1.30 nM, respectively). Glucagon-stimulated C-peptide concentrations were somewhat higher than the postprandial values. However, equal discrimination between insulin-requiring and non-insulin-requiring diabetic patients was found by measuring postprandial or glucagon-stimulated C-peptide concentrations.
Social Environment and Regimen Adherence Among Type II Diabetic Patients
Authors: Glasgow Russell E , Toobert Deborah J
Published: March 2007

We investigated the reliability and predictive validity of several measures of the social environment using a sample of 127 adults with type II (non-insulindependent) diabetes. Of particular interest was a revised scale of family support for performing diabetes self-care behaviors. Across four different aspects of the diabetes regimen, it was consistently found that regimen-specific measures of family support differentiated subjects who were low, medium, or high on adherence better than global family-support scores. Social-environment measures were generally successful in predicting a subject's level of regimen adherence after accounting for variance attributable to demographic factors. The family-support measures were the strongest and most consistent predictors of adherence, but measures of stress and medical-care satisfaction and the interaction between stress and the other social-environment measures also often improved the prediction of a subject's adherence status. These results support the usefulness of measures of the social environment specific to diabetes, and research to investigate other aspects of the social context of regimen adherence is recommended.
Early Detection of Neurological Involvement in IDDM and NIDDM: Multimodal Evoked Potentials Versus Metabolic Control
Authors: Pozzessere Giuseppe , Rizzo Paolo A , Valle Elvira , Mollica Michele A , Meccia Augusta , Morano Susanna , Mario Umberto Di , Andreani Domenico , Morocutti Cristoforo
Published: March 2007

Clarification of the extent and mechanisms of damage to the central nervous system in diabetes is a frontier of current neurological research. Our aim was to obtain ample electrophysiological documentation of possible neurological abnormalities in both insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetic patients with a short duration of disease and without overt complications, taking into account metabolic control. Group 1 comprised 11 IDDM patients, and group 2 included 14 NIDDM patients treated with diet alone; the duration of disease was <4 yr, and no concomitant clinicalcomplications were present. Age and sex-matched normal subjects formed groups 3 and 4. Pattern visual evoked potentials (VEP), brain stem auditory evoked potentials (BAEP), and somatosensory evoked potentials (SEP; after the stimulation of both median and tibial nerves) were recorded in all subjects, and metabolic control was evaluated in terms of glycemia and glycosylated hemoglobin. In group 1, significant abnormalities were found in the latency values ofVEP, median SEP, and tibial SEP compared with control subjects. Similar latency abnormalities were shown in group 2 for VEP, median SEP, and tibial SEP values and for wave I latency of BAEP. Glycosylated hemoglobin values were correlated with BAEP and SEP abnormalities in many patients in both groups. Furthermore, in group 2, glycemic values correlated with SEP abnormalities. We therefore conclude that neurophysiological abnormalities are present at different levels in IDDM and NIDDM patients only a few years after clinical diagnosis and before the appearance of overt complications, and these abnormalities seem to be correlated with metabolic-control status.
Selective Insulin Action on Skin, Ovary, and Heart in Insulin-Resistant States
Authors: Geffner Mitchell E , Golde David W
Published: March 2007

States of hyperinsulinemia with resistance to insulin action on glucose disposal are frequently associated with proliferative tissue abnormalities of the skin (acanthosis nigricans), ovary, and heart. That insulin may be involved in the pathogenesis of these growth-related abnormalities despite resistance to its metabolic effects mediated through the insulin receptor issuggested by the known ability of high concentrations of insulin to stimulate DNA synthesis and cell proliferation in vitro through the insulin-like growth factor I (IGF-I) receptor. IGF-I receptors are present in skin keratinocytes, some ovarian tissue compartments, and in the heart. Furthermore, ovarian tissue from hyperinsulinemic insulin-resistant women responds to supraphysiologic insulin concentrations in vitro by enhanced steroidogenesis. Cultured, transformed T-lymphocytes from an infant with leprechaunism fail to augment basalcolony formation in response to physiologic insulin concentrations in vitro (compared to a doubling seen in normal subjects), but respond normally to supraphysiologic insulin concentrations, the effect of which is competitively inhibited by a monoclonal antibody to the IGF-I receptor. Thus, insulin action mediated through the IGF-I receptor may initiate growth-promoting tissue effects in the face of limited insulin effect on glucose metabolism. Such spillover actions may add to the morbidity associated with states of clinical insulin resistance.
Psychosocial Correlates of Survival in Diabetes
Authors: Davis Wayne K , Hess George E , Hiss Roland G
Published: March 2007

The goal of this research was to quantify therelationships between patient survival and a set of explanatory variables in a randomly selected sample of community-based patients with non-insulin-dependent diabetes mellitus (NIDDM). The sample included 343 patients with NIDDM initially entered into the study in 1981–1982 and reexamined in 1985–1986. Mortality data were collected on reexamination in 1985 and updated from death-certificate data through 1 January 1986. The data collected from the patients included demographic and clinical variables, psychosocial variables related to diabetes, measures of physiologic control, hospitalization, and mortality. The Cox proportionalhazards model was used to compute a hazard rate for each individual and to determine risk covariates. The results indicated that the variables most associated with the risk of mortality were patient age, social impact of diabetes, renal function, complexity of diet regimen, and history of smoking. Two of these variables (social impact and complexity of diet regimen) were obtained from the Diabetes Educational Profile completed by all patients on entry to the study. The five predictor variables were more closely related to mortality than diabetes control as measured by HbA1, previous hospital admissions, previous heart attacks, and other physiologic measures frequently used as outcome measures. The only physiologic predictor was renal function.
Self-Measurement of Blood Glucose: Accuracy of Self-Reported Data and Adherence to Recommended Regimen
Authors: Gonder-Frederick Linda A , Julian Diana M , Cox Daniel J , Clarke William L , Carter William R
Published: March 2007

Reflectance meters containing memory chips were used in a study that addressed several questions concerning routine use of self-monitoring of blood glucose (SMBG), including accuracy of patient blood glucose (BG) diaries, reliability of self-reported frequency of SMBG, and adherence to recommended SMBG regimen. Thirty adults with insulin-dependent diabetes used memory meters and recorded test results in diaries for 2 wk while performing their normal SMBG regimen. Analysis of glucose diaries showed that only 23% of the subjects had no diary errors and 47% had clinically accurate diaries (>10% error rate). The most common types of errors were omissions of values contained in meter memory and additions of values not contained in meter memory, with significantly more omissions than additions. Alterations of test values (e.g., changing a 300-mg/dl reading to 200 mg/dl) were extremely rare. There was no difference in the rate of errors that resulted in a more positive clinical profile (omitting unacceptable values and adding acceptable values) or a more negative clinical profile (omitting acceptable values and adding unacceptable values). Examination of the actual frequency of SMBG showed that most subjects (56.6%) measured their BG an average of two to three times each day. Self-report of SMBG frequency correlated with both actual frequency and HbA1. Although actual frequency of SMBG was not related to physicians' recommendations, the majority (64%) of subjects were self-testing as often or more often than they had been instructed.
Pattern of Treatment Among Diabetic Patients in France
Authors: Papoz Laure , Vauzelle Françoise , Vexiau Patrick , Cathelineau Gérard
Published: March 2007

Both the treatment pattern and the degree of metabolic control were estimated from a sample of 1172 French diabetic patients. The subjects were recruited from 80 medical-analysis laboratories scattered throughout the country, where they came for biologic blood sample tests. Patients had to be diagnosed as having diabetes, give consent for additional blood sampling, and fill out a short self-questionnaire. Glycosylated hemoglobin A1c (HbA1c) was centrally determined by liquid chromatography (normal range 3.5–6.3%). We found 135 patients (11.5%) who were not drug treated or treated with diet alone, 862 (73.5%) treated with oral agents, and 175 (15.0%) treated with insulin. Among the latter, 79 (6.7%) were defined as true insulin-dependent diabetes mellitus (IDDM) patients. Among patients receiving no drug or a slight dosage of oral agents, 47% were found to be in the normal range of HbA1c. On the other hand, among the patients intensively treated with oral agents or secondarily with insulin, less than half were under fair control (HbA1c <7.5%). These results are in agreement with previous estimates of treatment distribution derived from national drug sales data. They provide evidence regarding the particular features of diabetes in France, i.e., low prevalence of IDDM, low consumption of insulin, high consumption of oral agents. The finding of a large proportion of normal HbA1c values in non-insulin-dependent diabetic patients suggests a state of overdiagnosis linked to the use of nonspecific criteria of diagnosis in large-scale screening.
Pancreatic Transplantation as Treatment for IDDM: Proposed Candidate Criteria Before End-Stage Diabetic Nephropathy
Authors:   University of Michigan Pancreas Transplant Evaluation Committee
Published: March 2007

Most candidates for pancreatic transplantation have end-stage diabetic nephropathy (ESDN) and receive a pancreas transplant either sequential to or simultaneous with a renal transplant. Because ESDN is often associated with severe irreversible neurovascular complications, the selection of these candidates may defeat the intent of pancreatic transplantation, i.e., the reversal, stabilization, or retardation of neurovascular complications. Also, advanced neurovascular complications in these candidates may result in serious morbidity and mortality after pancreatic transplantation. Our multidisciplinary Pancreas Transplant Evaluation Committee has developed tentative candidate criteria for insulin-dependent diabetic patients before ESDN. With the proposed criteria, candidates are selected who have predictors of future morbidity and mortality but who do not yet demonstrate irreversible neurovascular complications and an inexorable general course of deterioration. As pancreatic transplantation becomes more successful, candidate criteria must be continually reassessed to better identify those who may obtain maximal benefit.
Comparison of Different Models of Diabetes Care on Compliance with Self-Monitoring of Blood Glucose by Memory Glucometer
Authors: Hoskins Penelope L , Alford Jan B , Handelsman David J , Yue Dennis K , Turtle John R
Published: March 2007

The modern management of diabetes relies heavily on self-monitoring of blood glucose (SMBG), and therefore SMBG records are an important source of clinical data for management decision making. The development of a memory Glucometer has provided the opportunity to verify the validity of glucose records thus generated and observe the effects of different educational approaches on compliance with SMBG. Thirty-four patients without previous experience of SMBG were randomized into one of the following experimental groups differing in the model of diabetes care: mutual decision making, didactic, and authoritarian. Patients, unaware of the memory capacity of the glucose meter, were required to perform four glucose measurements per day over a 14-day observation period. Patient-generated blood glucose records were then compared with objective records stored in the glucose-meter memory. Patients with gestational diabetes mellitus recorded a lower proportion of correct results (63 vs. 79%, P = .049) and exhibited a tendency to invent results with lower blood glucose levels (5.3 vs. 7.5 mM, P < .0001) than the results omitted compared with patients with non-insulin-dependent diabetes mellitus. Predictors of greater validity of records were perceived intelligence of the subject (χ2 = 4.56, P < .02) and private health-insurance status (χ2 = 4.52, P < .04), whereas the experimental group assignment was not significant. These findings reflect potential motivational and sociodemographic limitations in the validity of SMBG recordings within the management and education of patients with gestational and nongestational diabetes.
Hypoglycemic Convulsions Cause Serious Musculoskeletal Injuries in Patients With IDDM
Authors: Hepburn David A , Steel Judith M , Frier Brian M
Published: March 2007

Six diabetic patients are described who sustained serious musculoskeletal injuries during insulin-induced hypoglycemia. The convulsions were associated with nocturnal hypoglycemia, superoptimal glycemic control, pregnancy, hypoglycemic unawareness, or errors in selfmanagement.
Effect of Life-Style Activity of Varying Duration on Glycemic Control in Type II Diabetic Women
Authors: Paternostro-Bayles Madeline , Wing Rena R , Robertson Robert J
Published: March 2007

Life-style activities such as walking are often recommended for patientswith type II (non-insulindependent) diabetes. Because many of these patientsare overweight and sedentary, such low-intensity activity would appear most appropriate, especially during initial intervention. However, there has beenlittle research on the effects of low-intensity life-style activity on glycemic control. This study examined the effects of varying the duration (0, 20, or 40 min) of low-intensity exercise (50–55% of age-predicted max heart rate)on glycemic responses during exercise and a subsequent meal in type II diabetic patients. Glycemic response to exercise was significantly related to the duration of activity; 20 min of activity decreased blood glucose (BG) by 6 mg/dl, whereas 40 min decreased BG by 16 mg/dl. The effect of exercise on glucose was maintained over a 30-min rest period but disappeared after a meal was consumed. Insulin and the insulin-to-glucose ratio were not affected by the length of activity. These data suggest that life-style activity of long duration (20–40 min) produces a significant, but modest, decrease in glucose levels in type II diabetic women.
Metabolism of Cyclamate and Its Conversion to Cyclohexylamine
Authors: Collings Alan J
Published: March 2007

Since cyclamates were first introduced in the early 1950s, arguments have raged over the potential carcinogenicity of this artificial sweetener. Concern over the safety of cyclamates arises from observations that some individuals and experimental animals can metabolize cyclamate to cyclohexylamine and that cyclohexylamine has been shown to produce testicular atrophy in experimental animals. This study examines the absorption, excretion, and metabolism of cyclamate, particularly its conversion to cyclohexylamine. In addition, the potential toxicity and pharmacology of cyclohexylamine are discussed.
Maleness as Risk Factor for Slowly Progressive IDDM
Authors: Kobayashi Tetsuro , Nakanishi Koji , Sugimoto Tadao , Itoh Tokuji , Murase Toshio , Kosaka Kinori , Tsuji Kimiyoshi
Published: March 2007

The effect of sex on longitudinal changes in serum C-peptide immunoreactivity (CPR) response to the oral glucose tolerance test (OGTT) was examined up to 48 mo in 30 islet cell antibody-positive (ICA+), non-insulindependent diabetes mellitus (NIDDM) subjects (15 men, 15 women) who were matched for age, duration of diabetes, and mode of treatment. The subjects were recruited from 2858 NIDDM patients screened for ICA between 1980 and 1984. In male NIDDM subjects, CPR levels to OGTT decreased insidiously, and 8 of 15 men developed the insulin-dependent state with abolished CPR. Only 2 female NIDDM subjects progressed to the insulin-dependent state (P < .05, women vs. men). Thus, CPR in female subjects tended to decrease less than in male subjects. There were no significant differences between the two groups in human leukocyte antigens (HLA) or titer of ICA during the follow-up period. These results suggest that maleness is a major risk factor for slowly progressive β-cell dysfunction in adult-onset insulin-dependent diabetes mellitus (IDDM).
Colorado IDDM Registry: Lower Incidence of IDDM in Hispanics Comparison of Disease Characteristics and Care Patterns in Biethnic Population
Authors: Gay Elizabeth C , Hamman Richard F , Carosone-Link Phyllis J , Lezotte Dennis C , Cook Magdalena , Stroheker Robert , Klingensmith Georgeanna , Chase H Peter
Published: March 2007

The Colorado IDDM Registry identifies newly diagnosed cases of insulin-dependent diabetes mellitus (IDDM) throughout the state. Hispanics in Colorado are a racial mixture of American Indian and White populations. Because American Indians have a low risk of IDDM, and differing frequencies of HLA antigens and haplotypes are reported for Hispanics and non-Hispanics, we compared incidence rates and disease characteristics. Eligible participants were <18 yr of age and Colorado residents at time of diagnosis, diagnosed between 1 January 1978 and 31 December 1983, and on insulin within 2 wk of diagnosis. Subjects were reported by their physicians, and statewide validation of reporting was conducted through review of hospital discharge indexes. Incidence rates for Hispanics (n = 76) were significantly lower than those for non-Hispanics (n = 628), although 95% confidence intervals overlapped for children aged 10–17 yr. Age-adjusted rates were significantly lower in Hispanic than non- Hispanic males, whereas age-adjusted rates for females did not differ. The cumulative risk of IDDM was less for Hispanic males aged 0–17 yr than for non-Hispanic males (P < .001); cumulative risk among females was not different (P = .10). Clinical onset characteristics and medical care at diagnosis were similar. After diagnosis, hospitalizations per 100 person-yr appeared higher in Hispanics, but ketoacidosis and insulin reactions per 100 person-yr were similar. Difference in rate of hospitalizations may have been due to lower response rates among older non-Hispanics. From the data, it appeared that Hispanics and non-Hispanics had similar disease characteristics and therefore probably the same disease. Further genetic and environmental studies are needed to understand the patterns of Hispanic agespecific incidence rates.
Unbiased and Flexible Iterative Computer Program to Achieve Glucose Clamping
Authors: Matthews David R , Hosker John P
Published: March 2007

Glucose clamping has become a widely used test for assessing insulin sensitivity and β-cell function. We present a new method of achieving a reliable and unbiased clamp using an iterative computer program. After initial parameter estimation, the program uses no fixed algorithm or physiological preconceptions but makes predictions according to previous glycemic responses to infusion rates. The program can be used for human or animal studies and for euglycemic or hyperglycemic clamps. The program has flexible data entry, graphic display, running statistics of mean infusion data, and mean glucose levels and their standard deviations. These form part of the criteria for the assessment of glucose clamping, which includes the sampling interval, the duration of the clamp, the achieved glucose concentration (together with its coefficient of variation), and the percent change of glucose infused at the end of the clamp. Data for 151 consecutive clamp studies were analyzed. Median coefficient of variation of glucose values at the end of the clamp was 2%.
Persistence of Hypertriglyceridemic Effect of Low-Fat High-Carbohydrate Diets in NIDDM Patients
Authors: Coulston Ann M , Hollenbeck Clarie B , Swislocki Arthur L M , Reaven Gerald M
Published: March 2007

Although low-fat high-carbohydrate diets are recommended for patients with non-insulin-dependent diabetes mellitus (NIDDM) in an effort to reduce the risk of coronary artery disease (CAD), the results of short-term studies have shown that these diets can lead to changes in carbohydrate and lipid metabolism associated with an increased risk of CAD. This study has extended these earlier observations by determining the metabolic effects of such diets over a longer period in these patients. The comparison diets contained either 40 or 60% of the total calories as carbohydrates, with reciprocal changes in fat content from 40 to 20% consumed in random order for 6 wk in a crossover experimental design. The ratio of polyunsaturated to saturated fat and the total cholesterol intake were held constant in the two diets. Plasma glucose and insulin concentrations were significantly (P < .001) elevated throughout the day when patients consumed the 60% carbohydrate diet, and 24-h urinary glucose excretion more than doubled (0.8 vs. 1.8 mol/24 h). Fasting plasma total and very-low-density lipoprotein (VLDL) triglyceride (TG) concentrations increased by 30% (P < .001) after 1 wk on the 60% carbohydrate diet, and the magnitude of carbohydrate-induced hypertriglyceridemia persisted unchanged throughout the 6-wk study period. Total plasma cholesterol concentrations were similar after both diets. However, VLDL cholesterol (VLDL-chol) was significantly increased, whereas both low-density lipoprotein (LDL-) and high-density lipoprotein (HDL-) chol concentrations were significantly decreasedafter consumption of the 60% carbohydrate diet. Consequently, neither total-chol-to-HDL-chol nor LDL-chol-to-HDL-chol ratios changed. The results of this study indicate that high-carbohydrate diets lead to several changes in carbohydrate and lipid metabolism in patients with NIDDM that could lead to an increased risk of CAD, and these effects persist for >6 wk. Given these results, it seems reasonable to suggest that the routine recommendation of low-fat high-carbohydrate diets for patients with NIDDM be reconsidered.
Emphysematous Pyelonephritis: Complicated Urinary Tract Infection in Diabetes
Authors: Cook Deborah J , Achong Michael R , Dobranowski Julian
Published: March 2007

Renal emphysema is rare condition that may affect diabetic patients. Radiographic demonstration of gas limited to the collecting system is often treated with antibiotics. However, intraparenchymal gas requires early nephrectomy because mortality rates are high without surgical intervention.
Elevated Plasma Glucose and Lowered Triglyceride Levels From Omega-3 Fatty Acid Supplementation in Type II Diabetes
Authors: Friday Karen E , Childs Marian T , Tsunehara Christine H , Fujimoto Wilfred Y , Bierman Edwin L , Ensinck John W
Published: March 2007

We studied the effect of omega-3 fatty acids (ω3FA) on glucose homeostasis and lipoprotein levels in eight type II (non-insulin-dependent) diabetic subjects ingesting 8 g/day to3FA for 8 wk as marine-lipid concentrate capsules. After ω3FA supplementation, fasting plasma glucose levels increased 22% (P = .005) and meal-stimulated glucose increased 35% (P = .036). The percentage of glucose elevation correlated with percentage ideal body weight (r = .73, P = .04). No significant changes were seen in fasting or meal-stimulated plasma insulin, glucose disposal, or insulin-to-glucagon ratios. Very-low-density lipoprotein cholesterol and triglyceride (TG) levels showed consistent reductions of 56% (P < .001) and 42% (P < .001), respectively, after ω3FA supplementation. Total cholesterol levels decreased 7% (P < .05) without alteration in low- or high-density lipoprotein cholesterol. Thus, ω3FA supplementation at a dose of 8 g/day significantly improves plasma TG levels but increases fasting and meal-stimulated glucose concentrations in the type II diabetic patient not treated with insulin or sulfonylurea agents. Marine-lipid concentrate capsules supplying large amounts of ω3FAs should be used cautiously in the type II diabetic patient.
Clinical Evaluation of Computer-Assisted Self-Monitoring of Blood Glucose System
Authors: Marrero David G , Kronz Kathleen K , Golden Michael P , Wright James C , Orr Donald P , Fineberg Naomi S
Published: March 2007

The Glucometer M Diabetes Management System includes a glucose-reflectance meter with memory that can interface with a microcomputer for data manipulation and analysis. We evaluated the system in a short-term randomized control trial to determine its impact on metabolic control, self-monitoring of blood glucose (SMBG) testing behaviors, regimen selfadjustment, understanding of insulin-dependent diabetes mellitus (IDDM) treatment, attitudes about SMBG, and perceived quality of patient-physician interaction. Twenty-nine adolescent subjects (experimental) with IDDM were randomly assigned the Glucometer M system for 4 mo. Twenty-eight control subjects used meters without memory. All subjects returned twice to the clinic at 2-mo intervals during the study. At clinic visits, both groups reviewed their SMBG data with their physician. Reviews on experimental subjects were conducted with computer-generated data formats. Control subject reviews used traditional logbooks. Both groups showed a significant drop in glycosylated hemoglobin during the study period (P < .001); however, there were no between-group differences. There were also no differences in SMBG testing behavior or self-reported regimen selfadjustment between groups or within groups compared with baseline. Compared with control subjects, experimental subjects indicated a significant increase in self-reported understanding of IDDM treatment (P = .002), perceived importance of testing (P = .006), and the quality of interaction with their physician (P < .001). These data suggest that use of computer-assisted SMBG systems in the outpatient setting does not improve metabolic control over 4 mo. It may, however, contribute to improving communication between the patient and health-care providers.
Perceived and Actual Level of Knowledge of Diabetes Mellitus Among Nurses
Authors: Drass Janice A , Muir-Nash Joanne , Boykin Priscilla C , Turek Jane M , Baker Karen L
Published: March 2007

The purpose of this study was to survey staff nurses on their perceived and actual level of knowledge of diabetes mellitus. A convenience sample of 184 professional staff nurses from both inpatient and outpatient settings of a large research-teaching hospital was surveyed. The Diabetes Self-Report Tool (Cronbach's α = .91) was used to assess staff nurses′ perceptions of knowledge of diabetes mellitus. The Diabetes: Basic Knowledge Test (DBKT; Cronbach's α = .79) was used to measure the actual level of knowledge of diabetes mellitus. The data were analyzed with Pearson's correlation coefficients. A moderately low negative correlation (r = –.36, P < .001) indicated that the staff nurses′ perceived knowledge of diabetes mellitus was inversely related to actual knowledge. Subjects were found to have a mean score of 64% on the DBKT. Study findings raise questions as to the adequacy of staff nurse knowledge of diabetes and the ability of staff nurses to assess themselves for knowledge deficits.
Basal-Rate Intravenous Insulin Infusion Compared to Conventional Insulin Treatment in Patients With Type II Diabetes: A Prospective Crossover Trial
Authors: Blackshear Perry J , Roussell Anne M , Cohen Alfred M , Nathan David M
Published: March 2007

We compared continuous basal-rate intravenous insulin infusion, delivered by means of a totally implantable pump, to two types of conventional insulin administration in patients with type II (non-insulindependent) diabetes in a prospective crossover trial. Ten patients entered the study, and 5 completed all three 8-mo study periods. When results from the infusion study period were compared with results from the periodinvolving single daily injections of ultralente insulin, significant improvements were noted in the pump arm in glycosylated hemoglobin concentrations (which were nearly normal), M-component values, mean daily outpatient fasting blood glucose concentrations, mean fasting and 24-h blood glucose concentrations during an inpatient 24-h glycemic profile, and urinary glucose concentrations. When the pump arm was compared to a period of single daily injections of lente insulin, three of six monthly mean fastingblood glucose concentrations and overall means for the entire study period were significantly lower during the pump arm than during the lente arm; in addition, significantly fewer hypoglycemic reactions were noted during infusion therapy than during lentetherapy. Finally, mealtime free-insulin and C-peptide excursions appeared to be greater during infusion treatment when compared with lente or ultralente treatment. In the 50% of patients who completed the study, it appeared that significant improvements in glycemic control could be achieved by simple basal-rate intravenous insulin infusion compared with conventional treatment with single daily injections of ultralente or lente insulin without an increased incidence of symptomatic hypoglycemia.
Different HLA Haplotypes in Mexican Americans With IDDM
Authors: Vadheim Constance M , Zeidler Adina , Rotter Jerome I , Langbaum Michael , Shulman Ira A , Spencer Marion R , Costin Gertrude , Riley William J , Maclaren Noel K
Published: March 2007

The study of HLA histocompatibility antigens and insulin-dependent diabetes mellitus (IDDM) in non- White populations may provide a unique opportunity to more accurately define the diabetes susceptibility gene(s) located within the HLA region. To determine whether HLA haplotypes differ between ethnic groups, we compared 105 HLA haplotypes from 55 Mexican- American IDDM patients with 272 haplotypes from 136 IDDM patients of non-Hispanic White descent. The accurate determination of genotypes and haplotypes requires the study of family units. Therefore, all diabetic patients in this study were from studies of families having one or more siblings with IDDM. In the Mexican-American group, HLA-DR3 and -DR4 were the most common HLA-DR alleles and were present in comparable frequencies in the non-Hispanic White group (HLA-DR3, 27% of Mexican-American and 29% of non-Hispanic White haplotypes; DR4, 46% of Mexican- American and 43% of non-Hispanic White haplotypes). However, the HLA-B/DR-containing haplotypes and haplotype frequencies differed between the two groups. Several common haplotypes (B8/DR3, B15/DR4) in the non-Hispanic White group occurred less frequently in the Mexican-American group. In contrast, uncommon haplotypes in the non-Hispanic White group comprised nearly 50% of the DR4-containing haplotypes (B35/DR4, B40/DR4, B44/DR4) in the Mexican-American group. Although both DR3- and DR4-haplotype frequencies differed significantly between the two groups, the relative frequency of DR3- but not DR4-containing haplotypes was similar in both ethnic groups. This adds to the evidence suggesting that different susceptibilities are provided by the haplotypes carrying the DR3 and DR4 alleles.
Left Ventricular Regional Function After Acute Anterior Myocardial Infarction in Diabetic Patients
Authors: Takahashi Nobuyuki , Iwasaka Toshiji , Sugiura Tetsuro , Hasegawa Tadashi , Tarumi Noritaka , Kimura Yutaka , Kurihara Shigemitsu , Onoyama Hideki , Inada Mitsuo
Published: March 2007

To elucidate the pathophysiological role of diabetes mellitus in determining the left ventricular regional function of the noninfarcted area, 55 patients with acute Q wave anterior myocardial infarction (MI) were studied. The regional ejection fraction of the noninfarcted area was obtained by radionuclide angiocardiography and was used to estimate the left ventricular regional function of the noninfarcted area. Multiple regression analysis was performed to determine the important variables contributing to the regional ejection fraction based on 10 clinical variables: age, sex, QRS score, diabetes mellitus, hypertension, smoking, postinfarction angina, body mass index, serum cholesterol, and coronary atherosclerosis. A high QRS score (P < .001) and the association of diabetes mellitus (P < .05) were the important factors contributing to regional left ventricular dysfunction. The regional ejection fraction and QRS score had an inverse linear relationship in the diabetic and nondiabetic groups, and the regional ejection fraction was significantly lower in diabetic patients at every QRS score (P < .05). The association of hypertension, severity of coronary atherosclerosis, serum cholesterol level, age, and body mass index did not differ between diabetic and nondiabetic patients, which indicates that diabetes mellitus was not mediated through these atherogenic traits. Thus, diabetes mellitus is another discrete cause of regional left ventricular dysfunction of the noninfarcted area after acute MI.
Mapping Diabetic Sensory Neuropathy by Current Perception Threshold Testing
Authors: Rendell Marc S , Dovgan Daniel J , Bergman Thomas F , O'Donnell Gregory P , Drobny Edward P , Katims Jefferson J
Published: March 2007

Detailed clinical neurological examinations were conducted on 44 nondiabetic volunteers and 59 diabetic subjects. The examinations focused particularly on sensory symptomatic and physical evaluation. Standardized assessment of symptoms and physical testing of light touch, pain, vibratory, and thermal sensation was performed at the hand, wrist, elbow, foot, ankle, and knee. A total symptom score and physical score were defined by summing test scores at each site. Current perception threshold (CPT) testing that used constant sine-wave-alternating current was conducted at the same anatomic sites. CPT correlations with the physical score gave r values of .55 for 5 Hz, .60 for 250 Hz, and .62 for 2000 Hz (n = 618). Correlations with the symptom score were not as strong: r = .45 for 5 Hz, .46 for 250 Hz, and .51 for 2000 Hz. The correlation with symptom score was due primarily to a strong relationship for the symptom of numbness (r = .53 for all 3 frequencies). Correlations with pain and paresthesia were much lower. CPTs for diabetic subjects at the three frequencies were higher at most locations than for the nondiabetic volunteers. However, CPTs were no different from normal values in diabetic subjects without evidence of neuropathy. CPT testing appears to be a useful technique for assessment of diabetic sensory neuropathy.