bluuebunny/crossref_metadata_2025 huggingface dataset:
Circulating antibodies to common food antigens in Japanese children with IDDM
Authors: Ahmed Tahmeed , Kamota Tomohiro , Sumazaki Ryo , Shibasaki Masanao , Hirano Takeki , Takita Hitoshi
Published: March 2007

OBJECTIVE

To investigate the humoral immune response to common food antigens in Japanese children with IDDM.

RESEARCH DESIGN AND METHODS

IgG antibodies to cow's milk, β-lactoglobulin, bovine serum albumin (BSA), alpha-lactalbumin, and hen's egg ovalbumin were examined by enzyme-linked immunosorbent assay in the sera of 33 patients with IDDM, ages 11.8 ± 3.4 years. The data were compared with that of 50 normal subjects, ages 10.3 ± 5.1 years, who acted as control subjects. A positive antibody to a food antigen was defined as an antibody titer greater than the 95th percentile value in normal subjects.

RESULTS

Children with IDDM had significantly higher median titers of IgG antibodies to β-lactoglobulin and ovalbumin (P = 0.03 and P = 0.0005 respectively). More children with IDDM than control subjects had positive IgG antibody to ovalbumin (21 vs. 6%, P = 0.04). Titers, as well as the number of positive antibodies to other food antigens, including BSA, did not differ between the two groups.

CONCLUSIONS

Japanese children with IDDM show an enhanced humoral immune response to β-lactoglobulin and ovalbumin, a phenomenon that may be related to the pathogenesis of the disease.
The Psychosocial Impact of Severe Hypoglycemic Episodes on Spouses of Patients With IDDM
Authors: Gonder-Frederick Linda , Cox Daniel , Kovatchev Boris , Julian Diana , Clarke William
Published: March 2007

OBJECTIVE

No previous studies have examined the psychosocial impact of severe hypoglycemic episodes in IDDM patients on their spouses. This study compared spouses of IDDM patients with and without a history of recent severe hypoglycemia (SH) using traditional measures of psychosocial status and marital conflict, as well as diabetes-specific measures.

RESEARCH DESIGN AND METHODS

A total of 61 nondiabetic spouses (23 wives and 38 husbands) of IDDM patients participated in the study. Spouses completed a battery of traditional psychometric measures (depression, anxiety, marital conflict) and diabetes-specific measures (fear of hypoglycemia, marital conflict over diabetes, sleep disturbance caused by hypoglycemia). Scores of spouses of IDDM patients with and without a recent history of SH were compared with t tests.

RESULTS

Spouses of IDDM patients with and without a recent history of SH showed no differences on traditional psychometric measures of depression, anxiety, and marital conflict. However, spouses of patients with a recent history of SH showed significantly more fear of hypoglycemia, marital conflict about diabetes management, and sleep disturbances caused by hypoglycemia. Exploratory analyses of variance (ANOVAs) found no differences on psychometric measures between wives and husbands, with the exception that husbands of SH patients reported more sleep disturbance. Nondiabetic spouses, on average, showed greater fear of hypoglycemia than their diabetic partners.

CONCLUSIONS

Although SH in IDDM patients can have a significant impact on the psychosocial status of their spouses, in this study the negative impact was restricted to areas of life that are directly related to diabetes and its management. Thus, SH per se is not necessarily associated with significant increases in spousal anxiety, depression, or marital conflict, but may be associated with types of diabetes-specific psychosocial distress that are not easily identified by traditional psychometric measures.
Associations of GAD65- and IA-2-Autoantibodies With Genetic Risk Markers in New-Onset IDDM Patients and Their Siblings. The Belgian Diabetes Registry
Authors: Vandewalle Christina L , Falorni Alberto , Lernmark Åke , Goubert Patrick , Dorchy Harry , Coucke Willy , Semakula Crispin , Van Der Auwera Bart , Kaufman Leon , Schuit Frans C , Pipeleers Daniël G , Gorus Frans K
Published: March 2007

OBJECTIVE

To investigate the association of GAD (65-kDa) autoantibodies (GAD65-Abs) and IA-2 autoantibodies (IA-2-Abs) with human leukocyte antigen (HLA)-DQ and insulin gene (INS) risk markers in patients with recent-onset IDDM and their siblings.

RESEARCH DESIGN AND METHODS

Blood was sampled from 608 recent-onset IDDM patients and 480 siblings, aged 0–39 years and consecutively recruited by the Belgian Diabetes Registry, to determine GAD65- and IA-2-Ab (radiobinding assay), HLA-DQ- (allele-specific oligonucleotyping), and INS-genotypes (restriction fragment length polymorphism analysis; siblings, n = 439).

RESULTS

At the onset of IDDM, GAD65-Abs were preferentially associated with two populations at genetic risk but only in the 20- to 39-year age-group: 1) their prevalence was higher in carriers of DQA1*0301-DQB1*0302 (88 vs. 73% in non[DQA1*0301-DQB1*0302], P = 0.001), and 2) an association was found in patients lacking this haplotype but carrying DQA1*0501-DQB1*0201, together with INS I/I (87 vs. 54% vs. non[INS I/I], P = 0.003). Siblings of IDDM patients also presented the association of GAD65-Abs with DQA1*0301-DQB1*0302 (13 vs. 2% non[DQA1*0301-DQB1*0302], P < 0.001), while associations with the second genetic risk group could not yet be assessed. At the onset of IDDM, IA-2-Ab prevalence was higher in carriers of DQA1*0301-DQB1*0302 (69 vs. 39% non[DQA1*0301-DQB1*0302], P < 0.001) but not of DQA1*0501-DQB1*0201 or INS I/I. This association was present in both the 0- to 19- and the 20- to 39-year age-groups. It was also found in siblings of IDDM patients (4 vs. 0% non[DQA1*0301-DQB1*0302], P < 0.001).

CONCLUSIONS

Both GAD65- and IA-2-Abs exhibit higher prevalences in presence of HLA-DQ- and/or INS-genetic risk markers. Their respective associations differ with age at clinical onset, suggesting a possible usefulness in the identification of subgroups in this heterogeneous disease.
Glucose Tolerance, Insulin Secretion, and Insulin Sensitivity in Nonobese and Obese Japanese Subjects
Authors: Matsumoto Kazunari , Miyake Seibei , Yano Mayumi , Ueki Yukitaka , Yamaguchi Yoshihiko , Akazawa Shoichi , Tominaga Yuko
Published: March 2007

OBJECTIVE

To investigate the relative contributions of insulin secretion and insulin resistance to the development of glucose intolerance in Japanese subjects.

RESEARCH DESIGN AND METHODS

A cross-sectional study of 756 Japanese subjects (530 nonobese, 226 obese) was performed. A 75-g oral glucose tolerance test (OGTT) was given, and subjects were classified according to the World Health Organization (WHO) criteria (normal glucose tolerance [NGT], impaired glucose tolerance [IGT], and diabetes). Early-phase insulin secretion was assessed by the insulinogenic index (the ratio of the increment of insulin to that of plasma glucose [PG] 30 min after a glucose load [ΔIRI0-30 min/Δ PG0-30 min]). Total insulin secretion was assessed by mean immunoreactive insulin (IRI) during the OGTT, and insulin resistance was assessed by use of the homeostasis model [HOMA(R)].

RESULTS

Early-phase insulin secretion was significantly decreased in IGT, compared with patients with NGT, in both the nonobese and obese subjects (0.70 ± 0.05 vs. 0.37 ± 0.03, P < 0.01 and 1.36 ± 0.19 vs. 0.73 ± 0.08, P < 0.01, respectively). However, mean IRI and HOMA(R) in both nonobese and obese subjects with IGT and NGT were not statistically different. Subjects with diabetes showed a significant decline in early-phase and total insulin secretion and a significantly higher level of insulin resistance than did subjects with IGT. When the fasting glucose (FPG) exceeded 100 mg/dl, early-phase insulin decreased progressively. The graphed relationship between FPG and mean IRI did not show an inverted U-shape, and mean IRI decreased progressively when FPG exceeded 100–130 mg/dl. The pattern of changes in insulin secretion and insulin resistance associated with the progression of glucose intolerance was similar in both the nonobese and obese subjects.

CONCLUSIONS

The worsening from NGT to IGT in Japanese subjects may be associated with a decrease in early-phase insulin secretion in nonobese as well as in obese subjects. Hyperinsulinemia in IGT is not common. We suggest that impaired early-phase insulin secretion may be the initial abnormality in the development of glucose intolerance in Japanese people. Insulin resistance may be a consequence of hyperglycemia and/or obesity.
Insulin Response in a Triethnic Population: Effects of Sex, Ethnic Origin, and Body Fat: The Miami Community Health Study
Authors: Donahue Richard P , Bean Judy A , DeCarlo Donahue Rosemary A , Goldberg Ronald B , Prineas Ronald J
Published: March 2007

OBJECTIVE

To assess sex and ethnic differences in hyperinsulinemia/insulin resistance and to examine the impact of percent body fat on such differences.

RESEARCH DESIGN AND METHODS

A cross-sectional epidemiological study was performed in a normoglycemic population of African-Americans (n = 159), Cuban Americans (n = 128), and non-Hispanic whites (n = 207) who resided in Dade County, Florida, from 1990 to 1995. The insulin area under the curve (AUC) in response to a standard 75-g oral glucose tolerance test (OGTT) was used as an indicator of hyperinsulinemia/insulin resistance. Analysis of covariance was performed to compare sex and ethnic differences in the insulin AUC. Multiple linear regression was used to evaluate the independent correlates of the insulin AUC.

RESULTS

After covariate adjustment for percent body fat, men displayed a significantly higher insulin AUC than did women (P < 0.001). African-Americans and Cuban-Americans each had a significantly higher insulin AUC than did non-Hispanic white participants (P = 0.01). Alcohol consumption was inversely related to AUC (P = 0.04).

CONCLUSIONS

Despite the greater percentage of body fat in women, the insulin AUC was similar in women and men. After adjustment for the sex difference in percent body fat, women displayed a lower insulin AUC than did men, indicating enhanced insulin sensitivity. These differences by sex and ethnicity in insulin resistance are consistent with established differences in heart-disease risk (i.e., higher in men and African-Americans) and suggest that hyperinsulinemia/insulin resistance may partly underlie such differences.
U.K. Prospective Diabetes Study 27: Plasma lipids and lipoproteins at diagnosis of NIDDM by age and sex
Authors:   U.K. Prospective Diabetes Study Group
Published: March 2007

OBJECTIVE

To compare fasting plasma lipids and lipoproteins in male and female patients at diagnosis of NIDDM and to examine age and sex differences in lipid concentrations.

RESEARCH DESIGN AND METHODS

Cross-sectional study of fasting plasma total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride in 2,139 male and 1,574 female white patients, aged 25–65 years, at diagnosis of NIDDM.

RESULTS

At diagnosis of NIDDM, the mean age ± SD for men was 52 ± 9 and 53 ± 9 years for women; BMI was 28.3 ± 4.9 and 30.8 ± 6.7 kg/m2, and fasting plasma glucose was 11.6 ± 3.6 and 12.4 ± 3.8 mmol/l, respectively. The mean total and LDL cholesterol were higher in female than in male NIDDM patients, 5.8 ± 1.2 vs. 5.5 ± 1.1 and 3.9 ± 1.1 vs. 3.6 ± 1.0 mmol/l (both P < 0.001), respectively, while triglyceride levels were similar: geometric mean (1 SD interval) for men and women was 1.8 (1.1–3.1) vs. 1.8 (1.1–2.9) mmol/l. HDL cholesterol was higher in female than in male NIDDM patients, 1.09 ± 0.2 vs. 1.01 ± 0.24 mmol/l (P < 0.001); the sex differential for HDL cholesterol was 7% in NIDDM patients compared with 22% in the general population. Data analysis by 5-year age bands showed a significant trend toward lower total cholesterol and triglyceride and higher HDL cholesterol in men diagnosed above the age of 50 years. In female NIDDM patients, lipid concentrations increased with age of diagnosis but reached a plateau above the age of 50 years.

CONCLUSIONS

The effect of NIDDM, observed at diagnosis, on plasma lipid and lipoprotein levels is more pronounced in women than in men. This may explain in part why the cardiovascular risk is proportionally higher in female patients.
Lipoprotein(a) in Android Obesity and NIDDM
Authors: Wassef Nicola , Sidhom Gloria , El-Khayat Zakareya , El-Kholy Mohamed
Published: March 2007

OBJECTIVE

To assess the level of serum lipoprotein(a) [Lp(a)] in nonobese and obese NIDDM subjects with android body distribution.

RESEARCH DESIGN AND METHODS

Serum Lp(a) levels were measured in 30 long-standing NIDDM patients (duration of diabetes 12.5 ± 3 years, mean ± SD), with 15 of the patients being obese of android distribution (BMI > 30 kg/m2 and waist-to-hip ratio > 0.8). In addition, there were 15 android obese nondiabetic subjects and 10 healthy subjects serving as the control group.

RESULTS

All groups of patients in this study (diabetic, obese, and obese diabetic) showed significantly higher levels of Lp(a) than the healthy control group. Lp(a) concentrations were significantly higher in NIDDM patients with android type of obesity than in nondiabetic androids (24.1 ± 5.6 vs. 14.8 ± 2.4 mg/dl, P < 0.001). Significantly greater levels of Lp(a) were found in nonobese subjects with diabetes when compared with obese subjects without diabetes (22.3 ± 4.1 vs. 14.8 ± 2.4 mg/dl, P < 0.001). Furthermore, Lp(a) serum concentrations were not dependent on the degree of glycemic control (controlled NIDDM 23.6 ± 5.0 vs. uncontrolled NIDDM 21.4 ± 2.7 mg/dl, NS), but were much greater in subjects with diabetes complicated by vascular disease (complicated 26.3 ± 5.0 vs. uncomplicated 20.5 ± 2.7 mg/dl, P < 0.001). No correlation was found between Lp(a) and other lipid parameters in this study.

CONCLUSIONS

Lp(a) levels are significantly elevated in both android-obese and nonobese NIDDM patients regardless of the degree of glycemic control. Lp(a) is an independent risk factor showing greater elevations in those subjects complicated with diabetic vascular diseases.
Impairment of Peripheral Blood Flow Responses in Diabetes Resembles an Enhanced Aging Effect
Authors: Stansberry Kevin B , Hill Michael A , Shapiro Shane A , McNitt Patricia M , Bhatt Bankim A , Vinik Aaron I
Published: March 2007

OBJECTIVE

To test the hypothesis that skin blood flow responses in the fingertip of diabetic patients are impaired and to examine the role of aging in both healthy control subjects and diabetic patients.

RESEARCH DESIGN AND METHODS

We measured cutaneous blood flow using laser Doppler techniques in 40 people with diabetes and in 20 age- and sex-matched healthy control subjects. To induce vasoconstriction, subjects were asked to perform three 1-min stressor tasks: mental arithmetic, contralateral hand grip, and immersion of the contralateral hand in ice water. To induce vasodilatation, a local heat stimulus of 45 degrees C was applied for 5 min.

RESULTS

Basal blood flow did not differ between groups, but vasoconstrictive responses induced by arithmetic or immersion of the contralateral hand in ice-cold water and vasodilatation induced by local heating were severely impaired in diabetic subjects, compared with healthy control subjects (P < 0.01). These responses correlated with autonomic nerve function and deteriorated significantly with advancing age in control subjects, but not in diabetic subjects. Blood flow in younger diabetic subjects resembled that of older control subjects.

CONCLUSIONS

These data demonstrate that diabetes has effects on precapillaries that may by direct or mediated via autonomic nerves, which result in a deficit that resembles premature aging.
Visual Function in Young IDDM Patients Over 8 Years of Age: A 4-year longitudinal study
Authors: North Rachel V , Farrell Una , Banford Denise , Jones Colin , Gregory John W , Butler Gary , Owens David R
Published: March 2007

OBJECTIVE

To carry out a longitudinal study of visual functions in young patients over the age of 8 years with IDDM and to assess the impact of metabolic control on the presence of diabetic retinopathy.

RESEARCH DESIGN AND METHODS

There were 37 young IDDM patients from the Paediatric and Adolescent Clinic at the University Hospital of Wales studied annually for 4 years, with a control group of 24 healthy subjects observed over a 2-year period. Assessment of visual functions included visual acuity, color vision, and contrast sensitivity. Ophthalmoscopy and retinal photography were used to determine the presence or absence of diabetic retinopathy. In addition, pubertal status and metabolic control (glycosylated hemoglobin) were determined at each visit.

RESULTS

Patients with IDDM demonstrate abnormal color vision and contrast sensitivity compared with the control group (P < 0.05), but visual acuity was unaffected. Visual functions were not significantly different between those IDDM patients with and without retinopathy. After 4 years, diabetic retinopathy was present in 43% of the group and was related to diabetes duration and metabolic control (P < 0.05).

CONCLUSIONS

Visual function testing could not distinguish between those IDDM patients with and without retinopathy, but the color vision and contrast sensitivity in those with IDDM were significantly impaired compared with the control group. The presence of retinopathy was related to the duration of diabetes and metabolic control. It is important to ensure that good glycemic control and regular attendance for retinopathy screening is encouraged in the adolescent patients.
Insulin Resistance and Arteriosclerosis Obliterans in Patients With NIDDM
Authors: Matsumoto Kazunari , Miyake Seibei , Yano Mayumi , Ueki Yukitaka , Yamaguchi Yoshihiko , Akazawa Shoichi , Tominaga Yuko
Published: March 2007

OBJECTIVE

To investigate the risk factors for arteriosclerosis obliterans (ASO) in NIDDM, we measured insulin sensitivity and other risk factors including lipoprotein(a) [Lp(a)] in NIDDM patients with and without ASO.

RESEARCH DESIGN AND METHODS

A case-control study in 100 patients with NIDDM, 35 with and 65 without ASO, was performed. Insulin sensitivity was assessed by the short insulin tolerance test's K index (KITT). Duration of diabetes, a history of smoking, prevalence of hypertension, prevalence of coronary artery disease (CAD), serum C-peptide, 24-h urinary C-peptide, serum lipids, and Lp(a) were compared in the two groups.

RESULTS

Age, BMI, HbA1c, and fasting plasma glucose were comparable in the two groups. Patients with ASO were significantly more insulin resistant than patients without ASO (KITT 2.16 ± 0.16 vs. 3.00 ± 0.13%/min, P < 0.0001, respectively), had a longer duration of diabetes (10.3 ± 1.2 vs. 7.5 ± 0.8 years, P < 0.05), included a greater number of smokers (68.6 vs. 40.0%, P < 0.01), had a higher prevalence of CAD (60.0 vs. 16.9%, P < 0.01), and had a greater percentage of insulin therapy (48.6 vs. 29.2%, P < 0.05). However, urinary and serum C-peptide levels, serum lipids, and Lp(a) levels were comparable in the two groups. Multiple logistic regression analysis indicated that a history of smoking (odds ratio 3.70, P = 0.011), insulin resistance (odds ratio 3.68, P < 0.001), and an elevated Lp(a) level (odds ratio 1.03, P = 0.020) were independently related to ASO. When patients with CAD were removed from the logistic regression analysis, insulin resistance was most strongly related to ASO (odds ratio 20.9, P < 0.001).

CONCLUSIONS

Patients with ASO were characterized by a higher prevalence of CAD, a greater percentage of smokers, a greater percentage of insulin therapy, and a higher insulin resistance than were patients without ASO. Insulin resistance, especially, may be the most powerfully related to ASO. Lp(a) may play a minor role in the development of ASO.
GLP-1 Tablet in Type 2 Diabetes in Fasting and Postprandial Conditions
Authors: Gutniak Mark K , Larsson Hillevi , Sanders Steven W , Juneskans Olof , Holst Jens J , Ahrén Bo
Published: March 2007

OBJECTIVE

To examine the absorption of glucagon-like peptide (GLP)-1(7-36) amide from the buccal mucosa of type 2 diabetic patients. Previously, the effects of the peptide have been studied following intravenous and subcutaneous injection. Now, a mucoadhesive, biodegradable buccal GLP-1 tablet (9 mm) containing 119 nmol has been developed as a possible alternative to injection.

RESEARCH DESIGN AND METHODS

A total of 10 type 2 diabetic patients received a single tablet under fasting conditions and before a standard meal in this randomized placebo-controlled study.

RESULTS

The mean peak GLP-1 concentration was 125.1 pmol/l and occurred 30 min after application. The mean placebo-adjusted area under the curve was 5,334 min pmol/l, consistent with a relative bioavailability of 6% vs. intravenous injection and 42% vs. subcutaneous injection. The half-life of total peptide activity after buccal administration was 17 min. The placebo-adjusted glucose concentrations decreased by 1.4 mmol/l in fasting experiments and by 4.2 mmol/l after a standard mixed meal. In the fasting state at 30 min, plasma insulin increased by 185% and glucagon decreased by 20%, consistent with the increase in plasma GLP-1 concentrations. The peptide exerted a significant insulinotropic effect during meals (calculated as an insulinogenic index, 0–120 min; 84.1 vs. 45.7 in placebo experiments).

CONCLUSIONS

Potentially therapeutic plasma levels of GLP-1 were achieved after administration of a single buccal tablet in type 2 diabetic patients. The peptide had a marked glucose-lowering effect during the first 2 h. This new GLP-1 tablet may become a feasible alternative treatment for type 2 diabetic patients, although a more prolonged pharmacokinetic profile is required.
Hepatitis B Vaccination in Diabetic Patients: Randomized trial comparing recombinant vaccines containing and not containing pre-S2 antigen
Authors: Douvin Catherine , Simon Dominique , Charles Marie Aline , Deforges Lionel , Bierling Philippe , Lehner Valérie , Budkowska Agata , Dhumeaux Daniel
Published: March 2007

OBJECTIVE

To investigate the immunogenicity of two recombinant hepatitis B vaccines containing S antigen alone (Engerix B) or both S and pre-S2 antigens (GenHevac B) in diabetic patients.

RESEARCH DESIGN AND METHODS

Of the adult diabetic patients, 71 (26 IDDM, 45 NIDDM) were randomized to receive Engerix B or GenHevac B at 0, 1, 2, and 12 months in a single-blind clinical trial; if the antibody to hepatitis B surface antigen (anti-HBs) titers were < 10 <10 IU/1 at month 4, a fourth injection of vaccine was given. A positive response was defined by anti-HBs titer ≥ 10 IU/l at month 13.

RESULTS

The anti-HBs response rate and the titers of anti-HBs did not differ significantly between the two types of vaccine. Overall, > 90% of the patients responded at month 13. In patients vaccinated with GenHevac B, anti-pre-S2 antibodies appeared earlier than anti-HBs. The anti-HBs response tended to decrease with age (P = 0.07) and tended to be higher in IDDM patients than in NIDDM patients (P = 0.06). Metabolic control, as assessed by HbA1c level, did not influence the response rate. The presence of the HLA DQ2 allele was associated with a low response.

CONCLUSIONS

A large majority of diabetic patients can be efficiently vaccinated against the hepatitis B virus using a booster dose at month 4. The choice of the vaccine (with or without pre-S2 antigen) appears to have little influence, if any, on the response rate.
Meal Composition is a Determinant of Lispro-Induced Hypoglycemia in IDDM
Authors: Burge Mark R , Castillo Kristen R , Schade David S
Published: March 2007

OBJECTIVE

Lispro is a newly FDA-approved analog of human insulin that will be widely used in patients with IDDM. This insulin, however, may have an increased potential for hypoglycemia because of its very rapid subcutaneous absorption, especially in a setting of decreased carbohydrate intake. Using a short-term prospective randomized parallel group-study design, we studied the incidence of hypoglycemia when lispro was given before breakfast compared with regular human insulin. Since carbohydrate intake is a determinant of postprandial glycemia, we administered three isocaloric meals characterized by low, average, and high carbohydrate content.

RESEARCH DESIGN AND METHODS

Two groups of six IDDM subjects were randomized to receive 0.15 U/kg of lispro or regular human insulin subcutaneously before the ingestion of three 500-kcal breakfast meals of differing carbohydrate content on separate days. Lispro was administered at mealtime, and regular insulin was administered 30 min before mealtime.

RESULTS

Postprandial plasma glucose concentrations were decreased in the lispro group compared with the regular-insulin group for all three meal types (P < 0.05), and hypoglycemia developed more frequently and rapidly in the lispro group, compared with the regular-insulin group by survival analysis. Additionally, peak insulin concentrations were higher (P < 0.001) and peaked more rapidly (P < 0.05) in the lispro group, compared with the regular-insulin group.

CONCLUSIONS

We conclude that lispro has a tendency for early postprandial hypoglycemia compared with regular insulin in the setting of reduced carbohydrate intake. This fact should be told to patients who decide to switch from regular insulin to lispro. Health care professionals should instruct their IDDM patients to monitor glucose levels frequently after switching to lispro since adjustments in their carbohydrate intake and/or their lispro dosage may be necessary to avoid hypoglycemia.
A Comparison of Global Versus Disease-Specific Quality-of-Life Measures in Patients With NIDDM
Authors: Anderson Robert M , Fitzgerald James T , Wisdom Kimberlydawn , Davis Wayne K , Hiss Roland G
Published: March 2007

OBJECTIVE

This study was conducted to compare the Short Form 36 (SF-36) (a global measure of health-related quality of life) and the Diabetes Care Profile (DCP) (a diabetes-specific measure of self-care and diabetes-related quality of life) in patients with NIDDM.

RESEARCH DESIGN AND METHODS

This study was conducted as part of a larger study initiated in 1991 using a randomly selected sample of communities, physicians, and patients with diabetes located throughout Michigan. A total of 255 patients with NIDDM participated. The study examined the relationship between the two measures and diabetes variables, such as glycosylated hemoglobin level and number of complications.

RESULTS

The SF-36 and the DCP have both common and discrete measurement domains. Both instruments have acceptable subscale reliability. The DCP has predictive validity regarding glycemic control, whereas the SF-36 does not. Both measures correlate with the number of complications for patients who have NIDDM treated with insulin.

CONCLUSIONS

This study suggests that for examining relationships within diabetes, e.g., the impact of acute complications and/or regimen on quality of life, the DCP is the appropriate measure. Conversely, when examining relationships between the patient's experience of living with diabetes and quality of life and other chronic diseases, the SF-36 would be an appropriate measure. Both instruments can be used to illuminate the experience and behavior of patients living with and caring for NIDDM.
Severe Hypoglycemia in Children With IDDM: A prospective population study, 1992–1994
Authors: Nordfeldt Sam , Ludvigsson Johnny
Published: March 2007

OBJECTIVE

Is an increased incidence of severe hypoglycemia an unavoidable effect of improved metabolic control? And, if so, to what extent?

RESEARCH DESIGN AND METHODS

In 1992–1994, severe hypoglycemia was prospectively registered in our intensively treated IDDM population, 146 children 1–18 years of age with > 90% of the patients on ≥ 4 insulin injections per day. The two categories, “severe hypoglycemia with unconsciousness” (U hypoglycemia) and “severe hypoglycemia without unconsciousness but needing the assistance of another person” (NU hypoglycemia), were analyzed in relation to yearly mean HbA1c levels, insulin doses and proportion of short-acting insulin, age at onset, duration of diabetes, age, sex, and weight-to-height ratio.

RESULTS

Yearly mean HbA1c levels improved from 8.1 ± 1.6% in 1992 to 6.9 ± 1.3% in 1994. The yearly incidence of U hypoglycemia was 0.15–0.19 events per patient-year, seen in 10–16% of patients, showing no significant increase from 1992–1994. For NU hypoglycemia, slightly increasing figures from 1.01 to 1.26 events per patient-year, seen in 27–38% of patients yearly, were reported. There was no significant correlation between severe (U or NU) hypoglycemia and HbA1c, but still an association was seen in certain calculations. In multiple regression analysis, U hypoglycemia was not related to any factor, but the square root of the rate of NU hypoglycemia was related to lower HbA1c levels (P = 0.0003), higher insulin doses (IU · kg−1 · 24 h−1) (P = 0.0024), and a lower proportion of short-acting insulin out of the total daily insulin dose (P = 0.031).

CONCLUSIONS

Multiple-dose insulin therapy with rather low yearly mean HbA1c values causes a slight increase of NU hypoglycemia but no increase of U hypoglycemia in our population of children with IDDM. Near physiological HbA1c levels may be achieved without any pronounced risk of increasing the incidence of severe hypoglycemia when multiple-injection insulin therapy is combined with adequate self-control based on psychosocial support and active education.
Incidence and Prevalence of Diabetes in Children Aged 0–14 Years in Manitoba, Canada, 1985–1993
Authors: Blanchard James F , Dean Heather , Anderson Kristin , Wajda Andre , Ludwig Sora , Depew Noella
Published: March 2007

OBJECTIVE

To estimate the incidence and prevalence of type I diabetes among Manitoba children aged 0–14 years from 1985–1993.

RESEARCH DESIGN AND METHODS

The Manitoba Diabetes Database (a population-based database of individuals diagnosed with diabetes based on Manitoba's health insurance system) was used to estimate the annual incidence of diabetes for the years 1985–1993 and the point prevalence of diabetes at 31 March 1993 for Manitoba children aged 0–14 years. The Diabetes Education Resource for Children and Adolescents program database was used to correct incidence and prevalence rates for ascertainment using the two-source capture-recapture method.

RESULTS

The overall ascertainment rate of the Manitoba Diabetes Database was 95% for incident cases and 93% for prevalent cases. The average annual incidence was 20.4 per 100,000 for children aged 0–14 years. The annual incidence appears to be stable for all age-groups 0–14 years over the past decade. The point prevalence of diabetes among children was 120.4 per 100,000.

CONCLUSIONS

The incidence of type I diabetes in children aged 0–14 years in Manitoba is higher than reported previously in other urban regions of Canada, but similar to population-based estimates from Prince Edward Island. The incidence appears stable in Manitoba over the past decade even in the 0–4 year age-group. The Manitoba Diabetes Database appears to be a highly accurate population-based source of data on the epidemiology of diabetes in children.
The Receiver Operating Characteristics Curve in the Evaluation of a Random Urine Specimen as a Screening Test for Diabetic Nephropathy
Authors: Zelmanovitz Themis , Gross Jorge L , Oliveira Jarbas R , Paggi Alexandre , Tatsch Mariana , Azevedo Mirela J
Published: March 2007

OBJECTIVE

To assess the performance of measurements of urinary albumin concentration (UAC) and urinary albumin:creatinine ratio (UACR) in a diurnal random urine specimen (RUS) for the screening of diabetic nephropathy.

RESEARCH DESIGN AND METHODS

A total of 95 ambulatory NIDDM patients (49 women, ages 40–75 years) collected 123 RUSs during the morning after completing a timed 24-h urine collection. Albumin was measured by immunoturbidimetry. According to timed urinary albumin excretion rate (UAER) measured in the 24-h collection (criterion standard), samples were classified as normoalbuminuric (UAER < 20 μg/min; n = 54), microalbuminuric (UAER 20–200 μg/min; n = 44), and macroalbuminuric (UAER > 200 μg/min; n = 25). The receiver operating characteristics (ROC) curve approach was used. The ROC curves of UAC and UACR in RUS for screening of microalbuminuria (normo- and microalbuminuric samples; n = 98) and macroalbuminuria (micro- and macroalbuminuric samples; n = 69) were plotted.

RESULTS

Spearman's coefficients of correlation of 24-h UAER vs. UAC and UACR were 0.91 and 0.92, respectively (P < 0.001). The calculated areas (± SE) under the ROC curves to screen microalbuminuria for UAC (0.9766 ± 0.015) and UACR (0.9689 ± 0.014) were similar (P > 0.05) as were the corresponding areas for macroalbuminuria (0.9868 ± 0.0094 and 0.9614 ± 0.0241, respectively; P > 0.05). The first point with 100% sensitivity and the point of intersection with a 100%-to-100% diagonal for microalbuminuria were as follows: 16.9 and 33.6 mg/l for UAC and 15.0 and 26.8 mg/g for UACR; for macroalbuminuria 174.0 and 296.2 mg/l for UAC and 116.0 and 334.3 mg/g for UACR, respectively.

CONCLUSIONS

Albumin measurements (UAC and UACR) in an RUS presented almost perfect accuracy for the screening of micro- and macroalbuminuria and UAC measured in an RUS is simpler and less expensive than UACR and UAER. It is suggested as a valid test for use in screening for diabetic nephropathy.
Quality of Life and Associated Characteristics in a Large National Sample of Adults With Diabetes
Authors: Glasgow Russell E , Ruggiero Laurie , Eakin Elizabeth G , Dryfoos Janet , Chobanian Lisa
Published: March 2007

OBJECTIVE

This study investigated the quality of life and the demographic, medical-history, and self-management characteristics associated with it.

RESEARCH DESIGN AND METHODS

A diabetes self-management survey was sent to 2,800 adults with diabetes throughout the U.S. who were part of a marketing company national sample. The response rate was 73%. The final sample of 2,056 persons was heterogeneous: the average age was 59 years (range, 18–92 years); 53% had high school education or less; 86% had type II diabetes; 62% were female; and 31% reported being on an intensive management plan, such as the one used in the Diabetes Control and Complications Trial. Quality-of-life items included the social, physical, and mental health dimensions of the Short Form (SF-20) of the General Health Survey.

RESULTS

Overall, respondents reported a moderate to low quality of life, relative to previous studies. Factors related to lower quality of life included: less education, lower income, older age, being female, type of health insurance (no medical insurance or Medicare/Medicaid recipients reported lower quality of life than those with either a health maintenance organization or private insurance), number of diabetes complications, number of comorbid illnesses, and lower levels of physical activity. Multiple regression analyses revealed that the level of self-reported exercise was the only significant self-management behavior to predict the quality of life, after controlling for demographic and medical variables.

CONCLUSIONS

If the findings regarding physical activity are replicated, it may be that moderate-intensity physical activity programs could be initiated with diabetic individuals at risk of low quality of life. Quality of life is an important and understudied topic in diabetes that appears to be related to demographic, medical-history, and self-management factors.
Levels and Risks of Depression and Anxiety Symptomatology Among Diabetic Adults
Authors: Peyrot Mark , Rubin Richard R
Published: March 2007

OBJECTIVE

To determine levels of depression and anxiety symptoms among adults with diabetes and identify factors associated with increased risk.

RESEARCH DESIGN AND METHODS

This study administered self-report symptom inventories to patients at the beginning (n = 634) and end (n = 578) of an outpatient diabetes education program. Subjects (n = 246) contacted by mail 6 months later completed the same instruments.

RESULTS

Rates of disturbance for depression (41.3%; 95% CI: 37.4–45.2%) and anxiety (49.2%; 95% CI: 45.3–53.1%) were higher than those typical in the general population (10–20%). Probability of disturbance ranged from 5–7% for those with the lowest risk profile to 82–92% for those with the highest risk profile. Diabetes-related complications were the only disease factor associated with significantly increased risk of disturbance. Women and those with less education were at much higher risk. Only 13% of those followed for 6 months were disturbed at all three time-points.

CONCLUSIONS

Diabetes is associated with increased risk of psychological disturbance, especially for those with more diabetes-related complications. Sociodemographic factors account for much of the risk differential among people with diabetes.
Cholesterol Lowering With Simvastatin Improves Prognosis of Diabetic Patients With Coronary Heart Disease: A subgroup analysis of the Scandinavian Simvastatin Survival Study (4S)
Authors: Pyörälä K , Pedersen Terje R , Kjekshus John , Faergeman Ole , Olsson Anders G , Thorgeirsson Gudmundur ,   The Scandinavian Simvastatin Survival Study (4S) Group
Published: March 2007

OBJECTIVE

To assess in diabetic patients with coronary heart disease (CHD) the effect of cholesterol lowering with simvastatin on mortality and the risk of CHD and other atherosclerotic events.

RESEARCH DESIGN AND METHODS

A post hoc subgroup analysis was carried out on data from 202 diabetic patients and 4,242 nondiabetic patients with previous myocardial infarction or angina pectoris, serum total cholesterol 5.5–8.0 mmol/l, and serum triglycerides ≤ 2.5 mmol/l who were participating in the Scandinavian Simvastatin Survival Study (4S). Participants in the 4S were randomly assigned to double-blind treatment with simvastatin, 20 mg daily, with blinded dosage titration up to 40 mg daily, according to cholesterol response during the first 6–18 weeks, or placebo. Endpoints were 1) total mortality, 2) major CHD events (CHD death or nonfatal myocardial infarction), 3) other acute atherosclerotic events, 4) myocardial revascularization procedures.

RESULTS

Over the 5.4-year median follow-up period, simvastatin treatment produced mean changes in serum lipids in diabetic patients similar to those observed in nondiabetic patients. The relative risks (RRs) of main endpoints in simvastatin-treated diabetic patients were as follows: total mortality 0.57 (95% CI, 0.30–1.08; P = 0.087), major CHD events 0.45 (95% CI, 0.27–0.74; P = 0.002), and any atherosclerotic event 0.63 (95% CI, 0.43–0.92; P = 0.018). The corresponding RRs in nondiabetic patients were the following: 0.71 (95% CI, 0.58–0.87; P = 0.001), 0.68 (95% CI, 0.60–0.77; P < 0.0001), and 0.74 (95% CI, 0.68–0.82; P < 0.0001).

CONCLUSIONS

The results strongly suggest that cholesterol lowering with simvastatin improves the prognosis of diabetic patients with CHD. The absolute clinical benefit achieved by cholesterol lowering may be greater in diabetic than in nondiabetic patients with CHD because diabetic patients have a higher absolute risk of recurrent CHD events and other atherosclerotic events.
The Tactile Circumferential Discriminator: A new, simple screening device to identify diabetic patients at risk of foot ulceration
Authors: Vileikyte L , Hutchings G , Hollis S , Boulton A J M
Published: March 2007

OBJECTIVE

To evaluate the tactile circumferential discriminator (TCD) (Tacticon Medical Enterprises, West Chester, PA), a new, simple, handheld quantitative sensory testing device, in the identification of patients at potential risk of neuropathic ulceration.

RESEARCH DESIGN AND METHODS

Patients with diabetes (n = 133) attending the Manchester Diabetes Centre or diabetic foot clinic seen within a 5-week period were assessed using the TCD, monofilaments, and vibration perception threshold (VPT) measured over the hallux. The sensitivity and specificity of each method in the identification of “high-risk” patients were compared.

RESULTS

The TCD was easy to use, and there was a highly significant correlation between the results obtained compared with both filaments and VPT (P < 0.0001). Similarly, in the identification of patients at risk of ulceration, the TCD agreed with VPT in 75.2% of cases and with the monofilaments in 78.9%. In the identification of the 37 foot ulcer patients, TCD was highly sensitive (100%) but less specific (58.3%) than VPT (86.5%; 79.2%) and the monofilaments (91.9%; 76.0%).

CONCLUSIONS

These data suggest that the TCD is a simple and reliable new technique for population screening for neuropathy and foot ulcer risk.
Sex Hormone-Binding Globulin and Glucose Tolerance in Postmenopausal Women: The Rancho Bernardo Study
Authors: Goodman-Gruen Deborah , Barrett-Connor Elizabeth
Published: March 2007

OBJECTIVE

Sex hormone-binding globulin (SHBG) has been shown to be associated with several diabetes risk factors, including total body fat, central obesity, and hyperinsulinemic insulin resistance. We examined the cross-sectional association between SHBG and impaired glucose tolerance (IGT) and NIDDM.

RESEARCH DESIGN AND METHODS

We conducted a cross-sectional study including 657 postmenopausal women, aged ≥50 years, who were not using hormone replacement therapy. Blood for SHBG and fasting plasma glucose was obtained concurrently in the morning; all women had a 75-g oral glucose tolerance test and measurement of BMI and waist-to-hip ratio (WHR).

RESULTS

SHBG was significantly associated with age, BMI, and WHR but not with smoking, physical activity, or alcohol intake. In these women, SHBG was significantly and independently inversely associated with IGT and with NIDDM.

CONCLUSIONS

These data strongly support an association between SHBG, or androgenicity, and diabetes in postmenopausal women. Because of the cross-sectional nature of this study, however, the directionality of the association is uncertain.
The Impact of Diabetes on Survival Among Patients With First Myocardial Infarction
Authors: Chun Byung Y , Dobson Annette J , Heller Richard F
Published: March 2007

OBJECTIVE

The purpose of this paper is to estimate the impact of diabetes on survival among patients with first acute myocardial infarction, using data from the World Health Organization (WHO) Monitoring Trends and Determinants of Cardiovascular Disease (MONICA) Project in Newcastle, New South Wales, Australia.

RESEARCH DESIGN AND METHODS

The WHO MONICA Project is a community-based surveillance system that monitors coronary heart disease morbidity and mortality. All patients with suspected coronary events were observed for 28 days after the onset of symptoms.

RESULTS

Of 5,322 patients with acute myocardial infarction and no previous history of ischemic heart disease (3,643 men and 1,679 women), 333 men (9%) and 224 women (13%) had a history of diabetes. The age-adjusted 28-day case fatality for women with diabetes (25%) was significantly higher than for women without diabetes (16%); relative risk 1.56 (95% CI: 1.19–2.04). The difference for men was also significant (25% with diabetes and 20% without diabetes); relative risk 1.25 (95% CI: 1.02–1.53). Age-specific case fatality increased significantly with age in both men and women without diabetes, but systematic age effects were not so apparent in patients with diabetes. Case fatality significantly decreased over the study period in patients without diabetes, but not among the diabetic patients.

CONCLUSIONS

The increased risk of death in the diabetic patients remained after accounting for their poorer risk factor profiles; even if they reached the hospital alive, diabetic patients were also less likely to survive than nondiabetic patients. The relative impact of diabetes on survival is greater in women than in men.
Model of Complications of NIDDM: II. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia
Authors: Eastman Richard C , Javitt Jonathan C , Herman William H , Dasbach Erik J , Copley-Merriman Catherine , Maier William , Dong Fred , Manninen Diane , Zbrozek Arthur S , Kotsanos James , Garfield Sanford A , Harris Maureen
Published: March 2007

OBJECTIVE

To analyze the health benefits and economics of treating NIDDM with the goal of normoglycemia.

RESEARCH DESIGN AND METHODS

Incidence-based simulation model of NIDDM was used. Hazard rates for complications were adjusted for glycemia using risk gradients from the Diabetes Control and Complications Trial. Treatment costs were estimated from national survey data and clinical trials. Incremental costs and benefits were expressed in present value dollars (3% discount rate). Life-years were adjusted for quality of life, yielding quality-adjusted life-years (QALYs).

RESULTS

Comprehensive treatment of NIDDM that maintains an HbA1c value of 7.2% is predicted to reduce the cumulative incidence of blindness, end-stage renal disease, and lower-extremity amputation by 72, 87, and 67%, respectively. Cardiovascular disease risk increased by 3% (no effect of treating glycemia is assumed). Life expectancy increased 1.39 years. The cost of treating hyperglycemia increased by almost twofold, which is partially offset by reductions in the cost of complications. The estimated incremental cost/QALY gained is $16,002. Treatment is more cost-effective for those with longer glycemic exposure (earlier onset of diabetes), minorities, and those with higher HbA1c under standard care.

CONCLUSIONS

The incremental effectiveness of treating NIDDM with the goal of normoglycemia is estimated to be ∼ $16,000/QALY gained, which is in the range of interventions that are generally considered cost-effective.
The Prevalence of Diabetic Retinopathy and Associated Risk Factors Among Sioux Indians
Authors: Berinstein Daniel M , Stahn Ruggles M , Welty Thomas K , Leonardson Gary R , Herlihy John J
Published: March 2007

OBJECTIVE

To estimate the prevalence of and risk factors for diabetic retinopathy among Sioux Indians of South Dakota.

RESEARCH DESIGN AND METHODS

Strong Heart Study (SHS) participants with diabetes who are members of the Cheyenne River Sioux Tribe and the Oglala Sioux Tribe were invited to have ophthalmological examinations in 1991. A total of 417 people had eye examinations out of the 488 diabetic SHS participants of the two tribes (85% participation rate). Fundus photographs were obtained of each eye and graded for severity of retinopathy using the modified Airlie House Classification Scheme. Risk factors for retinopathy were determined from the SHS database.

RESULTS

The prevalence of diabetic retinopathy among participants from these tribes was 45.3%. Risk factors associated with severity of retinopathy include mean fasting glucose, level. HbA1c, systolic blood pressure, urinary albumin-to-creatinine ratio, renal dialysis, and duration of diabetes.

CONCLUSIONS

The prevalence of diabetic retinopathy among diabetic Sioux Indians is similar to or higher than the prevalence in other diabetic Indian and non-Indian populations. Aggressive glycemic and blood pressure control is urgently needed to reduce this high rate, and annual eye examinations to detect and treat diabetic retinopathy should be emphasized.