bluuebunny/crossref_metadata_2025 huggingface dataset:
The Low Prevalence of Immunogenetic Markers in Korean Adult-Onset IDDM Patients
Authors: Park Yongsoo , Lee Hongkyu , Koh Chang-Soon , Min Hunki , Rowley Merrill , Mackay Ian R , Zimmet Paul , McCarthy Bridget , McCanlies Erin , Dorman Janice , Trucco Massimo
Published: March 2007

OBJECTIVE

IDDM is an autoimmune disease that occurs among genetically susceptible individuals. In Asian populations, it is not uncommon for adult patients with NIDDM to eventually lose β-cell function and develop IDDM. These individuals may be characterized by autoantibodies to GAD and high-risk HLA-DQ alleles, which are unlikely to be prevalent among patients with true NIDDM or in the general population. The objective of the present study was to evaluate and compare the prevalence of these immunogenetic markers in NIDDM patients and healthy nondiabetic individuals from Korea.

RESEARCH DESIGN AND METHODS

The prevalences of anti-GAD antibodies and HLA-DQA1 and DQB1 alleles among 121 patients with newly diagnosed NIDDM identified from a population-based study in Yonchon, Korea, and 100 matched healthy control subjects were evaluated and compared.

RESULTS

The overall prevalence of anti-GAD antibodies was 1.7% (2 of 121) in patients with previously undiagnosed NIDDM, whereas 1 of 100 control subjects had a positive test for antibodies. Among those who tested positive, titers of antibodies to GAD were not high. No statistically significant differences in the distributions of either mean levels of anti-GAD antibodies or DQA1 and DQB1 alleles were found comparing NIDDM patients with control subjects. Interestingly, the frequency of DQB1*non-Asp-57 and DQA1*Arg-52 alleles in the Korean adult control population was similar to that in the U.S. white population (DQB1*non-Asp-57: 0.431 vs. 0.475; DQA1*Arg-52: 0.492 vs. 0.463).

CONCLUSIONS

The low prevalence of anti-GAD antibodies and HLA-DQA1 and DQB1 susceptibility alleles among recent-onset NIDDM patients, which was similar to observations in control subjects, suggests that diabetes in Korean adults is unlikely to have an autoimmune component to its pathogenesis.
A Comparison of Acarbose Versus Metformin as an Adjuvant Therapy in Sulfonylurea-Treated NIDDM Patients
Authors: Bayraktar Miyase , Van Thiel David H , Adalar Nezaket
Published: March 2007

OBJECTIVE

To compare the effects of acarbose or metformin treatment used as an adjunct with a sulfonylurea agent in the treatment of NIDDM not adequately controlled with the use of a sulfonylurea agent alone.

RESEARCH DESIGN AND METHODS

Of the poorly controlled female NIDDM patients on sulfonylurea treatment, 18 were randomly selected from the outpatient diabetic clinic for study. For 8 weeks, they received either acarbose (300 mg/daily) or metformin (1,500 mg/daily) in addition to sulfonylurea in a crossover design using a 3-week washout period between treatments. The efficacy of each drug regimen was assessed by measuring the levels of glycosylated hemoglobin, fasting and 2-h postprandial blood glucose (PPBG) levels, cholesterol, triglyceride, and fibrinogen levels before and after 8 weeks of therapy.

RESULTS

The metabolic parameters measured before initiation of either treatment regimen were similar. Mean fasting and 2-h postprandial glucose levels were reduced moderately at the end of 8 weeks of both combination treatments (P < 0.05). Although the fasting and 2-h postprandial plasma insulin and C-peptide and fibrinogen levels at the end of the 8-week treatment periods were lower than those obtained at the beginning of the study, the differences between these values were not statistically significant. Cholesterol levels remained unchanged. Only the 2-h PPBG level in the group using acarbose plus a sulfonylurea was lower than the level achieved by the group using metformin plus a sulfonylurea (8.1 ± 0.8 vs. 9.8 ± 1.0 mmol/l, respectively, P < 0.05). The difference between pre- and posttreatment levels of the 2-h PPBG level in both arms of the study were statistically significant (Δ-acarbose, 5.3 ± 0.4 vs. ff-metformin, 2.9 ± 0.3) (P < 0.05). Specific drug-associated side effects were observed in 12 patients on acarbose and 3 patients on metformin.

CONCLUSIONS

Acarbose or metformin can be used as effective adjuvant therapies with a sulfonylurea agent in NIDDM patients who are poorly controlled with the sulfonylurea agent alone.
Excess Mortality and Its Relation toHypertension and Proteinuria in Diabetic Patients
Authors: Wang Shu-Li , Head Jenny , Stevens Clynda , Fuller John H ,   World Health Organization,   Multinational Study Group
Published: March 2007

OBJECTIVE

To determine the extent that mortality in IDDM and NIDDM patients is inexcess of that of the general population and examine its relation to hypertension and proteinuriain diabetic patients.

RESEARCH DESIGN AND METHODS

A stratified random sample of 4,714 diabetic patients aged 35–55 years participating in the World Health Organization MultinationalStudy of Vascular Disease in Diabetes has been followed up from 1975 to 1987. Excess mortality,compared with the background population, was assessed in terms of standardized mortalityratios (SMRs) for each of the 10 international cohorts. The relationship between excess mortalityand proteinuria/hypertension was examined by diabetes type and sex.

RESULTS

SMRs were in general higher in patients with IDDM (ranging from 188 to 686 formen and from 336 to 790 for women) than with NIDDM (from 138 to 370 for men and from 126to 435 for women). For both diabetes types and in both sexes, SMRs decreased with increasingage and increased with increasing diabetes duration. Patients with both hypertension and proteinuria experienced a strikingly high mortality risk: 11-fold for men with IDDM and 18-fold forwomen with IDDM and 5-fold for men with NIDDM and 8-fold for women with NIDDM. Evenin the absence of proteinuria and hypertension, SMRs were significantly increased in both IDDM(284 men and 360 women) and NIDDM (192 men and 236 women) patients.

CONCLUSIONS

Considerable international differences were found not only in mortalityrates for the two types of diabetes but also in the extent of excess mortality among centers. IDDM patients had a high excess mortality in comparison with the general population. The significantexcess mortality was demonstrated even in patients without proteinuria and without hypertension for both sexes and diabetes types.
Fatty Acids and Insulin Resistance
Authors: Boden Guenther
Published: March 2007

We have demonstrated that physiological elevations in plasma free fatty acid concentrations inhibit insulin-stimulated glucose uptake in a dose-dependent manner in normal control subjects and in patients with NIDDM. Two possible mechanisms were identified: 1) a fat-related inhibition of glucose transport or phosphorylation that appeared after 3-4 h of fat infusion and 2) a decrease in muscle glycogen synthase activity that appeared after 4-6 h of fat infusion. We conclude that elevations of plasma FFAs caused insulin resistance and hence may play a significant role in the pathogenesis of insulin resistance in obesity and NIDDM.
Effectiveness of a Behavioral Weight Control Program for Blacks and Whites With NIDDM
Authors: Wing Rena R , Anglin Kimberly
Published: March 2007

OBJECTIVE

To compare the weight losses of black and white patients with NIDDM treated in a year-long behavioral weight loss program.

RESEARCH DESIGN AND METHODS

Subjects were randomly assigned to a behavioral program that either used a low-calorie diet throughout or included two 12-week periods of a very-low calorie diet (VLCD). Weight, dietary intake, and exercise were measured at 0, 6, and 12 months of treatment, and attendance and self-monitoring records were assessed weekly throughout the year.

RESULTS

Blacks had smaller weight losses than whites regardless of treatment condition. Overall weight losses (baseline to 1 year) were 7.1 kg in blacks vs 13.9 kg in whites. The differences in overall outcome resulted primarily from greater weight regain in blacks during months 6-12 than in whites. There was a trend for blacks to have poorer attendance than whites during the latter half of the program and for blacks to report smaller changes in calorie intake from baseline to 6 months.

CONCLUSIONS

The results confirm prior studies with nondiabetic patients showing smaller weight losses in blacks than in whites and suggest that these differences may result primarily from faster weight regain in blacks. Further research is needed to more carefully examine the variables that may explain this difference and to develop more effective programs for blacks with NIDDM.
Can Postmenopausal Hormone Replacement Improve Plasma Lipids in Women With Diabetes?
Authors: Robinson Jennifer G , Folsom Aaron R , Nabulsi Azmi A , Watson Robert , Brancati Frederick L , Cai Jianwen ,   For the Atherosclerosis Risk in Communities Study Investigators
Published: March 2007

OBJECTIVE

To evaluate the association of postmenopausal hormone replacement with plasma lipids in diabetic women.

RESEARCH DESIGN AND METHODS

Cross-sectional data from a multiracial population study were used to evaluate the relationship of hormone replacement status with plasma lipids in diabetic (n = 694) versus nondiabetic (n = 5,321) postmenopausal women.

RESULTS

Although diabetic women who currently used hormone replacement had higher adjusted mean HDL cholesterol levels than those who did not (56.9 vs. 53.6 mg/dl), they had proportionately lower hormone-related increases in HDL, HDL2, and HDL3 cholesterol than did nondiabetic women (HDL cholesterol 64.9 [current users] vs. 55.7 mg/dl [those who never used hormones]). There was a trend toward greater triglyceride values with hormone replacement in diabetic women (156.6 [current users] vs. 125.4 mg/dl [those who never used hormones]) than in nondiabetic women (143.3 [current users] vs. 123.7 mg/dl [those who never used hormones]). LDL cholesterol and apolipoprotein B levels were lower and apolipoprotein A-I levels were higher with hormone replacement, to a similar degree in diabetic and nondiabetic women.

CONCLUSIONS

Diabetic women appear to have a blunted response to the HDL-raising effects of estrogen and an exaggerated hypertriglyceridemic response. This may result in attenuated cardioprotection from postmenopausal hormone replacement therapy and potentially an increased risk of acute pancreatitis from hypertriglyceridemia. The risks and benefits of postmenopausal hormone replacement need to be carefully weighed in diabetic women.
Evolution, Risk Factors, and Prognostic Implications of Albuminuria in NIDDM
Authors: Niskanen Leo K , Penttilã Ilkka , Parviainen Markku , Uusitupa Matti I J
Published: March 2007

OBJECTIVE

To study the cumulative incidence of albuminuria and its determinants in NIDDM patients and nondiabetic subjects from the diagnosis and impact of albuminuria on cardiovascular mortality.

RESEARCH DESIGN AND METHODS

We performed a 10-year prospective observational study of 133 well-characterized middle-aged patients with newly diagnosed NIDDM and 144 control subjects. Both groups were examined at baseline and after 5 and 10 years. Urinary albumin excretion was determined from timed 24-h (baseline and 5-year examinations) or overnight samples (10-year examination). Microalbuminuria was defined as urinary albumin excretion of 30–300 mg/24 hr or 20–200 μg/min, with the higher values considered as macroalbuminuria.

RESULTS

The cumulative incidence of micro- and macroalbuminuria increased sharply after 5 years in NIDDM patients (baseline: 18.2 and 3.0%; 5 years: 18.9 and 1.8%; and 10 years: 33.0 and 10.2%) but markedly less in control subjects (baseline: 1.4 and 0%, P < 0.001 for diabetic patients vs. control subjects for any albuminuria; 5 years: 6.0 and 0.8%, P < 0.01; 10 years: 11.9 and 0.8%, P < 0.001). The most important determinant of the development of albuminuria was the metabolic control of diabetes in NIDDM patients during the follow-up, whereas in nondiabetic subjects, the development of albuminuria was related to elevated blood pressure and fasting insulin levels. Baseline and 5-year albuminuria predicted subsequent cardiovascular mortality in diabetic patients, even when adjusted for multiple risk factors. The risk of cardiovascular death in NIDDM patients increased by simultaneous occurrence of hyperinsulinemia and albuminuria.

CONCLUSIONS

The frequency of microalbuminuria in patients with NIDDM increases sharply with the duration of diabetes. Chronic hyperglycemia is the main risk factor for microalbuminuria in diabetic patients. Microalbuminuria accompanied by hyperinsulinemia is a powerful predictor of cardiovascular death in NIDDM patients.
Structure and Costs of Health Care of Diabetic Patients in Finland
Authors: Kangas Tero , Aro Seppo , Koivisto Veikko A , Salinto Marjo , Laakso Markku , Reunanen Antti
Published: March 2007

OBJECTIVE

The aim of the present study was to examine both the structure, including modes of drug treatment, ambulatory care, and hospital inpatient care, and the costs of health care for drug-treated diabetic patients in Finland.

RESEARCH DESIGN AND METHODS

The modes of drug treatment and ambulatory care were studied with the help of a questionnaire given to all diabetic patients obtaining their medication through pharmacies in Finland during a 7-week period in 1989. The questionnaire sought information on drug treatment, site of health care, and frequency of visits to physicians. Hospital inpatient care was evaluated by linking the patient data from the Hospital Discharge Register and the Central Drug Register. The direct costs of health care were calculated by using relevant average costs.

RESULTS

A total of 30,266 questionnaires were returned, representing > 70% of all drug-treated diabetic patients receiving medication in the period studied. Of the diabetic patients, 63% were treated by oral medication only, 31% by insulin only, and 6% by a combination of insulin and oral agents. Of the patients in whom diabetes was diagnosed at ≥ 30 years of age, 75% were treated at health centers, whereas > 60% of those in whom diabetes was diagnosed at < 30 years of age were treated at outpatient clinics. The mean annual frequency of visits was 4.0 for patients receiving insulin treatment and 3.3 for patients receiving treatment with oral medications. The diabetic patients used 1.5 million hospital inpatient days per year, which was 13% of the total inpatient days in Finland. Of the inpatient days, 20% were for diabetes as the principal cause, 52% for diabetes-related diseases, and 28% for causes unrelated to diabetes. The direct costs of the health care of drug-treated diabetic patients in 1989 were 5.8% of the total costs of health care in Finland and were three times higher than the average costs of care for nondiabetic individuals. The direct costs were divided into inpatient care (81%), medication (9%), ambulatory care (8%), and self-care equipment (2%).

CONCLUSIONS

Hospital inpatient care is the major contributor to the excess of health care expenditures for diabetic patients.
Endogenous Insulin Modulates Circulating Endothelin-1 Concentrations in Humans
Authors: Ferri Claudio , Bellini Cesare , Desideri Giovambattista , De Mattia Giancarlo , Santucci Anna
Published: March 2007

OBJECTIVE

To assess the effect of oral glucose loading on plasma endothelin-1 (ET-1) levels in humans.

RESEARCH DESIGN AND METHODS

A total of 75 g D-glucose was given orally to 14 nonobese nondiabetic essential hypertensive subjects (eight men and six women, mean age 43.1 ± 3.0 years) and eight normotensive subjects (four men and four women, mean age 45.2 ± 4.1 years). Blood samples for plasma ET-1 measurement were drawn every 30 min for 2 h and then at 180 and 240 min.

RESULTS

After glucose load, insulin increased more significantly in hypertensive subjects than in normotensive subjects at times 60 (P = 0.004) and 90 (P = 0.001) min. Glucose loading was followed by a mild but significant increase in circulating ET-1 levels in both groups (hypertensive subjects, from 0.87 ± 0.25 pg/ml at time 0 to 1.64 ± 0.33 pg/ml at 120 min and 1.74 ± 0.38 pg/ml at 180 min, P < 0.05; normotensive subjects, from 0.82 ± 0.38 pg/ml at time 0 to 1.42 ± 0.18 pg/ml at 180 min, P < 0.05). Whereas baseline ET-1 levels were similar between the two groups, postload ET-1 levels were higher in hypertensive subjects than in normotensive subjects (P = 0.003 at 120 min; P = 0.04 at 180 min).

CONCLUSIONS

This study indicates that significant changes in circulating ET-1 levels occur after oral glucose loading, probably due to a glucose-induced increment in endogenous insulin concentration.
Quality of Outpatient Care Provided to Diabetic Patients: A health maintenance organization experience
Authors: Peters Anne L , Legorreta Antonio P , Ossorio R Clifford , Davidson Mayer B
Published: March 2007

OBJECTIVE

To document the quality of diabetes care provided to patients in a large health maintenance organization (HMO) from 1 January 1993 to 1 January 1994 and compare it to the standards of the American Diabetes Association (ADA).

RESEARCH DESIGN AND METHODS

To meet a Health Plan and Employer Data Information Set (HEDIS) requirement, a major HMO in California identified 14,539 members with diabetes and randomly selected 384 individuals for review. Charts were available on 353 of these patients, and after obtaining the information for the HEDIS review, additional information was extracted from the charts by an outside chart reviewer. This data set was used for an analysis of the quality of diabetic care provided by the participating medical groups to these HMO members during 1 year. Documentation of follow-up and measures of glycemic and lipid control was examined both for absolute values and for the frequency of measurement over the year. These results were compared to the ADA standards of care.

RESULTS

Although patients averaged 4.5 visits to their primary care physicians (PCPs) over the year, 21% had one or fewer visits per year. Glycated hemoglobin levels were not documented in 56% of patients (ADA recommends two to four measurements per year), and of those with a glycated hemoglobin level measured. 39% had at least one value ≥ 10%. Fasting plasma glucose concentrations were not documented in 65% of patients (four to six per year recommended). Foot exams (which should be performed at each regular visit) were not documented for 94% of patients. Urine protein measurements were not performed in 52% of patients. Additionally, many patients had elevated and untreated lipid abnormalities.

CONCLUSIONS

In spite of the frequency of PCP visits during the year for many of these patients, diabetes management was inadequate. This lack of adequate preventive care will lead to an increased risk of the development of the acute and chronic complications of diabetes, creating an even greater future burden on the health care system and negative consequences for patients.
Interlaboratory Variation of GHb Assays in Victoria, Australia
Authors: Gilbert Richard E , Goodall Ian , Young Val , Jerums George
Published: March 2007

OBJECTIVE

To determine the extent of interlaboratory variation and accuracy in the measurement of glycated hemoglobin (GHb).

RESEARCH DESIGN AND METHODS

All laboratories that measure glycated hemoglobin in the State of Victoria, Australia, were invited to participate, and positive responses were received from 27 to 30 laboratories. An aliquot of blood drawn from three patients with diabetes and varied glycemia and from one nondiabetic subject was sent to each participating laboratory. Distribution of results was analyzed according to the reported results and their variance from an assigned reference value and were expressed as differing from this latter value as percentage bias and in absolute terms. A bias ≥ 10% or an absolute difference of ≥ 1% HbA1c from the reference value was considered significant.

RESULTS

Reported results for the same blood sample ranged from 4.1 to 5.8%, 5.1 to 8.2%, 6.7 to 9.3%, and 10.1 to 14.7% for the specimens from the nondiabetic subject and the diabetic patients with good, moderate, and poor glycemic control, respectively. The proportion of laboratories with results that differed by ≥ 10% bias from the reference value were 39% (12 of 30), 29% (9 of 30), 16% (5 of 30), and 32% (10 of 30), and the proportion reporting results that differed by ≥ 1% HbA1c in absolute terms from the reference values were 3% (1 of 30), 6% (2 of 30), 16% (5 of 30), and 23% (7 of 30) for the specimens from the nondiabetic subject and the diabetic patients with good, moderate, and poor glycemic control, respectively.

CONCLUSIONS

A substantial degree of interlaboratory variation for GHb measurement exists in Victoria, Australia. This may lead to difficulties in interpretation when GHb is assayed by different laboratories in the same patient over time. Interlaboratory standardization may be achievable by calibration to a standard assigned by a reference laboratory and distributed to all laboratories measuring GHb.
Altered Taste Sensation in Newly-Diagnosed NIDDM
Authors: Perros Petros , MacFarlane T Wallace , Counsell Carl , Frier Brian M
Published: March 2007

OBJECTIVE

To assess gustatory appreciation in newly diagnosed NIDDM patients and to determine whether it altered with the improvement of glycemic control after treatment with diet and oral hypoglycemic drugs.

RESEARCH DESIGN AND METHODS

Assessments of taste, peripheral and autonomic neural function, diet, and oral microbiological flora were performed in 20 patients before and after treatment of hyperglycemia, 20 matched nondiabetic control subjects, and 11 patients with long duration of diabetes and advanced peripheral neuropathy.

RESULTS

Median total HbA1 fell from 12.6 to 8.8% in new diabetic patients after 3–5 months of treatment. Electrical taste thresholds, detection threshold for glucose, and recognition threshold for glucose and salt were increased in newly-diagnosed NIDDM patients compared with the control subjects. The dose-response curve to glucose (using a visual analogue scale [VAS]) of newly-diagnosed NIDDM patients was significantly impaired and improved after treatment. By contrast, newly-diagnosed NIDDM patients had normal VAS taste responses to fructose, salt, and urea. Measurements of somatic and autonomic nerve function did not correlate with electrical or chemical taste function.

CONCLUSIONS

Newly-diagnosed NIDDM patients have a blunted taste response, which displays a degree of specificity to glucose, is partially reversed after correction of hyperglycemia, and is independent of somatic or autonomic nerve function. This taste abnormality may influence the premorbid choice of nutrients, with a preference for sweet-tasting foods, thereby exacerbating hyperglycemia.
Decreased HbA1c Levels Due to Sulfonamide-Induced Hemolysis in Two IDDM Patients
Authors: Tack Cees J , Wetzels Jack F
Published: March 2007

Regular measurement of HbA1c (percentage) is an essential component of modern diabetes care. Factors that affect the life span of erythrocytes will also influence HbA1c results. In this study, we describe two patients with IDDM, whose regularly determined HbA1c values were considerably decreased with the concomitant use of two related sulfonamide drugs, sulfasalazine and dapsone. The fall in HbA1c results is explained by increased erythrocytopoiesis as a product of drug-induced hemolysis. Fructosamine concentrations are not affected by hemolysis and reflected glycemic control better. We conclude that under conditions of persistent (subclinical) hemolysis, as occurs during the use of sulfonamides, HbA1c is not a reliable indicator of glycemic control.
Incidence and Prevalence of Diabetes in Manitoba, 1986–1991
Authors: Blanchard James F , Ludwig Sora , Wajda Andre , Dean Heather , Anderson Kristin , Kendall Ora , Depew Noella
Published: March 2007

OBJECTIVE

To estimate the incidence and prevalence of diabetes among adults in Manitoba, Canada, from 1986 to 1991.

RESEARCH DESIGN AND METHODS

A population-based database of individuals diagnosed with diabetes (Manitoba Diabetes Database) was created using data from Manitoba Health's comprehensive insurance system. Using this database, estimates of the annual incidence and prevalence of diabetes among Manitoba adults aged ≥25 years were made for the years 1986–1991. Age-specific and age-adjusted rates were calculated separately for men and women.

RESULTS

The prevalence of diabetes in 1991 was 66.9/1,000 among adults ≥25 years. Between 1986 and 1991 the age-adjusted prevalence rose steadily among both men and women. In 1991, the incidence of diabetes was 5.6/1,000. After an observed decline prior to 1989, the annual incidence of diabetes appears to be relatively stable.

CONCLUSIONS

The prevalence of diabetes is increasing steadily despite relatively stable incidence rates. Population-based data are required for projecting future trends and are an important tool for planning the required health resources.
Effect of Maternal Diabetes on the Pattern of Selected Insulin Resistance Syndrome Parameters in Normal Glucose Tolerant Subjects of Two Algonquin Indian Communities in Quebec
Authors: Ekoé Jean-Marie , Thomas Frederique , Balkau Beverley , Eschwege Eveline , Delisle Helene
Published: March 2007

OBJECTIVE

To determine whether a maternal antecedent with diabetes has an effect on insulin resistance syndrome parameters.

RESEARCH DESIGN AND METHODS

We studied 352 Algonquin Indians from Quebec aged at least 15 years who had no personal antecedents with diabetes. Data concerned clinical and biological parameters and the parental antecedents with diabetes.

RESULTS

For subjects over > 30 years, fasting insulin and cholesterol levels were significantly higher in the group with a maternal history of diabetes than in the group with a paternal history. Significant differences were observed for serum triglyceride, BMI, and subscapular skinfold thickness when comparing subjects with a maternal history and those with no parental history of diabetes. Blood pressure and fasting glucose did not differ according to parental history.

CONCLUSIONS

Subjects of maternal antecedents with diabetes have known risk factors for NIDDM. This study does not identify whether there is a genetic or maternal environmental reason for this association.
Effects of a Brief Office-Based Intervention to Facilitate Diabetes Dietary Self-Management
Authors: Glasgow RE , Toobert DJ , Hampson SE
Published: March 2007

OBJECTIVE

There is a pressing need for brief practical interventions that address diabetes management. Using a randomized design, we evaluated a medical office-based intervention focused on behavioral issues relevant to dietary self-management.

RESEARCH DESIGN AND METHODS

There were 206 adult diabetes patients randomized to usual care or brief intervention, which consisted of touchscreen computer-assisted assessment to provide immediate feedback on key barriers to dietary self-management, and goal setting and problem-solving counseling for patients. Follow-up components to the single session intervention included phone calls and interactive video or videotape instruction as needed.

RESULTS

Multivariate analyses of covariance revealed that the brief intervention produced greater improvements than usual care on a number of measures of dietary behavior (e.g., fewer calories from saturated fat, fewer high-fat eating habits and behaviors) at the 3-month follow-up. There were also significant differences favoring intervention on changes in serum cholesterol levels and patient satisfaction but not on glycosylated hemoglobin. The intervention effects were relatively robust across a variety of patient characteristics, the two participating physicians, and intervention staff members.

CONCLUSIONS

If the long-term results are equally positive and generalize to other setting, this intervention could provide a prototype for a feasible cost-effective way to integrate patient views and behavioral management into office-based care for diabetes.
A Dose-Response Study of Glimepiride in Patients With NIDDM Who Have Previously Received Sulfonylurea Agents
Authors: Goldberg Ronald B , Holvey Sherman M , Schneider Jill ,   The Glimepiride Protocol #201 Study Group
Published: March 2007

OBJECTIVE

To assess the efficacy, safety, and dose-response relationship of glimepiride in patients with NIDDM.

RESEARCH DESIGN AND METHODS

After a 21-day placebo washout period, 304 patients were randomized to receive either placebo or glimepiride, 1, 4, or 8 mg once daily. Fasting plasma glucose (FPG), 2-h postprandial glucose (PPG), and HbA1c were measured at predetermined intervals during the washout period and the 14-week study. Adverse events were tabulated.

RESULTS

At each patient visit, reduction from baseline FPG was greater in each glimepiride group than in the placebo group (P < 0.001). Changes from baseline to endpoint after 1, 4, and 8 mg glimepiride exceeded those after placebo (P < 0.001) by 2.4, 3.9, and 4.1 mmol/l, respectively, for FPG; by 1.2, 1.8, and 1.9 percentage points, respectively, for HbA1c; and by 3.5, 5.1, and 5.2 mmol/l, respectively, for 2-h PPG. Greater reductions in these parameters were observed with 8 and 4 mg than with 1 mg (P < 0.05), indicating a dose-response relationship. When patients with baseline HbA1c levels ≥ 8% were assessed, more patients who received 8 mg glimepiride had HbA1c values < 8% at endpoint compared with patients receiving 4 mg. Glimepiride had a favorable safety profile.

CONCLUSIONS

Glimepiride in 1-, 4-, or 8-mg doses was effective and well tolerated. Although the 4- and 8-mg once-daily doses were significantly more potent than the 1-mg dose, all three doses yielded clinical improvement. Because the 8-mg dose controlled HbA1c values in a greater number of patients with high baseline HbA1c levels than did the 4-mg dose, this higher dose might be beneficial for patients who are difficult to treat.
Hyperglycemia affects cardiovascular autonomic nerve function in normal subjects
Authors: Yeap Bu B , Russo Antonietta , Fraser Robert J , Wittert Gary A , Horowitz Michael
Published: March 2007

OBJECTIVE

To evaluate the effect of acute hyperglycemia on autonomic nerve function in normal subjects.

RESEARCH DESIGN AND METHODS

Six healthy volunteers ages 19-32 years underwent paired studies during euglycemia (blood glucose 5.1 ± 0.04 mmol/l) and hyperglycemia (blood glucose 15.7 ± 0.48 mmol/l) induced by intravenous infusion of glucose and maintained for 150 min. The order of the two studies was randomized. In each experiment, supine heart rate, heart rate variation with respiration, ratio of the maximum to minimum R-R interval after standing (“30:15” ratio), systolic blood pressure response to standing, and diastolic blood pressure response to sustained handgrip were measured. Data were analyzed using repeated measures analysis of variance.

RESULTS

The supine heart rate was greater (P = 0.04) and the “30:15” ratio less (P = 0.03) during hyperglycemia than during euglycemia. Hyperglycemia had no significant effect on any of the other cardiovascular reflex tests.

CONCLUSIONS

These observations indicate that acute hyperglycemia affects autonomic nerve function in healthy humans.
Effects of the Short-Acting Insulin Analog [Lys(B28),Pro(B29)] on Postprandial Blood Glucose Control in IDDM
Authors: Torlone Elisabetta , Pampanelli Simone , Lalli Carlo , Sindaco Paola Del , Vincenzo Antonio Di , Rambotti Anna Maria , Modarelli Francesco , Epifano Lucilla , Kassi Giorgia , Perriello Gabriele , Brunetti Paolo , Bolli Geremia
Published: March 2007

OBJECTIVE

To establish the effects of the short-acting insulin analog Lispro versus human regular insulin (Hum-R) on postprandial metabolic control in IDDM.

RESEARCH DESIGN AND METHODS

Four studies were performed in 10 C-peptide-negative IDDM patients. Lispro or Hum-R (0.15 U/kg) or Lispro + NPH (0.07 U/kg) or Hum-R + NPH were injected subcutaneously 30 min (Hum-R) or 5 min (Lispro) before lunch. Preprandial plasma glucose (PG) was maintained on all four occasions at ∼ 7.3 mmol/l by intravenous insulin.

RESULTS

After subcutaneous Lispro injection, plasma free insulin (FIRI) was greater between 0 and 2 h (233 ± 22 pmol/l) than after Hum-R (197 ± 25 pmol/l) but lower between 2.25 and 7 h (81 ± 10 vs. 104 ± 13 pmol/l, P < 0.05). After Lispro, PG was lower versus Hum-R for 3 h (7.4 ± 0.6 vs. 8.3 ± 0.9 mmol/l) but subsequently increased more than after Hum-R (3.25-7h, 11.3 ± 1 vs. 9.6 ± 1.2 mmol/l), resulting in a 7-h postprandial PG greater than Hum-R (9.4 ± 0.5 vs. 8.8 ± 0.6 mmol/l) (all P < 0.05). Addition of NPH to Lispro increased the 2.5-to 7-h FIRI to 110 ± 11 pmol/l and decreased the 3.25- to 7-h PG to 7.7 ± 0.8 pmol/l, resulting in 0- to 7-h PG (7.3 ± 0.3 mmol/l) lower than after Hum-R + NPH (7.9 ± 0.5 pmol/l) (P < 0.05).

CONCLUSIONS

At meals, in order for Lispro to improve postprandial blood glucose not only at 2-h, but also over a 7-h period in C-peptide–negative IDDM, basal insulin must be optimally replaced.
A Two-Step Strategy for Identification of High-Risk Subjects for a Clinical Trial of Prevention of NIDDM
Authors: Narayan K M Venkat , Hanson Robert L , Pettitt David J , Bennett Peter H , Knowler William C
Published: March 2007

OBJECTIVE

To evaluate 2-h plasma glucose (2HPG), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1), a combination of FPG and HbA1 (FPG-HbA1), and other factors as screening tests for identifying high-risk subjects for a clinical trial of prevention of NIDDM and to identify strategies to minimize the total number of oral glucose tolerance tests (OGTTs) required to recruit eligible subjects to the trial.

RESEARCH DESIGN AND METHODS

One thousand, one hundred and eight nondiabetic Pima Indians aged 25–64 years were followed for up to 5 years, and factors predicting NIDDM, defined by World Health Organization criteria (2HPG ≥ 11.1 mmol/l), were assessed using Cox's proportional hazards analysis. Various threshold values of FPG, HbA1, and FPG-HbA1 were determined, which, when combined with an OGTT, identified subjects with impaired glucose tolerance (IGT) (2HPG ≥ 7.8 and < 11.1 mmol/l) at a number of specified risks for developing NIDDM in 5 years. The value of each of the three tests was then assessed by calculating (for each threshold) the numbers to be screened, the numbers requiring an OGTT, and the sample size of IGT subjects needed to detect a 33% reduction in NIDDM by an experimental intervention at a power of 80%.

RESULTS

During a median of 4.3 years of follow-up, 91 (8.2%) of the 1.108 nondiabetic subjects developed NIDDM. The estimated 5-year cumulative incidence rate was 13.5%. Each of the variables, 2HPG, FPG, HbA1, FPG-HbA1, BMI, IGT, and systolic (sBP), diastolic (dBP), and mean (MBP) blood pressures, predicted NIDDM (P < 0.05 for each) when controlled for age and sex. In a stepwise proportional hazards analysis model, 2HPG and FPG-HbA1 (P < 0.001 for each) were selected as the best set of predictors of NIDDM and of fasting hyperglycemia (FPG ≥ 7.8 mmol/l).

CONCLUSIONS

A two-step strategy, in which high-risk individuals are first identified by FPG or FPG-HbA1 and then the OGTT is used to select subjects with IGT, requires fewer OGTTs than when using 2HPG as the initial screening test without substantially increasing the numbers that would need to be screened. Such a strategy also offers the advantage of reducing the necessary sample size and is therefore an effective, efficient, and convenient method of identifying eligible subjects for a clinical trial of prevention of NIDDM.
Epidemiologic Studies of Insulin-dependent Diabetes Mellitus
Authors: Christy Morten , Green Andres , Christau Bjorn , Kromann Hans , Nerup Jørn
Published: March 2007

The incidence of insulin-dependent diabetes mellitus (IDDM) in Denmark in the years 1970–1976 was 13.3 per 100,000 in the age group 0–29 yr. This incidence is almost identical to that found in 1924 in Denmark in the same age group. The prevalence of insulin-consumers is 3.2 per 1,000. Comparison is made with incidence and prevalence data from other studies of Caucasian populations.
Ambulatory Diabetes Management by a Pulse of Subcutaneous Insulin Delivered by a Portable Pump: Preliminary Report
Authors: Riley William J , Silverstein Janet H , Rosenbloom Arlan L
Published: March 2007

Two teenage patients, who had severe psychosocial problems that complicated their diabetes management, were treated for one month (14-year-old girl) and two months (16-year-old boy) by frequent pulses of insulin injected subcutaneously by a portable, programmed pump. Additional pulses were manually adjusted by the patient before eating. Both patients experienced improved sense of well-being, marked reduction in urine volume and in glycosuria, and reduced glycemic excursions and average levels. The boy had accelerated linear growth and a decreas in HbA1 percentage. Despite marked clinical improvement, permitting return to school, the girl was impelled to interrupt pump administration after two weeks. Both patients continue to use the device voluntarily; a smaller unit, however, that doesn't have the conspicuous external controls, would likely be readily acceptable to most young patients.
Feasibility of Improved Blood Glucose Control in Patients With Insulin-Dependent Diabetes Mellitus
Authors: Peterson Charles M , Jones Robert L , Dupuis Andre , Levine Barbara S , Bernstein Richard , O'Shea Michael
Published: March 2007

An attempt was made to improve the control of blood glucose in patients with insulin-dependent diabetes mellitus. Ten patients were studied over a period exceeding 8 mo in the outpatient department. Each patient was taught to monitor his or her own blood glucose concentration and was enrolled in an exercise program. In addition, they were taught to calibrate insulin, food, and exercise in terms of the response of the blood glucose. After 3 mo of study, there was a significant decrease in hemoglobin A1c (Hb A1c) values from a mean concentration of 10.3 to 7.6%. Hb A1c values correlated well with mean blood glucose levels (r = 0.86). Dietary analysis revealed that the patients selected a diet consisting of 25% protein, 44% fat, and 31% carbohydrate, but there was a wide range in caloric distribution. There was no correlation between blood glucose control as measured by Hb A1c and caloric distribution. Systolic blood pressures decreased greater than 10 mm Hg. Serum alkaline phosphatase also decreased in each patient as control of blood glucose improved. Three of the patients with abnormalities of nerve conduction measurement at the beginning of the study had a complete return to normal at 8 mo. An outpatient program such as this may be cost effective through the avoidance of diabetes-related hospitalizations and may provide a mechanism whereby larger studies can be designed to define further the relationship of glycemia to the sequelae of diabetes.
Screening in Diabetes Mellitus: Report of the Atlanta Workshop
Authors: Herron Charles A
Published: March 2007

A Diabetes Screening Workshop was held in Atlanta, Georgia, May 15–17, 1978, which was sponsored by the Center for Disease Control, the American Diabetes Association, and the National Institute of Arthritis, Metabolism, and Digestive Diseases. The workshop formulated the following recommendations for the use of screening procedures in diabetes mellitus from a community control viewpoint: (1) screening for asymptomatic glucose intolerance should be done among pregnant women as part of a well-coordinated program to decrease perinatal morbidity and mortality; (2) screening programs to detect asymptomatic glucose intolerance per se are not recommended as health services in nonpregnant populations; (3) screening for diabetes or its complications for research purposes should be done only as part of well-designed studies focusing on identification of predictive factors, implementation and effectiveness of preventive and therapeutic measures, descriptive epidemiology in selected populations, dynamic and economic factors of the medical care system related to case detection and management, and the nature and effects of screening processes; (4) information and education programs for health care providers, parents, and the general public should be implemented to bring about increased awareness of the clinical signs and symptoms of diabetes; and (5) all persons known to have diabetes should be evaluated regularly for the detection and management of the common chronic complications of the disease.
Fiber and Diabetes
Authors: Anderson James W , Midgley Wendy R , Wedman Betty
Published: March 2007

Plant fibers have important influences on gastrointestinal physiology and the absorption of many nutrients. Certain fibers delay the absorption of carbohydrates and result in less postprandial hyperglycemia. Because the intake of plant fibers lowers plasma glucose concentrations and decreases glycosuria, high-fiber foods may be useful in the management of diabetes mellitus. Consumption of selected fibers and fiber-rich foods lowers serum cholesterol values and may lower triglyceride concentrations. Plant fiber intake may lead to mineral depletion or vitamin deficiency, but this has not been observed in several long-term studies. Further work is required to delineate the therapeutic utility of plant fibers in the diet of persons with diabetes and to assess the undesirable effects of fiber intake. In our opinion, persons with diabetes who are eating very low-fiber diets would benefit from an increase in plant fiber intake from whole grains, legumes, and vegetables.
Community Screening Programs for Diabetes?
Authors: West Kelly M
Published: March 2007

Considerable uncertainty and disagreement now prevail concerning the utility and priority of community screening programs for diabetes. A large majority of diabetologists believe that substantial benefits attend the early discovery of diabetes. Official statements of the American Diabetes Association support the view that mitigation of hyperglycemia lowers risk of morbidity. Much recent evidence indicates that aggressive early treatment often improves beta-cell function, thereby diminishing the severity of diabetes. Even so, some diabetologists and public health specialists question the practical benefits of community screening programs. Indeed, there is considerable evidence that, as previously performed, results sometimes have not justified costs. This article suggests that, when well designed, community screening is stil justified in some circumstances. To a considerable degree, failures of the past are correctable. The American Diabetes Association should neither approve nor disapprove community screening indisciminately. Affiliate organizations and health departments should be free to examine available evidence and local circumstances and, then, to decide whether to undertake screening programs. More care is needed in planning, executing, and critically evaluating these programs, but there is impressive and mounting evidence supporting the potential utility of the early discovery of diabetes.
Evaluation of a Portable Insulin Infusion Pump for Outpatient Management of Brittle Diabetes
Authors: Kitabchi Abbas E , Fisher Joseph N , Burghen George A , Gaylord Mark S , Blank Nancy M
Published: March 2007

Three “brittle” diabetic patients were given constant subcutaneous insulin infusion with a portable battery-driven pump, and their plasma glucose and hemoglobin A1 were measured at frequent intervals during inpatient or outpatient periods. Mean plasma glucose decreased significantly in all inhospital patients and remained significantly less before pump therapy in two of three as outpatients during the 8–12 wk of follow-ups; however, complete normalization of glucose metabolism was not accomplished in any. All three demonstrated a progressive decline in hemoglobin A1 levels to normal or near-normal values. The need for long-term studies of open loop infusion systems in a research setting before their adaptation to routine care is emphasized.
Measurement of Plasma LDL Cholesterol in Patients with Diabetes
Authors: Whiting Malcolm J , Shephard Mark D S , Tallis George A
Published: March 2007

OBJECTIVE

To assess the accuracy of plasma LDL cholesterol concentrations estimated by the Friedewald formula and a direct immunoseparation method by comparison with a reference ultracentrifugation procedure in patients with diabetes.

RESEARCH DESIGN AND METHODS

Fasting plasma samples with triglyceride concentrations < 4.5 mmol/l were collected from 100 patients with diabetes (28 type I and 72 type II) and LDL cholesterol concentrations were compared by the three methods.

RESULTS

LDL cholesterol values determined by the reference β-quantitation procedure were highly correlated with both the Friedewald formula (r = 0.96) and a direct immunoseparation method (r = 0.92). Calculated (Friedewald) LDL cholesterol coincided with the reference method with < 10% error in 74% of the total diabetic group (82% of type I and 68% of type II diabetic patients). However, agreement between the direct LDL cholesterol and reference methods was significantly less (P = 0.02), with only 44% of patients having an error of < 10% (52% of type I and 41% of type II diabetic patients). The direct immunoseparation method for LDL cholesterol showed a positive bias with increasing triglyceride concentrations, particularly for patients with type II diabetes.

CONCLUSIONS

In the group of diabetic patients studied with plasma triglyceride concentrations < 4.5 mmol/l, the Friedewald formula provided an accurate estimation of LDL cholesterol. The direct immunoseparation method significantly overestimated LDL cholesterol at triglyceride levels between 2 and 4.5 mmol/l.
Characteristics Related to Poor Glycemic Control in NIDDM Patients in Community Practice
Authors: Blaum Caroline S , Velez Lourdes , Hiss Roland G , Halter Jeffrey B
Published: March 2007

OBJECTIVE

To identify clinical characteristics related to poor glycemic control in patients with NIDDM cared for by Michigan primary care physicians.

RESEARCH DESIGN AND METHODS

This study was a cross-sectional secondary analysis of data from 393 NIDDM patients (mean age, 63 ± 11 years; 54% female; 92% white) in the 1990–1991 Michigan Diabetes in Communities II Study. We evaluated patient demographic, clinical, and physiological characteristics, attitudes toward diabetes, and self-care ability. Logistic regression was used for multivariate evaluation of the characteristics of those patients whose glycosylated hemoglobin (normal GHb 4–8%) was in the upper 25% of the study sample (GHb > 11.6%).

RESULTS

A high meal-stimulated plasma C-peptide was associated with a lower likelihood of poor control (odds ratio [OR] for highest quartile vs. all others = 0.37; 95% CI 0.23-0.58). Longer time since diagnosis (OR for each 5 years duration = 1.28; 95% CI 1.07-1.53), poor self-care ability (OR = 1.85; 95% CI 1.27-2.71), and perceived absence of dietary recommendations (OR = 2.37; 95% CI 1.11–5.08) were also independently associated with presence in the highest GHb quartile. Characteristics that were not significantly related to poor glycemic control included sex, age, obesity, educational level, exercise, self-rated health status, and pharmacological treatment.

CONCLUSIONS

1) Poor glycemic control may reflect progressive failure of islet function, although the independent relationships of C-peptide level and time since diagnosis are consistent with concepts of heterogeneous mechanisms underlying NIDDM. 2) Despite the important relationships of biological characteristics of NIDDM to glycemic control, patient attitudes and self-care ability may be useful targets for designing management strategies for certain poorly controlled patients.