bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum leptin levels in patients with premature ejaculation before and after citalopram treatment
Authors: Atmaca M. , Kuloglu M. , Tezcan E. , Ustundag B. , Semercioz A.
Published: March 2003

OBJECTIVE

To evaluate serum leptin levels (an adipocyte hormone involved in the suppression of appetite) in patients with premature ejaculation before and after treatment with citalopram, a selective serotonin reuptake inhibitor, with the hypothesis that leptin levels might become normal during this treatment.

PATIENTS AND METHODS

The inhibitory effect of serotonin on libido, ejaculation and orgasm is well documented. Although there is no direct evidence of an association involving brain pathways which are related to sexual behaviour, there is an interaction between leptinergic and serotonergic systems. In a previous study serum leptin levels were high in patients with premature ejaculation. The present study comprised 30 patients with premature ejaculation according to the Diagnostic and Statistical Manual of Mental Disorders Third Revised Version. Fifteen patients (group I) were randomly assigned to 8 weeks of citalopram treatment and the remainder (15, group II) received no therapy. The patients were asked to determine the average intravaginal ejaculation latency time, and their fasting serum leptin levels were measured at baseline and after 8 weeks.

RESULTS

There was no significant difference in the mean intravaginal ejaculation latency time between the groups at baseline; it increased after 8 weeks of treatment with citalopram in group I, to a mean (sd) of 209 (72.1) s, but not in group II. No difference was detected in leptin levels between the groups at baseline, but at 8 weeks they were lower in group I.

CONCLUSION

As hypothesized, leptin levels decreased in patients with premature ejaculation after treatment with citalopram, and this decrease seemed to be linked to the therapeutic effect. Further experimental studies are needed.
Screening practices for gestational diabetes mellitus in UK obstetric units
Authors: Mires G. J. , Williams F. L. R. , Harper V.
Published: March 2003

Aim To identify current screening practices for gestational diabetes mellitus (GDM) in all maternity units.

Methods A questionnaire was sent to the senior obstetrician of all obstetric units known to the UK Royal College of Obstetricians and Gynaecologists.

Results A response rate of 84% was achieved. 89% of units reported that they screened for GDM with a wide variation in the screening methods used, both between and within units. The most commonly employed procedure (81% of units) was screening based on the presence of maternal risk factors. The 75 g oral glucose tolerance test (OGTT) was the commonest diagnostic test (79% of units). Sixty‐six per cent of units operate a combined diabetic antenatal clinic and 58% of units have written guidelines for screening. Seventy‐six per cent of units would welcome national guidelines.

Conclusion The majority of obstetric units in the UK screen for GDM but with little consensus on the appropriate screening methods. National guidelines would probably be welcomed.

Diabet. Med. 16, 138–141 (1999)
Long‐term efficacy of Humalogã in subjects with Type 1 diabetes mellitus
Authors: Garg S. K. , Anderson J. H. , Perry S. V. , Mackenzie T. , Keith P. , Jennings M. K. , Hansen M. M. , Chase H. P.
Published: March 2003

Aims To evaluate the long‐term effectiveness of Humalog® insulin in lowering post meal glucose excursions.

Methods Twenty young subjects with Type 1 diabetes mellitus (DM) who had received insulin‐lispro (Humalog®) for a least 1 year (mean ± SD 1.8 ± 1.6 years) were studied on two occasions, 3–14 days apart. They consumed a similar breakfast consisting of 450–600 kCal having fasted overnight. The same amount of human soluble Humulin® Regular or Humalog® insulin was given 10 min before the meal in a randomized, double‐blind fashion.

Results Postprandial glucose excursions at 30, 60, and 120 min were significantly lower (P < 0.001,
ancova) when subjects received Humalog® as compared to human soluble insulin. Serum‐free insulin levels were significantly higher (P < 0.001,
anova) at 30 and 60 min when subjects received Humalog® as compared with human soluble insulin. Humalog® antibody levels after up to 5.4 years of receiving Humalog® insulin were not elevated beyond the values at 1 year.

Conclusions We conclude that Humalog® insulin is effective in lowering postprandial glucose excursions even after up to 5.4 years of treatment.
What is the role of between meal snacks with intensive basal bolus regimens using preprandial lispro?
Authors: Kong N. , Ryder R. E. J.
Published: March 2003

Aims Hypoglycaemia avoidance for patients on intensive insulin regimens requires the eating of snacks between meals. Insulin lispro with its shorter action profile may permit omitting such snacks.

Methods Ten Type 1 diabetes mellitus (DM) patients were rendered euglycaemic with a morning intravenous insulin infusion. Each was studied on six afternoons in random order, with previously determined equal doses of Humulin S (HS) injected at –30 min, or lispro injected at 0 min before a standard lunch. The snack was either eaten mid‐afternoon, combined with the lunch or omitted altogether.

Results Lispro and lunch with a snack combined at 0 min gave equal control to HS at –30 min and lunch at 0 min with a mid‐afternoon snack. Lispro and lunch at 0 min with a mid‐afternoon snack gave a lower early postprandial glucose. At 120 min glucose (mean mmol/l ±sem) were 7.4 ± 0.8 vs. 7.0 ± 1.0 (P = 1.0) and 3.9 ± 0.5 (P = 0.045), respectively. The area under the insulin curve over the whole afternoon was similar for HS and lispro (13 193.3 ± 974.6 vs. 13 193.6 ± 809.9 mIU/min, P = 1.0) but with a greater peak for lispro than HS with lispro falling more rapidly. Despite significantly lower lispro levels after 180 min, intermediary metabolites concentrations were similar in all HS and lispro study days.

Conclusions Lispro injected immediately before combined snack and lunch and with no subsequent snack achieves equivalent control to conventional regimens using HS –30 min before lunch and mid‐afternoon snack. Lispro taken with traditional meal patterns without dose reduction risks early postprandial hypoglycaemia and late hyperglycaemia.
Prevalence of autoantibodies to autonomic nervous tissue structures in Type 1 diabetes mellitus
Authors: Ejskjaer N. , Arif S. , Dodds W. , Zanone M. M. , Vergani D. , Watkins P. J. , Peakman M.
Published: March 2003

Aims The pathogenesis of diabetic autonomic neuropathy is multifactorial, but recent studies have suggested a link between the presence of autoantibodies to nervous tissue structures and severe, symptomatic autonomic neuropathy. The present study was designed to examine the true prevalence of these autoantibodies in a large clinic‐based population of Type 1 diabetic patients compared to nondiabetic controls.

Methods The presence of complement fixing autoantibodies to vagus nerve (CF‐VN), sympathetic ganglion (CF‐SG) and adrenal medulla (CF‐ADM) was assessed by immunofluorescence in a large cohort of patients (n = 394) of varying duration of Type 1 DM (median 28 years, range 6 months to 73 years) and 160 age and sex‐matched nondiabetic control subjects.

Results All three autoantibodies were frequently detected in Type 1 DM (CF‐VN, 22.1%; CF‐SG, 30.7%; CF‐ADM, 13.2%) but only rarely in healthy control subjects (4.4%, 4.4% and 3.1%, respectively; P < 0.0005 for all). There was no association between any of the autoantibodies and retinopathy (fundoscopy), peripheral somatic neuropathy (biothesiometry) or nephropathy (urinary albumin–creatinine ratio).

Conclusions Our results on this large cohort establish the extensive presence of autonomic nervous tissue autoantibodies in Type 1 DM. Their role in reflecting, causing or predicting autonomic neuropathy remains to be determined.
Autonomic nerve function in adolescents with Type 1 diabetes mellitus: relationship to microalbuminuria
Authors: Clarke C. F. , Eason M. , Reilly A. , Boyce D. , Werther G. A.
Published: March 2003

Aims Thirty adolescent patients with Type 1 diabetes mellitus and microalbuminuria were studied for evidence of early autonomic neuropathy

Methods Using tests involving cardiovascular and pupillary reflexes, the adolescents were compared with a normoalbuminuric group of patients with diabetes, who were matched for age, sex, puberty and duration of diabetes.

Results There was an increased prevalence of autonomic nerve dysfunction in the patients with microalbuminuria. These patients had higher resting heart rates (86 beats/min in the microalbuminuric group vs. 77 beats/min in normoalbuminuric controls, P = 0.002), and impaired pupillary dilatation in darkness (pupillary diameter % 56.5% vs. 62.5%, P = 0.003). Patients with microalbuminuria also had poorer long term glycaemic control (mean HbA1c 8.7% vs. 7.8%, P = 0.002) and higher blood pressures (systolic 125 vs. 116 mmHg, P = 0.001; diastolic 69 vs. 62 mmHg, P = 0.0001; mean arterial pressure 90 vs. 83 mmHg, P = 0.002) than those with normal urinary albumin excretion.

Conclusions Microalbuminuria and autonomic nerve dysfunction co‐exist in patients with Type 1 DM. Longitudinal studies will determine whether these findings have implications for the identification of patients at higher risk of progression of early renal complications.
Aspirin usage in a large teaching hospital diabetes clinic setting
Authors: Wood D. M. , Plehwe W. E. , Colman P. G.
Published: March 2003

Aim To document aspirin usage and the prevalence of large and small vessel complications in patients with diabetes mellitus (DM) attending the outpatient diabetes clinics of a large public hospital.

Methods All patients attending diabetes outpatient clinics at The Royal Melbourne Hospital in Melbourne, Australia were surveyed over a 3‐month period.

Results Complete data were available on 629 of 632 (296 male) patients surveyed. Of the 29.3% of patients who were suffering from one or more macrovascular complication (ischaemic heart disease, cerebrovascular disease or peripheral vascular disease), 63% were currently on aspirin treatment. Of those not on aspirin, 65% had no contra‐indication to aspirin treatment and a further 19% had only a relative contra‐indication of either aspirin or warfarin treatment recorded.

Conclusions The published recommendations for the use of aspirin in patients with macrovascular disease were generally being followed in this clinic‐based population. However, a significant proportion of patients without a contra‐indication to treatment were still not receiving aspirin. The lack of clear evidence‐based guidelines for aspirin use may be a factor in its under‐prescription. This survey suggests clear evidence‐based guidelines should be established and disseminated.
Comparison of ADA and WHO screening methods for diabetes mellitus in obese patients
Authors: Mannucci E. , Bardini G. , Ognibene A. , Rotella C. M.
Published: March 2003

Aims To compare the performance of fasting glycaemia (FG) and oral glucose tolerance testing (OGTT) in screening for diabetes mellitus in obese patients.

Methods A consecutive series of 528 (445 female, 83 male) obese (body mass index > 30 kg/m2) outpatients, aged 45.2 ± 14.3 years, was studied with FG and OGTT. The association of categories of glucose tolerance (diabetes and impaired glucose tolerance (IGT)) and fasting glycaemia (diabetes and impaired fasting glucose (IFG)) with hypertension and hyperlipidaemia were also assessed.

Results Prevalence of diabetes and IGT were 20.1 and 22.9%, respectively. FG (> 7 mmol/l) had a sensitivity of 56.7%. Using FG > 6.1 mmol/l, and OGTT in those above the threshold, the sensitivity for diabetes would have been 89.6%, with a positive predictive value of 59.0%, but 68.8% of cases of IGT would not have been detected. Patients with impaired fasting glucose (FG of 6.1–7.0 mmol/l) showed lower insulin sensitivity and impaired β cell function, and a weaker association to hypertriglyceridaemia, when compared to IGT.

Conclusion FG > 7.0 mmol/l does not show a sufficient sensitivity for the screening of diabetes in obese patients. FG > 6.1 mmol/l has a satisfactory sensitivity for diabetes, but not for IGT. IFG has different pathophysiological features than IGT and cannot be assumed to have the same prognostic value of IGT.
The use of digital cameras in a mobile retinal screening environment
Authors: Taylor D. J. , Fisher J. , Jacob J. , Tooke J. E.
Published: March 2003

Aims To assess how successfully digital camera technology might be incorporated into a mobile screening environment.

Methods One hundred and ninety‐seven people had their fundi photographed using a Topcon/Imagenet digital system and 534 using a Canon CR5/Ris‐Lite system in addition to concurrent 45° CR4NM Polaroid photography. One hundred and eighteen randomly selected patients were also sent for 7 field stereo photography as a gold standard. An acceptability questionnaire was answered by a random sample of those photographed

Results For the detection of any retinopathy, digital pictures had a sensitivity of 0.74 (95% confidence interval (CI) 0.68–0.80) whilst Polaroid was 0.72 (95% CI 0.66–0.78) and for referable retinopathy digital pictures had a sensitivity of 0.85 (95%CI 0.80–0.90) and Polaroid was 0.90 (95% CI 0.86–0.94). A concurrent ophthalmoscopic evaluation improved the sensitivity to 0.92 (95% CI 0.86–0.98) for detection of any retinopathy whilst the sensitivity at the referral level was improved to 0.95 (95% CI 0.91–0.99). Twenty‐nine of 176 respondents experienced flash discomfort with the Polaroid system with only four of 154 describing ‘some’ discomfort from the digital systems which have a lower flash power (10 W vs. 300 W) and a faster recovery time.

Conclusions This study indicates that digital systems are a feasible and acceptable alternative to Polaroid‐based cameras for use in a mobile environment.
Effects of the new oral hypoglycaemic agent nateglinide on insulin secretion in Type 2 diabetes mellitus
Authors: Whitelaw D. C. , Clark P. M. , Smith J. M. , Nattrass M.
Published: March 2003

Aims The new non‐sulphonylurea oral hypoglycaemic agent nateglinide has been shown to enhance insulin secretion in animals and in healthy human volunteers and thus offers a potential advance in the treatment of Type 2 diabetes mellitus. This study examined whether nateglinide can enhance insulin secretion, and particularly the first phase insulin response, in patients with Type 2 diabetes.

Methods A double‐blind, placebo‐controlled trial, examining the effects of a single oral dose of 60 mg nateglinide, given 20 min prior to an intravenous glucose tolerance test (IGTT), on insulin secretion in 10 otherwise healthy Caucasian men with recently diagnosed Type 2 diabetes (duration since diagnosis 0–44 months).

Results Insulin secretion (both overall and first phase) was significantly increased by nateglinide (P < 0.001), as were C‐peptide (P < 0.001) and proinsulin (P < 0.001) secretion. Overall glucose concentrations following glucose challenge were lower after nateglinide than after placebo (P = 0.05).

Conclusions Nateglinide significantly increases insulin secretion in Type 2 diabetic patients, in particular restoring the first phase insulin response. Further study is necessary to determine the effects of chronic administration on insulin secretion and blood glucose concentration.
Ketoacidosis in young adults is not related to the islet antibodies at the diagnosis of Type 1 diabetes mellitus – a nationwide study
Authors: Östman J. , Landin‐Olsson M. , Törn C. , Palmer J. , Lernmark Å. , Arnqvist H. , Björk E. , Bolinder J. , Blohmé G. , Eriksson J. , Littorin B. , Nyström L. , Scherstén B. , Sundkvist G. , Wibell L.
Published: March 2003

AimsTo test the hypothesis that there is lower prevalence of islet antibodies in subjects with newly diagnosed Type 1 diabetes mellitus in young adulthood than in children is associated with less severe diabetes at time of diagnosis.

MethodsThis investigation was based on a nationwide study (Diabetes Incidence Study in Sweden) of 15–34‐year‐old newly diagnosed diabetic subjects. During 1992–1993, all diabetic subjects (excluding secondary and gestational diabetes) were reported on standardized forms, with information about clinical characteristics at diagnosis. The study examined islet cell antibodies (ICA) by indirect immunofluorescence, and autoantibodies to glutamic acid decarboxylase (GADA), tyrosine phosphatase‐like antigen (IA‐2A) and insulin (IAA) as well as C‐peptide by radioimmunoassay.

ResultsBlood samples were available from 78 patients with diabetic ketoacidosis (DKA) and 517 non‐acidotic patients. The prevalence of ICA (63% vs. 57%), GADA (63% vs. 66%), IA‐2A (35% vs. 44%) and IAA (20% vs. 15%) were very similar in patients with or without DKA. The median levels of the four autoantibodies did not differ between the two groups. High blood glucose (P < 0.001) and low C‐peptide levels (P < 0.001) were the only parameters found to be related to DKA.

ConclusionsThe similarities in findings of newly diagnosed diabetic patients with or without DKA regarding ICA, GADA, IA‐2A and IAA suggest that there is no relationship between the expression of antigenicity and the severity of β‐cell dysfunction. The lower prevalence of the four autoantibodies in 15–34‐year‐old diabetic subjects compared with previous findings in children is not explained by misclassification of diabetes type.
Plasma concentrations of VCAM‐1 and ICAM‐1 are elevated in patients with Type 1 diabetes mellitus with microalbuminuria and overt nephropathy
Authors: Clausen P. , Jacobsen P. , Rossing K. , Jensen J. S. , Parving H. ‐H. , Feldt‐Rasmussen B.
Published: March 2003

SUMMARY

Aims  Elevated urinary albumin excretion is associated with macrovascular atherosclerotic complications in Type 1 diabetes mellitus. Adhesion molecules mediate leucocyte adhesion to the endothelium early in the atherosclerotic process. The present study tests the hypothesis that microalbuminuria and diabetic nephropathy are associated with elevated plasma concentrations of soluble vascular adhesion molecule (sVCAM)‐1, soluble intercellular adhesion molecule (sICAM)‐1, and soluble E‐selectin (sE‐selectin) aiming to illustrate factors of potential pathogenetic relevance for the excess cardiovascular disease in diabetic patients with renal complications.

Methods  Soluble adhesion molecule concentrations were measured by enzyme‐linked immunosorbent assays (ELISA) in healthy controls (n = 16) and in 59 Type 1 diabetic patients: group 1 – patients with normoalbuminuria (n = 16); group 2 – patients with microalbuminuria (n = 15); group 3 – patients with macroalbuminuria and normal serum creatinine (n = 15), group 4 – patients with macroalbuminuria and moderately elevated serum creatinine (n = 13).

Results  Plasma concentrations of sVCAM‐1 and sICAM‐1 were similar in healthy controls and normoalbuminuric Type 1 diabetic patients, but the concentrations were increased by the presence of microalbuminuria and overt nephropathy (P < 0.001 and P < 0.0001, anova). Concentrations of sE‐selectin did not differ between diabetic patients and controls.

Conclusions  Plasma concentration of sICAM‐1 is elevated in Type 1 diabetic patients with microalbuminuria and the concentrations of sICAM‐1 as well as sVCAM‐1 are elevated in patients with macroalbuminuria and normal s‐creatinine. The elevated plasma concentrations of these soluble adhesion molecule concentrations in patients with renal complication can be of pathogenetic importance for the development of atherosclerosis and plasma soluble adhesion molecule concentrations may provide additional information on cardiovascular risk.
The prevalence of diabetes, association with cardiovascular risk factors and implications of diagnostic criteria (ADA 1997 and WHO 1998) in a 1996 community‐based population study in Hong Kong Chinese
Authors: Janus E. D. , Wat N. M. S. , Lam K. S. L. , Cockram C. S. , Siu S. T. S. , Liu L. J. , Lam T. H. ,   on behalf of the Hong Kong Cardiovascular Risk Factor Steering Committee
Published: March 2003

SUMMARY

Aims  While the American Diabetes Association (ADA) 1997 diagnostic criteria advocate the use of fasting plasma glucose only, the World Health Organization (WHO) criteria retain the use of the standard oral glucose tolerance test (OGTT). The present study evaluated the relative merit of the respective diagnostic criteria in Chinese.

Methods  Data collected for the Hong Kong Cardiovascular Risk Factor Prevalence Study was analysed. This was a representative population‐based study, conducted from 1995 to 1996 among 2900 Chinese subjects aged 25–74 years using a 75‐g OGTT.

Results  The prevalence of diabetes (known plus unknown) was 6.2% (95% confidence interval 5.3–7.1%), 9.2% (8.1–10.3%), and 9.8% (8.7–10.9%) based on ADA 1997, WHO 1985 and WHO 1998 criteria, respectively, with a very high prevalence in older subjects. The 2451 subjects classified as normal under ADA 1997 criteria were heterogenous: 15.3% had impaired glucose tolerance; 2.1% had diabetes under WHO 1998 criteria. These latter two smaller groups had cardiovascular risk profiles comparable to that found among the impaired fasting glucose subjects (under ADA), but worse than that among the concordant normal glucose tolerance subjects.

Conclusions  The ADA criteria underestimate both diabetes prevalence and cardiovascular risk in this population. Hence fasting glucose alone is an inadequate approach and OGTT should be retained to identify at‐risk individuals in both clinical diagnosis and epidemiological studies.
Impact of the Xba1‐polymorphism of the human muscle glycogen synthase gene on parameters of the insulin resistance syndrome in a Danish twin population.
Authors: Fenger M. , Poulsen P. , Beck‐Nielsen H. , Vaag A.
Published: March 2003

SUMMARY

Aims  To establish the impact on the insulin resistance syndrome of the intron 14 Xba1‐polymorphism in human muscle glycogen synthase (GYS1).

Methods  Parameters related to the insulin resistance syndrome were measured in 244 monozygotic twins and 322 dizygotic twins with or without impaired glucose tolerance. In addition a standard oral glucose tolerance test (OGTT) was performed. The twins were genotyped for Xba1‐polymorphism in GYS1 intron 14.

Results  The allele frequency of Xba1 non‐cutters (A1) was 0.95 and of cutters (A2) was 0.05. Of the 566 twins examined, 90.0% had the genotype A1A1 and the remainder had the genotype A1A2. No A2A2‐genotypes were detected. In 11 genotypic discordant dizygotic twin pairs the insulin resistance was significantly increased in the twins carrying the A1A2 genotype regardless of sex (HOMA index 1.81 (A1A1) vs. 2.57 (A1A2), P < 0.05). Diastolic blood pressure was increased in female carriers of the A2‐allele with impaired glucose tolerance or Type 2 diabetes mellitus (79 ± 1 vs. 94 ± 4 mmHg, P < 0,01). Apart from a marginal increased waist‐to‐hip ratio, no other elements of the insulin resistance syndrome were associated with the polymorphism.

Conclusions  The Xba1‐polymorphism of the human muscle glycogen synthase gene is correlated to insulin resistance and to diastolic blood pressure. The polymorphism does not involve any known transcription factor or any structural change in GYS1, and these correlations are therefore most probably caused by linkage to other functional polymorphisms in GYS1 or other gene polymorphisms on chromosome 19.
Post‐challenge hyperglycaemia relates more strongly than fasting hyperglycaemia with carotid intima‐media thickness: the RIAD Study
Authors: Hanefeld M. , Koehler C. , Henkel E. , Fuecker K. , Schaper F. , Temelkova‐Kurktschiev T.
Published: March 2003

SUMMARY

Aims  Only scarce information exists on the distribution and atherosclerosis risk in different types of hyperglycaemia at diabetes detection. This study aimed to analyse the occurrence of isolated fasting (IFH), isolated post‐challenge (IPH) and combined hyperglycaemia (FH/PH) among subjects detected to have diabetes and the association of these types of hyperglycaemia with cardiovascular risk factors and carotid intima‐media thickness (IMT).

Methods  A total of 785 middle‐aged subjects of the Risk Factors in Impaired Glucose Tolerance (IGT) for Atherosclerosis and Diabetes (RIAD) study underwent a 75‐g oral glucose tolerance test and examination of various atherosclerosis risk factors. IMT was measured by B‐mode ultrasound.

Results  One hundred and nineteen (15.2%) asymptomatic diabetic subjects were detected: of these, 35.3% with IFH, 26% with IPH and 38.7% with FH/PH. The level of risk factors was higher in diabetic vs. non‐diabetic subjects. HbA1c and cardiovascular risk factors were in the same range for IFH and IPH except for active plasminogen activator inhibitor (PAI)‐1 which was significantly higher in IFH. A higher risk burden was found in the FH/PH group vs. both IFH and IPH. IMT was as follows: non‐diabetic subjects 0.85 ± 0.18 mm, IFH 0.91 ± 0.20 mm, IPH 0.94 ± 0.18 mm, FH/PH 0.98 ± 0.17 mm (P < 0.05 vs. non‐diabetes). 2 h post‐challenge glucose (2hPG) correlated more closely (r = 0.23, P < 0.001) to IMT than fasting plasma glucose (FPG) (r = 0.14, P = 0.004). The importance of 2hPG was confirmed by the direct comparison of FPG and 2hPG in a three dimensional analysis. A significant increase of IMT was only observed in the subgroups with abnormal post‐challenge hyperglycaemia for both combinations with normal FPG and IFG. FPG category did not significantly add to IMT in either group of post‐challenge hyperglycaemia. Regression analysis in the whole sample revealed 2hPG but not FPG as a significant determinant of IMT. Further significant risk factors were age, male sex, total cholesterol, HDL‐cholesterol and hypertension.

Conclusions  The RIAD study population at high risk for Type 2 diabetes mellitus, post‐challenge hyperglycaemia was found to relate more strongly than fasting hyperglycaemia with carotid IMT.
Increased secretion of TGF‐β1 by peripheral blood mononuclear cells from patients with Type 1 diabetes mellitus with diabetic nephropathy
Authors: Korpinen E. , Groop P. ‐H. , Fagerudd J. A. , Teppo A. ‐M. , Åkerblom H. K. , Vaarala O.
Published: March 2003

Summary

Aims  To study transforming growth factor (TGF)‐β1 secretion by peripheral blood mononuclear cells (PBMC) from Type 1 diabetic patients with and without nephropathy.

Methods  Thirty normoalbuminuric Type 1 diabetic patients (urinary albumin excretion rate (AER) < 20 μg/min), 12 microalbuminuric (AER 20–200 μg/min), 10 nephropathic (AER > 200 μg/min), and 13 non‐diabetic individuals were recruited. TGF‐β1 secretion by PBMC was measured by enzyme immunoassay (EIA) after 48 h culture with and without phytohaemagglutinin (PHA) (5 μg/ml).

Results  After 48 h culture, the highest TGF‐β1 levels secreted by unstimulated PBMC were found in patients with nephropathy (median 6.2 (range 0.9–20.0) ng/ml) when compared to patients with normal albumin excretion (4.1 (0.2–11.3) ng/ml), microalbuminuria (1.8 (0.2–6.4) ng/ml) and healthy controls (1.0 (0.2–7.0) ng/ml); P = 0.02 for the three diabetic groups and P = 0.006 for all groups. At 48 h, the PHA‐stimulated TGF‐β1 levels were 12.4 (2.9–30.0) ng/ml in nephropathic, 7.3 (0.5–21.2) ng/ml in normoalbuminuric, and 5.5 (0.5–27.6) ng/ml in microalbuminuric patients (P = 0.05). A correlation was observed between TGF‐β1 and diastolic blood pressure in the subgroup of patients with incipient and overt nephropathy (r = 0.45, P = 0.04).

Conclusions  Type 1 diabetic patients with overt nephropathy show increased TGF‐β1 secretion by PBMC. Diastolic blood pressure levels correlated with TGF‐β1 secretion in dyabetic patients with nephropathy. Increased TGF‐β1 secretion by PBMC may be associated with renal and vascular disease in Type 1 diabetes mellitus.
Glycaemia and insulinaemia in elderly European subjects (70–75 years)
Authors: Teuscher A. U. , Reinli K. , Teuscher A
Published: March 2003

SUMMARY

Aims  To determine glycaemia and insulinaemia in elderly subjects aged 70–75 years, living across Europe, who participated in the EURONUT‐SENECA (Survey in Europe on Nutrition and the Elderly, a Concerted Action) study.

Methods  Fasting plasma glucose (FPG) and fasting insulin concentrations were measured in 1830 subjects aged 70–75 years living in 15 traditional towns in 11 European countries. For the diagnosis of diabetes, the recommendations of the 1997 report of the American Diabetes Association ‘Expert Committee on the diagnosis and classification of diabetes mellitus’ were used.

Results  A total of 31.6% of the study subjects had either diabetes (17.5%) or impaired fasting plasma glucose (FPG) (14.1%). Fifty‐one per cent of the subjects with diabetes were unaware of the disease. No difference in diabetes prevalence was found for sex, but male subjects were more likely to have impaired FPG than female subjects (16.8 vs. 11.5%, P = 0.001). Hyperinsulinaemia (fasting insulin levels in the highest quartile) was associated with increased FPG, body mass index, and waist‐to‐hip ratio.

Conclusions  It was found that a substantial number of elderly Europeans have impaired glucose homeostasis, with diabetes and impaired FPG being present in almost a third of European subjects aged 70–75 years.
What attracts patients with diabetes to an internet support group? A 21‐month longitudinal website study
Authors: Zrebiec J. F. , Jacobson A. M.
Published: March 2003

SUMMARY

Aims  To establish and evaluate a web‐based educational and emotional resource for patients with diabetes and their family members.

Methods  A total of 47 365 user visits over a 21‐month period to three internet discussion groups about diabetes were tracked for user activity, characteristics and level of satisfaction.

Results  The primary domains of users were the US (70%) and Canada (4%). Of all users, 7.55% posted messages, while 92.45% read messages posted by others. The average length of use was 15 min 5 s. Forty‐four per cent posted messages to the nutrition discussion, 38% posted messages to the motivational discussion, and 18% posted messages to the family discussion. The most common postings addressed nutrition (42%), the emotional impact of diabetes (18%), managing high or low blood glucose levels (10%), and complications (8%). Respondents to the satisfaction survey were 64% female, 43% were insulin and 37% non‐insulin users. Eighty‐four per cent were older than 30 years, 34% had recently diagnosed diabetes and 32% had diabetes > 10 years. Forty‐three per cent visited more than three times. Seventy‐nine per cent of all respondents rated participation in the chat as having a positive effect on coping with diabetes.

Conclusions  A professionally moderated internet discussion group is actively visited by a broad base of patients and families, and appears to be a useful strategy for engaging patients with chronic disease for emotional support and information exchange.
Insulin secretion and insulin sensitivity are normal in non‐diabetic subjects from maternal inheritance diabetes and deafness families
Authors: Holmes‐Walker D. J. , Ward G. M. , Boyages S. C.
Published: March 2003

Background The pathophysiological mechanism of diabetes mellitus in the presence of the 3243 A‐G tRNALEU(UR) mitochondrial DNA mutation is thought to result from deficient insulin secretion. However, few subjects with normal glucose tolerance have been studied to determine the sequence of events resulting in the development of diabetes mellitus.

Aim To determine whether abnormalities of insulin sensitivity, insulin secretion or glucose effectiveness are present in non‐diabetic subjects with the 3243 A‐G tRNALEU(UUR) mitochondrial DNA mutation.

Methods Twelve non‐diabetic subjects with the mutation were compared with 12 controls, matched for age and anthropometric parameters, using both oral and intravenous glucose tolerance tests, the latter with Minimal Model analysis.

Results Following an oral glucose load we found significantly higher blood glucose levels at 90 min and 120 min and significantly higher insulin levels at 120 min and 180 min in non‐diabetic subjects with the mutation but no difference in the insulinogenic indices at 30 min and 180 min. From the intravenous glucose tolerance test there was no difference in overall glucose tolerance, insulin sensitivity, first‐ or second‐phase insulin secretion, proinsulin secretion or glucose effectiveness. Insulin‐independent glucose disposal was increased in subjects with lower insulin sensitivity and declined with increasing age in subjects with the mutation but not in controls.

Conclusions While there appear to be subtle defects of glucose handling in non‐diabetic subjects with the 3243 mutation, these could not be explained by differences in insulin sensitivity or secretion.

Diabet. Med. 18, 381–387 (2001)
Management of obesity in patients with Type 2 diabetes
Authors: Campbell L. , Rössner S.
Published: March 2003

Although prevention is clearly a logical first step in the management of the obese Type 2 diabetic patient, such programmes have had little long‐term success. Diet, exercise and behavioural modification still form the cornerstones of treatment and relatively small weight loss results in improvement of all major obesity‐related co‐morbidities, including Type 2 diabetes. The obese diabetic patient faces extra impediments to weight loss, including the adverse effects of diabetic medication, poor glycaemic control and diabetes‐related complications. New drugs may offer some additional help, in general by providing the benefit associated with the weight loss as such. Bariatric surgery can produce major long‐term weight loss in the severely obese.

Diabet. Med. 18, 345–354 (2001)
Enhanced endothelial activation in diabetic patients with unstable angina and non‐Q‐wave myocardial infarction
Authors: Mulvihill N. T. , Foley J. B. , Murphy R. T. , Pate G. , Crean P. A. , Walsh M.
Published: March 2003

Aims  Diabetes mellitus (DM) is associated with chronic endothelial dysfunction. Diabetic patients presenting with acute coronary syndromes have a worse prognosis than non‐diabetics. An acute inflammatory reaction at the site of coronary plaque rupture and increased expression of surface and soluble cellular adhesion molecules (CAMs) are pathological features of acute coronary syndromes. We set out to characterize the expression of soluble CAMs in patients with and without diabetes presenting with unstable angina (UA) and non Q‐wave myocardial infarction (NQMI).

Methods  Patients presenting with UA and NQMI had serum samples taken on presentation, after 72 h and then 3, 6 and 12 months after discharge. Levels of soluble intercellular adhesion molecule‐1 (ICAM‐1), vascular cell adhesion molecule‐1 (VCAM‐1), E‐selectin and P‐selectin were measured using an ELISA technique.

Results  We studied 15 diabetic patients and 15 age‐ and sex‐matched non‐diabetic patients presenting with either UA or NQMI. Levels of soluble E‐selectin were elevated in the diabetic patients in comparison with the non‐diabetic patients at all measured time points: 74  ± 10 ng/ml vs. 47

 ± 3 ng/ml, P < 0.03 at t = 0 h, 55

 ± 5 ng/ml vs. 38

 ± 2 ng/ml, P < 0.02 at t = 72 h. However, levels of soluble P‐selectin were lower in the diabetic cohort during follow‐up: 134 ± 15 ng/ml vs. 225 ± 32 ng/ml, P < 0.02 at t = 3/12 and 112 ± 8 ng/ml vs. 197 ± 23 ng/ml, P < 0.02 at t = 6/12. There was no significant difference in levels of soluble ICAM‐1 and VCAM‐1 between diabetic and non‐diabetic patients.

Conclusions  Levels of soluble E‐selectin are significantly elevated in diabetic patients presenting with UA and NQMI in comparison with non‐diabetics. This finding may reflect enhanced endothelial activation which may contribute to the adverse prognosis of diabetic patients with acute coronary syndromes.

Diabet. Med. 18, 979–983 (2001)
Elevation of von Willebrand factor in plasma in diabetic patients with neuropathic foot ulceration
Authors: Aso Y. , Fujiwara Y. , Tayama K. , Inukai T. , Takemura Y.
Published: March 2003

Aims The present study examines the relationship between markers of endothelial dysfunction and diabetic neuropathy or consequent neuropathic foot ulceration in patients with Type 2 diabetes mellitus.

Methods We studied 65 Type 2 diabetic patients including 25 diabetic patients without neuropathy, 27 with neuropathy but no history of foot ulceration, and 13 with neuropathic ulceration. Plasma concentrations of von Willebrand factor (vWF) and soluble thrombomodulin (TM), measures of endothelial dysfunction, were determined by enzyme immunoassays. We performed various tests quantifying aspects of diabetic neuropathy including vibration perception threshold (VPT; for sensory neuropathy), coefficient of variation of R–R intervals (CVR–R; for cardiac autonomic neuropathy), and cold‐induced vasodilation in the great toe for peripheral sympathetic neuropathy.

Results CVR–R and cold‐induced vasodilation were significantly diminished in patients with neuropathic foot ulceration compared with patients with neuropathy but no history of foot ulceration. Plasma vWF concentrations were positively correlated with VPT and cold‐induced vasodilation test, and were inversely correlated with CVR–R. Multivariate analysis disclosed that VPT and percentage vasodilation were independent factors for plasma vWF. Plasma vWF was significantly elevated in patients with foot ulceration compared with patients without neuropathy or those with neuropathy but not foot ulceration. However, plasma TM concentrations did not differ between the three groups.

Conclusions Diabetic patients with neuropathic foot ulceration had severe impairment of cardiac autonomic and peripheral sympathetic nerves. Elevation of vWF in plasma was associated with neuropathic foot ulceration, linking endothelial dysfunction to foot ulceration.
Blood Glucose Awareness Training in Dutch Type 1 diabetes patients. Short‐term evaluation of individual and group training
Authors: Broers S. , Le Cessie S. , Van Vliet K. P. , Spinhoven Ph. , Van Der Ven N. C. W. , Radder J. K.
Published: March 2003

Aims The aims of the present study were: (i) to evaluate the effects of a Dutch translation and adaptation of Blood Glucose Awareness Training (BGAT‐III) on blood glucose (bg) perception, glycaemic control, and decisions not to drive or to raise the bg during hypoglycaemia; (ii) to compare the effects of individual and group BGAT.

Methods Fifty‐nine patients with Type 1 diabetes participated in BGAT in either a group or an individual setting. Before and after BGAT, 39 (66%) of them completed 30–70 measurements on a hand‐held computer (hhc). During every measurement, they estimated their bg, indicated whether they would drive or raise their bg on the basis of their estimation, and then measured their bg.

Results Individual and group BGAT did not have significantly different effects (P = 0.35–0.98). Overall, BGAT did not significantly affect bg perception (P = 0.11–0.65). Before BGAT patients recognized a mean of 32% of their hypoglycaemic episodes, after BGAT a mean of 39% (P = 0.12). After BGAT, patients more often decided not to drive when their bg was low (P = 0.03). They tended to decide more often to raise their bg during hypoglycaemia (P = 0.09).

Conclusions The effects of BGAT were smaller than expected. Possible reasons for this negative outcome may be the adapted version of BGAT (shorter in duration), a lack of statistical power, or a difference between American and European samples in their reaction to BGAT.
Blood glucose overestimation in diabetic patients on continuous ambulatory peritoneal dialysis for end‐stage renal disease
Authors: Oyibo S. O. , Pritchard G. M. , Mclay L. , James E. , Laing I. , Gokal R. , Boulton A. J. M.
Published: March 2003

Aims Diabetic patients on continuous ambulatory peritoneal dialysis (CAPD) for renal failure depend on glucose analysers for regular monitoring of glycaemic control. We aim to inform health professionals of the potentially dangerous overestimation of blood glucose values by some analysers in patients using Icodextrin for dialysis.

Methods Twenty‐five patients on continuous ambulatory peritoneal dialysis (10 patients on an 8–12‐h nocturnal exchange of Icodextrin) had random glucose analysis performed on venous blood using standardized reference laboratory (lab) technique (glucose oxidase GOD‐PAP), and simultaneously on capillary blood using the Precision Q·I·D System (glucose oxidase method) and the Advantage meter (glucose dehydrogenase method).

Results The Precision Q·I·D System agreed with the lab results in both the Icodextrin group and the non‐Icodextrin group (80–90% of values fell within 20% of the corresponding lab result). In contrast, the Advantage meter agreed with the lab results only in the non‐Icodextrin group (95% of values within 20% of the corresponding lab value), and not in the Icodextrin group, where only 5% of the analyser values fell within 20% of the corresponding lab value.

Conclusions The Precision Q·I·D System, which utilizes glucose oxidase reaction, is safe for use in diabetic patients treated with Icodextrin. All analysers must be cross‐checked with the laboratory reference method before use in these patients.

Diabet. Med. 19, 693–696 (2002)
Autonomic neuropathy is associated with increased cardiovascular risk factors: the EURODIAB IDDM Complications Study
Authors: Kempler P. , Tesfaye S. , Chaturvedi N. , Stevens L. K. , Webb D. J. , Eaton S. , Kerényi Zs. , Tamás Gy. , Ward J. D. , Fuller J. H. ,   the EURODIAB IDDM Complications Study Group
Published: March 2003

Aims To assess the prevalence of and risk factors for autonomic neuropathy in the EURODIAB IDDM Complications Study.

Methods The study involved the examination of randomly selected Type I (insulin‐dependent) diabetic patients from 31 centres in 16 European countries. Neuropathic symptoms and two tests of autonomic function (changes in heart rate and blood pressure from lying to standing) were assessed and data from 3007 patients were available for the present analysis. Autonomic neuropathy was defined as an abnormality of at least one of the tests.

Results The prevalence of autonomic neuropathy was 36% with no sex differences. The frequency of one and two abnormal reflex tests was 30% and 6%, respectively. The R–R ratio was abnormal in 24% of patients while 18% had orthostatic hypotension defined as a fall in systolic blood pressure > 20 mmHg on standing. Significant correlations were observed between autonomic neuropathy and age (P < 0.01), duration of diabetes (P < 0.0001), HbA1c (P < 0.0001), diastolic blood pressure (P < 0.05), lower HDL‐cholesterol (P < 0.01), the presence of retinopathy (P < 0.0001) and albuminuria (P < 0.0001). New associations have been identified from the study: the strong relationship of autonomic neuropathy to cigarette smoking (P < 0.01), total cholesterol/HDL‐cholesterol ratio (P < 0.05) and fasting triglyceride (P < 0.0001). As a key finding, autonomic neuropathy was related to the presence of cardiovascular disease (P < 0.0001). All analyses were adjusted for age, duration of diabetes and HbA1c. However, data have been only partly confirmed by logistic regression analyses. Frequency of dizziness on standing up was 18%, while only 4% of patients had nocturnal diarrhoea and 5% had problems with bladder control.

Conclusion Cardiovascular reflex tests, even in the form of the two tests applied, rather than a questionnaire, seem to be appropriate for the diagnosis of autonomic neuropathy. The study has identified previously known and new potential risk factors for the development of autonomic neuropathy, which may be important for the development of risk reduction strategies. Our results may support the role of vascular factors in the pathogenesis of autonomic neuropathy.

Diabet. Med. 19, 900–909 (2002)
Determining variation in the success of New Zealand land birds
Authors: Cassey Phillip
Published: March 2003

The New Zealand avifauna has changed considerably since the arrival of humans approximately 1000 years ago. The extinction of native species followed by their replacement with introduced exotic species is recognized as having greatly reduced the distinctiveness of the avifauna. Using phylogenetically independent methods, I tested whether life history and ecological correlates of extinction, introduction and persistence were significant across species and within taxa. Extinct land bird species were, on average, and independent of phylogenetic relatedness, larger‐bodied than extant species. Introduction success was found to be significantly associated with increasing species body size, generation time and indices of human effort. In contrast, the geographical distribution of extant land birds was correlated with traits associated with high population growth rates (i.e. small, rapidly developing species, with high fecundity). My results suggest that selection pressures have changed significantly since the arrival of human colonists in New Zealand and that these changes have favoured different types of land birds, to the general detriment of endemic species. Comparative methods that explicitly examine historical changes are necessary to elucidate the changing roles of biological and extrinsic traits in the differential success of species in any assemblage.
Multiple source pools for Galápagos plant species richness: a critical analysis of the line of sight connectivity index
Authors: Rejmánek Marcel , Klinger Robert
Published: March 2003

An index (Ci*E) combining the number of line‐of‐sight islands (Ci) within a radius i and target island elevation (E) has been proposed as an improved predictive model of plant species richness (St) in the Galápagos Archipelago. We examined this index critically and found that several major flaws preclude it from being a useful predictive tool for the archipelago. Although the number of collecting trips to an island was reported over 20 years ago to have substantial predictive value for reported plant species richness in the Galápagos Islands, this relationship was ignored in multiple regression analyses of the index. When we included the number of collecting trips in different multiple regression analyses of the index, Ci*E had less predictive power than collecting trips or ceased to be significant at all. Additionally, the strong significant relationship between elevation and area in the Galápagos Archipelago results in area having a major confounding influence on the Ci*E index. When elevation is removed from the Ci*E index, the predictive power of Ci is far less than area alone. Finally, the data used to construct and correlate the Ci*E index with (St) were based only on a subset of the islands and species lists that were incomplete or out of date. Species richness on islands can be related to the interaction of different factors, so development and testing of indices like Ci*E is not inappropriate. However, it is important to examine the interrelationships among the components of these indices thoroughly, and not ignore the effect of factors already known to have high predictive power. We propose several ways in which more meaningful indices of source pool(s) capacity can be constructed.
Three challenges for a real people‐centred conservation
Authors: Brown Katrina
Published: March 2003

Many commentators attest to a paradigm shift in biodiversity conservation, away from exclusive protected areas towards more people‐centred or community‐based conservation. This has been referred to as ‘new conservation’. However, new conservation could be thought of as an attempt to re‐label and re‐package conservation and to ‘get people on board’ existing strategies. According to its critics even so‐called new conservation policy, practice and institutions remain expert‐driven, undemocratic and autocratic. I argue that for new conservation to become reality, then more fundamental changes in priority‐setting, decision‐making and organization are required. This paper presents three challenges for a real people‐centred conservation: a more pluralist approach to understanding knowledge and values of different actors, greater deliberation and inclusion in decision‐making, and a remodelling of institutions to support conservation.