bluuebunny/crossref_metadata_2025 huggingface dataset:
Rhinocerebral Mucormycosis and Juvenile Diabetes Mellitus: Report of a Case with Recovery
Authors: Marr Thomas J , Traisman Howard S , Davis A Todd , Kernahan Desmond
Published: December 2014

Rhinocerebral mucormycosis is a rapidly fatal fungal disease. Presentation and natural course are characterized by headache, facial and eye pain, maxillary sinus swelling, and bloody mucoid discharge with progression to bony destruction. A 15-year-old girl with juvenile diabetes who presented with cavernous sinus thrombosis is described, and the medical and surgical management is detailed.
Human Proinsulin Normalizes Fasting Hyperglycemia in Patients With NIDDM
Authors: Pasmantier RoseMarie , Hirsch Sondra R , Lebovitz Harold E
Published: December 2014

Human proinsulin (HPI) acutely lowers plasma glucose (PG) with 8% of the potency of insulin on a molar basis (1). Studies have shown the duration of action of HPI is longer than that of insulin, and its ability to suppress hepatic glucose production is 50% greater than its ability to stimulate glucose uptake compared with insulin (2). These data suggest that HPI may have a role in the treatment of patients with non-insulin-dependent diabetes mellitus (NIDDM). We compared the efficacy of HPI versus sulfonylureas in chronically (6 mo) controlling glycemia in patients with NIDDM who had previously not been adequately controlled on sulfonylureas.
Saccharin
Authors: Miller Sanford A , Frattali Victor P
Published: December 2014

Saccharin, a nonnutritive sweetener discovered in 1879, has been the subject of controversy concerning its effect on public health on several occasions during this century. Over this period, the substance has come to be regarded as a useful commodity in the dietary management of diabetes mellitus. We review the historical and scientific background on the subject and proposea new approach in making public-health decisions on unique foods that serve a special dietary purpose.
Combined Insulin-Sulfonylurea Therapy in Treatment of NIDDM
Authors: Groop Leif C , Groop Per-Henrik , Stenman Svante
Published: December 2014

For the past few years, interest has focused on the combination of insulin and sulfonylurea in the search for effective treatments for non-insulin-dependent diabetes mellitus (NIDDM) patients who fail on oral hypoglycemic agents. Although several studies have demonstrated beneficial effects of such therapy in NIDDM patients, the average effect is small and is observed in only about half of the patients. However, there are several problems with most previous studies, including small sample size, selection of patients, and simultaneous use of several end points. First, residual β-cell function has been considered to be a prerequisite for a beneficial effect of combination therapy.

Therefore, most studies have failed to demonstrate improved glycemic control after adding sulfonylurea to insulin therapy in patients with insulin-dependent diabetes mellitus. Inclusion of patients with impaired β-cell function will therefore attenuate the effect of combination therapy. Second, most studies have used glycemic control as an end point. Nevertheless, the insulin dose has been reduced by 20–30% to avoid hypoglycemia after adding sulfonylurea to insulin. Thus, the comparison has been made between treatments with a smaller insulin dose with sulfonylurea and a larger insulin dose without sulfonylurea. The patient most likely to benefit from combination therapy is slightly obese, has had NIDDM for a relatively short period, and has preserved β-cell function. In such a patient, combined insulin-sulfonylurea therapy predominantly stimulates basal insulin secretion, resulting in more effective suppression of hepatic glucose production and lower fasting plasma glucose. The side effects are few, most notably more frequent but mild hypoglycemic reactions.
Workshop Report: Prevention and Early Treatment of NIDDM
Authors: Wilson Robert , Horton Edward
Published: December 2014

RESEARCH OPPORTUNITIES— Critical scientific and practical questions are whether it is possible to prevent NIDDM and whether early treatment of diabetes is effective. There are three potential strategies that may retard the development of prevention of NIDDM and which are also of importance in the early treatment of NIDDM—control of obesity, preservation of insulin action, and preservation of insulin secretion. The panel stressed the impact of exercise both on the control of obesity and the preservation of insulin action. A structured exercise program such as that conducted in the Zuni community can be made available to an entire community. The importance of community involvement in establishing and sustaining such programs, and the importance of using sound principles of effective behavior modification were recognized.
Clinical Pharmacology of Human Insulin
Authors: Heinemann Lutz , Richter Bernd
Published: December 2014

Nowadays, human insulin is used daily by millions of diabetic patients. The biological effect of human insulin is comparable to that of porcine insulin. However, after subcutaneous injection, pharmacological and clinical studies showed pharmacokinetic and pharmacodynamic differences between human and animal insulins. Human insulin tends to have faster absorption and shorter duration of action compared with animal insulin. These differences are more pronounced and can be of clinical relevance with intermediate- and long-acting insulin preparations. Optimal metabolic control can be achieved with either human or highly purified animal insulin preparations, provided appropriate insulin replacement strategies are used.
Midcourse Correction
Authors: Drash Allan L
Published: December 2014

I last communicated directly with you 18 months ago in the January 1992 issue of Diabetes Care—the first issue of the journal under the editorial direction of the Pittsburgh Group. That editorial was written at poolside in late August 1991 as the hand-over process from Dr. David Robbins and his excellent group of associate editors began.
Is Tropical Pancreatic Diabetes Malnutrition Related?
Authors: Rao R Harsha
Published: December 2014

Clinical syndromes of diabetes in tropical countries defy attempts to separate them into reasonably homogeneous groups that are analogous to the traditional classification into IDDM and NIDDM. Their geographical and clinical uniqueness has only been recognized relatively recently. For most of this century, diabetes in the tropics was thought to be no different from the classical form seen in more temperate climates, being found only in the well-nourished elite, but not in the malnourished masses (1). Thus, the WHO, in its first examination of the problem of diabetes from a world-wide perspective in 1965, stated emphatically that “the evidence that malnutrition protects populations from diabetes seems unassailable (2).” Notwithstanding this assertion, evidence had been accumulating for at least a decade that many diabetic individuals in the tropics had unusual features that made it impossible to pigeonhole them into either of the classic varieties of diabetes mellitus. From the earliest descriptions of the two syndromes of diabetes that have come to be recognized as being unique to the tropics (type J diabetes and TPD), the association of both syndromes with malnutrition was emphasized (3,4). Faced with the overwhelming evidence that diabetes did occur in malnourished individuals, WHO reversed its opinion in 1980, acknowledging that “in some societies … malnutrition is probably a major determinant (of diabetes) (5).”
Should the Bee Suck Honey or Lard?: That is the question
Authors: Vinik Aaron I , Lauterio Thomas J , Wing Rena R
Published: December 2014

Of all the nonpharmacologic endeavors available to diabetic patients to mitigate the complications of diabetes, none has as profound an effect as nutritional manipulation. There has, however, continued to be a great CHO versus fat controversy. The Papyrus Ebers, written around 1500 BC, advocated a high-CHO diet consisting of wheat grains, fruit, and sweet beer ‘to drive away the passing of too much urine.’ Araetus the Cappadocian coined the term diabetes (to flow through), and prescribed starches, fruit, and sweet wines (1). These sentiments were echoed by the ADA in their consensus statement Nutritional Recommendations and Principles for Individuals with Diabetes Mellitus (2), first published in 1986. This statement recommended liberalizing CHO intake, not so much to replace the lost CHO, but to fill the void derived from a restriction in protein intake, to protect the kidney, and to reduce total fat intake to reduce morbidity and mortality from macrovascular disease. The recommendations of ADA were extremely similar to those being promoted by the AHA and the American Cancer Association, which are concerned with the possible relationship between fat intake, heart disease, and bowel and breast cancer. Other researchers, however, disagree with the liberalization of CHO intake. They argue that a high-CHO intake might worsen glycemic control, and suggest that a high-fat diet is much more palatable to the American public than a high-CHO diet. There is no doubt that meals for ‘fat teeth’ will always suit the hedonistic tendencies of our population. Nonetheless, considerable recent evidence strongly supports the 30% dietary-fat guideline recommended by ADA.
From Diagnosis and Classification to Complications and Therapy: DCCT Part II?
Authors: Orchard Trevor J
Published: December 2014

I have long been concerned about our approach to diagnosing diabetes. While one can readily agree that an elevated blood glucose level is a key component of diabetes, I strenuously argue that the cause of that blood glucose elevation is also of critical importance, i.e., a deficiency in insulin action. Diabetes is, after all, an endocrine disease, and it has always disturbed me as to how little diagnostic attention is paid to the concentration of the hormone involved. This is, I believe, unlike virtually all other endocrine diseases. Instead of measuring insulin (along with glucose), we have become obsessed with the oral glucose tolerance test (OGTT), which I view as a highly variable test of an unnatural gastronomic excess.
Can We Prevent IDDM?
Authors: Gale Edwin A M , Bingley Polly J
Published: December 2014

Diabetes always has been a defensive specialty for the physician. The treatment of insulin-dependent diabetes mellitus (IDDM) aims to mimic normal physiology, minimize hazards, palliate late complications, and offer guidance and support. It is essentially an exercise in damage limitation. Much can be achieved with current therapy, and microvascular complications can be prevented— or at least delayed—by improved glycemic control. Even so, current means of achieving safe near normoglycemia remain limited at best. Many of us hope and believe that, as the next millenium approaches, it will for the first time prove possible to assume the offensive, whether by restoring insulin secretion or halting the incipient disease process before clinical onset of IDDM. New and safer means of restoring normoglycemia are high on the research agenda for the established diabetic patient, but progress remains frustratingly slow. In contrast, work into the pathogenesis of IDDM continues to gather momentum 20 years after its human leukocyte antigen associations (1,2) and islet cell antibodies (ICAs) (3) were discovered.
Screening for NIDDM: Opportunities for detection, treatment, and prevention
Authors: Knowler William C
Published: December 2014

Although non-insulin-dependent diabetes mellitus (NIDDM) is a common and serious disease, in the U. S. about half of the people with this disease are unaware of it. Approximately four million Americans 20–74 years of age have undiagnosed NIDDM (1), making this disease a candidate for early detection and treatment (2). I will present my views on the principles of screening as applied to NIDDM and on the benefits, costs, methods, and unanswered questions regarding the screening and diagnosis of this disease.
Selected Vitamins and Minerals in Diabetes
Authors: Mooradian Arshag D , Failla Mark , Hoogwerf Byron , Maryniuk Melinda , Wylie-Rosett Judith
Published: December 2014

The interrelationship between diabetes and various vitamins and minerals is characterized by a high degree of reciprocity. Chronic uncontrolled hyperglycemia can cause significant alterations in the status of these nutrients, and conversely, some of these substances, especially those that have been characterized as micronutrients, can directly modulate glucose homeostasis (1). Differences in patient populations studied and methodological uncertainties account for the discrepancies in most reported studies. Certain subgroups of individuals with diabetes, such as elderly patients, vegans (who consume no animal products), and pregnant and lactating women, are at particular risk for deficiencies for such nutrients. Additionally, caloric restriction for obese patients and the effects of a high fiber diet and a host of drugs on the metabolism of vitamins and minerals are of concern (2,3).
Food Labeling
Authors: Wheeler Madelyn L , Franz Marion , Heins Joan , Schafer Rebecca , Holler Harold , Bohannon Betsy , Bantle John P , Barrier Phyllis
Published: December 2014

In June 1990, the American Diabetes Association approved a food labeling position statement (1) that emphasized the following four general points: 1) food labeling must be truthful, meaningful, understandable, and complete; 2) no food should be designated or promoted as nutritionally good, bad, healthful, or unhealthful for people with diabetes; 3) education, based on principles of good nutrition and use of food labels, is essential for people with diabetes; and 4) specific recommendations for label inclusions.
Eye-Care Delivery for People With Diabetes: An unmet need
Authors: Klein Ronald
Published: December 2014

Diabetic retinopathy is a leading cause of blindness in the U. S. (1). However, this need not be the case. A recently completed clinical trial sponsored by the National Eye Institute, the Early Treatment Diabetic Retinopathy Study, demonstrated that early detection and treatment of proliferative retinopathy and clinically significant macular edema with laser photocoagulation could prevent vision loss (2,3). Ferris (4) estimated that timely treatment of proliferative retinopathy with panretinal photocoagulation should reduce serious vision loss by 95%. However, data from a number of studies suggest that a significant number of Americans with diabetes may not be receiving recommended eye examinations for the detection of retinopathy (5–7). Delivery of such care has been shown to prev nt vision loss and be cost-effective (8,9).
Summary of Current Diabetes-related Data from the National Center for Health Statistics
Authors: Sayetta Rona Beth , Murphy Robert S
Published: December 2014

The National Center for Health Statistics (NCHS) conducts national studies, publishes results, and releases microdata tapes that contain information of central importance to diabetes epidemiology. The prevalence, incidence, and distribution of diabetes with associated medical conditions and therapies are available from interviews and examination study sources. Utilization patterns, multiple morbidity, and cost data for diabetic patients and others using health resources are available through studies of provider records, physician visit encounter forms, vital record follow-back questionnaires, and insurance records. The vital statistics system also provides data about mortality and its geographic distribution. In the second Health and Nutrition Examination Survey conducted by NCHS, a fasting oral glucose tolerance test was administered to 2244 persons using a 75-g glucose challenge. Blood samples were taken fasting, 1 h, and 2 h after glucose challenge. These provisional data are representative only of the sample persons ages 20–74 yr participating in the first 34 sample locations of the survey. Many facets of data evaluation remain to be explored, such as response bias and use of medications. Nevertheless, using the criteria proposed by the National Diabetes Data Group for diagnosis of diabetes, 2.7% of the sample (in which the poor and persons ages 60–74 yr are overrepresented) had fasting plasma glucose levels greater than 140 mg/dl. About 3.9% had fasting levels less than 140 mg/dl, but had 1-h and 2-h plasma glucose levels after challenge greater than or equal to 200 mg/dl. The data in final weighted form will not overrepresent specific groups in the population
Fasting Hyperglycemia and Associated Free Insulin and Cortisol Changes in “Somogyi-Like” Patients
Authors: Schmidt Maria Ines , Hadji-Georgopoulos Angeliki , Rendell Marc , MargoliS Simeon , Kowarski David , Kowarski A Avinoam
Published: December 2014

Blood glucose levels were measured over a 24-h period in eight insulin-dependent diabetic subjects who were difficult to control and who presented with morning fasting hyperglycemia. At least seven exhibited clinical characteristics suggestive of the Somogyi phenomenon. A continuous glucose monitoring apparatus was used to relate the concentrations of glucose during the day to concomitant levels of free insulin and cortisol. In all patients a significant (P < 0.01) rise in fasting morning glucose started at about 0600 h, while they were still asleep. In six patients the morning elevation of blood glucose was preceded by stable, almost normal glucose levels during the night (117 ± 2.5 mg/dl); one of the two remaining patients (no. 7) exhibited high overnight glucose levels (268 ± 7.2 mg/dl), whereas the other (no. 8) had a mild hypoglycemic episode (45 mg/dl) 6 h before the hyperglycemic period. In all patients the fasting glucose rise was associated with the usual morning cortisol surge (P < 0.05) and with a significant decrease in the concentration of serum free insulin (P < 0.01). The free insulin levels in patient no. 8 were higher, while those of patient no. 7 were lower, than in the other six patients. We conclude that the diurnal morning rise in cortisol may cause hyperglycemia in insulindependent diabetic patients if insufficient exogenous insulin remains and/or endogenous insulin is not secreted. In such patients the high levels of fasting glucose in the morning may misrepresent their overnight control of blood glucose and lead to an erroneous impression of the Somogyi phenomenon.
Ego Development and Self-Esteem in Diabetic Adolescents
Authors: Hauser Stuart T , Pollets Daniel , Turner Barbara L , Jacobson Alan , Powers Sally , Noam Gil
Published: December 2014

This study explores the impact of diabetes mellitus upon aspects of adolescent development. Using specific assessment techniques and interviews, we followed ego development and self-esteem variables. Clinical considerations suggest that both personality dimensions are important for the understanding of diabetic adolescents. The significance of ego development is implied in many case reports, which note the disruption in individual coping that frequently follows the onset of diabetes. Clinical observations and empirical studies have also commented upon diminished self-esteem in diabetic patients. Our sample consisted of male and female diabetic adolescents, whose average age was 13. All patients completed Loevinger's sentence completion test of ego development and the Coopersmith self-esteem inventory. Previous studies have indicated favorable reliability and validity for both instruments. A subgroup of the sample was also interviewed. The ego development and self-esteem scores were contrasted with two groups of similar age adolescents who had previously completed these same tests, and a control group. The diabetic adolescents were clearly at lower levels of ego development than the nondiabetic groups. These lower stages were not correlated with duration of illness. A second finding was that the boys were at lower levels of ego development than the girls, regardless of age or illness duration. Self-esteem scores were associated with both illness duration and ego development. Subjects at the lowest levels of ego development also had the lowest self-esteem. Study of the interviews revealed that the patients at these lower ego development levels manifested concrete, more stereotyped, and resigned responses than those patients at the higher ego development stages.
occupational Therapy Diabetic Program
Authors: Budurowich Maria , Lofton William
Published: December 2014

Considerable attention, in terms of money and research, is given to diseases such as cancer and heart disease. When attention is focused on the diagnosis of diabetes by the medical/paramedical world, it tends to center on the understanding of the biochemical process and hopeful cures of the disease. This aspect is indeed crucial, but attention should also be given to the effects inherent in this diagnosis which have tremendous impact on the individuals' ability to accomplish the tasks required by their life-style/role. For example, there is the housewife who cannot satisfactorily perform her chores because she is blind and there is a numbness in her hands. In order to enable her to more adequately and satisfactorily perform, she needs education and training in homemaking skills as well as an increased activity level. As can be noted, the daily self-care, work, and leisure activities that make up an individual's occupational role are seriously affected by diabetes. These patients can become more aware of their own personal resources to prevent and to combat the tolls of the disease with proper early education and training. An early therapeutic program can and should more realistically direct the patient's personal attention to “What can I do to assist in my treatment? What can I do to prevent complications in the future?”

With this in mind, an Occupational Therapy Diabetic Program has been developed. The program is designed to enhance the knowledge of diabetic patients to the extent that they know, through verbalization and demonstration, the practical application of basic principles that will allow for more independence in their occupational role.
Natural History of Glucose Tolerance in Relatives of Diabetic Patients: Low Prognostic Value of the Oral Glucose Tolerance Test
Authors: KÖbberling J , Berninger D
Published: December 2014

Seven hundred and fifty-one initially nondiabetic relatives of diabetic persons, in whom oral glucose tolerance tests (OGTT) have been performed, were followed for over 10 yr. Of these, 11.6% have died and no information was available from 13.7%. All other subjects were either retested (N = 369) or answered by questionnaire whether they are being treated for diabetes (N = 32) or not (N = 155). For test evaluation the sum of the 1- and the 2-h values during OGTT was used. The diagnosis of “diabetes” after 10 yr was made if the sum exceeded 500 mg/dl, which in 88% of cases coincides with fasting blood glucose values above 120 mg/dl. Among the retested individuals the results of OGTT showed a high degree of variation in both directions, which seems to represent just random variance rather than improvement or deterioration of biologic significance. These random changes in glucose tolerance do not correlate with changes in body weight. Sixty-three individuals have developed overt diabetes within the 10 yr. To optimize the discriminating value of the initial tests, the criteria dividing impaired glucose tolerance (IGT) from “normal” have been varied by a computer program. Sensitivity and specificity of the diagnosis IGT with respect to later development of diabetes depend on the criteria used and are inversely related. At the point where sensitivity and specificity are equal, both amount to 45%, and their sum never exceeds 90%. Using the criteria for IGT and diabetes recently proposed by members of an expert committee at the NIH, which are mainly based on the 2-h value and the fasting value, a sensitivity of 66% and a specificity of 19% are found. Thus, although a higher tendency toward the development of overt diabetes can be observed in the group of subjects with IGT compared with normal subjects, the prognostic value of the OGTT is very low when applied to individuals.
Obesity in Pregnancy: The Effect of Dietary Advice
Authors: Borberg C , Gillmer M D G , Brunner E J , Gunn Philippa J , Oakley N W , Beard R W
Published: December 2014

Plasma glucose and insulin concentrations, body weight, and skinfold thickness were measured at 16 and 36 wk of pregnancy and 5–7 days after delivery in 37 women with normal glucose tolerance. Nine thin women [less than 80% ideal body weight (IBW)], 10 normal women (90-110% IBW), and 10 obese women (more than 120% IBW) were allowed to eat according to appetite. Another eight obese women were advised to restrict their carbohydrate intake to between 150 and 180 g while maintaining the calorie content of their diet between 1800 and 2000 cal. The thin, normal, and obese women displayed a net weight increase between 16 wk and 5–7 days after delivery of 6.3, 2.8, and 4.9 kg, respectively. The dieted obese women, however, showed a mean weight loss of 2.3 kg. There was a strong association between the overall pregnancy weight gain and the change in skinfold measurements between 16 wk and delivery in the women studied. A significant decrease in glucose tolerance was observed in all four groups, although this was least in the dieted women and greatest in the thin. The mean basal and glucose-stimulated insulin concentrations of the two obese groups were found to be significantly higher at 16 wk than those of the normal women. In the thin, normal, and obese subjects the mean basal and glucose-stimulated insulin concentrations at 36 wk were double those observed at 16 wk of pregnancy. A much smaller increase in insulin concentrations occurred between 16 and 36 wk in the dieted obese group. It is concluded that obesity preceding pregnancy produces a stress on carbohydrate metabolism, which can be ameliorated if an isocaloric diet with mild carbohydrate restriction is advised. No adverse effect on neonatal outcome was observed.
Does Pregnancy Influence the Prognosis of Uncomplicated Insulin-dependent Diabetes Mellitus?
Authors: Carstensen Lisbeth L , Frost-Larsen Kim , Fugleberg Steen , Nerup Jørn
Published: December 2014

To evaluate the effect of one or two pregnancies on the prevalence and severity of late diabetic complications, 22 pairs (44 patients) of female insulin-dependent diabetic (IDDM) patients were examined. Each pair consisted of one patient who had completed one or two pregnancies and one who had not. The two groups were carefully matched with respect to age, duration of disease, endogenous insulin secretory capacity, quality of blood glucose control, insulin requirement, hospitalization, and social status. No differences in prevalence or severity of retinopathy, nephropathy, and neuropathy were found.
Affinity of IgG-Insulin Antibodies to Human (recombinant DNA) Insulin and Porcine Insulin in Insulin-treated Diabetic Individuals With and Without Insulin Resistance
Authors: Schernthaner Guntram
Published: December 2014

The affinity of human (recombinant DNA) insulin and porcine insulin to preformed IgG-insulin antibodies of insulin-treated diabetic individuals was studied in 29 insulin-treated diabetic patients. The binding of 125I-human insulin and 125I-porcine insulin with antibodies was similar in the group of patients without insulin resistance (N = 25). The sera of insulin-resistant diabetic patients (N = 4), containing very high IgG-insulin immunoglobulins, showed a significantly lower affinity for human insulin compared with porcine insulin (P < 0.01). All four patients with insulin-antibody-mediated insulin resistance were positive for HLA-DR4, but negative for -DR3, supporting the concept of an immunogenetically transferred anti-insulin immune response in insulin-treated diabetic individuals. Based on the reduced binding of human insulin to IgG-antibodies of very high titers in patients with insulin resistance, a potential therapeutic advantage of human insulin therapy can be expected in such infrequent cases of immunologic insulin resistance.
Development of IgE Antibodies to Human (recombinant DNA), Porcine, and Bovine Insulins in Diabetic Subjects
Authors: Fireman Philip , Fineberg S Edwin , Galloway John A
Published: December 2014

Thirty-one previously untreated diabetic individuals received only human insulin (recombinant DNA) for 1 yr with no adverse reactions. The development of serum IgE antibodies to human, porcine, and bovine insulins was assessed by a sepharose radioallergoabsorbent test (RAST). Immunoglobulin (total Ig antibody) binding was assessed by a nonabsorbed species-specific radioimmunoassay. During therapy 2 patients developed IgE antibodies to human insulin as well as increased total Ig binding. The IgE antibodies to human insulin cross-reacted with porcine and bovine insulins, were transient, and were not accompanied by insulin allergy. Ig binding to insulin developed and persisted in 11 of the human insulin-treated diabetics. In comparison, 62 previously untreated diabetic persons received only purified porcine insulin (PPI, < 5 ppm proinsulin, N = 40) or a mixed bovine-porcine insulin (proinsulin < 50 ppm, N = 21). Increased Ig antibody developed in 16 of 21 patients receiving mixed bovineporcine insulin and 25 of 41 PPI-treated patients (P < 0.05). Seven of 41 PPI-treated patients and 4 of 21 mixed bovine-porcine-treated patients developed anti-insulin IgE antibodies, which were transient in 4 and persisted in 6 diabetic patients. IgE antibody levels did not correlate with total Ig antibody. These data suggest that IgE and total Ig antibodies develop less often after human insulin treatment. Also, the immunoregulation mechanisms responsible for anti-insulin IgE antibody synthesis differ from those regulating other Ig that bind to insulins. Since none of the patients in this study have developed clinical manifestations of insulin allergy or resistance, the clinical relevance of the antibody data must remain speculative.
Insulin-Specific IgG and IgE Antibody Response in Type I Diabetic Subjects Exclusively Treated with Human Insulin (recombinant DNA)
Authors: Velcovsky H G , Federlin K F
Published: December 2014

Bovine and porcine insulins elicit specific antibody response in diabetic subjects after a few months of treatment. In seven type I diabetic individuals who were exclusively treated with human insulin (recombinant DNA) each month, sera were examined for the development of insulin-specific IgG and IgE antibodies. In all patients (except one), IgG antibodies occurred after 2 mo and tended to further increase in concentration after 5–6 mo. IgE antibodies could be detected after 1 mo with a further increase after 2–3 mo and a marked decline thereafter. No patient exhibited allergic symptoms. The results indicate that physicochemical properties of insulin preparations used for treatment and the route of administration are of more importance for immunogenicity than species differences of insulin.
Decrease of Circulating Insulin Antibodies in Two Patients Treated with Continuous Subcutaneous Infusion of Human Insulin (recombinant DNA)
Authors: Spijker A J , Poortman J , Thijssen J H H , Erkelens D W
Published: December 2014

Circulating insulin antibodies (CIA) were measured in two patients treated with continuous subcutaneous infusion (CSII) of human insulin (recombinant DNA). CIA were determined by a kinetic equilibrium assay after pretreatment of the serum to remove bound and free insulin. We observed that by changing from either purified bovine or purified porcine insulin to human insulin given by CSII, there is a gradual decrease in CIA detectable after 3 wk and more pronounced 3 mo after changing. These findings suggest that human insulin in combination with the improved metabolic control by CSII considerably reduces the antibody formation in patients with IDDM.
Clinical Pharmacology of Human Insulin of Recombinant DNA Origin in Healthy Volunteers
Authors: Ebihara Akio , Kondo Kazuoki , Ohashi Kuroichi , Kosaka Kinori , Kuzuya Takeshi , Tarui Seiichiro
Published: December 2014

The serum insulin, fractional absorption, serum human C-peptide, and plasma glucose responses of normal fasting subjects were compared after the subcutaneous and intravenous administration of human insulin (recombinant DNA) and Novo Actrapid insulin. While no statistical difference at each time point was observed between the two insulins, for each time point after 0.05 and 0.1 U/kg s.c, the 0–6 h area under curve (AUC) after the 0.05 U/kg dose was greater for human insulin than for pork insulin. There was no difference in the 0–6 h AUC after the 0.1 U/kg s.c. dose. The serum human C-peptide responses to the two insulins were virtually identical. With the 0.05 U/kg s.c. dose, hypoglycemic effect of human insulin was greater than for Actrapid. This difference did not occur after 0.1 U/kg s.c. Following intravenous administration using 0.05 U/kg, the serum IRI, serum C-peptide, and glucose responses were the same. These data indicate only slight differences between human insulin and Actrapid insulin.
Authenticity and Purity of Human Insulin (recombinant DNA)
Authors: Johnson Irving S
Published: December 2014

A summary of the exhaustive analyses of human insulin (recombinant DNA) shows chemical, structural, and biologic equivalence to pancreatic human insulin. The high degree of purity accounts for its lack of pyrogenicity and immunogenic contamination. Human insulin from both the proinsulin and chain combination methods is essentially identical. The role of proinsulin as an alternate route to human insulin, and as a new treatment for diabetes when used alone or in combination with human insulin or connecting peptide, warrants further investigation.
The Capillary Barrier to Circulating Insulin
Authors: Rasio Eugenio
Published: December 2014

Following β-cell stimulation, insulin does not equilibrate between vascular and extravascular compartments of muscle and fat. The action of circulating insulin on these tissues is manifested only if relatively high plasma threshold concentrations are achieved for a critical period of time.
Problems in Adapting a Glucose-Oxidase Electrochemical Sensor into an Implantable Glucose-Sensing Device
Authors: Thévenot Daniel R
Published: December 2014

Taking into account the analytic patterns of different types of glucose-oxidase electrochemical sensors, the specific problems which have to be solved for such a sensor to be implantable are outlined. Of particular interest is the lifetime of enzymatic membrane and the dependence of the sensor responses to oxygen concentration and hydrodynamics.
An Overview of the Investigational Device Exemption Regulation
Authors: Gatling Robert R
Published: December 2014

An Investigational Device Exemption (IDE) is required of most medical devices that are to be clinically investigated to determine their safety and effectiveness. Several types of devices are exempt from the requirement, and nonsignificant-risk devices have abbreviated requirements. The IDE regulation is discussed and a source of additional information is listed.
Insulin Receptor Assays Used in Human Studies: Merits and Limitations
Authors: Pedersen Oluf
Published: December 2014

The establishment of insulin receptor assays about 10 yr ago made it possible to study the regulatory role of the insulin receptor in a variety of physiologic and pathophysiologic conditions in man. Although it would be desirable to examine insulin receptors on muscle and liver cells, due to the ethical and technical limitations most clinical research in insulin receptor binding in man has been confined to accessible cell models, that is, fat and blood cells. The two major components of the receptor assay are (125I)-labeled insulin and isolated cells. Most iodoinsulin preparations used have differed with respect to purity, homogeneity, and distribution of (125I) within the molecule. This makes comparison of insulin binding data between laboratories difficult. Comparing monocytes, erythrocytes, and adipocytes as cell models each cell type possesses several limitations. The human adipocyte, however, has the advantage in that it allows simultaneous measurements of insulin receptor binding and biologic insulin effects under similar conditions of physiologic pH and temperature. Scatchard analysis has been widely used in the interpretation of insulin binding data. The assumptions and prerequisites required for the application of this mathematical approach are, however, not fulfilled. Furthermore, whether the nonlinear Scatchard plot is caused by multiple receptor classes or negative cooperativity in one homogeneous receptor class is an unsolved problem. In general there is a tendency to give values of total receptor concentration and affinity constants based on the negative cooperativity model. The informative value of these binding quantities is questionable, however, due to bias and lack of precision in data generation. Finally, generalization of insulin receptor results from one cell type to other insulin-binding tissues within the same individual should be avoided since the available literature suggests that the insulin receptor status and its changes seem to be tissue specific.
International Workshop on the Epidemiology of Insulin-dependent Diabetes Mellitus
Authors: Hamman Richard F , Berlin Nina
Published: December 2014

The International Workshop on the Epidemiology of Insulin-Dependent Diabetes Mellitus was held in October of 1983 in Philadelphia, Pennsylvania. This workshop, the first of its kind to focus specifically the epidemiology on of insulin-dependent diabetes (IDDM), was sponsored jointly by the Juvenile Diabetes Foundation (JDF), the Pennsylvania Department of Health, and the Centers for Disease Control. The purpose of the workshop was to delineate epidemiologic research needs in IDDM; to foster interaction among disciplines to conduct this research; and, specifically, to recommend priorities for population-based epidemiologic research.
The Epidemiology of Insulin-dependent Diabetes Mellitus (IDDM) in Finland and in Northern Europe
Authors: Åkerblom Hans K , Reunanen Antti
Published: December 2014

The incidence and prevalence of IDDM are high by international standards in all Nordic countries, and Finland has the highest incidence and prevalence figures of the disease in the world. During the period 1970–1980, the mean annual incidence (per 100,000) in 0–14-yr-old children was 28.6 in Finland, 22.7 in Sweden, 17.6 in Norway, and 14.0 in Denmark. The corresponding prevalence figures were: Finland 191, Sweden 148, Iceland 141, Norway 120, and Denmark 83. Thus, on a countrywide basis the incidence increased from south to north (and from west to east). However, within some of the Nordic countries (Finland, Norway, and Sweden) there were regional variations not compatible with the above “latitude rule.” As in many studies from other countries, the following characteristics were observed in the IDDM epidemiology in children and adolescents: a steady rise of incidence throughout childhood until puberty, the peak occurring earlier in girls than in boys, a male excess in young children and adolescents, a seasonal variation, and a secular trend. The possible causes of the high incidence and prevalence are briefly discussed.
A Comparison of the Epidemiology of Youth-onset Insulin-dependent Diabetes Mellitus Between Japan and the United States (Allegheny County, Pennsylvania
Authors: Tajima Naoko , LaPorte Ronald E , Hibi Itsuro , Kitagawa Teruo , Fujita Hidehiro , Drash Allan L
Published: December 2014

Children in the United States are almost 20 times more likely to develop insulin-dependent diabetes mellitus (IDDM) than children in Japan. Little is known about the differences between the two countries that might account for this very large difference in risk. The current research compared the characteristics of IDDM in Japan with those of the United States (Allegheny County, Pennsylvania). Seasonality, relationship to socioeconomic status, and age at onset were similar. There was some suggestion of a sex difference. Of interest was that reported recent infections at onset were much higher in the United States. In addition, the risk to first-degree relatives in Japan appeared to be somewhat lower than in the United States, although this may have been the result of differences in ascertainment. These results are discussed in relation to potential factors that might account for the major incidence differences.
Epidemiologic Approaches to the Identification of Problems in Diabetes Care
Authors: Connell Frederick A
Published: December 2014

We conducted two epidemiologic studies in Washington state to identify remediable problems in health care for persons with diabetes. In one study, mortality among persons with diabetes under the age of 45 was found to be 8 times higher than that in nondiabetic individuals of the same age. One-third of the deaths may have been preventable; problems in access to care may have contributed to premature mortality for some of these cases. The second investigation found that in counties with high hospital admission rates for diabetes, medical care may have been suboptimal. In these counties there was greater likelihood of hospitalization for mild metabolic problems, and less vigorous diagnostic and therapeutic management of hospitalized patients with similar case urgency. Population-based epidemiologic studies can identify health care problems and help focus interventions to improve diabetes care.
Improvement of Microgrid Dynamic Performance under Fault Circumstances using ANFIS for Fast Varying Solar Radiation and Fuzzy Logic Controller for Wind System
Authors: Izadbakhsh Maziar , Rezvani Alireza , Gandomkar Majid
Published: December 2014

The microgrid (MG) technology integrates distributed generations, energy storage elements and loads. In this paper, dynamic performance enhancement of an MG consisting of wind turbine was investigated using permanent magnet synchronous generation (PMSG), photovoltaic (PV), microturbine generation (MTG) systems and flywheel under different circumstances. In order to maximize the output of solar arrays, maximum power point tracking (MPPT) technique was used by an adaptive neuro-fuzzy inference system (ANFIS); also, control of turbine output power in high speed winds was achieved using pitch angle control technic by fuzzy logic. For tracking the maximum point, the proposed ANFIS was trained by the optimum values. The simulation results showed that the ANFIS controller of grid-connected mode could easily meet the load demand with less fluctuation around the maximum power point. Moreover, pitch angle controller, which was based on fuzzy logic with wind speed and active power as the inputs, could have faster responses, thereby leading to flatter power curves, enhancement of the dynamic performance of wind turbine and prevention of both frazzle and mechanical damages to PMSG. The thorough wind power generation system, PV system, MTG, flywheel and power electronic converter interface were proposed by using Mat-lab/Simulink.
A Performance Study on Synchronous and Asynchronous Update Rules for A Plug-In Direct Particle Swarm Repetitive Controller
Authors: Ufnalski Bartlomiej , Grzesiak Lech M.
Published: December 2014

In this paper two different update schemes for the recently developed plug-in direct particle swarm repetitive controller (PDPSRC) are investigated and compared. The proposed approach employs the particle swarm optimizer (PSO) to solve in on-line mode a dynamic optimization problem (DOP) related to the control task in the constant-amplitude constant-frequency voltage-source inverter (CACF VSI) with an LC output filter. The effectiveness of synchronous and asynchronous update rules, both commonly used in static optimization problems (SOPs), is assessed and compared in the case of PDPSRC. The performance of the controller, when synthesized using each of the update schemes, is studied numerically.
Triassic-Jurassic Flora of Poland; Floristical Support of Climatic Changes
Authors: Barbacka Maria , Pacyna Grzegorz , Feldman-Olszewska Anna , Ziaja Jadwiga , Bodor Emese
Published: December 2014

Plant macroremains from five boreholes in Poland were studied. Two of them (Huta OP-1 and Studzianna) from the northern margin of the Holy Cross Mountains, yielded several taxa. In the other three boreholes determinable fos-sil plants were sporadic, albeit important. Most of the taxa from the Huta OP-1 and Studzianna boreholes are typi-cal of the European Early Jurassic (Hettangian and Sinemurian). Both localities, although close to one another, show incertae sedis, Desmiophyllum harrisii phytes and conifers (a new species incertae sedis, Desmiophyllum harrisii Barbacka et Pacyna is herein proposed), which would suggest rather wet and warm conditions. This flora is typical of the European Province of the Euro-Sinian Region. In Studzianna the Siberian elements dominate, gymnosperms, mainly Czekanowskiales, which in-dicate a drier and colder environment. The palaeobotanical data correspond to the results of clay mineral studies, in particular the kaolinite/illite ratio in the source formations. The kaolinite content confirms a decrease in temperature and a reduction in rainfall in the late Early Hettangian and the latest Hettangian in the area.
Cyclic Groups Obtained as Quotient Hypergroups
Authors: Mousavi S.Sh. , Leoreanu-Fotea V. , Jafarpour M.
Published: December 2014

We introduce a strongly regular equivalence relation ρ*A on the hypergroup H, such that in a particular case the quotient is a cyclic group. Then by using the notion of ρ*A-parts, we investigate the transitivity condition of ρA. Finally, a characterization of the derived hypergroup Dc(H) has been considered.
Electrospun Thermoplastic Polyurethane Mats Containing Naproxen– Cyclodextrin Inclusion Complex
Authors: Akduman Çiğdem , Özgüney Işık , Akçakoca Kumbasar E. Perrin
Published: December 2014

Incorporation of cyclodextrins (CDs) into electrospun nanofibrous materials can be considered as potential candidates for functional medical textile applications. Naproxen (NAP) is a type of non-steroidal anti-inflammatory drug commonly administered for the treatment of pain, inflammation and fever. Drug-inclusion complex formation with CDs is an approach to improve the aqueous solubility via molecular encapsulation of the drug within the cavity of the more soluble CD molecule. In this study, NAP or different NAP-CD inclusion complexes loaded nanofibres were successfully produced through electrospinning and characterised. The inclusion complex loaded mats exhibited significantly faster release profiles than NAP-loaded thermoplastic polyurethane (TPU) mats. Overall, NAP-inclusion complex loaded TPU electrospun nanofibres could be used as drug delivery systems for acute pain treatments since they possess a highly porous structure that can release the drug immediately.