bluuebunny/crossref_metadata_2025 huggingface dataset:
A Strategy for Selection of Elderly Type 2 Diabetic Patients for Insulin Therapy, and a Comparison of Two Insulin Preparations
Authors: Tindall H. , Bodansky H. J. , Stickland M. , Wales J. K.
Published: July 2009

Sixty‐six patients with secondary failure to oral hypoglycaemic therapy were assessed in hospital, and those whose fasting blood glucose concentration was ≥ 10.0 mmol l−1 were treated with insulin once a day for 6 months. Only 22 patients fulfilled this criterion, and they were randomly allocated to a daily injection of either Humulin‐Zn (12 patients) or Neulente insulin (10 patients). The remaining patients were considered to be non‐compliant with therapy. At the end of 6 months' insulin therapy a significant (p<0.05) improvement occurred in HbA1c from a median (range) of 13.2(9.8–16.4)% and 13.1(10.5–16.2)% to 10.6(8–14.2)% and 11.2(8.7–13.5)% in patients given Humulin‐Zn and Neulente, respectively. However, there were 46 episodes of hypoglycaemia reported by patients who received Humulin‐Zn, 36 of which occurred between 0300 and 0600 h. Only four episodes were reported by the Neulente‐treated group. In addition, six patients treated with Humulin‐Zn (but only one patient on Neulente insulin) required the addition of short‐acting insulin. The patients not treated with insulin showed a significant (p<0.05) improvement in blood glucose control 2 months after in‐patient assessment but this improvement was not sustained to 6 months.
Aldose Reductase Inhibition in Diabetic Neuropathy: Clinical and Neurophysiological Studies of one Year's Treatment with Sorbinil
Authors: O'Hare J. P. , Morgan M. H. , Alden P. , Chissel S. , O'Brien I. A. D. , Corrall R. J. M.
Published: July 2009

In a double‐blind placebo‐controlled trial the effect of Sorbinil (250 mg daily) on diabetic neuropathy was examined. After a 2‐month run‐in placebo period (with three major assessments) 21 patients were randomized to Sorbinil and 10 to placebo, and all were studied for a further 12 months with neurophysiological measurements at 3‐month intervals of nerve conduction velocity in multiple nerves, autonomic function tests, vibration thresholds as well as clinical examination and an extensive self‐assessment of symptoms. Two subjects on Sorbinil treatment developed a hypersensitivity reaction and were withdrawn. Metabolic control and severity of neuropathy was not significantly different between groups. There were no changes in symptoms as judged by self‐assessment scores. No patient entered the trial with neuropathic ulcers but ulceration developed in 4 patients during Sorbinil treatment and in 1 of the placebo group. No beneficial effect of Sorbinil was demonstrated on either the clinical manifestation or on the neurophysiological measurements made in these neuropathic diabetic patients over 12 months of treatment.
Immunoglobulin Heavy Chain Switch Region Polymorphisms are not Associated with Type 1 Diabetes
Authors: Millward B. A. , Hitman G. A. , Cassell P. G. , Sachs J. A. , Welsh K I. , Demaine A. G.
Published: July 2009

In order to ascertain whether the immunoglobulin heavy chain genes are important in the aetiology of Type 1 diabetes, we have used restriction fragment length polymorphism (RFLP) analysis of genomic DNA to study 148 Caucasoid subjects with Type 1 diabetes and 146 normal Caucasoid subjects. A DNA probe homologous to the switch regions for the IgM (Sμ) and IgA1 (Sa1) genes when used in conjunction with the restriction endonuclease Sst I detects RFLPs at both these loci. There were no significant differences in phenotype or gene frequencies for the alleles of Sμ or Sa1 in the patients when compared with control subjects; nor were there significant associations of Sμ or Sa1 with HLA‐DR type or gender.
The Fluorescence of Serum Proteins in Diabetic Patients with and without Retinopathy
Authors: Jones A. F. , Jennings P. E. , Wakefield A. , Winkles J. W. , Lunec J. , Barnett A. H.
Published: July 2009

Non‐enzymatic glycosylation of long‐lived proteins results in a characteristic fluorescence, known as protein ‘browning’. The degree of fluorescence of skin collagen correlates with retinopathy in diabetes. We have therefore measured the fluorescence of serum albumin and IgG by a sensitive HPLC technique in 69 diabetic patients, 38 with retinopathy and 31 without complications, and in 26 age‐matched controls. The fluorescence of the IgG fraction, calculated as the ratio of fluorescence (excitation 360 nm, emission 454 nm) to optical density (280 nm), was elevated in diabetic patients with retinopathy (1.5 ± 0.5) compared with those without retinopathy (1.1 ± 0.2, p<0.005) and control subjects (1.1 ± 0.2, p<0.005). The fluorescence ratio for the albumin fraction was increased in all diabetic patients (11.2 ± 2.7) compared with control subjects (8.9 ± 1.5, p<0.001). There was no significant difference in the fluorescence ratios of albumin in those with and without retinopathy. The fluorescence of serum albumin and IgG were not significantly correlated with serum protein glycosylation measured by the fructosamine method.
Acute and Long‐term Renal Effects of Angiotensin Converting Enzyme Inhibition in Normotensive, Normoalbuminuric Insulin‐dependent Diabetic Patients
Authors: Pedersen M. Mau , Schmitz A. , Pedersen E. Bjerregaard , Danielsen H. , Christiansen J. Sandahl
Published: July 2009

Glomerular filtration rate (GFR) (thalamate clearance), renal plasma flow (RPF) (hippuran clearance), and urinary albumin excretion rate (AER) were measured in 10 normoalbuminuric, normotensive insulin‐dependent diabetic patients and 8 normal subjects before and during acute angiotensin converting enzyme (ACE) inhibition by means of enalapril (10 mg IV). The effect of placebo versus enalapril (30 mg day−1) was also studied for 3‐month treatment periods in the insulin‐dependent diabetic patients.

Acute ACE‐inhibition caused a decline in filtration fraction (FF) from 0.259±0.011 (±SE) to 0.237±0.013 (2p<0.01) in the diabetic patients, and from 0.210±0.010 to 0.188±0.006 (2p<0.02) in the normal subjects. Mean arterial blood pressure was lowered from 90±1 to 84±2 mmHg (2p<0.01) and from 91±1 to 86±2 mmHg (2p<0.05). No significant change in blood glucose, AER or fractional albumin excretion (θAlb) was seen in either group.

After 3 months of enalapril treatment FF was decreased from 0.253±0.011 to 0.235±0.011 (2p<0.05), AER from 5.6 × / ÷ 1.7 to 4.3 × / ÷ 1.6 μg min−1 (2p<0.01) and θAlb from 1.22±0.22 times 10−6 to 0.92±0.12 times 10−6 (2p<0.02). The decline in total renal resistance was not significant (0.175±0.0.013 to 0.165±0.012 mmHg ml−1 min−1) and significant changes in GFR, RPF, mean arterial pressure or HbA1c were not observed.

Thus, acute and long‐term ACE‐inhibition in normotensive normoalbuminuric insulin‐dependent diabetic patients are associated with changes in renal haemodynamics and albumin excretion rate, probably as a result of a reduction in glomerular capillary hydrostatic pressure.
NPH Insulin Administration by Means of a Pen Injector
Authors: Jørgensen J. O. L. , Flyvbjerg A. , Jørgensen J. T. , Sørensen H. Holmegaard , Johansen B. Rose , Christiansen J. S.
Published: July 2009

In an open randomized cross‐over study 50 patients with insulin‐dependent diabetes were allocated to 3 months of treatment with NPH insulin either by means of a pen injector (Insuject‐X) or by conventional syringes. The needle of the NPH pen injector was removed immediately after use to avoid possible leakage of solvent. Ambulatory control was assessed every 6 weeks, including blood sampling (HbA1c and insulin antibodies) and recording of hypoglycaemia. NPH insulin containers were collected for insulin potency measurement by HPLC. A seven‐point blood glucose profile was performed fortnightly by means of home blood glucose monitoring. At the end of the 6 months a questionnaire was completed. No significant changes occurred in HbA1c (difference 0.1±0.7 (SD) %), blood glucose profile, or the incidence of hypoglycaemic episodes on the two regimens. The concentration of NPH insulin in the containers remained constant. All but two of the patients preferred to continue to use the pen injector. This NPH pen injector is a reliable and efficacious tool which may also prove more convenient for the patients.
Diabetes Care in a UK Health Region: Activity, Facilities and Costs
Authors: Alexander William D. ,   South East Thames Diabetes Physicians Group
Published: July 2009

A survey of district facilities and staffing for diabetes care in the South East Thames Region of England (population 3.58 million) is reported, and compared with the recommendations of the Royal College of Physicians and British Diabetic Association. Hospital Activity Analysis for diabetic patients in the Region for the year 1985 is also reported and costs assessed. Compared with recommended staffing levels there was a deficit of 12.8 Consultant Physicians with a weekly deficit of 109 sessions, and of 49.6 whole time equivalent Specialist Nurses. There were 11857 admissions of diabetic patients, 4185 with diabetes as a primary cause. Seventy‐six per cent of these were for diabetes without mention of complications and were therefore theoretically and potentially preventable. Total cost of diabetes care was estimated to be £21.6 million p.a. for the Region or £1.44 million per District Health Authority. We suggest it is time every Regional and District Health Authority gave some priority to diabetes care and established formal care strategies. To provide adequate staffing and facilities would improve standards of care, reduce morbidity and hospital admission rates, and be cost effective.
Diabetic Renal Disease in Central Africa
Authors: Rolfe M.
Published: July 2009

Six hundred African diabetic patients were examined using a protocol based on the WHO Multinational study in which no country from Africa was represented. The salicyl‐sulphonic acid test for proteinuria was used to assess the presence of diabetic renal disease. Overall 23.8% of patients had proteinuria (95% confidence interval 20.4 to 27.2) and 3.8% chronic renal failure (95% confidence interval 2.3 to 5.3). Patients with proteinuria were older and had had diabetes longer than those without (p < 0.001). Systolic blood pressure rose with increasing proteinuria in both sexes but only men with severe nephropathy showed an increase in diastolic pressure. Minimal diabetic nephropathy was more common than severe nephropathy which carried a particularly poor prognosis in African diabetic patients due to lack of resources.
Screening for Diabetes: Does Measurement of Serum Fructosamine Help?
Authors: Swai A. B. M. , Harrison K. , Chuwa L. M. , Makene W. , McLarty D. , Alberti K. G. M. M.
Published: July 2009

The diagnostic sensitivity and specificity for diabetes of serum fructosamine levels and fasting venous blood glucose concentrations were compared in 613 subjects during a diabetes community screening programme of 1049 adult Muslim Asians in Dar es Salaam, Tanzania. Using WHO (1985) criteria 228 had impaired glucose tolerance (IGT), 41 had previously been diagnosed as having diabetes while 32 had newly recognized diabetes. The mean (± SD) serum fructosamine levels were 20.9 ± 3.2, 21.6 ± 3.2, 23.9 ± 4.9, and 30.1 ± 7.9 (μmol g−1 albumin) in subjects with normal glucose tolerance, IGT, newly diagnosed diabetes, and previously diagnosed diabetes, respectively (p < 0.001 for differences between groups). The specificity of values above the mean + 2SD normal was 99% for abnormal glucose tolerance with a sensitivity of only 22% for diabetes. The predictive values were 44% and 97% for positive and negative results, respectively. Very little difference from normal was found for IGT subjects. Expressing fructosamine values in absolute terms or per gram albumin made little difference to sensitivity and specificity. The sensitivity was only 32% for fasting blood glucose ≥ 6.7 mmol l−1, 73% for values ≥ 5.5 mmol l−1 and 100% for fasting blood glucose ≥ 4.5 mmol l−1. It is concluded that both serum fructosamine and fasting blood glucose are poor screening and diagnostic tests for diabetes and for IGT, and that glucose loading is required.
Recurrent Diabetic Ketoacidosis
Authors: Chapman J. , Wright A. D. , Nattrass M. , FitzGerald M. G.
Published: July 2009

In a study over 15 years, 740 episodes of diabetic ketoacidosis occurred in 505 patients. A total of 113 patients had more than one episode. The majority (90%) of recurrences were within 4 years of the initial episode. Taking a definition of recurrent ketoacidosis as three or more episodes within 4 years, 39 patients were identified. Two subgroups appeared prone to such frequent recurrences, namely girls less than 20 years of age and women more than 59 years of age. A variety of causes of recurrent episodes was noted in the young patients but in the older patients other chronic illnesses complicated the diabetes. The need for good domiciliary supervision of elderly chronic sick patients who require insulin is emphasized.
Uncontrolled Hypertension in Type 1 Diabetes: Assessment of Patients' Desires about Treatment and Improvement of Blood Pressure Control by a Structured Treatment and Teaching Programme
Authors: Mühlhauser I. , Sawicki P. , Didjurgeit U. , Jörgens V. , Berger M.
Published: July 2009

Control of arterial blood pressure at near‐normal levels is of importance for the prognosis of patients with Type 1 (insulin‐dependent) diabetes mellitus. In non‐diabetic populations patient compliance to antihypertensive therapy is frequently poor, especially in young people. Thirty‐seven consecutive eligible patients with longstanding Type 1 diabetes and persistently uncontrolled hypertension were questioned about their preferences regarding hypertension treatment. Throughout they expressed a strong desire for more information about hypertension and for active participation in monitoring of blood pressure and therapeutic decision‐making. In addition, they showed considerable reluctance to accept a pharmacological intervention. Therefore, in order to improve blood pressure control, the patients participated in a structured outpatient hypertension treatment and teaching programme for groups of about 6 patients consisting of four teaching sessions at weekly intervals. The programme comprised home‐monitoring of blood pressure and involvement of the patients in treatment decision‐making. In 34 patients who had a complete follow‐up examination after an average of 16 months, mean sitting arterial pressure had decreased from 111 to 101 mmHg (p < 0.001) and 53 % of the patients were below 140/90 mmHg. The number and dosage of prescribed antihypertensive agents remained unchanged by the intervention. Sodium intake was not reduced during the study, but pulse rate decreased significantly in patients treated with β‐adrenergic blockers and serum uric acid rose in patients on diuretic therapy, suggesting increased adherence of the patients to prescribed antihypertensive drug therapy. In 34 comparable Type 1 diabetic patients who were not subjected to a hypertension treatment and teaching programme mean arterial blood pressure remained unchanged during a 12‐month period.
Contamination of Insulin by Silicone Oil: a Potential Hazard of Plastic Insulin Syringes
Authors: Baldwin R. N.
Published: July 2009

A 32‐year‐old insulin‐dependent diabetic patient reported recurrent clouding of her short‐acting insulin, caused by silicone oil contamination from re‐used disposable syringes.
Suppression of Insulin Secretion by Falling Plasma Glucose Levels is Impaired in Type 2 Diabetes
Authors: Hosker J. P. , Burnett M. A. , Matthews D. R. , Turner R. C.
Published: July 2009

The ability of Type 2 diabetic patients to suppress islet B‐cell secretion in response to falling plasma glucose levels has been studied with two different protocols. (1) Five diet‐treated diabetic patients and 6 normal subjects were studied after the termination of a hyperglycaemic clamp at 15 mmol l−1 for 150 min, with the plasma glucose levels then being allowed to fall and the glucose clamp re‐established at 10 mmol l−1. The plasma insulin levels fell in normal subjects from 178 ± 141 (± SD) mU l−1 at the end of the 15 mmol l−1 clamp to 147 ± 97 mU l−1 (p < 0.02) 20 min later, whereas in diabetic patients there was no significant change from 61 ± 41 to 56 ± 35 mU l−1, respectively (NS). (2) The second study was performed to assess the turn‐off of islet B‐cell secretion with diabetic patients and normal subjects starting at comparable plasma insulin levels. Twelve diet‐treated diabetic patients and 11 normal subjects were given a continuous low‐dose glucose infusion for 60 min at a rate of 5 mg kg l−1 ideal body weight min l−1, after which the infusion was turned off and the plasma glucose level allowed to fall. The plasma insulin levels in normal subjects fell from 18.8 ± 8.2 mU l−1 at the end of the infusion to 13 ± 4.3 mU l−1 (p < 0.01) and 10.5 ± 3 mU l−1 (p <0.005) 20 and 30 min later, respectively, whereas in diabetic patients there was no change from 18.4 ± 6.8 mU l−1 at the end of the infusion to 18.3 ± 5.6 (NS) and 17.1 ± 5.1 mU l−1 (NS) 20 and 30 min later. Diet‐treated Type 2 diabetic patients have reduced islet B‐cell sensitivity to falling plasma glucose levels, compared with normal subjects.
A Nation‐wide Cross‐sectional Study of Glycosylated Haemoglobin in Danish Children with Type 1 diabetes
Authors: Mortensen H. B. , Hartling S. G. , Petersen K. E. ,   The Danish Study Group of Diabetes in Childhood
Published: July 2009

A nation‐wide screening for HbA1cwas carried out in Denmark. Twenty‐one paediatric departments treating children with Type 1 diabetes participated. During a period of 4 months 884 children were included, 93% of all those followed at these centres, representing approximately 70–80% of all children and adolescents with Type 1 diabetes in Denmark. Among the children 351 were ≤ 12 years and 533 were adolescents between 12 and 18 years. Children ≤ 12 years had a HbA1cconcentration of 8.9 ± 1.5 (± SD)% and an insulin dose of 0.71 ± 0.3 U kg−124‐h−1. For adolescents HbA1cwas significantly higher 9.7 ± 2.0% (p< 0.001) and insulin dose significantly increased 0.85 ± 0.3 U kg−124‐h−1(p< 0.001). Normal range for HbA1c' is 4.0–6.5 (mean 5.3)% of total haemoglobin. Boys and girls ≤ 12 years had similar HbA1c' but girls received 13% more insulin (p< 0.001). In the group of adolescents, girls had a HbA1c4% higher than boys (9.9 ± 2.0 vs 9.5 ± 2.0%p< 0.025), received 11% more insulin (p< 0.001), and had 6% higher body mass index (p< 0.001). A weak correlation was found between insulin dose and the HbA1clevel (r= 0.29,p< 0.001). Children and adolescents on four or more injections daily received significantly more insulin (p< 0.001) than those on conventional treatment and had a significantly higher body mass index (p< 0.001). These changes were most pronounced for girls who, despite receiving 15% more insulin, had a significantly higher HbA1clevel (9.9 ± 1.8 vs 9.3 ± 1.9%,p< 0.005) and 12% higher body mass index (p< 0.001). Furthermore standard deviation score for height decreased with longer duration of the disease and more so in children with the highest HbA1cvalues. Our data confirm that current treatment of childhood diabetes in Denmark produces unsatisfactory results.
Employment and Diabetes: a Survey of the Prevalence of Diabetic Workers known by Occupational Physicians, and the Restrictions Placed on Diabetic Workers in Employment
Authors: Waclawski E. R.
Published: July 2009

A postal survey of occupational physicians identified a prevalence of known diabetes among workers of 7.5 per 1000. The prevalence of insulin‐treated diabetes was 2.6 per 1000 and of other diabetes was 4.9 per 1000. The figure for insulin‐treated diabetes is lower than expected from population studies. The restrictions placed on diabetic workers in employment include shift‐work, heights, dangerous areas, driving, civil aviation, emergency teams, offshore oil work, and work overseas. Certain companies within the chemical, oil, steel, confectionery, and drinks industries had lower than expected numbers of diabetic workers and merit further detailed study.
Serum Lipids and Lipoproteins in Insulin‐dependent Diabetic Patients with Persistent Microalbuminuria
Authors: Watts G. F. , Naumova R. , Slavin B. M. , Morris R. W. , Houlston R. , Kubal C. , Shaw K. M.
Published: July 2009

Serum lipid and lipoprotein concentrations were measured in 18 insulin‐dependent diabetic patients with persistent microalbuminuria and an equal number with persistently normal albumin excretion. The groups were matched for sex, age, duration of diabetes, body mass index, insulin dose, and glycosylated haemoglobin. Diabetic patients with persistent microalbuminuria were found to have a significantly lower high density lipoprotein (HDL) cholesterol concentration (difference 0.29,95 % Cl 0.12 to 0.46, mmol l−1, p < 0.01) and a higher low density lipoprotein (LDL) cholesterol:HDL cholesterol ratio (difference 0.97, 95% Cl 0.29 to 1.65, p < 0.01) than patients with normal albumin excretion. No significant differences were found in total cholesterol, triglycerides, LDL cholesterol, apolipoprotein (apo) A‐***I and apo B concentrations. Compared to an age and sex‐matched group of non‐diabetic subjects with normal albumin excretion, diabetic patients with persistent microalbuminuria had significantly higher concentrations of total cholesterol (p < 0.05), LDL cholesterol (p < 0.05) and apo B (p < 0.01), but a lower concentration of HDL cholesterol (p < 0.05). No significant differences were found in serum lipids and lipoproteins between diabetic patients with normal albumin excretion and non‐diabetic subjects.
Hand Abnormalities are Associated with the Complications of Diabetes in Type 2 Diabetes
Authors: Jennings A. M. , Milner P. C. , Ward J. D.
Published: July 2009

Limited finger joint mobility, Dupuytren's contracture, and the complications of diabetes were assessed in 233 Type 2 diabetic patients. Limited joint mobility was present in 34% and Dupytren's contracture in 26%. The prevalence of limited joint mobility and Dupuytren's contracture increased with duration of diabetes and with age. Logistic regression analysis showed that, after allowing for age and duration of diabetes, limited joint mobility was independently associated with Dupuytren's contracture (odds ratio 5.7, 95% Cl 2.0–16.4) and retinopathy (odds ratio 3.1, Cl 1.5–6.4). Dupuytren's contracture was independently associated with vision‐threatening retinopathy (odds ratio 2.6, Cl 1.1–6.4), limited joint mobility (odds ratio 2.5, Cl 1.3–4.8), and foot ulceration (odds ratio 4.9, Cl 1.4–16.4). Both Dupuytren's contracture and limited joint mobility were associated with peripheral neuropathy but neither hand abnormality was associated with neuropathy independently of other complications of diabetes. The association of connective tissue abnormalities in the hand with the complications of diabetes suggests that similar factors may be contributing to their pathogenesis.
Measuring Outcome of Diabetes: a Retrospective Survey
Authors: Macleod C. A. , Murchison L. E. , Russell E. M. , Dingwall‐Fordyce I.
Published: July 2009

The feasibility of using hospital discharge data to monitor six outcome indicators for diabetes care was assessed by reviewing retrospectively the occurrence of these events recorded in hospital records. The population studied was that of the Orkney Islands (19 500) over a 10‐year period (1976–1985). During that time, 230 Orkney diabetic patients were treated in Orkney and/or Aberdeen hospitals. The six outcome indicators were: hospital admission rates for diabetic patients (609 in 230 patients), hospital admission rates specifically for diabetic ketoacidosis (29 in 20 patients), rates of diabetes‐related lower limb amputations (36 in 23 patients), perinatal mortality rates related to maternal diabetes (nil), visual loss or blindness (13 eyes in 9 patients) and end‐stage renal failure (one patient). Scottish Morbidity Returns (which collect data similar to that in the Hospital In‐patient Enquiry in England) were shown by case note review to underestimate these outcomes by 41%. Cardiovascular disease, cerebrovascular disease, and peripheral vascular disease accounted for half of all in‐patient bed use by diabetic patients (6077 of 13 951 days). The routinely available Scottish hospital discharge data, which are collected for a different purpose, are not sufficiently accurate or complete to reflect variations in actual diabetic events.
Insulin Increases Plasma Somatomedin C (IGF‐1) Concentrations in Adult Type 1 Diabetic Patientss
Authors: Bristow A. F. , Clarke R. F. , Grant P. J. , Stickland M. H. , Wales J. K.
Published: July 2009

The role of insulin in the control of somatomedin release has been investigated in people with Type 1 diabetes. Six patients underwent insulin‐induced hypoglycaemia of 20 min duration and 8 patients were studied using the hyperinsulinaemic euglycaemic clamp technique at insulin infusion rates of 0.25, 1.25, 2.5, and 0.25 mU kg−1 min−1 for 1 h at each rate. In the first study plasma insulin concentrations rose from (median, range) 23 (10–36) to 114(60–200) mU I−1 at the onset of hypoglycaemia, and fell to 53 (23–100) mU I−1 after 20 min hypoglycaemia and 30 (15–73) mU I−1 on return to normoglycaemia. Plasma IGF‐1 rose from 140 (96–292) to 179 (127–352) μg I−1 (p < 0.05) at the onset of hypoglycaemia and fell to 131 (125–173) μg I−1 after 20 min and to 154 (121–287) μg I−1 at the end of the study. During hyperinsulinaemia plasma insulin rose from 23 (19–40) mU I−1 at the lowest infusion rate to 61 (33–84) and 148 (68–200) mU I−1 at the two higher infusion rates. Over the same period, plasma IGF‐1 increased from 91 (13–203) to 123 (98–182) μg I−1 (p < 0.05) and 109 (84–160) μg I−1. There was no correlation between growth hormone levels and IGF‐1 in either study. These results suggest that insulin produces short‐term increases in IGF‐1 levels in man in the absence of a growth hormone response.
Validity of Routinely Collected Hospital Admissions Data on Diabetes
Authors: Williams D.R.R. , Fuller J.H. , Stevens L.K.
Published: July 2009

Data from the clinical records of patients known to have diabetes and admitted to hospital in North West London, Cambridge or Newcastle were compared with data on the same admissions taken from the system responsible for recording information on all acute hospital admissions (Hospital Activity Analysis). In 89 out of 751 admissions (12%), either the sex, date of birth or marital status of the patient was incorrectly recorded. The diagnosis of diabetes was omitted in 32 (10%) of 315 admissions in which diabetes or a complication of diabetes was regarded as the principal cause of admission and in 12 (23%) out of 53 in which the principal cause was closely related to diabetes. These included cases in which the diagnosis had not been stated (by the clinician) on the discharge summary (the source document for Hospital Activity Analysis) as well as instances in which the coding clerk had failed to record the diagnosis. The validity of information collected on hospital admissions is dependent on the presentation of data by the clinician to the coding clerk. There may be a lack of awareness of the importance of the clinical discharge summary as a source document for such systems.
Childhood Diabetes Mellitus: An Increasing Incidence
Authors: Heamshaw J. R. , Burden A. C. , Swift P. G. F.
Published: July 2009

The incidence of childhood diabetes was determined using the register of Leicestershire children with diabetes and from the population of Leicestershire. The register was commenced in the 1940s and has continued since then prospectively, being based on individual consultant records, specialist nurse records, and the Register of Births and Deaths. Accuracy was determined from hospital admission data and the U 100 insulin conversion register achieved in 1983. The incidence rates for all children of 0–14 years inclusive in the decade 1951–1960 was 3.84 patients per 100 000 per year. This increased to 5.34 during the period 1961–1970, and further increased in the years 1971–1980 to 10.6 patients per 100 000 per year. This was significant (p < 0.05) using the 95 % confidence interval of the odds ratio and very significant (p < 0.001) by regression analysis (correlation coefficient r = 0.79). Statistically significant changes were found in each of the age groups 0–4, 5–9, and 10–14 years, and for girls and boys within those age groups (except boys aged 10–14 years).
Exercise Augments the Absorption of Isophane (NPH) Insulin
Authors: Thow J.C. , Johnson A.B. , Antsiferov M. , Home P.D.
Published: July 2009

In order to determine the effect of exercise on the rate of absorption of an isophane (NPH) insulin, 7 normal men were studied on two separate occasions using the euglycaemic clamp technique. On one day subjects undertook 60 min of exercise on a treadmill (5 km h−1, 5 ° slope) 180 min after injection of human isophane (NPH) insulin (0.25 U kg−1), while on the control day they remained at rest throughout the 420 min study. Serum insulin concentrations rose in parallel after injection achieving similar values at 180 min on exercise and control days (13.7 ± 1.2 (± SE) vs 12.0 ± 1.5 mU) I−1; NS), respectively. After the onset of exercise, insulin concentrations rose markedly to a peak of 29.8 ± 2.2 mU I−1 after 50 min of exercise (p < 0.001), compared with a slight fall on the control day to 10.4 ± 1.7 mU I−1 (NS). At the end of the exercise period, serum insulin concentrations returned rapidly to control day values. Glucose infusion requirements rose significantly during the exercise period from 2.8 ± 0.5 mg kg−1 min−1 to a peak at 235 min of 11.1 ± 1.2 mg kg−1 min−1 (p < 0.001), compared with an increase on the control day from 2.0 ± 0.6 to 2.5 ± 0.6 mg kg−1 min−1 (NS) over the same period. These results demonstrate an enhanced rate of absorption of an isophane (NPH) insulin during exercise in normal subjects.
Data Source Automation: New Technology for the Management of Patient‐generated Test Results
Authors: Saudek C.D.
Published: July 2009

Self‐monitoring of blood glucose is widely accepted by patients today, but its usefulness to clinicians has been seriously limited by our inability to interpret the patient‐generated data. It is difficult or impossible to make optimal use of hand‐kept diaries, no matter how compulsively kept. Patterns elude us, summaries are inaccurate, and large blocks of data are almost entirely ignored. To remedy these problems, data source automation—the automatic recording of data at their site of origin—is being applied to diabetes. Meters will measure blood glucose and memorize the result, date, and time of day. One system even allows the patient to record insulin dosage, exercise, and diet. The advantage of these systems lies in their potential for data management. Recognition of patterns of blood glucose concentration, easy longitudinal comparison of data, and aggregation of large data bases are all facilitated by computerized manipulation of the stored data. In‐hospital use of glucose meters can have better documented quality control. It is possible to communicate data to physicians by telephone modem. Effective use of these systems, though, requires convenient software; and their acceptance in actual clinical practice must be demonstrated. But data management capabilities, as they are refined and brought into common use, could significantly improve diabetic management.
Islet Cell Antibodies and Insulin Autoantibodies in Patients Treated with Oral Hypoglycaemic Agents
Authors: Jennings A.M. , Spencer K.M. , Dean B.M. , Wilson R.M. , Bottazzo G.F. , Ward J.D.
Published: July 2009

Clinical and immunological features suggesting Type 1 diabetes were assessed in 202 patients treated with oral hypoglycaemic agents for presumed Type 2 diabetes. Islet cell antibodies (ICA) were detected at a level exceeding 5 JDF units in 5.9 % of patients, and complement‐fixing ICA were detected in 3.4 %. IgG insulin autoantibodies were detected in 8.8 % of insulin‐naive patients, none of whom were ICA positive. ICA were detected more frequently in patients with shorter duration of diabetes (p = 0.02). Age and relative body weight were similar in ICA positive and negative groups. ICA positive patients were more likely to have lost weight (p < 0.02) than ICA negative patients, although this may have been attributable to the differing duration of diabetes in the two groups. Other individual clinical features suggesting Type 1 diabetes were not significantly more frequent in ICA positive patients. However, a higher proportion of ICA positive than ICA negative patients had one or more features suggestive of Type 1 diabetes irrespective of the duration of diabetes. Clinical features suggesting Type 2 diabetes were present in a similar proportion of ICA positive and ICA negative patients. Fasting and glucagon stimulated C‐peptide levels were similar in ICA positive and matched ICA negative patients.
Mental Arithmetic Stress as a Test for Evaluation of Diabetic Sympathetic Autonomic Neuropathy
Authors: Locatelli A. , Franzetti I. , Caviezel F. , Lepore G. , Maglio M. L. , Gaudio E. , Pozza G.
Published: July 2009

The effects of a 1‐min mental arithmetic stress test on heart rate change were studied in 72 Type 1 diabetic patients, 36 without and 36 with diabetic autonomic neuropathy (mean age 33 and 44 yr, respectively), and in 80 matched normal subjects. Variation in hand skin temperature was also recorded in 25 normal subjects and 30 diabetic patients without and 32 with autonomic neuropathy. While mental arithmetic rapidly reduced skin temperature of normal volunteers and of patients without autonomic neuropathy, no effect was found in autonomic neuropaths (a drop of 0.63 ± 0.05 (± SE), 0.52 ± 0.04 and 0.16 ± 0.02 †C (p <0.001), respectively). In control subjects and in diabetic patients without and with autonomic neuropathy the heart rate increase was 22.9 ± 6.8 (±SD), 21.4 ± 8.4 and 7.0 ± 3.7 beats min−1, respectively (p <0.001). The ratio between maximum mental arithmetic‐induced heart rate and basal heart rate was 1.29 ± 0.10, 1.24 ± 0.10 and 1.07 ± 0.05 (p <0.001) for healthy subjects, non‐neuropathic patients, and neuropathic patients. Cut‐off values (the low normal limit for these variables) are proposed: skin temperature 0.23 °C, heart rate increase 11.6 beats min−1 and heart rate ratio 1.12. Anxiety state, blood glucose concentration (excluding hypoglycaemia), body position, basal heart rate, and age did not interfere with responses to mental arithmetic stress.
Evidence Against a Role for Prostaglandins in Sustaining Renal Hyperfiltration in Type 1 Diabetes Mellitus
Authors: Jenkins D.A.S. , Craig K. , Collier A. , Watson M.L. , Clarke B.F.
Published: July 2009

The acute effect of inhibition of prostaglandin synthesis with indomethacin 50 mg by mouth on renal haemodynamics has been examined in 8 male Type 1 diabetic patients with elevated glomerular filtration rate who were free of diabetic complications. Renal plasma flow and glomerular filtration rate were measured by constant infusion of para‐amino hippurate and polyfructosan, the patients being studied at normoglycaemia. Urinary excretion of prostaglandin E2 fell from 885 ± 160 to 345 ± 115 pg min−1, and excretion of 6‐keto‐prostaglandin F1α fell from 489 ± 77 to 283 ± 50 pg min−1. There was no change in renal plasma flow or glomerular filtration rate following indomethacin. The results do not support the hypothesis that increased renal prostaglandin synthesis is a cause of hyperfiltration in diabetes mellitus.
A Randomized Crossover Study of Sulphonylurea and Insulin Treatment in Patients with Type 2 Diabetes Poorly Controlled on Dietary Therapy
Authors: Wolffenbuttel B.H.R. , Weber R.F.A. , van Koetsveld P.M. , Weeks L. , Verschoor L.
Published: July 2009

In 13 non‐obese patients with Type 2 diabetes mellitus who failed to achieve adequate blood glucose control on dietary treatment (fasting blood glucose 13.4 ± 2.7 (±SD) mmol I−1, glycosylated haemoglobin 13.0 ± 1.7 %), the effects of 6 months insulin or sulphonylurea therapy on blood glucose control and lipid metabolism were compared in a randomized crossover study. Three patients, who showed a clear improvement on insulin (median glycosylated haemoglobin fell from 14.7 to 8.6 %), withdrew from the study prematurely because of subjective and objective signs of hyperglycaemia after crossover from insulin to sulphonylurea. Daily dose after 6 months was 2000 mg tolbutamide (n=3), 18 ± 1 mg glibenclamide (n=7), or 34 ± 3 U insulin. On insulin, fasting (8.0 ± 1.9 mmol I−1) and postprandial blood glucose (10.4 ± 2.7 mmol I−1), and glycosylated haemoglobin (9.5 ± 1.1 %) were lower than on sulphonylurea (11.0 ± 3.4 mmol I−1, 14.4 ± 4.8 mmol I−1 and 11.0 ± 2.5 %, respectively, p < 0.05 in each case). Median increase in body weight was greater on insulin (4.2 vs 1.1 kg, p < 0.05). Six patients experienced improved well‐being on insulin compared with sulphonylurea. Median plasma non‐esterified fatty acids decreased from 825 μmol I−1 to 476 μmol I−1 (sulphonylurea) and 642 μmol I−1 (insulin, both p < 0.05). HDL cholesterol was higher after insulin (1.12 ± 0.40 mmol I−1) than after sulphonylurea (0.94 ± 0.25 mmol I−1, p < 0.05), and the LDL:HDL cholesterol ratio (3.27 ± 1.07 vs 3.90 ± 1.08) and VLDL triglycerides (0.67 ± 0.22 vs 1.13 ± 0.40 mmol I−1) were lower (both p < 0.05). A C‐peptide response after intravenous glucagon of below 5.0 nmol I−1 15 min identified those patients who had better blood glucose control with insulin.
Effects of Short‐term Strict Metabolic Control on Kidney Function and Extracellular Fluid Volume in Incipient Diabetic Nephropathy
Authors: Mathiesen E.R. , Gall M.‐A. , Hommel E. , Skøtt P. , Parving H.‐H.
Published: July 2009

The effects of strict metabolic control (multiple insulin injections for 1 week) on urinary albumin excretion, glomerular filtration rate and extracellular fluid volume was evaluated in long‐term Type 1 diabetic patients with (n=9) and without (n=10) incipient nephropathy. Investigations were carried out in poor (blood glucose 15 (interquartile range, 13–18) mmol I−1) and good metabolic control (5 (4–8) mmol I−1). In patients with incipient nephropathy glomerular filtration rate was 125 (SD 26) (poor control) vs 125 (20) ml min−1 (good control), urinary albumin excretion 60 (range 37–247) vs 60 (13–359) mg 24 h−1, fractional albumin clearance 6.1 (0.9–67.6) vs 6.7 (2.1–65.4) x10−6, extracellular fluid volume 13.4 (2.3) vs 14.3 (2.8) I (p<0.10). Apart from an increase in extracellular fluid volume during improved metabolic control (12.2 (1.6) vs 13.6 (2.5) I, p<0.02) all the above mentioned variables remained unchanged in the patients with normal urinary albumin excretion. In conclusion, strict metabolic control for 2–7 days has no effect on urinary albumin excretion and glomerular filtration rate in long‐term Type 1 diabetic patients with or without incipient diabetic nephropathy.
Diabetes in the Elderly: The Oxford Community Diabetes Study
Authors: Neil H.A.W. , Thompson A.V. , Thorogood M. , Fowler G.H. , Mann J.I.
Published: July 2009

Most diabetic patients are elderly but their clinical characteristics remain poorly defined. A population survey identified 259 known diabetic patients aged 60 years or more giving a prevalence of 3% in this age group. A total of 193 patients (75%) were interviewed and examined, 155 (80%) of whom had been diagnosed at under 70 years of age. Forty‐two patients (22%) were insulin‐treated but clinical characteristics suggested that at least 95% of all elderly patients had Type 2 diabetes. Blood glucose control was poor with median HbA1 9.7% (range 4.9–17.1%, normal reference range 5.0–7.5%), and 55% were either overweight or obese. There was a high morbidity from diabetes and other conditions: the prevalence of hypertension (untreated blood pressure of 160/95 mmHg or more or antihypertensive medication) was 52%, of stroke 5%, of nephropathy (urinary albumin concentration ≥300 mg I−1) 3%, of lower limb amputations 4%, and of foot ulcers 7%. The prevalence of symmetrically impaired distal vibration perception was 23%, and 54% of patients either needed or were receiving chiropody. The prevalence of a corrected distant visual acuity of 6/12 or worse was 32% and of retinopathy of any degree was 26%. There was extensive co‐morbidity which was not confined to a single subgroup of patients.
Quantitative Aspects of Subcutaneous Insulin Absorption
Authors: Furler S.M. , Kraegen E.W.
Published: July 2009

Subcutaneous insulin absorption is a complex process, whose quantitative aspects have important clinical implications. In this review we briefly discuss the rationale of modelling techniques before introducing some of the more common types of models (empirical vs mechanistic, simple vs complex, compartmental) found in the biological literature. The various approaches are compared regarding their suitability to model subcutaneous absorption of insulin. Methods are described (monitoring residual depot activity or the appearance of insulin in the systemic circulation) which allow the determination of model parameters from experimental data. The degree to which current model predictions describe the available experimental data is discussed. Since the absorption of insulin involves a number of poorly understood events it would be difficult, at this time, to construct a complex model which completely describes all aspects of the absorption process. Although the simpler techniques (such as the use of a one‐pool model) provide only an approximate description of subcutaneous kinetics they are likely to remain useful tools in routine investigation.
The Effects of Acute Insulin‐induced Hypoglycaemia on Renal Function in Normal Human Subjects
Authors: Patrick A.W. , Hepburn D.A. , Craig K.J. , Thomson I. , Swainson C.P. , Frier B.M.
Published: July 2009

The effects of acute insulin‐induced hypoglycaemia on renal function were studied in 8 normal male subjects. Plasma glucose (mean (SE)) fell from 4.6(0.2) to 1.3(0.2) mmol I−1, the nadir being coincident with the acute autonomic reaction, and returned to the basal value over the following 120 min. Glomerular filtration rate declined from 118(6) to 95(4) ml min−1 at the glucose nadir (p < 0.01), and during the recovery phase returned to 118(7) ml min−1 (NS compared with basal). Renal plasma flow fell from 625(38) to 485(27) ml min−1 (p < 0.01), rising to 545(46) ml min−1 during recovery from hypoglycaemia (NS compared with basal). Following hypoglycaemia, urinary excretion of sodium and dopamine were reduced significantly, but the albumin excretion rate was unchanged. Plasma concentrations of adrenaline, noradrenaline, angiotensin II, and plasma renin activity increased in response to hypoglycaemia. These acute changes in renal function are probably caused by sympatho‐adrenal activation and secretion of catecholamines, but other hormones, such as angiotensin II, may be contributory.
An Analysis of Glycosylated Blood Proteins and Blood Glucose Profiles Over One Year in Patients with Type 1 Diabetes
Authors: Winocour P.H. , Bhatnagar D. , Kalsi P. , Hillier V.F. , Anderson D.C.
Published: July 2009

The clinical value of prospective measurement of several direct and indirect measures of blood glucose control in the management of Type 1 diabetes has been investigated. Ninety‐eight Type 1 diabetic patients were followed over a period of 1 year after a 6‐week period of intensification of management, with monthly measurements of blood glucose profiles and 3‐monthly HbA1, glycosylated serum albumin, and fructosamine measurements. All measures improved markedly after the initial 6‐week period (p < 0.001), and all except glycosylated serum albumin and fructosamine then remained relatively stable. Of fourteen serial comparisons, glycosylated blood proteins were significantly correlated more often with levels of mean blood glucose and M value (on 4–7 occasions, rs 0.30‐0.58) than with fasting blood glucose levels (on only 2–3 occasions, rs 0.34‐0.44). Serum fructosamine levels correlated significantly with mean blood glucose on four occasions (rs 0.30‐0.50), whilst glycosylated serum albumin and HbA1 correlated with mean blood glucose on six occasions (rs 0.36‐0.54). Glycosylated serum albumin correlated with HbA1 and fructosamine levels throughout the year (rs 0.47‐0.68 and 0.48‐0.76, respectively), but HbA1 and fructosamine were less clearly correlated with each other (rs 0.38‐0.44), with no significant association immediately after the period of intensive management or 3 months later. When the various measures were used to categorize blood glucose control, HbA1 was more often discordant with fructosamine than with glycosylated albumin. Over the year glycosylated albumin and fructosamine values were discordant on 6–15% of comparisons. Significant intra‐individual variations in levels of glycosylated albumin, fructosamine, mean blood glucose, and the M value were observed during the stable year of the study. Cluster analyses revealed that fructosamine values were least closely associated with other variables. In 19 patients with normal HbA1 levels and near normal mean blood glucose and M values throughout the year following intensified management, a substantial proportion had persistently high levels of fructosamine and glycosylated albumin. We conclude that the use of several measures of blood glucose control in the management of Type 1 diabetes provides complementary information. Fructosamine is a less appropriate measure of blood glucose control in Type 1 diabetes than glycosylated serum albumin.
Knowledge About Diabetes in Type 1 Patients is Related to Metabolic Control
Authors: Surawy C.
Published: July 2009

Twenty‐five Type 1 diabetic patients and their spouses attending a diabetes clinic completed the recently developed CCQ‐1 questionnaire, which assesses knowledge about the disease. Questionnaires were completed in the presence of a clinical psychologist. Glycosylated haemoglobin concentration was inversely correlated with patient scores for general management (r = −0.69, p< 0.001), insulin (r = −0.66, p< 0.001), home monitoring (r = −0.53, p< 0.01), and overall knowledge (r = −0.55, p< 0.01), but not for diet and footcare. No association was found between patients' metabolic control and scores among spouses, who knew significantly less about the disease than the patients themselves. The strength of the associations found supports the use of well‐designed psychological instruments in diabetes research.
Clinical Utility of Assays of Glycosylated Haemoglobin and Serum Fructosamine Compared: Use of Data on Biological Variation
Authors: Howey J.E.A. , Browning M.C.K. , Fraser C.G. , Bennet W.M. , Jung R.T.
Published: July 2009

Assessment of the relative clinical usefulness of glycosylated haemoglobin (HbA1) and serum fructosamine is complicated by their markedly different half‐lives. They have therefore been compared using a number of indices derived from data on biological variation, as applied in a study of blood glucose control in newly diagnosed diabetic patients. The within‐subject (CV1) and between‐subject (CVG) variation of fructosamine and HbA1 were assessed in 8 stable diabetic patients. A slightly smaller relative change, or critical difference, is required between serial HbA1 results than between fructosamine results before a significant change can be said to have occurred. The heterogeneity of within‐subject variance is also less for HbA1, rendering the critical difference more generally applicable. HbA1 may therefore be more appropriate for long‐term monitoring. Monitoring of blood glucose control of a group of 26 newly diagnosed diabetic patients before the commencement of therapy and 1, 2, and 3 months later by serum fructosamine or HbA1 provided very similar information. Fructosamine responds more rapidly with changes of blood glucose control. However, whether this confers any clinical advantage will depend upon the frequency of testing.