bluuebunny/crossref_metadata_2025 huggingface dataset:
Increasing prevalence of diabetes mellitus and impaired glucose tolerance among 60‐year‐old Danes
Authors: Drivsholm T. , Ibsen H. , Schroll M. , Davidsen M. , Borch‐Johnsen K.
Published: March 2003

SUMMARY

Aims  The age‐specific prevalence of diabetes mellitus and impaired glucose tolerance (IGT) was estimated in 60‐year‐old individuals in 1996/97 and compared to the prevalence in 1974/75. The study also examined whether or not the change in prevalence of diabetes and IGT could be explained by changes in body mass index (BMI) and physical activity.

Methods  Diabetes and IGT were diagnosed by a standardized oral glucose tolerance test (OGTT) in two Danish population‐based, age‐specific, birth cohorts.

Results  The prevalence of diabetes in 1996/97 was 12.3% among 60‐year‐old men and 6.8% among women, representing an increase in diabetes of 58% in men and 21% in women compared to 1974/75. The prevalence of IGT was 15.9% among men and 13.1% among women, representing increases of 109 and 16%, respectively. A concurrent increase in BMI in the 22‐year period between the two studies explained the increase found in the prevalence of diabetes and IGT.

Conclusions  A marked increase in the prevalence of diabetes and IGT among 60‐year‐old individuals over a 22‐year period was observed – especially in men. The increase was fully explained by a concurrent increase in BMI.
Evaluation of a hospital diabetes specialist nursing service: a randomized controlled trial
Authors: Davies M. , Dixon S. , Currie C. J. , Davis R. E. , Peters J. R.
Published: March 2003

SUMMARY

Aims  To evaluate the effectiveness and cost implications of a hospital diabetes specialist nursing service.

Methods  We conducted a prospective, open, randomized, controlled trial of standard in‐patient care for adults with diabetes, with and without the intervention of a diabetes specialist nursing (DSN) service. The setting was a single UK university hospital.

Subjects  were unselected patients referred to the hospital DSN service. Primary outcome measures were length of hospital stay and patterns of readmission (frequency and time to first readmission). Secondary outcome measures were subjects' diabetes‐related quality of life, diabetes knowledge score, satisfaction with treatment, and GP and community care contacts following discharge. Costs were estimated from the hospital and published sources.

Results  Median length of stay was lower in the intervention group (11.0 vs. 8.0 days, P < 0.01). Readmission rates were the same in the two groups (25%), and mean time to readmission was similar in the two groups, although slightly less in the control group (278 vs. 283 days, P = 0.80). The cost per patient for nursing input was £38.94. However, when the reduced length of stay was accounted for, the intervention produced a mean cost per admission of £436 lower than that of the control group (P = 0.19). Patients in the intervention group were more knowledgeable regarding their diabetes and more satisfied with their care.

Conclusions  Diabetes specialist nurses are potentially cost saving by reducing hospital length of stay (LOS). There was no evidence of an adverse effect of reduced LOS on re‐admissions, use of community resources, or patient perception of quality of care.
Comparison between repaglinide and glipizide in Type 2 diabetes mellitus: a 1‐year multicentre study
Authors: Madsbad S. , Kilhovd B. , Lager I. , Mustajoki P. , Dejgaard A. ,   for the Scandinavian Repaglinide Group
Published: March 2003

Aims To evaluate the long‐term effectiveness and safety of repaglinide, a novel prandial glucose regulator, in comparison with glipizide in the treatment of patients with Type 2 diabetes.

Methods Diet or tablet‐treated patients with Type 2 diabetes (n = 256; age 40–75 years, body mass index (BMI) 20–35 kg/m2, HbA1c 4.2–12.8%), without signs of severe microvascular or macrovascular complications, were included in this double‐blind, multicentre, parallel‐group comparative trial. Patients were randomized at a 2:1 ratio to repaglinide, 1–4 mg at mealtimes, or glipizide, 5–15 mg daily.

Results  Changes in fasting blood glucose (FBG) and HbA1c during the 12 months of treatment showed a significant difference in favour of repaglinide. In oral hypoglycaemic agents (OHA)‐naive patients, HbA1c decreased in the repaglinide and glipizide groups by 1.5% and 0.3%, respectively (P < 0.05 between groups). Fasting blood glucose decreased in the repaglinide group by 2.4 mmol/l and increased in the glipizide group by 1.0 mmol/l (P < 0.05 between groups). In the study population as a whole, repaglinide was able to maintain glycaemic control (HbA1c level) during the 1‐year study period, whereas control deteriorated significantly with glipizide. Change in HbA1c from baseline was significantly better with repaglinide than with glipizide after 12 months (P < 0.05). In addition, FBG deteriorated significantly in the glipizide group compared with the repaglinide group (P < 0.05). No patients in either group experienced a major hypoglycaemic event; the number of patients experiencing minor hypoglycaemia was similar in the repaglinide and glipizide groups (15% and 19%, respectively).

Conclusions Repaglinide, given as a prandial glucose regulator, is shown to be an effective and safe treatment of patients with Type 2 diabetes, and is better than glipizide in controlling HbA1c and FBG levels, overall, and in OHA‐naive patients.

Diabet. Med. 18, 395–401 (2001)
Skin microvascular vasodilatory capacity in offspring of two parents with Type 2 diabetes
Authors: Lee B. C. , Shore A. C. , Humphreys J. M. , Lowe G. D. , Rumley A. , Clark P. M. , Hattersley A. T. , Tooke J. E.
Published: March 2003

Aims  Microvascular dysfunction occurs in Type 2 diabetes and in subjects with fasting hyperglycaemia. It is unclear whether this dysfunction relates to dysglycaemia. This study investigated in normogylcaemic individuals whether a genetic predisposition to diabetes, or indices of insulin resistance including endothelial markers, were associated with impaired microvascular function.

Methods  Maximum microvascular hyperaemia to local heating of the skin was measured using laser Doppler flowmetry in 21 normoglycaemic subjects with no family history of diabetes (Group 1) and 21 normoglycaemic age, sex and body mass index‐matched offspring of two parents with Type 2 diabetes (Group 2).

Results  Although Group 2 had normal fasting plasma glucose and glucose tolerance tests, the 120‐min glucose values were significantly higher at 6.4 (5.3–6.6) mmol/l (median (25th – 75th centile)) than the control group at 4.9 (4.6–5.9) mmol/l (P = 0.005) and the insulinogenic index was lower at 97.1 (60.9–130.8) vs. 124.0 (97.2–177.7) (P = 0.027). Skin maximum microvascular hyperaemia (Group 1: 1.56 (1.39–1.80) vs. Group 2: 1.53 (1.30–1.98) V, P = 0.99) and minimum microvascular resistance which normalizes the hyperaemia data for blood pressure (Group 1: 52.0 (43.2–67.4) vs. Group 2: 56.0 (43.7–69.6) mmHg/V, P = 0.70) did not differ in the two groups. Significant positive associations occurred between minimum microvascular resistance and indices of the insulin resistance syndrome; plasminogen activator inhibitor type 1 (Rs = 0.46, P = 0.003), t‐PA (Rs = 0.36, P = 0.03), total cholesterol (Rs = 0.35, P = 0.02), and triglyceride concentration (Rs = 0.35, P = 0.02), and an inverse association with insulin sensitivity (Rs = −0.33, P = 0.03).

Conclusions  In normoglycaemic adults cutaneous microvascular vasodilatory capacity is associated with features of insulin resistance syndrome, particularly with plasminogen activator inhibitor type 1. A strong family history of Type 2 diabetes alone does not result in impairment in the maximum hyperaemic response.

Diabet. Med. 18, 541–545 (2001)
Drinking water composition and childhood‐onset Type 1 diabetes mellitus in Devon and Cornwall, England
Authors: Zhao H. X. , Mold M. D. , Stenhouse E. A. , Bird S. C. , Wright D. E. , Demaine A. G. , Millward B. A.
Published: March 2003

Aims  Previous studies have reported inconsistent results on the association between some compositions (e.g. nitrate) in domestic water and the risk of childhood‐onset Type 1 diabetes mellitus. This study aimed to examine the relationship between nitrate, zinc and magnesium in drinking water and the risk of childhood‐onset Type 1 diabetes mellitus.

Methods  The study covers the Cornwall and the former Plymouth Health Authority Regions in the far south‐west of England. Five hundred and seventeen children, aged 0–15 years, diagnosed with Type 1 diabetes mellitus between 1975 and 1996, were identified for inclusion in the study. Domestic water data (nitrate, Zn, Mg, Cu, Al, Ca, Fe and Mn) between 1993 and 1997 were provided by South‐west Water Plc, UK, for each of the 40 Water Supply Zones in which the subjects had been resident at the time of diagnosis. The standardized incidence ratio (SIR) of the disease was calculated for each Water Supply Zone using the UK 1991 census population data. The relationship between the SIR of the disease and the water quality indicators in thirds (three strata of low, medium and high concentrations) was examined by χ2 test for trend and Poisson regression analysis.

Results  The initial analyses by χ2 test for trend on the relation of SIRs and drinking water compositions suggested that copper, magnesium and nitrate might have some protective effects, but Poisson regression analyses showed that only zinc and magnesium were significant factors. The data suggest that the incidence rate of childhood diabetes is significantly lower when the concentrations of zinc and magnesium in the domestic drinking water are in the range 22.27–27.00 µg/l (incidence rate ratio (IRR), 0.76; 95% CI, 0.59–0.97) and greater than 2.61 mg/l (IRR, 0.72; 95% CI, 0.58–0.91), respectively.

Conclusions  Our findings suggest evidence of a possible association between zinc and magnesium in the domestic drinking water and childhood diabetes in the far south‐west of England. However, these possible protective effects of zinc and magnesium in domestic drinking water warrant further confirmation.

Diabet. Med. 18, 709–717 (2001)
Post‐prandial insulin lispro vs. human regular insulin in prepubertal children with Type 1 diabetes mellitus
Authors: Tupola S. , Komulainen J. , Jääskeläinen J. , Sipilä I.
Published: March 2003

Aims  To study whether post‐prandial insulin lispro (PL) could be used as a part of insulin therapy instead of premeal human regular insulin (HR) in prepubertal children with Type 1 diabetes mellitus (Type 1 DM).

Patients and methods  In this open, randomized cross‐over study patients used either PL or HR at breakfast and at dinner. After a 1‐month screening period, patients were randomized to treatment with PL or HR for 3 months and then they crossed over to the other insulin for an additional 3 months. The patients were 24 prepubertal children with Type 1 DM (median age 6.2 years, duration of diabetes 37 months). Home monitoring of 1‐day glucose profiles at meals (premeal, 1 h and 2 h after breakfast and after dinner) and HbA1c were measured before randomization, before cross‐over, and at the last visit. Data on hypoglycaemic episodes were collected at each of the seven visits. The variables were compared between the two treatments.

Results  Of the patients 22/24 completed the study. There were no major differences in the glucose excursions between PL and HR after breakfast (mean ± sd: 1‐h PL 3.7 ± 4.7 vs. HR 2.9 ± 3.9 mmol/l, P = 0.3; 2‐h −0.9 ± 5.4 vs. 0.3 ± 4.5 mmol/l, P = 0.2, respectively) or after dinner (1‐h PL −2.5 ± 4.8 vs. HR −0.4 ± 3.7 mmol/l, P = 0.07, 2‐h −4.1 ± 5.2 vs. −0.7 ± 5.0 mmol/l, P = 0.05, respectively). Mean change of HbA1c was similar in both treatment groups (PL 0.2 ± 0.8% vs. HR −0.4 ± 0.7%, P = 0.1). The frequency of hypoglycaemic episodes was 4.9 per patient per month during treatment with PL, and 4.4 during HR (P = 0.3).

Conclusion  Treatment with post‐prandial lispro as a meal insulin is as effective and safe as traditional treatment with regular insulin in young children.

Diabet. Med. 18, 654–658 (2001)
Improved glycaemic control by addition of glimepiride to metformin monotherapy in Type 2 diabetic patients
Authors: Charpentier G. , Fleury F. , Kabir M. , Vaur L. , Halimi S.
Published: March 2003

Aim  To compare the effect of glimepiride in combination with metformin with monotherapy of each drug on glycaemic control in Type 2 diabetic patients.

Design and methods  Randomized, double‐blind, double‐dummy, parallel‐group multicentre study conducted in France. Type 2 diabetic patients aged 35–70 years inadequately controlled by metformin monotherapy 2550 mg daily for at least 4 weeks were randomized to either metformin, glimepiride or metformin and glimepiride.

Results  Three hundred and seventy‐two patients aged 56 ± 8 years were treated for 5 months. Combination treatment was significantly more efficient in controlling HbA1c (% change + 0.07 ± 1.20 for metformin, + 0.27 ± 1.10 for glimepiride, −0.74 ± 0.96 for combination treatment, P < 0.001), fasting blood glucose (FBG) (mmol/l change + 0.8 ± 0.4 for metformin, + 0.7 ± 3.1 for glimepiride and −1.8 ± 2.2 for combination treatment, P < 0.001) and post‐prandial blood glucose (PPBG) (mmol/l change + 1.1 ± 5.9 for metformin, + 0.1 ± 5.1 for glimepiride and −2.6 ± 3.9 for combination treatment, P < 0.001) than either glimepiride or metformin alone. There was no significant difference between metformin or glimepiride monotherapy with respect to the change in HbA1c or FBG; however, glimepiride was significantly more effective than metformin in reducing PPBG. The incidence of symptomatic hypoglycaemia was higher in the combination group than in either monotherapy group (P = 0.039).

Conclusions  Addition of glimepiride to metformin in Type 2 diabetic patients inadequately controlled by metformin alone resulted in superior glycaemic control compared with glimepiride or metformin monotherapy.

Diabet. Med. 18, 828–834 (2001)
The short insulin tolerance test lacks validity in adolescents with Type 1 diabetes
Authors: Särnblad S. , Kroon M. , Åman J.
Published: March 2003

Aims The short insulin tolerance test (SITT) has been found to be a simple and valid method for determining insulin sensitivity in healthy adults and patients with Type 2 diabetes. In this study we evaluated the reproducibility and validity of SITT in 16 adolescents with Type 1 diabetes.

Methods Thirteen patients underwent two SITT and eight patients were examined with both SITT and a euglycaemic hyperinsulinaemic clamp. At the SITT insulin sensitivity was measured from the slope of arterialized blood glucose concentrations determined for 16 min after an intravenous bolus injection of short‐acting insulin, 0.1 U/kg body weight, and expressed as glucose disappearance rate (KITT).

Results There was a significant correlation between the insulin sensitivity estimations made at the two SITT (r = 0.73, P = 0.003). The reproducibility was low, however, with a coefficient of variation of 38.7%. KITT showed a strong inverse correlation to the fasting blood glucose concentration (r = −0.74, P < 0.0001). We found no correlation between insulin sensitivity measured by SITT and that measured by the euglycaemic clamp.

Conclusions We conclude that the short insulin tolerance test cannot be used in adolescent patients with Type 1 diabetes for a simple estimation of insulin sensitivity.
The effect of subclinical hypothyroidism on metabolic control in children and adolescents with Type 1 diabetes mellitus
Authors: Mohn A. , Di Michele S. , Di Luzio R. , Tumini S. , Chiarelli F.
Published: March 2003

Aims Associated autoimmune phenomena might influence metabolic control in children and adolescents with Type 1 diabetes mellitus. A retrospective case control study was performed in order to explore the effect of subclinical hypothyroidism on metabolic control in Type 1 diabetes mellitus.

Patients and methods For this purpose each patient with Type 1 diabetes and subclinical hypothyroidism (cases) was matched for age, duration of disease and, if possible, for sex, with two to three diabetic patients without hypothyroidism (controls). Parameters of metabolic control such as HbA1c, total insulin requirement and frequency of symptomatic hypoglycaemia were retrieved for 12, 6 and 3 months before and after diagnosis of hypothyroidism.

Results Thirteen patients (two male/11 female) patients were diagnosed with subclinical hypothyroidism and were matched with 31 controls (nine male/22 female). There was no difference (mean and range) in terms of age (11.9 years (4.4–18.1) vs. 11.7 years (3.5–18.1), P = 0.9) and duration of disease (5.1 years (1.2–10.5) vs. 4.38 years (0.9–10.8), P = 0.6) between the two groups. There was no difference in HbA1c and total insulin requirement between the two groups at any time point of assessment (anovaP = 0.8 and P = 0.1, respectively). Patients with hypothyroidism had significantly more symptomatic hypoglycaemic episodes during the 12 months before diagnosis (anovaP = 0.05), increasing progressively during this time period and reaching a peak at time 0 (5.5 ± 0.4 vs. 1.6 ± 0.1 episodes/month, P = 0.01). No difference could be detected within 6 months of starting substitution therapy (2.4 ± 0.2 vs. 1.6 ± 0.1 episodes/week, P = 0.8).

Conclusions These data suggest that subclinical hypothyroidism is associated with an increased risk of symptomatic hypoglycaemia. The prompt introduction of substitution therapy is recommended as it reduces its frequency.
Age‐related increase in haemoglobin A1c and fasting plasma glucose is accompanied by a decrease in β cell function without change in insulin sensitivity: evidence from a cross‐sectional study of hospital personnel
Authors: Yates A. P. , Laing I.
Published: March 2003

Aims To examine the influence of age on glucose homeostasis in a population of healthy, non‐diabetic hospital personnel.

Methods One hundred and twenty female and 71 male non‐diabetic individuals (fasting plasma glucose < 7.0 mmol/l) were fasted overnight prior to blood sampling. Glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and fasting plasma insulin (FPI) were measured using a BioRad Diamat automated HPLC, a Hitachi 747 analyser and a sensitive in‐house radioimmunoassay, respectively. Mathematical modelling of the fasting glucose and insulin pairs (homeostasis model assessment (HOMA)) generated indices of pancreatic β cell function, HOMA‐B and tissue insulin sensitivity HOMA‐S.

Results Spearman rank correlation analysis showed that in the whole group there was a significant negative correlation between age and HOMA‐B (rs= −0.218, P = 0.0022) and a significant positive correlation between age and both HbA1c (rs= 0.307, P = 0.0001) and FPG (rs= 0.26, P = 0.0003). There was no correlation between age and either FPI (rs= −0.08, P = 0.266) or HOMA‐S (rs= 0.024, P = 0.75). Analysis by gender showed the above associations to be present in the females (rs= −0.243, P = 0.0076; rs= 0.304, P = 0.0007; rs= 0.32, P = 0.0004 for age vs. HOMA‐B, HbA1c, and FPG, respectively). Again there was no correlation of age with FPI or insulin sensitivity. In the males there was a significant correlation of HbA1c with age (rs= 0.35, P = 0.002), but no significant correlation of age with any of the other parameters.

Conclusions Glycaemic control deteriorates with age in healthy, non‐diabetic individuals. Age‐related rises in FPG and haemoglobin A1c result from a small but steady decline in pancreatic β cell function.

Diabet. Med. 19, 254–258 (2002)
Antibodies to GAD in Japanese patients classified as Type 2 diabetes at diagnosis. High titre of GAD Ab is a predictive marker for early insulin treatment—report of west Japan (Kyushu, Yamaguchi, Osaka) study for GAD Ab(+) diabetes
Authors: Takino H. , Yamasaki H. , Abiru N. , Sera Y. , Abe T. , Kawasaki E. , Yamaguchi Y. , Eguchi K. , Kanazawa Y. , Nagataki S. ,   14 participating centres
Published: March 2003

Aim We evaluated the prevalence of GAD Ab in Japanese Type 2 diabetic patients treated with oral hypoglycaemic agents (OHA) and/or diet and followed GAD Ab(+) patients to assess the usefulness of GAD Ab as a marker for future insulin treatment prospectively.

Methods A total of 2658 Japanese Type 2 diabetic patients treated by OHA and/or diet were randomly selected between April 1996 and December 1998. The clinical characteristics at entry were assessed and patients were followed for 1–3 years.

Results The overall prevalence of GAD Ab among Type 2 diabetic patients was 2.0%. Forty‐five had a history of diabetes of ≤ 5 years (short history) while those with duration > 5 years (long history) totalled nine. Among them, 47% of patients with a short history did not require insulin in the follow‐up period. However, none of those with a long history required insulin treatment within 2 years. Comparison of patients based on GAD titre in those with short history showed that 33% of patients in the high‐titre group (≥ 20 U) required no insulin treatment in the first year of follow‐up. In contrast, this proportion was 80% in the first and 67% in the second year in the low‐titre group (< 20 U).

Conclusions The prevalence of GAD Ab in Japanese patients with a short and long history of diabetes was 2.8% and 0.9%, respectively. The presence of GAD Ab in Japanese Type 2 diabetic patients with a short history of diabetes is a marker for early insulin treatment.
Patient‐assessed health outcome measures for diabetes: a structured review
Authors: Garratt A. M. , Schmidt L. , Fitzpatrick R.
Published: March 2003

Aims To identify available disease‐specific measures of health‐related quality of life (HRQL) for diabetes and to review evidence for the reliability, validity and responsiveness of instruments.

Methods Systematic searches were used to identify instruments. Instruments were assessed against predefined inclusion and exclusion criteria. Letters were sent to authors requesting details of further instrument evaluation. Information relating to instrument content, patients, reliability, validity and responsiveness to change was extracted from published papers.

Results The search produced 252 references. Nine instruments met the inclusion criteria: Appraisal of Diabetes Scale (ADS), Audit of Diabetes‐Dependent Quality of Life (ADDQoL), Diabetes Health Profile (DHP‐1, DHP‐18), Diabetes Impact Measurement Scales (DIMS), Diabetes Quality of Life Measure (DQOL), Diabetes‐Specific Quality of Life Scale (DSQOLS), Questionnaire on Stress in Diabetic Patients‐Revised (QSD‐R), Diabetes‐39 (D‐39) and Well‐being Enquiry for Diabetics (WED). The shortest instrument (ADS) has seven items and the longest (WED) has 50 items. The ADS and ADDQoL are single‐index measures. The seven multidimensional instruments have dimensions covering psychological well‐being and social functioning but vary in the remainder of their content. The DHP‐1 and DSQOLS are specific to Type 1 diabetes patients. The DHP‐18 is specific to Type 2 diabetes patients. The DIMS and DQOL have weaker evidence for reliability and internal construct validity. Patients contributed to the content of the ADDQoL, DHP‐1/18, DQOL, DSQOLS, D‐39, QSD‐R and WED. The authors of the ADDQoL, DHP‐1/18, DQOL, DSQOLS gave explicit consideration to content validity. The construct validity of instruments was assessed through comparisons with instruments measuring related constructs and clinical and sociodemographic variables. None of the instruments has been formally assessed for responsiveness to changes in health.

Conclusions Five of the diabetes‐specific instruments have good evidence for reliability and internal and external construct validity: the ADDQoL, DHP‐1/18, DSQOLS, D‐39 and QSD‐R. Instrument content should be assessed for relevance before application. The instruments should be evaluated concurrently for validity and responsiveness to important changes in health.
Risk of developing diabetes is inversely related to lung function: a population‐based cohort study
Authors: Engström G. , Janzon L.
Published: March 2003

Aim To investigate whether reduced lung function is a risk factor for developing diabetes.

Methods Non‐diabetic men (n = 382) from the population‐based cohort ‘Men Born in 1914’ were examined with spirometry at age 55 years. The cohort was re‐examined at 68 years. Diabetes and fasting plasma glucose at follow‐up were studied in relation to vital capacity (VC) and forced expiratory volume (FEV1.0) at baseline.

Results Fifteen men developed diabetes during the follow‐up. The percentage with diabetes in the 1st, 2nd, 3rd and top quartile of vital capacity were 7%, 5%, 2%, and 1%, respectively (P for trend = 0.01). Fasting glucose (log transformed, mmol/l) at follow‐up was 1.63 ± 0.16, 1.62 ± 0.18, 1.61 ± 0.11 and 1.60 ± 0.11, respectively (P for trend = 0.11). The longitudinal associations between VC and diabetes (P = 0.001) and log glucose (P = 0.036) were significant after adjustments for several potential confounders. FEV1.0 at baseline showed similar associations with diabetes at follow‐up.

Conclusions The risk of developing diabetes is inversely associated with pulmonary function among middle‐aged men.
Predictors of insulin sensitivity in Type 2 diabetes mellitus
Authors: Bonora E. , Targher G. , Alberiche M. , Formentini G. , Calcaterra F. , Lombardi S. , Marini F. , Poli M. , Zenari L. , Raffaelli A. , Perbellini S. , Zenere M. B. , Saggiani F. , Bonadonna R. C. , Muggeo M.
Published: March 2003

Aims To identify the independent predictors of insulin sensitivity in Type 2 diabetes, and to establish whether isolated Type 2 diabetes (i.e. diabetes without overweight, dyslipidaemia and hypertension) is a condition of insulin resistance.

Methods We examined 45 patients with non‐insulin‐treated Type 2 diabetes undergoing a 4‐h euglycaemic hyperinsulinaemic clamp (20 mU/m2 per min) combined with 3H‐3‐D‐glucose and 14C‐U‐glucose infusions and indirect calorimetry. We also examined 1366 patients with non‐insulin‐treated Type 2 diabetes randomly selected among those attending the Diabetes Clinic and in whom insulin resistance was estimated by Homeostasis Model Assessment (HOMA‐IR).

Results In the 45 patients undergoing glucose clamp studies, insulin‐mediated total glucose disposal (TGD) was independently and negatively associated with systolic blood pressure (standardized β coefficient = −0.407, P = 0.003), plasma triglycerides (β= −0.355, P = 0.007), and HbA1c (β= −0.350, P = 0.008). The overall variability of TGD explained by these variables was 53%. Overweight diabetic subjects with central fat distribution, hypertension, hypertriglyceridaemia and poor glycometabolic control had insulin‐mediated TGD values markedly lower than their lean counterparts without hypertension, with normal triglycerides, and with good glycometabolic control (16 ± 5 vs. 31 ± 10 µmol/min per kg lean body mass, P < 0.01). Nevertheless, the latter still were markedly insulin‐resistant when compared with sex‐ and age‐matched non‐diabetic control subjects (31 ± 10 vs. 54 ± 13 µmol/min per kg lean body mass, P < 0.01). In the 1366 Type 2 diabetic patients of the epidemiological study, HOMA‐IR value was independently associated with HbA1c (β = 0.283, P < 0.0001), plasma triglycerides (β = 0.246, P < 0.0001), body mass index (β = 0.139, P < 0.001), waist girth (β = 0.124, P < 0.001) and hypertension (β = 0.066, P = 0.006).

Conclusion Overweight, central fat distribution, dyslipidaemia, hypertension and poor glycometabolic control are strong independent predictors of insulin resistance in Type 2 diabetes. However, reduced insulin sensitivity can be found even when Type 2 diabetes is isolated and well controlled.

Diabet. Med. 19, 535–542 (2002)
The relationship between blood glucose excursions and painful diabetic peripheral neuropathy: a pilot study
Authors: Oyibo S. O. , Prasad Y. D. M. , Jackson N. J. , Jude E. B. , Boulton A. J. M.
Published: March 2003

Aims Peripheral neuropathy affects 30% of Type 1 diabetic patients. Unfortunately, 10–20% of affected patients have disabling symptoms. The aim of this study was to examine the relationship between blood glucose excursions and pain in patients with symptomatic diabetic neuropathy.

Methods Twenty Type 1 diabetic patients with peripheral neuropathy (10 painful and 10 painless) wore a continuous glucose monitoring system for 3 days. Symptomatic patients kept a daily pain score diary. The mean amplitude of glycaemic excursions (MAGE) and the M‐values (measure of glucose deviations from an arbitrarily selected point) were calculated.

Results Groups were matched for (mean ± sd) age: 52.0 
±
 11.1 years; duration of diabetes: 24.8 
±
 10.7 years; HbA1c: 9.7 
±
 2.3%; duration of neuropathy: 5.6 
±
 2.6 years; and CGMS performance. The painful group had a greater mean glucose (12.1 
±
 2.9 mmol/l vs. 9.3 
±
 1.9 mmol/l, P
 
=
 0.02), a greater M‐value (68.4 vs. 31.1, P
 
=
 0.02) and more glycaemic excursions (13 vs. 10, P  < 0.01), compared with the painless group. However, there was no difference in the MAGE between both groups, and no correlation between the number of glycaemic excursions and the number of painful episodes in the painful group.

Conclusions Patients with painful neuropathy have greater glucose flux and possibly poorer diabetes control, compared with patients with painless neuropathy.
Affluence is not related to delay in diagnosis of Type 2 diabetes as judged by the development of diabetic retinopathy
Authors: Litwin A. S. , Clover A. , Hodgkins P. R. , Luff A. J.
Published: March 2003

Aim To determine the relationship between affluence and the presence of diabetic retinopathy at time of diagnosis of Type 2 diabetes.

Methods Records of patients held by Southampton Retinal Screening Programme were examined. Patients (n   =  1844) newly diagnosed with Type 2 diabetes and subsequently receiving photographic retinal screening within 24 months were selected. Townsend scores for social deprivation were calculated and the patients with and without retinopathy at first screening were then compared.

Results No significant difference was found in the median Townsend score of those people with (−0.2, interquartile range (IQR) −3.7 to 3.8) and those without (−0.5, IQR −3.3 to 3.6) diabetic retinopathy at first screening after diagnosis of Type 2 diabetes (P   =  0.6).

Conclusion The relative affluence of the area in which a person lives, as judged by postcode, does not appear to predict likelihood of diabetic retinopathy at diagnosis of Type 2 diabetes.
Proposed diagnostic thresholds for gestational diabetes mellitus according to a 75‐g oral glucose tolerance test. Maternal and perinatal outcomes in 3260 Danish women
Authors: Jensen D. M. , Damm P. , Sørensen B. , Mølsted‐Pedersen L. , Westergaard J. G. , Korsholm L. , Ovesen P. , Beck‐Nielsen H.
Published: March 2003

Aims To study if established diagnostic threshold values for gestational diabetes based on a 75‐g, 2‐h oral glucose tolerance test can be supported by maternal and perinatal outcomes.

Methods Historical cohort study of 3260 pregnant women examined for gestational diabetes on the basis of risk indicators. Information on oral glucose tolerance test results and clinical outcomes were collected from medical records.

Results There was an increased risk of delivering a macrosomic infant in women with 2‐h capillary blood glucose of 7.8–8.9 mmol/l compared with women with 2‐h glucose < 7.8 mmol/l. Despite treatment, 2‐h glucose of 9.0–11.0 mmol/l and ≥ 11.1 mmol/l were both associated with increased rates of macrosomia, spontaneous preterm delivery, hypertensive complications, and neonatal hypoglycaemia. Adverse outcomes tended to be more frequent in women with 2‐h glucose ≥ 11.1 mmol/l than in women with 2‐h glucose of 9.0–11.0 mmol/l.

Conclusions The risk for several maternal and perinatal complications increased with the diagnostic threshold for 2‐h glucose. Large‐scale blinded studies are needed to clarify the question of a clinically meaningful diagnosis of gestational diabetes mellitus. Until these results are available, a 2‐h threshold level of 9.0 mmol/l after a 75‐g oral glucose tolerance test seems acceptable.
Methicillin‐resistant Staphylococcus aureus in the diabetic foot clinic: a worsening problem
Authors: Dang C. N. , Prasad Y. D. M. , Boulton A. J. M. , Jude E. B.
Published: March 2003

Aims  To determine if there has been a change in the prevalence of pathogenic organisms in foot ulcers in diabetic patients in 2001 compared with our previous study in 1998.

Methods  A retrospective analysis of wound swabs taken from infected foot ulcers in diabetic patients attending the outpatient clinic in the Manchester Foot Hospital over a twelve‐month period. A total of 63 patients with positive wound swabs were identified.

Results  Gram‐positive aerobic bacteria still predominate (84.2%) and the commonest single isolate remains Staphylococcus aureus (79.0%) which is higher than we previously reported. MRSA was isolated in 30.2% of the patients which is almost double the proportion of MRSA‐affected patients three years ago. This did not appear to be related to prior antibiotic usage. There was no increase in hospitalisation because of MRSA infection.

Conclusions  The problem of MRSA continues to increase despite the precautions taken to prevent MRSA spread. There is a need for a multi‐centre study looking into the prevalence of MRSA in diabetic foot ulcer and how this can be reduced in the diabetic foot clinic.
The role of fire disturbance for global vegetation dynamics: coupling fire into a Dynamic Global Vegetation Model
Authors: Thonicke Kirsten , Venevsky Sergey , Sitch Stephen , Cramer Wolfgang
Published: March 2003

Disturbances from fire, wind‐throw, insects and other herbivores are, besides climate, CO2, and soils, critical factors for composition, structure and dynamics of most vegetation. To simulate the influence of fire on the dynamic equilibrium, as well as on potential change, of vegetation at the global scale, we have developed a fire model, running inside the modular framework of the Lund–Potsdam–Jena Dynamic Global Vegetation Model (LPJ‐DGVM).

Estimated litter moisture is the main driver of day‐to‐day fire probability. The length of the fire season is used to estimate the fractional area of a grid cell which is burnt in a given year. This affected area is converted into an average fire return interval which can be compared to observations.

When driven by observed climate for the 20th century (at a 0.5° longitude/latitude resolution), the model yielded fire return intervals in good agreement with observations for many regions (except parts of semiarid Africa and boreal Siberia). We suggest that further improvement for these regions must involve additional process descriptions such as permafrost and fuel/fire dynamics.
Mammals on mountainsides: elevational patterns of diversity
Authors: Brown James H.
Published: March 2003

The four major papers in this special feature present and interpret data from field studies on the distributions and diversity of small mammals in elevational gradients on mountains in the Philippines, Borneo, southern Mexico and western United States. In the introductory paper, Lomolino places these studies in the context of historical, methodological and conceptual themes in contemporary biogeography. In this final paper, I focus on some important similarities and interesting differences among the four case studies. All of the studies provide evidence for the influence of ecological factors, such as climate, productivity and habitat heterogeneity, on mammalian diversity. All also provide evidence for the influence of historical dispersal, extinction, and speciation events. Perhaps the most interesting result is the documentation of a frequent, but not universal, peak in species diversity at some elevation intermediate between the base and peak of a mountain. Efforts to understand the mechanistic basis for this pattern — and why it differs from the continuous decrease in diversity from the equator to the poles — promise to contribute to developing a general theoretical explanation for the major patterns of biodiversity on earth.
Elevation gradients of species‐density: historical and prospective views
Authors: Lomolino MARK. V.
Published: March 2003

Studies of elevation clines in diversity and composition of ecological communities date back to the origins of biogeography. A modern resurgence of interests in these elevational clines is likely to contribute important insights for developing a more general theory of species diversity. In order to gain a more comprehensive understanding of geographical clines in diversity, the research programme for montane biogeography should include statistically rigorous tests of apparent patterns, comparisons of patterns among regions and taxonomic or ecological groups of species, and analyses of clines in environmental variables concurrent with biogeographical surveys. The conceptual framework for this research programme should be based on the assumption that elevational gradients in species diversity result from a combination of ecological and evolutionary processes, rather than the presumed independent effects of one overriding force. Given that montane ecosystems are hot spots of biological diversity, an expanded and integrated programme for biogeographic surveys in montane regions should provide valuable insights for conservation biologists.
Breaking taboos in the tropics: incest promotes colonization by wood‐boring beetles
Authors: Jordal Bjarte H. , Beaver Roger A. , Kirkendall Lawrence R.
Published: March 2003

Inbreeding and parthenogenesis are especially frequent in colonizing species of plants and animals, and inbreeding in wood‐boring species in the weevil families Scolytinae and Platypodidae is especially common on small islands. In order to study the relationship between colonization success, island attributes and mating system in these beetles, we analysed the relative proportions of inbreeders and outbreeders for 45 Pacific and Old World tropical islands plus two adjacent mainland sites, and scored islands for size, distance from nearest source population, and maximum altitude.

 The numbers of wood‐borer species decreased with decreasing island size, as expected; the degree of isolation and maximum island altitude had negligible effects on total species numbers.

 Numbers of outbreeding species decreased more rapidly with island size than did those of inbreeders. Comparing species with similar ecology (e.g. ambrosia beetles) showed that this difference was best explained by differential success in colonization, rather than by differences in resource utilization or sampling biases. This conclusion was further supported by analyses of data from small islands, which suggested that outbreeding species have a higher degree of endemism and that inbreeding species are generally more widespread.

 Recently established small populations necessarily go through a period of severe inbreeding, which should affect inbreeding species much less than outbreeding ones. In addition, non‐genetic ecological and behavioural (‘Allee’) effects are also expected to reduce the success of outbreeding colonists much more than that of inbreeders: compared with inbreeders, outbreeders are expected to have slower growth rates, have greater difficulties with mate‐location and be vulnerable to random extinction over a longer period.
The concept of the taxon cycle in biogeography
Authors: Ricklefs Robert E. , Bermingham Eldredge
Published: March 2003

Taxon cycles are sequential phases of expansion and contraction of the ranges of species, associated generally with shifts in ecological distribution. The important contribution of the taxon cycle to biogeographical analysis is its emphasis on evolutionary and ecological interactions among colonizing and resident species, which influence their extinction dynamics and establish patterns of geographical distribution. Taxon cycles were inferred originally from the distribution of species across island archipelagos, where a correlation was noted between gaps in island occupancy and the degree of phenotypic differentiation. This pattern implied that phases of colonization were followed by range contraction, while endemic Antillean species that were undifferentiated between islands suggested secondary expansion and the beginning of a new cycle. This interpretation was met with scepticism, but reconstruction of phylogenetic relationships from gene sequences has now permitted us to characterize taxon cycles in Lesser Antillean birds. The relative timing of phases of the cycle can be deduced from genetic divergence between island populations. We have found that taxon cycles have periods in the order of 106 years and that cycles in different lineages occur independently of each other and independently of Pleistocene climate cycles. Individual island populations may persist for several millions of years on the larger islands of the Lesser Antilles; occasional expansion phases lead to the replacement of island populations that have disappeared, thus reducing the archipelago‐wide rate of extinction to nil. What drives taxon cycles is unknown, but we speculate that they may be caused by co‐evolution with enemy populations, and a probable mechanism would involve infrequent mutations influencing parasite virulence and avian host disease resistance. Taxon cycles undoubtedly occur on continents, but the geographical configuration of island archipelagos reveals more clearly their presence and invites their study.
Distributional change and conservation on the Andean flank: a palaeoecological perspective
Authors: Bush Mark B.
Published: March 2003

Aim To review the insights that palaeoecology can offer on the threat posed to Andean communities by global climate change.

Location The geographical focus is the eastern flank of the tropical Andes, with particular reference to Peru.

Method The article presents a synthetic review of the problem.

Results Species‐rich communities of the eastern Andean flank are threatened both by development and climate change. If, as predicted, the cloudbase and frost line lifts 600 m elevation this century, there will be a substantial loss of cloud forest habitat. Palaeoecology provides insights on the location and nature of past ecotones, the continuity of niche availability, and estimates for rates and modes of migration. With further warming and drying of lower montane regions, upslope migration of species will be individualistic: a new equilibrium with the altered climate is unlikely to be attained. The zone of agriculture will move upslope faster than the migrating trees and so landscape conversion will negate the ability of some species to respond to the new conditions. Conservation of the lower reaches of modern cloud forest is advocated as a means to limit this foreseeable extinction event.

Main Conclusions Climate change will induce changes in plant and animal communities. Human disturbance will invade climatically marginal agricultural lands at the pace of climate change. Rapid migratory response such as that witnessed at the onset of the Holocene may not be evident as climates warm, because Holocene climatic stability has reduced outlying upslope populations that may have served as expansion nuclei. Conservation must aim to maintain plant and animal niches, rather than particular communities of species.
Environmental factors and vegetation composition, Lefka Ori massif, Crete, S. Aegean
Authors: Vogiatzakis I. N. , Griffiths G. H. , Mannion A. M.
Published: March 2003

Aim The aim of this study was to explore the environmental factors that determine the spatial distribution of oro‐mediterranean and alti‐mediterranean plant communities in Crete.

Location The paper provides a quantitative analysis of vegetation–environment relationships for two study areas within the Lefka Ori massif Crete, a proposed Natura 2000 site.

Methods Eleven environmental variables were recorded: altitude, slope, aspect, percentage of bare rock, percentage of unvegetated ground, soil depth, pH, organic matter content and percentages of sand, silt and clay content. Classification of the vegetation was based on twinspan, while detrended correspondence analysis (DCA) and canonical correspondence analysis (CCA) were used to identify environmental gradients linked to community distribution.

Results One hundred and twenty‐five species were recorded from 120 plots located within the two study areas. Forty‐seven of the recorded species are endemic, belonging to 35 families. Hemicryptophytes and chamaephytes were the most frequent, suggesting a typical oro‐mediterranean life form spectrum. The samples were classified into five main community types and one transitional. The main gradients, identified by CCA, were altitude and surface cover type in the North‐west site, while in the Central site the gradients were soil formation‐development and surface cover type.

Main conclusions The use of classification in combination with ordination techniques resulted in a good discrimination between plant communities and a greater understanding of controlling environmental factors. The methodology adopted can be employed for improving baseline information on plant community ecology and distribution in Mediterranean mountain zones.
The coincidence of people and biodiversity in Europe
Authors: Araújo Miguel B.
Published: March 2003

A positive correlation between human population density and species richness has been recorded across the tropics. Here I investigate whether this correlation holds true for Europe. Analyses reveal a positive correlation between human population density and plant (rho = 0.505), mammal (rho = 0.471) and reptile and amphibian (rho = 0.556) species richness. The results are largely concordant with those obtained in similar studies for Africa. However, contrary to previous analyses, the correlation found between people and breeding bird species richness (rho = 0.186) was weak. Of three measures of endemism used, only combined European endemic species richness correlated with human density (rho = 0.437). Richness among combined restricted‐range European endemics was not correlated (rho = 0.095) with human density, while richness among all combined restricted‐range species was only weakly correlated with human density (rho = 0.167). The results partially support the idea of a correlation between people and biodiversity, although there are some important exceptions. Discussion of possible mechanisms underling the observed patterns is undertaken.
Genomic structure of the mouse trefoil factor (Tff) gene cluster in 17q
Authors: Kayademir Tuncay , Rosewell Ian , Blin Nikolaus , Gött Peter
Published: March 2003

Introduction In vertebrates, trefoil factor (TFF) domain peptides constitute a class of peptides secreted by the mucous epithelia of the gastrointestinal tract. These peptides promote healing and protection in the gastrointestinal tract. Since the three known human genes are clustered in 21q22.3, a similar arrangement in a paralogous region was possible in mice. The murine intestinal trefoil factor is encoded by the gene Tff3 and was mapped to murine chromosome 17.

Materials and methods Three bacterial and one yeast artificial chromosome recombinants (BAC and YAC) were identified and used for characterisation by PCR, restriction mapping, hybridisation, and fluorescence in situ hybridisation (FISH).

Results and discussion Here we have characterised the genomic structure of all three mouse Tff genes starting with a contig formed by one YAC and three BACs. In a similar fashion to the TFF gene cluster in humans, the Tff genes cover a region of approx. 40 kb in the transcriptional order Tff1–Tff2–Tff3 and localised on mouse chromosome 17. Based on this conserved genomic structure, we propose a model of how mammalian TFF genes may have evolved by exon duplication and unequal crossing over.