bluuebunny/crossref_metadata_2025 huggingface dataset:
Type II Diabetic Subjects Lose Less Weight Than Their Overweight Nondiabetic Spouses
Authors: Wing Rena R , Marcus Marsha D , Epstein Leonard H , Salata Rose
Published: March 2007

To determine whether diabetic individuals have more difficulty losing weight than nondiabetic individuals, 12 overweight diabetic subjects (6 men, 6 women) and their overweight nondiabetic spouses were treated together in a behavioral weight-control program. Diabetic and nondiabetic subjects did not differ in age, weight, or percent overweight. Weight losses of nondiabetic spouses were significantly greater than those of diabetic patients (13.4 ± 1.7 vs. 7.5 ± 1.4 kg; P < .01). Differences emerged by wk 5 and became greater over the 20-wk program. Nondiabetic subjects reduced their intake significantly more than diabetics, suggesting that differences in dietary adherence were responsible for the differences in weight loss.
Long-Term Use of Intranasal Insulin in Insulin-Dependent Diabetic Patients
Authors: Frauman Albert G , Cooper Mark E , Parsons Barry J , Jerums George , Louis William J
Published: March 2007

This study, in 3 phases, compared the long-term acceptability and efficacy of insulin administered by nasal spray with an intensified subcutaneous regimen in nine type I (insulin-dependent) diabetic subjects on baseline therapy with ultralente insulin. In phase 1, patients were begun and stabilized on a regimen of ultralente daily and Actrapid insulin three times daily. Phase 2 consisted of 4 mo of this intensified subcutaneous regimen. In phase 3, intranasal administration of insulin, with 1% (wt/vol) sodium glycocholate, replaced Actrapid insulin for 4 mo. Glycemic control was compared in each of the three phases. It was possible to maintain the dose of ultralente insulin relatively constant in only six of the nine subjects during the intranasal phase of the study. The six subjects showed a significant rise in glycosylated hemoglobin during the intranasal phase (10.4 ± 0.6% intranasal vs. 9.1 ± 0.3% subcutaneous, P < .05) but not in plasma or urinary glucose levels. There was no significant change in the incidence of hypoglycemic episodes during intranasal insulin therapy in this group. The other three subjects were considered treatment failures. Six of the nine original subjects expressed a preference for intranasal insulin, and one subject complained of mild nasal irritation insufficient to cease treatment. The intranasal route of administration of insulin has the potential to replace short-acting insulin as an adjunct to longer-acting insulin in some insulin-treated diabetic patients.
Postexercise Late-Onset Hypoglycemia in Insulin-Dependent Diabetic Patients
Authors: MacDonald Michael J
Published: March 2007

A new clinical entity that is prevalent in young type I (insulin-dependent) diabetic patients, postexercise late-onset (PEL) hypoglycemia, is described. A prospective case-finding study suggested that PEL hypoglycemia occurred in 48 of ∼300 diabetic type I patients who were diagnosed as diabetic before age 20 yr and who were monitored for up to 2 yr. Typically, hypoglycemia was nocturnal and occurred 6—15 h after the completion of unusually strenuous exercise or play. In more than half the cases the hypoglycemia resulted in loss of consciousness or seizures and necessitated treatment with subcutaneous glucagon or intravenous glucose and/or attendance by a health professional. The hypoglycemia was not limited to patients in good or excellent metabolic control and often occurred after a single bout of exercise in patients unaccustomed to exercise or in athletic patients who were making the transition from an untrained to a trained state. Surprisingly, 12 of the patients who experienced nocturnal PEL hypoglycemia were not using significant amounts of insulin that peaked at night. Type I diabetic patients should be made aware of the possibility of PEL hypoglycemia to enable them to make adjustments in their management plans in anticipation of unusually strenuous exercise, so that they may attempt to minimize or avoid late-onset hypoglycemia.
Macrosomia in Pregnancy Complicated by Insulin-Dependent Diabetes Mellitus
Authors: Small Michael , Cameron Alan , Lunan C Burnett , MacCuish Angus C
Published: March 2007

We assessed the factors influencing the birth weight of infants born to 83 women with insulin-dependent diabetes mellitus (IDDM) over a 5-yr period. Maternal glycosylated hemoglobin (HbA1) concentrations at delivery correlated with the percentile birth-weight ratios (r = .43, P < .001) and indicated that ∼18% of variance in the birth weight could be ascribed to glycemic control in the third trimester. Fetal macrosomia occurred in 22 (27%) pregnancies. When 20 of these pregnancies were compared closely with 20 nonmacrosomic pregnancies in diabetic women, the mothers of macrosomic infants were found to be more obese, have a history of previous macrosomic birth, and have higher concentrations of serum human placental lactogen and urinary estriols in the third trimester. Macrosomic pregnancy was further distinguished by accelerated fetal growth (judged by serial ultrasonography) from the 32nd wk of gestation and by biochemical (but asymptomatic) hypoglycemia in the neonate. In our study, no serious neonatal morbidity could be attributed to macrosomic pregnancy. Good glycemic control was attained in both groups, and no significant differences between the groups in overall glycemic control throughout pregnancy were noted. Thus, despite good glycemic control, macrosomia remains comparatively common in modern pregnancy complicated by IDDM, and factors other than maternal hyperglycemia must contribute to its etiology.
Is Aspirin Usage Associated With Diabetic Retinopathy?
Authors: Klein Barbara E K , Klein Ronald , Moss Scot E
Published: March 2007

The relationship between the history of aspirin usage and diabetic retinopathy is examined in this report. The study population consists of a sample of people (n = 1370) who developed diabetes mellitus after 30 yr of age, who lived in south-central Wisconsin, and who participated in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. These participants were questioned about recent and past use of aspirin. There was no association between the number of aspirin used in the month before the exam and the severity of diabetic retinopathy. Three hundred thirty-eight of these individuals reported taking aspirin daily for at least 3 mo since they were diagnosed as having diabetes. There was no association between the severity of retinopathy and having used aspirin in this way. These analyses suggest that aspirin usage, as herein described, is unrelated to the severity of diabetic retinopathy in older-onset diabetic patients.
New Management Concepts for Timely Diagnosis of Diabetic Retinopathy Treatable by Photocoagulation
Authors: Klein Ronald , Moss Scot E , Klein B E K
Published: March 2007

Diabetic retinopathy is a leading cause of blindness in the United States. Photocoagulation has been shown to reduce visual loss from macular edema and proliferative retinopathy. Because serious diabetic retinopathy may be asymptomatic and its detection difficult, several recommendations have been made by the National Diabetes Advisory Board for routine ophthalmologic examinations to ensure timely treatment. In geographic areas devoid of ophthalmologists, alternate approaches are necessary. These include intensive training of primary-care physicians in ophthalmoscopy, use of objective recording of retinopathy by fundus photography with interpretation of fundus photographs by retinal specialists, and better communication between primary-care physicians and retinal specialists.
Hypoglycemic Symptoms and Decreased β-Adrenergic Sensitivity in Insulin-Dependent Diabetic Patients
Authors: Berlin Ivan , Grimaldi André , Payan Christine , Sachon Claude , Bosquet Frédérique , Thervet Francis , Puech Alain J
Published: March 2007

Thirty-seven insulin-dependent diabetic patients were tested for symptoms of hypoglycemia, cardiac autonomic neuropathy (i.e., heart rate variation during deep breathing, Valsalva maneuver, immediate heart rate response to standing), and isoproterenol sensitivity (defined as the dose of isoproterenol required to increase heart rate by 25 beats/min: I25). Tests of cardiac autonomic neuropathy showed no relation to hypoglycemic symptoms. On the contrary, a clear relationship could be established between isoproterenol sensitivity and adrenergic symptoms of hypoglycemia. Diabetic patients with decreased response to isoproterenol had fewer adrenergic symptoms, perceived hypoglycemia at a lower blood glucose level, and had more hypoglycemic accidents. Symptoms most related to isoproterenol sensitivity were tremor, sweaty palms, and hunger. With the isoproterenol-sensitivity test a distinction could be made between the groups at high (I25 > 3 μg) and low (I25 < 3 μg) risk for hypoglycemic accidents. We suggest that the isoproterenol-sensitivity test could be used to identify diabetic patients at increased risk for hypoglycemia.
Absorption Characteristic of Breakfast Determines Insulin Sensitivity and Carbohydrate Tolerance for Lunch
Authors: Nestler John E , Barlascini Cornelius O , Clore John N , Blackard William G
Published: March 2007

To test the hypothesis that prolonging absorption of breakfast might improve the glucose tolerance of the subsequent meal served at lunch, normal male volunteers were administered the same carbohydrate in either a rapidly absorbed (sucrose, S) or slowly absorbed (sucrose with guar, S + G) form for breakfast (0800) and lunch (1145). Area under the curve (AUC) for glucose did not differ for S at breakfast vs. S + G at breakfast, although AUCinsulin for S at breakfast was greater than that for S + G at breakfast (3389 ± 608 vs. 1523 ± 246 μU · min · ml−1, P < .002). Plasma glucose and insulin profiles for the two breakfast meals differed markedly. Once S was ingested, plasma glucose and insulin returned to baseline after 120 and 160 min, respectively. However, once S + G was ingested, plasma glucose and insulin were still significantly above baseline values after 180 min. When S was eaten for breakfast, AUCgiucose for lunch was similar to that for breakfast, regardless of whether lunch consisted of S or S + G. However, if S + G was eaten for breakfast, AUCglucose for S + G or S at lunch was 44% (P < .005) and 75% of that for breakfast, respectively. Only one of five subjects who ingested S + G for breakfast failed to exhibit a fall in AUCglucose when S was eaten for lunch. The beneficial effect of prolonged absorption of breakfast on the glucose tolerance of lunch was not observed if the timing of lunch was delayed by 2 h (i.e., served at 1345). These observations suggest that in normal humans, prolonged absorption of breakfast results in prolonged elevation of plasma insulin levels and enhanced insulin sensitivity at lunch, thereby improving carbohydrate tolerance for lunch.
Method for Estimating Confidence Levels for Measurements by Blood Glucose Monitoring Systems
Authors: Kelly Thomas M , Jensen Robert L , Robinson M Kay
Published: March 2007

A joint conference on self-monitoring of blood glucose (SMBG) has proposed that all glucose monitoring systems generate values that are within 10% of the actual blood glucose level 100% of the time. To estimate the confidence limits of blood glucose measurements made in a typical university ambulatory care setting and to ascertain whether they met the proposed standard, we performed duplicate determinations of blood glucose using a reflectance meter and applied to the measurements a method for calculating the closeness of measured values to a “true” mean. Based on paired measurements in 100 consecutive diabetic subjects, we were able to show that one measurement would be within 11.9% of a true mean value 95% of the time and within 8.4% of the mean 90% of the time. The 95 and 90% confidence limits for the average of two repeated measurements were calculated to be 8.4 and 5.9%, respectively. Our methodology can be applied to any set of SMBG values to calculate their confidence limits and to determine whether the measurements meet recommended standards.
Pediatric, Adolescent, and Young-Adult Nutrition Issues in IDDM
Authors: Brink Stuart J
Published: March 2007

Although insulin is life sustaining for patients with insulin-dependent diabetes mellitus (IDDM), the meal plan is of critical importance for avoiding hyperglycemia, preventing hypoglycemia, and maintaining metabolic balance. Consistency, timing, composition, and caloric content of food intake and physical activity, age, sex, growth, and pubertal status alter meal-plan needs. Self-monitoring of blood glucose should be used to individualize the meal plan. The general American Diabetes Association recommendations suggest that 50–65% of total calories be from carbohydrates from foods with a lower glycemic index and/or high fiber content. Protein should contribute 12–20% of total calories and fat <30%, with <10% saturated fat and <300 mg/day cholesterol. More severe fat restriction should be considered in individuals with persistent lipid abnormalities when compared with sex- and ageadjusted values. Calories should be sufficient for growth and development, with growth data obtained several times a year and plotted on standardized weight, height, and velocity charts. Blood pressure should be similarly plotted on age- and sex-standardized curves. All meal plans should be individualized, but certain circumstances require special attention in IDDM patients: 1) lack of minerals or vitamins in a youngster who is a picky eater; 2) eating disorders (i.e., obesity, bulimia, anorexia nervosa); 3) specific gastrointestinal diseases (i.e., Crohn's disease, celiac disease, giardiasis, or IgA deficiency); 4) low iron stores because of associated achlorhydria and positive gastroparietal antibodies; 5) alternative sweeteners, especially in pregnant women and very young children; 6) mineral balance changes that may occur with increased soluble fiber intake and episodes of hyperglycemia with or without ketosis/ketoacidosis; 7) changes in physical activity that require nutritional counterbalancing; and 8) intensified insulin therapy (including multidose insulin and continuous subcutaneous insulin infusion) associated with more frequent hypoglycemia and increased risk of obesity—both conditions potentially amenable to appropriate nutrition counseling.
Response to Single Dose of Aspartame or Saccharin by NIDDM Patients
Authors: Horwitz David L , McLane Michael , Kobe Peter
Published: March 2007

Twelve normal subjects and 10 subjects with non-insulin-dependent diabetes mellitus were given, in random order at intervals of ≥ 1 wk, three drinks of the same beverage: one unsweetened, one sweetened with 400 mg aspartame, and one sweetened with 135 mg saccharin. The amount of sweetener approximated that in 1 L of sugar-free soft drink. Plasma glucose, insulin, and glucagon were measured for 3 h after ingestion of the test beverage. Plasma glucose declined slightly throughout the test period, probably due to fasting, with no differences between the three treatments. Neither sweetener affected peak insulin levels in subjects with or without diabetes. Analysis of area under the curve showed that mean insulin levels were statistically significantly higher after aspartame than after saccharin or unsweetened beverage in normal subjects only, but the magnitude of the difference was small and unlikely to be of physiological importance in the absence of differences in glucose levels. Furthermore, the differences could largely be accounted for by a decrease in insulin values after both unsweetened beverage and saccharin, with no change from baseline after aspartame. Glucagon levels showed time-to-time variation but no overall differences. We conclude that ingestion of aspartame- or saccharin-sweetened beverages by fasting subjects, with or without diabetes, did not affect blood glucose homeostasis.
Prevalence of Gestational Diabetes and Macrosomic Newborns in a Mexican Population
Authors: Forsbach Gerardo , Contreras-Soto Jesús J , Fong Gerardo , Flores Guillermo , Moreno Obdulia
Published: March 2007

Prevalence of gestational diabetes was investigated in 693 pregnant patients between the 24th and 28th wk of gestation. A glucose screening test (GST) was performed with a 50-g glucose load, followed by a blood sample 1 h later. Patients with glucose levels >140 mg/dl 1 h after the GST were scheduled for a full oral glucose tolerance test (OGTT). One hundred seven patients had an abnormal GST, and 30 patients (4.3%) were diagnosed as having gestational diabetes mellitus (GDM). The percentage of GDM increased significantly when glucose levels were >180 mg/dl to a maximum of 84.61% when glucose levels were >200 mg/dl. Also, patient age was directly related to GDM, which increased in incidence to 20% when patients >26 yr had an abnormal GST. After delivery, newborn weights were compared between those born to mothers with GDM (n = 30) and those born to mothers with an abnormal GST (n = 77). Patients with an abnormal GST and normal OGTT had 12 (15.58%) macrosomic and 2 premature newborns. However, patients with GDM had 5 (16.66%) macrosomic and no premature newborns. Patients with a normal GST had 7.33% of the macrosomic newborns. There was no perinatal mortality in newborns of GDM mothers; only 1 of the 5 macrosomic newborns presented transient hypoglycemia. Evaluation of 26 GDM patients was possible after delivery, disclosing 3 (11.53%) with non-insulin-dependent diabetes mellitus and 5 (19.23%) with impaired glucose tolerance. These results showed 4.3% undetected GDM in our population and no differences in the proportion of macrosomic newborns between those born to mothers with GDM and those born to mothers with an abnormal GST.
Measurement of Pulse Reappearance Time in Diagnosis of Peripheral Vascular Disease in Diabetes
Authors: Vogelberg Karl H , Stork Wolfgang
Published: March 2007

Forty-eight patients (20 diabetic, 28 nondiabetic) with angiographically confirmed peripheral vascular disease (PVD) were examined to discover whether the measurement of pulse reappearance time (PRT) during reactive hyperemia is a more useful method than the measurement of peripheral systolic blood pressure (ankle pressure index; API) for making a specific diagnosis of PVD. Specific diagnosis refers to the degree and localization of occlusive atherosclerosis determined by Doppler ultrasound techniques for both measurements. We found that PRT and API both provided accurate qualitative proof of a peripheral blood flow deficit in diabetic and nondiabetic subjects. However, in relation to the angiographically defined degree and localization of sclerotic lesions, there were significant differences. The sclerotic degree of occlusive PVD in diabetic subjects was correlated with the results of the PRT (P < .001), whereas the API was not (P > .05). The occlusion localization could only be distinguished by PRT measurements in both diabetic and nondiabetic subjects. Compared with control subjects (4.1 s) the half-maximum PRT of blood flow velocity was delayed in stenotic PVD to 5.7 s, in occlusive PVD of the upper leg to 14.3 s, in occlusive PVD of the lower leg to 29.6 s, and in multilevel disease to 45.0 s (P < .0005 vs. control). The results show that Doppler sonographic measurement of the peripheral systolic blood pressure is only useful for an overall diagnosis of PVD in diabetic subjects, whereas PRT measurement, by quantifying the degree and localization of sclerotic lesions, can be used additionally either to confirm or to specify this diagnosis.
Gestational Diabetes May Represent Discovery of Preexisting Glucose Intolerance
Authors: Harris Maureen I
Published: March 2007

A representative sample of 817 American women aged 20–44 yr who were not pregnant and had no medical history of diabetes were given 75-g 2-h oral glucose tolerance tests (OGTTs). Although these conditions are somewhat different from those recommended for pregnant women (100 g glucose, 3-h OGTT), 3.8% of the women might have been considered to have met O'Sullivan and Mahan criteria for gestational diabetes mellitus (GDM) had they been pregnant. Prevalence was 2–3% below age 35 yr, similar to that found in studies of pregnant women, and rose to 8% at age 40–44 yr. Rates of women meeting World Health Organization criteria for gestational impaired glucose tolerance (G-IGT) rose steadily from 5% at age 20–24 yr to 11% at age 40–44 yr. Risk factors for non-insulin-dependent diabetes mellitus (NIDDM) including parental history and obesity were more prevalent among women meeting these criteria than among women in the entire group; the same risk factors are also more prevalent among pregnant women with GDM. The similarity of rates in this study to rates of GDM and G-IGT, together with their association with risk factors for NIDDM, indicate that these entities are compatible with undiagnosed glucose intolerance occurring before pregnancy and discovered during the metabolic testing that generally accompanies prenatal care rather than conditions that have an etiologic relationship to pregnancy.
Salivary Insulin in Normal and Type I Diabetic Subjects
Authors: Pasic Jagoda , Pickup John C
Published: March 2007

We studied the relationship of salivary insulin to serum insulin concentrations in normal subjects and type I (insulin-dependent) diabetic patients to test the hypothesis that salivary insulin might be a simple measure of insulinemia in diabetes. In 8 nondiabetic subjects, salivary insulin levels increased after an oral glucose load but with a delay in peak concentrations of ∼45 min in comparison with serum insulin levels. There was a significant correlation (r = .810, P < .01) between mean serum insulin and the salivary insulin 30 min later. In 12 type I diabetic patients, day profiles of saliva and serum insulin were obtained during usual insulin treatment, diet, and physical activity. In serum, the mean (±SE) percentage of bound insulin was 58.8 ± 5.2%, and in saliva it was 45 ± 3.5%. The mean ratio of salivary to serum free insulin throughout the day cwas 1:1.6. Although there was a significant correlation (r = .913, P < .001) between mean serum free insulin for all patients and the corresponding mean free salivary insulin, several individual profiles showed marked discrepancies between the timing and magnitude of insulin changes in the two compartments. We would not, therefore, recommend salivary insulin concentrations as a reliable index of insulinemia in individuals with type I diabetes.
Improvement of Glucose Tolerance in NIDDM by Clofibrate Randomized Double-Blind Study
Authors: Kobayashi Masashi , Shigeta Yukio , Hirata Yukimasa , Omori Yasue , Sakamoto Nobuo , Nambu Seiki , Baba Shigeaki
Published: March 2007

A randomized double-blind study was performed to examine the effect of clofibrate on glucose tolerance in subjects with non-insulin-dependent diabetes mellitus (NIDDM). Clofibrate (1.5 g/day) or placebo was administered to 70 patients and an oral glucose tolerance test (OGTT) was performed before and 12 wk after treatment. Blood glucose levels were significantly improved in clofibrate-treated groups at all time points during OGTT, whereas there was no change in insulin levels. Improvement of fasting glucose levels required 8 wk of clofibrate treatment. Insulin binding to erythrocytes demonstrated no significant change in the clofibrate-treated subjects.A randomized double-blind study was performed to examine the effect of clofibrate on glucose tolerance in subjects with non-insulin-dependent diabetes mellitus (NIDDM). Clofibrate (1.5 g/day) or placebo was administered to 70 patients and an oral glucose tolerance test (OGTT) was performed before and 12 wk after treatment. Blood glucose levels were significantly improved in clofibrate-treated groups at all time points during OGTT, whereas there was no change in insulin levels. Improvement of fasting glucose levels required 8 wk of clofibrate treatment. Insulin binding to erythrocytes demonstrated no significant change in the clofibrate-treated subjects. These results suggest that clofibrate improves glucose tolerance in NIDDM subjects without a change in insulin receptors and that clofibrate increases insulin sensitivity through an unknown postreceptor mechanism.
Psychosocial Profiles in Patients With Visual Impairment Due to Diabetic Retinopathy
Authors: Bernbaum Marla , Albert Stewart G , Duckro Paul N
Published: March 2007

The psychological impact of vision loss due to diabetic retinopathy is compounded by the loss of diabetes self-management skills. The appropriate role and timing for rehabilitative intervention has not been determined. Twenty-nine individuals with diabetes mellitus, 16 with stable visual impairment and 13 with fluctuating and transitional visual impairment, underwent psychological assessment before and after entering into a specially designed rehabilitation program. Low levels of performance were demonstrated by the Rosenberg Self- Esteem Scale and the Diabetes Self-Reliance Test in both groups. The Minnesota Multiphasic Personality Inventory, the Zung Self-Rating Depression Scale, and the Rand Mental Health Index suggested that subjects with stable vision impairment were moderately compensated relative to the transitional group, although the former group may have been totally blind. Both groups demonstrated significant improvements in psychological profiles after the program. It is suggested that a rehabilitation program may be of clinical benefit early in the course of vision loss associated with diabetic retinopathy.
Depression in Adults With Diabetes: Results of 5-yr Follow-Up Study
Authors: Lustman Patrick J , Griffith Linda S , Clouse Ray E
Published: March 2007

Little is known about the course of affective illnesses in patients with diabetes or in other physically ill patients. We report a follow-up study of 37 diabetic adults with major depression (according to DSM-III), 28 (76%) of whom were located and reinterviewed 5 yr after the index evaluations. At follow-up, 18 (64%) of the 28 depressed patients had experienced an episode of major depression within the previous 12 mo; 12 of these patients satisfied diagnostic criteria for depression at the time of reevaluation. The 18 patients with recurrent depression had a mean of 4.2 depressive episodes over the 5-yr period. An additional 4 patients met criteria for current dysthymic disorder, bringing the number to 22 (79%) of the total patients ill with affective disorder during the 5-yr follow-up period. In contrast, the likelihood of symptomatic affective disorder was only 10% over the same follow-up period in a comparison group of diabetic subjects without depression at the index evaluation (P < .001). Occurrence of depressive episodes appeared independent of diabetes complications because both the depressed and comparison groups had similar rates of neuropathy, retinopathy, and nephropathy. These data suggest that the natural course of depression in diabetes is malevolent, possibly more so than depression in the medically well.
New Approach to Technical and Clinical Evaluation of Devices for Self-Monitoring of Blood Glucose
Authors: Koschinsky Theodor , Dannehl Karsten , Gries F Arnold
Published: March 2007

Despite the wide distribution of devices for selfmonitoring of blood glucose (SMBG), there is no internationally accepted agreement on a standardized procedure for their evaluation. This is due to incomplete or even inappropriate technical evaluation and to inadequate evaluation criteria for their clinical acceptability. To provide adequate information on the performance of these devices over the whole clinically relevant range for SMBG (30-350 mg/dl), a standardized test procedure has been established for technical (accuracy, precision, and total deviation) and clinical (acceptance analysis) evaluation. To demonstrate the potency of this new approach, the following SMBG devices and test strips were evaluated: Chemstrip bG batch (n = 10), Glucostix batch (n = 2), Accu-Check II (n = 5), Diascan (n = 5), Diascan strip batch (n = 4), Glucocheck SC (n = 4), and Glucometer II (n = 4). The devices and test strips were examined by trained technicians, and in addition, 1 Chemstrip bG batch and 2 Accu-Check II meters were examined by 10 and 5 trained diabetic patients, respectively. Even the best-performing device did not achieve the American Diabetes Association's goal that SMBG measurements should be within 15% of the reference value. Instead, the maximal total deviation within the clinically relevant blood glucose range reached values that equalled deviations from the reference value between 16 and 108%. Three of 36 devices were classified as good, 29 as acceptable, and 4 as unacceptable for clinical use. In conclusion, this new approach to the technical and clinical evaluation of devices for SMBG is easy to perform and provides more realistic and comparable information for clinical use and approval than commonly used methods.
Prevalence of Asymptomatic Bacteriuria in Subjects with NIDDM in San Luis Valley of Colorado
Authors: Keane Ellen M , Boyko Edward J , Reller L Barth , Hamman Richard F
Published: March 2007

This study examined whether non-insulin-dependent diabetic (NIDDM) subjects have an increased prevalence of asymptomatic bacteriuria compared with subjects with normal glucose tolerance. Diabetic (n = 206) and normal (n = 418) subjects were identified from a defined geographic area in the San Luis Valley of southern Colorado. Presence of asymptomatic bacteriuria was determined by testing the subjects' urine with a reagent-strip test for nitrite and leukocyte esterase (Chemstrip LN). The ability of the Chemstrip LN to detect bacteriuria was evaluated by comparing its results with those from urine culture on a subsample of subjects. There were 7 control and 12 diabetic subjects with bacteriuria as measured by the Chemstrip LN. The prevalence of urinary tract colonization among diabetic compared with control subjects was increased 3.5-fold (95% confidence interval 1.4–8.6). Adjustment for confounding by age, sex, ethnicity, and county of residence resulted in an adjusted prevalence ratio of 4.4 (95% confidence interval 1.1–17.4). Among diabetic subjects, prevalence of bacteriuria increased with longer disease duration but was not affected by measures of glucose control. We conclude that NIDDM increases the prevalence of bacterial colonization of the urine and, therefore, probably also increases the risk of symptomatic urinary tract infection.
Reliability and Validity of a Diabetes Quality-of-Life Measure for the Diabetes Control and Complications Trial (DCCT)
Authors:   The DCCT Research Group
Published: March 2007

We have developed a diabetes quality-of-life (DQOL) measure oriented toward the patient with insulin-dependent diabetes mellitus (IDDM). The DQOL was assessed for its reliability and validity in a group of patients with IDDM (n = 192). We found that the DQOL and its four scales had high degrees of internal consistency (Cronbach's r = .66−.92) and excellent test-retest reliability (r = .78−.92). Using conceptually relevant measures of psychiatric symptoms, perceived well-being and adjustment to illness, we also demonstrated convergent validity of the DQOL. This instrument was initially designed for use in the Diabetes Control and Complications Trial, a multicenter controlled clinical trial evaluating the effects of two different diabetes treatment regimens on the appearance and progression of early vascular complications. However, the DQOL may also be useful in evaluating the quality of life in other groups of patients with IDDM.
Aspartame Metabolism in Normal Adults, Phenylketonuric Heterozygotes, and Diabetic Subjects
Authors: Filer L J , Stegink Lewis D
Published: March 2007

This study reviews clinical studies testing the effects of various doses of aspartame on blood levels of phenylalanine, aspartate, and methanol in normal subjects and known phenylketonuric heterozygotes. The effect of aspartame on the phenylalanine-to-large neutral amino acid ratio under various feeding situations is shown. The clinical studies of aspartame in diabetic subjects are limited to observations of its effects on blood levels of glucose, lipids, insulin, and glucagon. These studies clearly demonstrate the safety of this high-intensity sweetener for use by humans.
Contribution of Diabetes Duration Before Puberty to Development of Microvascular Complications in IDDM Subjects
Authors: Kostraba Jill Norris , Dorman Janice S , Orchard Trevor J , Becker Dorothy J , Ohki Yukashi , Ellis Demetrius , Doft Bernard H , Lobes Louis A , LaPorte Ronald E , Drash Allan L
Published: March 2007

The contribution of diabetes duration, both pre- and postpuberty, to the development of microvascular complications and mortality in diabetic subjects was investigated in three study populations from the Children's Hospital of Pittsburgh Insulin-Dependent Diabetes Mellitus (IDDM) Registry. Life-table analyses by total and postpubertal IDDM duration were used to evaluate differences in the prevalence of microvascular complications and diabetes-related mortality in subjects diagnosed before and during puberty, as defined by an age at IDDM onset marker of 11 yr for girls and 12 yr for boys. The prevalence of retinopathy and overt nephropathy in 552 White adult diabetic subjects (population 1, mean IDDM duration 20.8 yr) was significantly greater in subjects diagnosed during puberty compared with those diagnosed before puberty. However, similar analyses by postpubertal duration showed no difference in microvascular complication prevalence between the two groups. These findings did not appear to be due to a confounding effect of age. Additional analyses of 239 adolescent diabetic subjects (population 2, mean duration 8.3 yr) revealed the same trend for the prevalence of retinopathy. Finally, results concerning the risk of diabetes-related mortality in a cohort of 1582 subjects (population 3, mean duration 12.9 yr) indicated that postpubertal duration of IDDM may be a more accurate determinant of the development of microvascular complications and diabetes-related mortality than total duration, and it is suggested that the contribution of the prepubertal years of diabetes to long-term prognosis may be minimal.
Sperm Function and Structure and Seminal Plasma Prostanoid Concentrations in Men With IDDM
Authors: Shrivastav Pankaj , Swann John , Jeremy Jamie Y , Thompson Cecil , Shaw Robert W , Dandona Paresh
Published: March 2007

Semen from 18 men with insulin-dependent diabetes mellitus (IDDM) aged 20-40 yr was compared with that from 15 age-matched control subjects. Although semen volume, sperm count, and spermatozoal motility were similar in the two groups, semen from diabetic men had significantly greater numbers of abnormal spermatozoa and significantly lower ability to penetrate hamster eggs. Concentrations of prostaglandins E2, F2αa, and I2 and thromboxane A2 were significantly elevated in the seminal plasma from semen of diabetic subjects compared with control subjects. These observations indicate the need for a careful assessment of fertility in diabetic men, the mechanisms underlying the abnormalities in spermatozoa, and the relationship of these abnormalities to the increase in prostanoid concentrations in diabetic men.
Renal Papillary Necrosis in Patients With IDDM
Authors: Groop Leif , Laasonen Leena , Edgren Johan
Published: March 2007

Although diabetes mellitus is reported in 29% of patients with renal papillary necrosis (RPN), the frequency of RPN among patients with insulin-dependent diabetes mellitus (IDDM) has from autopsy studies been estimated to be only 4.4%. In vivo data on the prevalence of RPN in patients with IDDM have been lacking. We therefore studied the prevalence of RPN in 76 patients with long-standing IDDM and in 34 age-matched control subjects by intravenous urography. None of the control subjects showed radiographic signs of papillary necrosis. RPN was observed in 18 patients (23.7%); 15 were women (83.3%). Age and duration of diabetes was not different between patients with and without papillary necrosis, and there was no significant difference between the two groups regarding the prevalence of microangiopathic complications, i.e., proliferative retinopathy and diabetic nephropathy. Microscopic hematuria was three times more frequent in patients with than without RPN (44 vs. 16% P < .02). In addition, pyuria was reported in 40% of patients with papillary necrosis, and 61% of them gave a positive history of urinary tract infection compared to 16% (P < 05) and 32% (P < .02), respectively, in patients without papillary necrosis. It is concluded that RPN is a more frequent complication of long-standing IDDM than appreciated from autopsy studies, and being female and having a history of urinary tract infection are associated with an increased risk of RPN.
Motor Vehicles, Hypoglycemia, and Diabetic Drivers
Authors: Ratner Robert E , Whitehouse Fred W
Published: March 2007

Individuals with diabetes are increasingly persuing employment in fields previously restricted as a result of the development of chronic complications. Improved glycemic control resulting from use of sophisticated insulin delivery and monitoring systems has also led to the recognition of recurrent hypoglycemia as a potential major clinical and occupational hazard. No data concerning the occupational safety of individuals with insulin-treated diabetes mellitus (ITDM) are available. We review the literature on diabetic drivers in an effort to examine the impact of certification of ITDMs as commercial drivers. In the absence of significant worldwide experience with ITDMs as commercial drivers, the discussion is necessarily based on projected accident rates derived from data on frequency of hypoglycemia. These studies are universally flawed by variable definitions of hypoglycemia, ascertainment bias, and patient selection. They do, however, provide a worst-case/best-case scenario for discussion. It is imperative that any expansion of employment opportunities for ITDMs be followed carefully with prospective studies to assess the impact on public safety.
Fenfluramine Increases Insulin Action in Patients With NIDDM
Authors: Pestell Richard G , Crock Patricia A , Ward Glenn M , Alford Frank P , Best James D
Published: March 2007

These studies examined the effect of fenfluramine on insulin action and insulin secretion in healthy subjects and patients with non-insulin-dependent diabetes mellitus (NIDDM). In the first study, a double-blind crossover design was used in healthy subjects to compare the effect of short-term fenfluramine therapy (60 mg orally for 3 days) with placebo. Insulin secretion and whole-body insulin sensitivity (determined by frequently sampled intravenous glucose tolerance tests with analysis by the minimal-model method) were unchanged by fenfluramine. In the second study, involving patients with NIDDM inadequately controlled on submaximal to maximal doses of oral hypoglycemic agents, a double-blind crossover strategy was used to compare baseline studies (conducted after a run-in period) with fenfluramine (60 mg orally) or placebo for 4 wk. There was a signficant fall in fasting blood glucose after therapy with fenfluramine compared with the baseline study period (13.0 ± 1.2 vs. 8.4 ± 0.89 mM, mean ± SE, P < .01) with no significant fall in fasting serum insulin (20± 2 vs. 24 ± 3 (μU/ml) or C-peptide (1.3 ± 0.2 vs. 1.3 ± 0.1 nM). During euglycemichyperinsulinemic (1 mU · kg−1 · min−1) clamp studies there was a significant increase in insulin action from 12.7± 2.3 to 17.3 ± 1.8 min−1 103 μU · ml1 (P < .05), although clamp insulin levels were lower after fenfluramine treatment (136 ± 14 vs. 96 ± 9 μU/ml−1, P < .02), reflecting an enhanced metabolic clearance rate for insulin (12.7 ± 1.5 vs. 20.1 ± 2.1 ml · kg−1 · min−1 P < .025). When insulin action was normalized for the prevailing insulin level during the clamp, the increase of insulin action/in concentration was more marked (0.11 ± 0.22 to 0.22 ±0.04 min−1 103μU · ml−1 <.005). The insulin secretory response to arginine was unchanged from 21 ± 4 to 22 ± 6 μU/ml at similar levels of glycemia. Chronic fenfluramine therapy can lower fasting plasma glucose and increase insulin sensitivity without affecting insulin secretion in patients with NIDDM. Acute fenfluramine treatment in healthy individuals has no effect on glucose metabolism. We conclude that in patients with inadequately controlled NIDDM, fenfluramine may serve as a useful adjunct to sulfonylurea therapy.
Diabetes in American Indians of Washington, Oregon, and Idaho
Authors: Freeman William L , Hosey Gwendolyn M , Diehr Paula , Gohdes Dorothy
Published: March 2007

The prevalence of diabetes among 29,000 American Indians living on or near 10 reservations in the Pacific Northwest was established from clinical data sources. The age- and sex-adjusted prevalence rate in 1987 was three times higher [95% confidence interval (Cl) 2.8–3.1] than the comparable United States rate in 1980. The ageadjusted prevalence for women was 1.3 times that for men (95% Cl 1.2–1.4). The prevalence varied by culture area. Reservation communities whose principal tribe came from the Great Basin culture area had 3.6 times more diabetes than found in the U. S. as a whole. Reservation communities whose principal tribe was from the Plateau culture had 3.0 times more diabetes than found in the U. S., and those from the Northwest Coast culture had 1.9 times more diabetes than found in the U. S. The reasons for these variations are unknown and warrant investigation.
Hyperglycemic Effect of Sucrose Ingestion in IDDM Patients Controlled by Artificial Pancreas
Authors: Forlani Gabriele , Galuppi Valeria , Santacroce Giovanna , Braione Antonia F , Giangiulio Silvio , Ciavarella Adolfo , Vannini Pietro
Published: March 2007

The hyperglycemic effect of 28 g sucrose, taken during a mixed meal, was studied in six insulin-dependent diabetes mellitus (IDDM) patients controlled by artificial pancreas. On 2 consecutive days the patients were given, in random order, two Italian meals containing macaroni, bread, meat, vegetables, fruit, olive oil, and an eggnog made with sucrose (meal A) or saccharin (meal B). The two meals were isocaloric and contained equal amounts of carbohydrates. The feedback control on blood glucose continued for 180 min after the meals. Plasma glucose levels and insulin infusion rates delivered by the artificial pancreas after the two test meals did not show any significant differences regarding basal and peak values, peak times, and areas under the curves. A modest amount of sucrose, taken during a mixed meal, does not produce a hyperglycemic effect higher than an equal amount of complex carbohydrates in IDDM patients controlled by artificial pancreas. The same may be expected in well-controlled IDDM patients in conventional therapy because a correlation exists between insulin requirement for conventional therapy and insulin delivered during glucose-controlled insulin infusion.
Accuracy of Nurses in Performing Capillary Blood Glucose Monitoring
Authors: Lawrence Patricia A , Dowe Mary C , Perry Elizabeth K , Strong Susan , Samsa Gregory P
Published: March 2007

The accuracy and outcome of capillary blood glucose (CBG) monitoring as routinely performed by nursing staff were assessed. The sample consisted of 160 readings conducted by 93 nursing staff members in four hospitals; 19% of the readings deviated from simultaneous laboratory results by >20%, and deviations resulted in altered responses to standing orders in 26 patients (17%). There was no statistically significant difference between the total variation attributed within and between nurses, possibly indicating that all nurses should be given the same intensity of follow-up training rather than targeting those who perform incorrectly on 298 DIABETES CARE, VOL. 12, NO. 4, APRIL 1989 SHORT REPORTS sample tests. Nurses in the one hospital that required certification before CBG monitoring had significantly less deviation from the laboratory standard than the other three hospitals. Although these data do not provide direct evidence that the certification program increased accuracy, this seems a logical conclusion. More study is needed to determine the most costeffective type of training and follow-up.
Prevalence of IDDM in Schoolchildren in Khartoum, Sudan
Authors: Elamin Abdelaziz , Omer Mohamed IA , Hofvander Yngve , Tuvemo Torsten
Published: March 2007

The prevalence of insulin-dependent diabetes mellitus (IDDM) in 42,981 schoolchildren (aged 7–14 yr) in Khartoum, Sudan, was determined. With the 1985 World Health Organization revised criteria for diagnosis and classification of diabetes mellitus, the overall crude prevalence rate of IDDM was 0.95/1000 in the age groups studied. This figure is thought to reflect the minimum prevalence of IDDM in that population, because there is an inherent tendency in the method of screening used toward underestimating the true prevalence rate. The prevalence of IDDM was found to increase significantly with age and was slightly higher in girls than boys, but this was not statistically significant. Of 41 children with IDDM detected in the survey, 7 were not known to have IDDM before but were showing suggestive symptoms at the time of the study. This study showed that IDDM in childhood is not rare in Sudan and that probably a substantial number of undiagnosed cases exist.
Proteinuria in Mexican Americans and Non-Hispanic Whites With NIDDM
Authors: Haffner Steven M , Mitchell Braxton D , Pugh Jacqueline A , Stern Michael P , Kozlowski M Katherine , Hazuda Helen P , Patterson Judith K , Klein Ronald
Published: March 2007

Mexican Americans have a threefold greater prevalence of non-insulin-dependent diabetes mellitus (NIDDM) than non-Hispanic Whites as found in the San Antonio Heart Study, a population-based study of diabetes and cardiovascular disease. In addition, Mexican-American d a etic subjects have higher levels of glycemia than non-Hispanic White diabetic subjects. We therefore hypothesized that the prevalence of clinical proteinuria would be greater among Mexican-American diabetic subjects (n = 317) than among non-Hispanic White diabetic subjects (n = 67). Clinical proteinuria, defined as ≥1 + on the Ames Albustix test, was 2.82 times more prevalent in Mexican-American diabetic subjects compared with non-Hispanic White diabetic subjects adjusting for age and duration (95% confidence interval [Cl] = 1.05, 7.55; P = .039). After controlling for other possible confounding variables (i.e., glycemia, systolic b ood pressure, smoking, and insulin use), the excess of proteinuria in Mexican-American diabetic subjects was only slightly attenuated, although the statistical significance became borderline (odds ratio [OR] = 2.59, 95% Cl = 0.91, 7.32; P = .072). The prevalence of microalbuminuria (>30 mg/L) was also significantly higher in Mexican-American diabetic subjects than in non-Hispanic White diabetic subjects (OR = 3.54, 95% Cl = 1.28, 9.81; P = .015). We also compared previously diagnosed Mexican-American diabetic subjects (n = 243) from San Antonio with previously diagnosed non-Hispanic White diabetic subjects in Wisconsin (n = 476). After controlling for age and duration of diabetes, Mexican-American diabetic subjects had a significantly higher prevalence of clinical proteinuria than the Wisconsin diabetic subjects (Mantel-Haenszel OR = 1.58, 95% Cl = 1.05, 2.40; P = .017). Our data indicate that Mexican-American diabetic ubjects have a higher prevalence of clinical proteinuria and microalbuminuria than non-Hispanic White diabetic subjects.