bluuebunny/crossref_metadata_2025 huggingface dataset:
Prior feeding Alters the Response to the 50-g Glucose Challenge Test in Pregnancy: The Staub-Traugott Effect revisited
Authors: Lewis Gary F , McNally Colleen , Blackman John D , Polonsky Kenneth S , Barron William M
Published: March 2007

OBJECTIVE

To examine the effect of prior meal ingestion on the glucose, insulin, and C-peptide response to a 50-g glucose challenge test in the third trimester of pregnancy.

RESEARCH DESIGN AND METHODS

Ten pregnant women with gestational diabetes mellitus and 12 nondiabetic pregnant control subjects matched for age and weight underwent a 50-g glucose challenge test on three occasions within a 2-wk period, in random order. On one occasion the test was administered in the fasting state (fasting glucose challenge test), on a second occasion the test was administered 1 h after ingestion of a standard mixed meal (1-h postprandial study), and on a third occasion the test was administered 2 h after ingestion of a standard mixed meal (2-h postprandial study).

RESULTS

In the control subjects, the plasma glucose level 1 h after ingestion of 50 g of glucose was higher in the fasting study (7.8 ±0.4 mM, 7 of 12 subjects with glucose ≥7.8 mM) than in the 1-h postprandial study (6.7 ± 0.3 mM, 3 of 12 subjects with glucose ≥7.8 mM) and the 2-h postprandial study (6.3 ± 0.4 mM, 3 of 12 with glucose ≥7.8 mM) (P < 0.01). In the postprandial studies of control subjects, insulin and C-peptide levels were higher at the time of ingestion of the 50 g of glucose, but the early (1 h) insulin secretory response was less than in the fasting study. In the diabetic patients, glucose levels 1 h after 50-g glucose ingestion were similar in the fasting study (10.5 ± 0.4 mM, no subjects with glucose value <7.8 mM) and the 1-h postprandial study (11.0 ± 0.6 mM, 1 subject with glucose <7.8 mM), but was lower in the 2-h postprandial study (9.3 ± 0.3 mM, 1 subject with glucose <7.8 mM) (P < 0.03). In contrast to the control subjects, the insulin secretory response to 50 g of oral glucose was greater in the two postprandial studies than in the fasting study.

CONCLUSIONS

We have reached the following conclusions. 1) In nondiabetic gravidas, plasma glucose concentrations 1 h after ingestion of a 50-g oral glucose load are higher if administered in the fasting state compared with the postprandial state. 2) During normal pregnancy the Staub-Traugott Effect, i.e., improved glucose disposal after successive glucose load administrations, occurs and appears to be caused by mechanisms other than enhanced insulin secretion with successive glucose loads. 3) The effect of the prandial state on plasma glucose response to the 50-g glucose challenge test used to screen for gestational diabetes mellitus may be of sufficient magnitude to significantly alter the operating characteristics, i.e., sensitivity and specificity, of this test.
IDDM Is a Risk Factor for Adolescent Psychiatric Disorders
Authors: Blanz Bernd J , Rensch-Riemann Beatrice S , Fritz-Sigmund Doris I , Schmidt Martin H
Published: March 2007

OBJECTIVE

To determine whether the rate of psychiatric disorders increases in children and adolescents with IDDM.

RESEARCH DESIGN AND METHODS

The rate of psychiatric disorders was assessed by highly structured interviews in a group of 93 IDDM adolescents 17–19 yr of age and compared with a healthy (nondiabetic) age-, sex-, and socioeconomic status-matched control group.

RESULTS

The rate of psychiatric disorders was 33.3% in the diabetic group, more than threefold higher than in the control group (9.7%). With regard to the ratepsychiatric disorders, no sex-specific differences between the two groups were found. The diabetic adolescents suffered from significantly more introversive symptoms than their healthy counterparts, especially somatic symptoms, sleeping disturbances, compulsions, and depressive moods. In spite of the elevated rate of psychiatric disorders, the rates of life events and familial adversities did not increase in the diabetic group.

CONCLUSIONS

The results support the notion that IDDM adolescents should be seen as a high-risk group for psychiatric disorders.
Cerebral and Ophthalmic Artery Hemodynamic Responses in Diabetes Mellitus
Authors: Albert Stewart G , Gomez Camilo R , Russell Stephen , Chaitman Bernard R , Bernbaum Marla , Kong Barbara A
Published: March 2007

OBJECTIVE

To address whether hemodynamic responses in the cerebral arteries and OAs may be altered in patients with diabetic retinopathy. We used TCD to evaluate the effects of changes in BP, posture, and exercise on MCA and OA blood flow velocities.

RESEARCH DESIGN AND METHODS

We evaluated 13 patients with BDR, 19 with PDR, and 11 control subjects. Each was tested while supine, breathing 100% oxygen, sitting, and during exercise.

RESULTS

Control subjects exhibited linear increases in velocity in the MCA and OA with increases in BP. Those with BDR had higher baseline sBP than control subjects. The MCA velocity response to BP in the BDR group was parallel to, but differed significantly from, the response in control subjects in compensation for the level of BP (ANCOVA F1,53 = 10.1, P = 0.003). The OA velocity response to BP was indistinguishable between the control subjects and the group with BDR. The group with PDR had more elevated BP than control subjects, and those with BDR had more advanced autonomic neuropathy. The PDR group had heterogenous velocity responses in the MCA and OA with respect to BP. None of the control subjects and 3 of 13 of the BDR group had abnormal autoregulatory velocity responses in the MCA or OA to 100% oxygen breathing, whereas 12 of 19 PDR patients were abnormal (P < 0.01). Of those with PDR, 4 had elevated MCA and 3 had elevated OA velocities while supine at rest.

CONCLUSIONS

Patients with PDR demonstrated abnormal hemodynamic responses of the cerebral and ophthalmic circulation both at rest and with exercise.
Patients' Attitudes Toward Screening for Gestational Diabetes Mellitus in the Illawarra Area, Australia
Authors: Griffiths Rhonda D , Rodgers Dianne V , Moses Robert G
Published: March 2007

OBJECTIVE

To examine the attitudes toward screening of a group of women who have had GDM compared with a group who were screened but did not have GDM.

RESEARCH DESIGN AND METHODS

We surveyed 90 women with GDM and 100 control women with a postal questionnaire. They were asked to mark on a six-point Likert scale their responses to statements about certain aspects of screening for diabetes in pregnancy.

RESULTS

No significant differences were found in mean responses between the two groups. The method of screening was found to be convenient (GDM group, 5.02; control group, 4.77). A strong belief that all women should be screened in pregnancy (GDM group, 5.76; control group, 5.66) and a personal desire for screening in any future pregnancy (GDM group, 5.73; control group, 5.62) were expressed.

CONCLUSIONS

Both groups of women surveyed in this study were extremely positive about the convenience of the screening method used, the need for all women to be screened in pregnancy, and their desire for screening in future pregnancies.
Perceived Symptoms in the Recognition of Hypoglycemia
Authors: Cox Daniel J , Gonder-Frederick Linda , Antoun Basim , Cryer Philip E , Clarke William L
Published: March 2007

For people with diabetes, detection of hypoglycemic symptoms is a critical tool for the recognition and treatment of hypoglycemia. This is not a simple process involving only the occurrence of a hypoglycemic-relevant physiological event, such as sweating. We propose a four-step biological and psychological model that leads to the accurate recognition of hypoglycemia through symptoms. The model illustrates both the chronic and transient modifiers that can enhance and interfere with recognition of hypoglycemia. Three common methods are used to investigate the occurrence and utility of hypoglycemic symptoms that relate to this model. This article reviews the advantages and disadvantages of these methods, providing previously unpublished illustrative data. The field study hit/false alarm approach was shown to be the most useful method. The relevance of this model and data to the concept of hypoglycemic awareness/unawareness and blood glucose awareness training is discussed.
Skin Surface pH in Intertriginous Areas in NIDDM Patients: Possible Correlation to Candidal intertrigo
Authors: Yosipovitch Gil , Tur Ethel , Cohen Ohad , Rusecki Yael
Published: March 2007

OBJECTIVE

To compare skin surface pH and moisture in intertriginous areas in diabetic patients and healthy control subjects and to study the relationship between these parameters and candidal infection.

RESEARCH DESIGN AND METHODS

We measured the skin surface pH and moisture in the axillary, inframammary, inguinal, and forearm skin with a pH meter with a flat-glass electrode and skin corneometer. The subjects were 50 NIDDM patients from the diabetic outpatient clinic at Beilinson Medical Center, Petah Tiqva, Israel, and 40 healthy control subjects from hospital personnel. The main outcome measures were skin surface pH, skin moisture, and skin culture for Candida.

RESULTS

Skin pH in the inguinal and axillary regions was significantly higher in diabetic patients compared with healthy control subjects (P < 0.0001), whereas no difference was noted in the forearm. In the inframammary region, diabetic women had significantly higher pH than nondiabetic women (P < 0.01). No difference was noted in men in this region. Six patients (12%) had candidal infection in intertriginous areas.

CONCLUSIONS

Our study indicates that in intertriginous regions, skin surface pH of diabetic patients is significantly higher than in normal control subjects and implies the significance of skin pH as a possible factor promoting host susceptibility to skin candidal infection.
Development of Impaired Glucose Tolerance With or Without Weight Gain
Authors: Charles Marie A , Pettitt David J , Saad Mohammed F , Nelson Robert G , Bennett Peter H , Knowler William C
Published: March 2007

OBJECTIVE

To evaluate whether risk factors and changes in insulin concentrations differ in subjects who develop impaired glucose tolerance with or without weight gain. Hyperinsulinemia is a risk factor for impaired glucose tolerance, and insulin concentrations increase further with the development of impaired glucose tolerance. Its development, however, often is accompanied by weight gain, which, by itself, is associated with high insulin concentrations.

RESEARCH DESIGN AND METHODS

Participants for this study were adult Pima Indians involved in an ongoing epidemiological study. Initially, all had normal glucose tolerance. During follow-up, 80 of 387 who did not gain weight developed impaired glucose tolerance, as did 295 of 1026 who gained weight. Risk factors for impaired glucose tolerance and the relationships between changes in weight and glucose and changes in insulin were evaluated by multivariate analyses.

RESULTS

High baseline fasting insulin predicted impaired glucose tolerance regardless of weight after adjustment for age, sex, body mass index, and glucose. The development of impaired glucose tolerance was accompanied by a further increase in fasting and 2-h insulin, whether or not subjects gained weight. In both weight-change groups, impaired glucose tolerance was associated with more centralized fat distribution.

CONCLUSIONS

Fasting hyperinsulinemia, a reflection of insulin resistance, is associated with the risk of developing impaired glucose tolerance whether or not weight is gained. Impaired glucose tolerance occurs when insulin resistance increases further. Weight gain is the most common precipitating factor. Aging and physical inactivity are other possible precipitating factors.
Renal Function Changes in Microalbuminuric Normotensive Type II Diabetic Patients Treated With Angiotensin-Converting Enzyme Inhibitors
Authors: Romero Ramon , Salinas Isabel , Lucas Anna , Abad Elena , Reverter Jordi L , Johnston Susan , Sanmarti Anna
Published: March 2007

OBJECTIVE

To determine the effects of captopril on microalbuminuria and renal function in normotensive type II diabetic patients.

RESEARCH DESIGN AND METHODS

A total of 26 patients were randomized in two homogeneous groups for clinical and analytical data in a 6-mo follow-up study. Group A received captopril (initial dose: 12.5 mg daily, increased according to tolerance); group B was untreated.

RESULTS

Microalbuminuria decreased only in the treated group at 6 mo (P = 0.044) and a significant (P = 0.027) mean percentage change on microalbuminuria excretion between the groups was observed. Filtration fraction decreased in group A (baseline: 0.23 ± 0.03; 6 mo: 0.22 ± 0.04) and increased in group B (baseline: 0.22 ± 0.04; 6 mo: 0.25 ± 0.04) with a significant mean percentage change between the groups at 6 mo (P = 0.032). The mean percentage change in microalbuminuria was significantly correlated with a mean percentage change in diastolic blood pressure throughout the trial. Neither metabolic control nor sodium or protein intake changed in either group during the trial.

CONCLUSIONS

These results suggest that captopril can help arrest microalbuminuria in normotensive type II diabetic patients, with a decrease in diastolic blood pressure and filtration fraction after a 6-mo treatment.
Effects of Metformin on Insulin Resistance, Risk Factors for Cardiovascular Disease, and Plasminogen Activator Inhibitor in NIDDM Subjects: A study of two ethnic groups
Authors: Nagi Dinesh K , Yudkin John S
Published: March 2007

OBJECTIVE

To investigate the effects of metformin on glycemic control, insulin resistance, and risk factors for cardiovascular disease in NIDDM subjects from two ethnic groups (Caucasian and Asian) with different risks of cardiovascular disease.

RESEARCH DESIGN AND METHODS

A total of 27 subjects with NIDDM (17 Caucasian, 10 Asian) were given metformin and placebo each for a 12-wk period in a randomized, double-blind, placebo-controlled crossover study, and the dose was increased after 1 and 6 wk, up to a maximum of 850 mg three times a day. Insulin resistance, glycemic control, and cardiovascular risk factors were assessed before and after each treatment phase. The end of 12 wk of metformin treatment was compared with the end of 12 wk of placebo treatment.

RESULTS

Metformin treatment was associated with significant improvement in FPG at 6 and 12 wk (mean difference at 12 wk, −3.08 mM, 95% CI −4.12 to −2.04 mM, P < 0.0001) and MCR of glucose (median difference 0.40 ml · kg−1 · min−1, interquartile range −0.10 to 1.30 ml · kg−1 · min−1, P = 0.036). β-cell function calculated by HOMA also improved significantly (median difference 14%, interquartile range 7 to 23%, P < 0.001). Total triglyceride (median difference −0.2 mM, interquartile range −0.6 to 0.1 mM, P = 0.034), total cholesterol (mean difference −0.52 mM, 95% CI −0.83 to −0.22 mM, P = 0.002), and LDL cholesterol (mean difference −0.40 mM, 95% CI −0.64 to −0.16 mM, P = 0.002) fell significantly on metformin treatment, whereas no significant changes were observed in HDL cholesterol. PAI-1 activity fell significantly (mean difference −5.3 AU/ml, 95% CI −8.2 to −2.4 AU/ml, P = 0.001), but plasma fibrinogen concentrations and platelet function, spontaneous or agonist induced, were unaffected. UAE was lower on metformin treatment (median difference −2.4 μg/min, interquartile range −4.4 to −0.2 μg/min, P = 0.004), but metformin had no significant effect on BP. The effects of metformin on glycemic control and cardiovascular risk factors were generally similar in the two ethnic groups.

CONCLUSIONS

These findings indicate that metformin treatment improves glycemic control, and lowers insulin resistance and risk factors for cardiovascular disease, including PAI-1, and may therefore be useful in the long-term management of NIDDM subjects who have a high risk of cardiovascular disease.
Glucose Concentration in Subcutaneous Extracellular Space
Authors: Schmidt Frans J , Sluiter Willem J , Schoonen Adelbert JM
Published: March 2007

OBJECTIVE

To compare the subcutaneous glucose sensor measurements with two reference methods. Previous studies provide conflicting findings about the real glucose concentrations in subcutaneous tissue. Some suggest substantially lower concentration, whereas others measure proportionally higher glucose concentrations compared with the blood compartment. Before these results can be taken seriously as an expression of the real glucose concentration in the extracellular space, the measurements must be validated by an independent method.

RESEARCH DESIGN AND METHODS

We applied a microdialysis-based enzyme sensor to measure glucose concentration in subcutaneous tissue. We also developed two reference methods: subcutaneous filtrate collection and an equilibration method using ultrafiltration membranes to support the earlier findings. We provided an anatomical model to explain the results.

RESULTS

The mean overall intercellular filtrate glucose concentration, sampled with the filtrate collector and taken after a 6-h stabilization time, including the values during the glucose clamp period, was 46 ± 9%. The mean subcutaneous glucose concentration measured with the glucose sensor, calibrated in vitro, was 44 ± 8% of the mean venous blood glucose concentration. Mean overall intercellular equilibrate glucose concentration, i.e., the mean glucose concentration in the subcutaneous extracellular space, taken after a 4-h stabilization time, was 46 ± 15% of the mean venous blood glucose concentration.

CONCLUSIONS

The close agreement between the mean values of subcutaneous glucose concentrations, obtained with three independent methods— filtration, equilibration, and dialysis (sensor)— shows the real glucose concentration in subcutaneous interstitial fluid is — 50% the blood glucose value in normal humans. Our results clarify some of the conflicting evidence presented in previous studies.
Provider-Patient Communication and Metabolic Control
Authors: Street Richard L , Piziak Veronica K , Carpentier Wllma S , Herzog Jean , Hejl Joyce , Skinner Gladys , McLellan Lynn
Published: March 2007

OBJECTIVE

To determine whether nurses' and NIDDM patients' communicationstyles during consultations are related to subsequent metabolic control and to examine factors influencing patterns of communication in these consultations.

RESEARCH DESIGN AND METHODS

A total of 47 NIDDM patients participated in the study and completed the following procedures: 1) assessment of baseline HbA1 2) attended 3.5 days of diabetes education, 3) returned in 1 mo fora follow-up consultation with a nurse, and (4) returned in 9–12 wk for a follow-up HbA1 assessment. The communication variables coded from the consultations were the frequency with which nurses produced controlling, informative, and patientcentered utterances and the frequency with which patients sought information, engaged in decision making, and expressed negative affect.

RESULTS

The results were as follows: 1) patients experienced poorer metabolic control after interacting with nurses who were more controlling and directive in their communication with patients (r = 0.39, P < 0.01); 2) the nurses' use of patientcentered responses was directly related to the degree to which patients expressed feelings (r = 0.34, P < 0.01) and exhibited decision-making behavior (r = 0.62, P < 0.01); and 3) several of the nurses' and patients' communicative behaviors were related to patient characteristics such as age, sex, education, and baseline HbA1 levels.

CONCLUSIONS

The results suggest that providers' attempts to exert considerable control during consultations with NIDDM patients may be counterproductive and contribute to poorer outcomes. The findings also indicate that patient-centered behaviors (e.g., encouraging the patient's involvement, respecting the patient's opinion, and offering support) facilitate the patient's ability to be an active participant in the consultation.
Plasma Norepinephrine in Sensory Diabetic Polyneuropathy
Authors: Tsigos Constantine , Reed Paul , Weinkove Cyril , White Anne , Young Robert J
Published: March 2007

OBJECTIVE

To examine whether changes in circulating norepinephrine are associated with the sensory disturbances of diabetic polyneuropathy. Experimental studies have indicated that NE can excite sprouts from injured nerves, producing pain.

RESEARCH DESIGN AND METHODS

We measured supine and erect plasma NE in 13 normal, nondiabetic control subjects and three groups of diabetic patients: 20 without clinical neuropathy, 20 with chronic painful neuropathy, and 15 with painless neuropathy and foot ulceration. Neuropathy was characterized bysymptom and deficit scores, sensory thresholds, electrophysiology, and cardiovascular autonomic function tests. Neuropathic pain was scored by the patients on a linear analogue scale.

RESULTS

In painless neuropathy, NE levels were greatly reduced (supine, 1.3 nM; erect, 2.2 nM) compared with control subjects (supine, 2.4 nM; erect, 4.0 nM; P < 0.001) and were combined with grossly abnormal autonomic reflexes. NE also was reduced in the diabetic group without neuropathy (supine, 1.7 nM; erect, 2.7 nM; P < 0.01 vs. control subjects). By contrast, in painful neuropathy NE levels (supine, 2.2 nM; erect, 3.6 nM) were similar to control subjects and significantly higher than in painless neuropathy (P < 0.01). Furthermore, NE correlated with the severity of neuropathic pain (r = 0.46, P = 0.02). To assess whether pain, acting as a stressor, could account for the observed differences in NE, we also measured the stress hormones epinephrine and cortisol. They did not differ among the diabetic groups.

CONCLUSIONS

Circulating NE is higher in painful than painless diabetic neuropathy. We suggest that painful neuropathy is associated with a relatively higher number of functioning sympathetic fibers that may contribute to pain.
Effects of Age and Body Fat Insulin Resistance in Healthy Men
Authors: Boden Guenther , Chen Xinhua , DeSantis Richard A , Kendrick Zebulon
Published: March 2007

OBJECTIVE

Aging is known to be associated with increasing insulin resistance and declining glucose tolerance. The cause for the insulin resistance, however, remains uncertain. In this study, we examined the hypothesis that at least part of the insulin resistance may be attributable to age-related changes in body composition and muscle blood flow rather than age itself.

RESEARCH DESIGN AND METHODS

We studied 6 healthy, elderly (66.2 ± 1.7 yr) and 6 younger, healthy men (31.8 ± 3.0 yr) matched for height and weight by determination of their body composition (by underwater weighing), leg blood flow (by mercury strain-gauge plethysmography), rates of glucose uptake (by stable isotope dilution analysis with 6,6 D2-glucose), and carbohydrate oxidation (by indirect calorimetry) during euglycemic hyperinsulinemic clamping.

RESULTS

Body fat (kg fat mass or in percentage of body weight), rates of insulin-stimulated leg blood flow, glucose uptake, oxidation, and storage were all similar in elderly and younger men. Body fat (in percentage of body weight) of both elderly and younger men correlated closely and negatively with glucose uptake (r = −0.73, P < 0.01), glucose oxidation (r = −0.67, P < 0.05), and with glucose storage (r = −0.65, P < 0.05). In contrast, age did not correlate significantly with any parameter of glucose metabolism.

CONCLUSIONS

Our data suggested that insulin sensitivity in men until around 60–70 yr of age appears to be determined more by body fat than by age.
Low Levels of Intraplatelet cGMP in IDDM
Authors: Amado Jose A , Salas Eduardo , Botana Manuel A , Poveda Juan J , Berrazueta Jose R
Published: March 2007

OBJECTIVE

To determine the levels of intraplatelet cGMP, an index of activity of the antiaggregatory nitric oxide pathway, in IDDM patients.

RESEARCH DESIGN AND METHODS

We measured intraplatelet and plasmatic cGMP levels in 22 IDDM patients and 22 age- and sex-matched control subjects.

RESULTS

Intraplatelet cGMP levels decreased in the IDDM patients (0.32 ±; 0.16 pmol/109 platelets) when compared with the control group (0.52 ±; 0.32 pmol/109 platelets), P = 0.032. Plasmatic cGMP levels were not significantly different between groups. Intraplatelet cGMP levels correlated negatively with the duration of the disease (r = −0.43, P < 0.05).

CONCLUSIONS

IDDM patients have lower levels of intraplatelet cGMP, which may be responsible in part for their platelet hyperactivity.
Nephropathy in NIDDM is Associated With Cellular Markers for Hypertension
Authors: Herman William H , Prior Donna E , Yassine May D , Weder Alan B
Published: March 2007

OBJECTIVE

To determine if nephropathy in NIDDM is associated with cellular markers for hypertension.

RESEARCH DESIGN AND METHODS

We compared 11 patients with clinical diabetic nephropathy with 15 control subjects with no diabetic nephropathy. The patients were white and had had NIDDM for > 9 yr and serum creatinine levels < 177 M (2.0 mg/dl).

RESULTS

Patients with nephropathy were more obese and had higher blood pressures and triglyceride levels, and lower high-density lipoprotein cholesterol levels than control subjects. Erythrocyte sodium lithium countertransport activity, erythrocyte sodium content, and platelet sodium-proton exchange were higher in patients with nephropathy than in control subjects.

CONCLUSIONS

The results of this small study suggest that in white patients with long-standing NIDDM, diabetic nephropathy is associated with cellular markers for hypertension. Measurement of cellular markers for hypertension may be useful to identify patients who are at risk for developing nephropathy.
Screening for Diabetic Retinopathy: The wide-angle retinal camera
Authors: Pugh Jacqueline A , Jacobson James M , Van Heuven W A J , Watters John A , Tuley Michael R , Lairson David R , Lorimor Ronald J , Kapadia Asha S , Velez Ramon
Published: March 2007

OBJECTIVE— To define the test characteristics of four methods of screening for diabetic retinopathy.

RESEARCH DESIGN AND METHODS— Four screening methods (an exam by an ophthalmologist through dilated pupils using direct and indirect ophthalmoscopy, an exam by a physician's assistant through dilated pupils using direct ophthalmoscopy, a single 45° retinal photograph without pharmacological dilation, and a set of three dilated 45° retinal photographs) were compared with a reference standard of stereoscopic 30° retinal photographs of seven standard fields read by a central reading center. Sensitivity, specificity, and positive and negative likelihood ratios were calculated after dichotomizing the retinopathy levels into none and mild nonproliferative versus moderate to severe nonproliferative and proliferative. Two sites were used. All patients with diabetes in a VA hospital outpatient clinic between June 1988 and May 1989 were asked to participate. Patients with diabetes identified from a laboratory list of elevated serum glucose values were recruited from a DOD medical center.

RESULTS— The subjects (352) had complete exams excluding the exam by the physician's assistant that was added later. The sensitivities, specificities, and positive and negative likelihood ratios are as follows: ophthalmologist 0.33, 0.99, 72, 0.67; photographs without pharmacological dilation 0.61, 0.85, 4.1, 0.46; dilated photographs 0.81, 0.97, 24, 0.19; and physician's assistant 0.14, 0.99, 12, 0.87.

CONCLUSIONS— Fundus photographs taken by the 45° camera through pharmacologically dilated pupils and read by trained readers perform as well as ophthalmologists for detecting diabetic retinopathy. Physician extenders can effectively perform the photography with minimal training but would require more training to perform adequate eye exams. In this older population, many patients did not obtain adequate nonpharmacological dilation for use of the 45° camera.
β-Cell Function in Relation to Islet Cell Antibodies During the First 3 Yr After Clinical Diagnosis of Diabetes in Type II Diabetic Patients
Authors: Gottsäter Anders , Landin-Olsson Mona , Fernlund Per , Lernmark Åke , Sundkvist Göran
Published: March 2007

OBJECTIVE— To determine the effects of islet cell antibodies on β-cell function during the first 3 yr after diagnosis in type II diabetic patients.

RESEARCH DESIGN AND METHODS— β-cell function in type II diabetic patients with (n = 11, 50 ± 5 yr of age) and without (n = 10, 52 ± 4 yr of age) ICA was followed prospectively and compared with β-cell function in type I adult diabetic patients (n = 17, 37 ± 5 yr of age) and in healthy control subjects (n = 34, age 45 ± 3 yr). β-cell function was evaluated as fasting C-peptide, 1 + 3 min C-peptide after intravenous glucose, and ∆ C-peptide after glucagon.

RESULTS— Fasting C-peptide was equal in type II diabetic patients with ICA (0.30 ± 0.03 nM) and type I diabetic patients (0.24 ± 0.03 nM) at diagnosis, and decreased (P < 0.05) during 3 yr in these groups but not in type II diabetic patients without ICA. At diagnosis, type II diabetic patients with ICA showed a 1 + 3 min C-peptide (0.92 ± 0.17 nM) lower (P < 0.001) than control subjects but higher (P < 0.05) than type I diabetic patients (0.53 ± 0.11 nM). After 1 yr, 1 + 3 min C-peptide in type II diabetic patients with ICA had decreased (P < 0.05) to 0.18 ± 0.11 nM and was equal to type I diabetic patients (0.38 ± 0.10 nM). ∆ C-peptide after glucagon was equally impaired in type II diabetic patients with ICA (0.38 ± 0.06 nM) and type I diabetic patients (0.35 ± 0.11 nM) at diagnosis. After 3 yr, type II diabetic patients with ICA had fasting C-peptide of 0.09 ± 0.04 nM, 1 + 3 min C-peptide of 0.18 ± 0.10 nM, and ∆ C-peptide after glucagon of 0.20 ± 0.09 nM, values equal to type I diabetic patients but lower (P < 0.01) than in type II diabetic patients without ICA, whose values remained unchanged; fasting C-peptide of 0.97 ± 0.17 nM, 1 + 3 min C-peptide of 2.31 ± 0.50 nM, and ∆ C-peptide after glucagon of 1.76 ± 0.28 nM.

CONCLUSIONS— In patients considered type II diabetic with ICA, β-cell function progressively decreased after diagnosis, and after 3 yr was similar to type I diabetic patients, whereas β-cell function in type II diabetic patients without ICA was unchanged.
Fibrocalculous Pancreatic Diabetes in Pune, India: Clinical features and follow-up for 7 yr
Authors: Yajnik Chittaranjan S , Shelgikar Kishore M
Published: March 2007

OBJECTIVE— To study clinical features of fibrocalculous pancreatic diabetes from this clinic, to compare these with the published criteria of malnutrition-related diabetes mellitus, and to conduct serial follow-up of these patients to study difficulties in their treatment.

RESEARCH DESIGN AND METHODS— Details of presenting symptoms, anthropometry, diabetic tissue damage, treatment, and follow-up of 55 patients with fibrocalculous pancreatic diabetes (pancreatic calculi demonstrated on X-ray and sonography) treated during the last 7 yr were studied.

RESULTS— Many patients did not fit the accepted criteria of malnutrition-related diabetes. Thus, 17 (31%) were diagnosed after 30 yr of age and 23 (42%) had a body mass index > 18 kg/m2, and the daily dose of insulin in these patients (mean 0.8 U/kg) was similar to that in the IDDM patients (mean 1.0 U/kg). The two pathognomonic complaints (pancreatic pain and steatorrhea) were not always present. Many patients took very irregular treatment, but none suffered diabetic ketoacidosis despite stopping insulin for long periods of time; 33% of patients had some diabetic tissue damage when first seen. Fourteen patients were lost to follow-up, and 11 died during the follow-up.

CONCLUSIONS— Clinical features of these fibrocalculous pancreatic diabetes patients were somewhat different than the classic descriptions. A need exists to reconsider classification of FCPD under malnutrition-related diabetes mellitus. Many patients receive irregular treatment, and a substantial proportion die within a few years of diagnosis, many as a result of preventable causes.
Epidemiology of IDDM in Southern Chinese Children in Hong Kong
Authors: Wong Gary W , Leung Sophie S , Oppenheimer Stephen J
Published: March 2007

OBJECTIVE— To provide reliable data on the incidence of IDDM in southern Chinese children in Hong Kong.

RESEARCH DESIGN AND METHODS— A registry was established in 1991 to collect childhood IDDM cases retrospectively and prospectively from four districts in Hong Kong. The study included all newly diagnosed cases of IDDM with onset < 15 yr of age from 1 January 1986 to 31 December 1990. Primary ascertainment was based on review of medical records at a regional hospital serving the four districts. An independent school survey validated registry data.

RESULTS— The completeness of ascertainment was 93.8%. The age-standardized incidence of IDDM was 2.0/100,000/yr with the 95% confidence interval of 1.2–3.0/100,000/yr for children < 15 yr of age during the study period. The incidence rates/100,000/yr for the three age-groups were: < or = 4 yr, 0.8; 5–9 yr, 2.2; 10–14 yr, 2.8. The incidence for males was 1.5/100,000/yr (95% confidence interval 0.7–2.9/100,000/yr) and for females, 2.4/100,000/yr (95% confidence interval 1.3–4.0/100,000/yr).

CONCLUSIONS— This study documents a very low incidence rate of childhood IDDM in southern Chinese in Hong Kong.
Prevalence of Cardiovascular and Renal Complications in Older Adults With Normal or Impaired Glucose Tolerance or NIDDM: A population-based study
Authors: Wingard Deborah L , Barrett-Connor Elizabeth L , Scheidt-Nave Christa , McPhillips Janice B
Published: March 2007

Objective— To determine the prevalence of CVD and renal disease by glucose tolerance status in a population-based study.

Research Design and Methods— The study consisted of 991 men and 1243 women, aged 50-89 yr, living in the upper-middle class community of Rancho Bernardo, CA. All participants received a standard OGTT between 1984 and 1987.

Results— A total of 159 men and 158 women had NIDDM, whereas 237 men and 348 women had IGT. Age-adjusted prevalence of complications generally was highest in those who were previously diagnosed with NIDDM. A significant correlation was observed between increases in the prevalence of complications and increases in glucose intolerance for microproteinuria, macroproteinuria, and myocardial infarction (borderline), as well as for stroke and claudication in men and myocardial infarction and stroke in women. In men with IGT or NIDDM, the age-adjusted prevalence of proteinuria and CVD was highest when other complications were present whereas in women such a prevalence was highest when other complications were absent. In men with diabetes, microproteinuria was associated with duration of disease.

Conclusions— Prevalent CVD and renal disease were increased in adults with NIDDM and elevated in adults with IGT compared to those with normal glucose tolerance. The prevalence of complications in NIDDM subjects in this population-based study was substantially lower than that reported for clinic-based diabetic populations.
Lessening the Burden of Diabetes: Intervention Strategies
Authors: Eastman Richard C , Silverman Robert , Harris Maureen , Javitt Jonathan C , Chiang Yen Pin , Gorden Phillip
Published: March 2007

OBJECTIVE

To evaluate the impact of primary and secondary interventions on the development of complications from diabetes, we modeled the effects of primary and secondary interventions for diabetes on a single well-studied complication, diabetic retinopathy.

RESEARCH DESIGN AND METHODS

A model was developed to predict cumulative incidence of retinopathy in IDDM and NIDDM. Risk functions are based on duration of diabetes. The effects of intervention strategies were simulated by altering the retinopathy risk. The effects of the simulations were assessed using cumulative incidence.

RESULTS

Simulations of delaying the onset of IDDM from 2 to 8 yr and decreasing the retinopathy rates by 20–80% were performed for each type of retinopathy. Simulating primary prevention shifted the cumulative incidence curves to the right, and simulating secondary intervention shifted the curves downward. Primary prevention was less effective than secondary prevention. This difference was more apparent for IDDM than for NIDDM, where disease duration and exposure to retinopathy risk were shorter. All interventions shifted the development of retinopathy to later in life.

CONCLUSIONS

The greatest effect on cumulative incidence of all forms of retinopathy occurs when primary and secondary interventions are combined.
A Highly Successful and Novel Model for Treatment of Chronic Painful Diabetic Peripheral Neuropathy
Authors: Pfeifer Michael A , Ross David R , Schrage Jon P , Gelber David A , Schumer Mary P , Crain Goldie M , Markwell Stephen J , Jung Sonya
Published: March 2007

OBJECTIVE

To investigate why, in spite of a vast variety of treatment agents, the alleviation of pain in patients with diabetic neuropathy is difficult. Previous studies have not used a treatment algorithm based on anatomic site and neuropathophysiological source of the neuropathic pain.

RESEARCH DESIGN AND METHODS

A model that categorizes the types of pain into three groups (superficial, deep, and muscular) was applied in 75 diabetic patients with chronic (> 12 mo) painful distal symmetrical polyneuropathy in a controlled case series. Twenty-two patients were untreated and 53 patients were treated with imipramine ± mexiletine for deep pain, capsaicin for superficial pain, and stretching exercises and metaxalone ± piroxican for muscular pain. Each type of pain was scored separately on a scale of 0 (none) to 19 (worst), and the total of all three types was used as an index of overall pain. Ability to sleep through the night was scored by a scale of 1 (never) to 5 (always).

RESULTS

No significant differences were observed in initial pain scores, sleep scores, demographics, biochemistries, or physical findings between the two groups. After 3 mo a significant improvement in scores was noted in the treated but not the untreated patients. In addition, a significant difference was found in the change of scores between the treated and untreated patients: total pain (−18 ± 2 vs. 0 ± 2), deep pain (−7 ± 1 vs. 0 ± 1), superficial pain (−5 ± 1 vs. 0 ± 1), muscular pain (−6 ± 1 vs. 0 ± 1), and sleep (1.2 ± 0.2 vs. 0.2 ± 0.2), all P < 0.0001. In treated patients 21% became pain-free (total pain < 2), 66% had improvement (decrease in total pain > 5, but not total elimination of painful symptoms), and 13% were considered treatment failures (a decrease in total pain of < or = 5). This compares with 0 (P < 0.02), 10 (P < 0.0001), and 90% (P < 0.0001), respectively, in the untreated patients.

CONCLUSIONS

This study presents a new rationale and hypothesis for the successful treatment of chronic painful diabetic peripheral neuropathy. It uniquely bases the treatment algorithm on the types and sources of the pain.
Is the Corrected QT Interval a Reliable Indicator of the Severity of Diabetic Autonomic Neuropathy?
Authors: Bravenboer Bert , Hendriksen Peter-Henk , Oey Liam P , Gispen William-Hwndrik , Huffelen Alexander C Van , Erkelens D William
Published: March 2007

Objective— We investigated whether the corrected QT interval correlated with two other tests for diagnosing autonomic dysfunction in 60 type I diabetic patients with proven peripheral neuropathy. The mean age ± SD was 48.3 ± 11.2 yr, the mean duration of diabetes was 24.9 ± 11.4 yr, and the mean HbA1 was 9.3 ± 2.4%.

Research Design and Methods— All patients underwent three autonomic function tests: 1) the standard five cardiovascular Ewing tests, each scored 0 (normal), 0.5 (borderline), or 1.0 (abnormal). We used the sum of the abnormal findings for the analysis, the cardiovascular autonomic score; 2) measurement of the corrected QT interval taken from a routine electrocardiogram recording; and 3) static and dynamic pupillometry: measurement of dark adapted pupil diameter as percentage of total iris diameter and of pupil constriction latency using an infrared light reflex technique.

Results— No significant correlation was found between age, duration of diabetes, or HbA1 and any of the autonomic function tests, except for one between age and cardiovascular autonomic score (r = 0.3202, P = 0.0126). Corrected QT interval did not correlate with cardiovascular autonomic score, pupil diameter, or constriction latency. A significant inverse correlation was found between cardiovascular autonomic score and pupil diameter (r = −0.4861, P < 0.001) and constriction latency (r = 0.3783, P < 0.001). Pupil diameter and constriction latency correlated well (r = −0.4276, P < 0.001).

Conclusions— The corrected QT interval did not correlate with cardiovascular autonomic tests nor pupillometry results. The corrected QT interval therefore should not be used for the diagnosis of the severity of diabetic autonomic neuropathy.
Clinical Gallbladder Disease in NIDDM Subjects: Relationship to duration of diabetes and severity of glycemia
Authors: Haffner Steven M , Diehl Andrew K , Valdez Rodolfo , Mitchell Braxton D , Hazuda Helen P , Morales Philip , Stern Michael P
Published: March 2007

Objective— To examine the relationship between the prevalence of gallbladder disease and severity of glycemia among diabetic individuals and to provide insight into whether the diabetes-gallstone association is a causal one, because NIDDM patients have an increased prevalence of clinical gallbladder disease.

Research Design and Methods— We examined 462 diabetic individuals identified during the San Antonio Heart Study, a population-based survey of diabetes and cardiovascular disease in Mexican Americans and non-Hispanic whites. Diabetes was diagnosed according to National Diabetes Data Group criteria.

Results— The prevalence of self-reported gallbladder disease was 34.2% in diabetic women and 7.2% in diabetic men. Although duration of diabetes was positively related to the prevalence of gallbladder disease (P < 0.01), type of therapy was not associated, and fasting glucose concentration was inversely associated with gallbladder disease.

Conclusions— Factors other than hyperglycemia may account for the increased prevalence of gallbladder disease in diabetic subjects.
Factitious Diabetes Mellitus and Spontaneous Hypoglycemia: Consequences of unrecognized Munchausen syndrome by proxy
Authors: Kovacs Christopher S , Toth Ellen L
Published: March 2007

Objective— To increase health-care professionals′ awareness and knowledge of factitious illness by proxy, or Munchausen syndrome by proxy, in relatives of diabetic patients.

Research Design and Methods— A case report is described of a 14-yr-old male who has a 6-yr history of diet-controlled diabetes mellitus, and a 6-mo history of reported spontaneous hypoglycemia.

Results— Neither diabetes nor spontaneous hypoglycemia was present in this child on objective testing. The child was subjected to inappropriate use of a strict diabetic diet and daily glucometer measurements for at least 8 yr. The father had convinced his son and health-care professionals of these diagnoses, in spite of evidence of the contrary.

Conclusions— When confronted with history and clinical findings that contradict laboratory findings, health-care professionals should have a high index of suspicion for factitious illness and should pursue it aggressively with the help of legal services.
Decreased Polymorphonuclear Leukocyte Deformability in NIDDM
Authors: Pécsvarády Zsolt , Fisher Timothy C , Darwin Christine H , Fabók Agnes , Maqueda Teresita S , Saad Mohammed F , Meiselman Herbert J
Published: March 2007

OBJECTIVE

To determine the rheological properties of polymorphonuclear leukocytes (PMN) from non-insulin-dependent diabetes mellitus (NIDDM) patients.

RESEARCH DESIGN AND METHODS

The deformability of PMN from 33 NIDDM subjects, 13 with impaired glucose tolerance (IGT), and 22 with normal glucose tolerance (NGT) was studied. A Cell Transit Analyzer that measures the transit time of PMN through 8-(xm pores was used. Studies were performed under three different conditions: J) basal state; 2) after incubation with cytochalasin B (20 μM) to dissociate f-actin from the cytoskeleton; and 3) following activation with N-formyl-methionyl-leucyl-phenylalanine (fMLP, 1 nM).

RESULTS

PMN from diabetic patients were more rigid (i.e., had longer transit time) than those from subjects with NGT or IGT under basal conditions and after cytochalasin B, but not after stimulation with fMLP. The deformability of PMN from subjects with IGT was similar to those of the NGT group. In the pooled data, basal transit time correlated with age; systolic and diastolic blood pressure; HbA1c; and serum creatinine, cholesterol, and triglyceride concentrations (r = 0.29, 0.34, 0.37, 0.48, 0.25, 0.36, 0.29, respectively, P < 0.05 for each). Hypertensive diabetic patients had less deformable PMN than normotensive ones. No relation was found between PMN deformability and the duration of diabetes, type of treatment, or the presence of retinopathy.

CONCLUSIONS

These data indicate increased rigidity of PMN in NIDDM that may contribute to development of microcirculatory disturbances and microangiopathy.
Normalization of Lipoprotein Composition by Intraperitoneal Insulin in IDDM: Role of increased hepatic lipase activity
Authors: Ruotolo Giacomo , Parlavecchia Mariella , Taskinen Marja-Riitta , Galimberti Gabriella , Zoppo Adele , Le Ngoc-Anh , Ragogna Francesca , Micossi Piero , Pozza Guido
Published: March 2007

OBJECTIVE

To characterize the effects of intraperitoneal insulin pump therapy on lipoprotein composition and lipolytic enzyme activity in patients with insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS

Ten IDDM patients were studied 3 times: when receiving conventional subcutaneous insulin therapy and at 3 and 9 months from the initiation of intraperitoneal insulin regimen. Ten nondiabetic subjects matched for age, sex, and body weight were studied as controls. Levels of cholesterol, triglycerides, apolipoprotein A-I (apoA-I) and B (apoB) were measured in total plasma and lipoprotein fractions (very-low-density lipoprotein [VLDL], intermediate-density lipoprotein [IDL], low-density lipoprotein [LDL], and high-density lipoprotein [HDL]: HDL2 and HDL3). Postheparin plasma lipoprotein lipase and hepatic lipase activities were determined by an immunochemical method.

RESULTS

IDDM patients showed higher levels of HDL3 and lower levels of HDL2 particles during intraperitoneal insulin therapy in comparison with subcutaneous insulin therapy. Both cholesterol and apoA-I significantly increased in HDL3 and decreased in HDL2 during intraperitoneal treatment. Plasma total cholesterol significantly decreased in the diabetic patients at 3 months of intraperitoneal insulin therapy compared with both subcutaneous insulin regimen and control subjects. IDL triglyceride concentrations during intraperitoneal treatment were significantly lower than those seen with subcutaneous therapy. Furthermore, triglyceride:apoB ratio in VLDL and cholesterol:apoB ratio in LDL significantly decreased in IDDM patients treated by intraperitoneal insulin. A significant increase in the activity of hepatic lipase with intraperitoneal insulin therapy by 9 months compared with subcutaneous insulin therapy has been shown.

CONCLUSIONS

The increased activity of hepatic lipase after intraperitoneal insulin administration in IDDM patients appears to be one of the main determinants of lipoprotein changes observed, resulting in the normalization of lipoprotein composition during this mode of therapy. The normal inverse relationship between VLDL triglycerides and HDL cholesterol, which was not present in IDDM patients with subcutaneous therapy, was restored with intraperitoneal insulin regimen.