bluuebunny/crossref_metadata_2025 huggingface dataset:
Determinants of Progression of Microalbuminuria in Adolescents With IDDM
Authors: Rudberg Susanne , Dahlquist Glsela
Published: March 2007

OBJECTIVE

To evaluate the significance of microalbuminuria in adolescents with IDDM and to study the relative importance of blood pressure (BP), metabolic control, and albumin excretion rate (AER) on progression of microalbuminuria.

RESEARCH DESIGN AND METHODS

A cohort of 155/156 children and adolescents followed from onset up to 18.3 years of IDDM participated. In a previous follow-up in July 1991 (up to 15 years of duration), 17 patients had developed persistent microalbuminuria (≥20 μg/min). In these adolescents, we analyzed whether microalbuminuria had progressed (in mean ≥5% per year), had remained unchanged, or had normalized (<20 μg/min) after another 3 years. The predictive values of mean HbA1c, diastolic blood pressure (dBP), systolic blood pressure (sBP), overnight AER, sex, age, and duration of diabetes for the progression of microalbuminuria were determined using multiple regression modeling.

RESULTS

Seven of 17 patients with microalbuminuria in July 1991 had normalized, 6 of 17 patients had progressed, and 4 of 17 patients had remained unchanged after 3 years. Progressors had higher mean HbA1c during the first 5 years of IDDM and higher mean sBP in 1991 than nonprogressors. Patients with normalized microalbuminuria all had AER <30 μg/min in 1991, were younger at onset of microalbuminuria, had lower mean HbA1c, and had lower dBP before normalized AER than nonregressors at the same duration of microalbuminuria. In multivariate analysis, independent significant predictors for progression were first 5-year mean HbAlc, mean AER, and mean sBP in 1991 (R2 = 0.76, P = 0.001).

CONCLUSIONS

Progression of microalbuminuria in adolescents with IDDM is predicted by early sustained hyperglycemia, later elevated sBP, and increased AER per se. Microalbuminuria is frequently normalized in adolescents, and this is associated with better prevailing metabolic control, younger age, and lower dBP.
Socioeconomic Status and Clustering of Cardiovascular Disease Risk Factors in Diabetic Patients
Authors: Connolly V M , Kesson C M
Published: March 2007

OBJECTIVE

Correction of cardiovascular risk factors is an essential component of good diabetes care. Our goal was to examine the relationship of socioeconomic status in five risk factors: obesity, hypertension, high cholesterol, smoking, and high HbA1c.

RESEARCH DESIGN AND METHODS

We conducted a cross-sectional prevalence study of all patients with diabetes (n = 1,553) attending a clinic in Glasgow, U.K. Area-based codes were used to measure socioeconomic status; these ranged from 1, the most affluent, to 7, the most deprived.

RESULTS

Comparing patients with NIDDM from the seven categories of socioeconomic status, we found that those from deprived categories experienced a higher prevalence of obesity. In the most affluent groups, 30% had a BMI > 30 kg/m2 compared with 47% in the most deprived categories (P < 0.002). With regard to smoking, 13% in the most affluent category smoked compared with 33% in the most deprived (P < 0.001). In patients with IDDM from affluent categories, 13% smoked compared with 34% from deprived categories (P < 0.001). The proportion of patients with no cardiac risk factors fell by 30.6% from deprived category 1 to 7 (P < 0.001), and the proportion of patients with three or more risk factors rose from 8.6% in category 1 to 20.2% in category 7.

CONCLUSIONS

Diabetic patients from areas of low socioeconomic status are at increased risk of cardiovascular disease. To counter this, specific health education programs should be evolved and resources should be directed toward these areas.
Increased Tissue Factor Pathway Inhibitor Activity in IDDM Patients With Nephropathy
Authors: Yokoyama Hiroki , Myrup Bjarne , Rossing Peter , østergaard Per B
Published: March 2007

OBJECTIVE

Tissue factor pathway inhibitor (TFPI) is bound to vascular endothelium (presumably to heparan sulfate) and circulates in complex with plasma lipoproteins. It directly binds and inhibits factor Xa. The purpose of the study is to investigate whether plasma TFPI activity is altered in IDDM and nephropathy and to evaluate the possible determinants of the alteration.

RESEARCH DESIGN AND METHODS

We assessed plasma concentration of TFPI (total, truncated, and domain 3 TFPI) and plasma activity of factor Xa inhibition in nondiabetic control subjects (n = 22) and in IDDM patients with normoalbuminuria (urinary albumin excretion rate [UAE] < 30 mg/24h, n = 17), incipient nephropathy (UAE 30-300 mg/24 h, n = 17), clinical nephropathy (UAE > 300 mg/24h, n = 25).

RESULTS

Total, truncated, and domain 3 TFPI concentrations were increased in IDDm patients compared with those in control subjects and were more pronounced in IDDM patients with nephropathy. Plasma activity of factor Xa inhibition measured by HEPTEST (Haemachem, St. Louis, MO) assay was increased in IDDM patients, especially in those with nephropathy. TFPI-dependent factor Xa inhibition, obtained as the difference in clotting time with and without adding activity-neutralizing anti-TFPI antibody to samples, was increased in IDDm patients with nephropathy. This was, however, not sufficient to inhibit the biological activity of factor Xa as demonstrated by increased levels of prothrombin fragment 1 + 2. LDL cholesterol and HbA1c were independently correlated to plasma TFPI.

CONCLUSIONS

Inhibition of factor Xa activity is increased in IDDM patients with nephropathy, mainly because of increased plasma TFPI activity. The increased plasma TFPI activity in these patients may be associated with and regulated by LDL in plasma and metabolic control. The anticoagulant activity of TFPI may attenuate the hypercoagulable state in diabetes but does not seem to be able to normalize hemostasis.
Does a High-Carbohydrate Diet Have Different Effects in NIDDM Patients Treated With Diet Alone or Hypoglycemic Drugs?
Authors: Parillo M , Giacco R , Ciardullo A V , Rivellese A A , Riccardi G
Published: March 2007

OBJECTIVE

To compare the effects of a nigh-carbohydrate diet on blood glucose and plasma lipids in NIDDM patients with either mild or severe glucose intolerance.

RESEARCH DESIGN AND METHODS

A crossover design with a 15-day intervention diet was used. Eighteen patients were separated into two groups on the basis of hypoglycemic treatment (diet, n = 9, or diet plus glibenclamide, n = 9) and were assigned to a 15-day treatment with a high-carbohydrate/low-fiber diet containing 60% energy from carbohydrate and 20% from fat or a low-carbohydrate/low-fiber diet with 40% energy from carbohydrate and 40% from fat and then crossed over to the other diet for 15 more days.

RESULTS

The high-carbohydrate diet produced a significant increase in postprandial blood glucose in patients on glibenclamide (13.6 ± 1.4 vs. 11.0 ± 1.8 mmol/l, P < 0.002, while no difference was recorded in the group on diet alone (9.7 ± vs. 8.9 ± 0.6 mmol/l). Postprandial insulin levels were significantly higher after the high-carbohydrate diet in the group on diet along (248 ± 32 vs. 192 ± 28 pmol/l, P < 0.01), while no significant differences were observed in the other group (226 ± 19 vs. 202 ± 24 pmol/l) The high-carbohydrate diet also induced a significant increase in fasting plasma triglyceride concentrations in both groups (1.36 ± 0.2 vs. 1.12 ± 0.2 mmol/l, P < 0.05 and 1.4 ± 0.3 vs. 1.1 ± 0.1 mmol/l, P < 0.05). No differences were observed in fasting plasma cholesterol and HDL.

CONCLUSIONS

The effects of the high-carbohydrate diet on blood glucose control in NIDDM patients differ according to severity of glucose intolerance.
Rapid HbA1c Testing in a Community Setting
Authors: Carter Janette S , Houston Caron A , Gilliland Susan S , Perez Georgia E , Owen Charles L , Pathak Dorothy R , Little Randie R
Published: March 2007

OBJECTIVE

To determine whether the DCA 2000 analyzer provides valid and reliable HbA1c results when used under field conditions and operated by nonmedical personnel. This study was part of a community diabetes education program, the Native American Diabetes Project, in which HbA1c was measured as an indicator of average glycemic control.

RESEARCH DESIGN AND METHODS

Two study samples were taken, the first in the spring of 1994 and the second in the spring of 1995. Seven community members in 1994 and six new community members in 1995 were trained over 2 days, using standard protocol, to operate the DCA 2000 HbA1c analyzer and to collect two capillary blood samples from participants in the Native American Diabetes Project. Duplicate DCA 2000 HbA1c measurements performed by the community workers were compared with measurements from a high-performance liquid chromatography (HPLC) system. Validity and reliability measures were calculated.

RESULTS

Of the participants, 43 were studied in 1994 and 14 in 1995. Comparison of the mean DCA 2000 results with those of HPLC showed high validity, with the absolute relative difference between the mean DCA 2000 and the external reference of HPLC (│ mean DCA 2000-HPLC │ /HPLC) as 4.0 and 2.0% for 1994 and 1995, respectively. The Pearson correlation coefficients (r) between these two measures were 0.968 and 0.996 for 1994 and 1995, respectively. While the 1994 data appeared to have less validity for values > 10%, they included only one value with a 60-min warm-up of the DCA analyzer. The 1995 data, all collected after a 60-min warm-up, had good correlation throughout the range of values. The within-run reliability was excellent, with an intraclass correlation coefficient of reliability of 0.959 and 0.975 for paired samples, for 1994 and 1995 respectively. The mean coefficient of variation for these paired measures was 3.0% in 1994 and 2.8% in 1995. Both validity and reliability were improved by changing the warm-up period of the DCA 2000 analyzer from 5 to 60 min. All correlation coefficients were statistically significant (P < 0.0001).

CONCLUSIONS

The DCA 2000 gave valid and reliable HbA1c results when operated in a community setting by nonmedical personnel. Extending the warm-up period of the device to 60 min slightly improved the validity and reliability of the test.
Trends in the Epidemiology of IDDM During 1970–2020 in Fyn County, Denmark
Authors: Green Anders , Sjølie Anne K , Eshøj Ole
Published: March 2007

OBJECTIVE

To present an epidemiological model applicable to diabetes based on which prevalence rates are estimated from assumed rates of incidence and mortality of diabetes. Furthermore, this study illustrates the model by analyzing epidemiological data on IDDM in a Danish population during 1970–1990, with predictions of prevalence rates for 1990–2020.

RESEARCH DESIGN AND METHODS

The epidemiological model assumes known prevalence rates as well as incidence rates and mortality at a given time. Under assumed rates of incidence and mortality of IDDM and its complications, the prevalence rate is the dependent variable, estimated as a function of calendar time. We use epidemiological data on IDDM (operationally defined as insulin-treated diabetes with onset before age 30 years), blindness, and nephropathy, as well as mortality, as reported for 1973 and 1987 in Fyn County, Denmark.

RESULTS

During 1970–1990, the prevalence of IDDM increased steadily because of increasing incidence and decreasing risk of complications and mortality. The relative prevalence of patients with nephropathy increased, whereas that of blind patients decreased considerably. Under specified assumptions regarding the future levels of incidence of disease, complications, and mortality, it is estimated that the prevalence rate of IDDM in the year 2020 will be 45–60% higher than the level in the year 1990. The relative prevalence of patients with nephropathy will increase further, whereas the relative prevalence of blind patients will remain constant at a low level.

CONCLUSIONS

IDDM will represent an increasing public health problem in Denmark during the next decades, with increasing overall prevalence rates and a rising proportion of patients with nephropathy. The major determinant of this trend is increasing incidence combined with declining mortality and declining risk of complications. It is strongly recommended that epidemiological models like the one presented here be further developed and implemented at regional levels to provide data for the dimensioning of the current and future diabetes care systems.
Parental History of Diabetes in a Population-Based Study
Authors: Klein Barbara E K , Klein Ronald , Moss Scot E , Cruickshanks Karen J
Published: March 2007

OBJECTIVE

To evaluate the relative frequency of parental history of diabetes in a population-based study of younger- and older-onset groups of individuals with diabetes and a comparison group of individuals without diabetes.

RESEARCH DESIGN AND METHODS

Study participants were queried about a family history of diabetes. The frequencies of positive responses for parents and siblings were compared between younger- and older-onset groups.

RESULTS

At least one parent had diabetes in 18.6% of the families of younger-onset individuals and in 38.6% of the families of older-onset individuals. For those of younger-onset diabetes, 9.1% of fathers, 8.3% of mothers, and 1.3% of both parents had diabetes; the corresponding percentage for those of older-onset diabetes were 11.5, 23.5, and 3.6%, respectively. The difference between frequencies in mothers and fathers was significant (P < 0.0001) in the older-onset group. In the nondiabetic comparison group, for those of similar ages to the younger- and older-onset groups, the corresponding frequencies were 6.2 and 9.0% and 7.7 and 9.8% for fathers and mothers, respectively. The greater frequencies of diabetes in mothers of older-onset diabetic individuals were not accounted for by maternal age. In younger-onset individuals, the relative risk (RR) of diabetes in a sibling if the father had diabetes was 1.22 (95% CI, 0.72–2.05); if the mother had diabetes, the RR was 2.39 (95% CI, 1.64–3.48); and, if both parents had diabetes, the RR was 5.61 (95% CI, 3.37–9.34). In the older-onset individuals, the corresponding RR values were 1.69 (95% CI, 1.35–2.13) for fathers, 1.72 (95% CI, 1.44–2.06) for mothers, and 2.42 (95% CI, 1.81–3.25) for both parents.

CONCLUSIONS

These data confirm a familial influence on the frequency of diabetes. The excess of cases in mothers of older-onset diabetic individuals is compatible with both environmental and genetic influences.
Decreased Serum 1,5-Anhydroglucitol in Nondiabetic Subjects With a Family History of NIDDM
Authors: Tsukui Satoshi , Fukumura Yukihito , Kobayashi Isao
Published: March 2007

OBJECTIVE

To investigate the effect of a family history of NIDDM on HbAlc and serum 1,5-anhydroglucitol (AG) in nondiabetic subjects.

RESEARCH DESIGN AND METHODS

A 75-g oral glucose tolerance test was performed; 258 subjects with normal glucose tolerance and 106 subjects with impaired glucose tolerance (IGT) were selected HbA1c and serum AG were compared between subjects with and without a family history of NIDDM. The relationships between age, BMI, HbA1c, serum AG, fasting and 2-h plasma glucose, and urinary glucose were also examined using principal component analysis with a varimax rotation.

RESULTS

In the normal group, only serum AG was lower in subjects with a positive family history than in those with no family history. On the other hand, in the IGT group, subjects with a positive family history were younger and had a higher 2-h plasma glucose, a higher urinary glucose, and a lower serum AG than those with no family history, whereas there was no difference in HbA1c. Principal component analysis identified three factors. The first factor, a linear combination of HbA1c and fasting plasma glucose, was labeled an average glycemic factor. The second factor, which included serum AG, 2-h plasma glucose, and urinary glucose, was labeled an oscillatory glycemic factor. The third factor, which contrasted age against BMI, was labeled an environmental factor.

CONCLUSIONS

Serum AG is related to glycosuria even among nondiabetic subjects, and its concentrations are decreased in those with a family history of NIDDM. Our results suggest that serum AG rather than HbA1c reflects early metabolic abnormalities in these subjects.
High Prevalence of Hepatitis C Virus Infection in Diabetic Patients
Authors: Simó Rafael , Hernández Cristina , Genescà Joan , Jardí Rossend , Mesa Jordi
Published: March 2007

OBJECTIVE

To evaluate the prevalence of hepatitis C virus (HCV) infection in diabetic patients and to investigate the influence of several epidemiological and clinical factors on HCV infection.

RESEARCH DESIGN AND METHODS

A total of 176 consecutive diabetic patients were compared with 6,172 blood donors, matched by recognized risk factors to acquire HCV infection. Serologic testing for anti-HCV was done using a second-generation commercial enzyme-linked immunosorbent assay (ELISA) and an immunoblot assay was performed in anti-HCV positive samples to confirm HCV specificity. Diabetic patients were divided in two groups according to their HCV antibody status and analyzed for the following variables: age, sex, type of diabetes, duration of disease, mode of therapy, late diabetic complications, previous blood transfusions, intravenous drug addiction, hospital admissions, major surgical procedures, and liver function tests (LFTs).

RESULTS

A higher prevalence of HCV infection was observed in diabetic patients in comparison with blood donors (11.5 vs. 2.5%; P < 0.001; odds ratio 4.39; 95% CI 2.61–7.24). We did not detect any particular epidemiological factor for HCV infection in anti-HCV positive diabetic patients. In these patients, abnormal LFTs were observed in 72.3%, compared with only 24.7% of anti-HCV negative diabetic patients (P < 0.001).

CONCLUSIONS

A high prevalence of HCV infection was detected in diabetic patients, and most of anti-HCV positive patients presented with abnormal LFTs. Therefore, testing for HCV infection of diabetic patients with an abnormal LFT is mandatory. The lack of any particular epidemiological factor for HCV infection in our diabetic population suggests that HCV may have a direct role in the development of diabetes.
Plasma lipid levels in insulin-dependent diabetes mellitus
Authors: Moore Wayne V , Knapp Joyce , Kauffman Ralph L , Perkins William G
Published: March 2007

Because several recent reports have indicated a high incidence of hyperlipidemia in insulin-dependent juvenile diabetes, the plasma lipid levels were measured in a population of insulin-dependent diabetic patients to determine if hyperlipidemia is necessarily associated with diabetes. Only one patient had an elevated cholesterol concentration (> 220 mg. per deciliter) and two patients had an elevated triglyceride concentration (> 140 mg. per deciliter), giving an incidence of 6.4 per cent. A normal control group had an incidence of hyperlipidemia of 5.7 per cent. The mean cholesterol level (164 ± 38 mg. per deciliter) of the diabetic population was significantly less than that of the normal control group (183 ± 38 mg. per deciliter). The diabetic patients were divided into groups on the basis of 24-hour urinary glucose excretion and records of glycosuria. The serum triglyceride of the patients in group 4 (highest urinary glucose content and spills) was significantly elevated above three other groups with less glucosuria. Dietary history revealed that group 4 patients consumed a significantly higher percentage of fat. Cholesterol levels did not correlate with parameters of regulation of the diabetes.
Epidemiology of Diabetes and its Macrovascular Manifestations in Pacific Populations: The Medical Effects of Social Progress
Authors: Zimmet P
Published: March 2007

Worldwide diabetes epidemiology studies have shown quite marked differences in diabetes prevalence rates between ethnic groups. This pattern holds true in the Pacific region and provides unique opportunities for comparative studies. Diabetes is rare in Melanesians, and also in Polynesians, Micronesians, and Australian Aboriginals who retain their traditional life-style. High prevalence rates of insulin-independent diabetes have been demonstrated in Polynesians, Micronesians, and Australian aboriginals who have adopted a Western life-style. Along with the Pima Indians, the Micronesian population of Nauru have the highest diabetes prevalence yet reported—40% of people aged 20 yr and over. As diabetes is rare in traditional living Polynesians and Micronesians, yet high in westernized populations of these ethnic groups, it appears these people may have a “diabetic genotype” that is unmasked by the change in life-style. Obesity, a high caloric Western diet, and reduced physical activity may be the major precipitating factors. Bimodality of glucose tolerance distributions has been demonstrated in both westernized Polynesians and Micronesians. The frequency distributions of both fasting and 2-h postload glucose levels allow separation of these populations into normal and hyperglycemic groups. The optimal cut-off levels between the two groups were a fasting plasma glucose ≃ 140 mg/dl and a 2-h level of ≃ 200 mg/dl. These findings provide a valid basis for the diagnosis of diabetes mellitus to be based on the above levels. Only sparse information exists on the prevalence of microvascular and macrovascular complications of diabetes in these populations. However, there is clear evidence that they are occurring and they are similar in nature to the complications seen in Caucasian diabetic patients. Coronary artery disease is not yet a major problem in Pacific Islanders although most of the major risk factors are not present in urbanized communities. However, with increasing westernization, and given more time for the pathologic process of atheroma to develop, it can be expected that coronary artery disease will become a major cause of morbidity and mortality in Polynesians, Micronesians, and the Australian aboriginal.
Standardization of definition, classification, and reporting in diabetes-related epidemiologic studies
Authors: West Kelly M
Published: March 2007

This working paper reviews some advantages and disadvantages of various alternative definitions and classification schemes. Certain of these alternatives were discussed by an international group of experts on the epidemiology of diabetes. It was recommended by the conferees that the following terms not be used as standard descriptors in epidemiologic reports: juvenile diabetes, juvenile-type diabetes, maturity-onset diabetes of youth (MODY), latent diabetes, subclinical diabetes, clinical diabetes, chemical diabetes, and J-type (Jamaica) diabetes. Alternative ways of describing these conditions were offered. Some, but not all, conferees favored abandonment or modification of the terms “secondary diabetes” and “pancreatic diabetes.” Two alternate approaches are described in classification. One is designed to classify all types of cases in a single scheme. In this system each case is described by indices that include etiology and special etiologic concomitants, fatness, severity, type of treatment, and, if present, special or peculiar manifestations, and morbidity. This system makes it possible to classify all cases by mutually exclusive categories. A disadvantage of this scheme is that the number of combinations of classifying indices and subindices is great. Another approach is to classify cases by syndromes, using in each class a mixture of indices (e.g., etiology, severity, fatness, etc.). The conferees failed to reach a consensus in the specifics of this approach. There was considerable disagreement on how certain terms should be defined, whether they should be used, and on the degree of need for specific definitions. These designations included the terms “insulin-dependent,” “idiopathic,” “insulin-requiring,” and “ketosis-prone.” The conferees agreed that in either of the two approaches to classification, the prime indices should be those that can be ascertained by ordinary clinical methods. Much progress could be accomplished, even in the absence of international standardized definitions and classification systems, provided that authors keep in mind the need to describe the major characteristics of their cases and define the sense in which they use terms such as insulin-dependent, ketosis-prone, obese, etc.
Pathogenesis of Diabetic Ketoacidosis: A Reappraisal
Authors: Schade David S , Eaton R P
Published: March 2007

This study reviews the pathogenic hormonal abnormalities (insulin deficiency and stress hormone excess) in diabetic ketoacidosis. The data both supporting and negating a primary role for insulin deficiency in the pathogenesis of diabetic ketoacidosis are examined. Evidence implicating excess stress hormone secretion as a necessary event in the development of severe metabolic decompensation is discussed. The data suggest that diabetic ketoacidosis may be prevented by correcting either the relative deficiency of insulin or the excess secreation of one or a combination of the stress hormones. Studies supporting a primary role for insulin deficiency in the pathogenesis of diabetic ketoacidosis include the beneficial therapeutic response to insulin administration in ketoacidosis, development of ketoacidosis; and (3) stress hormone excess is necessary for fulminant ketoacidosis to be manifested.s following insulin withdrawal from diabetic man and animals, and hypoglycemic and hypoketonemic effects of insulin. Studies negating a primary role for insulin deficiency in ketoacidosis include the “normal” plasma insulin concentration in the majority of ketoacidotic cases, delayed onset of ketoacidosis after insulin withdrawal from diabetic man, and lack of hypolipolytic and hypoketonemic effect of insulin without prior stress hormone adipocyte and hepatocyte stimulation. Evidence that stress hormones (glucagon, catecholamines, cortisol, and growth hormone) contribute to the metabolic decompensation of ketoacidosis includes: (1) in all cases of ketoacidosis, at least one stress hormone is always elevated; (2) pharmacologic blockade of each of the stress hormones reduces the rate and/or frequency of metabolic decompensation in diabetic man; (3) removal of the pituitary and/or the adrenal gland in diabetic animals completely prevents the development of ketoacidosis after insulin withdrawal; and (4) administration of each of the four stress hormones under appropriate conditions induces metabolic decompensation in diabetic man with “normal” circulating levels of plasma insulin concentration. From these studies, the following conclusions are supported: (1) absolute insulin deficiency is an unusual cause of ketoacidosis; (2) the presence of relative insulin deficiency is necessary for the development of ketoacidosis; and (3) stress hormone excess is necessary for fulminant ketoacidosis to be manifested.
Standard Parameters of Diabetic Control: Are They Reliable?
Authors: Winter Robert J , Stone Neil J , Wise Joyce E , Traisman Howard S , Green Orville C
Published: March 2007

To evaluate the reliability of the tradional methods to assess short-term control of diabetes, 25 children with insulin-dependent diabetes were studied with a 24-h glucose profile in addition to the traditional assessment techniques. Patient compliance was elminated as much as possible from the experimental design. The correlation of the routine methods with the 24-h glucose profile was excellent, and a scoring system for control was empirically derived. The single method of assessment that correlated best with the overall control score was the traditional daily urine test. In 6 of the 25 subjects studied, relative hypoglycemia was observed, occurring asymptomatically at night, and was followed by a hyperglycemic rebound. Traditional assessment techniques did not detect this event. Five additional patients had symptomatic daytime hypoglycemia. We conclude that the traditional daily urine tests are adquate indicators of day-to-day control in most diabetic patients, given adquate compliance. Our data also suggest that asymptomatic nocturnal hypoglycemia occurs frequently in children with diabetes, although clinical proof is difficult in the absence of a 24-h glucose profile.
Effect of Nutritional Counseling on the Blood Glucose and Nutritional Knowledge of Diabetic Subjects
Authors: Chandalia Hemraj B , Bagrodia Jayshree
Published: March 2007

The nutritional knowledge and control of diabetes was assessed in 43 nonketosis-prone diabetic subjects. Patients were semiliterate or illiterate. They were exposed to a 1-h nutritional counseling program in groups of three to five. The nutritional counseling program was highly simplified and emphasized only a few important aspects of diabetic diet. Patients′ nutritional knowledge improved significantly after nutritional counseling. The control of diabetes also improved significantly in those patients in whom control had been inadequate.
Some Social Factors Related to Control of Diabetes Mellitus in Adult Jamaican Patients
Authors: Alleyne Sylvan I , Morrison Errol Y ST A , Richards Rolf R
Published: March 2007

A population of 103 adult diabetic patients was interviewed at the Outpatient Clinic for diabetic patients of the University Hospital of the West Indies to examine the effects of severity of the illness and social variables, such as facilities at home, education attained, employment status, informal medication, and understanding of the illness in relation to its control.

Patients were classified as severe if there were clinical evidence of vascular or neurologic complications of diabetes and as mild if there were no complications. Control of diabetes was regarded as good if the patients were free from or had less than 2+ glycosuria and as poor if they had had 2+ or more glycosuria during the six months before the study.

We found that the quality of control was mainly determined by the severity of the disease. In the mild diabetic, proper diabetic control was not influenced by any social variable examined. In the severe diabetic the quality of control was associated with social amenities, educational status, employment status, and understanding of the disease.
Gastrointestinal Manifestations of Diabetes Mellitus
Authors: Taub Sheldon , Mariani Anthony , Barkin Jamie S
Published: March 2007

This review briefly outlines the gastrointestinal manifestations of diabetes mellitus. Usually, gastrointestinal abnormalities are asymptomatic. Severe gastrointestinal dysfunction may be quite debilitating, however. Gastrointestinal symptoms that are a consequence of diabetes may be confused with other primary gastrointestinal disorders. We attempt to provide a clinical approach to differentiating the basis of symptoms and outline the therapeutic plan that we generally employ. Much additional research is necessary to clarify our understanding of the pathophysiology of the gastrointestinal complications of diabetes and to develop improved therapeutic strategies.
Motivational Interviewing to Improve Adherence to a Behavioral Weight-Control Program for Older Obese Women With NIDDM: A pilot study
Authors: Smith Delia E , Heckemeyer Christine M , Kratt Polly P , Mason Dehryl A
Published: March 2007

OBJECTIVE

The aim of this randomized pilot study was to examine whether the addition of motivational interviewing strategies to a behavioral obesity intervention enhances adherence and glucose control in older obese women with NIDDM.

RESEARCH DESIGN AND METHODS

Twenty-two older obese women (41% black) with NIDDM were randomly assigned to 1) a standard 16-week group behavioral weight-control program that provided instruction in diet, exercise, and behavioral modification or 2) the same group behavioral program with three individualized motivational interviewing sessions added.

RESULTS

The motivational group attended significantly more group meetings (13.3 vs. 8.9), completed significantly more food diaries (15.2 vs. 10.1), and recorded blood glucose significantly more often (46.0 vs. 32.2 days) than the standard group. Further, participants in the motivational group had significantly better glucose control post-treatment (9.8 vs. 10.8%). Although both groups demonstrated significant weight loss, no differences were apparent between groups.

CONCLUSIONS

These results suggest that augmenting a standard behavioral treatment program for obese women with NIDDM with a motivational interviewing component may significantly enhance adherence to program recommendations and glycemic control. Preliminary data warrant further investigation with larger samples and a longer follow-up.
Chronic Administration of Levosulpiride and Glycemic Control in IDDM Patients With Gastroparesis
Authors: Melga Pierluigi , Mansi Carlo , Ciuchi Emanuela , Giusti Roberta , Sciabà Luigi , Prando Romano
Published: March 2007

OBJECTIVE

We evaluated the effect of chronic administration of levosulpiride, a prokinetic drug that is a selective antagonist for D2 dopamine receptors, on the glycemic control of IDDM subjects.

RESEARCH DESIGN AND METHODS

The study was performed on 40 long-standing IDDM subjects with clinical signs of autonomic neuropathy and delayed gastric emptying. Gastric emptying time and glycemic parameters (diurnal glycemic profile and HbA1c) were checked under double-blind conditions before and after the administration of levosulpiride at the dosage of 25 mg t.i.d. orally for 6 months, or placebo.

RESULTS

No significant differences were noted in the glycemic and HbA1c values before and after 6 months of placebo administration. In contrast, after 6 months of levosulpiride, glycemic control had improved (HbA1c 6.7 ± 0.4 and 5.7 ± 0.3%, P < 0.01; mean daily glycemia 10.9 ± 0.8 and 8.8 ± 0.4 mmol/l, P < 0.05, at the start and at the end of the study), while the dosage of injected insulin (0.65 ± 0.02 IU · kg−1 · day−1) and the number of severe hypoglycemic episodes remained unchanged. After 6 months of levosulpiride therapy, the time of gastric emptying was significantly reduced from 321 ± 14 to 261 ± 9 min (P < 0.001) and dyspeptic symptoms had improved.

CONCLUSIONS

Our results show the importance of gastric emptying in the maintenance of glycemic control and the usefulness of chronic administration of levosulpiride in diabetic subjects with gastroparesis.
The Effects of Health Beliefs on Weight Loss in Individuals at High Risk for NIDDM
Authors: Polley Betsy A , Jakicic John M , Venditti Elizabeth M , Barr Susan , Wing Rena R
Published: March 2007

OBJECTIVE

To determine whether perceived risk and other health beliefs held by individuals at high risk for developing NIDDM predict weight loss and behavior change during a behavioral weight loss program to reduce the risk of NIDDM.

RESEARCH DESIGN AND METHODS

Health beliefs and objective risk factors for diabetes were examined in 154 overweight men and women with a family history of NIDDM. The effects of these factors on adherence, dietary intake, weight loss, and changes in glucose levels were examined in a subset of 79 of these subjects who participated in a 2-year behavioral weight control program.

RESULTS

Those subjects who perceived themselves at highest risk of developing diabetes had a stronger family history of the disease and were more likely to be women than subjects considering themselves at more moderate risk. These participants also rated diabetes as a more serious disease, but were less likely to believe that weight loss would lower their risk. None of these health beliefs were related to attendance at meetings, dietary intake, weight loss, or fasting glucose, but higher perceived seriousness predicted larger reductions in BMI at 1 year. Of the objective risk factors for NIDDM, higher baseline BMI predicted larger weight losses throughout the program, and a stronger family history of diabetes was related to greater weight regain after an initial weight loss.

CONCLUSIONS

Perceived risk of developing diabetes and other health beliefs did not predict performance in a behavioral weight loss program. These data suggest that efforts to modify health beliefs by educating high-risk individuals about their risk and benefits of weight loss may not be effective in improving long-term weight loss results.
Epidemiology, Clinical Aspects, and Biology of IDDM Patients Under Age 40 Years: Comparison of data from Antwerp with complete ascertainment with data from Belgium with 40% ascertainment. The Belgian Diabetes Registry
Authors: Vandewalle Christina L , Coeckelberghs Marina I , De Leeuw Ivo H , Caju Marc V Du , Schuit Frans C , Pipeleers Daniel G , Gorus Frans K
Published: March 2007

OBJECTIVE

To compare the incidence rate of IDDM in the age-groups 0–14 and 15–39 years in Antwerp, Belgium, and to compare demographic, clinical, and biological data from Antwerp IDDM patients with 92% ascertainment with those from a larger Belgian patient group with 40% ascertainment.

RESEARCH DESIGN AND METHODS

Incident cases of IDDM were reported by physicians of the Belgian Diabetes Registry and in Antwerp by several other sources. In Antwerp, completeness of ascertainment was calculated by the capture-recapture method. Demographic and clinical data were collected by questionnaire. Blood was sampled for HLA-DQ genotyping and, in new-inset patients, for autoantibodies.

RESULTS

In Antwerp, the age- and sex-standardized IDDM incidence rates were similar in both age-groups (0–14 years: 11.8/100,000; 15–39 years: 8.9/100,000). The incidence rate decreased in girls above age 15 years (6.9/100,000; P = 0.003) but not in boys (11.0/100,000). Both in Antwerp and Belgium, IDDM was diagnosed more frequently in the 15–39 years age-group (60% of all cases) than under age 15 years, with a lower prevalence of acute symptoms, ketonuria, high-risk HLA-DQ genotype, and autoantibodies against insulin, islet cells, and IA-2, but with a higher prevalence of GAD65 autoantibodies.

CONCLUSIONS

In Antwerp, the incidence rate of IDDM under age 15 years is intermediately high compared with the rates in other European regions. It is similar in the 15–39 years age-group, but with a marked male predominance. Demographic, clinical, and biological data show the same age-dependent heterogeneity as the data collected nationwide, with 40% ascertainment indicating the representativeness of the latter.
Multicenter Evaluation of the Micral-Test II Test Strip, an Immunologic Rapid Test for the Detection of Microalbuminuria
Authors: Mogensen Carl E , Viberti Gian C , Peheim Edgar , Kutter Dolphe , Hasslacher Christoph , Hofmann Walter , Renner Rolf , Bojestig Mats , Poulsen P Logstrup , Scott Graham , Thoma John , Kuefer Juergen , Nilsson B , Gambke Brigitte , Mueller Peter , Steinbiss Joachim , Willamowski Klaus-Dieter
Published: March 2007

OBJECTIVE

To assess the performance of the Micral-Test II immunologic test strip for the detection of microalbuminuria, a multicenter evaluation in eight European study sites was performed.

RESEARCH DESIGN AND METHODS

Using both the Micral-Test II test strip and the routine method for the determination of albumin concentration, we investigated 2,228 urine samples from diabetic patients. Additionally, interperson variability, color stability, and possible interfering factors (temperature, pH, leucocyturia, erythrocyturia, and drugs) were tested.

RESULTS

For a cutoff concentration of 20 mg/l with respect to the routine methods, a sensitivity of 96.7% and a specificity of 71% were calculated for the Micral-Test II test strip. The negative predictive value was 0.95, and the positive predictive value was 0.78, with a prevalence of positive samples (laboratory method) of 52%. The interperson variability of color interpretation showed 93% concordant readings. The interference study showed an influence of oxytetracycline, leading to higher readings. There was no interference from pH. A sample temperature of <10 degrees C led to lower readings. In the case of samples with massive leucocyturia and erythrocyturia that may delete the chromatographic process, waiting an additional 1-2 min is needed before reading.

CONCLUSIONS

The results of the multicenter evaluation show that the Micral-Test II test strip permits an immediate and reliable semiquantitative determination of low albumin concentrations in urine samples with an almost user-independent color interpretation.
Prevalence of Diabetes and Its Risk Factors in China, 1994
Authors: Pan Xiao-Ren , Yang Wen-Ying , Li Guan-Wei , Liu Juan ,   National Diabetes Prevention and Control Cooperative Group
Published: March 2007

OBJECTIVE

To determine the prevalence of diabetes and impaired glucose tolerance (IGT) and its risk factors in the Chinese population.

RESEARCH DESIGN AND METHODS

This study was a population-based cross-sectional study of 224,251 residents aged 25–64 years in 19 provinces and areas, including cities and rural areas of the north, south, east, and middle part of China.

RESULTS

Using the 1985 World Health Organization criteria, the prevalence of diabetes and IGT was 2.5 and 3.2%, respectively, in 213,515 subjects aged 25–64 years. Two thirds (70.3%) of the cases had newly recognized diabetes. The prevalence of diabetes in China is about three times higher than it was 10 years ago. On average, subjects with diabetes are older, have higher personal annual incomes, and more often have a family history of diabetes. They also have higher mean BMI, waist-to-hip ratio (WHR), systolic blood pressure, diastolic blood pressure, and a greater prevalence of hypertension. They perform less physical activity and have less education than people with normal oral glucose tolerance test results. Multiple logistic stepwise regression analysis shows that age, BMI (or WHR), family history of diabetes, hypertension, less physical activity, and higher annual income are independent risk factors of NIDDM, and that low education is also an independent risk factor of NIDDM in people with higher personal annual income.

CONCLUSIONS

The prevalence of diabetes in China is increasing with economic development and changes from traditional to modernized lifestyle, especially where people had lower level of education and socioeconomic development. Therefore, Chinese people should attempt to retain certain features of their traditional lifestyle (physical activity, healthy food, moderate body weight). Increased knowledge of risk factors for diabetes may help to prevent a further rapid increase in the prevalence of diabetes in China.
Pronounced Insulin Resistance and Inadequate β-cell Secretion Characterize Lean Gestational Diabetes During and After Pregnancy
Authors: Kautzky-Willer Alexandra , Prager Rudolf , Waldhäusl Werner , Pacini Giovanni , Thomaseth Karl , Wagner Oswald F , Ulm Martin , Streli Carola , Ludvik Bernhard
Published: March 2007

OBJECTIVE

To evaluate β-cell secretion and glucose metabolism in lean subjects with gestational diabetes mellitus (GDM) compared with that in subjects with normal pregnancy and obesity.

RESEARCH DESIGN AND METHODS

Insulin secretion, insulin sensitivity (S1), and hepatic insulin extraction were assessed in pregnant women with GDM before and after delivery and in those with normal glucose tolerance (NGT) in comparison to healthy nonpregnant lean and obese women. Kinetic analysis of glucose, insulin, and C-peptide plasma concentrations during oral and intravenous glucose tolerance tests was performed by mathematical modeling.

RESULTS

S1 was blunted in pregnant women with GDM by 84% and in those with NGT by 66% compared with lean nonpregnant women (P < 0.005 vs. healthy nonpregnant lean control subjects; P < 0.05, GDM vs. pregnant women with NGT), whereas glucose effectiveness was decreased by 33% in both pregnant groups (P < 0.05 vs. healthy nonpregnant lean control subjects). Insulin secretion was 30% higher (P < 0.05) in subjects with GDM than in pregnant women with NGT or in nonpregnant lean women, but decreased (P < 0.005) when compared with obese women with a comparable degree of insulin resistance. Fractional hepatic insulin extraction was similar in both pregnant groups, being lower (P < 0.0001) by 30% versus nonpregnant females. β-cell sensitivity to glucose for insulin release was decreased in subjects with GDM versus pregnant women with NGT as well as nonpregnant women by 40-50% (P < 0.01). Twelve weeks after delivery, GDM returned to normal glucose tolerance, but S1 remained 50% lower than that in lean nonpregnant women, while β-cell sensitivity to glucose did not change (P < 0.01 vs. healthy nonpregnant lean control subjects).

CONCLUSIONS

Pregnancy is characterized by insulin resistance, diminished hepatic insulin extraction, and glucose effectiveness. Lean subjects with GDM are additionally characterized by having more pronounced insulin resistance and inadequate insulin secretion, which persist after delivery. Compared with other insulin-resistant prediabetic states like impaired glucose tolerance (IGT), defective insulin secretion seems to be a predominant defect in lean GDM subjects, indicating that it might represent a specific prediabetic condition.
Diabetes and Accident Insurance: A 3-year follow-up of 7,599 insured diabetic individuals
Authors: Mathiesen Bent , Borch-Johnsen Knut
Published: March 2007

OBJECTIVE

Individuals with diabetes pay increased premiums and experience limited coverage when taking out accident insurance, despite the lack of scientific support for this practice. The aim of the present study was to analyze whether diabetic individuals have an increased risk of accident or an increased risk of permanent disability after an accident, compared with two nondiabetic groups.

RESEARCH DESIGN AND METHODS

All diabetic members of the Danish Diabetes Association were given free accident insurance for a 3-year period. Based on informed consent, they were also asked to participate in a follow-up study, comparing accident rates in diabetic individuals with a nondiabetic group. A total of 7,599 diabetic members accepted. The control groups were 1) individuals with a leisure-time insurance in the same company (individual issue) and 2) members of full-time group-based insurance (bank employees) in the same company.

RESULTS

The risk of accidents was 0.7 per 1,000 person-years in the diabetic group, compared with 4.5 per 1,000 person-years in the first and 5.5 per 1,000 person-years in the second nondiabetic control group (P < 0.001). The degree of permanent injury did not differ between the diabetic and the nondiabetic group.

CONCLUSIONS

The risk of accidents and permanent disability is not increased in diabetic individuals. Thus, diabetic individuals should be offered accident insurance at a standard premium without limited coverage.