bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of IDDM in German Children Aged 0–14 years: A 6-year population-based study (1987–1993)
Authors: Neu Andreas , Kehrer Martin , Hub Regine , Ranke Michael B
Published: March 2007

OBJECTIVE

Generally accepted data on the incidence of childhood diabetes in Germany have not been available up to now. To register the total number of newly diagnosed cases in Baden-Wuerttemberg (a federal state in southwest Germany), data on 1,160 children were retrospectively collected for the years 1987–1993.

RESEARCH DESIGN AND METHODS

Hospital records were the primary data source. There were 32 hospital units in Baden-Wuerttemberg included in this study. A secondary independent data source was a questionnaire circulated among the patients' association, Deutscher Diabetiker Bund. Case definition was done according to criteria EURODIAB ACE, a collaborative European study set up to assess the incidence of childhood diabetes. The degree of ascertainment was 96.2%, using the capture-mark-recapture method. The study includes a population at risk, entailing 1.5 million children, corresponding to 12.3% of all German children.

RESULTS

The incidence was found to be 11.6/100,000 (95% CI 10.9–12.2) for children aged 0–14 years. There was no significant difference between the incidence rates of boys and girls. Seasonal variation was observed, with cases increasing between November and February and incidence increasing with age. Peaks were found in early childhood (3–4 years of age) and prepuberty (10–12 years of age). There was marked geographical variation that did not correlate significantly with population density.

CONCLUSIONS

For the first time, internationally comparable data on the incidence of diabetes in children up to 15 years of age are available for Germany. The yearly incidence of 11.6/100,000 proved to be much higher than assumed so far.
Effects of Diet and Exercise in Preventing NIDDM in People With Impaired Glucose Tolerance: The Da Qing IGT and Diabetes Study
Authors: Pan Xiao-Ren , Li Guang-Wei , Hu Ying-Hua , Wang Ji-Xing , Yang Wen-Ying , An Zuo-Xin , Hu Ze-Xi , Juan-Lin  , Xiao Jina-Zhong , Cao Hui-Bi , Liu Ping-An , Jiang Xi-Gui , Jiang Ya-Yan , Wang Jin-Ping , Zheng Hui , Zhang Hui , Bennett Peter H , Howard Barbara V
Published: March 2007

OBJECTIVE

Individuals with impaired glucose tolerance (IGT) have a high risk of developing NIDDM. The purpose of this study was to determine whether diet and exercise interventions in those with IGT may delay the development of NIDDM, i.e., reduce the incidence of NIDDM, and thereby reduce the overall incidence of diabetic complications, such as cardiovascular, renal, and retinal disease, and the excess mortality attributable to these complications.

RESEARCH DESIGN AND METHODS

In 1986, 110,660 men and women from 33 health care clinics in the city of Da Qing, China, were screened for IGT and NIDDM. Of these individuals, 577 were classified (using World Health Organization criteria) as having IGT. Subjects were randomized by clinic into a clinical trial, either to a control group or to one of three active treatment groups: diet only, exercise only, or diet plus exercise. Follow-up evaluation examinations were conducted at 2-year intervals over a 6-year period to identify subjects who developed NIDDM. Cox's proportional hazard analysis was used to determine if the incidence of NIDDM varied by treatment assignment.

RESULTS

The cumulative incidence of diabetes at 6 years was 67.7% (95% CI, 59.8–75.2) in the control group compared with 43.8% (95% CI, 35.5–52.3) in the diet group, 41.1% (95% CI, 33.4–49.4) in the exercise group, and 46.0% (95% CI, 37.3–54.7) in the diet-plus-exercise group (P < 0.05). When analyzed by clinic, each of the active intervention groups differed significantly from the control clinics (P < 0.05). The relative decrease in rate of development of diabetes in the active treatment groups was similar when subjects were stratified as lean or overweight (BMI < or ≥ 25 kg/m2). In a proportional hazards analysis adjusted for differences in baseline BMI and fasting glucose, the diet, exercise, and diet-plus-exercise interventions were associated with 31% (P < 0.03), 46% (P < 0.0005), and 42% (P < 0.005) reductions in risk of developing diabetes, respectively.

CONCLUSIONS

Diet and/or exercise interventions led to a significant decrease in the incidence of diabetes over a 6-year period among those with IGT.
Dietary Fiber, Glycemic Load, and Risk of NIDDM in Men
Authors: Salmerón Jorge , Ascherio Alberto , Rimm Eric B , Colditz Graham A , Spiegelman Donna , Jenkins David J , Stampfer Meir J , Wing Alvin L , Willett Walter C
Published: March 2007

OBJECTIVE

Intake of carbohydrates that provide a large glycemic response has been hypothesized to increase the risk of NIDDM, whereas dietary fiber is suspected to reduce incidence. These hypotheses have not been evaluated prospectively.

RESEARCH DESIGN AND METHODS

We examined the relationship between diet and risk of NIDDM in a cohort of 42,759 men without NIDDM or cardiovascular disease, who were 40–75 years of age in 1986. Diet was assessed at baseline by a validated semiquantitative food frequency questionnaire. During 6-years of follow-up, 523 incident cases of NIDDM were documented.

RESULTS

The dietary glycemic index (an indicator of carbohydrate's ability to raise blood glucose levels) was positively associated with risk of NIDDM after adjustment for age, BMI, smoking, physical activity, family history of diabetes, alcohol consumption, cereal fiber, and total energy intake. Comparing the highest and lowest quintiles, the relative risk (RR) of NIDDM was 1.37 (95% CI, 1.02–1.83, P trend = 0.03). Cereal fiber was inversely associated with risk of NIDDM (RR = 0.70; 95% CI, 0.51–0.96, P trend = 0.007; for > 8.1 g/day vs. < 3.2 g/day). The combination of a high glycemic load and a low cereal fiber intake further increased the risk of NIDDM (RR = 2.17, 95% CI, 1.04–4.54) when compared with a low glycemic load and high cereal fiber intake.

CONCLUSIONS

These findings support the hypothesis that diets with a high glycemic load and a low cereal fiber content increase risk of NIDDM in men. Further, they suggest that grains should be consumed in a minimally refined form to reduce the incidence of NIDDM.
Alternate Site Testing for HbA1c Using the Primus CLC330 GHb Analyzer
Authors: Phillipov George , Charles Peter , Beng Clive , Phillips Patrick J
Published: March 2007

OBJECTIVE

To determine whether the Primus high-pressure liquid chromatography (HPLC) is suited to alternate site testing (AST) for HbA1c in a hospital diabetes outpatient clinic.

RESEARCH DESIGN AND METHODS

Patients were attending the clinic for routine management of their diabetes. A number of diabetic patients with uremia (n = 11) were also investigated. HbA1c levels were measured in the outpatient setting by the Primus HPLC and in a more limited study the DCA-2000 instrument using the new 6-min assay cartridge. HbA1c measurements were also performed with Pierce affinity minicolumns and a Bio-Rad Variant HPLC.

RESULTS

The Primus HPLC assay had low imprecision of 2.3, 1.6, and 1.0% for HbA1c levels of 4.7, 7.3, and 11.1%, respectively, and was not prone to interference by carbamylated hemoglobin as found for the ion-exchange Variant HPLC method. Method comparison studies showed that the bias and proportional error between the Pierce affinity minicolumn procedure (standardized with respect to an external quality control program) and the Primus HPLC (Y) was −0.4 and 1.2% respectively (n = 32). Similarly the bias and proportional error between the Primus and DCA-2000 methods was 0.7 and −2.5%. The Primus was shown to give falsely elevated HbA1c concentrations if the time between sequential injections was > 28 min.

CONCLUSIONS

The Primus HPLC has a decided advantage over specialty AST instruments, like the DCA-2000, in not only meeting AST requirements but also allowing rapid automated batch processing of all laboratory HbA1c samples.
Catheter Survival During Long-Term Insulin Therapy With an Implanted Programmable Pump
Authors: Scavini Marina , Galli Laura , Reich Sanford , Eaton R Philip , Charles M Arthur , Dunn Fredrick L ,   The Implantable Insulin Pump Trial Study Group
Published: March 2007

OBJECTIVE

To survey catheter complications and to analyze catheter survival during long-term intraperitoneal and intravenous insulin therapy with an implanted programmable pump with a sideport.

RESEARCH DESIGN AND METHODS

Catheter occlusions were documented by measuring dynamic catheter resistance. Catheter migrations or breaks were demonstrated by × ray. When flushing the catheter with buffer solution through the sideport failed to clear the occlusion, catheters were replaced or laparoscopy was performed for the excision of fibrous tissue growth. Broken or migrated catheters were replaced.

RESULTS

Occlusions were the most common catheter complications, and the majority of them (79% intraperitoneal and 84% intravenous) were cleared by flushing the catheter. Survival at 3 years was significantly higher for intraperitoneal catheters compared with intravenous catheters (60% intraperitoneal and 22% intravenous).

CONCLUSIONS

Nonsurgical management of catheter occlusions contributed to extend catheter lifetime. Intraperitoneal catheters have a lower morbidity and a higher survival than intravenous catheters.
Effect of Long-Acting Somatostatin Analog (Somatulin) on Renal Hyperfiltration in Patients With IDDM
Authors: Jacobs Marloes L , Derkx Frans H M , Stijnen Theo , Lamberts Steven W J , Weber Rob F A
Published: March 2007

OBJECTIVE

To investigate whether long-acting somatostatin (SMS) can suppress renal hyperfiltration in patients with IDDM.

RESEARCH DESIGN AND METHODS

A double-blind, randomized treatment of nine patients with IDDM was used. Selection criteria were renal hyperfiltration (glomerular filtration rate [GFR] ≥ 129 ml · min−1 · 1.73 m2) and absence of hypertension and macroalbuminuria. Treatment was either with a long-acting SMS analog (Somatulin, 30 mg) or with placebo, given by intramuscular injections every 10 days for 9 months. GFR, effective renal plasma flow (ERPF), IGF-I, and 24-h growth hormone (GH) profiles were used as evaluation parameters.

RESULTS

Five patients were randomized to Somatulin, four patients to placebo. One of the patients treated with Somatulin stopped after 3 months because of persistent abdominal discomfort after the injections. Somatulin treatment for 3 months lowered GFR and ERPF compared with placebo (P < 0.05). After 9 months, the differences were no longer significant. After 3 months, IGF-I concentrations were decreased in all Somatulin-treated patients. GH secretion tended to increase in the placebo group.

CONCLUSIONS

The administration of long-acting Somatulin to patients with IDDM and renal hyperfiltration leads to only a temporary reduction of ERPF/GFR.
Fluctuations in GAD65 Antibodies After Clinical Diagnosis of IDDM in Young Children
Authors: Batstra Manou R , Pina Mònica , Quan Joanne , Mulder Paul , de Beaufort Carine E , Bruining G Jan , Aanstoot Henk-Jan
Published: March 2007

OBJECTIVE

To investigate whether the presence of GAD antibodies at onset of IDDM correlates to a more aggressive rate of β-cell destruction after clinical onset.

RESEARCH DESIGN AND METHODS

We studied GAD antibodies at onset of disease, after 1 year, and after 6 years in 33 consecutively referred children (mean age 8.08, range 1.7–16.3). In a subset of 11 patients, GAD antibodies were studied very frequently. The correlation between GAD antibodies and clinical parameters, including glycosylated hemoglobin, residual insulin secretion, and insulin dosage, was evaluated.

RESULTS

GAD antibody titers were highly variable. Four patients became GAD antibody positive weeks to years after clinical onset. Other patients switched between testing positive and negative for GAD antibodies shortly after clinical onset. No correlation was found between the presence of GAD antibodies and the rate of β-cell destruction, but patients with high GAD antibody indexes at onset had significantly higher glycosylated hemoglobin levels.

CONCLUSIONS

GAD antibodies at clinical onset do not predict the rate of β-cell destruction in young children with newly diagnosed IDDM. The highly variable GAD antibody levels suggest variation of the autoimmune process.
Given Diabetes, Is Fat Better Than Thin?
Authors: Ross Carolyn , Langer Robert D , Barrett-Connor Elizabeth
Published: March 2007

OBJECTIVE

To evaluate the association between BMI and mortality in women and men with type II diabetes.

RESEARCH DESIGN AND METHODS

Fasting plasma glucose (FPG), height and weight measurements, and medical history were obtained from 4,483 community-dwelling adults, aged 40–79 years, in 1972–1974. A total of 373 persons with either a history of diabetes or FPG ≥ 7.77 mmol/l were studied. Subjects were grouped into four sex-specific weight categories based on U.S. population data. Vital status after 14 years was known for 99.9% of the patients studied. Cox models were used to assess relative survival by weight category.

RESULTS

Diabetic men and women of average weight had the lowest mortality. A J-shaped relative risk curve by weight category was found, with a poorer survival rate for those who were thin, overweight, or obese. This effect was not explained by early mortality or cigarette smoking.

CONCLUSIONS

Being thin may not provide a mortality benefit for diabetic men and women. Average weight appears to be desirable.
Diabetes in Urban African-Americans. IX. Provider Adherence to Management Protocols
Authors: El-Kebbi Imad M , Ziemer David C , Musey Victoria C , Gallina Daniel L , Bernard Annette M , Phillips Lawrence S
Published: March 2007

OBJECTIVE

Staged diabetes management should permit glycemic goals to be attained in a timely manner, but the success of such an approach requires conformity by health care providers. To test performance, we analyzed the adherence of practitioners to a protocol for staged management of NIDDM patients.

RESEARCH DESIGN AND METHODS

Records of patients treated at the Grady Memorial Hospital Diabetes Clinic were reviewed retrospectively over a 3-year period. For each patient, intensification of therapy was indicated if fasting plasma glucose was > 7.8 mmol/l and a prior HbA1c was > 7.0%. Protocols dictated a progression from dietary therapy alone to increasing dosages of sulfonylureas to increasing dosages of insulin. Patients were seen at bimonthly intervals.

RESULTS

During the 3-year period, 1,051 patient visits met protocol criteria for intensification. Adherence to the protocol improved significantly in the 3rd year compared with the first 2 years (30, 31, and 47% adherence in the 1st, 2nd, and 3rd years, respectively). Patients treated with diet alone were significantly less likely to have their therapy intensified than patients on sulfonylureas or insulin (intensification rates 25, 41, and 47%, respectively). In the management of patients treated with diet alone, practitioners were reluctant to intensify therapy at early visits, but were more likely to do so later, 19% of patients beyond goal range at the 2-month visit were started on pharmacological therapy vs. 28% at the 4-month visit, and 39% at the 6-month visit (P < 0.01). In contrast, there was no significant difference in the frequency of therapy intensification between early and late visits for patients on sulfonylureas or insulin. Practitioners appeared to base the decision to intensify on the fasting plasma glucose level more than on the most recent HbA1c. Age did not appear to be a significant factor in the decision to intensify.

CONCLUSIONS

Although staged management protocols constitute critical tools to achieve glycemic goals, the adherence of health care providers may be suboptimal. Special efforts may be needed to assure compliance.
Contribution of Central Neuropathy to Postural Instability in IDDM Patients With Peripheral Neuropathy
Authors: Uccioli Luigi , Giacomini Pier Giorgio , Pasqualetti Patrizio , Girolamo Stefano Di , Ferrigno Paola , Monticone Giovanna , Bruno Ernesto , Boccasena Paolo , Magrini Antonio , Parisi Leoluca , Menzinger Guido , Rossini Paolo Maria
Published: March 2007

OBJECTIVE

To evaluate the contribution of central neuropathy on postural impairment observed in diabetic patients with peripheral neuropathy.

RESEARCH DESIGN AND METHODS

Central sensory and motor nervous propagation, nerve conduction velocity, and static posturography were assessed in the following age-matched subjects: 7 IDDM patients with peripheral neuropathy (group DN), 18 IDDM patients without peripheral neuropathy (group D), and 31 control subjects (group C). Somatosensory-evoked potentials (SEPs) during tibial nerve stimulation were recorded, and the spine-to-scalp sensory central conduction time (SCCT) was evaluated. Motor-evoked potentials (MEPs) were recorded from leg muscles during magnetic transcranial brain stimulation, and the scalp-to-spine motor central conduction time (MCCT) was evaluated. The following posturographic parameters were calculated from the statokinesigram: trace length, trace surface, velocity of body sway with its standard deviation, and VFY (a parameter derived from the velocity variance and the anteroposterior mean position of the body).

RESULTS

SCCT was significantly higher in the DN group than in the C and D groups (P < 0.001). MCCT was similar in all groups. Posturographic parameters were all significantly impaired in the DN group (P < 0.01). While posturographic parameters showed a direct relationship with some parameters of peripheral nerve conduction, no correlations were observed with SEP and MEP central conduction time. These results were also confirmed by logistic regression, which indicates peripheral neuropathy as the only implicating factor in postural instability (odds ratio 0.22, 95% CI 0.07–0.75) after data reduction by means of factor analysis.

CONCLUSIONS

Although diabetic patients with peripheral neuropathy show a delay in central sensory conduction, postural instability may be fully explained by the presence of peripheral neuropathy.
A Prospective Study of Coronary Heart Disease in Relation to Fasting Insulin, Glucose, and Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Folsom Aaron R , Szklo Moyses , Stevens June , Liao Fangzi , Smith Robert , Eckfeldt John H
Published: March 2007

OBJECTIVE

To determine the association of coronary heart disease (CHD) incidence with diabetes, fasting serum glucose, and insulin in a biracial cohort of middle-aged men and women.

RESEARCH DESIGN AND METHODS

We examined a population-based sample (n = 13,446 free of baseline CHD) from four U.S. communities in 1987–1989. We defined diabetes on the basis of baseline fasting glucose concentration (≥ 7.8 mmol/l), medical history, and current medications. A central laboratory measured fasting insulin with a nonspecific radioimmunoassay. After 4–7 years, 209 men and 96 women developed CHD.

RESULTS

After adjustment for sociodemographic characteristics, smoking status, ethanol intake, sports participation, and hormone replacement therapy, the relative risk of CHD for people with diabetes versus those without diabetes was 3.45 (95% CI 2.16–5.50) among women and 2.52 (1.78–3.56) among men. Relative risks of CHD with diabetes were somewhat lower in blacks than non-blacks, but because diabetes was more than twice as prevalent in blacks, the percentage of CHD cases attributable to diabetes (population attributable risk) was 27% for black women, 15% for non-black women, 8% for black men, and 12% for non-black men. Among people without diabetes, fasting glucose was not independently associated with CHD incidence. Among women without diabetes, there was a positive association between fasting insulin and CHD; multivariable adjusted relative risks of CHD across quintiles of fasting insulin were 1.00, 0.76, 2.08, 2.08 and 2.82 (P for linear trend = 0.02). However, among men without diabetes, fasting insulin and CHD were not associated.

CONCLUSIONS

Diabetes conveys a high risk of CHD in black and non-black middle-aged men and women. Fasting insulin, however, is a CHD risk factor only among women in this cohort.
A Trial of Cognitive Analytic Therapy in Poorly Controlled Type I Patients
Authors: Fosbury Jacqueline A , Bosley Catherine M , Ryle Anthony , Sönksen Peter H , Judd Susan L
Published: March 2007

OBJECTIVE

This study compared the effect of cognitive analytic therapy (CAT), a focused time-limited psychotherapy, and diabetes specialist nurse education (DSNE) in a controlled trial of 26 chronically poorly controlled adult type I patients.

RESEARCH DESIGN AND METHODS

Patients were randomized to either 16 sessions of CAT (treatment) or 14–18 sessions of DSNE (control). Pre- and post-treatment blood glucose control (HbA1), interpersonal difficulties, and diabetes knowledge were measured before and up to 9 months after treatment was completed.

RESULTS

Although HbA1 levels improved in the DSNE group, at the end of treatment (mean fall 1.2%, P = 0.004) this was not maintained; so by the 9-month follow-up, the overall net fall was limited to 0.9% (P = 0.03 vs. entry value). There were no significant improvements in interpersonal difficulties in DSNE subjects at any retest point (P > 0.05). In contrast, glycemic control and interpersonal difficulties both improved after CAT. In contrast to DSNE, this improvement continued so that at the 9-month follow-up visit, the changes were significant (mean fall in HbA1 = 2%, P = 0.002 and P = 0.03 for the Inventory of Interpersonal Problems [IIP] scores).

CONCLUSIONS

These results suggest that although there is no statistical difference between CAT and DSNE, the effects of CAT produce a more prolonged effect on glycemic control. If psychological difficulties underlying problems with self-care in a type I population are addressed, then improvements in diabetes control are likely to continue.
IDDM Incidence in a Multiracial Population: The Hawaii IDDM Registry, 1980–1990
Authors: Patrick Sarah L , Kadohiro Jane K , Waxman Sorrell H , Curb J David , Orchard Trevor J , Dorman Janice S , Kuller Lewis H , LaPorte Ronald E
Published: March 2007

OBJECTIVE

The Hawaii IDDM Registry was created to determine the incidence rate of IDDM among children aged < 15 years of Oahu between 1980 and 1990. Because of the multiracial population living in Hawaii, it is an ideal state in which to study the effect of migration on IDDM incidence.

RESEARCH DESIGN AND METHODS

Data were collected by a retrospective hospital chart review and physician survey. Registry criteria included 0–14 years of age at IDDM diagnosis and primary residence on Oahu. Children who were military dependents were excluded. Denominator data were compared from two sources.

RESULTS

A total of 113 new-onset IDDM cases were identified. Case ascertainment was 97%. The unadjusted annual incidence rate was 7.04–7.61 per 100,000 (95% CI 5.83–9.19), depending on which denominator source was used. Race- and ethnicity-specific rates varied greatly (all rates per 100,000): part Hawaiian, 15.34–16.58; Caucasian, 6.21–6.71; Filipino, 3.66–3.96; and Japanese, 2.85–3.08. Temporally, the incidence fluctuated between a low of 2.96 per 100,000 in 1981 to highs of 11.11 and 11.85 per 100,000 in 1985 and 1989, respectively. Ascertainment-corrected rates for these years (3.70, 11.76, and 13.48 per 100,000, respectively) show that the fourfold incidence increase between 1980 and 1989 was not due to ascertainment differences.

CONCLUSIONS

IDDM incidence among children < 15 years of age in Hawaii was the lowest documented in the U.S. The incidence among part-Hawaiian children was 2.5 times > that of Caucasian children in Hawaii. IDDM incidence rates among Japanese children in Hawaii were comparable with rates in Japan. The temporal variation in IDDM incidence corresponded with a mid-1980s pandemic of IDDM documented elsewhere.
Determinants of Progression of Microalbuminuria in Patients With NIDDM: A prospective study
Authors: Smulders Yvo M , Rakic Melina , Stehouwer Coen D A , Weijers Rob N M , Slaats Ed H , Silberbusch Joseph
Published: March 2007

OBJECTIVE

To assess the degree of interindividual variation in the rate of progression of microalbuminuria and to identify determinants of progression of microalbuminuria in patients with NIDDM.

RESEARCH DESIGN AND METHODS

In a prospective cohort study, 58 microalbuminuric NIDDM patients were followed for a period of at least 24 months. During this period, the level of microalbuminuria in these patients was assessed in triplicate 24-h urine samples on at least four separate visits. All patients had stable metabolic control and controlled blood pressure during follow-up. Microalbuminuria was defined as an albumin-to-creatinine ratio in 24-h urine of between 3 and 30 mg/mmol. The individual rates of progression of microalbuminuria were calculated from linear regression analysis. At baseline, the following data were collected for all patients: age, sex, ethnicity, time since diagnosis of NIDDM, smoking habits, drug use, blood pressure, BMI, HbA1c, serum creatinine, cholesterol, triglyceride, and HDL cholesterol concentrations.

RESULTS

Microalbuminuria was found to progress linearly in time. Considerable differences in rates of progression of microalbuminuria were found, the absolute yearly change in albumin-to-creatinine ratio ranging from −5.2 to 12.9 mg/mmol. In bivariate analyses, serum triglyceride concentration, use of ACE inhibitors, mean arterial blood pressure, HDL cholesterol, and time since diagnosis of NIDDM correlated with progression of microalbuminuria (P ≤ 0.05). In stepwise multiple regression analysis, a high triglyceride-to–HDL cholesterol ratio at baseline (P = 0.006) and the use of ACE inhibitors (P = 0.007) were identified as the only independent predictors of progression of microalbuminuria.

CONCLUSIONS

The rate of progression of microalbuminuria in NIDDM differs considerably between subjects. Diabetic dyslipidemia (high serum triglyceride and low HDL cholesterol) is a predictor of more rapid progression of microalbuminuria in patients with well-controlled blood pressure.
The Unchanging Incidence of Hospitalization for Diabetic Nephropathy in a Population-Based Cohort of IDDM Patients in Finland
Authors: Tuomilehto J , Borch-Johnsen K , Molarius A , Jormanainen V , Lounamaa R , Grönhagen-Riska C , Reunanen A , Sarti C
Published: March 2007

OBJECTIVE

Finland has the highest documented incidence of childhood IDDM in the world, but the incidence of diabetic nephropathy in Finland is unknown. The aim of the present study was to determine the incidence of hospitalization for diabetic nephropathy in a population-based cohort of Finnish IDDM patients and to analyze the prognostic effect of sex, age at diagnosis, and calendar year of diagnosis of IDDM.

RESEARCH DESIGN AND METHODS

We included all Finnish patients who had onset of IDDM before age 18 years, were diagnosed between January 1965 and December 1979 (n = 5,149), and were traced for hospitalizations between January 1970 and the end of December 1989 in the Hospital Discharge Register, using the unique personal identification code given to all Finnish citizens. The development of diabetic nephropathy was defined as the first hospitalization with a diagnosis of nephropathy (International Classification of Diseases-8th Revision [ICD-8] 250.04, or 9th Revision [ICD-9] 2503B/2503X).

RESULTS

Among the 5,149 patients included, we identified 446 cases of diabetic nephropathy. The incidence of hospitalization for diabetic nephropathy was very low during the first 8 years of diabetes duration, and after that increased to a maximum of 1.6–2.0% per year. Female subjects developed nephropathy slightly earlier than male subjects, but the cumulative risk was independent of sex. Patients diagnosed at ages 5–14 years had the highest risk of hospitalization for diabetic nephropathy. We observed no effect of calendar year of diagnosis.

CONCLUSIONS

We found a 20% cumulative incidence of hospitalization for diabetic nephropathy during a total 24 years of IDDM duration. This finding is compatible with the cumulative incidence of hospitalization for diabetic nephropathy found in other European populations. The incidence of hospitalization for diabetic nephropathy did not decrease during the 20-year observation period.
Low Prevalence of Antibodies to GAD65 in a 50- to 74-Year-Old General Dutch Population: The Hoorn Study
Authors: Ruige Johannes B , Batstra Manou R , Aanstoot Henk-Jan , Bouter Lex M , Bruining G Jan , De Neeling J Nico D , Heine Robert J
Published: March 2007

OBJECTIVE

To assess the prevalence of antibodies to GAD65 (GAD65-A) in relation to glucose tolerance disturbances and to blood glucose-lowering therapy in a general Dutch population.

RESEARCH DESIGN AND METHODS

A population sample of 2,350 Dutch subjects, age 50–74 years, agreed to undergo an oral glucose tolerance test (OGTT). They were classified as having normal glucose tolerance, impaired glucose tolerance, newly detected diabetes, or known diabetes. GAD65-A levels were measured in serum by means of a standardized radioligand assay and subsequently were expressed as indexes. The prevalence rates were defined as the proportions of individuals of each category of glucose tolerance exceeding the value of the index at the 99th percentile of the entire study population.

RESULTS

The prevalence rates and the 95% CIs of GAD65-A were 0.7% (0.4–1.2%) in cases of normal glucose tolerance, 2.4% (0.9–5.3%) in impaired glucose tolerance, 0% (0–3.3%) in newly detected diabetes, according to the World Health Organization (WHO) criteria, and 3.5% (0.7–10.0%) in known diabetes. A total of 2 out of 3 subjects with GAD65-A indexes above the 99th percentile and 10 out of 18 subjects with GAD65-A indexes above the 85th percentile received insulin therapy for their diabetes, which showed an association between GAD65-A and insulin therapy

CONCLUSIONS

Low prevalence rates of latent autoimmunity to GAD were found in 50- to 74-year-old Dutch subjects with normal and abnormal glucose tolerance, and GAD65-A was associated with insulin use in known diabetic subjects.
Blood Glucose Concentration Influences Postprandial Fullness in IDDM
Authors: Jones KL , Horowitz M , Berry M , Wishart JM , Guha S
Published: March 2007

OBJECTIVE

Upper gastrointestinal (GI) symptoms and delayed gastric emptying both occur frequently in patients with long-standing IDDM, but the relationship between them is relatively weak. Recent studies in normal subjects have indicated that blood glucose concentration may increase the perception of sensations arising from the upper GI tract. The purpose of this study was to examine the relationships among postprandial fullness, the rate of gastric emptying, and blood glucose concentration in IDDM patients.

RESEARCH DESIGN AND METHODS

We studied measurements of gastric emptying, blood glucose concentrations, cardiovascular autonomic nerve function, upper GI symptoms, and postprandial hunger and fullness in 40 IDDM patients (16 men, 24 women). ages 19–63 years. Gastric emptying of solids and liquids was measured scintigraphically, upper GI symptoms were measured by questionnaire immediately before ingestion of the test meal, and fullness and hunger were measured by visual analog scales every 15 min. Blood glucose concentrations were measured at −5, 30, 60, 90, and 120 min.

RESULTS

Solid gastric emptying was delayed in 58% of the patients, and both solid and liquid gastric emptying were slower (P < 0.05) in women than in men. The score for upper GI symptoms was not significantly related to gastric emptying. In contrast, postprandial fullness, but not hunger, was related to the amount of solid (r = 0.36, P < 0.05) but not liquid in the stomach. Both before (r = 0.39, P < 0.05) and after (r = 0.47, P < 0.01) the meal, fullness was related to blood glucose concentration. Postprandial fullness was also related to autonomic nerve dysfunction (r = 0.39, P < 0.05). Multiple regression analysis confirmed that blood glucose concentration, the rate of solid gastric emptying, and autonomic nerve dysfunction were independent determinants of postprandial fullness, together accounting for 47% of the variance.

CONCLUSIONS

These observations demonstrated that, in IDDM, postprandial fullness is influenced by blood glucose concentration, the rate of solid gastric emptying, and autonomic nerve function.
Incidence of Blindness in Relation to Diabetes: A population-based study
Authors: Trautner Christoph , Icks Andrea , Haastert Burkhard , Plum Frank , Berger Michael
Published: March 2007

OBJECTIVE

A reduction of diabetes-related blindness was declared a primary objective for Europe (St. Vincent Declaration). We collected data about incidence rates of blindness in the diabetic population compared with the nondiabetic population. Up to now, such data are scarce—even worldwide.

RESEARCH DESIGN AND METHODS

A complete list of newly registered blindness allowance recipients was drawn up in the district of Württemberg-Hohenzollern, Germany, between 1990 and 1993. From these data, we estimated age-specific and standardized incidence rates of blindness in the entire, the diabetic, and the nondiabetic population, as well as relative and attributable risks due to diabetes.

RESULTS

There were 2,714 people meeting the inclusion criteria; 1,823 (67.2%) were female and 781 (28.8%) had diabetes. In 318 subjects, diabetes was likely to be the only cause of blindness; in 192 subjects, it was one of several contributory causes. Age of women was 73.9 ± 19.4 years (mean ± SD) and of men 63.3 ± 25.5 years. Results standardized to the (West) German population are as follows: incidence rates (per 100,000 person-years): total population: 13.5; diabetic population: 60.6; nondiabetic population: 11.6; relative risk: 5.2; attributable risk among exposed: 0.81; and population attributable risk: 0.14. The relative risks decreased considerably with increasing age. When the study is repeated to monitor the St. Vincent targets, a reduction in the incidence rate of blindness in the diabetic population by 17% will be detected with 95% power.

CONCLUSIONS

Great relative and attributable risks, especially in younger age-groups, indicate the need for increased attention to preventive measures for microvascular complications.
Alanine and Terbutaline in the Prevention of Nocturnal Hypoglycemia in IDDM
Authors: Saleh Tarek Y , Cryer Philip E
Published: March 2007

OBJECTIVE

To test the hypothesis that because of sustained glycemic actions, bedtime administration of the glucagon-releasing amino acid alanine or the epinephrine-simulating β2-adrenergic agonist terbutaline more effectively prevents nocturnal hypoglycemia than a conventional bedtime snack, we studied 15 patients with 1DDM.

RESEARCH DESIGN AND METHODS

On each of four occasions, the same individualized dose of NPH insulin (0.1–0.2 U/kg) was administered with either no treatment (control) or, in random sequence, oral treatment with a snack (240 ml of 2% milk plus one slice of toast, ∼200 kcal), alanine (40 g, plus 10 g of glucose, ∼200 kcal), or terbutaline (5.0 mg) at 2200.

RESULTS

During the first half of the night (2315–0300), mean plasma glucose concentrations were higher after the snack (P < 0.02), alanine plus glucose (P < 0.01), or terbutaline (P < 0.001), compared with no treatment. During the second half of the night, mean plasma glucose levels were no different from control values (73 ± 5 mg/dl, 4.1 ± 0.3 mmol/1) after the snack (73 ± 7 mg/dl, 4.1 ± 0.4 mmol/1), tended to be higher after alanine plus glucose (96 ± 16 mg/dl, 5.3 ± 0.9 mmol/1), and were significantly higher after terbutaline (124 ± 15 mg/dl, 6.9 ± 0.8 mmol/1, P < 0.01). Nocturnal plasma glucose levels of 40 mg/dl (2.2 mmol/1) or less(which were treated with intravenous glucose) occurred on 13 occasions in seven patients in the control arm and 10 occasions in six patients in the snack arm (not significantly different from the control arm), but on only 1 occasion in the alanine-plus-glucose.arm (P < 0.02) and the terbutaline arm (P < 0.02).

CONCLUSIONS

In patients with 1DDM given an evening dose of NPH insulin, a conventional bedtime snack exerts an inconsistent glycemic effect only during the first half of the night, and bedtime administration of the glucagon-releasing amino acid alanine or the epinephrine- simulating β2-adrenergic agonist terbutaline more effectively prevents nocturnal hypoglycemia than a conventional bedtime snack.
The Role of Late-Onset Autoimmune Diabetes in White Familial NIDDM Pedigrees
Authors: Elbein Steven C , Wegner Kimberley , Miles Cindy , Yu Liping , Eisenbarth George
Published: March 2007

OBJECTIVE

To determine whether autoimmunity is a prominent feature of NIDDM among diabetic members in families with a strong history of NIDDM or in families with a mixture of NIDDM and IDDM.

RESEARCH DESIGN AND METHODS

We determined GAD and islet cell (ICA512) autoantibodies from 215 NIDDM individuals and from 14 individuals with impaired glucose tolerance (IGT) of 68 families, including 1 family with maturity-onset diabetes of the young (MODY) and 3 families ascertained specifically for a mixture of NIDDM and IDDM. We tested 2 control populations: 50 unrelated spouses form Utah families, including 29 spouses with either IGT or NIDDM and 198 random nondiabetic white individuals from Colorado.

RESULTS

We detected either GAD or ICA512 autoantibodies in 11 members of seven families and in one spouse used as a control subject. In two families, two affected individuals showed evidence of autoimmunity, but NIDDM individuals in each of the seven families showed no evidence of autoimmunity. Among the five families with both IDDM and NIDDM individuals (three families ascertained for a mixture and two families ascertained with an incidental IDDM child), antibodies were detected in members of only one family. Antibody-positive individuals were significantly younger at diabetes onset and had low waist-to-hip ratios, but were not more likely to be insulin treated.

CONCLUSIONS

Autoimmunity is an important cause of apparent NIDDM, even among families with a strong history of NIDDM. However, autoimmunity among affected family members appeared to be a chance event and not the manifestation of a different genetic cause of diabetes.
Independent Physiological Predictors of Foot Lesions in Patients With NIDDM
Authors: Litzelman Debra K , Marriott Deanna J , Vinicor Frank
Published: March 2007

OBJECTIVE

To identify and quantify independent physiological risk factors for foot lesions in diabetic patients.

RESEARCH DESIGN AND METHODS

There were 352 patients enrolled in a 1-year randomized controlled trial aimed at reducing risks for lower-extremity pathology through patient education and system interventions. Inclusion criteria were as follows: being age 40 years or over, being at or above ideal body weight, and having been diagnosed with NIDDM. Participants were predominantly African-American (76%), elderly (mean 60 years of age), indigent (77% with annual income < $10,000), or women (81%) who had diabetes for 10 years. Prospective multivariate modeling used baseline clinical signs (e.g., blood pressure, dermatological characteristics, and neuropathic measures) and laboratory values (e.g., lipid profiles and measures of glycemic control) to predict foot lesions rated using the Seattle Wound Classification.

RESULTS

When controlling for intervention effects, only measures of neuropathy (monofilament testing [odds ratio {OR} 2.75, 95% CI 1.55–4.88] and thermal sensitivity testing [2.18, 1.13–4.21]) predicted wounds classified 1.2 (minor injury), but investigation of wounds rated at least 1.3 (nonulcerated lesions) indicated baseline wounds (13.41), 3.19–56.26), monofilament abnormalities (5.23, 2.26–12.13), and low HDL (1.63, 1.11–2.39) as predictors. Although fungal dermatitis, dry cracked skin, edema, ingrown nails, microalbuminuria, fasting blood glucose, and hemoglobin A1c were candidates for one or both of the multivariable models (P < 0.3), they were not significant multivariate predictors.

CONCLUSIONS

Lesions may be preventable with aggressive screening for peripheral neuropathy and abnormal lipids. Also, these results provide empirical support for the commonly held belief that foot lesions prospectively predict future wounds.
Metabolic Efficacy of Preprandial Administration of Lys(B28), Pro(B29) Human Insulin Analog in IDDM Patients: A comparison with human regular insulin during a three-meal test period
Authors: Jacobs Maarten A J M , Keulen Erik T P , Kanc Karin , Casteleijn Sandrina , Scheffer Peter , Devillé Walter , Heine Robert J
Published: March 2007

OBJECTIVE

The objective of this study was to compare the efficacy of the rapid-acting Lys(B28), Pro(B29) human insulin analog, insulin lispro, with currently available short-acting human insulin in a multiple injection therapy (MIT) regimen with respect to blood glucose and plasma insulin profiles and to serum metabolites (lactate, free fatty acids, glycerol, and β-hydroxybutyrate) in 12 well-controlled type 1 diabetic subjects (8 male, HbA1c 6.8 ± 0.9% [mean ± SD]).

RESEARCH DESIGN AND METHODS

After a run-in period of 4 weeks, patients were treated with either lispro at mealtime or human insulin 30 min before the meal for two periods of 4 weeks in a randomized open-label crossover study. Intermediate-acting insulin (NPH insulin) was given at bedtime. At the end of both study periods, metabolic profiles were assessed from 10:00 P.M. to 7:00 P.M. the next day.

RESUlTS

During the treatment periods, glycemic control was stable during lispro but improved during human insulin (ΔHbA1c lispro 0.1 ± 0.48, NS; human insulin −0.41 ± 0.34%, P < 0.05). Glucose excursions, as measured by the incremental AUC, during the day and for the 2-h postprandial periods, were lower, although not significantly, for lispro. Insulin profiles demonstrated a faster rise after administration of lispro as compared with human insulin, peaking at 61 ± 11.9 and 111 ± 48.1 min (P < 0.01). Glycerol levels showed a slight increase before lunch and dinner, suggestive of enhanced lipolytic activity and compatible with the lower insulin levels.

CONCLUSIONS

Lispro insulin applied in an MIT regimen creates more physiologic insulin profiles and tends to lower the glycemic excursions during the day compared with short-acting insulin. The analog can be applied safely in an MIT regimen, with mealtime intervals up to 5 h.
Evaluation of the Efficacy and Tolerability of Nitrendipine in Reducing Both Pressure and Left Ventricular Mass in Hypertensive Type 2 Diabetic Patients
Authors: Scognamiglio Roldano , Nosadini Romano , Marin Marco , Nisti Stefano , Fasoli Giuseppe , Palisi Monica , Frigato Francesco , Virgili Flavio , Carraro Andrea , Crepaldi Gaetano
Published: March 2007

OBJECTIVE

To evaluate the efficacy and tolerability of nitrendipine in comparison with captopril in hypertensive diabetic patients with left ventricular hypertrophy (LVH).

RESEARCH DESIGN AND METHODS

A total of 75 patients enrolled in this study presented stable type 2 diabetes (not treated with insulin) and mild-to-moderate hypertension with a left ventricular mass ≥ 75 g/m2 by two-dimensional echocardiography. After a 4-week washout period, 38 patients were assigned to treatment with captopril, and 37 patients to nitrendipine (random allocation). The duration of follow-up was 36 weeks.

RESULTS

Patients of both groups were similar with regard to the duration of diabetes and hypertension, systolic and diastolic blood pressure at rest, degree of LVH, metabolic control, and albumin excretion rate (AER). Both drugs were equally effective in reducing systolic and diastolic blood pressure (captopril: from 165 ± 13/100 ± 4 to 147 ± 11/87 ± 4 mmHg; nitrendipine: from 167 ± 17/100 ± 5 to 143 ± 9/86 ± 4 mmHg; P < 0.05) and in reversing LVH (nitrendipine: from 87 ± 2 to 81 ± 1 g/m2; captopril: from 89 ± 2 to 85 ± 2 g/m2; P = 0.0001). Neither the left ventricular end-diastolic volume index nor the left ventricular ejection fraction changed significantly during the treatment period.

CONCLUSION

Nitrendipine is as effective as captopril in reducing both systolic and diastolic blood pressure and in reversing LVH. Neither drug showed any negative side effects on fasting plasma glucose and glycated hemoglobin (HbA1c) levels, and both maintain constant AERs.
Susceptibility to Type 1 Diabetes in the Senegalese Population Is Linked to HLA-DQ and Not TAP and LMP Genes
Authors: Chauffert M , Cissé A , Chevenne D , You J F , Michel S , Trivin F
Published: March 2007

OBJECTIVE

To investigate the frequency of the transporter associated with antigen processing (TAP) and large multifunctional protease (LMP) alleles and their role in the susceptibility to type 1 diabetes, in comparison with the well-known HLA-DQ alleles susceptibility, in Senegalese subjects.

RESEARCH DESIGN AND METHODS

Three loci in the TAP/LMP region were analyzed in 92 type 1 diabetic subjects and 117 nondiabetic control subjects by means of polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).

RESULTS

No association was found between the studied polymorphisms of TAP1, TAP2, and LMP2 and type 1 diabetes in the Senegalese population, in contrast to the HLA-DQA1 and DQB1 genes, which were associated with type 1 diabetes.

CONCLUSIONS

Diabetogenic genes in the class II HLA region are located near the DQA1 and DQB1 loci rather than the TAP and LMP loci.
Determination of Amputation Level in Ischemic Limbs: Reappraisal of the measurement of TcPo2
Authors: Wütschert Robert , Bounameaux Henri
Published: March 2007

OBJECTIVE

To study the accuracy of the measurement of TcPo2 for the determination of the optimal level of amputation in patients with end-stage vascular disease (i.e., the level at which the reamputation rate and the proportion of too-proximal amputations will be minimized).

RESEARCH DESIGN AND METHODS

We used a Medline literature search of all published studies of the past 12 years that fulfilled predefined quality criteria, and we analyzed the data by means of receiver operating characteristic (ROC) curve.

RESULTS

Ten studies could be identified with a total of 615 lower-limb amputations (51% of them being performed in diabetic patients) and a reamputation rate of 16.4%. The best performances of the TcPo2 measurement were obtained between 10 and 20 mmHg with an accuracy of ∼ 80%.

CONCLUSIONS

Preoperative TcPo2 measurement may be of considerable help to predict stump outcome and level of amputation. Our study provides objective prognostic values for the range 0–50 mmHg and suggests that TcP02 should usually be 20 mmHg at the site of amputation, which will predict healing with 80% accuracy and should, therefore, not be used as a sole criteron. Despite this aid in making his decision about the amputation level, the surgeon still has to balance between his goal of achieving primary wound healing and his hope of preserving the maximal limb length and has to consider patient preferences.