bluuebunny/crossref_metadata_2025 huggingface dataset:
Glomerulopathy in Patient With Donohue Syndrome (Leprechaunism)
Authors: Ellis Eileen N , Kemp Stephen F , Frindik J Paul , Elders M Jocelyn
Published: March 2007

Objective

To evaluate renal structure in a child with Donohue syndrome (leprechaunism), who at 10 yr of age was noted to have hypertension, microalbuminuria, and enlarged kidneys, a renal biopsy was performed.

Research Design And Methods

The renal biopsy tissue was evaluated by light and electron microscopy with standard stereological techniques to measure glomerular volume, glomerular basement membrane width, fractional mesangial volume, and peripheral capillary filtering surface density.

Results

On renal biopsy, there was a marked increase in glomerular volume, glomerular basement width, and mesangial volume, findings similar to those seen in patients with diabetic nephropathy.

Conclusions

This patient with marked insulin resistance associated with Donohue syndrome demonstrates renal and glomerular enlargement and morphometric glomerular changes similar to those seen in patients with diabetic nephropathy. In unusual syndromes with hyperglycemia and hyperinsulinemia, renal structural and functional changes typical of traditional diabetes mellitus may be seen.
Hyperinsulinemia or Increased Sympathetic Drive as Links for Obesity and Hypertension
Authors: Modan Michaela , Halkin Hillel
Published: March 2007

The association of obesity with hypertension has been amply demonstrated in cross-sectional, longitudinal, and dietary-intervention studies, but the mechanisms remain enigmatic. Both conditions are independently characterized by similar metabolic alterations, i.e., glucose intolerance, dyslipoproteinemia, elevated serum uric acid, and inadequate Na+ transport. Obesity, hypertension, and these metabolic alterations are associated with hyperinsulinemia/insulin resistance. The degree of these alterations is lowest in lean hypertensives, intermediate in obese normotensives, and greatest in obese hypertensives, but mortality risk is highest in lean hypertensives. This apparent discrepancy may be related to the divergent hemodynamic characteristics, possibly indicating different etiology, of lean and obese hypertensives, i.e., contracted blood volume, increased total vascular peripheral resistance, and normal sympathetic drive in the former, expanded blood volume, normal peripheral resistance, and increased sympathetic drive in the latter. Current knowledge suggests that the interrelationships of obesity and hypertension with the metabolic alterations could be mediated by high carbohydrate and fat consumption and low physical activity, resulting in obesity and separate pathways in hyperinsulinemia and increased sympathetic drive, leading to a double vicious cycle. In one, hyperinsulinemia and the consequent insulin resistance would compound one another. In the second, the increasing hyperinsulinemia would increasingly stimulate the sympathetic nervous system. This double vicious cycle could result in increasing hemodynamic and metabolic derangements causing hypertension, diabetes, and atherosclerotic cardiovascular disease (ASCVD). The association of lean hypertension with ASCVD may be through other mechanisms, e.g., hemodynamic forces on the vascular endothelium.
Learning to Empower Patients: Results of Professional Education Program for Diabetes Educators
Authors: Anderson Robert M , Funnell Martha M , Barr Patricia A , Dedrick Robert F , Davis Wayne K
Published: March 2007

The patient empowerment approach to diabetes education is intended to enable patients to make informed decisions about their own diabetes care and to be fully responsible members of the health-care team. Facilitating patient empowerment requires a specific set of skills and attitudes on the part of diabetes educators. A professional education program designed to facilitate the acquisition and enhancement of the requisite skills and attitudes was designed, implemented, and evaluated. The program involved adhering to a simulated diabetes care regimen for 3 days followed by a 3-day intensive skills-based workshop. The 23 educators who participated in the first two offerings of this program made significant gains in their counseling skills and demonstrated a positive change in attitude.
Microalbuminuria: Invalidity of Simple Concentration-Based Screening Tests for Early Nephropathy Due to Urinary Volumes of Diabetic Patients
Authors: Kouri Timo T , Viikari Jorma S A , Mattila Kari S , Irjala Kerttu M A
Published: March 2007

Objective

To evaluate the possibility of replacing quantitative albumin excretion rate (AER) measurements with rapid screening tests for microalbuminuria.

Research Design and Methods

Dipstick-negative specimens from 363 consecutive insulin-dependent diabetes mellitus (IDDM) and 46 non-insulin-dependent diabetes mellitus (NIDDM) patients from primary-care and hospital clinics (11% inpatients) within the district of Turku University Hospital were studied. Albumin concentrations and 12-h nightly excretion rates (N-AER) were measured by nephelometry (sensitivity 2 mg∕L).

Results

An increased N-AER (> 15 μgrams∕min) was seen in 99 IDDM (27%) and 15 NIDDM (33%) patients. The median urinary volume was 900 ml∕12 h, with a maximum of 3000 ml. At the level of 20 mg albumin∕L, the sensitivity to detect elevated N-AER was 70% among IDDM patients and 60% among NIDDM patients. At a lower albumin concentration of 10 mg∕L, the sensitivities were increased to 91 and 87% in IDDM and NIDDM patients, respectively, but the specificities were reduced to 77 and 71% respectively.

Conclusions

To evaluate incipient nephropathy, we recommend quantitative measurements of N-AER from timed urine collections only. Dipstick tests are either insensitive or nonspecific.
Psychological Responses of Obese Type II Diabetic Subjects to Very-Low-Calorie Diet
Authors: Wing Rena R , Marcus Marsha D , Blair Elaine H , Burton Lisa R
Published: March 2007

Objective

Very-low-calorie diets have been shown to produce dramatic improvements in glycemic control in obese subjects with non-insulin-dependent (type II) diabetes. There have been no studies of the psychological responses of diabetic subjects to these diets.

Research Design and Methods

This study examined changes in hunger, depression, and anxiety in 33 obese type II diabetic subjects who were randomly assigned to behavior modification programs that used either a balanced diet of 4185–6277 J∕day (1000–1500 cal∕day) throughout or included an 8-wk period of a very-low-calorie diet (1674 J∕day or 400 cal∕day of lean meat, fish, or fowl). Subjects completed the Beck Depression Inventory, the Spielberger State Anxiety Questionnaire, and self-report measures of hunger frequently throughout the 20-wk program.

Results

Both groups experienced significant improvements in depressive symptomatology, anxiety, and lessening of hunger during the course of the program, with no significant differences observed between the balanced diet and the very-low-calorie diet groups.

Conclusions

Very-low-calorie diets, used in the context of a behavioral weight-control program, result in reductions in hunger and improvements in mood state comparable to those observed on more moderate weight-loss regimens.
Hypoglycemic Symptoms and Frequency of Severe Hypoglycemia in Patients Treated With Human and Animal Insulin Preparations
Authors: Mühlhauser Ingrid , Heinemann Lutz , Fritsche Esther , von Lennep Katja , Berger Michael
Published: March 2007

Objectives

To compare hypoglycemic warning symptoms (main objective) and incidence of severe hypoglycemia (secondary objective) between patients treated with animal and human insulin preparations.

Research Design And Methods

Two hundred forty-seven patients on treatment with animal insulin preparations and 276 patients on human insulins, matched for duration of diabetes (16 ± 11 vs. 15 ± 10 yr), were recruited for the study. Patients were interviewed with a standardized questionnaire.

Results

When asked which symptom usually occurs first during hypoglycemia, 19% of the animal insulin group and 22% of the human insulin group answered “sweating,” 19 and 17%, respectively, answered “trembling,” and 15 and 11%, respectively, answered “unrest.” According to the patients' perception, in both groups, their most reliable hypoglycemic warning symptoms were “trembling” (26 and 22%) and “sweating” (15 and 18%). Six and eight percent of patients, respectively, reported hypoglycemia unawareness and 17 and 18%, respectively, impaired awareness of hypoglycemia. The incidence of severe hypoglycemia was 0.45 cases/patient-yr in patients treated with animal insulins and 0.46 cases/patient-yr in patients treated with human insulin preparations. The differences were not statistically significant.

Conclusions

This study shows that hypoglycemic warning symptoms and the incidence of severe hypoglycemia are comparable between patients on treatment with human and animal insulin preparations.
Lipoprotein Physiology in Nondiabetic and Diabetic States: Relationship to Atherogenesis
Authors: Ginsberg Henry N
Published: March 2007

Abnormalities of plasma lipid and lipoprotein concentrations are common in both insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetes mellitus. In general, individuals with IDDM who are untreated or inadequately treated have elevations in both postprandial and fasting triglyceride levels in association with reduced activity of lipoprotein lipase. Low-density lipoprotein (LDL) cholesterol levels can rise when insulin deficiency impacts on LDL-receptor function. When patients with IDDM are treated and plasma glucose levels well controlled, plasma very-low-density lipoprotein (VLDL) triglyceride and LDL cholesterol levels are usually normal. In addition, plasma high-density lipoprotein (HDL) cholesterol levels are normal or elevated in well-controlled IDDM subjects. In NIDDM, increased VLDL triglyceride and reduced HDL cholesterol concentrations are common and are only partially related to glycemic control. Overproduction of VLDL leads to hypertriglyceridemia, which can be exacerbated if lipoprotein lipase activity is also reduced. The regulation of LDL levels is complex; catabolism can be reduced if significant insulin deficiency exists or increased if significant hypertriglyceridemia is present. The reduced levels of HDL cholesterol in NIDDM appear to be related to increased exchange of HDL cholesteryl esters for VLDL triglycerides, although other mechanisms may exist. The roles of insulin resistance, obesity, and independently inherited abnormalities of lipoprotein metabolism in the etiology of dyslipidemia of NIDDM are complex and require further investigation. Finally, the effects of diabetes on glycosylation of apoproteins; on other lipid enzymes, particularly hepatic triglyceride lipase; on lipoprotein surface lipids; and on hepatic uptake of remnants have only just begun to be defined. In view of the marked increase in atherosclerotic cardiovascular disease in individuals with diabetes mellitus, prompt attention to and aggressive therapy for dyslipidemia should be a central component of care for these patients.
Care of Diabetic Pregnant Women by Primary-Care Physicians: Reported Strategies for Managing Pregestational and Gestational Diabetes
Authors: Marrero David G , Moore Patricia , Langefeld Carl D , Golichowski Alan , Clark Charles M
Published: March 2007

Objective

—To ascertain the strategies used by primary-care physicians for treating pregestational and gestational diabetes mellitus (GDM) during pregnancy, because many women with pregnancies complicated by these types of diabetes are treated by physicians who have no special training in intensive diabetes management.

Research Design and Methods

—Two hundred twenty-four family-practice (FP) physicians and 184 obstetrics/gynecology (OB/GYN) physicians were surveyed by mail.

Results

—When compared with OB/GYNs, FPs were less likely to screen all pregnant women for GDM (P = 0.03), use multiple-injection insulin regimens (P = 0.004) or self-monitoring of blood glucose (SMBG) (P = 0.01) for Pre-GDM patients, and refer these patients to a specialist for medical (P = 0.01) or ophthalmologic (P < 0.001) care. FPs were more likely to implement insulin therapy (P = 0.003), SMBG (P = 0.02), and examine eyes for retinopathy (P < 0.001) when treating gestational patients.

Conclusions

—These data show that there are considerable discrepancies between the strategies used by FPs and OB/GYNs and also suggest that physicians in both groups are under-utilizing recommended treatment strategies described in publications targeted specifically to primary-care physicians. Increased exposure to and dissemination of guidelines for diabetes management and additional medical school and postgraduate education programs are recommended as methods to improve utilization of these strategies.
Double-Blind Randomized Trial of Nicotinamide on Early-Onset Diabetes
Authors: Lewis Cynthia M , Canafax Damiel M , Sprafka J Michael , Barbosa Jose J
Published: March 2007

Objective

—To determine the efficacy of nicotinamide in inducing remission in early-onset insulin-dependent diabetes mellitus.

Research Design and Methods

—This study was a double-blind, randomized clinical trial.

Results

—Nicotinamide failed to induce remission or differences on β-cell secretion between the two groups.
Effect of Conventional and Intensified Insulin Therapy on Free-Insulin Profiles and Glycemic Control in NIDDM
Authors: Lindström Torbjörn H , Arnqvist Hans J , Schenck Henning H von
Published: March 2007

Objective

–To investigate the effects on 24-h insulin and glucose profiles of two- and four-dose insulin regimens in patients with non-insulin-dependent diabetes mellitus (NIDDM) who have failed oral agent therapy.

Research Design and Methods

–Ten patients with NIDDM and 10 matched nondiabetic control subjects took part in the study, a randomized crossover trial with 8-wk treatment periods. We determined 24-h profiles of blood glucose and free insulin in control subjects and patients when they were taking oral agents and at the end of each treatment period. The two-dose regimen was mixed (15% regular, 85% NPH) insulin given before breakfast and dinner, and the four-dose regimen was regular insulin given before meals and NPH given at 2200.

Results

–Patients taking oral agents had higher mean blood glucose than control subjects (mean ± SE 12.6 ± 0.6 vs. 4.5 ± 0.1 mM, P < 0.0001) and similar 24-h insulin concentrations but lower postprandial insulin concentrations (at breakfast, 87.6 ± 13.8 vs. 228.6 ± 29.4 pM, P < 0.01). Mean 24-h insulin concentrations were the same on two- and four-dose regimens, and both regimens caused basal hyperinsulinemia. Glycemic control also improved. Postprandial insulin peaks were higher at lunch and dinner on the four-dose regimen, and postprandial blood glucose was lower. Fasting proinsulin was elevated in patients compared with the control subjects (25.1 ± 4.7 pM vs. 5.0 ± 0.9 pM, P < 0.001) and was suppressed to normal during insulin treatment.

Conclusions

–Two- and four-dose insulin regimens can achieve similar glycemic control. Both regimens cause basal hyperinsulinemia but normalize the hyperproinsulinemia observed during failure of oral agent therapy. Four-dose insulin regimens offer few advantages to the glycemic control achieved with two-dose regimens but may be more physiological.
Inhibitory Effect of Circulating Insulin on Glucagon Secretion During Hypoglycemia in Type I Diabetic Patients
Authors: Liu Dating , Adamson Ule C K , Lins Per-Eric S , Kollind Magnus E , Moberg Erik A R , Andréasson Karin
Published: March 2007

Objective

–To clarify whether the circulating insulin level influences hormonal responses, glucagon secretion in particular, during hypoglycemia in patients with insulin-dependent (type I) diabetes.

Research Design and Methods

–Nine type I diabetic patients were studied. During two separate experiments, hypoglycemia was induced by low-dose (244 pmol.kg−1.h−1) and high-dose (1034 pmol.kg−1.h−1) intravenous insulin infusions for 180 min in each case. The arterial blood glucose level was directly monitored every 1.5 min, and glucose was infused in the high-dose test to clamp the arterial blood glucose level to be identical as in the low-dose test.

Results

–Despite the fact that the plasma insulin level was four times higher in the high-dose than in the low-dose test (740 ± 50 vs. 180 ± 14 pM), a close to identical arterial hypoglycemia of ∼ 3.3 mM was obtained in the two experiments. During hypoglycemia, a significant rise of the plasma glucagon level was found only in the low-dose test (188 ± 29 vs. 237 ± 37 ng/L, P < 0.05), and the incremental area under the glucagon curve was significantly greater in the low-dose than in the high-dose test (140 ± 19 vs. −22.7 ± 34 ng/L.h−1, P < 0.005). The responses of plasma epinephrine, norepinephrine, growth hormone, pancreatic polypeptide, and somatostatin were similar in both tests and, consequently, were not significantly modified by the circulating insulin level.

Conclusions

–This study demonstrates that, in type I diabetic patients, the glucagon response to hypoglycemia is suppressed by a high level of circulating insulin within the physiological range. Our findings may help to explain the impairment of glucagon secretion during hypoglycemia frequently seen in these patients.
Permanent Diabetes Without Serological Evidence of Autoimmunity After Transient Neonatal Diabetes
Authors: Gottschalk Michael E , Schatz Desmond A , Clare-Salzler Michael , Kaufman Daniel L , Ting Grace S P , Geffner Mitchell E
Published: March 2007

OBJECTIVE

To describe a probable association between TNDM and subsequent permanent IDDM.

RESEARCH DESIGN AND METHODS

A longitudinal follow-up of a single case from birth to 12 yr of age was conducted analyzing sequential OGTTs, ICAs, AIAs, anti-GAD antibodies, and other organ-specific and nonspecific antibodies.

RESULTS

A small-for-gestational-age infant developed hyperglycemia at 20 h of age and required insulin therapy for the 1st 14 wk of life (TNDM). Transient hyperglycemia and ketonuria were noted again at age 2 yr 10 mo during an intercurrent illness, but OGTT was normal; and ICA, AIA, anti-GAD65 and anti-GAD67 antibodies, antithyroid microsomal, anti-gastric parietal cell, antiadrenal, antisteroidal, and antinuclear antibodies were negative 3 wk later. At age 9 yr, hyperglycemia returned and persisted in the setting of hypoinsulinemia; ICA, AIA, anti-GAD65 and anti-GAD67 antibodies, and other organ-specific and nonspecific antibodies were again negative. Insulin therapy was initiated and has been maintained over 3 yr of follow-up.

CONCLUSIONS

Our case is the fifth reported with permanent diabetes occurring after resolution of TNDM. The etiology of permanent diabetes in this setting is unknown but, unlike classical IDDM, appears unrelated to autoimmunity in our patient. The true frequency of this association remains unknown.
Greater Effect of Glycemia on Incidence of Hypertension in Women Than in Men
Authors: Haffner Steven M , Valdez Rodolfo , Morales Philip A , Mitchell Braxton D , Hazuda Helen P , Stern Michael P
Published: March 2007

OBJECTIVE

In subjects with NIDDM, diabetic women have a greater relative excess of CHD relative to nondiabetic women than do diabetic men relative to nondiabetic men. This excess in diabetic women is explained partially by the particularly atherogenic pattern of lipoproteins in this group. We hypothesize that diabetic women also may have a higher incidence of hypertension than diabetic men.

RESEARCH DESIGN AND METHODS

We examined the effect of NIDDM and IGT relative to NGT on the incidence of hypertension separately in men (n = 844) and women (n = 618) in the 8-yr follow-up of the San Antonio Heart Study, a population-based study of diabetes and cardiovascular disease.

RESULTS

Women had a greater risk of hypertension with worsening glucose tolerance (RR NIDDM/NGT = 2.65 and RR IGT/NGT = 1.94) compared with men (RR NIDDM/NGT = 1.61 and RR IGT/NGT = 0.91). Controlling for other possible confounding variables such as age, obesity, body fat distribution, and fasting insulin concentration did not alter the interaction of sex and glycemia on incidence of hypertension.

CONCLUSIONS

The especially increased risk of hypertension in women with abnormal glucose tolerance may explain partly the high risk of CHD in this group.
High Incidence Rate of IDDM in Sardinia
Authors: Muntoni Sergio , Songini Marco
Published: March 2007

OBJECTIVE

To provide reliable data on the incidence of IDDM in Sardinia and contribute to a better understanding of its geographical variability throughout Europe.

RESEARCH DESIGN AND METHODS

All newly diagnosed cases of IDDM with onset < 30 yr of age between 1 January 1989 and 31 December 1990 among residents in Sardinia were recorded. Primary ascertainment was based on notification by all Sardinian hospitals, outpatient clinics, family doctors, and pediatricians. The local IDDM patient association served as the secondary and independent source.

RESULTS

The completeness of ascertainment was 92.8%. The annual incidence rate of IDDM (per 100,000) over the 2-yr period was 30.7 in the 0–14–yr-old age-group and 24.1 in the entire 0–29–yr-old range, respectively, with no significant differences between the two groups. Male/female ratios were 1.25 and 1.55, respectively. No significant seasonal variation in incidence was observed.

CONCLUSIONS

Sardinia appears to have the second-highest IDDM incidence rate in Europe after Finland, and the island contradicts the generally accepted rule of a south-to-north incidence gradient.
Metabolic Effects of Dietary Fructose in Diabetic Subjects
Authors: Bantle John P , Swanson Joyce E , Thomas William , Laine Dawn C
Published: March 2007

OBJECTIVE

To assess the metabolic effects of chronic dietary fructose consumption in diabetic subjects.

RESEARCH DESIGN AND METHODS

Six type I and 12 type II diabetic subjects consumed, in random order, two isocaloric study diets for 28 days. In one diet, 20% of energy was derived from fructose. In the other diet, <3% of energy came from fructose, and carbohydrate energy was derived primarily from starch. Both study diets were composed of common foods. All meals were prepared in a metabolic kitchen where all foods were weighed during meal preparation.

RESULTS

Mean plasma glucose, urine glucose, and serum glycosylated albumin values were lower during the fructose diet than during the starch diet, but the differences achieved only marginal statistical significance. The day-28 value for mean plasma glucose was 12.5% lower (P = 0.03) during the fructose diet than during the starch diet. At days 14, 21, and 28, fasting serum cholesterol and LDL cholesterol were both significantly higher during the fructose diet than during the starch diet. The day-28 values for serum cholesterol and LDL cholesterol during the fructose diet were 6.9% (P = 0.008) and 10.9% (P = 0.002) higher, respectively, than the corresponding values during the starch diet. No differences were observed between the study diets in fasting serum HDL cholesterol, fasting serum triglycerides, peak postprandial serum triglycerides, or fasting serum lactate. Peak postprandial serum lactate was significantly higher during the fructose diet. Type I and type II diabetic subjects responded to the diets in a consistent way, but type I subjects experienced significantly more hypoglycemia during the fructose diet than during the starch diet.

CONCLUSIONS

A high-fructose diet may result in reduced glycemia in diabetic subjects but at the expense of increased fasting serum total and LDL cholesterol.
Nitrate Levels in Community Drinking Waters and Risk of IDDM: An ecological analysis
Authors: Kostraba Jill N , Gay Elizabeth C , Rewers Marian , Hamman Richard F
Published: March 2007

OBJECTIVE

To investigate whether higher IDDM incidence rates occurred in areas with high nitrate levels in their potable water supplies.

RESEARCH DESIGN AND METHODS

Incidence rates for the 63 counties in Colorado were calculated using the Colorado IDDM Registry of children diagnosed < 18 yr of age between 1978 and 1988 (n = 1280). A weighted average of the nitrate levels from each water district within each county was calculated using data collected by the Colorado Department of Health between 1984 and 1988.

RESULTS

The rs between nitrate levels and IDDM incidence was 0.26 (P = 0.03). After controlling for differences in ethnicity, counties with water nitrate levels in the third tertile (0.77-8.2 mg/L) had a significantly increased risk of IDDM compared with those in the first tertile (0.0-0.084 mg/L) (rp = 0.29, P = 0.02).

CONCLUSIONS

This ecological analysis suggests that low-level nitrate exposure through drinking water may play a role in the etiology of IDDM, perhaps as a promoter through the generation of free radicals.
Multicenter Study of the Prevalence of Diabetes Mellitus and Impaired Glucose Tolerance in the Urban Brazilian Population Aged 30–69 yr
Authors: Malerbi Domingos A , Franco Laercio J ,   The Brazilian Cooperative Group on the Study of Diabetes Prevalence
Published: March 2007

OBJECTIVE

To assess the prevalence of diabetes and IGT in the urban adult Brazilian population.

RESEARCH DESIGN AND METHODS

We used a two-stage, multicenter, cross-sectional survey in a random sample of 21,847 individuals aged 30–69 yr from nine large cities. Subjects were first screened by FCG. All positive screenees (FCG ≥ 5.6 mM/L) and every sixth consecutive negative screenee were administered a 75 g OGTT and classified as diabetic, IGT, or normal (nondiabetic) according to WHO recommendations. OGTT findings from the negative screenees were extrapolated to all negative screenees after adjustments for potential biases.

RESULTS

The overall rates were 7.6 and 7.8% for diabetes and IGT, respectively. Men (7.5%) and women (7.6%) had similar rates of diabetes. Similar rates resulted with whites (7.8%) and nonwhites (7.3%). Diabetes prevalence increased from 2.7% in the 30–39-yr age-group to 17.4% in the 60–69-yr age-group. Diabetes was more prevalent among less educated people, but this difference disappeared after adjusting for age. Family history of diabetes was associated with a twofold increase in diabetes prevalence (12.5 vs. 5.8%); the same increase occurred with obesity (11.6 vs. 5.2%). Undiagnosed diabetes accounted for 46% of the total prevalence. Among previously diagnosed cases, 22.3% were not under treatment, 7.9% were on insulin, 40.7% were on oral agents, and 29.1% were on dietary treatment only. Self-reported diabetes prevalence was 0.1, 3.2, and 11.6% in the age groups < 30, 30–69, and > 70 yr, respectively.

CONCLUSIONS

The prevalence of diabetes in Brazil is comparable with that of more developed countries, where it is considered a major health problem.
Epidemiology of Childhood Type I Diabetes in Sudan, 1987–1990
Authors: Elamin Abdelaziz , Omer Mohamed I A , Zein Kamel , Tuvemo Torsten
Published: March 2007

OBJECTIVE

To determine the incidence of type I diabetes in children 0–14 yr of age in Khartoum, Sudan.

RESEARCH DESIGN AND METHODS

Prospective registration of newly diagnosed patients in a hospital-based registry with independent validation of completeness of case ascertainment. Eligible patients were Sudanese children < 15 yr of age, who developed type I diabetes during the period 1 January 1987 through 31 December 1990, and who were living in Khartoum city at the time of diagnosis. The denominator is the stable childhood population of Khartoum city, as estimated by the National Bureau of Statistics.

RESULTS

In 4 yr, 239 cases were notified in the primary source and 268 in the secondary source. Some 196 patients were registered in both sources. Using the capture-recapture method to correct for underascertainment, the estimated total number of cases was 327, and the overall degree of ascertainment was 95%. The incidence of type I diabetes in children 0–14 yr of age increased from 5.9/105) in 1987 to 10.1/105) in 1990 (P < 0.001). Girls exhibited slightly higher incidence rates than boys in the 10–14-yr age-group throughout the 4 yr, but the differences were not statistically significant. The age distribution at onset was bimodal with a clear peak at age 12 yr in girls and age 14 yr in boys and another smaller peak at age 7 yr in both sexes. The number of new cases was markedly higher in the cooler months of the year, with a peak in January and a nadir in June (P < 0.01). This trend was consistent over the period of observation.

CONCLUSIONS

Childhood diabetes is increasing in Sudan. Our incidence figures are higher than those reported from other Arab countries and is similar to reports from France and Italy.
Screening for Microalbuminuria: A comparison of single sample methods of collection and techniques of albumin analysis
Authors: Schwab Steve J , Dunn Fredrick L , Feinglos Mark N
Published: March 2007

OBJECTIVE

To evaluate single-sample urine collections to determine their ability to screen patients for the presence of microalbuminuria. Microalbuminuria in patients with type I diabetes predicts the development of diabetic renal disease.

RESEARCH DESIGN AND METHODS

Cross-sectional analysis of single-sample urine collection techniques (first morning void, random upright void) and methods of albumin analysis (RIA, reagent tablet) were compared with conventional 24-h urine collections (RIA). The study included 94 patients (45 males, 49 females; mean serum creatinine 88 μM) with type I diabetes, selected from a screened population of 301 patients from the University Hospital Subspecialty Clinics.

RESULTS

A 24-hour urine collection RIA analysis for albumin revealed 36 normal patients (< 30 mg), 27 with microalbuminuria (30–300 mg), and 31 with albuminuria (> 300 mg). Random upright urine samples were more sensitive (RIA 89%, tablets 78%) for the detection of microalbuminuria than first morning void specimens (RIA 70%, tablets 60%). Specificity was > 80% with both random and first morning voids.

CONCLUSIONS

Screening for microalbuminuria can be performed in the clinic by random upright single-sample urine collections. When reagent tablets were used, these results are available immediately. Patients who screen positive should be confirmed by 24-h or other timed urine collections.
Randomized Prospective Double-Blind Trial in Healing Chronic Diabetic Foot Ulcers: CT-102 activated platelet supernatant, topical versus placebo
Authors: Steed David L , Goslen J Blake , Holloway G Allen , Malone James M , Bunt T J , Webster Marshall W
Published: March 2007

OBJECTIVE

To assess the efficacy of topically applied CT-102 APST for treating diabetic neurotrophic foot ulcers.

RESEARCH DESIGN AND METHODS

Thirteen patients entered a randomized, double-blind trial of topically applied CT-102 APST vs. placebo (normal saline) gauze dressings for the treatment of nonhealing diabetic neurotrophic foot ulcers. CT-102 APST (Curative Technologies, Setauket, NY) was prepared from homologous platelets and contained multiple growth factors including PDGF, PDAF, EGF, PF-4, TGF-β, aFGF, and bFGF. Inclusion criteria for subjects included diabetes, ulcer of > 8 wk duration, peri-wound transcutaneous oxygen tension > 30 mmHg, platelet count > 100,000/mm3, and no wound infection. Wounds were excised before entry and were > 700 mm3 but < 50,000 mm3 in volume, < 100 cm2 in area, and involved subcutaneous tissue.

RESULTS

In the CT-102 group, 5 of 7 ulcers were healed (100% epithelialized) by 15 wk, but only 1 of 6 ulcers was healed by 20 wk with placebo (P < 0.05). Average percent reduction in ulcer area at 20 wk was 94% for CT-102 vs. 73% for placebo. Daily reduction in ulcer volume was 73.8 ± 42.4 mm3/day (mean ± SE) for CT-102 vs. 21.8 ± 8.1 mm3/day for placebo (P < 0.05). Daily reduction in ulcer area was 6.2 ± 1.8 mm2/day for CT-102 vs. 1.8 ± 0.4 mm2/day for placebo (P < 0.05).

CONCLUSIONS

CT-102 significantly accelerated wound closure in diabetic leg ulcers when administered as part of a comprehensive program for the healing of chronic ulcers.
Habitual Physical Activity in Adult IDDM Patients: A study with portable motion meters
Authors: Chantelau Ernst , Wirth Rainer
Published: March 2007

The objective of this study was to assess the habitual physical activity of insulin-dependent diabetes mellitus (IDDM) patients on intensive insulin therapy. This case-control study consisted of 34 IDDM patients (14 on multiple injection therapy, 20 on continuous subcutaneous insulin infusion [CSII], and control subjects matched for sex, age, weight, height, body mass index, smoking behavior, and occupational status). Seven IDDM patients were studied before and after changing from multiple injection to CSII therapy. All patients were well controlled according to HbA1c. Portable motion meters were used to assess habitual physical activity during 7 consecutive days with appreciable reproducibility (coefficient of variation 1.24%) and agreement to standardized activity protocols (r = 0.96, P < 0.001). Habitual physical activity was similar in IDDM patients on injection treatment and in controls, respectively. CSII-treated patients exhibited on the average 17% less habitual physical activity than control subjects (P < 0.05). Changing from multiple injection therapy to CSII lowered habitual physical activity insignificantly in seven patients. There was no indication of decreasing physical exercise (e.g., sports) by CSII in this patient group. No correlations were found between habitual physical activity and HbA1c or body mass index, respectively. Habitual physical activity is similar in IDDM patients on multiple injection therapy and control subjects, but may decrease by CSII therapy.
Prevention of Hypoglycemia During Exercise in Type I Diabetes
Authors: Kemmer Friedrich W
Published: March 2007

Insulin-dependent (type I) diabetic subjects who exercise for whatever reason do this at the risk of hypoglycemia. To enjoy physical activities without major metabolic complications, diabetic patients can take measures to prevent exercise-induced hypoglycemia. These measures basically include preventing accelerated insulin absorption, mimicking physiological insulin secretion during exercise, supplying additional carbohydrates during exercise, and providing effective diabetes education. When adapting the insulin dose, duration and intensity of the work load, time of day, prevailing insulin levels, and the state of nutrition must be considered. Additional carbohydrates can prevent hypoglycemia when exercise is spontaneous and insulin dose reduction is impossible. Prevention of exercise-induced hypoglycemia may be best achieved if patients participate in intensive and comprehensive teaching programs for self-management of diabetes.
Moderate Exercise Increases Platelet Function in Type I Diabetic Patients Without Severe Angiopathy and in Good Control
Authors: Trovati Mariella , Anfossi Giovanni , Facis Roberto De , Mularoni Elena , Massucco Paola , Cavalot Franco , Burzacca Serenella , Mattiello Luigi , Lucchina Pietro Greco
Published: March 2007

OBJECTIVE

The aim of this study was to investigate whether a 45-min moderate exercise, performed postprandially with a timing that partially prevented the risk of hypoglycemia, was able to modify platelet function in patients affected by insulin-dependent (type I) diabetes mellitus without severe late complications and in a good metabolic control.

RESEARCH DESIGN AND METHODS

We submitted 6 male type I diabetic patients (27.2 ± 3.4 yr; body mass index, 21.4 ± 0.6 kg/m2; HbA1c, 7.6 ± 0.9%) on a daily three-insulin injection regimen, without severe late complications of diabetes, to a 45-min moderate exercise (about 50% of maximal oxygen consumption) with a cycle ergometer, beginning 180 min after breakfast and 195 min after a subcutaneous shot of regular insulin. Serial venous blood samples were conducted to measure plasma glucose, free insulin, counterregulatory hormones (glucagon, growth hormone, cortisol, and catecholamines), platelet sensitivity to ADP, platelet activating factor and collagen, and plasma concentrations of the platelet-specific protein beta-thromboglobulin (a marker of the platelet release reaction in vivo).

RESULTS

Exercise was accompanied by a decrease of plasma glucose (from 5.9 ± 1.2 to 4.6 ± 1 mmol/L, P = 0.067) and free insulin (from 180 ± 36 to 114 ± 30 pmol/L, P = 0.003), and by a significant increase of growth hormone (from 5 ± 1 to 15 ± 4 μg/L, P = 0.045), cortisol (from 240 ± 30 to 406 ± 69 nmol/L, P = 0.018), epinephrine (from 1005 ± 240 to 5143 ± 1753 pmol/L, P = 0.077), and norepinephrine (from 5.04 ± 1.08 to 13.48 ± 2.98 nmol/L, P = 0.009). Platelet sensitivity to the agonists and plasma concentrations of β-thromboglobulin increased during the exercise period. In particular, ADP ED50 reached during exercise 61 ± 16% of basal values (P = 0.048), platelet activating factor ED50 reached 73 ± 11% (P = 0.043), and collagen ED50 reached 68 ± 9% (P = 0.008). β-Thromboglobulin rose from 24 ± 2 to 32 ± 3 μg/L (P = 0.007).

CONCLUSIONS

Moderate exercise enhances platelet function in type I diabetic patients without severe angiopathy and in a good metabolic control.
Glycation Products and the Pathogenesis of Diabetic Complications
Authors: Brownlee Michael
Published: March 2007

Glucose irreversibly modifies long-lived macromolecules by forming AGEs as a function of glucose concentration and time. AGEs cause qualitative and quantitative changes in extracellular matrix components such as type IV collagen, laminin, and vitronectin. These AGE-induced changes can affect cell adhesion, growth, and matrix accumulation. AGE-modified proteins also alter cell function by interacting with specific receptors on macrophages and endothelial cells, inducing changes that promote matrix overproduction, focal thrombosis, and vasoconstriction. DNA and nuclear proteins also may be targets for AGE damage. The persistence of accumulated AGEs during periods of normal glucose homeostasis may explain the phenomenon of hyperglycemic memory. Pharmacological inhibition of in vivo AGE formation by aminoguanidine prevents or ameliorates diabetic retinopathy, nephropathy, and neuropathy in animal models. These data suggest that aminoguanidine and other AGE inhibitors have a potential therapeutic role in the treatment of diabetic patients.
Psychosocial Factors and Complications of IDDM. The Pittsburgh Epidemiology of Diabetes Complications Study. VIII
Authors: Lloyd Cathy E , Matthews Karen A , Wing Rena R , Orchard Trevor J
Published: March 2007

Objective

— To investigate whether psychosocial factors are associated with diabetic complications.

Research Design and Methods

— Questionnaires on quality of life, depressive symptomatology, and personality type were completed and a clinical assessment was performed. The study population was an incident cohort of childhood-onset insulin-dependent diabetic (IDDM) subjects whose duration of IDDM was ≥ 25 yr (n = 175).

Results

— Patients with macrovascular disease (P < 0.01) or nephropathy (P < 0.05) reported significantly poorer quality of life compared with those who were free from all complications. Patients with macrovascular disease also reported greater depressive symptomatology (P < 0.05). Quality of life significantly deteriorated according to the presence of multiple (≥ 4) complications (P < 0.001). Higher depression symptom scores were also related to the presence of ≥4 complications (P < 0.001). Those with multiple complications reported less type A behavior than those without any complications (P < 0.05).

Conclusions

— This study shows that psychosocial differences exist according to both the number and the type of diabetic complications present. Because poorer quality of life and symptoms of depression may both result form complications, prospective follow-up is needed to clarify their temporal interrelationships, and to determine whether type A personality affords any protection against complications or is diminished as a result of developing complications.
Lifetime Prevalence of Major Depression and Its Effect on Treatment Outcome in Obese Type II Diabetic Patients
Authors: Marcus Marsha D , Wing Rena R , Guare John , Blair Elaine H , Jawad Abbas
Published: March 2007

Objective

— To assess the lifetime prevalence of major depression (MD) and its relation to glycemic control among a group of non-insulin-dependent (type II) diabetic subjects seeking obesity treatment and to determine whether a history of MD affected response to treatment.

Research Design and Methods

— Sixty-six obese subjects with type II diabetes (22 men, 44 women) completed the Inventory to Diagnose Depression-Lifetime Version before a 52-wk behavioral weight-control program. Weight, glycosylated hemoglobin, fasting blood glucose, and mood were assessed at pre-and posttreatment.

Results

— Thirty-two percent of the subjects reported a history of MD. Neither a history of MD nor current depressive symptoms were associated with pretreatment glycemic control. However, a history of MD was related to treatment attrition (52.4 vs. 22.2%, P = 0.03). Subjects with and without a history of MD showed comparable improvements in weight, glycemic control, and mood.

Conclusions

— A history of MD among type II diabetic patients seeking obesity treatment was not related to pretreatment glycemic control but was associated with higher rates of attrition from treatment. Individuals with a history of MD who completed the program did not differ from those with no history of MD in response to treatment.
Insulinotropic Action of Glucagonlike Peptide-I-(7–37) in Diabetic and Nondiabetic Subjects
Authors: Nathan David M , Schreiber Eric , Fogel Howard , Mojsov Svetlana , Habener Joel F
Published: March 2007

Objective

Whether glucagonlike peptide-I-(7–37) (GLP-I-[7–37]), a naturally occurring intestinal peptide, is insulinotropic in nondiabetic and non-insulindependent (type II) diabetic subjects.

Research Design and Methods

GLP-I-(7–37) or saline placebo was infused (1–5 ng · kg−1 · min−1 for 30 min) in 4 nondiabetic and 11 type II diabetic subjects in the fasting and prandial state. Glucose, insulin, and GLP-I-(7–37) levels were measured.

Results

GLP-I-(7–37) infusion resulted in a 3- to 10-fold increase in peak insulin levels and in insulin area under the curve in nondiabetic and diabetic subjects. In diabetic subjects, infusion concurrent with a standard meal eliminated the postprandial glucose excursion for 60 min after the meal. Insulin-releasing potency of GLP-I-(7-37) was attenuated at decreased glucose levels.

Conclusions

GLP-I-(7–37) has potent insulinotropic effects in nondiabetic and diabetic subjects. Whether GLP-I-(7–37) is useful as a therapeutic medication in type II diabetes requires further investigation.
β-Cell Dysfunction Induced by Chronic Hyperglycemia: Current Ideas on Mechanism of Impaired Glucose-Induced Insulin Secretion
Authors: Leahy John L , Bonner-Weir Susan , Weir Gordon C
Published: March 2007

Non-insulin-dependent diabetes mellitus is characterized by abnormal β-cell function. The characteristic secretory defect is a selective loss of glucose-induced insulin secretion. Substantial data have been generated in animal models to support the concept that chronic hyperglycemia causes the loss of glucorecognition (the so-called glucose toxicity hypothesis). This review summarizes the data supporting the concept of hyperglycemia-induced β-cell dysfunction and then focuses on the ideas for the mechanism of the glucose unresponsiveness. The lack of access to islet tissue in humans means that these studies have all been conducted in animal models. Another major stumbling block continues to be the lack of in vitro systems that faithfully reproduce the secretory abnormalities that occur in vivo. Despite these limitations, many hypotheses are being investigated that span most of the major intracellular steps for glucose-induced insulin secretion, including abnormalities in glucose transport, storage, metabolism/oxidation, and the second messengers. No single hypothesis stands out as being able to explain all of the characteristics of the secretory abnormalities. In the last few years major advances have occurred in our knowledge about the events that normally cause glucose-induced insulin secretion. Similarly, biochemical and molecular tools have become available to probe the different steps. As better in vitro models of the selective glucose unresponsiveness become available, rapid progress can be expected in unraveling the biochemical basis for the loss of glucose responsiveness in diabetic rat models. The long-term hope is that this information will lead to innovative new strategies for the therapy of non-insulin-dependent diabetes mellitus.
Nonselective Loss of Contrast Sensitivity in Visual System Testing in Early Type I Diabetes
Authors: Di Leo Mauro AS , Caputo Salvatore , Falsini Benedetto , Porciatti Vittorio , Minnella Angelo , Greco Aldo V , Ghirlanda Giovanni
Published: March 2007

Objective

Psychophysical methods in patients with diabetes mellitus reveal deficits of central or foveal vision. Our aim was to evaluate the contrast-sensitivity thresholds in 24 insulin-dependent (type I) diabetic patients with a short disease duration and without retinopathy, taking into account metabolic control.

Research Design and Methods

The control group consisted of age-matched nondiabetic subjects. None had visual or systemic symptoms. Contrast sensitivity measured at eight different spatial frequencies to sinusoidal bar patterns of 0.6–12.2 cycles/deg can detect functional defects in the spatially sensitive retinal ganglion cells or in higher visual pathways. We performed two different temporal types of contrast-sensitivity testing, dynamic (8 Hz) and static (0 Hz).

Results

Significant losses with dynamic contrast-sensitivity test at all but the highest spatial frequencies (i.e., 12.2 cycles/deg) were shown, whereas there was significant attenuation of contrast sensitivity at five spatial frequencies (1.0, 1.4, 2.2, 7.1, and 9.6 cycles/deg) in the static mode. Grating losses (<2SD of control means) of contrast sensitivity were found in 33.3% (dynamic) and in 72.9% (static) of eyes of diabetic patients. HbA1c values were positively correlated at variable spatial frequencies (1.0, 1.4, and 2.2 cycles/deg for dynamic test and 0.6, 1.0, 1.4, 2.2, 4.8, and 7.1 cycles/deg for static test).

Conclusions

Our results suggest an early, generally nonselective neuronal damage of visual pathways that occurs before the onset of clinically detectable retinopathy. The visual deficit may be related directly to the effects of diabetes; repetitive minor hypoglycemic insults may contribute more than a marked hyperglycemic condition to the mechanisms underlying physiological changes along the optic nerve.