bluuebunny/crossref_metadata_2025 huggingface dataset:
Jet-Injected Insulin Is Associated With Decreased Antibody Production and Postprandial Glucose Variability When Compared With Needle-Injected Insulin in Gestational Diabetic Women
Authors: Jovanovic-Peterson Lois , Sparks Suzanne , Palmer Jerry P , Peterson Charles M
Published: March 2007

OBJECTIVE

To elucidate the glycemic response and antibody formation in gestational diabetic women treated with insulin injected by a needle or a jet. The American Diabetes Association's position statement on jet injectors raised the concern that “insulin could be denatured as a result of forceful injection through a tiny port, which could lead to an increase in antibody formation” (Diabetes Care11:600, 1988). However, the pharmacokinetics of jet-injected insulin suggest that it might be useful in controlling postprandial glucose levels.

METHODS

We randomized 20 women with gestational diabetes mellitus (<34 wk gestation) who required insulin to receive either jet-injected or needle-injected human NPH and regular insulin. Variables of interest were evaluated at the start of therapy, weekly until delivery, and 6-wk postpartum that included: 1) insulin antibodies in the mother and her infant, 2) HbA1c, 3) insulin dose, 4) fasting and postprandial glucose levels, and 5) subject acceptance and preference.

RESULTS

Of the 10 women in the needle group, 6 developed significant insulin antibodies compared with 1 of 10 in the jet group (P < 0.001). HbA1c and insulin doses were the same in both groups. During the test meal, glucose levels in the jet group were significantly lower (P < 0.01), yet none of the women in the jet group experienced blood glucose 70 mg/dl (3.89 mM) at 3–4 h after the meal, compared with 5 in the needle group (P < 0.001). Jet injection was associated with less variability (P < 0.001) in postprandial glucose values but slightly greater variability (P < 0.05) in fasting glucose. Jet-injected insulin was more readily accepted by subjects than needle injections.

CONCLUSIONS

Jet injection is associated with a diminished antibody response and postprandial variability compared with needle-injected insulin. Thus, this warrants consideration as a therapeutic option for women with gestational diabetes mellitus and may also be applicable to nonpregnant, insulin-requiring diabetic patients.
Association of Lipoprotein Lipase Gene Variation with the Physiological Components of the Insulin-Resistance Syndrome in the Population of the San Luis Valley, Colorado
Authors: Ahn Young I , Ferrell Robert E , Hamman Richard F , Kamboh M Ilyas
Published: March 2007

OBJECTIVE

To cross-sectionally evaluate the presence of clustering of the insulin-resistance syndrome components. Tests were conducted for association of the Hind III restriction site polymorphism at the lipoprotein lipase locus with clustering of the physiological components of the insulin resistance syndrome.

RESEARCH DESIGN AND METHODS

DNA samples of 370 normoglycemic Hispanics and 520 normoglycemic non-Hispanic whites from the San Luis Valley, Colorado, were amplified by the polymerase chain reaction. Lipids and glucose were determined by the standard procedures. Cross-tabulation and χ2 analysis were used.

RESULTS

The insulin-resistance syndrome components (elevated fasting insulin, reduced high-density lipoprotein cholesterol, and elevated triglycerides) appeared together in individuals of this population sample more often than expected by chance. Individuals in the population with the (+/+) lipoprotein lipase-HindIII restriction of fragment-length polymorphism genotype were more likely to have elevated fasting insulin and triglycerides and a reduced high-density lipoproteincholesterol level than subjects with the (+/−) genotype (odds ratio = 2.3, 95% confidence interval 1.38–3.98).

CONCLUSIONS

As expected from the physiological function of lipoprotein lipase, the primary association of lipoprotein lipase genotypes is with triglyceride and high-density lipoprotein-cholesterol levels. This appears to be the first reported genetic association with the insulin-resistance syndrome and may reflect genotype specific differences in the regulation of lipoprotein lipase by insulin.
Effect of Cold Remedies on Metabolic Control of NIDDM
Authors: LeMar Homer J , Georgitis William J
Published: March 2007

OBJECTIVE

To compare the effects of two cough syrup formulations (one with sugar and alcohol and one without) on the metabolic control of NIDDM.

RESEARCH DESIGN AND METHODS

A prospective, blinded cross-over study was performed at the Endocrinology Clinic of a U.S. Army Medical Center on 20 volunteers with NIDDM, treated with diet alone or diet plus an oral hypoglycemic agent. After a 7-day lead-in period, patients took 3-day courses of each cough syrup (10 ml 4 times/day) with an intervening 4-day wash-out period. Fasting and postprandial blood glucose and lipids before and immediately after each course were compared.

RESULTS

No differences in pretherapy and posttherapy values were found with either formula. Values taken after the sugar- and alcohol-containing formula were not different from those taken after the alcohol- and sugar-free formula.

CONCLUSIONS

We conclude that patients with NIDDM can take standard daytime cough formulas, in short courses of standard doses, without adverse effect on blood glucose or lipids.
Plasma C3d Levels and Ischemic Heart Disease in Type II Diabetes
Authors: Figueredo A , Ibarra J L , Bagazgoitia J , Rodriguez A , Molino A M , Fernandez-Cruz A , Patino R
Published: March 2007

OBJECTIVE

To test the hypothesis that the complement system may be activated in patients with type II diabetes and CAD.

RESEARCH DESIGN AND METHODS

The plasma C3d concentration was measured in 106 type II diabetic patients and 25 nondiabetic control subjects. The patient group was subdivided according to AER, and the groups were adjusted for age, sex, and known duration of diabetes. For the assignment to a given subgroup, normoalbuminuria was defined as AER < 15 μm/min, microalbuminuria as AER 16–250 μg/min, and macroalbuminuria as AER > 250 μg/min. The presence or absence of coronary disease was assessed through clinical examination, ECG, and coronary angiography. An RIA system was used for measurement of urinary albumin levels, and the plasma C3d concentrations were measured by ELISA.

RESULTS

Within each of the AER-defined subgroups, the plasma C3d levels were significantly higher in patients with IHD than in those without. Thus, in the normoalbuminuric group, plasma C3d levels were 16.3 AU/ml (95% CI 13.9–19) in patients with IHD vs. 11.6 AU/ml (95% CI 10.5–12.7) in those without (P < 0.001). The corresponding data for the microalbuminuric and macroalbuminuric groups were 21.8 (95% CI 18.1–26.3) vs. 13.6 (95% CI 12.3–15.1) and 31.6 (95% CI 24.9–40) vs. 17.5 (13.6–22.6) AU/ml (P < 0.01), respectively. Patients with IHD also had significantly higher plasma C3d levels than normal control subjects, regardless of AER subgroup. A multiple logistic regression analysis demonstrated an association between the plasma C3d concentration and IHD and AER.

CONCLUSIONS

Activation of the complement system may play a role in the development of macrovascular disease in type II diabetes.
The Impact of Preconception Counseling on Pregnancy Outcomes: The experience of the Maine Diabetes in Pregnancy Program
Authors: Willhoite M Beth , Bennert Harry W , Palomaki Glenn E , Zaremba Maryann M , Herman William H , Williams Josephine R , Spear Nona H
Published: March 2007

OBJECTIVE

To determine if a noncentralized, statewide program could be established to educate health-care providers and women with pregestational diabetes on available strategies to prevent adverse outcomes in pregnancies complicated by diabetes. Characteristics of women who participated in the program and the outcomes of their pregnancies are evaluated.

RESEARCH DESIGN AND METHODS

A network of regional providers caring for pregnant women with diabetes was developed. Continuing education sessions were delivered to both providers and women with existing diabetes on the importance of preconception counseling.

RESULTS

Maine health-care providers collaborated on the development and adoption of three patient-care guidelines that address preconception counseling, prenatal care, and contraception for women with established diabetes. A total of 185 pregnancies among 160 women with pregestational diabetes reporting estimated delivery dates between 1 January 1987 and 31 December 1990 were identified. Of the total pregnancies, 62 (34%) occurred in women who received preconception counseling: among these 62 pregnancies were one major congenital defect (1.6%) and four fetal or neonatal deaths (6.4%). Among the 123 (66%) pregnancies occurring in women that had not received preconception counseling, 8 (6.5%) infants were born with congenital abnormalities, and 26 (21.1%) fetal or neonatal deaths were documented.

CONCLUSIONS

A program promoting preconception counseling can be implemented on a statewide basis by using various health-care providers to deliver the program. Participation in such a program appears to be related to improved pregnancy outcomes among women with pregestational diabetes.
Proposed Strategies for Reducing User Error in Capillary Blood Glucose Monitoring
Authors:   The National Steering Committee for Quality Assurance In Capillary Blood Glucose Monitoring
Published: March 2007

For individuals with diabetes mellitus, CBGM provides a more accurate picture of daily glucose fluctuation than urine glucose testing (1–9). As a result, CBGM is the preferred method to assess short-term glucose control and provide data for management decisions and insulin adjustment (10–16). Moreover, the wide availability of glucose monitoring systems designed for patient use has made SMBG the standard of care in diabetes management for all capable persons with insulin-requiring diabetes and an appropriate management tool for persons with non-insulin-requiring diabetes (13–20). In spite of the relative accuracy of current CBGM systems in measuring blood glucose levels, a recent study by the FDA suggests that user-procedural errors can cause inaccurate results (21). Inaccurate data affect patients efforts to achieve good metabolic control and, if used as the basis for regimen adjustment, may endanger health (21–42). Therefore, until reliable, technique-free systems are available, the accuracy of data with this technology must be improved through reduction of user error. This article presents strategies to accomplish this goal recommended by a national group of experts, the NSCQA in CBGM.
Designing Medical and Educational Intervention Studies: A review of some alternatives to conventional randomized controlled trials
Authors: Bradley Clare
Published: March 2007

The advantages and limitations of RCT designs are discussed, and a range of alternative designs for medical and educational intervention studies considered. Designs selected are those that address the much neglected psychological issues involved in the recruitment of patients and allocation of patients to treatments within trials. Designs include Zelen's (18) randomized consent design, Brewin and Bradley's (20) partially randomized patient-centered design, and Korn and Baumrind's (21) partially randomized clinician-centered design. The possibilities of combining features from each of the last two designs are illustrated, and the advantages of adopting a more flexible and clinically relevant approach to the design of clinical trials are discussed.
Effects of Benfluorex on Insulin Resistance and Lipid Metabolism in Obese Type II Diabetic Patients
Authors: Bianchi Rutgert , Bongers Vivian , Bravenboer Bert , Erkelens D Willem
Published: March 2007

OBJECTIVE

To evaluate the change in lipids and insulin sensitivity in 10 obese type II diabetic patients after treatment with benfluorex or placebo for 2 wk.

RESEARCH DESIGN AND METHODS

The study had a double-blind, cross-over design. Insulin sensitivity was measured with the euglycemic hyperinsulinemic glucose clamp technique at two different insulin infusion rates: 0.05 (clamp 1) and 0.10 U.kg−1 · h−1 (clamp 2).

RESULTS

Subanalysis of the glucose infusion rate under steady-state conditions in the last 30 min of clamp 2 yielded a glucose infusion rate of 5.36 and 3.87 mmol.kg−1.min−1 after benfluorex and placebo, respectively (P = 0.018).

CONCLUSIONS

Benfluorex increases insulin sensitivity in obese type II diabetic patients.
Apolipoprotein E Polymorphism Is Associated With Plasma Cholesterol Response in a 7-day Hospitalization Study for Metabolic and Dietary Control in NIDDM
Authors: Murakami Kaori , Shimizu Mizuo , Yamada Nobuhiro , Ishibashi Shun , Shimano Hitoshi , Yazaki Yoshio , Akanuma Yasuo
Published: March 2007

OBJECTIVE

To investigate the effects of apolipoprotein E phenotype, which is an important genetic factor determining plasma cholesterol level, on plasma lipoprotein metabolism during a 7-day diet therapy of diabetes.

RESEARCH DESIGN AND METHODS

Diet therapy was performed in 242 subjects with NIDDM. Plasma lipid levels and apolipoprotein A-I, B, and E levels on hospital days 2 and 9 were compared in three phenotype groups, ε2 (E2/2, and E2/3), ε3 (E3/3), and ε4 (E3/4 and E4/4).

RESULTS

No differences were observed in fasting blood glucose level, body mass index, age, duration of NIDDM, or medication among the three phenotype groups. Before starting the treatment, total plasma cholesterol did not vary by apolipoprotein E phenotype, although the mean plasma low-density lipoprotein cholesterol level in epsilon 4 patients was higher than in either ε3 or ε2 patients (ε4, 145 ± 42; ε3, 131 ± 34; ε2, 128 ± 36 mg/dl; P < 0.05). Changes in fasting blood glucose/body mass index after the 7-day treatment were not different among the apolipoprotein E phenotype groups, whereas the decrease in plasma cholesterol level after the treatment was significantly greater in ε2 patients than in either ε3 or ε4 patients (ε2, 10.3 ± 14.2; ε3, 6.1 ± 11.0; ε4, 3.8 ± 9.6%; P < 0.05).

CONCLUSIONS

Total plasma cholesterol response to in-hospital diet therapy varies by apolipoprotein E phenotypes, with subjects with apolipoprotein E2 showing the greatest response, whereas those with apolipoprotein E4 show the least. We suggest that subjects with apolipoprotein E4 should be controlled more strictly than other subjects from a viewpoint of reducing plasma cholesterol levels.
Exaggerated Hyperglycemia After A Pizza Meal in Well-Controlled Diabetes
Authors: Ann Ahern Jo , Gatcomb Patricia M , Held NANcy A , Petit William A , Tamborlane William V
Published: March 2007

OBJECTIVE

To examine whether the postprandial hyperglycemic effect of pizza in well-controlled IDDM patients is related to overeating or to unique properties of this popular food.

RESEARCH DESIGN AND METHODS

On two evenings, each patient (n = 8) consumed a meal that was similar in macronutrient composition except that one consisted of pizza and the other was a control meal that included high glycemic index foods. The insulin regimen was held constant.

RESULTS

Postprandial glucose levels were within the target range (< or = 10 mM) after the control meal. Although the initial glucose increase was similar for the two meals, plasma glucose continued to rise and was significantly increased from 4 to 9 h after ingestion of pizza compared with the control meal (P < 0.05). This increase occurred even though free insulin, glucagon, and free fatty acid levels did not differ significantly.

CONCLUSIONS

Our data suggest that pizza has properties that accentuate and sustain postprandial hyperglycemia.
Insulinemia in Children at Low and High Risk of NIDDM
Authors: Pettitt David J , Moll Patricia P , Knowler William C , Mott David M , Nelson Robert G , Saad Mohammed F , Bennett Peter H , Kottke Bruce A
Published: March 2007

OBJECTIVE

Fasting hyperinsulinemia in the presence of normoglycemia usually indicates insulin resistance and is characteristic of populations at high risk for developing NIDDM. Hyperinsulinemia predicts the development of impaired glucose tolerance and NIDDM in Pima Indians, a population with a high incidence of NIDDM. Insulin concentrations in population-based samples of children who have different risks of developing NIDDM later in life have not been reported previously.

RESEARCH DESIGN AND METHODS

We compared fasting insulin concentrations in two populations of nondiabetic children, 6–19 yr of age: Pima Indians from southern Arizona and Caucasians from Minnesota.

RESULTS

Insulin concentration varied with age, sex, glucose concentration, and relative weight. Mean fasting insulin concentration was 140.3 pM in Pima Indian males, 94.4 pM in Caucasian males, 171.5 pM in Pima Indian females, and 107.1 pM in Caucasian females. For each sex, the mean fasting insulin concentration, controlled for age, glucose, and relative weight, was significantly higher in the Pima Indians than in the Caucasians (P < 0.001).

CONCLUSIONS

From a young age, Pima Indian children have higher fasting insulin concentrations than Caucasian children. As hyperinsulinemia predicts subsequent NIDDM, these data suggest that the susceptibility to NIDDM is manifest at a young age as fasting hyperinsulinemia.
Pupillary Abnormalities in Type I Diabetes Occurring During Adolescence: Comparisons with cardiovascular reflexes
Authors: Schwingshandl Josef , Simpson Judy M , Donaghue Kim , Bonney Mary-Ann , Howard Neville J , Silink Martin
Published: March 2007

OBJECTIVE

To evaluate computerized infrared pupillometry for the assessment of autonomic neuropathy in adolescents with type I diabetes.

RESEARCH DESIGN AND METHODS

We measured resting pupil diameters and pupillary light reflexes in 142 adolescents with type I diabetes (72 boys and 70 girls, 10.4–19.8 yr of age, duration of diabetes 0.7–18.3 yr) and in 75 nondiabetic control subjects (29 boys, 46 girls, 11.3–19.8 yr of age). All study participants were assessed using four standard cardiovascular tests: maximum – minimum heart rate during deep breathing (mean of three cycles); heart-rate change during a Valsalva maneuver (Valsalva ratio, mean of three maneuvers); lying-to-standing heart-rate change (30:15 ratio); and lying-to-standing BP change.

RESULTS

Mean resting pupil diameters were significantly smaller in the diabetic group: 6.28 ± 0.06 vs. 6.77 ± 0.11 mm, P < 0.0001); and significantly smaller with greater duration of diabetes (r = −0.29, P = 0.0006) and higher levels of GHb (r = −0.24, P = 0.004). Patients with retinopathy grade 30 or more (Wisconsin 191 grading) had significantly smaller resting pupil diameters: 5.9 ± 0.16 vs. 6.4 ± 0.12 mm, P = 0.008). The phasic light reflex as determined by reflex amplitude and maximum constriction velocity was significantly reduced in the diabetic group: 2.27 ± 0.03 vs. 2.44 ± 0.04 mm, P = 0.0009; and 6.68 ± 0.12 vs. 7.24 ± 0.16 mm/s, P = 0.007). Reduced reflex amplitude was related to a longer postpubertal duration of diabetes (r = −0.18, P = 0.04). We found no association between pupillary and cardiovascular tests.

CONCLUSIONS

Infrared computerized pupillometry demonstrates subclinical diabetic autonomic neuropathy as early as adolescence. Its presence seems to be related to longer duration of diabetes and unfavorable metabolic control.
Effects of Low-Dose EPA-E on Glycemic Control, Lipid Profile, Lipoprotein(a), Platelet Aggregation, Viscosity, and Platelet and Vessel Wall Interaction in NIDDM
Authors: Westerveld H Tineke , de Graaf Jacques C , Van Breugel Hans HFI , Akkerman Jan Willem N , Sixma Jan J , Erkelens D Willem , Banga Jan Dirk
Published: March 2007

OBJECTIVE

To assess the effects of low-dose eicosapentaenoic acid-ethyl-ester on diabetes regulation, lipid metabolism, blood rheology, and platelet reactivity.

RESEARCH DESIGN AND METHODS

In a double-blind, randomized, placebo-controlled study, 24 NIDDM subjects received 1800 mg of EPA-E, 900 mg of EPA-E, or a placebo (1656 mg olive oil) daily for 8 wk.

RESULTS

The EPA: arachidonic acid plasma ratio increased over an 8-wk period, then declined after a 4-wk wash-out period in the fish-oil groups in a dosedependent way. Platelet-activating factor-induced platelet aggregation decreased from 75 ± 7% at wk 0 to 35 ± 21% at wk 8 in the 900-mg group (P = 0.016) and from 72 ± 11 to 40 ± 30% in the 1800-mg group (P = 0.039), but did not change in the placebo group. No effects on A DP- or collagen-induced aggregation could be attributed to EPA-E. In the 1800-mg group low-density-lipoprotein cholesterol increased significantly, without concomitant rise in apolipoprotein B. Triglycerides, glycemic control, lipoprotein (a), blood and plasma viscosity, erythrocyte deformability, and platelet adhesion to and aggregate formation on extracellular endothelial cell matrix were not significantly influenced.

CONCLUSIONS

Purified EPA-E in doses of 900 and 1800 mg reduces Plateletactivating factor-induced platelet aggregation without negatively affecting glycemic control. Low-density-lipoprotein cholesterol was elevated in the 1800-mg group.
Sex Differences in the Impact of Coexistent Diabetes on Survival in Patients With Coronary Heart Disease
Authors: Liao Youlian , Cooper Richard S , Ghali Jalal K , Lansky David , Cao Guichan , Lee John
Published: March 2007

OBJECTIVE

To evaluate the sex difference in the impact of diabetes on survival in patients with coronary heart disease.

RESEARCH DESIGN AND METHODS

Cohort study based on a sample from a hospital registry in Chicago, IL. A total of 974 consecutive patients (585 men and 389 women) with angiographically confirmed coronary artery disease were followed for 4.6 yr.

RESULTS

At baseline, 160 men and 155 women had diabetes. The age-adjusted relative risk of death from all causes for patients with diabetes versus patients without diabetes was 0.93 (95% confidence interval 0.65–1.34) in men and 1.99 (95% CI 1.30–3.05) in women. For cardiac death, the corresponding relative risk was 1.00 (95% CI 0.64–1.56) and 1.96 (95% CI 1.19–3.24) in men and women, respectively. Baseline differences in age, hypertension, body mass index, number of diseased vessels, and ejection fraction did not fully explain the excess mortality risk in diabetic women. Excess risk was apparent in both cardiac and noncardiovascular categories. Among nondiabetic patients, the risk of death was significantly lower in women compared with men (multivariate-adjusted relative risk = 0.61, 95% CI 0.41–0.89). However, the mortality risk of diabetic women became similar to men as a whole (relative risk =1.13, 95% CI 0.80–1.60).

CONCLUSIONS

Diabetes confers a substantially higher risk of mortality in women than in men when it occurs in the presence of coronary heart disease.
Lipoprotein(a) in Diabetic Patients and Normoglycemic Relatives in Familial NIDDM
Authors: Velho Gilberto , Erlich Danielle , Turpin Elisabeth , Néel Dominique , Cohen Daniel , Froguel Philippe , Passa Philippe
Published: March 2007

OBJECTIVE

To compare lipoprotein(a) levels in diabetic patients and normoglycemic relatives in familial NIDDM and to assess whether Lp(a) is a risk factor for myocardial infarction in this population.

RESEARCH DESIGN AND METHODS

We compared 577 patients and 261 normoglycemic relatives from 189 NIDDM multiplex families with 49 unrelated healthy individuals. of the 577, 23 patients with previously documented myocardial infarction were further analyzed as a separate group.

RESULTS

Lp(a) concentrations in diabetic patients, normoglycemic relatives, and the control group were not significantly different. Variance of Lp(a) in a given individual could not be accounted for by any clinical or biological parameter, but was strongly related to the mean Lp(a) value in his or her family. Diabetic patients with previous myocardial infarction (and their relatives) had significantly higher levels of Lp(a) than patients without coronary heart disease complaints.

CONCLUSIONS

Lp(a) concentration in familial NIDDM was not related to the degree of glucose intolerance, but presented a strong familial aggregation. High Lp(a) levels seem to be an independent risk factor for myocardial infarction in this NIDDM cohort.
Autonomic Neuropathy Predicts Deterioration in Glomerular Filtration Rate in Patients With IDDM
Authors: Sundkvist Göran , Lilja Bo
Published: March 2007

OBJECTIVE

To evaluate whether autonomic neuropathy predicts deterioration in glomerular filtration rate in IDDM patients.

RESEARCH DESIGN AND METHODS

A prospective study in which 35 IDDM patients have been followed for 10–11 yr. Autonomic nerve function tests included heart-rate reactions to deep breathing (expiration-to-inspiration ratio) and to tilt (acceleration and brake indexes). GFR was evaluated by the 51Cr-EDTA plasma clearance method.

RESULTS

At entry to the study, no significant differences were noted in age (39 ± 2 [mean ± SE] vs. 42 ± 4 yr), duration of diabetes (20 ± 3 vs. 23 ± 4 yr), supine blood pressures (120/79 ± 3/2 mmHg vs. 121/78 ± 6/3 mmHg), and GFR (113 ± 6 vs. 107 ± 3 ml·min−1·1.73 m−2) between 20 patients with and 15 without autonomic neuropathy (age-corrected criteria). After 10–11 yr, GFR had decreased significantly (22 ± 4 ml·min−1·1.73 m−2 P < 0.001) in patients with autonomic neuropathy but not (8 ± 5 ml·min−1·1.73 m−2, NS) in patients without. In keeping with this, GFR decreased more than expected (difference in GFR/ expected decrease in GFR) in patients with autonomic neuropathy, compared with those without (4.46 ± 0.98 vs. 0.48 ± 0.73, P < 0.005).

CONCLUSIONS

Autonomic neuropathy predicts future deterioration in GFR in IDDM patients.
Factors Involved in Catheter Obstruction During Long-Term Peritoneal Insulin Infusion
Authors: Bousquet-Rouaud Regine , Castex Françoise , Costalat Guy , Bastide Madeleine , Hedon Bernard , Bouanani Majida , Jouvert Sylvie , Mirouze Jacques
Published: March 2007

OBJECTIVE

To analyze the efficacy of ECPII and the factors responsible for technical problems often encountered. This treatment has been in use with IDDM patients since 1980.

RESEARCH DESIGN AND METHODS

Forty-four IDDM treated by ECPII for 42–78 mo (mean, 53 mo). patients were

RESULTS

Glycemic equilibrium was improved during treatment (mean plasma glucose level, 7.6 mM; mean GHb level, 8%). Catheter blockage was the main reason for ECPII failure (74%). Mean catheter survival of each catheter, determined by actuarial analysis, was 11.7 mo and significantly decreased with subsequent implantation. SEM of the catheter tips showed deposits composed of fibrin and cells occluding the inner lumen. Factors such as age, sex, local infection, and low insulin basal rate were not found to have any incidence on the catheter survival. Placement of the catheter in the upper part of the peritoneum, however, increased catheter survival. Anti-insulin antibodies did not seem to be directly involved in blockage.

CONCLUSIONS

We conclude from this long-term experience that during ECPII, catheter blockage remains the major recurring complication, probably involving a local immune-inflammatory response in the peritoneum.
Effect of War on Glycemic Control in Type II Diabetic Patients
Authors: Roglic Gojka , Metelko Zeljko
Published: March 2007

OBJECTIVE

To determine the effect of war-related, protracted stress on glycemic control in type II diabetic patients.

RESEARCH DESIGN AND METHODS

We examined 35 patients with type II diabetes as part of their routine control in October 1990. We reexamined them in October 1991, 3 mo after the war in Croatia began. We also administered a questionnaire to assess the patients' exposure to stress and changes in diet and exercise.

RESULTS

The patients were exposed to considerable stressors. The wartime diet differed from the prewar diet. We found significant changes in total serum cholesterol and TG values (P < 0.01), but we observed no significant changes in body weight, FBG, postprandial blood glucose, and HbA1c values. Insulin and glibenclamide dosages did not change.

CONCLUSIONS

We detected no significant impact of stress on glycemic control, probably because of differences in individual stress responsiveness. Changes in the lipid status probably were attributable to changes in dietary habits caused by specific circumstances.
Alternative Approaches to Public Health Surveillance of IDDM
Authors: Newman Jeffrey M , Herman William H , Vinicor Frank
Published: March 2007

OBJECTIVE

To assess the appropriateness of national surveillance of IDDM.

RESEARCH DESIGN AND METHODS

We reviewed the structure and function of national disease surveillance, the diverse goals of IDDM surveillance, and prior experience with IDDM as a reportable disease.

RESULTS

Surveillance is the systematic and ongoing collection, analysis, interpretation,and dissemination of data linked to public health action. The potential goals of surveillance of IDDM are to understand the etiology and trends in incidence of IDDM, to measure the burden of IDDM and its complications, and to assess mortality. Problems associated with surveillance of IDDM include underreporting, delayed reporting, and lack of funding.

CONCLUSIONS

To make IDDM a nationally reportable disease is neither warranted nor feasible at this time. Although surveillance is needed to understand diabetes better and for diabetes control, proposed initiatives, such as major expansions of IDDM reporting, should be developed to address specific questions, problems, and needs— stillrecognizing real-world issues of competing priorities and limited resources.
Association Between Fish Intake and Coronary Heart Disease Mortality: Differences in normoglycemic and glucose intolerant elderly subjects
Authors: Feskens Edith J M , Bowles Carel H , Kromhout Daan
Published: March 2007

Objective— To compare the association of habitual fish intake with 17-yr mortality of coronary heart disease between normoglycemic and glucose intolerant elderly subjects.

Research Design and Methods— In 1971, 272 men and women, 64-87 yr of age, were examined in a general practice in the town of Rotterdam, The Netherlands. Glucose intolerance (impaired glucose tolerance or diabetes mellitus) was observed in 83 subjects, and 189 subjects were found to be normoglycemic and free of clinically diagnosed diabetes mellitus. Information on usual dietary intake was obtained using the cross-check dietary history method.

Results—Fish consumption was found in 58.7% of the normoglycemic population and in 62.4% of the glucose intolerant population. Among normoglycemic subjects, the age- and sex-adjusted 17-yr mortality for coronary heart disease was 10.9/1000 person-yr for those who ate fish and 25.1/1000 person-yr for those who did not. For the glucose intolerant population, the rates were 20.6/1000 and 31.2/1000 person-yr, respectively. Adjusted for age, sex, body mass index, smoking, alcohol use, intake of energy, polyunsaturated fat, and carbohydrates, the risk ratio for normoglycemic population was 0.34 (95% confidence interval: 0.16-0.72). For glucose intolerant subjects, an adjusted risk ratio of 0.80 (95% confidence interval: 0.31–2.05) was observed.

Conclusions— These results suggest that in a glucose intolerant population the possible protective effect of fish intake on coronary heart disease may be smaller than in normoglycemic subjects.
Metabolic and Hemodynamic Effects of Metformin and Glibenclamide in Normotensive NIDDM Patients
Authors: Chan Juliana C N , Tomlinson Brian , Critchley Julian A J H , Cockram Clive S , Walden Richard J
Published: March 2007

Objective— To compare the metabolic and hemodynamic effects of metformin and glibenclamide in normotensive NIDDM patients.

Research Design and Methods— After a 2-wk run-in period on dietary treatment alone, 12 Chinese normotensive patients with uncomplicated NIDDM were randomized to receive either metformin, or glibenclamide for 4 wk before being crossed-over to the alternative treatment for an additional 4 wk. Metabolic and hemodynamic index, including cardiac output estimation by impedance cardiography, were measured at baseline and at the end of each treatment period.

Results— Body mass index was reduced more with metformin than with glibenclamide, although glycemic control was similar with both drugs. Plasma total cholesterol concentration fell more with metformin (mean difference −0.65 mM, 95% confidence interval −0.96 to −0.32) than glibenclamide (mean difference −0.20 mM, 95% confidence interval −0.54–0.12) (P < 0.05). Compared with baseline values, erect diastolic blood pressure was reduced more by metformin (12.9% [95% confidence interval −21.5 to −4.4%]) than glibenclamide (−6.8% [95% confidence interval −14.9 to 1.2%]) (P < 0.001). The relative changes in the systemic vascular resistance index also differed between the two treatments (glibenclamide, 6.2 [−4.3 to 16.6%]; metformin, −1.2 [95% confidence interval −8.8−6.4%]) (P < 0.05)].

Conclusions— In normotensive NIDDM patients, treatment with metformin was associated with greater reductions in body weight, plasma total cholesterol concentration, and erect diastolic blood pressure, whereas the systemic vascular resistance index increased after treatment with glibenclamide. These findings merit long-term investigation.
Acute Insulin Response to Glucose and Glucagon in Subjects at Risk of Developing Type I Diabetes
Authors: Vialettes Bernard , Zevaco-Mattei Catherine , Thirion Xavier , Lassmann-Vague Véronique , Pieron Henri , Mercier Pierre , Vague Philippe
Published: March 2007

Objective— To determine if knowledge of characteristics of insulin response to various secretagogues during the preclinical phase of type I diabetes may facilitate the diagnosis of subjects at risk.

Research Design and Methods— A test consisting of sequential intravenous challenge with glucose (0.3 g/kg) and glucagon (1 mg, 10 min after the end of glucose injection) was performed on 171 ICA− relatives of type I diabetic patients, 18 ICA+ relatives of type I diabetic patients, and 5 transiently hyperglycemic subjects. Acute response to glucose was expressed as the sum of plasma insulin at 2 and 5 min and response to glucagon as the increase in plasma insulin after 10 min.

Results— Responses below the lower 95% confidence interval in the ICA− population (40 and 43 μU/ml for glucose and glucagon, respectively) were considered abnormal. The two values were correlated (r = 0.62). Abnormalities coexisted in 2.3% of the ICA− group, 11% of the ICA+ group, and 100% of the transiently hyperglycemic group. All the relatives who subsequently developed diabetes or hyperglycemic subjects who required insulin exhibited combined abnormalities. Some ICA− and ICA+ relatives were tested repeatedly over a follow-up period of 1.5–4 yr. Although the intraindividual coefficient of variation for the two responses was high (28 and 30%), values tended to run parallel in both ICA+ and ICA− relatives. In 2 patients monitored for 2 and 4 yr before diabetes developed, both responses declined at the same rate. In terms of prediction of diabetes, sensitivity of combined abnormalities was high (100%). But compared with the intravenous glucose tolerance test, improvement of specificity by the double challenge was not statistically significant.

Conclusions— Both insulin responses to glucose and glucagon are related. They depend on the secretory capacity of β-cells and simultaneously become abnormal in the prediabetic phase.
Stability Over Time of Modern Diagnostic Criteria for Type II Diabetes
Authors: Stern Michael P , Valdez Rodolfo A , Haffner Steven M , Mitchell Braxton D , Hazuda Helen P
Published: March 2007

Objective— To examine the long-term stability of the World Health Organization criteria for diabetes in the 8-yr follow-up of the San Antonio Heart Study. A problem with older criteria for diagnosing diabetes was that many individuals classified as having borderline or chemical diabetes reverted to nondiabetic status on follow-up. Few studies have addressed this issue among diabetic patients who meet the more stringent, modern National Diabetes Data Group or World Health Organization criteria.

Research Design and Methods— We studied 98 Mexican-American and 44 non-Hispanic white type II diabetic patients 8 yr after they were diagnosed according to World Health Organization criteria in a population-based epidemiological survey. Patients were classified as follows: whether they were on pharmacological treatment for diabetes at baseline, or, if not, whether they had a prior diagnosis of diabetes at the time of their baseline survey visit or were newly diagnosed.

Results— Of the 142 patients who met the study criteria for type II diabetes at baseline and whose status at follow-up was known, 20 (14.1%; 95% confidence interval 9.0–20.5%) no longer met criteria at follow-up 8 yr later. All but 2 of those who reverted to nondiabetic status were from the newly diagnosed group. Two of 20 had lost more than 5.0 kg over the 8 yr and an additional 5 had lost 2.5–5.0 kg. The 20 patients who reverted to nondiabetic status lacked many of the associated anthropometric, physiological, and metabolic findings of diabetes such as obesity, unfavorable body fat distribution, and dyslipidemia. Moreover, only one had proteinuria, and none had any grade of diabetic retinopathy at baseline.

Conclusions— Epidemiological surveys that rely on a single oral glucose tolerance test to determine the prevalence of type II diabetes may overestimate prevalence by as much as 16% (95% confidence interval 10.5–23.6%) (142/122 = 1.16). The actual overestimate could well be less because some patients who truly have diabetes at baseline may be in remission at follow-up as a result of significant weight loss. Despite these difficulties, the modern National Diabetes Data Group and World Health Organization criteria are more stable than earlier criteria.
A Prospective Population-Based Study of Microalbuminuria as a Predictor of Mortality in NIDDM
Authors: Neil Andrew , Hawkins Michael , Potok Michael , Thorogood Margaret , Cohen David , Mann Jim
Published: March 2007

Objective— To assess prospectively the relationship between microalbuminuria and mortality in a geographically defined population of NIDDM patients and to determine the relative importance of microalbuminuria as a risk factor for mortality.

Research Design and Methods–A survey of known diabetes undertaken in 1982 identified a cohort of 249 NIDDM patients. Follow-up information was available for 246 patients who contributed 1498 person-yr exposure and were followed up for a mean period of 6.1 yr. The median age of the cohort at entry was 68 yr (range 28–89 yr), and the median duration of diabetes was 7 yr (range 1–41 yr). At baseline, a clinical examination was performed and a random daytime urine specimen was obtained for measurement of urinary albumin concentration.

Results— UAC results were available for 236 patients: 45 (19%) patients had a UAC > 15- < 40 mg/L; 36 (15%) had a UAC 40–200 mg/L; 10 (4%) had a UAC > 200 mg/L; and 145 (61%) had a normal UAC < or = 15 mg/L. During the follow-up period, 93 patients died. All-causes mortality, expressed as standardized mortality ratio (SMR = 149) and coronary heart disease mortality (CHD SMR = 166) were significantly increased. This excess mortality was significant in women (all-causes SMR = 194, CHD SMR = 234) but not in men (all-causes SMR = 118, CHD SMR = 128). On univariate analysis, systolic blood pressure was the only significant association with albumin concentration (P = 0.0002). An age-stratified log-rank test was conducted to determine the effect of potential explanatory variables on survival. Survival distributions were significantly different for known duration of diabetes (P = 0.045), intermittent claudication (P = 0.012), severity of retinopathy, lens opacity (P < 0.001) and UAC (P = 0.013) and diastolic blood pressure approached significance (P = 0.051). After adjusting for the effects of these potentially confounding variables identified by the log-rank analysis, significant predictors of early mortality on multivariate survival analysis were age, UAC of 40–200 mg/L (relative risk = 2.2, 95% confidence interval 1.3–3.7), more severe retinopathy (relative risk = 3.4, 95% confidence interval 1.9–6.0), and lens opacity (relative risk = 2.4, 95% confidence interval 1.6–3.8).

Conclusions— The findings from this population-based cohort confirm the predictive power of microalbuminuria as a risk factor for mortality in NIDDM. In contrast to prospective studies of conventional cardiovascular risk factors in NIDDM, consistent evidence indicates that microalbuminuria is an independent predictor of excess mortality regardless of the collection procedure used.
Psychosocial Adjustment to Advanced Proliferative Diabetic Retinopathy
Authors: Wulsin Lawson R , Jacobson Alan M , Rand Lawrence I
Published: March 2007

OBJECTIVE

To identify the major problems with adjustment to the advanced stages of proliferative diabetic retinopathy and to examine the relationship between adjustment and visual acuity.

RESEARCH DESIGN AND METHODS

A cross-sectional descriptive cohort study was conducted at the referral-based eye unit at Joslin Diabetes Center in Boston, Massachusetts. We studied 47 adults with IDDM and advanced proliferative diabetic retinopathy. Thirty reported recent visual loss, and 17 had more stable vision.

RESULTS

Psychosocial Adjustment to Illness Scale scores were significantly elevated relative to a normative diabetic sample (t = 2.94, P < 0.01). Our proliferative diabetic retinopathy sample reported the most difficulties in the domain of health-care orientation. No significant differences were observed in adjustment scores between those with recent partial visual loss and those with more stable vision. However, visual acuity in the best eye correlated significantly with the proliferative diabetic retinopathy sample's total adjustment score (r = −0.34, P = 0.02) and with 4 of 7 adjustment subscales.

CONCLUSIONS

These results suggest that advanced proliferative diabetic retinopathy may be associated with particular difficulties in adjustment that are more related to best visual acuity than to recent visual loss. Relatively mild visual impairment may have significant psychosocial impact.
Calculated Low-Density Lipoprotein Cholesterol Should Not Be Used for Management of Lipoprotein Abnormalities in Patients With Diabetes Mellitus
Authors: Rubiés-Prat Juan , Reverter Jordi L , Sentí Mariano , Pedro-Botet Juan , Salinas Isabel , Lucas Anna , Nogués Xavier , Sanmartí Anna
Published: March 2007

OBJECTIVE

To assess the validity of calculated low-density lipoprotein cholesterol by the Friedewald formula for management of lipoprotein abnormalities in patients with diabetes mellitus.

RESEARCH DESIGN AND METHODS

Calculated LDL cholesterol by the Friedewald formula was compared with measured LDL cholesterol after separation by ultracentrifugation in 61 patients with type I diabetes, 50 patients with type II diabetes, and 116 healthy control subjects.

RESULTS

Calculated LDL cholesterol coincided with measured LDL cholesterol, with < 10% error, in 54 (49%) patients with diabetes mellitus, and 85 (73%) control subjects. Calculated LDL cholesterol was overestimated, with an error of > or = 10% of measured LDL cholesterol in 39% of patients and 26% of control subjects, and underestimated in 13 and 1%, respectively. Despite a good correlation between calculated and measured LDL cholesterol, the intraclass correlation coefficients demonstrated a poor concordance between calculated and measured LDL cholesterol, both in patients and control subjects. When comparing the mean differences of calculated and measured LDL cholesterol for diabetic subjects versus control subjects, significantly greater differences in type II (but not type I) diabetic subjects were seen.

CONCLUSIONS

Calculation of LDL cholesterol by the Friedewald formula may be inaccurate for assessment of cardiovascular risk in patients with type II diabetes and may not be appropriate for management of lipoprotein abnormalities in those diabetic patients.
Hemostasis Variables in Type I Diabetic Patients Without Demonstrable Vascular Complications
Authors: Khawand Charbel El , Jamart Jacques , Donckier Julian , Chatelain Bernard , Lavenne Edith , Moriau Maurice , Buysschaert Martin
Published: March 2007

OBJECTIVE

To determine hemostasis variables in type I diabetic patients without clinically demonstrable micro- and macroangiopathy and to relate them to glycemic control.

RESEARCH DESIGN AND METHODS

Fifty patients and 50 comparable control subjects were enrolled in this study. The patients were subdivided in two groups, according to their level of HbA1c (group 1, n = 30, HbA1c ≤ 8% group 2, n = 20, HbA1c > 8%). We determined the platelet count, the platelet aggregation in the spontaneous state and in the presence of ADP or collagen, β-thromboglobulin, platelet factor 4, fibrinogen, von Willebrand factor (factors VIII:C, VIIIR:Ag, and VIIIR:VW), plasma and urinary fibrinopeptide A, euglobulin lysis time, anticoagulant proteins C and S, and plasma viscosity.

RESULTS

All coagulation variables were significantly higher in diabetic patients compared with control subjects. Moreover, when the patients were subdivided according to their levels of HbA1c, the hemostatic disturbances appeared significantly more pronounced in the poorly controlled than in the well-controlled subjects.

CONCLUSIONS

This study confirms the existence of a state of hypercoagulability in type I diabetes. This hypercoagulability may be related to poor glycemic control. Our study suggests that the hemostasis disturbances precede demonstrable vascular complications.
Metabolic Pathways of Glucose in Skeletal Muscle of Lean NIDDM Patients
Authors: Kelley Davids E , Mokan Marian , Mandarino Lawrence J
Published: March 2007

OBJECTIVE

To characterize the ability of insulin to activate the skeletal muscle metabolic pathways of glucose storage, oxidation, and glycolysis in normal weight patients with NIDDM and nondiabetic volunteer subjects closely matched for age, sex, relative weight, and body composition.

RESEARCH DESIGN AND METHODS

Ten patients with NIDDM (body mass index 23.9 ± 0.74 kg/m2) and 8 nondiabetic volunteer subjects (body mass index 23.4 ± 0.41 kg/m2) were studied. Leg muscle glucose uptake, non-oxidized glycolysis, glucose oxidation, and glucose storage were determined during euglycemic-hyperinsulinemic clamp experiments using the leg balance technique combined with leg indirect calorimetry. Percutaneous muscle biopsies were obtained to assay insulin stimulation of muscle glycogen synthase activity as a biochemical marker of insulin action.

RESULTS

During hyperinsulinemic clamp experiments, leg glucose uptake was equivalent in NIDDM patients and nondiabetic subjects (6.38 ± 1.14 vs. 6.41 ± 0.73 μmol.min−1 · 100 ml tissue−1), as were rates of leg glucose oxidation (1.63 ± 0.25 vs. 2.14 ± 0.17 μmol.min−1 · 100 ml tissue−1) and leg glucose storage (4.35 ± 1.10 vs. 3.48 ± 0.65 μmol·min−1 · 100 ml tissue−1). The combined net balance of lactate and Ala (non-oxidized glycolysis) was lower in NIDDM patients (−0.39 ± 0.06 vs. −0.79 ± 0.11 μmol·min−1 · 100 ml tissue−1, P = 0.01). Muscle glycogen synthase was activated to a similar extent during the hyperinsulinemic clamp in NIDDM patients and nondiabetic volunteer subjects, through basal glycogen synthase activity was lower in NIDDM patients. Nondiabetic subjects and NIDDM patients who were withdrawn from sulfonylurea therapy had impaired insulin secretion during a 75-g oral glucose tolerance test, with similar basal levels as nondiabetic subjects (54 ± 12 vs. 42 ± 6 pM), but reduced peak insulin levels (126 ± 30 vs. 468 ± 102 pM, P < 0.01).

CONCLUSIONS

Detailed in vivo and in vitro assessment of insulin regulation of skeletal muscle glucose metabolism in lean NIDDM patients indicates that insulin action is intact in the muscle tissue of these patients.