bluuebunny/crossref_metadata_2025 huggingface dataset:
Common Carotid Arterial Wall Thickness in NIDDM Subjects
Authors: Pujia Arturo , Gnasso Agostino , Irace Concetta , Colonna Alfredo , Mattioli Pier Luigi
Published: March 2007

OBJECTIVE

To verify whether carotid arterial intimal plus media thickness (IMT) is greater in non-insulin-dependent diabetes mellitus (NIDDM) subjects, known to be at high risk for atherosclerosis. Evidence is growing that IMT is increased in subjects with coronary heart disease (CHD) risk factors like hypercholesterolemia and cigarette smoking.

RESEARCH DESIGN AND METHODS

Fifty-four NIDDM subjects and 54 sex- and age-matched control subjects underwent CHD risk factors assessment and echo-Doppler examination of carotid arteries. IMT was measured by computer technique in the common carotid artery (CCA). Presence of plaques and/or stenosis (carotid atherosclerosis [CA]) was also evaluated by a single-blinded reader.

RESULTS

NIDDM subjects had larger IMT, higher levels of triglycerides, and lower concentrations of high-density lipoprotein (HDL) cholesterol compared with control subjects. IMT was positively correlated to age and systolic blood pressure and inversely to HDL cholesterol in both groups. The prevalence of CA was 46% in NIDDM subjects and 18% in control subjects. In multiple regression analysis, IMT was the only variable significantly associated to CA.

CONCLUSIONS

IMT of CCA is enlarged in NIDDM subjects compared with control subjects. Its association with carotid plaques and/or stenosis might be of importance to detect early atherosclerotic lesions in the carotid arteries.
Effect of Added Fat on the Plasma Glucose and Insulin Response to Ingested Potato Given in Various Combinations as Two Meals in Normal Individuals
Authors: Ercan Nacide , Gannon Mary C , Nuttall Frank Q
Published: March 2007

OBJECTIVE

In normal subjects, ingestion of fat with potato in a morning meal resulted in a decrease in the glucose response. Therefore, we wished to determine whether a fat-induced decrease in blood glucose also would be observed after a second identical meal. In addition, we were interested in determining if fat ingestion with a morning meal would have an effect on the blood glucose and insulin responses to a second meal not containing fat.

RESEARCH DESIGN AND METHODS

Nine healthy male subjects ingested two meals consisting of an amount of potato containing 50 g carbohydrate, either alone or with 50 g fat as butter. The meals were served in four combinations as follows: 1) potato for the first meal, potato for the second meal; 2) potato for the first meal, potato with fat for the second meal; 3) potato with fat for the first meal, potato for the second meal; and 4) potato with fat for the first meal, potato with fat for the second meal. Meals were ingested at 8:00 A.M. and noon. Plasma glucose and C-peptide, serum insulin, triglyceride, and free fatty acid (FFA) concentrations were determined over an 8-h period. The integrated area responses to the meals were quantified over the subsequent 4-h period using the fasting value or the noon value as baseline for the first and second meals, respectively.

RESULTS

When the first meal contained potato only, the glucose area response to the second meal was significantly less when the second meal contained fat. However, fat ingestion had no effect on the glucose area response to the second meal when fat was present in the first meal. The insulin area responses to the first and second meals were similar after ingestion of potato or potato with fat. However, the insulin response to the second meal always was less that to the first meal. The C-peptide area responses after ingestion of the second meal also were all higher than those after the first meal. The triglyceride area responses were slightly negative after ingestion of potato alone in the first meal. When fat was ingested, they were positive. When the first meal contained fat but the second meal did not, there was a rise in triglyceride concentration after the second meal as well as after the first meal. That is, a rise occurred without ingestion of fat with the second meal. If fat was present in the second meal the rise was even greater. The FFA area responses were similar to the triglyceride area responses.

CONCLUSIONS

When fat was ingested with carbohydrate in either the first or second meal, the glucose area response was decreased. However, when both meals contained fat, a decrease in the glucose area response did not occur with the second meal. The glucose area responses all were greater after the second meal compared with those after the first meal, i.e., the opposite of a Staub-Traugott effect was observed. The insulin area responses to the first and second meals were similar whether fat was ingested or not.
Relationship Between Lineprotein Profile and Urinary Albumin Excretion in Type II Diabetic Patients With Stable Metabolic Control
Authors: Reverter Jordi L , Pizarro Eduarda , Sentí Marian , Pedro-Botet Juan , Rubiés-Prat Juan , Romero Ramón , Lucas Anna , Sanmartí Anna , Saunas Isabel
Published: March 2007

OBJECTIVE

To assess lipids and lipoprotein composition and the relationship between lipoprotein abnormalities and urinary albumin excretion (UAE) in select type II diabetic patients with stable metabolic control.

RESEARCH DESIGN AND METHODS

Fifty-five type II diabetic patients and 55 healthy control subjects both with a body mass index <30 kg/m2 were studied. Patients were classified according to their level of UAE as normoalbuminuric (n = 37), microalbuminuric (n = 11), and macroalbuminuric (n = 7). In all cases, serum creatinine and albumin concentrations were in the normal range.

RESULTS

Normoalbuminuric patients showed increased triglyceride (TG) contents in intermediate-density lipoprotein (IDL) (P < 0.01), low-density lipoprotein (LDL) (P < 0.001), and high-density lipoprotein (HDL) (P < 0.001) compared with control subjects. Lipoprotein concentration in microalbuminuric patients did not differ from that of normoalbuminuric patients. On the other hand, patients with macroalbuminuria showed a significant increase in IDL cholesterol (P < 0.01) and IDL (P < 0.01), LDL (P < 0.05), and HDL TGs (P < 0.01) compared with the other groups. Diabetic patients with nephropathy, both microalbuminuric and macroalbuminuric, tended to have higher mean lipoprotein(a) (Lp[a]) concentrations than normoalbuminuric patients and control subjects. A strongly positive correlation was observed between UAE and serum TGs (r = 0.56) and very-low-density lipoprotein (r = 0.55), IDL (r = 0.52), LDL (r = 0.54), and HDL TGs (r = 0.52).

CONCLUSIONS

Lipoprotein alterations observed in diabetic patients, specifically IDL abnormalities and a tendency toward high Lp(a) levels, which are more marked in those with increased UAE, may contribute to the excess of cardiovascular disease in type II diabetic patients, particularly those with nephropathy.
Muscle Fiber Composition and Capillary Density in Women and Men With NIDDM
Authors: MÅrin Per , Andersson Björn , Krotkiewski Marcin , Björntorp Per
Published: March 2007

OBJECTIVE

To determine whether muscle fiber composition and capillary density differed between diabetic and nondiabetic subjects.

RESEARCH DESIGN AND METHODS

Muscle fiber composition and capillary density were determined in biopsies from women and men with non-insulindependent diabetes mellitus (NIDDM) and compared with those of control subjects matched for gender, age, obesity, and the waist-to-hip ratio, which are all factors known to influence muscle morphology.

RESULTS

Patients with NIDDM, as well as control subjects with abdominal obesity and insulin resistance, showed the same abnormalities in muscle morphology, namely, a low percentage of type I fibers, elevated type II (particularly type IIB) fibers, and a low capillary density. These changes correlated closely with insulin concentrations in both diabetic and nondiabetic groups.

CONCLUSIONS

Recent information suggests that insulin may regulate myosin synthesis in muscle in the direction of the changes observed. Therefore, it is possible that muscle fiber composition abnormalities in insulin-resistant conditions are secondary to hyperinsulinemia. However, the low capillary density, hypothetically, may contribute to insulin resistance.
Incidence of Type I Diabetes in People Under 30 Years of Age in Barbados, West Indies, 1982-1991
Authors: Jordan Oscar W , Lipton Rebecca B , Stupnicka Elzbieta , Kennedy Cruickshank J , Fraser Henry S
Published: March 2007

OBJECTIVE

To determine the incidence of type I diabetes among individuals <30 years of age on the island of Barbados in the Caribbean. The population is predominantly African in origin but exhibits a relatively westernized lifestyle.

RESEARCH DESIGN AND METHODS

Cases occurring during the years 1982–1991 were drawn from records at Queen Elizabeth Hospital and from physicians treating insulin-dependent diabetes mellitus (IDDM) patients. Patients using insulin and <30 years of age at onset were included. Ascertainment was estimated at 94%.

RESULTS

The average annual incidence of type I diabetes among Barbadians was 4.1/100,000 when age-adjusted to the world's population. There were 59 incident cases during this 10-year interval. The risk for males was 4.4 and for females 4.0/100,000. Among those 0–14 years of age, the risk was 5.0/100,000. Mean age at onset (± SD) was 14.7 ± 6.9 for males and 12.5 ± 5.7 for females. Males showed marked seasonal variation in risk and a more than threefold increase in annual incidence during 1984–1985. In contrast, females exhibited a stable pattern of IDDM risk during the 10-year interval.

CONCLUSIONS

The incidence rate in Barbados falls near the lower limits of rates reported for Caribbean populations. There was a marked seasonal effect among males, even though the climate varies little throughout the year. This observation, and the incidence peak during 1984–1985, provide support for the role of environmental factors in the etiology of IDDM.
Low-Birth-Weight Infants Show Earlier Onset of IDDM
Authors: Khan Naznin , Couper Jennifer J
Published: March 2007

OBJECTIVE

Pancreatic β-cell mass increases rapidly during gestation and early infancy. Infants who are small for gestational age, which is a marker for poor intrauterine nutrition, have reduced β-cell mass. We examined whether weight and length in early infancy, and in inference β-cell mass, is related to age at onset of insulindependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS

Data from infant records of 232 patients with IDDM, including birth weight, birth length, gestational age, weight at 6 months of age, and feeding history during the first 6 months of life, were analyzed. Maternal recall was not used for data collection.

RESULTS

Low-birth-weight infants (<2.5 kg) showed a significantly earlier onset of diabetes (4.3 [3.2–6.0] years vs. 9.0 [5.3–11.8] years, median [25–75th percentile]; P < 0.0001). Infants small for gestational age also had earlier onset than those with birth weight above the 10th percentile after correction for gestational age (6.2 [3.6–10.5] vs. 9.2 [5.4–11.8] years; P < 0.0001). Infants with corrected birth weight: length ratio below the 10th percentile had earlier onset, as did infants with corrected 6-months weight below the 10th percentile (4.9 [2.8–6.0] years vs. 8.8 [5.2–11.8] years; P < 0.0001). Infants who were exclusively breast-fed for 6 months showed a slightly later onset of diabetes than those who were bottle- or mixed-fed, independent of weight (9.4 [5.0–11.3] years vs. 8.3 [4.2–11.7] years; P < 0.0001).

CONCLUSIONS

Weight and growth parameters in utero and early infancy may influence the age at onset of IDDM. β-cell mass is likely to be a significant factor.
Physical Activity and Fibrinogen Concentration in Newly Diagnosed NIDDM
Authors: Vanninen Esko , Laitinen Jaana , Uusitupa Matti
Published: March 2007

OBJECTIVE

To evaluate whether plasma fibrinogen concentration is correlated with the level of physical activity and aerobic power in patients with newly diagnosed non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

We studied 78 middle-aged (54 ± 6 years, mean ± SD), obese (body mass index [BMI] 32 ± 5 kg/m2) patients (45 men and 33 women) before and after a 12-month treatment period consisting of either conventional treatment given by community health centers or intensified dietary and exercise education given by a university outpatient clinic. Plasma fibrinogen concentration was measured by using a coagulometer. Physical activity was assessed by a questionnaire, and the patients were classified into a sedentary group or moderately or intensively exercising groups. Aerobic power (maximum oxygen uptake [], anaerobic threshold []) was measured by direct breath-by-breath technique.

RESULTS

At baseline, the sedentary patients had higher fibrinogen concentration than those with moderate or high physical activities (3.8 ± 0.8 vs. 3.3 ± 0.7 g/I, P < 0.01). Both and (ml · min−1 · kg−1) showed an inverse linear correlation with fibrinogen (r = -0.38, P < 0.001, and r = -0.29, P < 0.01, respectively). In the step wise multiple regression analysis, BMI, Vo2 max (ml/min), and smoking were the only significant independent factors explaining 23% of the variance in fibrinogen concentration. In sedentary patients, poor glycemie control was related with high fibrinogen concentration. During the follow-up period, patients maintained, on the average, good to moderate glycemie control. The originally sedentary group showed a decrease in fibrinogen concentration (to 3.3 ± 0.7 g/I, P < 0.001) that reached the same level that the physically more active groups had at baseline. This change was associated with improved glycemie control, but not with any of the other assessed factors, including fatty acid composition of serum lipids reflecting dietary intake of fats.

CONCLUSIONS

In addition to BMI and smoking, low reported physical activity and low aerobic power are independently associated with high plasma fibrinogen concentration in newly diagnosed NIDDM.
Adolescent Diabetes Management and Mismanagement
Authors: Weissberg-Benchell Jill , Glasgow Allen M , Tynan W Douglas , Wirtz Philip , Turek Jane , Ward Joseph
Published: March 2007

OBJECTIVE

To document the existence and prevalence of adolescent-generated diabetes management techniques.

RESEARCH DESIGN AND METHODS

One hundred forty-four adolescents completed the confidential questionnaire developed for this study. Glycohemo-globin was also obtained for each individual.

RESULTS

Within the 10 days before their clinic visit, many adolescents admitted to engaging in various mismanagement behaviors, with 25% admitting to missing shots. Parents tend to underestimate adolescent mismanagement. Missing shots was significantly related to poor control (P < 0.01). Older adolescents engaged in more mismanagement than their younger cohorts (P < 0.001). The questionnaire factored into two subscales: blatant mismanagement and faking.

CONCLUSIONS

This study shows the importance of recognizing the prevalence of mismanagement among adolescents.
Increased Plasma Levels of Immunoreactive Endothelin and von Willebrand Factor In NIDDM Patients
Authors: Morise Toshio , Takeuchi Yoshihiro , Kawano Mitsuhiro , Koni Ichiro , Takeda Ryoyu
Published: March 2007

OBJECTIVES

To elucidate the significance of plasma levels of endothelin (ET) and von Willebrand factor (vWF) as possible markers for endothelial dysfunction in non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

Plasma levels of ET and vWE were determined in 22 NIDDM patients with or without retinopathy and 10 normal control subjects.

RESULTS

The plasma levels of immunoreactive endothelin (irET) and vWF in NIDDM patients were 0.78 ± 0.06 pmol/1 and 218.3 ± 18.4%, respectively, which represented significant (P < 0.05, P < 0.01, respectively) differences from the values in the control group (0.50 ± 0.06 pmol/1 and 139.1 ± 11.1%, respectively, n = 10). However, when the diabetic patients were divided into two groups according to the presence or absence of diabetic retinopathy, the plasma levels of irET and vWF in the NIDDM patients with retinopathy were significantly higher (1.01 ± 0.07 pmol/1 and 283.0 ± 21.4%, respectively, n = 12) compared with the control group and NIDDM patients without retinopathy (0.59 ± 0.06 pmol/1 and 164.3 ± 17.0%, respectively). Plasma levels of irET showed a significant (P < 0.01) positive correlation with the levels of vWF.

CONCLUSIONS

These data strongly suggest that increased plasma irET reflects the endothelial cell damage in NIDDM.
Empirical Validation for a Family-Centered Model of Care
Authors: Hanson Cindy L , De Guire Michelle J , Schinkel Angle M , Kolterman Orville G
Published: March 2007

OBJECTIVE

To examine whether family relations and family-life stress predict adherence behaviors and metabolic control in youths by testing a theoretically- and empirically-based model.

RESEARCH DESIGN AND METHODS

HbA1c levels of 157 youths 12–20 years of age with insulin-dependent diabetes mellitus (IDDM) were evaluated, along with treatment adherence and psychosocial family data based on interviews and self-reports. A family-centered model for IDDM care was analyzed with the EQS structural modeling statistical program. An additional exploratory model including HbA1c levels 6 months earlier was also tested.

RESULTS

Positive family relations (high family cohesion and low family conflict), especially during the first years of illness, indirectly related to good metabolic control through positive adherence behaviors. High levels of family-life stress related to worse metabolic control directly, and also indirectly via poor family relations, which in turn related to poor adherence to treatment. Longer illness duration related indirectly to metabolic control via adherence to treatment. Longer illness duration also related to maternal perceptions of higher family-life stress. Older youths perceived more family-life stress as well. The older age of the youths related indirectly to poor metabolic control through its association with poor adherence behaviors and less cohesive and more conflictual family relations. Results were consistent when earlier levels of metabolic control were included in the model, except that the direct relationship between family-life stress and metabolic control became nonsignificant.

CONCLUSIONS

The findings suggest that a family-centered approach to diabetes care that facilitates positive family functioning and leads to lower levels of family-life stress may be useful in promoting optimal health outcomes.
Psychological Impact of Islet Cell Antibody Screening for IDDM on Children, Adults, and Their Family Members
Authors: Johnson Suzanne Bennett , Tercyak Kenneth P
Published: March 2007

OBJECTIVE

To describe the psychological impact of positive islet cell antibody (ICA) screening results in children and adults, as well as their parents and spouses.

RESEARCH DESIGN AND METHODS

The psychological impact of ICA screening results was assessed subsequent to subjects' being informed of ICA-positive (ICA+) status and was re-evaluated 4 months later. Impact was measured using the state subscale of the State-Trait Anxiety Inventory (STAI) for adults or the State-Trait Anxiety Inventory for Children (STAIC), as well as structured interviews. A total of 34 ICA+ children, 34 ICA+ adults, 33 parents, and 25 spouses were evaluated.

RESULTS

At initial notification of ICA+ status, clinically and statistically significant anxiety was observed in ICA+ children and adults and their family members (P < 0.001). Parents of ICA+ children were more anxious than spouses of ICA+ adults (P < 0.05). Child and parent anxiety were significantly correlated (P < 0.05); more-anxious children lived with more-anxious parents. No significant association was found between ICA+ adults' initial anxiety and their spouses' anxiety. For ICA+ participants and their family members, anxiety dissipated to normal levels in 4 months (P < 0.02). ICA+ children were less likely than parents to believe they would ever develop insulin-dependent diabetes mellitus (IDDM). Nevertheless, 52% of ICA+ children and 24% of ICA+ adults endorsed lifestyle or behavior changes as a result of their ICA+ status. Behavior change was associated with greater initial anxiety in both children and adults (P < 0.05 for both).

CONCLUSIONS

These data suggest that notification of ICA+ status has both emotional and behavioral impact. Initial notification of ICA+ status is associated with considerable anxiety in both ICA+ individuals and their family members. In most cases, this initial anxiety appears to dissipate to normal levels over time. However, many ICA+ individuals report initiating lifestyle or health behavior changes in an effort to delay or prevent IDDM onset.
Visceral Adiposity, Fasting Plasma Insulin, and Blood Pressure in Japanese-Americans
Authors: Boyko Edward J , Leonetti Donna L , Bergstrom Richard W , Newell-Morris Laura , Fujimoto Wilfred Y
Published: March 2007

OBJECTIVE

To examine the associations among blood pressure, body mass index (BMI), intra-abdominal fat, and fasting plasma insulin levels among nondiabetic subjects.

RESEARCH DESIGN AND METHODS

Second- (Nisei, n = 290) and third- (Sansei, n = 230) generation Japanese-American subjects without non-insulin-dependent diabetes mellitus (NIDDM) were selected from a community-based study of NIDDM incidence and complications. A cross-sectional comparison of measures obtained at the baseline visit was performed. Intra-abdominal fat (IAF) area was assessed using computed tomography. Associations among blood pressure, fasting insulin, and adiposity measures were assessed by comparison of mean values and multiple linear regression analysis.

RESULTS— Hypertensive men and women had significantly higher mean IAF areas. Fasting insulin levels were somewhat higher in hypertensive subjects, with the only significant difference occurring among Sansei men. Both systolic and diastolic blood pressure correlated more strongly with IAF than BMI or skinfold thicknesses among Nisei, whereas among Sansei, IAF and BMI correlated equally well with either blood pressure. Significant positive correlations were found between fasting insulin level and blood pressure among Sansei only, even after adjustment for IAF and BMI (diastolic blood pressure - insulin coefficient = 0.24, P = 0.0043; systolic blood pressure insulin coefficient = 0.36, P = 0.0025).

CONCLUSIONS

IAF correlated more strongly with blood pressure than BMI or skinfold thicknesses among older, second-generation Japanese-Americans and was positively correlated with blood pressure among Sansei independent of fasting insulin level. Fasting insulin was significantly correlated with blood pressure independent of visceral and overall adiposity among third-generation Japanese-Americans.
Low-Dose Iloprost Infusion Improves Insulin Action in Aged Healthy Subjects and NIDDM Patients
Authors: Paolisso Giuseppe , Maro Giosue Di , D'Amore Anna , Passariello Nicola , Gambardella Antonio , Varricchio Michele , D'Onofrio Felice
Published: March 2007

OBJECTIVE

To investigate the effect of iloprost infusion on insulin action.

RESEARCH DESIGN AND METHODS

Thirteen healthy subjects and 13 non-insulin-dependent diabetes mellitus (NIDDM) patients matched for age (68.2 ± 0.5 vs. 67.9 ± 0.5 years, NS), gender ratio (7 men:6 women vs. 6 men:7 women), body weight, body fat distribution, arterial blood pressure, and plasma triglycéride levels (1.89 ± 0.09 vs. 1.87 ± 0.08 mmol/l, NS) were studied. In eight healthy subjects and eight NIDDM patients, we studied insulin action by euglycemic glucose clamp (insulin infusion rate 2 mU · kg−1 · min−1) along with saline and iloprost delivery (0.7 ng · kg−1 · min−1). In the other five subjects of each group, forearm blood flow and insulin-mediated glucose uptake during saline and iloprost infusion (0.7 ng · kg−1 · min1) were investigated.

RESULTS

Iloprost infusion improved insulin-stimulated whole-body glucose uptake and oxidative and nonoxidative glucose metabolism in both study groups. Forearm blood flow under basal conditions and with insulin infusion (2 mU · kg−1 · min−1) did not show any significant difference from that during saline and iloprost infusion (0.7 ng · kg−1 · min−1) in healthy subjects and diabetic patients.

CONCLUSIONS

Iloprost infusion improves insulin action in healthy subjects and NIDDM patients.
Relationship of Low-Density Lipoprotein Particle Size to Plasma Lipoproteins, Obesity, ana Insulin Resistance in Japanese Men
Authors: Suehiro Tadashi , Ohguro Takashi , Sumiyoshi Ryota , Yasuoka Nobukazu , Nakauchi Yuh , Kumon Yoshitaka , Hashimoto Kozo
Published: March 2007

OBJECTIVE

To determine the clinical characteristics of patients with small low-density lipoprotein (LDL) particles among Japanese men with mild glucose intolerance and to investigate the relationship of LDL particle size to the levels of other plasma lipoproteins, obesity, insulin resistance, and blood pressure (BP).

RESEARCH DESIGN AND METHODS

The subjects were 40 men with impaired glucose tolerance or diabetes treated by diet alone, and 40 healthy men matched for age and body mass index (BMI) were used as control subjects. LDL particle size was measured using gradient gel electrophoresis.

RESULTS

Of the 40 patients with glucose intolerance, 19 had small LDL (particle size <25.5 nm) compared with only 4 of the 40 control subjects. In the patients with small LDL, the plasma levels of cholesterol, triglycerides, and apolipoprotein B, the fasting serum immunoreactive insulin, and the waist-to-hip ratio were all higher than in the patients with normal LDL (particle size ≥25.5 nm), while the high-density lipoprotein cholesterol level was lower. However, there were no significant differences in BMI, BP, or insulin sensitivity in a euglycemic clamp study between the small-LDL and normal-LDL subgroups.

CONCLUSIONS

Japanese men with glucose intolerance frequently have small LDL, and this abnormality is associated with other dyslipoproteinemias and increased waist-to-hip ratio.
Treatment of Hypercholesterolemia in NIDDM With Policosanol
Authors: Torres Omayda , Agramonte A J , Illnait Jose , Ferreiro Rosa Más , Fernández Lilia , Fernández Julio C
Published: March 2007

OBJECTIVE

To determine whether elevated levels of cholesterol and low-density lipoprotein (LDL) cholesterol in non-insulin-dependent diabetes mellitus (NIDDM) patients could be decreased by policosanol, a new cholesterol-lowering drug. NIDDM predisposes patients to coronary artery disease (CAD) through the direct action of hyperglycemia on the arteries as well as the dyslipidemia induced by NIDDM.

RESEARCH DESIGN AND METHODS

This double-blind placebo-controlled trial was performed in 29 patients with NIDDM and hypercholesterolemia. After stable glycemie control was achieved by diet and/or oral Hypoglycemic drugs, patients were instructed to follow a cholesterol-lowering diet for 6 weeks. Patients who met entry criteria received, under double-blind conditions, policosanol (5 mg) or placebo tablets twice a day for 12 weeks.

RESULTS

Policosanol (10 mg/day) significantly reduced total cholesterol by 17.5% and LDL cholesterol by 21.8% compared with baseline and placebo. Furthermore, high-density lipoprotein (HDL) cholesterol was raised by 11.3% (not significant), and triglycerides showed a statistically nonsignificant decrease of 6.6%. These changes in lipid profile were similar to those induced by policosanol in nondiabetic patients with type II hyperlipoproteinemia.

CONCLUSIONS

Glycemie control was unaffected by treatment. No clinically or biochemically adverse effects attributable to treatment were observed. Only one patient (placebo) withdrew from the trial because of an adverse experience (erythema). We concluded that policosanol is effective and safe in patients with NIDDM and hypercholesterolemia.
Effects of Maternal Gestational Diabetes and Adiposity on Neonatal Adiposity and Blood Pressure
Authors: Vohr Betty R , McGarvey Stephen T , Coll Cynthia Garcia
Published: March 2007

OBJECTIVE

To determine the effects of maternal factors, including prepregnancy maternal adiposity, weight gain during pregnancy, degree of abnormality of the glucose tolerance test, glycemia during pregnancy, and treatment with insulin versus diet therapy, on neonatal body weight, adiposity, and blood pressure in infants of mothers with gestational diabetes (IGDM) and control patients.

RESEARCH DESIGN AND METHODS

A total of 119 term IGDM, including 57 large-for-gestational-age (LGA) and 62 appropriate-for-gestational-age (AGA) infants, and 143 term control infants, including 74 LGA and 69 AGA infants, were prospectively enrolled. Maternal measurements of prepregnancy weight, height, and weight gain were abstracted from medical records. A diagnosis of gestational diabetes was made on the basis of an initial 1-h 50-g glucose screen value ≥130 mg/dl followed by two abnormal values in a 100-g oral glucose tolerance test. Infant anthropometric measurements were obtained, and blood pressure was measured on day 2 of life. Correlation analyses and multiple regression analyses were performed to assess the relationships among maternal factors and neonatal adiposity and blood pressure.

RESULTS

Multiple regression analyses to determine the effects of significant maternal factors on infant body mass index (BMI) revealed that prepregnancy weight and weight gain were significant predictors for both IGDM and control infants. An increased glucose screen predicted BMI for control subjects, whereas the mean 2nd and 3rd trimester glucose values were the significant predictors for IGDM. Also, increased newborn triceps skinfold thickness measurements correlated with increased systolic blood pressure for IGDM (r = 0.29, P < 0.03).

CONCLUSIONS

Increased maternal prepregnancy weight, weight gain in pregnancy, and glycemia in pregnancy all place IGDM at increased risk of macrosomia and adiposity. Increased adiposity in the IGDM appears to be related to increased infant blood pressure. Longitudinal evaluation is needed to determine whether neonatal adiposity in IGDM is predictive of increased adiposity and blood pressure during childhood.
National Data on the Epidemiology of IDDM in Greece: Cases diagnosed in 1992
Authors: Dacou-Voutetakis Catherine , Karavanaki Kyriaki , Tsoka-Gennatas Helen ,   The Hellenic Epidemiology Study Group
Published: March 2007

OBJECTIVE

To detect the incidence, geographic distribution, and seasonal variation of insulin-dependent diabetes mellitus (IDDM) in all of Greece.

RESEARCH DESIGN AND METHODS

One hundred and thirty-seven children (75 boys and 62 girls) up to 14.9 years of age were diagnosed with IDDM in Greece in 1992.

RESULTS

The age-adjusted incidence of IDDM in Greece in 1992 was 6.25/100,000 population (boys: 6.17/100,000;: girls: 6.28/100,000). There was a significant pubertal peak. The incidence of IDDM was significantly higher in metropolitan (10.0/100,000) than in rural (4.21/100,000), semirural (7.48/100,000), or urban areas (5.36/100,000) of Athens. There was a marginal difference between rural and semirural areas. No significant seasonal variation in the incidence of IDDM was observed.

CONCLUSIONS

We conclude that the incidence of IDDM in Greece is among the five lowest in Europe. An impressive clustering of cases was observed in the Athens metropolitan area compared with the rural and semirural areas, an observation that possibly underlines the importance of environmental factors (stressful situations, infections, dietary habits, and others) in the expression of IDDM.
Contribution of Obesity to Defects of Intracellular Glucose Metabolism in NIDDM
Authors: Chung Joyce W , Suh Kyo-Il , Joyce Mary , Ditzler Tim , Henry Robert R
Published: March 2007

OBJECTIVE

To examine the contribution of obesity to insulin resistance and abnormalities of intracellular glucose and fat metabolism in NIDDM.

RESEARCH DESIGN AND METHODS

Glucose turnover measurements and indirect calorimetry were performed in 10 obese non-insulin-dependent diabetes mellitus (NIDDM) and 10 lean NIDDM subjects (body mass index 35.3 ± 1.0 vs. 24.1 ± 0.5 kg/m2 P < 0.001) in the basal state and during hyperinsuhnemic (720 pmol · m-2 · min-1) euglycemic (5.0-5.5 mmol/1) clamps.

RESULTS

Obese and lean NIDDM subjects demonstrated similar basal rates of glucose uptake (GU) (1.15 ± 0.08 vs. 1.26 ± 0.08 mmol/min, NS) as well as oxidative (0.49 ± 0.07 vs. 0.53 ± 0.05 mmol/min, NS) and nonoxidative (0.67 ± 0.10 vs. 0.73 ± 0.12 mmol/min, NS) glucose metabolism. During hyperinsuhnemic glucose clamp studies, rates of GU were lower in obese NIDDM subjects (34.1 ± 2.3 vs. 55.2 ± 3.8 μmol · kg fat-free mass [FFM]-1 · min-1, P ≥ 0.001) as were rates of oxidative (14.1 ± 1.3 vs. 22.1 ± 2.1 μmol · kg FFM-1 · min-1 P < 0.005) and nonoxidative (20.0 ± 2.3 vs. 33.1 ± 3.6 μmol · kg FFM-1 · min-1 P < 0.01) glucose metabolism. Although absolute rates of insulin-stimulated GU were decreased in the obese group, the relative distribution into glucose oxidation (Gox) and nonoxidative glucose metabolism (Nox) was comparable in both groups (Gox 42% in obese and 41% in lean subjects; Nox 58% in obese and 59% in lean subjects). The NIDDM groups had similar basal free fatty acid levels that were suppressed equally during hyperinsulinemic clamps. However, basal fat oxidation (Fox) was greater in the obese NIDDM group (103 ± 11 vs. 73 ± 8 μmol/min, P ≥ 0.05) and was less suppressed to insulin (74 ± 13 vs. 16 ± 3 μmol/ min, P < 0.001).

CONCLUSIONS

These results indicate that when obesity is present in NIDDM subjects with this degree of hyperglycemia, insulin-stimulated GU is lower by 35-40%. Reduced GU in obese NIDDM subjects leads to decreased intracellular substrate availability and lower rates of oxidative and nonoxidative glucose metabolism. Insulin suppression of Fox is also impaired when obesity is present and may contribute to decreased insulin-mediated GU in NIDDM. We conclude that obesity increases insulin resistance in NIDDM primarily by effects on GU rather than the intracellular pathways of glucose metabolism.
Safety and Efficacy of Normalizing Fasting Glucose With Bedtime NPH Insulin Alone in NIDDM
Authors: Cusi Kenneth , Cunningham Glenn R , Comstock John P
Published: March 2007

OBJECTIVE

To examine the safety and overall clinical effects of normalizing the fasting plasma glucose (FPG) level with bedtime NPH insulin alone in patients with non-insulin-dependent diabetes mellitus (NIDDM) that is poorly controlled with maximal doses of sulfonylureas.

RESEARCH DESIGN AND METHODS

Twelve obese male NIDDM subjects were treated for 16 weeks with bedtime insulin after a 4-week sulfonylurea washout. The insulin dosage was increased until the FPG level was normalized. The 24-h plasma glucose profiles and lipid and HbA1c levels were measured at the beginning and end of the study, and the incidence and severity of hypoglycemic episodes were closely monitored. In addition, hyperglycemic clamp studies were performed to assess insulin secretion and provide an indirect measurement of insulin sensitivity.

RESULTS

FPG (14.6 ± 0.9 mmol/l at week 0) was normalized (<6.4 mmol/l) within 6 weeks (5.9 ± 0.6 mmol/l) and remained at target levels until the end of the study (4.0 ± 0.03 mmol/l at week 16, P < 0.001). The insulin dose was 80 ± 9 U/day (0.86 ± 0.10 U/kg). Improved glycemic control was confirmed by a reduction in HbA1c (10.9 ± 0.05 vs. 7.2 ± 0.2%, P < 0.001) and mean 24-h glucose (17.2 ± 0.2 vs. 7.4 ± 0.2 mmol/l, P < 0.001). The incidence of mild or moderate hypoglycemic episodes was 3.4 ± 1/patient for the entire 16-week study, and no patient experienced severe hypoglycemia. Bedtime insulin significantly improved total cholesterol, low-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol, and triglyceride levels (P < 0.01). Weight gain was 2.4 ± 0.7 kg, and blood pressure was unchanged. During the hyperglycemic clamp, there was an improvement in the first phase (P < 0.001) and in the second phase (P < 0.01) of insulin secretion. There also was an increase in the rate of exogenous glucose infused (M)(P < 0.01) and in the M/C-peptide ratio (P < 0.02), suggesting enhanced insulin sensitivity.

CONCLUSIONS

NPH insulin given at bedtime in amounts sufficient to achieve a normal FPG level does not cause excessive or severe hypoglycemia and does lead to good glycemic and lipid control in NIDDM. Bedtime insulin therapy also is accompanied by improved insulin secretion and insulin sensitivity. We conclude that a single dose of insulin alone at bedtime merits consideration as a therapeutic strategy in patients with poorly controlled NIDDM.
Diabetes in Urban African-Americans: II. High prevalence of microalbuminuria and nephropathy in African-Americans with diabetes
Authors: Goldschmid Merilyn G , Domin William S , Ziemer David C , Gallina Daniel L , Phillips Lawrence S
Published: March 2007

OBJECTIVE

African-Americans with diabetes have an increased risk of endstage renal disease, but underlying mechanisms are poorly understood. We undertook this study to evaluate prevalence and risk factors for renal disease in an African-American population with diabetes.

RESEARCH DESIGN AND METHODS

We measured urine albumin excretion in 578 consecutive patients presenting for the first time to the Grady Memorial Hospital Diabetes Unit in Atlanta, GA. The unit serves an urban population that is predominantly African-American; 85% of patients have non-insulin-dependent diabetes mellitus (NIDDM). Subjects provided 24-h and/or ∼ 3-h urine collections for measurement of albumin and creatinine.

RESULTS

Correlation of the albumin/creatinine ratio (μg/mg) with the 24-h albumin excretion rate was 0.89 (P < 0.001, n = 123). Although the median duration of diabetes was only 1 year, among all subjects, the estimated prevalence of microalbuminuria (30–300 mg albumin/24 h) was 25% and that of nephropathy (> 300 mg albumin/24 h) was 11%. Among African-Americans with NIDDM (n = 466), the estimated prevalence of microalbuminuria was 24% and that of nephropathy was 12% prevalence remained high (25 and 5%, respectively) among 219 patients with < 1 year known duration of diabetes. Metabolic control was not associated with disease. However, among all subjects with NIDDM, the odds ratio for nephropathy among subjects with disease duration > 5 years compared with those with disease duration < 1 year was 4.65 (95% confidence interval [CI] 2.24–9.79), and the odds ratio for nephropathy among subjects with hypertension compared with those without hypertension was 2.64 (CI 1.42–4.93). Odds ratios were comparable among African-Americans with NIDDM. Trends were similar but less significant for subjects with microalbuminuria.

CONCLUSIONS

Albuminuria can be identified reliably and conveniently by the albumin/creatinine ratio in brief urine collections. In our patients, clinically significant albuminuria occurred in 36% of persons at first presentation. Since increased risk was associated with hypertension and control of hypertension can slow progression of renal disease, screening for albuminuria and treatment of hypertension should be aggressive in urban populations of African-Americans with diabetes.
Apolipoprotein E Polymorphism and Insulin Levels in a Biethnic Population
Authors: Valdez Rodolfo , Howard Barbara V , Stern Michael P , Haffner Steven M
Published: March 2007

OBJECTIVE

To study the association of apolipoprotein E (apoE) polymorphism with important cardiovascular risk factors other than cholesterol levels, such as insulinemia and insulin resistance.

RESEARCH DESIGN AND METHODS

In this report, we study the association of three major apoE phenotypes (apoE 3/2, apoE 3/3, and apoE 4/3) with indicators of insulin resistance such as fasting insulin, glucose, and lipid levels in 320 nondiabetic Mexican-Americans and non-Hispanic whites from San Antonio, TX.

RESULTS

The two ethnic groups differed in the frequencies of the three major apoE phenotypes. However, the associations of these phenotypes with lipid and insulin levels were similar in both ethnic groups and in both sexes. Compared with the other two major apoE phenotypes, the apoE 3/2 phenotype was associated with lower levels of total and low-density lipoprotein cholesterol and lower levels of fasting and 2-h postload insulin.

CONCLUSIONS

In addition to the association with cholesterol levels, the variability at the apoE locus may be associated with a much broader set of metabolic factors that relate to insulin resistance.
Variability in Diagnostic Evaluation and Criteria for Gestational Diabetes
Authors: Solomon Caren G , Willett Walter C , Rich-Edwards Janet , Hunter David J , Stampfer Meir J , Colditz Graham A , Manson Joann E
Published: March 2007

OBJECTIVE

To determine the frequency of screening for gestational diabetes mellitus (GDM) among a population receiving regular prenatal care and to assess the extent to which National Diabetes Data Group (NDDG) criteria for the diagnosis of GDM are used by practicing obstetricians.

RESEARCH DESIGN AND METHODS

We studied participants in the Nurses' Health Study II, a large prospective cohort study of 116,678 nurses aged 25–42 years in 1989. A total of 422 women who reported a first diagnosis of GDM between 1989 and 1991 were sent supplementary questionnaires regarding diagnosis and treatment, and medical records were requested for a subset of 120 to validate self-reported GDM and assess criteria used for diagnosis. A sample of 100 women who reported a pregnancy not complicated by GDM were sent questionnaires addressing GDM screening and prenatal care.

RESULTS

Among a sample of 93 women who reported a pregnancy not complicated by GDM and responded to the supplementary questionnaire, 16 (17%) reported no glucose loading test; 69% of unscreened women had one or more risk factors for GDM. Among a sample of 114 women who self-reported GDM in a singleton pregnancy and whose medical records were available for review, a physician diagnosis of GDM was confirmed in 107 (94%). Records and supplementary questionnaires indicated that oral glucose tolerance tests (OGTTs) were performed in 96 (86%) of these women. Of women with a physician diagnosis of GDM whose OGTT results were available, 25% failed to meet NDDG criteria for this diagnosis, although all had evidence of abnormal glucose homeostasis.

CONCLUSIONS

Screening for GDM is not universal, even among a group of health professionals in whom screening prevalence is likely to be higher than in the general population. Diagnostic criteria for GDM among obstetricians in practice remain nonstandard despite NDDG recommendations. Better understanding of the implications of differing degrees of glucose intolerance and of varying GDM screening and management strategies is required to make policy recommendations for appropriate and cost-effective care.
Increased Molar Proinsulin-to-Insulin Ratio in Women With Previous Gestational Diabetes Does Not Predict Later Impairment of Glucose Tolerance
Authors: Hanson Ulf , Persson Bengt , Hartling Svend G , Binder Christian
Published: March 2007

OBJECTIVE

To evaluate if an increased proinsulin-to-insulin ratio (PI/I) in former gestational diabetes mellitus (GDM) subjects could be a marker for later impairment of glucose tolerance.

RESEARCH DESIGN AND METHODS

This study is a prospective follow-up. In a previous follow-up study of former GDM subjects 3–4 years after an index pregnancy, an increased PI/I was found also in normoglycemic nonobese former GDM subjects compared with control subjects. A 75–g oral glucose tolerance test (OGTT) was performed 3 years after the first follow-up, i.e., 6–7 years after the index pregnancy in 97 of the former GDM subjects and in 23 control subjects. A 75-g OGTT according to the World Health Organization was performed. Glucose, insulin, proinsulin, and C-peptide were determined at 0, 30, 60, 90, 120, 150, and 180 min after the glucose intake.

RESULTS

Since the first follow-up, an additional 3 in 97 (3.1%) and 15 in 97 (15.5%) of the former GDM subjects had NIDDM or impaired glucosetolerance (IGT), respectively. All control subjects still had a normal OGTT. The fasting PI/I at follow-ups 1 and 2 was significantly correlated in the former GDM subjects (r = 0.41, P< 0.001) and in the control group (r = 0.46, P < 0.05). There was no significant correlation between the PI/I in follow-up 1 and the fasting or 2-h glucose values at follow-up 2. If GDM subjects with a PI/I in the upper quartile in the first follow-up were compared with those with a lower PI/I, there were no significant differences in outcome of OGTT in the second follow-up.

CONCLUSIONS

The hypothesis that an increased fasting PI/I is a marker for later development of NIDDM or IGT in former GDM subjects could not be supported.
Can Caretakers of Children with IDDM Accurately Measure Small Insulin Doses and Dose Changes?
Authors: Silva Sheryl R , Clark Loretta , Goodman Steven N , Plotnick Leslie P
Published: March 2007

OBJECTIVE

To determine if caretakers of young children with IDDM could consistently reproduce small incremental measurements of insulin (U100).

RESEARCH DESIGN AND METHODS

Fifteen caretakers of children with IDDM were asked to deliver repeated small doses of insulin, including doses separated by only 0.25 U of insulin. A sensitive gravimetric technique was used to determine the error in measurement of these low doses of insulin. Statistical analysis was used to evaluate accuracy and internal consistency of each caretaker at each dose.

RESULTS

The means ± SD at each dose level were as follows: 2.75 ± 0.13 U at 2.5 U, 3.19 ± 0.13 U at 3.0 U, 3.55 ± 0.13 U at 3.25 U, and 3.70 ± 0.11 U at 3.5 U. All doses were biased toward overadministration. There was as statistically significant difference in the dose delivered when the target doses were varied by only 0.25 U. The average differences and standard errors between 2.5 U and 3.0 U, 3.0 U and 3.25 U, and 3.25 U and 3.5 U were 0.44 ± 0.20 U, 0.36 ± 0.018 U, and 0.15 ± 0.017 U, respectively.

CONCLUSIONS

Participants were not accurate in measuring small insulin doses, consistently overdrawing insulin by an average of 0.22 U. Caretakers are reasonably internally consistent with a given dose, since participants were able to measure statistically significant differences in 0.25 U dose changes. The error in insulin measurement does not vary with the intended dose level. Caretakers in the same family deliver insulin doses as variable from each other as they are from the population as a whole; however, when two or more individuals are responsible for one insulin dose in a child with IDDM, they have a combined variability that is ∼40% greater than a single individual's variability.