bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Diabetes in Different Regional and Religious South Asian Communities in Coventry
Authors: Simmons D. , Williams D.R.R. , Powell M.J.
Published: July 2009

The prevalence of Type 2 (non‐insulin‐dependent) diabetes in different South Asian (Asian) communities was compared during the Coventry Diabetes Study, a cross‐sectional house to house screening programme for diabetes. Screening was by capillary whole blood glucose measurement with oral glucose tolerance tests when concentrations were ± 6.0 mmol 1−1 within 2 h of a meal or ± 5.0 mmol 1−1 2 h or more after a meal and a random 10% of others. Of the 4395 resident Asians, 94% were represented by five communities: Punjabi Sikhs, Punjabi Hindus, Gujerati Moslems, Gujerati Hindus, and Pakistani Moslems. Response to screening was 77–89% and to glucose tolerance test was 59–79%. Differences in anthropometry, socioeconomic circumstances, and migratory patterns were found, but all groups had a higher prevalence of Type 2 diabetes than Europeans. Gujerati Moslems had the highest age‐adjusted prevalence (per 1000) of Type 2 diabetes (males: 160 (95% CI 107–228), females: 204 (95% CI 144–283)) when compared with the other Asian groups (males: Punjabi Sikhs 89(72–110), Pakistani Moslems 91(67–120), Gujerati Hindus 84(57–120), Punjabi Hindu 113(74–171); females: Punjabi Sikhs 75(60–94), Pakistani Moslems 103(78–133), Gujerati Hindus 88(62–122), Punjabi Hindu 116(77–174)). That all the Asian groups had a high prevalence of diabetes, in spite of their known dietary, cultural, and socioeconomic differences, suggests that the Asian predisposition to Type 2 diabetes is inherited although environmental factors may be necessary for this to be expressed.
The Short Insulin Tolerance Test for Determination of Insulin Sensitivity: A Comparison with the Euglycaemic Clamp
Authors: Akinmokun A. , Selby P. L. , Ramaiya K. , Alberti K. G. M. M.
Published: July 2009

The glucose clamp technique is currently regarded as the standard test for measuring insulin sensitivity against which other methods are compared but is unsuitable for routine screening of patients outside a hospital base. There is thus a need for a simpler test to measure insulin sensitivity. We have therefore compared the glucose disappearance rate KITT in the first 15 min of the insulin tolerance test (ITT) with the M and M/I values derived from the standard euglycaemic clamp in nine normal subjects and eight subjects with Type 2 (non‐insulin dependent) diabetes mellitus and coexisting obesity. All subjects underwent the ITT and euglycaemic clamp in random order. Nine subjects later had a repeat ITT to determine the reproducibility of the test. In the ITT, 0.1 U kg−1 body weight, human Actrapid insulin was given as an IV bolus and simultaneous arterialized and venous blood samples were obtained every minute for 15 min. The first order rate constant for the disappearance of glucose KITT over the period 3–15 min was taken as a measure of insulin sensitivity. The euglycaemic clamp was performed with an insulin infusion of 50 mU kg−1 h−1 for 120 min and a variable rate glucose infusion to maintain blood glucose concentration at 0.5 mmol I−1 below fasting level to minimize the effect of endogenous insulin secretion. The ratio of the mean rate of glucose infused (M, μmol kg−1 min−1) to the plasma insulin over the last 30 min of the clamp was taken as a measure of tissue sensitivity to insulin (M/I) assuming endogenous glucose output was suppressed. A close correlation was found between the glucose disappearance rate KITT and M/I values derived from the ITT and euglycaemic clamp, respectively, in both the normal (r = 0.86, p < 0.01) and the diabetic subjects (r = 0.81; p < 0.01) when arterialized blood was used but correlations were not significant with the venous blood sampling. The ITT was reproducible with a CV of 6%. The results suggest that the ITT is a suitable method of assessing insulin sensitivity and will be particularly useful in epidemiological studies, although the requirement for arterialized blood adds a measure of complexity.
Diabetes Mellitus in The Gambia, West Africa
Authors: Rolfe M. , Tang C.M. , Walker R.W. , Bassey E. , George M.
Published: July 2009

A register of diabetic patients attending the Royal Victoria Hospital, Banjul, The Gambia, was kept and data on hospital admissions recorded over a 1‐year period. Two hundred and sixty‐nine patients (110 men, 159 women) were registered of whom 66 (25%) were receiving insulin. Seventy‐five patients (28%: 40 men, 35 women) were newly diagnosed. There were significant differences in age (p < 0.001) and obesity (p < 0.001) between men and women and between patients with different types of diabetes. There were 95 hospital admissions (5.2%) related to diabetes, as were a fifth of medical out‐patient attendances. Ketoacidosis was the major cause of death while foot infections were more common (p < 0.01) in women. Diabetes imposed a heavy burden on the health services of The Gambia, a small developing country in West Africa; more than 3.6% of the annual health budget was spent on the treatment of diabetic patients.
Symptomatic and Hormonal Hypoglycaemic Responses to Human and Porcine Insulin in Patients with Type I Diabetes Mellitus
Authors: Ferrer J.P. , Esmatjes E. , Gonzalez‐Clemente J.M. , Goday A. , Conget I. , Jiménez W. , Gomis R. , Rivera F. , Vilardell E.
Published: July 2009

In recent years there has been great concern that human insulin (HI) may induce fewer hypoglycaemic warning symptoms than porcine insulin (PI). We addressed this issue in eight patients aged 25.6 ± 3.3 (SEM) years with Type I (insulin‐dependent) diabetes mellitus of 15.1 ± 3.7 years duration who complained that hypoglycaemia unawareness had appeared after transferring from PI to HI. Acute induction of hypoglycaemia was induced on two occasions with semisynthetic HI and purified PI under double‐blind conditions. Blood glucose was first clamped for 2 h at 4.4–6.7 mmol I−1 with an intravenous infusion of HI or PI at 50 mU kg−1 h−1 and 20% glucose at a variable rate. Thereafter, insulin infusion alone was maintained for 100 minutes. Heart rate, arterial pressure, reflex times, autonomic and neuroglycopenic signs and symptoms were assessed every 10 min. Arterialized venous blood samples were taken to measure blood glucose every 10 min and catecholamines, insulin, glucagon, growth hormone, and cortisol every 20 min. Autonomic symptoms first appeared at a plasma glucose level of 2.92 ± 0.21 mmol I−1 with HI vs 2.92 ± 0.48 mmol I−1 with PI (NS). There were no significant differences between the two studies concerning any of the above mentioned clinical parameters or the counterregulatory hormone responses. A differential effect of insulin species on the ability to perceive hypoglycaemia in patients who ascribed diminished perception of hypoglycaemia to the use of HI was thus not observed.
Hormonal Counterregulation, Symptom Awareness, and Neurophysiological Function in Type 1 Diabetes During Insulin‐induced Hypoglycaemia
Authors: Lingenfelser Th. , Buettner U.W. , Plonz C. , Steffen J. , Eggstein M. , Jakober B.
Published: July 2009

To evaluate a putative differential impact of human (HI) and porcine (PI) insulin on human brain function we examined 10 Type 1 (insulin‐dependent) diabetic patients without any signs of sensory or autonomic neuropathy. The glucose clamp technique was applied to achieve stable glycaemic plateaus of 5.6, 3.3, 2.2, and 1.7 mmol I−1 on two occasions with randomized and blinded allocation of either HI or PI. At each of the plateaus, symptom awareness, hormonal counterregulation, and neurophysiological functions (primary sensory information processing of the auditory and somatosensory system) were recorded. The effect of both types of insulin on glucose metabolism and counterregulatory hormone response was almost identical. Catecholamines increased (adrenaline p < 0.05; noradrenaline p < 0.02) during hypoglycaemia, independent of the type of insulin being used. Symptom awareness increased significantly during the fall of blood glucose concentration. This effect was more pronounced (total symptom score 26 vs 2, p < 0.05) with PI, but only during developing hypoglycaemia (3.3 mmol I−1‐plateau). For brainstem auditory evoked potentials and somatosensory evoked potentials, all individual and averaged latencies and corresponding amplitudes were within the normal range. No effect of insulin type or blood glucose concentration on neurophysiological measures could be detected. Our results suggest a differential impact of HI and PI on human brain function with regard to symptom awareness, but not hormonal counterregulation. This direct effect of insulin on central nervous function does not involve the afferent transmission in the auditory and somatosensory system.
Hypoglycaemia and Cardiac Arrhythmias in Patients with Type 2 Diabetes Mellitus
Authors: Lindström T. , Jorfeldt L. , Tegler L. , Arnqvist H.J.
Published: July 2009

Improved blood glucose control by insulin treatment in patients with Type 2 (non‐insulin dependent) diabetes mellitus increases the risk for hypoglycaemic episodes. Our objective was to investigate if hypoglycaemia causes electrocardiographic changes and cardiac arrhythmias in patients with Type 2 diabetes. Six insulin‐treated patients with Type 2 diabetes and no known cardiac disease took part in the study. Hypoglycaemia was induced by insulin infusion aiming at a plasma glucose ≥ 2.0 mmol I−1 or hypoglycaemic symptoms. All patients experienced hypoglycaemic symptoms. The median lowest arterial plasma glucose was 2.0 mmol I−1. Arterial plasma adrenaline concentration increased from 0.4 ± 0.1 (mean ± SE) to 6.9 ±0.3 nmol I−1 (p < 0.001) while serum potassium was lowered from 4.1 ± 0.3 mmol I−1 to 3.5 ± 0.2 mmol I−1 (p < 0.001). The heart rate increased significantly during hypoglycaemia except in one patient who developed hypoglycaemic symptoms and a severe bradyarrhythmia at a plasma glucose of 4.4 mmol I−1. One patient developed frequent ventricular ectopic beats during hypoglycaemia while four patients showed no arrhythmia. ST‐depression in ECG leads V2 and V6 was observed during hypoglycaemia in five patients (p < 0.05) and four patients developed flattening of the T‐wave.

In conclusion, the study supports the hypothesis that hypoglycaemia in patients with Type 2 diabetes may be hazardous by causing cardiac arrhythmias.
Childhood Diabetes, Insulin, and Africa
Authors: Makame M.H. ,   DERI Study Group
Published: July 2009

Mortality associated with Type 1 (insulin‐dependent) diabetes has perceptually declined with the identification and widespread use of insulin. In the pre‐insulin era, over 80% of all individuals developing diabetes died each year, now less than one in two hundred die. Sadly, this remarkable achievement has not reached the children who develop diabetes in sub‐Saharan Africa where the onset of childhood diabetes is the equivalent of a death sentence. Two major issues of importance related to Type 1 diabetes in African and other developing countries are missed diagnosis and unavailability of insulin, issues which cannot be ignored.
Diabetes Mellitus in Bahrain: An Overview
Authors: Musaiger A.O.
Published: July 2009

Bahrain has faced a rapid transition in its socio‐economic status, which resulted in great changes both in life‐style and in patterns of health and disease. There has been a marked decline in infectious diseases and an increase in chronic diseases. Diabetes mellitus has become one of the most common public health problems in the country. In 1988 it was estimated that 3.4% of total deaths in Bahrain were due to diabetes. A community‐based study among mothers aged 18 to 48 years showed that 8.5% of them had diabetes. The percentage was found to be higher among elderly Bahrainis (12.9%). Obesity, lack of physical activity, alteration in food habits, and change in social conditions have all played a vital role in the changing prevalence of diabetes in this country. The current programmes to manage and control diabetes are limited and ineffective. Thus measures to treat diabetes should be given a high priority in the national health policy. Training of physicians in the management of diabetes, public education, epidemiological surveys, and nutritional evaluation of local foods are among the most important measures needed to control diabetes in Bahrain.
Facilities in Diabetic Clinics in the UK: How Much Have They Changed?
Authors: Williams D.R.R. , Spathis G.S.
Published: July 2009

Two postal questionnaire surveys of facilities and staff available to hospital physicians responsible for the care of adults with diabetes in the United Kingdom have been carried out under the auspices of the British Diabetic Association. These surveys, in 1982–83 and 1990, achieved 92% and 94% responses, respectively, giving information on around 95% of UK health districts or their equivalent. Levels of provision and the use of existing facilities had, in general, improved over that time though several important deficiencies still remain. Respondents providing out‐of‐hours clinics and combined clinics with other specialties increased as did the availability of dietetic advice in outpatient clinics. Although the proportion of respondents reporting no specialist diabetes nursing assistance fell from 53% to 14%, this still left 29 reporting none at all. Access to blood glucose and HbA1 results, facilities for retinal examination, and access to photocoagulation had all improved but there was little change in the availability of adequate examination and educational facilities although this may have been due to a rise in expectations. Chiropodial care was less readily available in 1990 with 17% of respondents (compared with 11%) reporting a complete lack in the clinic. A recommendation that no locality should be without at least one physician with a special interest in diabetes was fulfilled in 81.9% of localities but some were still relatively poorly staffed.
The Effect of Chronic Hyperglycaemia on the Islet B‐cell Responsiveness in Newly Diagnosed Type 2 Diabetes
Authors: Gjessing H.J. , Reinhold B. , Pedersen O.
Published: July 2009

The aim of the present study was to evaluate the effect of chronic hyperglycaemia on the pancreatic B‐cell response to stimulation with a standard mixed meal or intravenous glucagon in 7 subjects with newly diagnosed Type 2 diabetes. Stimulation was performed at mean chronic fasting hyperglycaemia of 11.8 ± 0.7 (SEM) mmol I−1 and at normoglycaemia obtained by an intravenous infusion of regular insulin followed by an insulin wash‐out peroid. The incremental plasma C‐peptide area under the curve after stimulation with the meal was similar at normo‐ and hyperglycaemia. In contrast, prestimulatory plasma C‐peptide and the incremental plasma C‐peptide area under the curve after stimulation with glucagon were significantly higher at chronic hyperglycaemia than at normoglycaemia (p < 0.01 and p < 0.05). In conclusion, chronic hyperglycaemia as seen in newly diagnosed Type 2 diabetes is associated with a complete lack of potentiation of postprandial islet B‐cell secretion but a partly preserved potentiation of basal and post‐glucagon islet B‐cell secretion.
The Effect of Acipimox in Patients with Type 2 Diabetes and Persistent Hyperlipidaemia
Authors: Dean J.D. , McCarthy S. , Betteridge D.J. , Whately‐Smith C. , Powell J. , Owens D.R.
Published: July 2009

A placebo‐controlled, double‐blind study was performed to assess the effect of 12 weeks treatment with acipimox (250 mg three times per day) on lipoproteins and glycaemic control in patients with Type 2 diabetes. All patients studied had persistent hyperlipidaemia despite acceptable glycaemic control on treatment with diet alone or diet and oral hypoglycaemic agents, achieving glycosylated haemoglobin (HbA1) of < 10.5% but with fasting total triglycerides > 2.5 mmol I−1 or total cholesterol > 6.5 mmol I−1. Forty‐eight patients were randomized to treatment, 21 to acipimox and 27 to placebo; 43 completed the trial. All patients had been diabetic for at least 1 year. Total cholesterol fell by 6% and total triglycerides by 19% following 12 weeks of acipimox, compared to rises in the placebo group of 1% and 16%, respectively (p < 0.05). There were no significant differences between acipimox and placebo in the change in low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, apolipoproteins AI, AII, or B, or in glycaemic control during the treatment period.

Acipimox is effective in reducing fasting total cholesterol and total triglycerides in patients with Type 2 diabetes with acceptable blood glucose control but persistent hyperlipidaemia. Acipimox does not adversely affect glucose tolerance.
Does Increased Glomerular Filtration Rate or Disturbed Tubular Function Early in the Course of Childhood Type 1 Diabetes Predict the Development of Nephropathy?
Authors: Lervang H.‐H. , Jensen S. , Brøchner‐Mortensen J. , Ditzel J.
Published: July 2009

To clarify whether glomerular hyperfiltration or disturbances in renal tubular function may be early markers of the later development of nephropathy a follow‐up study was performed in 34 young Type 1 diabetic patients, who had originally been investigated 12 years previously. The initial median age was 14 (range 7–18) years and median diabetes duration 7 (2–14) years. At initial examination only one of the 34 diabetic patients exhibited increased urinary albumin excretion rate. The median glomerular filtration rate was increased (136 vs 107 ml min−1 1.73 m−2; p < 0.0001) and median threshold concentration of phosphate per litre of glomerular filtrate was decreased (1.27 vs 1.76 mmol I−1; p < 0.0001) in the diabetic group as compared to that of 28 healthy children. At follow‐up 17 patients showed increased urinary albumin excretion rate and the median glomerular filtration rate in this group was significantly lower than that of 17 patients with normal urinary albumin excretion rate (108 vs 125 ml min−1 1.73 m−2; p < 0.05). However, no relationships were found between the increased urinary albumin excretion (incipient and/or overt diabetic nephropathy) at follow‐up to either the initial glomerular filtration rate (134 vs 137 ml min−1 1.73 m−2; p > 0.05) or to renal tubular function assessed from urinary excretion rate of β2‐microglobulin (0.059 vs 0.069 μg min−1; p > 0.05) and the renal threshold concentration of phosphate per litre of glomerular filtrate (1.29 vs 1.22 mmol I−1; p > 0.05).
Increased Incidence of End‐stage Renal Failure Secondary to Diabetes Mellitus in Asian Ethnic Groups in the United Kingdom
Authors: Burden A.C. , McNally P.C. , Feehally J. , Walls J.
Published: July 2009

Diabetic renal disease is more common in patients of Asian ethnic origin than White Caucasians in the United Kingdom. This study determines whether a disparity in the incidence of end‐stage renal failure secondary to diabetes mellitus exists between these ethnic groups. The incidence of treated end‐stage renal failure was estimated using the person‐time at risk incidence rate for patients receiving renal replacement therapy secondary to diabetes mellitus in the county of Leicestershire from 1979 to 1988. The incidence rate of end‐stage renal failure expressed for the estimated population of patients with diabetes mellitus in patients of Asian ethnic origin was 486.6 (95% CI, 185.1 to 788.1) cases per million person‐years per year, compared to 35.6 (17 to 54.2) in White Caucasians. All patients of Asian ethnic origin developing end‐stage renal failure had non‐insulin‐dependent diabetes. The high incidence of end‐stage renal failure secondary to diabetes mellitus in patients of Asian ethnic origin in the UK imparts significant public health implications for resource planning and allocation, and the need to initiate strategies to ameliorate renal disease in this ethnic group.
Parity, Ethnic Group and the Prevalence of Type 2 Diabetes: The Coventry Diabetes Study
Authors: Simmons D.
Published: July 2009

The prevalence of Type 2 (non‐insulin‐dependent diabetes) in relation to parity was compared among South Asian (Asian) and European women during a cross‐sectional house‐to‐house screening programme for diabetes in Foleshill, Coventry, UK. The parity of female residents was ascertained in 8 of the 12 areas visited. These areas contained 2096 European (68 with diabetes diagnosed) and 1148 Asian women (95 with diabetes diagnosed). Crude prevalence of Type 2 diabetes was 3.2% and 14.7% in Europeans aged 30–64 years and ≥65 years, respectively, and 10.9% and 36.5% in similarly aged Asians, respectively. In those aged 30–64 years, the age and body mass index adjusted prevalence of Type 2 diabetes was highest among nulliparous (Europeans 4.4%, Asians 16.3%) and grand muciparous (parity ≥5: Europeans 6.3%, Asians 16.5%) women when compared with women who had had 1 or 2 deliveries (Europeans 0.9%, Asians 3.3%, p<0.001, both ethnic groups). However, parity had no effect among women aged ≥65 years.
Clinical Examination Versus Neurophysiological Examination in the Diagnosis of Diabetic Polyneuropathy
Authors: Valk G.D. , Nauta J.J.P. , Strijers R.L.M. , Bertelsmann F.W.
Published: July 2009

Several methods have been used to diagnose diabetic polyneuropathy and to quantitate the degree of affection of peripheral nerves. Using a newly developed scoring system we compared bedside clinical examination with neurophysiological examination in a group of 78 diabetic patients. Individual scores for clinical examination were significantly correlated with scores for neurophysiological examination (r = 0.7, p < 0.0005). All 78 patients had at least one clinical symptom or sign of polyneuropathy. Clinical examination indicated polyneuropathy in three patients with neuropathic complaints, while neurophysiological examination in these patients showed no abnormalities. In 12 out of 14 patients with normal neurophysiological sensory nerve function, clinical examination showed at least one abnormal sensory modality. Comparing the four different sensory modalities, light touch sense and pinprick sense indicated polyneuropathy better than vibration or position senses. An abnormal Hoffmann reflex of the soleus muscle was always associated with a decreased or absent ankle jerk. The scoring system for the clinical examination proved useful for diagnosing and quantitating the severity of diabetic polyneuropathy. Clinical sensory deficits could not be inferred from the results of neurophysiological testing of sensory nerve function. Pinprick sense, light touch sense, and ankle jerks were the most important parameters in the clinical diagnosis of diabetic polyneuropathy.
Prevalence of Haemochromatosis Amongst Patients with Diabetes Mellitus
Authors: Singh B.M. , Grunewald R.A. , Press M. , Muller B.R. , Wise P.H.
Published: July 2009

Four hundred and six white Caucasian patients with diabetes mellitus (243 male, mean age 54 ± 16 (SD) years) were screened for haemochromatosis. Four patients had a fasting transferrin saturation > 62% and all were HLA A3 positive. Two were probable homozygotes for haemochromatosis and two heterozygotes. Homozygote haemochromatosis prevalence in this diabetic population was therefore 2/406 (0.0049) which is identical to that reported in the general population. These findings do not support a genetic relationship between the two conditions.
Distinguishing Between Persistent and Transient Impaired Glucose Tolerance Using a Prediction Model
Authors: Bourn D. M. , Williams S. M. , Mann J. I.
Published: July 2009

Screening for impaired glucose tolerance (IGT) and Type 2 (non‐insulin dependent) diabetes was carried out in 777 people and those with high blood glucose levels completed three 2‐h oral glucose tolerance tests (OGTT). Blood lipid levels, fasting and 2‐h insulin levels, body mass index, and blood pressure were also measured and family history of Type 2 diabetes recorded. Fifty people were identified with IGT and of these 21 were found to have persistent IGT and 29 transient IGT. A model including the variables body mass index, fasting and 2‐h insulin levels, fasting triglycerides and family history of Type 2 diabetes was developed using the Speigelhalter‐Knill‐Jones weighting method to predict subjects with persistent IGT. This model could be useful in identifying people with persistent IGT and therefore eliminate the need for repeat OGTTs which are time consuming and expensive.
Description of a Diabetes Support Group: Lessons for Diabetes Caregivers
Authors: Toth E.L. , James I.
Published: July 2009

A weekly psychotherapy group has been established with 21 diabetic patients (mean sessions attended per patient 12.0 ± 8.9). In this non‐structured group, the topics spontaneously chosen most often for discussion included complications and fears regarding complications, diet, and relationships with physicians. Other topics included difficulties achieving diabetes control, relationships with families, devices for day to day management, pregnancy and parenting, depression and eating disorders, and occupational concerns including driving and diabetes. The presence of a physician co‐therapist was found to be valuable. Examples are provided of the patients' concerns. It is felt that understanding patients' needs for information and communication with physicians and allied health professionals will enrich the caregiver‐patient relationship.
Prevalence of Cardiovascular Autonomic Dysfunction Assessed by Spectral Analysis, Vector Analysis, and Standard Tests of Heart Rate Variation and Blood Pressure Responses at Various Stages of Diabetic Neuropathy
Authors: Ziegler D. , Dannehl K. , Mühlen H. , Spüler M. , Gries F.A.
Published: July 2009

To establish a test battery for the detection and characterization of cardiovascular autonomic neuropathy (CADN) and to evaluate its prevalence, a number of autonomic function tests based on spectral analysis, vector analysis, and standard tests of heart rate variation and blood pressure responses were performed in 261 diabetic patients aged 11–76 years with various stages of peripheral neuropathy. The percentages of abnormal results in the individual tests based on heart rate variation were 6–31% in 115 patients without peripheral neuropathy, 16–45% in 61 patients with subclinical neuropathy, 22–59% in 73 patients with symptomatic peripheral neuropathy, and 67–100% in 12 patients with the latter in conjunction with autonomic symptoms (p <0.05). The most frequently abnormal indices, each representing a different physiological basis, were the coefficient of variation, low‐frequency and mid‐frequency power spectrum at rest, mean circular resultant, postural change in systolic blood pressure, and, in particular, the max/min 30:15 ratio and Valsalva ratio. CADN, defined as the presence of ≥ 3 abnormalities among these seven parameters was detected in none of 120 control subjects, 13.0% of the patients without peripheral neuropathy, 34.4% of those with subclinical neuropathy, 49.3% of those with symptomatic peripheral neuropathy, and in 100% of the subjects with the latter and concomitant autonomic symptoms (p <0.05). The overall prevalence of CADN in 103 patients completing all parameters was 46.6%. The corresponding rate of CADN defined as ≥ 2 abnormalities among the five tests included in an optimized version of the battery proposed by Ewing and Clarke 1 was 38.8%. We conclude that: (1) the stage of peripheral neuropathy is a strong determinant of the prevalence of CADN, but the latter may also be detected selectively; (2) the max/min 30:15 and Valsalva ratios represent the most frequently abnormal standard tests; and (3) the combination of indices based on spectral, vector and conventional analysis of heart rate variation tends to be relatively more sensitive in detecting CADN when compared with a modified version of the most commonly used test battery.
Feeding in Infancy and the Risk of Type 1 Diabetes Mellitus in Finnish Children
Authors: Virtanen S.M. , Räsänen L. , Aro A. , Ylönen K. , Lounamaa R. , Tuomilehto J. , Åkerblom H.K. ,   ‘Childhood Diabetes in Finland’ Study Group
Published: July 2009

In a case—control design the feeding in infancy of newly diagnosed 7‐ to 14‐year‐old diabetic children (n = 426) was compared with that of age‐ and sex‐matched non‐diabetic children (n = 426) randomly selected from the Finnish population registry. All 7‐ to 14‐year‐old diabetic children diagnosed from September 1986 to the end of April 1989 from all hospitals which treat diabetic children in Finland were invited to participate in the study. Breast‐feeding was initiated in almost all children, but during the birth years of this study population (1972–1982), an increase was observed in the duration of breast‐feeding (whether alone or in combination with supplementary feeding) and in the age of introduction of supplementary milk feeding. The risk of Type 1 diabetes was decreased in the children who were totally breast‐fed for at least 2 months (odds ratio (OR) 0.64, 95% confidence interval (CI) 0.42–0.98) or 3 months (OR 0.67, 95% CI 0.48–0.95) or exclusively breast‐fed for at least 2 months (OR 0.60, 95% CI 0.41–0.89) or 3 months (OR 0.63, 95% CI 0.43–0.93). Those children who were younger than 2 months (OR 1.54, 95% CI 1.08–2.18) or 3 months (OR 1.52, 95% CI 1.11–2.08) at the time when supplementary milk feeding was begun had an increased risk of Type 1 diabetes. These associations remained significant after adjusting for the mother's education. The results suggest that early infant feeding patterns are associated with the risk of Type 1 diabetes developing at the age of 7 to 14 years.
Assessment of Glucose Turnover Rates in Euglycaemic Clamp Studies using Primed‐constant [3‐3H]‐glucose Infusion and Labelled or Unlabelled Glucose Infusates
Authors: Hother‐Nielsen O. , Møngel A. , Møller J. , Rasmussen O. , Schmitz O. , Beck‐Nielsen H.
Published: July 2009

Underestimation of glucose turnover rates has been a problem in clamp studies using primed‐constant [3‐3H]‐glucose infusion technique. Due to slow mixing in interstitial compartments concealed specific activity gradients may arise between plasma and interstitial compartments during intravenous unlabelled glucose infusion. Such specific activity gradients, however, can be prevented if plasma specific activity is maintained constant. Two euglycaemic clamp studies (insulin infusion 40 mU m−2 min−1) were performed in six lean normal subjects. Using conventional unlabelled glucose infusates plasma specific activity declined by 74%, tracer determined glucose appearance was smaller than actual glucose infusion rates (317 ± 11 vs 366 ± 15 mg m−2 min−1, p< 0.001), and erroneous negative values were calculated for glucose production (‐49 ± 7 mg m−2 min−1). Average underestimation during the first 2 h correlated with glucose infusion rates (r = 0.88, p < 0.02). In contrast, when plasma specific activity was maintained constant, using appropriately labelled glucose infusates, tracer determined glucose appearance and glucose infusion rates were similar (385 ± 16 vs 385 ± 17 mg m−2 min−1), and negative errors for glucose production were avoided. In conclusion, using unlabelled glucose infusates, as in previous studies, suppression of glucose production is overestimated and stimulation of glucose utilization is underestimated. As errors were greater with larger glucose infusions, the mistakes may have been greatest in insulin sensitive control subjects, and smaller in insulin resistant subjects. Therefore, re‐evaluation of hepatic insulin sensitivity seems appropriate in diabetes, obesity, and other insulin resistant states.
Hospital Admissions of Adolescent Patients with Diabetes
Authors: Challen A.H. , Davies A.G. , Williams R.J.W. , Baum J.D.
Published: July 2009

This study formed part of a psychological survey of young people aged 10–17 years attending three Bristol diabetes clinics. The aim was to examine the characteristics of those who were admitted to hospital with unstable diabetes during the period between two assessments, and analyse how they differed from the rest. Ten young people were admitted to hospital during the study period. These 10 individuals had greater emotional difficulty with diabetes as measured by diabetes specific psychometric scales (median scale score: 19) compared to the 89 adolescents who were not readmitted (median scale score: 14) (p = 0.01). They did not differ in demographic characteristics or glycaemic control. Overall there was no relationship between psychological response to diabetes and glycaemic control as assessed by mean glycated haemoglobin. Five of those admitted presented with hyperglycaemia; they had greater emotional difficulty (median scale score: 31, p = 0.02) and a more negative attitude (median scale score: 22, p = 0.02) to diabetes than those presenting with hypoglycaemia (median scale scores: 16). Only those with hyperglycaemia differed from those who were not readmitted, having greater emotional difficulty (p = 0.002) and a more negative attitude (p = 0.01). The possibility of psychological difficulties with diabetes should be sought following an admission, particularly for hyperglycaemia.
Reproducibility of Parameters for Assessment of Diabetic Neuropathy
Authors: Valensi P. , Attali J‐R. , Gagant S. ,   French Group for Research and Study of Diabetic Neuropathy
Published: July 2009

This study evaluated the reproducibility of nerve function assessment in a group of 132 diabetic patients with moderate peripheral polyneuropathy. Patients were investigated at the beginning and the end of the run‐in period (a 1‐month placebo period) of a multicentre trial of an aldose‐reductase inhibitor (Ponalrestat). Reproducibility was evaluated by performing four types of tests: quantitative visual scales of symptoms, quantitative sensory assessment (vibration perception thresholds in medial malleolus and great toe, foot thermal perception threshold to hot and cold), electrophysiological investigations on the dominant side (conduction velocities and potential amplitudes of sensory and median motor nerve, sural and peroneal nerves, amplitudes of F waves of median motor and peroneal nerves) and cardiac autonomic tests (Valsalva, deep‐breathing, lying‐to‐standing). Reproducibility was poor for symptoms, thermal sensitivity, and potential amplitudes. It was satisfactory (total coefficient of variation < 50%) for all the other parameters and even very good (total variation coefficient < 26%, intra‐subject variation factors corresponding to < 56% of total variance) for velocities of sensory and median motor and peroneal nerves, the amplitudes of F waves and the three autonomic tests. For most of the parameters total variance was mainly related to inter‐subject variability. However, inter‐subject variability for the three cardiac autonomic tests was very low and at least one cardiac autonomic test was altered in all the patients. Inter‐centre variability was low for all the parameters, except for action potential amplitudes and for F wave velocity of the median motor nerve. This study suggests those parameters that are appropriate for the assessment of diabetic neuropathy and for therapeutic trials. It also shows evidence of cardiac autonomic neuropathy in all these patients with moderate peripheral neuropathy.
Different Acute and Chronic Effects of Acipimox Treatment on Glucose and Lipid Metabolism in Patients with Type 2 Diabetes
Authors: Saloranta C. , Groop L. , Ekstrand A. , Franssila‐Kallunki A. , Eriksson J. , Taskinen M.‐R.
Published: July 2009

To study whether therapeutic reduction of non‐esterified fatty acids (NEFA) can be used to improve glucose metabolism, we administered the antilipolytic agent, acipimox, 250 mg four times daily for 4 weeks in eight obese Type 2 diabetic patients. Glucose and NEFA metabolism were assessed before and after treatment with a two‐step euglycaemic hyperinsulinaemic clamp (0.25 and 1 ***mU kg−1 min−1 insulin) combined with infusions of [3–3H] glucose and [1–14C] palmitate. Three days of acipimox treatment reduced 24‐h serum NEFA levels by 10%, but the difference disappeared after 4 weeks of treatment mainly due to a two‐fold rise in morning NEFA concentrations (p < 0.01). After 3 days of acipimox treatment, fasting and 24‐h plasma glucose and serum triglyceride concentrations were significantly reduced (p < 0.05), but no longer after 4 weeks of treatment. Despite the rebound rise in NEFA, acute administration of acipimox still inhibited both oxidative and non‐oxidative NEFA metabolism in the basal state (p < 0.01 – 0.001) and during insulin infusion (p < 0.05 – 0.001). Inhibition of NEFA metabolism was associated with increased insulin‐stimulated glucose uptake (from 3.56 ± 0.28 to 5.14 ± 0.67 μmol kg−1 min−1, p < 0.05), mainly due to stimulation of non‐oxidative glucose disposal (from 1.74 ± 0.23 to 3.03 ± 0.53 μmol kg−1 min−1, p < 0.05). In conclusion, acipimox administered acutely inhibits NEFA appearance (lipolysis), which is associated with improved glucose uptake. However, after 4 weeks of treatment, the beneficial effects on NEFA and glucose metabolism are outweighed by a marked rebound rise in fasting NEFA concentrations. The results emphasize the problems using acipimox as a means to improve glucose tolerance in patients with Type 2 diabetes.
Wine for Type 2 Diabetic Patients?
Authors: Christiansen C. , Thomsen C. , Rasmussen O. , Balle M. , Hauerslev C. , Hansen C. , Hermansen K.
Published: July 2009

To ensure an acceptable quality of life for Type 2 diabetic patients, the food recommendations have to be as liberal and individualized as possible. Unfortunately, disagreements exists about the consumption of different types of wine. Diabetic patients are advised by some to restrain their wine intake and to use dry wine containing little carbohydrate, while others are more liberal. The purpose of this study was to evaluate the effects of dry and sweet wine on the glycaemic control in Type 2 diabetes. Twelve diabetic patients consumed a light meal with either 300 ml tap water 300 ml dry white wine, 300 ml sweet white wine with ethanol added or 300 ml dry white wine with glucose added. Similar glucose, insulin, and triglyceride responses were obtained in all four situations. There was a greater suppression of the free fatty acid levels in the three situations with wine as compared with water (p < 0.001). This effect may be caused by an attenuation of the free fatty acid mobilization and esterification of free fatty acids to triglycerides induced by alcohol. Our results indicate that patients with well‐controlled Type 2 diabetes can drink moderate amounts of wine with meals without risking acute deterioration of glycaemic control. Whether the wine is dry or sweet has no impact on the glycaemic control.
Pre‐mixed Insulin Delivered by Disposable Pen in the Management of Children with Diabetes
Authors: O'Hagan M. , Greene S.A.
Published: July 2009

Pre‐mixed insulin preparations are being used increasingly in the management of children with IDDM. Recently this form of insulin has been produced in a disposable insulin pen device. An open randomized 3‐month crossover study was conducted to compare glycaemic control on a self‐titrating insulin regimen with a pre‐mixed (30:70) preparation, both given twice daily. The pre‐mixed preparation was delivered by disposable pen. Forty children (age range 7–16 yr) entered the study. Mean ± SEM glycosylated haemoglobin (HbA1%) at the start of the study (13.1 ± 0.6) compared with values at the end of the self‐titrating (11.8 ± 0.5) and pre‐mixed periods (12.5 ± 0.5), as well as blood glucose profiles taken at 3‐weekly intervals, showed no significant change. Fourteen of the children were on insulin ratios other than 30:70 (range 10:90 to 50:50) and were unaffected by the switch (HbA1 at the start of the study 12.7 ± 1; at the end of the self‐titrating 11.5 ± 0.8; and pre‐mixed period 12.5 ± 0.8). Twenty‐one children continued on the pen for a further 12 months with no deterioration in control (HbA1 at the beginning and end of this period being 11.9 ± 0.7 and 11.0 ± 0.7, respectively). The children (95%) preferred the disposable pen and pre‐mixed insulin regimen. Switching to pre‐mixed insulin, while not improving, has no detrimental effect on glycaemic control.
Evaluation of Glycaemic Control Limits Using the Ames DCA 2000 HbA1c Analyser
Authors: Rumley A.G. , Kilpatrick E.S. , Dominiczak M.H. , Small M.
Published: July 2009

The Ames DCA 2000 is a benchtop analyser that measures HbA1c by an agglutination inhibition immunoassay using a monoclonal antibody. Laboratory and nursing staff measured HbA1c on‐site in 78 patients with Type 1 diabetes at the outpatient clinic. Significant correlations were noted with both the Corning Glytrac total HbA1 assay (r = 0.89) and the Novoclone assay for HbA1c (r = 0.95). Mean within‐assay CV was 1.6% and 3.0% at HbA1c of 5.4% and 13.0%, respectively, while between‐assay CVs were 4.2% and 3.8%. These results are as good as our routine laboratory method based on the Corning HbA1 assay. Locally derived reference population data for HbA1c were produced and patients were assigned to categories of good, acceptable, and poor glycaemic control using conventional recommendations for Type 2 diabetes. There was poor agreement between the methods, with only 22% of patients achieving good/acceptable control using the DCA 2000, while 46% of patients had an HbA1 in this range. It appears that the convention for derivation of control limits for HbA1 does not hold for this HbA1c assay.
Prothrombotic and Antithrombotic Factors are Elevated in Patients with Type 1 Diabetes Complicated by Microalbuminuria
Authors: Lee P. , Jenkins A. , Bourke C. , Santamaria J. , Paton C. , Janus E. , Best J.
Published: July 2009

Increased urinary albumin loss in patients with Type 1 diabetes is associated with accelerated atherosclerosis. Prothrombotic factors known to be associated with cerebrovascular and coronary artery disease in the general population, and antithrombotic factors, were studied in 52 patients with Type 1 diabetes and varying urinary albumin loss and 24 non‐diabetic control subjects. Fibrinogen increased from 2.5 g I‐1(95 % confidence interval 2.3–2.8) in control subjects and 2.8 g I‐1(2.6–3.0) in diabetic patients without microalbuminuria to 3.1 g I‐1(2.7–3.5) with microalbuminuria (p< 0.005 vs control;p< 0.001 vs without microalbuminuria). Factor VIIc increased from 81 % (75–86 % in non‐diabetic control subjects and 84 % (78–90 %) in diabetic patients without microalbuminuria to 103 % (89–117 %) with microalbuminuria (p< 0.005 vs control;p< 0.05 vs without microalbuminuria) and 118% (86–150%) with albuminuria (p< 0.005 vs control andp< 0.001 vs without microalbuminuria). Levels of the antithrombotic factors protein C, protein S, and antithrombin III also rose in the diabetic patients with evidence of renal damage. Elevation of prothrombotic factors has been associated with increased risk of microvascular disease, whereas elevation of antithrombotic factors has no known protective effect. Therefore, this pattern of alteration of haemostatic factors in diabetic renal disease may contribute to the increased risk of vascular disease associated with both microalbuminuria and albuminuria.
An Evaluation of Bone Density and Turnover in Premenopausal Women with Type 1 Diabetes Mellitus
Authors: Gallacher S.J. , Fenner J.A.K. , Fisher B.M. , Quin J.D. , Fraser W.D. , Logue F.C. , Cowan R.A. , Boyle I.T. , MacCuish A.C.
Published: July 2009

Measurement of bone density and turnover was assessed in 20 premenopausal females with Type 1 diabetes mellitus and 27 age‐sex‐matched controls. Measurement was made of spinal (L2–4) and neck of femur bone density by dual‐energy X‐ray absorptiometry. L2–4 density was significantly higher in the diabetic patients compared with controls (1.224 ± 0.021 g cm−2 vs 1.161 ± 0.020 g cm−2: p = 0.016). No significant difference was noted between the groups in neck of femur density. Measurement of bone formation was assessed by serum alkaline phosphatase and bone resorption by fasting urinary hydroxyproline/creatinine ratio. Alkaline phosphatase was significantly higher in the diabetic patients (185 ± 16 U l−1 vs 135 ± 10 U l−1: p < 0.01) as was hydroxyproline/creatinine ratio (0.028 ± 0.003 vs 0.017 ± 0.002: p = 0.002). No significant correlation was found between L2–4 density and glycated haemoglobin, duration of diabetes or daily dose of insulin taken. These data suggest that osteopenia is not associated with Type 1 diabetes mellitus; however these patients do have evidence of increased bone turnover and may therefore be at risk of osteoporosis in later life, particularly after the menopause.
The Relationship Between Obesity, Plasma Immunoreactive Insulin Concentration and Blood Pressure in Newly Diagnosed Indian Type 2 Diabetic Patients
Authors: Yajnik C.S. , Naik S.S. , Bhat D.S. , Joshi V.M. , Shelgikar K.M. , Alberti K.G.M.M. , Hockaday T.D.R.
Published: July 2009

The association of blood pressure with clinical and biochemical measures was studied in 185 newly diagnosed Type 2 diabetic patients, 74 impaired‐glucose‐tolerant (IGT) and 128 non‐diabetic control subjects. Hyperglycaemic subjects were older than control subjects (controls 40 (24–59) years, IGT 48 (29–64) years, diabetic 43 (29–60) years, median (5th‐95th centile) both p < 0.05). They were also more obese (body mass index (BMI) controls 23.5 kg m−2 (17.2–29.9), IGT 26.0 kg m−2 (19.8–33.9), diabetic 24.2 kg m−2 (19.3–32.2)) and with a greater waist‐hip ratio (controls 0.83 (0.70–0.98), IGT 0.88 (0.75–0.98), diabetic 0.89 (0.75–1.00)). Blood pressure was significantly higher in both IGT (systolic 127mmHg (108–162), diastolic 80 mmHg (66–99)) and diabetic patients (systolic 130 mmHg (104–160), diastolic 84 mmHg (66–102)) compared to non‐diabetic controls (systolic 120 mmHg (100–151), diastolic 80 mmHg (60–94)). Univariate analysis showed that in diabetic patients systolic blood pressure was related to age (r = 0.17, p < 0.05), BMI (r= 0.23, p < 0.01) and plasma immunoreactive insulin (fasting and post glucose, r= ˜ 0.25, p<0.01) but not to C‐peptide concentrations; diastolic blood pressure to BMI (r= 0.35, p < 0.001), waist‐hip ratio (r = 0.23, p < 0.01) and plasma immunoreactive insulin (fasting r= 0.30, p < 0.001, post glucose r = ˜ 0.20, p < 0.05) but not to C‐peptide concentrations. Multivariate analysis revealed that systolic blood pressure in diabetic patients was related to BMI (p < 0.01) and fasting immunoreactive insulin (p < 0.05) while diastolic blood pressure was related to BMI (p < 0.001) and waist‐hip ratio (p < 0.01). Thus, blood pressure is associated with obesity even in our relatively non‐obese population and it is also associated with plasma immunoreactive insulin concentrations. The mechanism of these associations remains to be established.