bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Lipid Lowering Drugs on Metabolic Control and Lipoprotein Composition in Type 2 Diabetic Patients with Mild Hyperlipidaemia
Authors: Stewart M.W. , Dyer R.G. , Alberti K.G.M.M. , Laker M.F.
Published: July 2009

Patients with Type 2 diabetes are at increased risk from macrovascular disease whether or not they are hyperlipidaemic. Several factors may contribute to this increased risk including abnormalities of lipoprotein composition. The aim of our study was to determine the effects of lipid lowering drugs on lipoprotein composition (lipoprotein fractions were separated by sequential flotation ultracentrifugation) and insulin sensitivity (measured by a modified Harano technique) in 44 patients with mild hyperlipidaemia. All patients had total cholesterol concentrations between 5.2 and 6.5 mmol l−1 and total triglyceride concentrations < 3.0 mmol l−1, and were randomized by minimization to receive treatment for 12 weeks with bezafibrate, acipimox, simvastatin or placebo. Total cholesterol concentrations were decreased by simvastatin, 5.7 ± 0.4 to 3.7 ± 0.6 mmol l−1 (p < 0.05), due mainly to reduced LDL‐cholesterol levels (−1.25 mmol l−1; p < 0.05), and bezafibrate 5.7 ± 0.6 to 4.6 ± 0.4 mmol l−1 (p < 0.05). The LDL:HDL‐cholesterol ratio was reduced in the simvastatin group 2.0 ± 0.5 to 1.2 ± 0.3 (p < 0.005). There was no effect of the drugs on glycated haemoglobin or insulin sensitivity. In conclusion bezafibrate and simvastatin improve the lipid profile in Type 2 diabetic patients without adversely affecting diabetic control.
Thrombomodulin Levels in Insulin‐dependent Diabetic Patients with Microalbuminuria
Authors: Gruden G. , Pagano G. , Romagnoli R. , Frezet D. , Olivetti C. , Cavallo‐Perin P.
Published: July 2009

Thrombomodulin (TM) plays an important role in the regulation of blood coagulation at the endothelial surface. TM is also present in plasma, where an increase of its level seems to reflect endothelial damage. Since microalbuminuria is associated with an increased atherothrombotic risk and is considered an expression of widespread vascular damage, we evaluated plasma thrombomodulin levels, blood pressure, and plasma lipid values in Type 1 diabetic patients with micro‐ and normoalbuminuria. Thrombomodulin was measured in 12 microalbuminuric (albumin excretion rate 20–200 μg min−1 in 2 of 3 overnight urine collections) and in 12 normoalbuminuric (albumin excretion rate < 20 μg min−1) Type 1 diabetic patients matched for age, sex, body mass index, smoking habits, diabetes duration, and glycated haemoglobin. Mean thrombomodulin was significantly higher in micro‐ than in normalbuminuric group (59.34 ± 3.58 vs 43.56 ± 3.52 ng ml−1 p < 0.01). Systolic and diastolic blood pressure were significantly higher in micro‐ than in normoalbuminuric group (p < 0.05). There was a positive correlation between plasma thrombomodulin and albumin excretion rate (p = 0.013, r = 0.49), and between thrombomodulin and diastolic blood pressure (p = 0.023, r = 0.46) in diabetic patients as a whole but not in the individual groups. These findings suggest the presence of an endothelial injury in microalbuminuric patients.
The Prevalence of Autonomic and Peripheral Neuropathy in Insulin‐treated Diabetic Sbjects
Authors: Flynn M.D. , O'Brien I.A. , Corrall R.J.M.
Published: July 2009

The prevalence of autonomic and peripheral neuropathy was examined in 506 diabetic sbjects treated with insulin, mean age 43 years, diabetes duration 15 (range 1–54) years. Autonomic neuropathy was present if two or more (of four) cardiovascular autonomic function tests were abnormal using age‐related ranges derived from 310 normal control sbjects. Peripheral neuropathy was defined as a vibration threshold >95th centile for age combined with absent/impaired ankle reflexes. Eighty‐four (16.6%) of diabetic sbjects had abnormal autonomic function and 119 (23.5%) peripheral neuropathy, concordant in 44/506 (8.7%). Of the diabetic sbjects with autonomic neuropathy 40/84 (47.6%) did not have peripheral neuropathy and only 44/119 (37.0%) with peripheral neuropathy had abnormal autonomic function (p<0.001). The prevalence of both neuropathies increased in relation to diabetes duration (both p<0.001). Autonomic neuropathy was more common in sbjects diagnosed <20 years of age (18.2%) vs age >40 years (11.1%) (p<0.05). In contrast peripheral neuropathy was more common with older age at diagnosis (<20 years 13.5% vs 36.8% >40 years, p<0.001). The age‐related prevalence of autonomic neuropathy peaked at age 40–49 years while peripheral neuropathy increased progressively with age (p<0.001). The prevalence of peripheral exceeded autonomic neuropathy 20 years after diagnosis (40.2% vs 30.7%, p<0.001).
Assessing the Impact of Blood Sample Type on the Estimated Prevalence of Impaired Glucose Tolerance and Diabetes Mellitus in Epidemiological Surveys
Authors: Farrer M. , Albers C.J. , Neil H.A.W. , Adams P.C. , Laker M.F. , Alberti K.G.M.M.
Published: July 2009

In a prospective study of 353 patients who had undergone coronary artery bypass graft surgery a 75 g oral glucose tolerance test was performed at 3 months and 12 months after surgery. Venous whole blood glucose and venous plasma glucose samples were assayed on a bench‐top analyser. The World Health Organization diagnostic criteria for impaired glucose tolerance and diabetes mellitus were applied to venous whole blood glucose and venous plasma glucose measurements. The difference between the plasma and whole blood concentration of glucose was 0.79‐0.86 mmol I−1 at a plasma glucose of 7.8 mmol I−1 and 1.22‐1.24 mmol I−1 at a plasma glucose of 11.1 mmol I−1 (compared to 1.1 mmol I−1 by World Health Organization criteria at both cut‐points). Despite this, in our sbject population with a high prevalence of impaired glucose tolerance (20.3 % at 3 months, 15.3 % at 12 months) and diabetes mellitus (10.1 % at 3 months and 12 months), there was no significant difference in the proportion classified impaired glucose tolerance or having diabetes mellitus using venous whole blood glucose compared to venous plasma glucose. We conclude that despite the minor anomaly between WHO diagnostic criteria based on venous whole blood glucose and venous plasma glucose measurements, these criteria are robust and give broadly comparable population prevalence of diabetes mellitus and impaired glucose tolerance irrespective of blood sample choice.
Effect of Ambient Temperature and Humidity on Performance of Blood Glucose Meters
Authors: King J.M. , Eigenmann C.A. , Colagiuri S.
Published: July 2009

The accuracy of four blood glucose meters (Accutrend, ExacTech Companion, Medisense Companion 2, and Glucometer III) was tested at temperatures ranging from 4 to 44°C (control solutions) and 8°C, 24°C, and 36°C (venous blood) and at humidities of 60 % and 80 %. Low and high temperatures resulted in a number of statistically significant changes in glucose readings with all meters. However, Accutrend, Medisense Companion 2, and Glucometer III were 100% clinically accurate at all temperatures. With the ExacTech Companion, only 70.8 % of control solution and 55.6 % of venous blood results were clinically accurate. The main errors were: (1) cold temperatures lowered the result so that euglycaemic levels erroneously read in the hypoglycaemic range and hyperglycaemic levels gave a better than actual result and (2) hot temperatures increased the result whereby hypoglycaemic levels falsely gave a euglycaemic result. Weather conditions at which blood glucose meters may be operated can affect results and potentially lead to errors in clinical decisions.
The Effect of Haemolysis on Blood Glucose Meter Measurement
Authors: Kilpatrick E.S. , Rumley A.G. , Rumley C.N.
Published: July 2009

A study was performed to assess the effect of varying degrees of sample haemolysis on the measurement of blood glucose by the Accutrend, Companion 2, ExacTech, Glucometer II, Glucometer 4, One Touch II, and Reflolux II blood glucose meters. Fresh venous blood was sonicated to induce complete haemolysis and then added in increasing proportions to homologous untreated blood to obtain nine samples with free haemoglobin concentrations up to 50 g I−1. The Accutrend meter showed the only significant (p<0.05) linear relationship to degree of haemolysis (r = 0.988, p<0.0001). For every 7 % of red cells lysed, the Accutrend value increased by 15 %. All other meters gave results which were within 15 % of the non‐haemolysed value. However, extreme (100 %) haemolysis not only affected the Accutrend (glucose value 108 % greater than reference) but also the ExacTech (+98 %), the Glucometer II (‐32 %), and the Companion 2 (‐41 %). Thus, unwitting use of a haemolysed sample to measure whole blood glucose may, with the Accutrend in particular, lead to erroneous results.
A Study of Fluoxetine in Obese Elderly Patients with Type 2 Diabetes
Authors: Connolly V. M. , Gallagher A. , Kesson C. M.
Published: July 2009

In order to establish the safety and efficacy of fluoxetine in subjects over 60 years of age with Type 2 diabetes, a randomized, double‐blind, parallel study of 30 obese subjects was undertaken, comparing the use of fluoxetine 60 mg daily with placebo. Subjects were diet controlled with an HbA1< 14% (reference range 6–9%) and BMI > 29 kg m2. Those taking fluoxetine had a median weight loss of 2.6 kg at 3 months (p< 0.001) and 3.9 kg at 6 months (p< 0–02), compared with weight loss in the placebo group of 0.1 kg and 0.0 kg at 3 and 6 months, respectively. Improved glycaemic control was also demonstrated in the fluoxetine group compared with placebo, initial HbA1levels of 8.0% vs 8.7% (NS) falling at 4 months by 0.9% (p< 0.02) and at six months by 0.9% (p< 0.02). No sustained improvement in fasting blood glucose levels was demonstrated. Reporting of adverse events was similar in both groups. Fluoxetine in the short term aids weight loss and improves glycaemic control without a significant increase in adverse events in elderly Type 2 diabetic subjects.
Use of Thrombolysis for Acute Myocardial Infarction in the Presence of Diabetic Retinopathy in the UK, and Associated Ocular Haemorrhagic Complications
Authors: Higgs E. R. , Parfitt V. J. , Harney B. A. , Hartog M.
Published: July 2009

Diabetic retinopathy is still regarded as a relative contraindication to the use of thrombolysis for myocardial infarction because of a perceived risk of intraocular haemorrhage. However, this complication has rarely been reported and the risk may be too small to justify withholding thrombolysis. A questionnaire survey was therefore conducted of members of the Medical and Scientific Section of the British Diabetic Association (BDA), to ascertain the exclusion criteria applied to the use of thrombolysis in patients with diabetic retinopathy in the UK and to identify any related ocular haemorrhagic complications. Replies were received from 128 physicians in 107 centres. Exclusion criteria applied were: any retinopathy 7 (5 %), proliferative retinopathy and recent vitreous or pre‐retinal haemorrhage 74 (58 %), recent vitreous haemorrhage only 25 (20 %), thrombolysis given regardless of retinopathy 22 (17 %). No cases of intraocular haemorrhage following thrombolysis in diabetic myocardial infarction patients were identified. The risks of this complication appear to be very small and probably do not justify withholding thrombolytic therapy from diabetic patients with most forms of retinopathy, including proliferative.
Factitious Hypoglycaemia Documented by a Modified Assay for the Measurement of Plasma Sulphonylurea
Authors: Sener A. , Gillet C. , Verhelst J. , DeBoeck K. , Mahler C. , Malaisse W. J.
Published: July 2009

Two cases of factitious hypoglycaemia due to intentional or inadvertent intake of glipizide by non‐diabetic subjects were identified through the measurement of this sulphonylurea in plasma by a modified assay procedure.
Retinopathy in Maltese Type 2 Diabetic Patients
Authors: Schranz A. G. , Zarabinska L.
Published: July 2009

Since diabetes is a major health problem in Malta a study was conducted to gain a better insight into one of its most common complications, that of retinopathy. A random sample of 200 cases of adult onset diabetes with retinopathy who attended the main hospital's diabetes clinic was assessed by an experienced ophthalmologist. Non‐proliferative retinopathy was subdivided into three degrees of severity according to the number of microaneurysms, haemorrhages, exudates, and intraretinal microvascular abnormalities present while proliferative retinopathy included also advanced eye disease. Data on medical and family histories was gathered from personal interrogation and counterchecked from hospital files. A medical examination searched for other concomitant disease. The 124 females and 73 males were similarly aged with a mean of 59.5 ± 11.5 years. The mean age at onset of diabetes was 44.4 ± 7.9 years: no significant differences were seen between the grades of retinopathy or the sexes. Onset of eye disease was first detected at a mean age of 56.9 ± 7.0 years. The great majority (82%) of retinopathy cases occurred after 10 years of diabetes. Males appeared to develop eye disease (especially non‐proliferative) at a younger age (53.4 ± 7.6 vs 58.9 ± 6.6 years, p < 0.01) and after a shorter duration of diabetes (10.1 ± 6.6 vs 14.0 ± 7.8 years, p < 0.001) than females. Severity of retinopathy was strongly associated (p < 0.001), in females rather more than in males, with poor glycaemic control, use of insulin, presence of proteinuria and decreasing vision; and less markedly (p < 0.01) with duration of diabetes of more than 10 years, neuropathy and glaucoma. No important relation was observed between the degree of eye disease and body weight (expressed as BMI), hypertension, macroangiopathy (cardiac or peripheral), cataract, smoking or family history of diabetes or of retinopathy. These findings characterize those Maltese Type 2 diabetes patients that require closer attention to ophthalmic complications, and support the need to improve diabetes health care to reduce the burden of visual impairment.
Urinary Albumin Excretion in a Population Based Cohort
Authors: Vestbo E. , Damsgaard E.M. , Frøland A. , Mogensen C.E.
Published: July 2009

In order to compare a 1‐h daytime urine specimen collection with a timed overnight collection, as well as different ways of expressing urinary albumin excretion: (urinary albumin excretion rate (UAE), urinary albumin concentration (UAC), and urinary albumin creatinine ratio (UACR)), a population of 922 people of whom 35 had diabetes was examined. The median age was 47 (range 26–65) years. The results of the different ways of collecting urine specimens and the different expressions of urinary albumin excretion were related to known cardiovascular risk factors. The daytime collection showed higher values of urinary albumin excretion than the overnight collections. Systolic blood pressure was an important risk factor correlated to UAE and UACR in the day as well as the overnight collection, followed by HbA1c in the total group and by BMI in the non‐diabetic group. UAC showed significant relation to triglycerides and HDL‐cholesterol. In conclusion, urinary albumin in a 1‐h daytime collection showed a similar correlation to cardiovascular risk factors as the excretion of albumin in overnight collected urine. Follow‐up studies are needed to compare day collections of urine as predictors of cardiovascular disease and early death with overnight collections.
The Frequency of Known Diabetes, Hypertension and Ischaemic Heart Disease in Affluent and Poor Urban Populations of Karachi, Pakistan
Authors: Hameed K. , Kadir M. , Gibson T. , Sultana S. , Fatima Z. , Syed A.
Published: July 2009

The high frequency of diabetes mellitus and coronary artery disease among people of South Asian extraction living in the West is well established. The prevalence of these disorders in Southern Asia is less certain. No previous attempt has been made to estimate their occurrence in Pakistan. In order to compare the prevalence of known diabetes mellitus, hypertension and ischaemic heart disease between affluent and poor urban communities in Pakistan, a survey of consecutive households was undertaken in a relatively prosperous and a poor area in Karachi. Information was obtained on 4232 adults evenly distributed between the two areas. Body weight and height were measured in 199 healthy subjects at the two sites. The prevalence of known diabetes in the affluent population was 4.5%, significantly higher than 1.8% in the poor area (p<0.001). A maximal prevalence of 25% was seen in the affluent community aged 55–64. Diabetes was more common in females in both populations. The overall prevalence of hypertension was similar in the two areas although significantly more frequent in the middle aged and affluent. A history of ischaemic heart disease occurred in 1.9% of the affluent and 0.6% of the poor (p = 0.003). Healthy subjects were heavier and more obese in the richer community. Thus the susceptibility of South Asian populations to diabetes and ischaemic heart disease is also apparent in an affluent segment of Pakistani society. The phenomenon is not attributable simply to urbanization. Obesity is probably an important contributory factor. The economic implications for developing South Asian countries are serious.
Longitudinal Study of Lipoprotein(a) in Peripubertal Children with Insulin‐dependent Diabetes
Authors: Couper J.J. , Cocciolone R. , Bates D.J. , Nairn J. , Ryall R.G.
Published: July 2009

We aimed to examine the longitudinal relationship between lipoprotein(a) and haemoglobin A1c, albumin excretion rate, and puberty in peripubertal children with insulin‐dependent diabetes. A total of 114 patients aged 11.5 ± 3.6 years (mean (SD)) were followed prospectively for 15.2 ± 2.8 months. Lipoprotein(a), apolipoproteinB‐100, haemoglobin A1c, mean overnight albumin excretion rate and Tanner stage were determined at the beginning and end of the study period. Lipoprotein(a) and apolipoproteinB‐100 were measured using nephelometry. This method was correlated with radioimmunoassay and there was no significant change in mean bias during the study. Lipoprotein(a) fell significantly over time (214, (152, 276); 160 (84, 236) mg I−1 geometric mean (0.95 confidence intervals), p < 0.001); apolipoproteinB‐100 did not change. Lipoprotein(a) and apolipoproteinB‐100 did not differ in 233 cross‐sectional controls of similar age. The change in lipoprotein(a) did not correlate with a small fall in haemoglobin A1c or with overnight albumin excretion rate, Tanner stage or insulin dose. Separate analysis of male and female patients and prepubertal and pubertal patients continued to show a significant fall in lipoprotein(a) independent of change in haemoglobin A1c or albumin excretion rate. Likewise, 53 patients with a change in haemoglobin A1c of greater than 1%, and 20 patients who progressed from normal albumin excretion rate to albumin excretion rate above the 95th centile, showed no relationship between lipoprotein(a) and haemoglobin A1c or albumin excretion rate. In conclusion, longitudinal changes in lipoprotein(a) do not relate to metabolic control or early changes in albuminuria in young patients with insulin‐dependent diabetes.
An Optical Practice Based Diabetic Eye Screening Programme
Authors: Gatling W. , Howie A.J. , Hill R.D.
Published: July 2009

In many cases, blindness due to diabetic retinopathy can be prevented provided treatment with laser photocoagulation is used at the correct time. A screening programme is required to identify cases of sight threatening retinopathy. An optical practice based diabetic eye screening programme has been established in Dorset. The optometrist undertaking the examination is paid a fee. The findings are recorded on a coded form and sent to the hospital diabetologist who recalls positive cases. Seventy‐six optical practices have joined the scheme and 3224 patients have been screened in the first 6 months (Dorset population 655 000). In the Poole area (population 230 000), 1922 patients were screened and 129 (6.7%) were recalled in 6 months. Outcome of 3 months screening, identified 59 recalls. Referral to the opthalmologist was made in 15 cases for potentially sight threatening retinopathy, 14 cases were followed in the diabetic clinic for significant background retinopathy, and 24 cases were returned to the annual screening in the optical practices. Six cases where the patients either failed or were unable to attend were reviewed by the GP. An optical practice based diabetic eye screening programme has been successful in screening a large number of patients.
Comparative Analysis of Patency, Limb Salvage and Survival in Diabetic and Non‐diabetic Patients Undergoing Infrainguinal Bypass Surgery
Authors: Karacagil S. , Almgren B. , Bowald S. , Bergqvist D.
Published: July 2009

In 92 diabetic and 175 non‐diabetic patients undergoing 336 femoropopliteal or femorodistal bypass procedures, 1‐ and 3‐year cumulative life‐table patency, limb salvage, and survival rates were comparatively analysed. The peroperative mortality rate was significantly higher in diabetic patients (5% compared to 1.4%, p < 0.001). The cumulative graft patency rates were 61% at 12 months and 46% at 36 months in diabetic patients compared to 64 and 52% in non‐diabetic patients. Significantly better patency rates were observed in limbs with good runoff compared to limbs with poor runoff in both groups. The limb salvage rates at 3 years were 70% in diabetic patients and 62% in non‐diabetic patients. The survival rate at 3 years was significantly lower in diabetic patients, 62% compared to 86% in non‐diabetic patients. Diabetic patients with poor runoff demonstrated a significantly lower survival rate after 36 months compared to diabetic patients with good runoff (48% and 74%, respectively). The results of this study demonstrate that the early and intermediate patency and limb salvage rates are similar in diabetic and non‐diabetic patients. On the other hand the survival rate in diabetic patients, especially in those with poor distal runoff, is significantly lower than non‐diabetic patients.
Mortality and Outcome of Insulin‐dependent Diabetes in Soweto, South Africa
Authors: Gill G.V. , Huddle K.R. , Rolfe M.
Published: July 2009

Sixty‐four insulin‐dependent (Type 1) diabetic patients (IDDM) in Soweto, South Africa were followed over a 10‐year period. Patients were assessed in 1982 and again in 1992. There were 10 deaths (16%), half of which were due to renal failure. Ketoacidosis, hypoglycaemia, and sepsis accounted for the rest. At the 10‐year follow‐up mean age (± SD) was 32.4 ± 5.0 years and diabetes duration 13.6 ± 2.6 years. Retinopathy affected 52%, peripheral neuropathy 42%, and nephropathy 28% (all significantly increased from the 1982 assessment). Microalbuminuria and autonomic neuropathy were also common. Serum cholesterol was over 6.5 mmol I−1 in 19%, hypertension affected 22%, and 28% were cigarette smokers; though no patient had evidence of macroangiopathy. We conclude that IDDM in South Africa is associated with excess mortality, a significant proportion of which is related to nephropathy. Diabetes of long duration is now not uncommon in South Africa, and although diabetic complications frequently occur, most patients have good life quality and freedom from large vessel disease.
Heat Shock Protein Studies in Type 1 and Type 2 Diabetes and Human Islet Cell Culture
Authors: Child D.F. , Williams C.P. , Jones R.P. , Hudson P.R. , Jones M. , Smith C.J.
Published: July 2009

Heat shock proteins (HSP) play an important role in auto‐immunity and infection. Glutamic acid decarboxylase (GAD) the prime antigen in Type 1 diabetes has similar amino acid sequences to HSP65. An ELISA was developed using a plant‐derived HSP65 antibody. HSP65 antibody was present in the serum of all normal subjects (median 1.64 AU, IQ range 1.49‐1.74). Lower levels were found in established Type 1 diabetes (1.41 AU, 1.32‐1.61, p<0.001) and Type 2 diabetes (1.45 AU, 1.35‐1.59, p<0.006). In Type 1 HSP antibody levels fell with age (p = 0.007) and with duration (p = 0.008) and women with Type 1 had lower levels than men (p = 0.009). Human islet cell culture subjected to heat shock revealed an approximate four fold increase in heat shock protein antigen in the surrounding medium. The release of HSP antigen from stressed islet cells together with the finding of HSP antibody in the serum of all subjects suggest that HSP65 should not be completely discarded as having a possible role in the development of Type 1 diabetes. Low levels of HSP antibody in patients with established diabetes is probably a manifestation of imparied immunity induced by the diabetic state.
Psychosocial Predictors of Acute Complications of Diabetes in Youth
Authors: Dumont R. Herskowitz , Jacobson A.M. , Cole C. , Hauser S.T. , Wolfsdorf J.I. , Willett J.B. , Milley J.E. , Wertlieb D.
Published: July 2009

In this paper we determine whether individual and family psychosocial functioning predicts the risk for recurrent acute diabetic complications. An onset‐cohort of 61 children and adolescents with Type 1 diabetes received conventional diabetes care. Episodes of ketoacidosis and of severe hypoglycemia were recorded for 8 years, and glycaemic control was measured by glycohaemoglobin. Measures of psychosocial functioning of the patient and parents were obtained during the first year. Over 8 years, 28% of subjects had at least one episode of ketoacidosis, and 21% had at least one episode of hypoglycaemia. The odds of observing recurrent hypoglycaemia versus recurrent ketoacidosis was 14 times greater in boys than in girls (Fisher's exact test p<0.05). Girls with recurrent ketoacidosis had more behaviour problems and lower social competence, they reported higher levels of family conflict, and their parents reported lower levels of family cohesion, expressiveness and organization in year one. These relationships were independent of any association with poor glycaemic control. Recurrent hypoglycaemia in boys was generally unrelated to individual and family functioning or glycohaemoglobin. Despite our small sample size, our findings are suggestive of relationships that may lead to early identification of patients who are prone to recurrent ketoacidosis, and to the development of early intervention strategies.
Screening for Microalbuminuria in Type 2 Diabetic Patients: the Evaluation of a Dipstick Test in General Practice
Authors: de Grauw W.J.C. , van de Lisdonk E.H. , van den Hoogen H.J.M. , van Gerwen W.H.E.M. , van den Bosch W.J.H.M. , Willems J.L. , van Weel C.
Published: July 2009

To evaluate the Micral test, a semiquantitative dipstick test, in a general practice setting, 317 Type 2 diabetic patients completed a screening for microalbuminuria by means of the Micral test as well as immuno‐nephelometry with the Disc 120 immuno‐nephelometer (Hyland, Nivelles, Belgium). Data were collected in 10 general practices performing the Nijmegen Monitoring Project. At a regular check‐up each Type 2 diabetic patient was asked to collect first morning urine samples on three consecutive days. The sensitivity of the Micral test was 67 %, the specificity 93 %. Between the practices the sensitivity ranged from 58 % to 81 %, the specificity from 87 % to 95 %. Microalbuminuria, defined as a mean urine albumin concentration ≥ 20 mg l−1 by nephelometry on three consecutive days, was found in 66 patients (21 %). The first Micral test correctly picked out these patients with microalbuminuria in 70 % of the cases and in 90 % those patients without microalbuminuria. The diagnostic performance of the Micral test was further proved by a Receiver Operating Characteristic (ROC) curve. The Area Under the Curve (AUC) of the Micral test was 0.84 (95 % Cl 0.78–0.90). Micral test results of 0 and 10 should be regarded as negative.
Insulin Increases Renal Magnesium Excretion: A Possible Cause of Magnesium Depletion in Hyperinsulinaemic States
Authors: Djurhuus M.S. , Skøtt P. , Hother‐Nielsen O. , Klitgaard N.A.H. , Beck‐Nielsen H.
Published: July 2009

The effects of insulin upon renal magnesium excretion were examined. Urinary magnesium excretion rates were measured in seven healthy volunteers (three men, four women) before and during a euglycaemic, hyperinsulinaemic clamp. Insulin was infused at 120 pmol m−2 min−1 and at 240 pmol m−2 min−1. Compared to baseline, the renal magnesium excretion increased 30 % during the infusion of insulin at a rate of 120 pmol m−2 min−1. During infusion of insulin, 240 pmol m−2 min−1, renal magnesium excretion increased 50 % compared to baseline. There were no changes in either glomerular filtration rates, plasma magnesium, urinary volume or general changes in the renal handling of divalent ions as judged by an unchanged urinary excretion rate of calcium (0 % during infusion of insulin, 120 pmol m−2 min−1, and 8 % increase during infusion of 240 pmol m−2 min−1 (NS)). During the 120 pmol m−2 min−1 insulin infusion rate, plasma insulin rose from 46.1 pmol l−1 to 158.8 pmol l−1 and during the 240 pmol m−2 min−1 insulin infusion rate, mean plasma insulin concentration was 361.4 pmol l−1. Thus, physiological concentrations of insulin induce a specific increase in the renal excretion of magnesium. This might partly explain the magnesium depletion observed in various hyperinsulinaemic states, diabetes mellitus, atherosclerosis, hypertension, and obesity.
Neuropsychological Function in Older Subjects with Non‐insulin‐dependent Diabetes Mellitus
Authors: Atiea J.A. , Moses J.L. , Sinclair A.J.
Published: July 2009

Neuropsychological function was compared in three well‐matched groups of subjects: Group 1, 20 diabetic patients with hypertension, mean age 69.1 ± 4.8 years, 14 males and 6 females; Group 2, 20 normotensive diabetic patients, mean age 69.0 ± 6.2 years, 14 male and 6 females; Group 3, 20 healthy community controls, mean age 68.1 ± 4.5 years, 13 males and 7 females. There were no significant differences between the groups in education or estimated IQ using the NART (National Adult Reading Test). Groups 1 and 2 did not differ significantly in duration of diabetes (mean 10.6 and 9.5 years, respectively), or mean glycosylated haemoglobin, HbA1 (mean 9.8 and 10.6 %, respectively), or mean blood glucose before or after testing. On a battery of neuropsychological tests, sensitive to cognitive impairment in older subjects, analysis of covariance using estimated IQ as the covariate showed no significant differences between the groups on tests of recall, with (Brown‐Peterson Test) and without (Kendrick Object Learning Test) interference, forward and backward digit span, concentration (serial subtraction), verbal fluency, immediate and delayed prose recall, digit symbol substitution or psychomotor speed (Kendrick Digit Copying Test). These results provide no support for an association between cognitive deficits and Type 2 diabetes mellitus in older subjects or for the view that such deficits may also be mediated by hypertension.
Comprehensive Diabetes Care in North Tyneside
Authors: Whitford D.L. , Southern A.J. , Braid E. , Roberts S.H.
Published: July 2009

The care of a 25 % (n = 559) random sample of all patients with diabetes in a district was assessed to determine whether comprehensive diabetes care was being achieved. Process measures initially assessed were repeated 3 years later after several changes in the programme of diabetes care were instituted. The number of patients with diabetes in structured care increased from 91 % to 95 % between 1991 and 1994, at the same time as an increase in prevalence from 1.2 % to 1.8 %. There was a shift in the proportion of patients attending primary care from 27 % to 40 %. There were significant improvements in the delivery of process measures including education. The majority of process measures were delivered to more than 75 % of the district diabetes population (for example HbA1c in 93 %, fundoscopy in 86 %, urine protein in 81 %, education on diabetic control in 84 %). Comprehensive diabetes care has not yet been fully achieved in North Tyneside district but the programme of care has shown continuous improvement over a 3‐year period. Comprehensive diabetes care should be an aim of every district diabetes programme.
Variation of Diabetes Mellitus Prevalence in General Practice and Its Relation to Deprivation
Authors: Meadows P.
Published: July 2009

This is an observational study to compare age standardized diabetes prevalences and relate these to socio‐economic measures of deprivation. It includes data from eight general (family) practices in the Bristol, UK, area with no ethnic minorities affecting diabetes prevalence. A total population of 71 599 was covered, including 181 Type 1 and 901 Type 2 diabetic patients, 91 of whom were controlled with insulin, 499 with oral hypoglycaemics, and 311 with diet alone. Actual Type 1 and Type 2 diabetes prevalences were standardized to what they would be if each practice had the UK national age profile. Total standardized diabetes prevalence varied from 1.31 % to 2.51 % (p < 0.001) and Type 2 diabetes prevalence from 0.97 % to 2.29 % (p < 0.001). There was no significant variation in the prevalence of Type 1 diabetes. The Spearman rank correlation coefficient indicated a significant association between standardized diabetes prevalence and two measures, the Jarman and Townsend indices, of deprivation in the electoral ward where each practice was situated. Total standardized diabetes prevalence was significantly correlated with each of the Jarman and Townsend indices (rs = 0.76, p < 0.05). Standardized Type 2 diabetes prevalence was similarly significantly correlated to each deprivation index (rs = 0.74, p < 0.05). Type 2 diabetes prevalence is affected by socio‐economic factors with implications for health targets and capitation based budgets.
Comparing the Incidence of Lower Extremity Amputations Across the World: the Global Lower Extremity Amputation Study
Authors: Unwin N. ,   The LEA Study Group
Published: July 2009

A substantial proportion of lower extremity amputations (LEAs), particularly in people with diabetes, are thought to be preventable by the provision of appropriate health care. Information on the incidence of LEAs which is accurate, up‐to‐date, and comparable cross‐sectionally and longitudinally is essential to guide and monitor interventions aimed at their prevention. Current information on the incidence of LEAs is limited and differences between studies in case definition, presentation of rates, level of ascertainment, and population age structure often make meaningful comparisons impossible. To remedy this situation the global LEA study has been established. The study is designed to compare the incidence of LEAs over time within and between communities across the world. The methodology includes adherence to a standard definition of LEA, standardized methods of data collection with built‐in quality control, and correction for under‐ascertainment of cases (using capture‐recapture methodology). Centres wishing to take part in the study must be able to identify a study population of at least 250000, have reasonably up‐to‐date population numbers by age and sex, and be prepared to stay in the study for at least 2 years. A study registration form (Appendix 1) is provided.
Skin Capillary Circulation is More Impaired in the Toes of Diabetic Than Non‐diabetic Patients with Peripheral Vascular Disease
Authors: Jörneskog G. , Brismar K. , Fagrell B.
Published: July 2009

The aim of the present study was to investigate if diabetes negatively influences the skin microvascular reactivity in the toes of patients with peripheral vascular disease (PVD). Twenty healthy subjects, 20 diabetic, and 20 non‐diabetic patients with PVD participated. One foot in each subject was investigated. The patient groups were matched for age, sex, and toe pressure. The capillary blood cell velocity in the nailfold of the great toe was investigated by videophotometric capillaroscopy, and the total skin microcirculation within the same area by laser Doppler fluxmetry. Capillary blood cell velocity and laser Doppler flux were studied during rest, and following a 1 min arterial occlusion at the toe base. The skin microvascular reactivity was impaired in both diabetic and non‐diabetic patients. In the diabetic patients the disturbances were mainly seen in the capillaries, and the capillary blood flow was severely reduced during reactive hyperaemia (p<0.01). In contrast, the total skin microcirculation was normal, indicating that sufficient blood reaches the area, but does not come out into the capillaries. The ratio between capillary blood cell velocity and laser Doppler flux, representing the distribution of blood between nutritional and non‐nutritional blood compartments, was reduced in the diabetic patients (p<0.05). These findings may contribute to the higher risk for development of chronic foot ulcers in diabetic patients with PVD.
Insulin Secretion and Sensitivity in Women Fulfilling WHO Criteria for Gestational Diabetes
Authors: Nicholls J. S. D. , Chan S. P. , Ali K. , Beard R. W. , Dornhorst A.
Published: July 2009

Abnormalities of insulin secretion rather than insulin sensitivity are described in women fulfilling the American criteria for gestational diabetes. We examined insulin secretion and insulin sensitivity in 38 women at risk of gestational diabetes categorized according to the less stringent WHO criteria, based on the 75 g oral glucose tolerance test, performed at 24 weeks gestation. Insulin sensitivity was assessed at 28 and 36 weeks using the short insulin tolerance test. Applying WHO criteria, 18 women had GDM. Age and body mass index of the GDM and glucose tolerant women were similar (32.4 ± 1.1 (SE) vs 32.3 ± 1.9 yr; 28.7 ± 1.5 vs 28.8 ± 1.7 kg m‐2, respectively). Fasting glucose was higher in the GDM women than controls (5.1 ± 0.2 vs 4.5 ± 0.1 mmol l‐1, p<0.025) while fasting insulin was similar (75 ± 18 vs 90 ± 16 pmol l‐1). The 30‐min insulin concentration during the OGTT was lower in the GDM women than controls (436 ± 61 vs 788 ± 152 pmol l‐1, p< 0.05), while the insulin sensitivity at 28 (87 ± 5 vs 76 ± 5 μmol l‐1 min) and 36 weeks (73 ± 8 vs 76 ± 8 μmol l‐1 min) was similar. A negative correlation existed between the 30‐min insulin and 120‐min glucose concentration during the OGTT (Rho ‐0.328, p<0.05). The WHO criteria for GDM identify women with similar abnormalities of insulin secretion as the more stringent American criteria.
Factors Influencing the Low Density Lipoprotein Profile in Type 2 Diabetic Patients
Authors: James R. W. , Marini M. , Ruiz J. , Pometta D.
Published: July 2009

The lipoprotein distribution profile was examined in Type 2 (non‐insulin‐dependent) diabetic patients (n = 52), with particular emphasis on factors influencing low density lipoproteins (LDL). Triglycerides were negatively correlated with LDL‐2 (r = 0.34, p < 0.05) and positively correlated with smaller, denser LDL‐3 (r = 0.57, p < 0.001). This yielded a highly significant, negative correlation between triglycerides and the LDL‐2/LDL‐3 mass ratio (r = ‐0.59, p < 0.001) which is an indication of the presence of smaller LDL particles. Parameters of glycaemic control, in the form of fasting blood sugar and glycated haemoglobin (HbA1c), were also negatively correlated with the LDL‐2/LDL‐3 mass ratio in univariate analyses; both remained significantly correlated with the mass ratio when corrected for triglycerides. Stepwise multiple regression analysis identified a three‐parameter model comprising triglycerides, HbA1c, and high density lipoprotein cholesterol as best defining the variations in the LDL‐2/LDL‐3 mass ratio (adjusted r2 = 0.52). These observations are consistent with an independent impact of diabetes on the LDL distribution profile and the possibility that the latter may be subjected to multiple pathological influences in diabetic patients.
Aetiopathogenesis and Management of Impotence in Diabetic Males: Four Years Experience from a Combined Clinic
Authors: Veves A. , Webster L. , Chen T. F. , Payne S. , Boulton A. J. M.
Published: July 2009

The contribution of organic and psychogenic factors in the aetiopathogenesis of impotence was studied in a large number of diabetic males, to develop an algorithm for its management. We examined 110 consecutive patients who were referred to the Impotence Clinic of the Diabetes Centre. All patients were initially evaluated by a diabetologist and then underwent psychosexual assessment by a specialized psychiatrist. Patients with primarily organic disease were referred to a urologist for further management while those with psychogenic impotence received psychosexual counselling. Peripheral neuropathy was present in 71 (65%) and two or more autonomic tests were abnormal in 22 (20%) patients. Neuropathy was the only cause detected in 29 (27%) patients, the main cause in 22 (20%), and contributing, but not the main factor, in 20 (18%). Psychogenic factors were the only cause detected in 12 (11%) patients, the main cause in 26 (24%) and contributed in 19 (17%). Marital disharmony, medical treatment, and peripheral vascular disease were the main aetiopathogenic factors in the remaining cases. Psychosexual counselling resulted in successful intercourse in 17 (60%) out of the 24 treated patients and papaverine injections in 31 (61%) out of 56 treated patients. It is concluded that although organic factors are mainly responsible for the development of impotence in diabetic males, psychological factors contribute significantly and psychosexual assessment and counselling are essential adjuncts to its management. Treatment with papaverine injections is generally inexpensive and effective to overcome the multifactorial causes of erectile dysfunction in this population. An algorithm which may facilitate the investigation and treatment of impotent diabetic males is proposed.
Decreasing Incidence of Major Amputation in Diabetic Patients: a Consequence of a Multidisciplinary Foot Care Team Approach?
Authors: Larsson J. , Stenström A. , Apelqvist J. , Agardh C‐D
Published: July 2009

The purpose of this retrospective study was to evaluate the changes in diabetes‐related lower extremity amputations following the implementation of a multidisciplinary programme for prevention and treatment of diabetic foot ulcers in a 0.2 million population with a 2.4 % prevalence of diabetes. All diabetes‐related primary amputations from toe to hip from 1 January 1982 to 31 December 1993 were included. In 294 diabetic patients, 387 primary major (above the ankle) or minor (through or below the ankle) amputations were performed, constituting 48 % of all lower extremity amputations. The annual number of amputations at all levels decreased from 38 to 21, equalling a decrease of incidence from 19.1 to 9.4/100 000 inhabitants (p = 0.001). The incidence of major amputations decreased by 78% from 16/1 to 3.6/100 000 inhabitants (p<0.001). The absolute number of amputations with a final level below the ankle showed no increase, but their proportion increased from 28 to 53 % (p<0.001) and the reamputation rate decreased from 36 to 22 % (p<0.05) between the first and last 3‐year period. Thus, a substantial long‐term decrease in the incidence of major amputations was seen as well as a decrease in the total incidence of amputations in diabetic patients. Seventy‐one per cent of the amputations were precipitated by a foot ulcer. These findings indicate that a multidisciplinary approach plays an important role to reduce and maintain a low incidence of major amputations in diabetic patients
Inflammatory effects of nutritional stimuli: further support for the need for a big picture approach to tackling obesity and chronic disease
Authors: Egger G. , Dixon J.
Published: July 2009

The discovery of a form of low‐grade systemic inflammation (called ‘metaflammation’), and the close evolutionary link between the immune and metabolic systems, poses questions about the supposed antigens (inducers) of such an immune reaction. Initially, this was thought to be mediated through obesity. However, we have identified a number of lifestyle or environmentally related inducers that may cause metaflammation, even in the absence of obesity. In this paper, the third of a series linking obesity with broad environmental and evolutionary factors, we identify nutritional stimuli with evidence of an involvement in metaflammation. From this we propose that components of certain foods and beverages with which humans have not evolved, are more often the inducers of an inflammatory effect in the body than those with which humans have become more familiar, and to which a neutral, or anti‐inflammatory response may be expected to have developed. The implications of such a finding are considered in relation to broader aspects of the environment, economic growth, policy change and current global financial issues.
Beyond Inclusive Legal Positivism*
Authors: COLEMAN JULES L.
Published: July 2009

In this essay, I characterize the original intervention that became Inclusive Legal Positivism, defend it against a range of powerful objections, explain its contribution to jurisprudence, and display its limitations and its modest jurisprudential significance. I also show how in its original formulations ILP depends on three notions that are either mistaken or inessential to law: the separability thesis, the rule of recognition, and the idea of criteria of legality. The first is false and is in event inessential to legal positivism. The second is inessential to legal positivism. The third is likely inessential to law. I then characterize the central claim of ILP in a way that relies on none of these: ILP is the claim that necessarily social facts determine the determinants of legal content. I show that ILP so conceived leaves the central debates in law largely untouched. I suggest how the most fundamental of these—the question of the normativity of law—at least can be usefully addressed. The essay closes by suggesting that even though one can distinguish the social from the normative dimensions of law, a theory of the nature of law is necessarily an account of the relationship between the two: It is a theory either of the difference that certain distinctive social facts make in normative space, or it is an account of the distinctive normative difference that law makes, and the social and other facts that are necessary to explain that difference. One can distinguish between but one cannot separate the social from the normative aspects of legality.
The Shared Perception of Social Contexts and Its Conditions for Possibility
Authors: LO GIUDICE ALESSIO
Published: July 2009

Pragmatist reinterpretations of both deliberative‐communicative theory and legal positivism point out the mentalist fallacy entailed by these prevalent models. I argue that pragmatist approaches imply analogous erroneous beliefs since they presuppose as given the shared perception of social contexts. Therefore they take for granted the shared interpretation of social problems and shared selection of common goals. Hence I advance the necessity of inquiring into the possibility conditions for a shared perception of social contexts. This would entail the organization of institutional incentives meant to extend the scope and inclusiveness of the immediate perception of social context expressed by different agents.
PEGS, BOARDS, AND RELATIVISTIC PERDURANCE
Authors: BALASHOV YURI
Published: July 2009

In an earlier work I developed an argument favoring one view of persistence (viz., perdurance) over its rivals, based on considerations of the relativity of three‐dimensional spatial shapes of physical objects in Minkowski spacetime. The argument has since come under criticism (in the works of Theodore Sider, Kristie Miller, Ian Gibson, Oliver Pooley, and Thomas Sattig). Two related topics, explanatory virtues and explanatory relevance, are central to these critical discussions. In this paper I deal with these topics directly and respond to my critics by offering a new perspective on the issue.