bluuebunny/crossref_metadata_2025_split huggingface dataset:
Young Diabetics: Memories, Current Lifestyles and Attitudes
Authors: Mok J. Y. K. , Laing I. A. , Farquhar J. W. 
Published: July 2009

Eighty‐six subjects aged 22.3 ± 2.3 years (mean ± S.D.), who attended one clinic as diabetic children, filled in a questionnaire designed to evaluate their present health and lifestyles, as well as discover their childhood memories. About two‐thirds (66.3%) had unhappy recollections particularly of such irritating routines as urine testing, injections, and special food programmes. Only 6% complained that future complications were not discussed with the child at the appropriate time, but with the exception of blindness, childhood knowledge of diabetic complications was poor.Around two‐thirds (66.4%) left school with some examination result; 44.2% went into further education, while 19.8% entered into a trade. These attainments were comparable to those of local school leavers. As young diabetic adults, 62.8% were employed; 22.1% were students or housewives with no other occupations.
Prevalence of Morning Hyperglycaemia: Determinants of Fasting Blood Glucose Concentrations in Insulin‐treated Diabetics
Authors: Francis A. J. , Home P. D. , Walford S. , Alberti K. G. M. M. , Mann N. , Reeves W. G. 
Published: July 2009

A rise in blood glucose concentration at the end of the night, and consequent morning hyperglycaemia, are well recognized events in some diabetic patients. In 94 patients on twice daily insulin injections we have examined the prevalence and extent of morning hyperglycaemia, and its relation to control, insulin therapy, and insulin antibody levels. Blood glucose reached the highest level of the day before or after breakfast in 83% of patients, and in 50% this value was 2 mmol/l greater than any other time of day. Patients with higher fasting concentrations did not have worse blood glucose control over the rest of the day. No correlation was found between fasting blood glucose concentrations and the evening dose of intermediate acting insulin or the level of insulin antibodies. No consistent change in fasting blood glucose concentrations occurred with changes in antibody levels in patients switched between pork and beef insulin. Morning hyperglycaemia was as common with both insulin species.Pre‐ and post‐breakfast hyperglycaemia is common and significant in insulin‐treated diabetic patients. It is not directly related to diabetic control at other times of the day, and is independent of insulin species and insulin antibody levels.
Prevalence of Hypertension in White, Black and Asian Diabetics in a District Hospital Diabetic Clinic
Authors: Pacy P. J. , Dodson P. M. , Beevers M. , Fletcher R. F. , Taylor K. G. 
Published: July 2009

In a District General Hospital Diabetic Clinic 40.0% of a random sample of diabetics under the age of 65 years of age were hypertensive. Black patients (48.9%) had greater (p < 0.05) prevalence of hypertension than Whites (37.5%) and Asians (35.4%). Hypertension was more prevalent in females (49.1%) than males (33.0%) (p < 0.001) in each ethnic group except Asians, and patients not receiving insulin had greater prevalence (45.6%) than those on insulin (30.7%) (p < 0.001), except black diabetics where the reverse was found. There was a positive relationship between age and systolic (p < 0.00001) and diastolic blood pressure (p < 0.00001) and a negative association between duration of diabetes and diastolic blood pressure (p < 0.004) on multiple regression analysis but no relationship was noted between blood pressure and either weight or blood glucose.Forty‐six percent of all hypertensives were receiving conventional anti‐hypertensive drug therapy; 38.7% were normotensive with similar results in each ethnic group and between the sexes. Isolated systolic hypertension was the commonest form of hypertension (48.3%) with isolated diastolic hypertension (4.9%) the rarest. These findings were observed regardless of the ethnic group or gender.Although in the majority of cases hypertension was mild these data confirm the importance of routine blood pressure measurement in diabetic patients.
Delayed Diagnosis of Non‐insulin‐dependent Diabetes is Associated with Greater Metabolic and Clinical Abnormality
Authors: Hillson R. M. , Hockaday T. D. R. , Newton D. J. , Pim B. 
Published: July 2009

Seventy‐seven per cent of 235 newly diagnosed and untreated patients with diabetes mellitus were polysymptomatic at their first visit to hospital. The larger the number of typical symptoms, the greater was the duration of the longest lasting one (p<0.001). Symptom duration was positively correlated with pre‐treatment fasting plasma glucose (p<0.05), but this was more strongly linked to the number of symptoms (p<0.001). In those patients diagnosed because of symptoms typical of diabetes mellitus, mean fasting glucose was higher than when symptoms were elicited retrospectively in patients in whom glycosuria had been found unexpectedly. Weight loss at diagnosis (from ‘highest remembered’) was positively correlated with fasting plasma glucose (p<0.001).One hundred and thirty‐two patients had fundal colour photography 7 or 8 years after diagnosis. The mean pre‐diagnosis duration of symptoms was 2± S.D.17 months in 80 without retinopathy compared to 8±6 months for 52 with retinopathy (p<0.001). The severity of retinopathy was also positively associated with symptom duration, as was failure to attend for these ocular reviews. Prolonged symptoms pre‐diagnosis were associated with increased risk of death during the first 5 years post‐diagnosis among those with a normal electrocardiogram (ECG) initially (p<0.003), but was unrelated to ECG abnormality then or during the next 5 years.These findings accord with (but offer no proof of) the inherently plausible expectation that both morbidity and mortality would be lessened by earlier diagnosis of non‐insulin‐dependent diabetes mellitus.
Screening for Early Diabetic Nephropathy: Which Sample to Detect Microalbuminuria?
Authors: Gatling W. , Knight C. , Hill R. D. 
Published: July 2009

In a study to monitor the acceptability of using a timed overnight urine collection to measure microalbuminuria in a large diabetic population, it was found that only 184 (69.4%) of 265 diabetics returned the urine collection to the hospital laboratory. Three proposals for an initial screening test to predict high risk microalbuminuria were analysedProposal I: a random urinary albumin concentration (RAC) >25 μg/ml predicts an overnight albumin excretion rate (AER) >30 μg/min. In 159 diabetics, the sensitivity of this screening test was 56%, specificity 81%, and predictive value 15%.Proposal II: an albumin concentration >20 μg/ml in an early morning urine sample predicts an overnight AER >30 μg/min. In 175 diabetics, the sensitivity of this screening test was 86%, specificity 97%, and predictive value 71%.Proposal III: an albumin/creatinine ratio (albumin mg/l creatinine mmol/l) >3.5 in an early morning urine sample predicts an overnight AER >30 μg/minute. In 171 diabetics, the sensitivity of this screening test was 100%, specificity 95%, and predictive value 64%.It is concluded that an albumin/creatinine ratio performed on an early morning urine sample brought to the diabetic clinic would be a useful initial screening test to detect an overnight AER >30 μg/min.
Glucose Intolerance and Hypertension in North London: The Islington Diabetes Survey
Authors: Forrest R. D. , Jackson C. A. , Yudkin J. S. 
Published: July 2009

In a general practice‐based screening survey, 1040 (63.3%) of a randomly selected sample of 1644 people over the age of 40 years were examined for diabetes mellitus (DM) and hypertension (HT). Glucose intolerance was assessed by a single 2 h post‐load blood glucose estimation and HT (diastolic blood pressure ≥95mmHg by a single blood pressure reading) or being on anti‐hypertensive treatment.The sample included 41 patients (2.1%) with known DM and 135 (12.5%) with known HT. Screening identified 27 (2.6%) new diabetics (16 women) and 43 subjects (4.1%) with impaired glucose tolerance (30 women). A further 30 known diabetics over the age of 40 and 12 diabetics under 40 were registered at the practice. The estimated prevalence of diabetes in the over 40s was 4.6% and in all ages was 1.6%. DM appeared to affect Afro‐Caribbeans more commonly than Caucasians among those examined (5.9% versus 2.6%) though this difference did not reach statistical significance (z = 1.1106, p=0.134).A total of 190 subjects (17.5%) were found to have HT, of whom 55 (5.1%) were newly diagnosed; 10.2% of the sample were on anti‐hypertensive treatment, and in 79.3% of these the blood pressure was well controlled (diastolic <100 mmHg). HT was more common among known diabetics with a prevalence of 35.4%, of whom one‐third were previously undiagnosed. HT affected Afro‐Caribbeans significantly more commonly than Caucasians (z=4.206, p<0.001).This survey shows that the prevalence of DM diagnosed according to modern diagnostic criteria appears to be similar to that found in previous surveys using older criteria. The sensitivity and specificity of the 2hBG as a screening test for DM (with 95% confidence limits) were 69.2±25.1% and 97.4±2.3%, respectively. In 49 subjects glucose tolerance status changed on formal glucose tolerance testing. The use of a single 2hBG in screening for DM gave a false negative rate of 40%. It is concluded that a single 2hBG is not sufficiently sensitive as a screening test for DM in population screening. The prevalence of HT is higher than has been noted in previous general practice surveys.
Red Cell Sorbitol Levels During Hyper and Hypoglycaemic Clamp Studies in Insulin‐dependent Diabetic Patients
Authors: Price D. E. , Grant P. J. , Airey C. M. , Stickland M. H. , Kemp J. , Wales J. K. 
Published: July 2009

The red cell sorbitol concentration has been suggested as a measure of polyol pathway activity. Red cell sorbitol levels were higher in 53 patients having insulin‐dependent diabetes mellitus (IDDM) than in 16 control subjects. Six patients having IDDM underwent hyperglycaemic ‘clamp’ studies; the red cell sorbitol level returned to the normal range when the blood glucose was clamped at 5 mmol/l for 1 h and rapidly increased when it was clamped at 15 and 25 mmol/l for a further hour at each level. Seven patients with IDDM were rendered hypoglycaemic; red cell sorbitol levels rapidly fell to a level less than, but not significantly different from normal.The results of these studies suggest that in IDDM red cell sorbitol levels are a reflection of prevailing blood glucose concentration and do not indicate long‐term sorbitol accumulation in other tissues.
Optic Disc Swelling in Young Diabetic Patients: a Diagnostic Dilemma
Authors: Heller S. R. , Tattersall R. B. 
Published: July 2009

We describe four young diabetic patients presenting with swelling of one or both optica discs (‘papiloedema’). Two were asymptomatic while the others complained of blurred vision. Spontaneous resolution occurred in all within 6 months although three had developed optic atrophy within 5 years.These four patients fit into a spectrum of acute involvment of the optic nerve in young diabetic patients, of which over 50 cases have now been reported. Most have florid ophthalmoscopic appearances which resolve within weeks or months and usually‐carry a good visual prognosis. The condition apears to be a variant of anterior ischaemic optic neuropathy though its possible pathophysiology in diabetes is uncertain. Knowledge of the condition by diabetologists and ophthalmologists is important as patients and doctors may be reassured after fairly simple investigation.
Nerve Ischaemia‐Resistance: An early Abnormality in Diabetes
Authors: Newrick P. G. , Boulton A. J. M. , Ward J. D. 
Published: July 2009

Vibration perception threshold (VPT) has been measured before and 30 min after limb ischaemia in 17 newly diagnosed non‐insulin‐dependent diabetic patients and matched controls. Mean baseline VPT was higher in the diabetics than in controls (14 vs 11, p<0.01) while VPT at 30 min was lower (25 vs 30, p<0.05). The ischaemic index (VPT at 30 min/baseline VPT), calculated as a measure of nerve ischaemia‐resistance, was lower in the diabetics compared with controls (p<0.01), and correlated with blood glucose (r = −0.53, p<0.03) but not glycosylated haemoglobin at the time of testing. The difference in ischaemic index persisted even when baseline VPT measurements, rather than patients, were matched. Ischaemic index was re‐tested in 15 patients after a median interval of 17 months (range 6–19), at which time mean ±SD glycosylated haemoglobin had improved significantly (12.2%±0.4 versus 9.5%±0.05, p<0.001), but this bore no relation to changes in ischaemic index.Peripheral nerve ischaemia‐resistance is present at the time of diagnosis of non‐insulin‐dependent diabetes, even in the absence of other neurophysiological abnormalities, and is not explicable by glycaemic control alone.
Microvascular Disease and Limited Joint Mobility in Diabetes. A Comparison of Fibrinolysis and Prostacyclin in Diabetes and Systemic Sclerosis
Authors: Larkin J. G. , Belch J. J. F. , Flanigan P. , Forbes C. D. , Frier B. M. 
Published: July 2009

The pathogenesis of Limited Joint Mobility (LJM) in diabetes is unknown, but the abnormality is said to be associated with an increased incidence of microangiopathy. To examine the possibility that LJM may be a manifestation of microvascular disease, fibrinolysis and blood prostacyclin metabolites were measured in diabetic patients with and without LJM, and compared with patients who have systemic sclerosis (PSS). The concentrations of plasma fibrinogen (p<0.01) and Plasminogen Activator Activity (PAA) (p<0.02) were increased in both diabetic groups, compared with non‐diabetic controls, and were of similar magnitude to the changes observed in PSS. Antithrombin III (AT III) activity was significantly lower in diabetic patients with LJM than in those without LJM, but not significantly different from controls. Prostacyclin concentrations were raised in PSS patients compared to controls (p<0.02) but were not raised in diabetic subjects.Thus abnormal fibrinolysis was demonstrated in diabetic patients compared to non‐diabetic controls, and prostacyclin concentrations in diabetics were lower than in PSS patients. The diabetic patients with LJM had lower AT III activity than diabetics without LJM, but overall a convincing difference between the two groups of diabetics was not proven. No sure inferences could be drawn on the vascular aetiology of LJM, while the impaired prostacyclin activity might contribute to the development of diabetic microangiopathy.
Elevated Urinary Prostaglandin Excretion and the Effect of Indomethacin on Renal Function in Incipient Diabetic Nephropathy
Authors: Mathiesen E. R. , Hommel E. , Olsen U. B. , Parving H.‐H. 
Published: July 2009

We investigated whether the glomerular synthesis of prostaglandins modulates the glomerular filtration rate and urinary albumin excretion in incipient diabetic nephropathy (defined as urinary albumin excretion between 30 and 300 mg/24 h (microalbuminuria) in two out of three sterile ketone‐free 24‐h urine collections in patients having insulin‐dependent diabetes mellitus (IDDM) without hypertension or other kidney disease). The urinary excretion of prostaglandin E2 was significantly elevated in 8 insulin‐dependent diabetic patients with incipient nephropathy as compared with 9 normoalbuminuric IDDM patients and 11 healthy controls: 317 (182–1273); 95 (67–225); 132 (54–263) pg/min, respectively (2p<0.01). Glomerular filtration rate (single bolus 51Cr‐EDTA technique) and albuminuria (radioimmuno‐assay) were measured twice within 2 weeks in 8 females having IDDM with incipient nephropathy. The study design was a randomized double‐blind trial with the patients receiving either indomethacin (150 mg/day) or placebo for 3 days prior to the kidney function studies. Indomethacin treatment induced a significant reduction in urinary prostaglandin E2 excretion (73%) (2p<0.01), urinary albumin excretion rate diminished from 207 (63–253) to 87 (49–147) mg/24 h (2p<0.01), fractional clearance of albumin declined (70%) (2p<0.01). Glomerular filtration rate remained stable (108 (88–133) versus 110 (95–142) ml/min). Blood glucose and blood pressure were comparable during the placebo and indomethacin treatment (12.6 ± 3 versus 13.4 ± 5 mmol/l and 122/79±3/9 versus 122/82±4/10 mmHg, respectively).Our results suggest that enhanced glomerular synthesis of vasodilating prostaglandins may accelerate microalbuminuria in incipient diabetic nephropathy.
Marked Impairment of the Effect of Hyperglycaemia on Glucose Uptake and Glucose Production in Insulin‐dependent Diabetes
Authors: Arnfred J. , Schmitz O. , Hother‐Nielsen O. , Ørskova C. , Beck‐Nielsen H. , Hermansen K. , Christiansen J. S. , Alberti K. G. M. M. , Ørskov H. 
Published: July 2009

The effect of hyperglycaemia per se on glucose utilization and glucose production was evaluated in 12 patients with insulin‐dependent diabetes and in 9 non‐diabetic control subjects. In diabetic patients normoglycaemia was maintained during the night preceding the study by a variable intravenous insulin infusion. During the study endogenous insulin secretion was suppressed by somatostatin (300 μg h−1) and replaced by infusion of insulin (0.2 mU kg−1 min−1). Glucose utilization and hepatic glucose production rates were quantified at two plasma glucose concentrations (6.7 and 16.7 mmoll−1) using the two‐step sequential hyperglycaemic clamp technique in combination with 3‐3H‐glucose tracer infusion. Duration of each step was 120 min. In diabetic patients glucose utilization, at a glucose concentration of 6.7 mmol ***l−1, was not different from normal (mean ± SE: 2.9±0.2 vs 3.6±0.3 mg kg−1 min−1, 0.05<p<0.10), but the response to marked hyperglycaemia was significantly reduced (5.4±0.5 vs 9.4±1.0 mg kg−1 min−1, p<0.01). Hepatic glucose production was also normal at 6.7 mmol l−1 (1.4±0.1 vs 1.4±0.1 mg kg−1 min−1, NS), but whereas in control subjects glucose production was suppressed during hyperglycaemia of 16.7 mmoll−1 (0.3±0.4 mg kg−1 min−1,p<0.01), a slight increase was observed in diabetic patients (2.0±0.2 mg kg−1 min−1, p<0.05).In conclusion we found the effect of hyperglycaemia in both glucose utilization and hepatic glucose production to be reduced in patients with insulin‐dependent diabetes.
Absorption of NPH (Isophane) Insulin in Resting Diabetic Patients: Evidence for Subcutaneous Injection in the Thigh as the Preferred Site
Authors: Henriksen J. E. , Vaag A. , Hansen I. Ramsgaard , Lauritzen M. , Djurhuus M. S. , Beck‐Nielsen H. 
Published: July 2009

The absorption kinetics of NPH (isophane) insulin injected subcutaneously into the abdominal wall and subcutaneously (SC) and intramuscularly (IM) into the thigh was studied in 11 Type 1 diabetic patients. The thickness of the subcutaneous adipose tissue layer was measured by ultrasound.NPH (isophane) insulin injected IM into the thigh was absorbed faster than NPH insulin injected SC into the thigh (T50%, IM 8.0 ± 0.6 h and SC 10.3 ± 0.7 h,p< 0.05). No difference in T50%values was found for injection into the abdominal wall (9.7 ± 1.2 h) compared with the thigh. The mean absorption rate from 1.5 to 13.5 h after injection was higher after injection IM into the thigh (6.4 ± 0.3 % of initial dose injected absorbed per h) than after SC injection into the thigh (5.2 ± 0.3 % h−1) and SC into the abdominal wall (5.1 ± 0.3 % h−1) (p<0.01). The most constant absorption rate was obtained after SC injection into the thigh (within‐study day CV of the mean absorption rate 19.9 ± 3.2 % vs 34.4 ± 3.2 % after IM injection into the thigh and 27.1 ± 4.9 % after SC injection into the abdominal wall (p< 0.02)). The study provides further evidence that the subcutaneous tissue of the thigh is the preferred injection site for NPH insulin.
Abnormal Digital Pressure Measurements in Diabetic Neuropathic Foot Ulceration
Authors: Stevens M. J. , Goss D.E. , Foster A.V.M. , Pitei D. , Edmonds M.E. , Watkins P.J. 
Published: July 2009

The diabetic neuropathic ulcer is typically slow to heal and recurrent. Macrovascular insufficiency is usually excluded as foot pulses are present and ankle:brachial pressure ratios are not decreased. These assessments cannot however exclude more distal vascular disease. Digital pressure measurements enable a reliable assessment of the distal peripheral vascular status to be made. The aim of this study was therefore to use toe pressures to assess the contribution of distal ischaemia in the pathogenesis of the neuropathic ulcer. Sixteen diabetic patients with recurrent neuropathic foot ulceration had their toe pressures compared to 10 neuropathic patients without a history of foot ulceration, 10 diabetic control subjects, and 11 normal subjects. Four non‐diabetic patients with neuropathy and foot ulceration were also assessed. All subjects had ankle:brachial pressure indices ≧ 1. Toe pressure was assessed using laser Doppler flowmetry to record the return of skin blood flow. The toe:brachial pressure index (TBI) was then calculated. The diabetic patients with a history of recurrent neuropathic ulceration, had the lowest mean TBI, 0.63 ± 0.14 (SD), compared to the non‐ulcerated diabetic neuropathy patients, the diabetic control subjects, and the normal subjects. 0.84 ± 0.11, 0.82 ± 0.1, and 0.81 ± 0.07, p < 0.01, respectively. Three of the four non‐diabetic patients with neuropathic foot ulceration also had an abnormally low TBI. Reduced toe pressure measurements are thus found to be associated with neuropathic foot ulceration. The contribution of distal ischaemia in the pathogenesis of the diabetic neuropathic foot ulcer needs to be evaluated.One hundred and eight non‐insulin‐dependent diabetic patients who had been tested for autonomic dysfunction in 1984/85 were re‐evaluated 5 years later. Autonomic function was assessed by means of four cardiovascular tests (heart rate variation during deep breathing and standing, and blood pressure variation after standing and sustained handgrip). Eighteen subjects were lost to follow‐up; in the 90 patients who completed the study, both the deep breathing and the handgrip test significantly worsened (respectively from 13.7 ± 7.8 to 11.6 ± 6.3 beats min−1 p < 0.01, and from 16.9 ± 8.2 to 12.7 ± 7.1 mmHg, p < 0.001), whereas both the 30:15 ratio and the variation of blood pressure on standing did not change. The impairment of a comprehensive evaluation score (from 2.5 ± 1.7 to 3.0 ± 1.5; p < 0.05) also confirmed the gradual deterioration of autonomic function over the study period.