bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Importance of the Time Interval Between Insulin Injection and Breakfast in Determining Postprandial Glycaemic Control—A Comparison Between Human and Porcine Insulin
Authors: Patrick A. W. , Collier A. , Matthews D. M. , Macintyre C. C. A. , Clarke B. F. 
Published: July 2009

This study assessed the effect of the time interval between insulin injection and breakfast in determining subsequent postprandial glycaemic control and also whether this differed between highly purified porcine insulin and human insulin (crb) in six diabetic patients (age range 24–36 years, duration of diabetes >10 years) usually treated with twice daily Actrapid MC and Monotard MC and with stable insulin requirements and diabetic control. On separate mornings each patient was given, after an overnight fast, their usual dose of either Actrapid MC and Monotard MC or Humulin S and Humulin Zn injected 5, 20, or 40 min before a standard breakfast. The postprandial glycaemic profile was not significantly different at any of the three time intervals with Actrapid MC and Monotard MC. However, with the human insulin the profile was significantly better at the 40 min interval than at the 5 min interval (p<0.05) and this was also better than any of the profiles with the porcine insulin, there being a significant difference between the two types of insulin (p <0.05)These findings suggest that the time interval between insulin injection and breakfast may be more important with human insulin than with porcine insulin.
Development, Validation and Application of Computer‐linked Knowledge Questionnaires in Diabetes Education
Authors: Meadows K. A. , Fromson B. , Gillespie C. , Brewer A. , Carter C. , Lockington T. , Clark G. , Wise P. H. 
Published: July 2009

Multiple choice questionnaires (MCQs) capable of being marked manually or by a newly developed optical mark reader, or by use of an inexpensive inter‐active microcomputer system have been developed for the separate assessment of insulin‐dependent and non‐insulin‐dependent patient knowledge. Forty‐six insulin‐related and non‐insulin‐related multiple choice questions covering six main areas of knowledge were constructed for inclusion into draft questionnaires. From the responses of a total of 180 completed questionnaires, piloted in 18 randomly selected clinics in 14 Regional Health Authorities in England, psychometric analysis was performed to determine reliability, discrimination coefficients, and facility indices. Seventy‐three per cent of insulin‐dependent diabetic patients (IDDM) and 92% of non‐insulin‐dependent diabetic patients (NIDDM) MCQ correct options had facility indices within the acceptable range of 30 to 90%. 82% IDDM and 93% NIDDM correct options had discrimination coefficients exceeding 0.2.Questionnaire reliability (internal consistency) using the Kudor‐Richardson (KR20) formula was IDDM 0.87 and NIDDM 0.82. Evidence in support of the IDDM questionnaire's criterion validity was based on significant differences (p<0.05) identified between a number of knowledge area scores stratified according to HbA1 levels. Prescriptive correction for screen display and automatic hard copy feedback was designed for both incorrect and omitted question options, providing both educational (patient) and analytical (clinic) documentation. Both technical and psychometric properties of these knowledge assessment instruments should be acceptable for diabetic knowledge evaluation and instruction.
Renal Failure in Diabetics in the UK: Deficient Provision of Care in 1985
Authors:   Joint Working Party on Diabetic Renal Failure of the British Diabetic Association, the Renal Association, and the Research Unit of the Royal College of Physicians
Published: July 2009

Two surveys of diabetic renal failure were conducted in 1985. The first survey was designed to identify all diabetic patients having advanced renal failure (serum creatinine greater than 500 μmol/l and/or blood urea greater than 25 mmol/l in six selected health regions of the UK. The study identified 181 such patients indicating that approximately 10 people in every million of the population were affected. It is calculated that there were about 580 patients having diabetic renal failure in the whole of the UK. The majority of the patients (78%) were considered by their physicians to be suitable for renal support treatment. Those who were excluded were considered unsuitable chiefly on account of old age or cardiac problems.In the second survey all 66 renal units in the UK reported the number of diabetic patients starting renal support treatment in 1985. There were 273 patients, suggesting that there may be a shortfall when compared with the number of diabetics likely to need treatment.The Working Party recommends that diabetics who develop renal failure should always be considered for treatment by dialysis or transplantation, and that appropriate resources should be made available for them.
British Diabetic Association Holidays — What are they worth?
Authors: Vyas S. , Mullee M. A. , Kinmonth A.‐L. 
Published: July 2009

A postal survey among families of 63 children attending two BDA educational holidays studied their expectations before (Questionnaire 1) and experiences 3 months afterwards (Questionnaire 2). Of 47 families replying to both questionnaires (22M, 25F; mean age 8.4 years, range 5–13.8 years), expectations expressed by parents for their children were that they gain in confidence and independence (n = 36), mix with other diabetic children (n = 32), learn to self‐inject (n = 27), improve diet (n = 23), and have a good holiday (n = 10). Thirty‐five families subsequently reported that their expectations had been met.After the holiday, although there was no change in frequency of blood or urine testing, there was an increase in children doing tests on their own (Q1: 15, Q2: 28, p = 0.003); more parents reported confidence in their child recognizing a hypoglycaemic episode (Q1:29, Q2: 39, p = 0.001); and there was a sustained increase in independence with insulin injections (Q1:29, Q2:35, p = 0.042).This study provides evidence that BDA holidays benefit parents and their children, and do so mainly by increasing the children's confidence and independence in diabetic care.
The Medi‐Jector II: Efficacy and Acceptability in Insulin‐dependent Diabetic Patients With and Without Needle Phobia
Authors: Houtzagers C. M. G. J. , Visser A. Ph. , Berntzen P. A. , Heine R. J. , van der Veen E. A. 
Published: July 2009

Efficacy and acceptability of the Medi‐Jector II, compared with conventional syringes, was evaluated in a cross‐over study (two 4‐week periods) in 14 adult insulin‐dependent diabetic patients. In 6 out of these 14 patients the clinical diagnosis of needle phobia was confirmed by anxiety tests for trait (45.8 ± 12.8 (SD) versus 34.0 ± 6.2; p<0.05) and state (50.3 ± 10.9 versus 28.9 ± 5.2, p<0.05). Five patients (one needle‐phobic) dropped out, all for Medi‐Jector‐related problems. No significant differences were found in body weight, insulin dosage, and number of hypoglycaemic reactions. HbA1 after the Medi‐Jector period was significantly higher than after the conventional period (9.8 ± 1.2 (SE) versus 9.1 ± 1.1 (SE)%; p<0.05).The questionnaire, evaluating the Medi‐Jector, revealed poor acceptance of the device (7/9 patients' general impression being moderate or bad). The use of the Medi‐Jector in comparison with conventional injections caused the patients to complain about: more immediate pain (4/9 patients), delayed pain (often: 4/9, sometimes: 2/9), more insulin leakage (6/9), more bleeding (6/9), and more haematomas (5/9). Except for ‘often occurring delayed pain’ (4/5 needle‐phobics versus 0/4 non‐needle‐phobics; p<0.05), needle‐phobic patients scored the questionnaire similarly to the other patients.We conclude that the use of the Medi‐Jector II did not cause a major short‐term loss of metabolic control, but that the device was not well accepted by our patients, independent of the existence of needle phobia.
Serum Lipids, Lipoproteins and Macrovascular Disease in Non‐insulin‐dependent Diabetics: A Possible New Approach to Prevention
Authors: Seviour P. W. , Teal T. K. , Richmond W. , Elkeles R. S. 
Published: July 2009

The relationship between macrovascular disease and serum lipids, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL), and subfraction cholesterol, and apolipoproteins has been examined in 53 female and 95 male patients with non‐insulin‐dependent diabetes mellitus (NIDDM). In males, those with macrovascular disease had higher serum and LDL cholesterol concentrations than those without. In females, those with macrovascular disease had higher levels of serum triglyceride, cholesterol, LDL cholesterol, as well as lower HDL, HDL2, and HDL3 cholesterol and apoprotein A‐1, than those without. On multivariate analysis, LDL cholesterol was the most important association with macrovascular disease in males and apoprotein A‐1 in females.In a subgroup of 36 patients, a double‐blind placebo controlled study using bezafibrate or placebo, in addition to conventional oral hypoglycaemic therapy over 4 months, showed falls in serum and LDL cholesterol and in serum triglyceride and a rise in HDL cholesterol in the treated group. These changes should reduce the incidence of macrovascular disease in NIDDM and we suggest further prospective studies of such therapy in addition to conventional oral hypoglycaemic agents.
Microalbuminuria in Diabetes: A Population Study of the Prevalence and an Assessment of Three Screening Tests
Authors: Gatling W. , Knight C. , Mullee M. A. , Hill R. D. 
Published: July 2009

A single observer reviewed 842 of the 917 known diabetic patients registered with 40 GPs in the Poole area. A midstream urine specimen was tested for proteinuria using Albustix (Ames) and cultured to detect bacterial infection. After the first 3 months of the survey, the aliquot of this specimen was frozen for later determination of the random albumin/creatinine ratio (R‐Alb/Creat). Patients were requested to submit a timed overnight urine collection for estimation of urinary albumin excretion rate (AER).Of the 842 patients reviewed, 493 (59 %) submitted timed overnight urine collections; 43 were excluded because of urinary infection and/or proteinuria. One hundred and thirty‐three (30 %) of 450 diabetic patients were found to have microalbuminuria, although only 31 (7 %) had an AER >30 μg/min. Six hundred and seven urine samples were collected for R‐Alb/Creat but 68 were excluded because of infection and/or proteinuria; in 10 further samples urinary creatinine was not measured. Two hundred and four (38 %) of 532 diabetic patients were found to have an elevated R‐Alb/Creat.There was a significant correlation between AER and R‐Alb/Creat (r=0.32, p<0.001) but a considerable number of patients showed either a normal AER and high R‐Alb/Creat or the reverse. The value of R‐Alb/Creat or an overnight urinary albumin concentration, or an overnight urinary albumin/creatinine ratio (ON‐Alb/Creat) as screening tests to predict AER > 30 μg/min was assessed. An ON‐Alb/Creat > 2.0 mg/mmol was the optimal screening test (sensitivity 96 % and specificity 99.7 %).The proportion of diabetic patients with an AER in the range indicating a high risk of developing nephropathy is small. If an ON‐Alb/Creat > 2 mg/mmol had been used, 84 % of diabetic patients in this survey would not have been identified as being at risk. In future, this will enable further assessment to be concentrated on the high risk group.
Extra‐laboratory Blood Glucose Measurement: A Policy Statement
Authors: Price C. P. , Burrin J. M. , Nattrass M. 
Published: July 2009

The introduction of test strips for measurement of blood glucose has led to their widespread use by medical and paramedical staff outside the central laboratory. While many users have developed ad hoc schemes of training and quality control, formal guidelines have not been presented. This paper makes recommendations on various aspects of extra‐laboratory blood glucose measurement in hospitals, but not in the home, with the aim of improving the safety and reliability of results.It is recommended that:

a formal programme of training should be devised by staff in the laboratory together with those in the diabetes service and others as appropriate;
laboratory and diabetes staff should train, assess, and approve more senior users who would then take responsibility for the training and performance of more junior colleagues;
all users should demonstrate their competence at regular intervals;
there should be a quality assurance programme arranged by the laboratory which tests the performance of the operator and the equipment;
laboratory staff, in consultation with users, should be responsible for the selection and purchase of equipment;
equipment should be cleaned and maintained on a regular basis by users.
Measuring Psychosocial Adaptation to Diabetes in Adolescence
Authors: Challen A. H. , Davies A. G. , Williams R. J. W. , Haslum M. N. , Baum J. D. 
Published: July 2009

We have developed a psychometric test to assess psychosocial adaptation to diabetes in young people aged from 10 to 17 years. This includes subscales which describe emotional difficulty with, and attitude to, diabetes.The content of the scales was drawn from unstructured discussions with 27 young people with diabetes. The scales were piloted on two further unselected groups of adolescents (n = 50, n = 99) to examine their reliability, validity, and acceptability. Highly significant correlations were found between the results of the scales and measures of psychosocial function (p < 0.001), parents' perceptions of adaptation to diabetes (p < 0.005), and to a lesser extent with paediatricians' perceptions. Performance on the scale also correlated with a number of behaviour variables and differentiated those who were reported to be restricted by their diabetes (p < 0.005) and those who had had a previous psychiatric referral (p < 0.05). The scales appear reliable within the constraints of the small population examined.
Insulin Antibodies do not Influence the Absorption Rate of Subcutaneously Injected Insulin
Authors: de Meijer P. H. E. M. , Lutterman J. A. , van ‘t Laar A. 
Published: July 2009

The influence of insulin antibodies on absorption rate and plasma free insulin concentrations after subcutaneous injection of insulin, was studied in two groups of insulin‐treated diabetic patients, one without insulin antibodies (n= 9) and a second with high plasma concentrations of antibodies (n= 14). Except for antibody concentration there were no differences in clinical variables. During 8 h after the injection of 12 U of iodinated neutral human insulin, residual radioactivity at the injection site, plasma glucose, and free and total insulin were measured.Significant differences in absorption rate of insulin were not found between the groups. Plasma glucose (basal value 16.8±4.4 SD vs 16.1±4.2 mmol l−1) and free insulin (basal value 8.3±1.4 vs 11.4±2.3 mU l−1maximum after 90 min 36.9±19.5 vs 30.5±18.7 mU l−1) were never significantly different between the groups, nor were areas under the curve for free insulin (191.4±69.2 vs 170.8±98.6 mU l−1h). In the high antibody group a small increase in bound insulin was found.
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.
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.
Incidence and Prevalence of Type 1 Diabetes in Children and Adolescents in Benghazi, Libya
Authors: Kadiki O.A. , Moawad S.E. 
Published: July 2009

The mean annual incidence rates of Type 1 diabetes mellitus in Arab children and adolescents in Benghazi, Libya were assessed as based on prospective registration of patients during the period 1981–1990. Results showed an annual incidence (per 100 000) of 7.0 (6.0–8.2) (males 6.3(5.0–7.9) females 7.8(6.3–9.7)) in 0–14 year olds and 8.8(7.8–10.0) (males 8.3(6.9–10.0), females 9.2(7.7–11.0)) in 0–19 year olds. There were no significant differences between males and females or between season of onset. The commonest age of onset was 15–19 years. Annual variations were significant in the 0–14 years age group (p < 0.001) and non‐significant in the 0–19 years age group. In 1981 the age adjusted prevalence rates of Type 1 patients (per 100 000) were 23.5 (17.1–31.5) (males 21.2(13.1–32.3), females 25.9(16.8–38.3)) in 0–14 year olds and 36.2(29.1–45.1) (males 31.4(22.2–43.2), females 41.0(30.2–54.5)) in 0–19 year olds. In 1990 the prevalence rates had increased to 37.3(30.5–45.5) (males 40.7(30.8–53.3), females 33.8 (24.6–45.3)) in 0–14 year olds and 59.5(51.6–58.5) (males 60.3(49.3–73.6), females 58.6 (47.7–72.1)) in 0–19 year olds. Increase in prevalence rates was significant in both sexes and in both age groups (p < 0.001).Increase in prevalence rates in girls in 1981 and in boys in 1990 were not significant. It is concluded that Type 1 diabetes is a common chronic disease of children and adolescents in Benghazi, Libya.
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

SummaryThe 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

AbstractIn 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

AbstractPragmatist 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.