bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insulin Dependence: Problems with the Classification of 100 Consecutive Patients
Authors: Wilson R. M. , Van der Minne P. , Deverill I. , Heller S. R. , Gelsthorpe K. , Reeves W. G. , Tattersall R. B. 
Published: July 2009

We have evaluated the clinical and immunogenetic features of 100 consecutive patients presenting to an adult diabetic clinic who were judged clinically to need insulin therapy but were not sufficiently ill to be admitted to hospital. Over this same period 15 newly diagnosed patients (aged 13–70 years) were started on insulin as in‐patients of whom ten were in ketoacidosis. The 100 out‐patients, aged 11–75 years at the time of starting insulin, were followed for at least a year. Fifty‐six had islet cell antibodies and/or were heterozygous for HLA DR3 and DR4 (Group A) whereas 44 had neither of these markers (Group B). Islet cell antibodies and/or DR3, DR4 heterozygosity were most common in the 70 patients diagnosed below the age of 40 years but were also found in older patients. Patients in Group A were significantly younger at diagnosis (29 vs. 43 years), had a shorter duration of symptoms (17 vs. 61 weeks), were more likely to have ketonuria, and had a lower random C‐peptide level at diagnosis (0.2 vs. 0.31 nmol/l). The two groups could not be distinguished by weight, haemogloblin A1 or blood glucose at diagnosis or by diabetic control or insulin dose after one year.The National Diabetes Data Group (NDDG) definition of insulin dependence stresses the importance of HLA types and islet cell antibodies although we found their prevalence to be low in the 30 patients diagnosed over 40 years who clinically were indistinguishable from the younger patients. The NDDG definition is based on extrapolation from the features of diabetes in children and adolescents and is too restrictive for use over the whole range of newly presenting insulin‐requiring diabetes.
Glycosylation of Maternal Hair and Cord Skin During Pregnancy in Diabetic and Non‐diabetic Women
Authors: Paisey R. B. , Lewin I. G. , Hopton M. , Frappel J. , Roland J. , Turner G. 
Published: July 2009

A study of 15 insulin‐dependent diabetics (IDD), 4 gestational diabetics (GDM), and 21 non‐diabetic women was undertaken to assess non‐enzymatic glycosylation in maternal hair, cord skin, and cord blood. Glycosylation of maternal hair was stable from tip to root in controls. In the IDD group, levels were highest at the tip, but were significantly lower in the middle and scalp segment, (p<0.01), both tip and middle segments were higher than control values (p<0.01). In contrast, only the scalp segment of hair from the GDM group had a higher than normal level of glycosylation (p<0.01). Cord skin and cord blood glycosylation were significantly increased in the IDD group compared with normal (0.100±0.002 vs 0.074±0.008 μmol fructosamine/100 mg, p<0.01, and 0.160±0.002 vs 0.14±0.008, p<0.05, mean±S.E.M.), respectively. Only cord skin glycosylation was increased in the GDM group (0.116±0.003, p<0.01).Thus near normal glycaemic control of maternal insulin‐dependent diabetes during pregnancy was associated with small but significant increases in cord skin glycosylation and a fall towards normal in maternal hair glycosylation which may provide a useful retrospective index of diabetic control.
Oesophageal Function in Diabetes Mellitus and its Association with Autonomic Neuropathy
Authors: Channer K. S. , Jackson P. C. , O'Brien I. , Corrall R. J. M. , Coles D. R. , Davies E. Rhys , Virjee J. P. 
Published: July 2009

We have evaluated oesophageal function in 34 diabetics and in 16 non‐diabetic controls by a timed bolus transit method derived from dynamic oesophageal scintiscans (water transit time: WTT) and barium swallow. The diabetics were screened for autonomic neuropathy using standard cardiovascular responses and 10 patients were classified as abnormal. WTT was significantly prolonged in autonomic neuropaths compared with other diabetics (p<0.01) and controls (p<0.001). Abnormal peristalsis on barium swallow was seen more frequently in autonomic neuropaths (9/10) than in other diabetics (11/24, p<0.002). WTTs from all diabetic patients correlated with abnormal heart rate responses at rest (Rs = −0.49, p<0.005), on deep inspiration (Rs = −0.48, p<0.005), and on standing (Rs = − 0.39, p<0.025) but not with the Valsalva manoeuvre. A weaker correlation was found between the postural fall in blood pressure (Rs = 0.3, p<0.05).Diabetics with autonomic neuropathy frequently have asymptomatic oesophageal dysfunction which may result from a vagal neuropathy in view of its association with abnormalities of vagally mediated cardiovascular responses.
Limited Finger Joint Mobility in Insulin‐dependent and Non‐insulin‐dependent Ethiopian Diabetics
Authors: Mengist M. , Abdulkadir J. 
Published: July 2009

The prevalence of limited joint mobility (LJM) was studied in 110 insulin‐dependent (IDDM) and 190 non‐insulin‐dependent (NIDDM) consecutive Ethiopian African diabetics and 300 age‐ and sex‐matched controls at the Tikur Anbassa Teaching Hospital in Addis Ababa over a period of 18 months. Mean ages±S.D. of the IDDM, NIDDM, and controls were 35±9.9, 49.4±12.0, and 43.3±14.0 years, respectively. LJM was found in 44.5% of IDDM, 25.3% of NIDDM, and 6.7% of controls, being significantly commoner in IDDM than NIDDM (p<0.001) and in the diabetics than in controls (p< 0.001).In IDDM those with LJM were significantly younger (p<0.05), had a higher prevalence of median fasting blood glucose (FBG) levels of 15 mmol/l and above (p<0.01), and retinopathy (p<0.05), but did not differ from those without LJM in duration of diabetes, or prevalence of neuropathy and nephropathy. In NIDDM those with LJM had a significantly longer duration of diabetes (p<0.005) and a higher prevalence of nephropathy (p<0.005), but did not differ from those without LJM in age at onset of diabetes, prevalence of neuropathy, and retinopathy or median FBG level.
Systolic Time Intervals in Adolescents with Insulin‐dependent Diabetes Mellitus
Authors: Northcote R. J. , Semple C. , Kesson C. M. , Ballantyne D. 
Published: July 2009

Systolic time intervals were used to evaluate left ventricular performance in 20 diabetic adolescents with a mean age of 15.2 ± 2.2 years (range 9–17 years) and were compared with an age‐ and sex‐matched control group. Pre‐ejection period index (PEPI), left ventricular ejection time index (LVET±l), total electromechanical systole index (QS2I) and the PEP to LVET ratio were calculated at rest and following sustained isometric handgrip (SIHG). None of the diabetics had demonstrable microangiopathy or autonomic neuropathy. There was no significant difference in resting or post‐exercise heart rate, PEPI, LVETI or PEP/LVET ratio between the two groups. QS2I was significantly prolonged (p<0.05) at rest in the diabetics, but was not significantly different following SIHG.These results indicate that cardiac contractility is not detectably abnormal in young diabetics, compared to their adult counterparts who may develop impaired myocardial performance.
The Effect of Residual Beta‐cell Function on the Development of Diabetic Retinopathy
Authors: Madsbad S. , Lauritzen E. , Faber O. K. , Binder C. 
Published: July 2009

The effect of residual B‐cell function on retinopathy was evaluated in a cross‐sectional study of 533 insulin‐dependent diabetic patients (disease duration 0 to 45 years).One hundred and fifty‐three patients with residual B‐cell function, as evaluated by stimulated plasma C‐peptide concentration, had lower prevalence of retinopathy than patients without B‐cell function. The patients with B‐cell function had a shorter duration of diabetes and were older at onset, but there was no difference in age at the time of the study.When patients with similar duration of diabetes were compared, no differences in the degrees of retinopathy could be demonstrated between patients with and without B‐cell function.These results indicate that residual B‐cell function does not protect against or delay the development of diabetic microvascular lesions.
The Relationship Between Autonomic Neuropathy and Urinary Sodium and Albumin Excretion in Insulin‐Treated Diabetics
Authors: Winocour Peter H. , Dhar Hanka , Anderson David C. 
Published: July 2009

There is evidence to suggest that renal function may alter in the presence of autonomic neuropathy. Albumin excretion rate (AER) and sodium excretion rate (NaER) in timed daytime (erect) and night‐time (supine) urine collections were assessed in 20 insulin‐treated diabetics with and in 20 without established autonomic neuropathy, matched for age, sex, duration of diabetes, diabetic control, and systolic blood pressure. All patients were free of proteinuria on albustix testing and had normal serum levels of urea and creatinine.AER based on daytime and pooled 24‐hour collections was higher, but not significantly so, in the group with autonomic neuropathy. The nocturnal AER on the other hand was significantly elevated in the group with autonomic neuropathy (p<0.02) as was the nocturnal urine volume (p<0.01) and sodium excretion rate (p<0.05). The corrected nocturnal albumin/creatinine ratio was likewise greater in this group (p<0.02). These findings suggest that autonomic neuropathy can independently affect renal function and that nocturnal renal haemodynamics and glomerulotubular balance may be deranged in insulin‐treated diabetics with autonomic neuropathy.
Aortic Stiffness in Insulin‐dependent Diabetics: An Echocardiographic Study
Authors: Thordarson H. , Thorgeirsson G. , Helgason T. 
Published: July 2009

To assess the aortic stiffness (AS) in young (15–35 year old) insulin‐dependent diabetics without manifestations of atherosclerotic disease or hypertension, M‐mode echocardiography was used to measure relative changes in aortic diameter expressed asAortic strain = Diameter change/Diastolic diameter x 100%Aortic stiffness can be calculated from the formula AS = Pulse pressure/Aortic strain. Fifty‐seven diabetics were investigated, 31 men (aged 23.6 ± 5.6 years, mean ± SD) and 26 women (aged 25.7 ± 6.4 years).There were 26 healthy controls with similar blood pressure, 14 men (aged 25.0 ± 5.5 years) and 12 women (aged 24.6 ± 7.1). The AS in diabetic men was 14 ± 8.0 (mean ± SD) compared to 3.6 ± 0.7 in controls (p<0.001). In diabetic women the AS was 5.8 ± 3.1 compared to 4.3 ± 1.3 in controls (p<0.05). Diabetic men also had much stiffer aortas than diabetic women (p<0.001). There was a linear correlation between AS and duration of diabetes in men (R= 0.70; (p<0.001). For females no such correlation was found, the AS frequently being within the range of the controls in spite of long duration of the disease. In males there was a significant correlation between AS and retinopathy (R = 0.49; p<0.01) and an inverse correlation with HDL‐cholesterol/total cholesterol ratio (R = 0.51; p<0.01). In diabetic females AS was significantly greater in smokers (7.0 ± 3.7) than in non‐smokers (4.2 ± 2.2; p<0.01). In neither sex were there significant correlations between AS and post‐prandial blood glucose, HbA1c, triglycerides or total cholesterol.The results show that AS frequently increases at a young age in insulin‐dependent diabetics, especially males, who on average double the stiffness increment every 7.5 years of the disease.
The Effects of Diabetes and Autonomic Neuropathy on Parotid Salivary Flow in Man
Authors: Lamey P‐J. , Fisher B. M. , Frier B. M. 
Published: July 2009

Stimulated parotid salivary flow studies were performed on 20 non‐diabetic subjects and on 30 patients with insulin‐dependent diabetes mellitus who had been screened for autonomic neuropathy using tests of cardiovascular reflexes. Electrical gustometry was performed to detect the taste threshold.The stimulated parotid salivary flow rates of diabetics with no autonomic neuropathy or early parasympathetic autonomic dysfunction alone were similar to those of non‐diabetic subjects. Diabetic patients with established parasympathetic autonomic neuropathy had significantly higher salivary flow rates as did those with combined sympathetic and parasympathetic neuropathies. Taste thresholds did not correlate either with the duration of the diabetes or with the presence of autonomic neuropathy.The cause of the increased salivary flow associated with diabetic autonomic neuropathy is unclear. It may represent the removal of a neural inhibitory mechanism which modulates salivary flow, or the effects of long‐standing diabetes on salivary secretion.
Physical Activity, Glucose Tolerance, and Diabetes Mellitus: the Whitehall Study
Authors: Jarrett R. J. , Shipley M. J. , Hunt R. 
Published: July 2009

In the Whitehall Study, 6 672 men aged 40–64 years completed a questionnaire concerning leisure time physical activity and had a capillary blood glucose measurement on a sample taken 2 h after a 50 g glucose load. An activity score was calculated by grouping subjects into three broad categories: inactive, moderately active, and active. In both univariate and multiple regression analysis no significant association between blood glucose level and activity score could be found.There were 49 previously diagnosed non‐insulin‐dependent diabetic men and 25 men with 2 h blood glucose levels exceeding 11.1 mmol/l. The proportion of men in each of these groups did not differ significantly between the three activity categories.In a 1:10 sub‐sample (n = 1 650) of the whole Study population there was no relationship between glucose tolerance distribution and a measure of energy expenditure (kcal/kg body weight).In this population there is no evidence for relationship between glucose tolerance or non‐insulin‐dependent diabetes and reported leisure time physical activity, or between glucose tolerance and energy expenditure.
Effect of Strict Metabolic Control on Regulation of Subcutaneous Blood Flow in Insulin‐dependent Diabetic Patients
Authors: Kastrup J. , Mathiesen E. R. , Saurbrey N. , Nørgaard T. , Parving H.‐H. , Lassen N. A. 
Published: July 2009

The effect of 10 weeks of improved metabolic control on the impaired autoregulation of the subcutaneous blood flow was studied at the level of the lateral malleolus in eight long‐term insulin‐dependent diabetic patients with clinical microangiopathy. Blood flow was measured by the local 133‐Xenon washout technique. Mean arterial blood pressure was reduced by a maximum of 23 mmHg by elevating the limb above heart level and elevated to a maximum of 65 mmHg by head‐up tilt; in the latter position venous pressure was kept constantly low by activation of the leg muscle vein pump (heel raising). Improved metabolic control was achieved using either continuous subcutaneous insulin infusion or multiple insulin injections. The blood glucose concentration declined from (median) 12.7 to 6.8 mmol/l and the HbA1c level from 10.1 to 7.5% during strict metabolic control (p<0.01 and p<0.01, respectively). The slope of the subcutaneous blood flow autoregulation curves during poor metabolic control (median: 11.6% per 10 mmHg, range: 8.0–30.5% per 10 mmHg) was not significantly different from the slope values during improved metabolic control (13.4% per mmHg, 10.1–24.4% per mmHg). No association was demonstrated between the impaired autoregulation of subcutaneous blood flow and the metabolic parameters.Our results indicate that improved metabolic control for 10 weeks has no effect on the impaired autoregulation of subcutaneous blood flow in long‐term insulin‐dependent diabetic patients with clinical microangiopathy.
Platelet Aggregation and Coagulation Factors in Insulin Dependent Diabetics With and Without Microangiopathy
Authors: Dallinger K. J. C. , Jennings P. E. , Toop M. J. , Gyde O. H. B. , Barnett A. H. 
Published: July 2009

Abnormalities of platelet aggregation and coagulation have been reported in insulin dependent diabetes mellitus (IDDM), although there is controversy concerning their relationship to microangiopathy. We have studied platelet function and haemostasis in 55 patients with IDDM, 23 without, 14 with mild (background retinopathy) and 18 with severe (proliferative retinopathy, or background retinopathy plus proteinuria) complications. Studies were done on 2 occasions 8 weeks apart and the results compared with 28 control subjects. There was evidence of increased in vivo platelet aggregation in the diabetic group v controls shown by raised values of beta‐thromboglobulin (61 ± 42, mean ± SD, v 18 ± 14 μg/ml, p<0.001), platelet factor 4 (62 ± 76 v 14 ± 11 μg/ml, p<0.01), and platelet micro‐aggregates (20 ± 16 v 12 ± 11%, p<0.01). There was no significant difference in fibrinogen and fibrinopeptide A levels, nor in ‘in vitro’ tests of platelet aggregation between the groups. Dilute whole blood clot lysis time was increased in the diabetic group v controls (6.4 ± 2.6 v 4.8 ± 0.5 hours, respectively, p<0.001). Subjects with severe complications had significantly increased platelet micro‐aggregates when compared to those without complications (23 ± 16 v 16 ± 11%, p<0.05) and increased dilute whole blood clot lysis time (7.0 ± 2.8 v 6.0 ± 2.5 hours, p<0.05).We conclude that patients with IDDM show increased intravascular platelet aggregation which is more severe in those with microangiopathy.
Comparison of Glycaemic Control in Diabetic Patients Treated with Morning or Evening Human Ultratard Insulin
Authors: Edsberg B. , Dejgaard A. , Kühl C. 
Published: July 2009

To investigate whether morning or evening injection of a long‐acting insulin preparation (Ultratard HM, Novo) affects the glycaemic control in insulin‐dependent diabetic (IDDM) patients, 24‐hour blood glucose and plasma free insulin profiles were obtained in nine C‐peptide negative IDDMs after one daily injection of insulin Ultratard HM either before breakfast (0800 h) or at 2200 h during the preceding 14 days.There was a tendency towards higher plasma free insulin levels and lower blood glucose values from 0100 h to 1300 h when Ultratard HM insulin was injected at 2200 h as compared to the morning injection. There was, however, only a significant difference between the corresponding plasma free insulin values at 1200 h, and blood glucose levels did not differ significantly at any time point investigated. The number of blood glucose values below 3 mmol/l in the study periods was 6 when insulin Ultratard HM was injected at 2200 h as opposed to 2 when insulin was given at 0800 h, but this difference was not significant.
Prevalence of Insulin‐Dependent Diabetes Mellitus in Asian Children
Authors: Samanta A. , Burden A. C. , Jones G. R. , Woollands I. G. , Clarke M. , Swift P. G. F. , Hearnshaw J. R. 
Published: July 2009

A survey was conducted in 1984–85, within Leicester City boundaries, which contains 64 535 children below the age of 15 years (20 267 Asian and 44 268 White Caucasian) to ascertain the prevalence of insulin‐dependent diabetes mellitus (IDDM) using a central register maintained for the changeover to U‐100 insulin, diabetic health visitor index cards, hospital admissions of diabetic children, and individual registers maintained by us. Overall prevalence per thousand for children aged 0–15 years was 0.54 for Asian and 0.99 for White Caucasians; for ages 10–15 years they were 0.97 and 1.87, and for ages 0–9 years, 0.31 and 0.18, respectively. This was not statistically different at the 5% level.Ours is the first population based study of its kind in Asian children, and challenges the view that there is a large difference in the prevalence of IDDM between Asians and White Caucasians. A wider analysis of this observation incorporating a large population base is suggested.
Long‐Term Organ Culture of Large Numbers of Human Fetal Pancreata: Analysis of Their Insulin Secretion
Authors: Tuch B. E. , Turtle J. R. 
Published: July 2009

Cultured human fetal pancreas has been transplanted into diabetic man in an attempt to cure the metabolic disorder. However, the capacity of large numbers of these organs to secrete insulin in organ culture has not been reported previously. This report sets out the characteristics of 321 human fetal pancreases of gestational age 12–20 weeks obtained over a period of 34 months, 295 of these being maintained in organ culture. Average insulin secretion was constant at 2.22 ± 0.35 mU/plate/day over a 90‐day period, the maximal duration of culture possible. Explants were lost because of infection or reduced insulin secretion.Practical guidelines for obtaining and maintaining viable explants in culture were established as follows:

Insulin secretion had to be greater than 0.1 mU/plate/day. Secretory rates of this order were associated with a positive insulinogenic response to theophylline.
Prostaglandin induction, suction curettage, and hysterotomy were equally suitable as methods of termination of pregnancy.
The pancreas had to be obtained within 4 hours of termination of pregnancy.
The tissue had to be diced into explants within a further 4 hours.
Prevalence of Smoking in a Diabetic Population: The Need for Action
Authors: Jones Raymond B. , Hedley Anthony J. 
Published: July 2009

Smoking habits in insulin‐treated diabetics in Nottinghamshire (UK) and clinic‐attending diabetics in Nottingham have been analysed. Compared with the general population, the prevalence of current cigarette smoking is significantly less (p < 0.001) in both diabetic men and women older than 50 years. Fewer diabetic men over 60 years have ever smoked than in the general population (p < 0.001) but this finding does not apply to diabetic women. While intervention probably plays some part in this lower prevalence, the most likely explanation is the multiplicative effect of both smoking and diabetes to produce high mortality risks.Actuarial analysis of insulin‐treated clinic attenders diagnosed after 1970 showed that at most 14% (95% confidence interval [CI] 9–18%) of the 183 who smoked at diagnosis had given up 5 years later while a minimum of 8% (95% CI, 6–11%) of the 313 who were non‐smokers had started smoking.Information about the patterns of smoking in patients with chronic disease is incomplete and it appears that too little is being done in clinical services which provide long‐term management for these patients to either discourage smoking or determine why some patients give up smoking but others do not.
Effect of Fluctuations in Albumin on Serum Fructosamine Assay
Authors: McCance D. R. , Coulter D. , Smye M. , Kennedy L. 
Published: July 2009

Serum fructosamine, albumin and plasma glucose were studied in eight patients during recovery from diabetic ketoacidosis, and in eight patients with “decompensated” diabetes without acidosis. In the ketoacidotic group, serum fructosamine had fallen significantly by a mean of 12% by 8h, and fell further during the remainder of the study. A smaller but significant fall in fructosamine (mean 6.1%) was seen in the decompensated group after only 18h, with again a further fall thereafter. These changes in serum fructosamine were accompanied by decreases in serum albumin. However, when fructosamine was corrected by calculating a fructosamine/albumin index (FAI) (fructosamine × 100/albumin), the FAI did not change significantly in either group until a small reduction was noted in the ketoacidotic group at 5 days, which might reasonably be expected as an index of intermediate‐term glycaemia.Therefore minor fluctuations in albumin levels seen in diabetic patients can affect fructosamine, and correction may be be advisable for the test to be a valid measure of glycosylated serum proteins.