bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defective Non‐insulin‐mediated and Insulin‐mediated Glucose Transport and Metabolism in Adipocytes from Obese and Lean Patients with Untreated Type 2 Diabetes Mellitus
Authors: Hjøllund E. , Beck‐Nielsen H. , Pedersen O. , Richelsen B. , Sørensen N. Schwartz 
Published: July 2009

Insulin binding, glucose transport, and glucose metabolism were investigated in isolated adipocytes from 11 lean and 13 obese patients with non‐insulin‐dependent diabetes mellitus. Insulin binding at 15°C was reduced by 35% (p<0.01) in both lean and obese diabetic patients, whereas insulin binding (or uptake) at 37°C was similar in diabetic patients and healthy controls. In lean diabetic patients both non‐insulin‐mediated (basal) and maximally insulin‐stimulated glucose transport and metabolism were significantly reduced (all p<0.01). The percentage responses to insulin were also markedly reduced (p<0.05, p<0.02). In obese diabetic patients basal glucose transport was reduced (p<0.01) but basal glucose metabolism was not. Insulin‐stimulated glucose transport and metabolism were significantly reduced (p<0.01, p<0.05). The percentage responses were reduced compared to healthy controls (p<0.05, p<0.05) but higher than in lean diabetic patients (p<0.05).We conclude that adipocytes isolated from both lean and obese patients with non‐insulin‐dependent diabetes mellitus are characterized by severely depressed non‐insulin‐mediated and insulin‐mediated glucose transport and depressed insulin‐mediated glucose metabolism. The major defect seems to be a reduced maximal effect of insulin on glucose metabolism, suggesting post‐binding and post‐transport abnormalities.
Experience With NovoPen®, an Injection Device using Cartridged Insulin, for Diabetic Patients
Authors: Walters D. P. , Smith P. A. , Marteau T. M. , Brimble A. , Borthwick L. J. 
Published: July 2009

An insulin injection device, NovoPen®, incorporating cartridged U100 Human Actrapid insulin was used in a group of 31 insulin‐dependent diabetic patients aged 31.4±11.2 years (mean±S.D.; range 16.5–57.0) to assess its acceptance and suitability in a regimen involving an injection before each of their three main meals plus an evening injection of Human Monotard® insulin from a conventional syringe.Twenty‐seven patients completed 48 weeks of NovoPen® therapy and preferred to continue with the multiple injection regimen in the long term. The device was well accepted and may make multiple injection regimens more feasible.
Beneficial Effect of Glycaemic Improvement in Non‐ischaemic Forms of Diabetic Retinopathy: A 3‐Year Follow‐up
Authors: Selam J. L. , Millet P. , Zaluski S. , Saeidi S. , Mirouze J. 
Published: July 2009

Recent studies have suggested that optimal glucose control fails to arrest or even worsens background retinopathy possibly by aggravating retinal ischaemia. Fourteen insulin‐dependent diabetic patients, aged 34±11 years (mean ± SD) treated by long‐term intraperitoneal insulin infusion using portable pumps, were followed for 3 years. Preproliferative or proliferative lesions on ophthalmoscopy and large non‐perfused areas on fluorescein angiography were exclusion criteria. Six patients were found to have minimal and 8 mild background retinopathy. The patients were retrospectively assigned to two comparable groups except for their glycaemic equilibrium under insulin infusion: average control (n=6) and excellent control (n=8), although glycaemic control was significantly improved in all cases when compared to previous conventional therapy. Fluorescein changes were scored blindly and independently by 3 ophthalmologists according to modifications of fluorescein diffusion and capillary abnormalities. The two types of retinal lesions improved gradually in 10 patients and deteriorated in only 1 patient, although not progressing to proliferative retinopathy. Structural improvements were significantly more frequent in the excellently controlled group.We conclude that non‐ischaemic lesions may still be arrested and even improved by tight metabolic control.
Hypotensive Therapy Reduces Microvascular Albumin Leakage in Insulin‐dependent Diabetic Patients with Nephropathy
Authors: Parving H.‐H. , Smidt U. M. 
Published: July 2009

The effect of hypotensive therapy on the transcapillary escape rate of albumin (TERalb) was studied in eight hypertensive insulin‐dependent diabetic patients (mean age 29, range 19–42 years) with nephropathy and retinopathy. Transcapillary escape rate of albumin (initial disappearance of intravenously injected 125l‐labelled human serum albumin), urinary albumin excretion rate (radial immunodiffusion), and glomerular filtrate rate (single bolus 51‐Cr‐EDTA technique) were measured. After hypotensive treatment (mean duration, 23 months, range 7–39 months) with combinations of metoprolol, hydralazine, and frusemide or thiazide diuretics, arterial blood pressure fell from 152/103 ± 18/6 mmHg (mean ± SD) to 133/81 ± 12/10 mmHg (p<0.01), transcapillary escape rate of albumin from 10.2 ± 1.8 to 8.1 ± 1.8% of intravascular mass of albumin/h (p0.01), albuminuria from 1803 (370–5066) μ/min to 940 (101–2676) μg/min (median and range, p<0.05), and glomerular filtration rate from 103 ± 23 to 84 ± 22 ml/min/1.73 m2 (p<0.01).Our study suggests that effective hypotensive treatment reduces the abnormally elevated albumin leakage characteristically found in insulin‐dependent diabetic patients with clinical microangiopathy. This may be due to a reduction in the hydrostatic pressure in the microcirculation.
Ambulatory Monitoring of the ST Segment in Diabetic Men With and Without Peripheral Neuropathy
Authors: Hume L. , Oakley G. D. G. , Boulton A. J. M. , Peach M. , Hardisty C. A. , Ward J. D. 
Published: July 2009

To assess whether myocardial ischaemia is more common in diabetic patients with neuropathy, 24‐hour ambulatory monitoring of the ST segment was performed on 27 diabetic men without peripheral neuropathy and in 28 with neuropathy. The patients were matched for age 54 ± 7 years (mean ± SD) versus 54 ± 7 years and for duration of diabetes (16 ± 9 years versus 16 ± 12 years). None had clinical evidence of heart disease.Episodes of ST segment depression were seen during ambulatory monitoring in 12 diabetics (22%) but were not more common in patients with peripheral neuropathy. Four of the 13 diabetics with autonomic neuropathy had ST depression during ambulatory monitoring. During a median follow‐up period of 50 months, four patients developed clinical heart disease. Three of these patients had shown ST depression during ambulatory monitoring.ST depression during ambulatory monitoring is common in diabetic men without cardiac symptoms but is not related to the presence of peripheral neuropathy. Diabetics with ST depression during ambulatory monitoring are at increased risk of developing heart disease in subsequent years.
Nine Years' Personal Experience of Intensified Diabetes Control: Infusion versus Injections
Authors: Jarratt A. M. 
Published: July 2009

The author, who had been an unstable diabetic since 1948, has attempted to maintain normoglycaemia since January 1977 after developing retinopathy and painful peripheral neuropathy. After 40 months of intensified conventional therapy (ICT), blood glucose fell from 13.0 ± 2.0 (mean ± S.D.) to 8.6 ± 1.5 mmol/l (p<0.001), but with 36% of blood glucose tests still exceeding 10.0 mmol/l. After 6 years of continuous subcutaneous insulin infusion (CSII) mean blood glucose was 6.6 ± 0.7 mmol/l (p<0.001) CSII/ICT, with only 10% of tests exceeding 10 mmol/l, smoother glycaemic profiles and excellent control overnight with no hypoglycaemia. These improvements under CSII were attributed to continuous varied insulin intake, which was instantly and unobtrusively adjustable, and more reliable food/insulin/blood glucose relationships. No infusion‐site abscesses or serious ketoacidosis developed.Under both therapies glycaemic control was readily disrupted by exercise, minor dietary inaccuracies, relaxing of vigilance and unknown factors. Whenever the sense of commitment faultered there was a tendancy to maintain higher glycaemic values to avoid distressing hypoglycaemia. Over the nine years, retinopathy progressed, foot pains regressed slightly but no fresh complications developed. Thus, intensified conventional management alone improved control, but CSII enabled the author to remain near‐normoglycaemic for years (given sufficient motivation), with a less regimented lifestyle.
Proteinuria Prevalence in Insulin‐treated Patients: Prediction of Need for End‐Stage Renal Failure Treatment
Authors: Waugh N. R. , Jung R. T. , Newton R. W. 
Published: July 2009

In the Dundee Diabetic clinic area (population circa 250 000), a population‐based survey of the prevalence of proteinuria in diabetic patients treated with insulin showed that 9.4% of such patients had persistent proteinuria. The percentage of males with proteinuria was 11.4%, against 7.2% of females. An additional 5.2% of patients had had proteinuria observed once, but did not meet the criteria for persistent proteinuria. No result was available in 10% of patients for a variety of reasons.Not every patient with diabetes and persistent proteinuria will progress to end‐stage renal failure, but consideration of the group as a whole allows predictions based on published reports, to be made of the likely future incidence of renal failure, and hence future need for renal replacement services. We estimate that over the next decade two patients per 125 000 total population will develop renal failure each year. If survival is unchanged, there could be two or three times that number on treatment at any time.
The Natural History of Insulin‐Dependent Diabetes Mellitus in Denmark: 1. Long‐term survival with and without late diabetic complications
Authors: Borch‐Johnsen K. , Nissen H. , Henriksen E. , Kreiner S. , Salling N. , Deckert T. , Nerup J. 
Published: July 2009

All 906 patients with insulin‐dependent diabetes mellitus (IDDM) diagnosed before the age of 31 years, prior to 1943, and admitted to the Steno Memorial Hospital were followed until death or until 1 January 1984. In an attempt to identify factors of prognostic importance, we compared patients dying within 35 years of the onset of diabetes with patients surviving for 40 years or more. Three hundred and seventy‐seven patients survived for 40 years or more; of these 224 were still alive and invited to a re‐examination, in which 184 participated.After 40 years of diabetes, the most frequent complications were impaired vision (due to diabetic retinopathy) and persistent proteinuria. However, 53% had no major complications despite 40 years with IDDM. The 184 re‐examined patients (median age 60 years, median diabetes duration 47 years) were all genuine IDDM patients, as defined by stimulated C‐peptide levels. Proliferative retinopathy or visual impairment was found in 56% of the 184 patients, abnormal ECG or amputations in 26%, and elevated urinary albumin excretion rate (AER) ≥ 30 mg/24 h) in 45%. Twenty‐five per cent had none of these complications. Proliferative retinopathy was associated with elevated AER and raised systolic blood pressure, macroangiopathy with the use of antihypertensive drugs, and proteinuria with low age at diagnosis, large increase in systolic blood pressure, smoking, and insulin‐binding antibodies. Sex, age and diabetes duration were not associated with any of these three late diabetic complications.
The Glycohaemoglobin Assay as a Screening Test for Diabetes Mellitus: The Islington Diabetes Survey
Authors: Forrest Richard D. , Jackson Caroline A. , Yudkin John S. 
Published: July 2009

Blood glucose 2 h after an oral glucose load (2hBG) and glycohaemoglobin (GHb) (Corning agar‐gel electrophoresis) levels were used as screening tests in a general practice diabetic screening programme. The diagnosis of diabetes (DM) was based on a separate oral glucose tolerance test (OGTT) in 223 of 1040 screened subjects, selected as a stratified sample biased towards higher levels of 2hBG and GHb. The GHb assay was also repeated at the recall examination and urine was tested for glycosuria before and after glucose administration.At a cut‐off level of 8.1%, the screening GHb assay correctly identified 90% of all probable diabetics with a specificity of 85.3% (95% CI 83.3–87.3%) and a positive predictive value of 14.0% (9.0–19.0%). The specificity of the screening GHb assay as a screening test for true DM was 45.8% (39.0–52.4%) at 90% sensitivity, and that of the recall GHb assay was 64.5% (57.9–71.1%). The screening 2hBG was 93.3% (88.9–97.7%) specific at 90% sensitivity as a screening test for true DM diagnosed by OGTT at recall. The test characteristics for fasting glycosuria were: sensitivity 16.7% (0–37.8%) and specificity 98.0% (96.0–100.0%). Equivalent values for the post‐glucose test for glycosuria were: 72.7% (46.4–99.0%) and 77.4% (70.1–84.7%), respectively.While GHb assay is a poorer screening test for DM than the 2hBG at the single cut‐off level quoted, comparison of the accuracy of the two tests shows that the GHb assay is only marginally less accurate. It is superior to testing for glycosuria as a screening test for DM and can be performed on any random blood sample, facilitating its use in population screening.
Reproducibility of the Glucagon Test
Authors: Arnold‐Larsen S. , Madsbad S. , Kühl C. 
Published: July 2009

The influence of the fasting blood glucose (FBG) concentration on the ß‐cell responsiveness to glucagon was studied twice in 9 insulin‐dependent diabetic patients with residual ß‐cell function. At a FBG of 7.7±0.3 mmol/l (mean ±SEM) all patients displayed a preserved ß‐cell function with a plasma C‐peptide concentration of 0.25±0.03 nmol/l 6 min after an i.v. injection of glucagon. In contrast, at a FBG of 3.2±0.01 mmol/l 4 out of 9 patients would have been classified as not having an endogenous insulin secretion. All the patients had the lowest 6 min C‐peptide concentration 0.06±0.01 nmol/l on the day with the lowest blood glucose concentration.The reproducibility of the glucagon test was assessed by comparing the results from two test days in 12 insulin‐dependent, 9 non‐insulin‐dependent diabetic patients and 6 normal subjects. The 6 min plasma C‐peptide concentration, the peak plasma C‐peptide concentration, and the area under the plasma C‐peptide curves were not different on the two test days in any subgroup. In all diabetic patients and normal subjects, the 6 min plasma C‐peptide concentration (r = 0.93, coefficient of variation (CV) = 0.16), the peak plasma C‐peptide concentration (r = 0.93, CV = 0.16) and the area under the plasma C‐peptide curve (r = 0.94, CV = 0.16) were all significantly correlated.The results show that the prevailing FBG significantly affects the outcome of the glucagon test and confirm its reproductibility.
A Comparison of Semisynthetic Human NPH Insulin and Porcine NPH Insulin in the Treatment of Insulin‐dependent Diabetes Mellitus
Authors: Pedersen C. , Høegholm A. 
Published: July 2009

Twenty‐two insulin‐dependent diabetic patients participated in a double‐blind, cross‐over study, where treatment with semisynthetic human NPH insulin (Novo Industri) was compared with porcine NPH insulin (Nordisk). Each treatment period lasted 8 weeks. Blood glucose level, glycosylated haemoglobin, insulin requirements, and frequency of hypoglycaemic events were compared. No difference was found in 24‐hour blood glucose profiles. Fasting blood glucose level was 8.3 mmol/l during treatment with human insulin and 8.7 mmol/l during treatment with porcine insulin (p<0.1). Mean HbA1c was 7.7% at the end of study compared to 9.5% at baseline (p<0.01), but this decline in HbA1c was independent of the treatment regimen. Forty‐six hypoglycaemic events occurred during treatment with human insulin compared to 39 events during treatment with porcine insulin. No difference was found regarding insulin requirements during the study.It is concluded that semisynthetic human NPH insulin is indistinguishable from porcine NPH insulin with respect to 24‐hour blood glucose profile, HbA1c level and insulin dose requirements.
Use of Hospital Services by Elderly Diabetics: The Frederica Study of Diabetic and Fasting Hyperglycaemic Patients Aged 60–74 Years
Authors: Damsgaard E. M. , Frøland A. , Green A. 
Published: July 2009

The use of hospital services was studied in 228 patients with known diabetes (KD) (52 insulin treated, 101 diet plus oral hypoglycaemic agents (OHAs), 66 diet treated and 9 without treatment) and 87 subjects with fasting hyperglycaemia (FH) found by screening of a well‐defined population aged 60–74 years. Ninety per cent were NIDDM as evaluated by a high C‐peptide response on glucagon stimulation. Information about all admissions during the year before ascertainment was obtained from the complete regional computerized hospital registration system.The overall average admission rate per year for KD males was 0.47 and for females 0.50. The average number of bed‐days occupied per person‐year was 6.8 for KD males and 8.2 for females. These rates are 2–3 times higher than those of the general population. Insulin treated NIDDM patients had a rate of 23.9, whereas IDDM patients had a rate of 15.2 bed‐days per person‐year. The corresponding figures for patients treated with OHAs were 3.5 and for patients treated with diet 4.6. FH had overall bed‐day occupancy rates of 0.50 and 1.09 for males and females, respectively, which was less than half of that expected from the general population.If discharge diagnosis (principal and/or subsidiary) had been used for identification of hospitalized patients with diabetes the bed‐days used by KD patients would have been underestimated by 15.3%, most pronounced for diabetics treated with OHAs (21.1%) or diet (21.6%).
Variability of Albumin Excretion in Insulin‐dependent Diabetics
Authors: Chachati A. , von Frenckell R. , Foidart‐Willems J. , Godon J.P. , Lefebvre P.J. 
Published: July 2009

Sixteen adults patients with insulin‐dependent diabetes mellitus and 16 healthy controls, matched for sex and age, were asked to collect their urine during the night and during the day at rest, at weekly intervals on four occasions. Subjects with heart failure, kidney disease, hypertension, abnormal urinanalysis (Albustix positive) or poorly controlled diabetes prior to entry in the study, were excluded.A high variability in the albumin excretion rates (AER) was observed in both diabetic and control groups but the variance was significantly greater in diabetics. Moreover the variance in AER was higher in daytime as compared to overnight urine collections in both groups. Overnight urine collections are more precise than daytime urine collections for the determination of AER.
A Pilot Diabetic Support Service Based on Family Practice Attenders: Comparison with Diabetic Clinics in East London
Authors: Boucher B. J. , Claff H. R. , Edmonson M. , Evans S. , Harris B. T. H. , Hull S. A. H. , Jones E. J. , Mellins D. H. , Safir J. G. , Taylor B. , Udezue E. , Young M. R. Y. , Yudkin J. S. 
Published: July 2009

A pilot Diabetic Support Service (DSS) based on a computer register was devised for diabetic patients identified within three group practices in an inner city district of London. Of 159 eligible diabetics, 142 were followed over 2 years. Glycosylated haemoglobin (GHb) monitoring and adequacy of clinic reviews were audited. Care achieved by the DSS was compared with conventional Diabetic Clinic (DC) management of a sample of 200 diabetics from the same district. Serial GHb measurements were made on 66.2% of DSS and 44.5% of DC patients: GHb fell significantly only in DSS patients (13.1% to 11.4%). Proportional falls in GHb were comparable in each DSS treatment group (diet alone, oral hypoglycaemic agents, and insulin) and for hospital attenders and non‐attenders equally. The planned clinical reviews were achieved in 40.1% of DSS patients entered (29% GP only, 54% of clinic attenders) and in 15% of DC patients (plus 75% fundal and blood pressure examination).The study led to provision of a formal diabetic clinic annual review system, diabetic mini‐clinics in two of the three group practices, and the appointment of two Diabetic Liaison Sisters. With administrative simplification the system is to be made available to all diabetics in the District through their GPs during 1986–8.
Ambulatory Medical Care for Elderly Diabetics: The Fredericia Survey of Diabetic and Fasting Hyperglycaemic Subjects aged 60–74 years
Authors: Damsgaard Else Marie , Frøland Anders , Holm Niels 
Published: July 2009

The use of services from the primary health care system and hospital outpatient clinics was studied in persons aged 60–74 years. We studied 228 persons with known diabetes (KD) (52 insulin treated, 101 OHA, 66 diet, 9 untreated) and 87 with fasting hyperglycaemia (FH) and compared with sex and age matched controls (223 CKD, 82 CFH). Information on all services provided by the primary health care system during the 12 months before ascertainment was obtained from local and national registers.FH did not receive more primary care services and did not visit outpatient clinics more than controls. Two to three times more KD than controls received all kinds of services from general practice or visited outpatient clinics. No difference was seen for specialists, except for dentists and otologists who provided fewer services to KD than to CKD. Of insulin treated KD 56% had ≥10 contacts with physicians during the year, independent of residual beta‐cell function. The corresponding proportions for OHA‐treated and diet treated KD were 27% and 29%. Outpatient clinics were visited by 79% of insulin treated KD (88% with high and 65% with low C‐peptide secretion), 26% of OHA‐treated KD and 33% of diet‐treated KD. The prevalence of ischaemic heart disease, hypertension, and microalbuminuria was not increased in the KD using most primary care services.
Alpha Glucosidase Inhibition in the Treatment of Non‐Insulin‐Dependent Diabetes Mellitus
Authors: Scott A. R. , Tattersall R. B. 
Published: July 2009

Two studies of the new alpha‐glucosidase inhibitor, miglitol, in patients with non‐insulin‐dependent diabetes mellitus (NIDDM) are reported. In the first, 13 patients, poorly controlled on sulphonylureas, received miglitol 50mg three times daily for 4 weeks. Post‐prandial blood glucose was reduced after breakfast, lunch, and tea compared with placebo (p<0.05–0.01) but there was no improvement in fasting blood glucose, serum fructosamine or haemoglobin A1.In a dose‐response study the effect of a single dose of miglitol (0,50,100,150 or 200mg) on post‐prandial glycaemia after a test breakfast was assessed in 20 patients with mean ± SEM fasting blood glucose 9.9 ± 0.4 mmol/l. With 50mg miglitol, there was a significant reduction in blood glucose from 30 to 120 min post‐prandially compared with placebo. Increasing doses of miglitol further depressed the post‐prandial rise in blood glucose and with 200mg there was no significant change from fasting levels. Side‐effects were limited to flatus and loose stools particularly with the higher doses but were not severe.Miglitol effectively reduces post‐prandial blood glucose rise in NIDDM with as little as 50mg but there is considerable individual variation. Larger doses may be necessary in patients already poorly controlled on sulphonylureas.
Diabetic Ketoacidosis During NovoPen Therapy
Authors: MacRury S. M. , Small M. , Boal A. , Paterson K. R. , McCuish A. C. 
Published: July 2009

To improve flexibility and acceptability of diabetic management five patients (age 15–26 years) were changed to NovoPen therapy (Human Actrapid Insulin 3 x daily + Human Ultratard Insulin at night). Diabetic ketoacidosis developed within 2–4 months of commencing this regimen and in one patient twice in only 4 weeks. All failed to increase their insulin dose in response to hyperglycaemia and two patients omitted insulin when they did not take meals believing this to be appropriate irrespective of the prevailing blood glucose.The NovoPen regimen may increase the risk of diabetic ketoacidosis in patients who do not monitor and control their diabetes assiduously and should not be seen as a solution for poorly motivated or ill‐educated patients.