bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Non‐insulin‐dependent Diabetes Mellitus in Europe: A Concensus View
Authors: Alberti K. G. M. M. , Gries F. A. 
Published: July 2009

Non‐insulin‐dependent diabetes mellitus (NIDDM) is a very common disorder, but less attention is paid to it than to the more dramatic but less prevalent insulin‐dependent diabetes. The majority of patients receive their care from primary health care physicians or doctors without particular training in diabetes. Care is highly variable and often inadequate. In the USA this problem has been tackled by promoting a national education programme involving extensive use of television together with written guidelines for management. These latter have been looked at with interest by many diabetologists in Europe, but it has been felt that the guidelines were not entirely suitable for European practice. As a result an initiative was taken to generate more suitable materials for European use.Diabetologists from 14 European countries, representing the European NIDDM Policy Group (EUR‐NIDDM‐PC) therefore met in Amsterdam in 1986 with the blessing of the Council of the European Region of the IDF. The aims were first to establish whether a concensus view on management of non‐insulin‐dependent diabetes could be achieved, and if this was possible then to produce written materials for use in the care of people with non‐insulin‐dependent diabetes aimed particularly at the primary health care sector and the general physician. A remarkable degree of concensus was reached considering the different backgrounds and specialities represented by the group. Discussions were lengthy but constructive and were pervaded by a determination to improve care for such patients in Europe. The first output from the group is the short concensus document which follows. This has already been published in the IDF Bulletin but is now reproduced in full in Diabetic Medicine in order to broaden the readership of the document. It is meant as a discussion paper. As such it was presented at a meeting of diabetologists in Berlin in September 1987 and was amended as a result of these discussions. Further comments and input will be welcome. Once such comments have been received the group will produce a desk‐top manual for physicians together with a more comprehensive volume discussing the problems of non‐insulin‐dependent diabetes.
Insulin Requirement in Non‐insulin‐dependent Diabetes Mellitus: Relation to Simple Tests of Islet B‐cell Function and Insulin Sensitivity
Authors: Gjessing H. J. , Matzen L. E. , Pedersen P. C. , Faber O. K. , Frøland A. 
Published: July 2009

Evaluation of simple tests of islet B‐cell function and insulin sensitivity as predictors of metabolic control was performed during 3 months of insulin withdrawal in 25 insulin‐treated diabetic subjects. All patients had a glucagon stimulated plasma C‐peptide concentration above 0.33 nmol/l and a fasting plasma C‐peptide concentration above 0.20 nmol/l a few days before insulin withdrawal. Insulin sensitivity was measured as the glucose disappearance rate (k) during an intravenous insulin tolerance test. Two patients were considered insulin‐requiring due to high fasting blood glucose levels (>20 mmol/l) and two patients due to an increase in glycosylated haemoglobin of more than 1.1% (>∼3SD) in combination with weight loss. None of the remaining patients had a significant increase in glycosylated haemoglobin.An inverse correlation was found between stimulated C‐peptide levels and insulin sensitivity (r=‐0.41, p<0.05). Fasting and stimulated C‐peptide concentrations of 0.40 and 0.70 nmol/l, respectively, separated non‐insulin‐requiring patients from a group consisting of both insulin‐ and non‐insulin‐requiring patients. At these C‐peptide levels the predictive value of a positive test was 100%, while the predictive value of a negative test was as low as 33%, or 27%, depending on whether fasting or stimulated C‐peptide concentration was used. Including the k value in the prediction only increased the predictive values of negative tests to 40%, and 33%, respectively.
Progression of Proteinuria in Type 1 and Type 2 Diabetes
Authors: Cooper M. E. , Frauman A. , O'Brien R. C. , Seeman E. , Murray R. M. L. , Jerums G. 
Published: July 2009

A longitudinal study evaluating the time course of the transition from normal to micro‐albuminuria, and then on to macroalbuminuria, was made over a mean period of 7 years in a cohort of 52 patients with Type 1 diabetes and 61 patients with Type 2 diabetes. Transient episodes of micro‐ and macroalbuminuria were often observed before the ultimate development of persistent Albustix‐positive proteinuria. The transition from normal to micro‐albuminuria and from micro‐ to macroalbuminuria was characterized by rises in renal albumin clearance accompanied by lesser rises in total proteinuria.Seven patients with Type 1 and 12 with Type 2 diabetes showed evidence of progression, the interval for the transition from normal to macroalbuminuria varying from 3 to 5 years. In Type 1 diabetic patients, the development of micro‐ and macroalbuminuria was associated with a decline in renal function and a rise in systolic blood pressure without a significant change in blood glucose control. In Type 2 diabetic patients, the development of microalbuminuria was associated with a small decline in renal function but no change in blood pressure or blood glucose control.It is concluded that the transition from normal to micro‐ and on to macroalbuminuria may be more rapid then previously reported and varies considerably among individuals.
Acute and Long‐term Renal Effects of Angiotensin Converting Enzyme Inhibition in Normotensive, Normoalbuminuric Insulin‐dependent Diabetic Patients
Authors: Pedersen M. Mau , Schmitz A. , Pedersen E. Bjerregaard , Danielsen H. , Christiansen J. Sandahl 
Published: July 2009

Glomerular filtration rate (GFR) (thalamate clearance), renal plasma flow (RPF) (hippuran clearance), and urinary albumin excretion rate (AER) were measured in 10 normoalbuminuric, normotensive insulin‐dependent diabetic patients and 8 normal subjects before and during acute angiotensin converting enzyme (ACE) inhibition by means of enalapril (10 mg IV). The effect of placebo versus enalapril (30 mg day−1) was also studied for 3‐month treatment periods in the insulin‐dependent diabetic patients.Acute ACE‐inhibition caused a decline in filtration fraction (FF) from 0.259±0.011 (±SE) to 0.237±0.013 (2p<0.01) in the diabetic patients, and from 0.210±0.010 to 0.188±0.006 (2p<0.02) in the normal subjects. Mean arterial blood pressure was lowered from 90±1 to 84±2 mmHg (2p<0.01) and from 91±1 to 86±2 mmHg (2p<0.05). No significant change in blood glucose, AER or fractional albumin excretion (θAlb) was seen in either group.After 3 months of enalapril treatment FF was decreased from 0.253±0.011 to 0.235±0.011 (2p<0.05), AER from 5.6 × / ÷ 1.7 to 4.3 × / ÷ 1.6 μg min−1 (2p<0.01) and θAlb from 1.22±0.22 times 10−6 to 0.92±0.12 times 10−6 (2p<0.02). The decline in total renal resistance was not significant (0.175±0.0.013 to 0.165±0.012 mmHg ml−1 min−1) and significant changes in GFR, RPF, mean arterial pressure or HbA1c were not observed.Thus, acute and long‐term ACE‐inhibition in normotensive normoalbuminuric insulin‐dependent diabetic patients are associated with changes in renal haemodynamics and albumin excretion rate, probably as a result of a reduction in glomerular capillary hydrostatic pressure.
Hypoglycaemia and Diabetes Mellitus Following Parenteral Pentamidine Mesylate Treatment in AIDS Patients
Authors: Perronne C. , Bricaire F. , Leport C. , Assan D. , Vilde J.L. , Assan R. 
Published: July 2009

Of 18 AIDS patients withPneumocystis cariniipneumonia treated with pentamidine mesylate parenterally, four developed serious to severe hypoglycaemia, three hypoglycaemia followed by insulin‐requiring diabetes, and two others diabetes alone. Hypoglycaemia (blood glucose 2.1 ± 0.2 (±SE) mmol l−1) occurred 9 (2–22) days after starting treatment, and diabetes (initial blood glucose 30 ± 6 mmol l−1) after 60 (20–90) days. The other patients remained euglycaemic. The dysglycaemic patients (hypo‐ and hyper‐glycaemic) had a higher pentamidine dosage (p< 0.01), and higher serum creatinine levels at end of treatment (p< 0.001), consistent with drug accumulation and dose‐dependent toxicity.Plasma C‐peptide levels were low in the diabetic patients, in the basal state (0.25–0.28 nmol l−1) and following stimulation by IV glucagon (0.35–0.40 nmol l−1), vs 0.80 ± 0.06 nmol l−1(basal) and 1.83 ± 0.16 nmol l−1(stimulated) in 23 healthy control subjects (mean ± SE). Islet cell or insulin antibodies were not detected. Serum amylase levels rose abnormally in the dysglycaemic group, and pancreatitis was proved in one, and suspected in another patient. None of 28 similar AIDS patients whoseP. cariniipneumonia was treated with cotrimoxazole showed blood glucose disturbance.
Outward Bound, Diabetes and Motivation: Experiential Education in a Wilderness Setting
Authors: Herskowitz R. D. 
Published: July 2009

Effective diabetes management requires the commitment to take charge of one's life, and the strength to face the daily challenges the illness presents on a long‐term basis. Outward Bound Programmes utilize challenging experiences in a wilderness setting to foster personal growth and responsibility, and to encourage the participants to reach beyond their limitations.Six Outward Bound courses were taught, to a total of 56 students with Type 1 diabetes, 14 to 42 years old. With appropriate precautions, the fairly strenuous programme was conducted safely. A battery of psychosocial measures, administered to the initial pilot group of eight students before the course, and again 7 to 11 months after returning home, indicated a statistically significant improvement in problem scores on the Achenbach Youth Self‐Report Profile, and suggested modest improvements in diabetes adjustment, locus of control, and self‐esteem. Other course participants report having had an exhilarating experience, which helped to increase their self‐confidence and determination to take charge. A few have begun to break previous patterns of dysfunction. Many have acquired new insights into the causes of fluctuating blood sugars, and into the options at their disposal to optimize self‐care.
Ethnic Differences in Insulin Secretion in Women at Risk of Future Diabetes
Authors: Dornhorst A. , Chan S. P. , Gelding S. V. , Nicholls J. S. D. , Baynes C. , Elkeles R. S. , Beard R. W. , Anyaoku V. , Johnston D. G. 
Published: July 2009

The plasma glucose and insulin responses to oral glucose were studied in 44 women who had previously had gestational diabetes, but had reverted to normal glucose tolerance. Twenty were White, 14 Black, and 10 Asian. A group of race‐, age‐ and weight‐matched controls was also studied. Fasting values of glucose and insulin did not differ significantly between the study group and controls. During the 2 h 75‐g OGTT the White and Black previously gestational‐diabetic women had similar plasma glucose values to their controls, while the Asian previously gestational‐diabetic women had significantly higher glucose values at 30 min (9.2 ± 0.6 (± SE) vs 7.1 ± 0.3 mmol I−1, p < 0.02) and at 60 min (8.6 ± 0.8 vs 6.2 ± 0.4 mmol I−1, p < 0.02). Compared with their race‐matched controls, the White previously gestational‐diabetic women had significantly lower insulin values at 60 min (median 41 range 2–91) vs 56 (15–118) mU I−1, p < 0.05), and the Black previously gestational‐diabetic women had lower values at both 30 min (17 (4–116) vs 53 (22–197) mU I−1) and 60 min (36 (4–148) vs 99 (12–169) mU I−1, p < 0.05). The insulin values were similar during the OGTT in the Asian previously gestational‐diabetic women and their controls. The ratio of the insulin area:glucose area during the OGTT was significantly lower in the White and Black previously gestational‐diabetic women compared with controls (White 5.0 ± 0.7 vs 7.3 ± 0.9 mU mmol−1, p < 0.05; Black 5.0 ± 1.0 vs 8.9 ± 1.2 mU mmol−1, p < 0.02) while similar area ratios were observed for the Asian previously gestational‐diabetic women and their controls (7.6 ± 1.7 vs 8.7 ± 0.9 mU mmol−1).The results suggest that there are ethnic differences in insulin secretion following oral glucose in previously gestational‐diabetic women.
Sequential Metabolic Studies of Pancreas Allograft Function in Type 1 Diabetic Recipients
Authors: Cottrell Daryl A. , Henry Mitchell L. , O'Dorisio Thomas M. , Tesi Raymond J. , Ferguson Ronald M. , Osei Kwame 
Published: July 2009

We have previously shown that the loss of acute first phase insulin secretion precedes pancreas allograft rejection and development of glucose intolerance in Type 1 diabetic patients. In order to examine whether there is a progressive loss of phases of insulin secretion and beta‐cell function in technically successful pancreas transplants during the first year, we measured glucose, insulin, and C‐peptide responses to physiological (mixed meal) and pharmacological (IV glucose and IV glucagon) stimulation in 27 glucose‐tolerant, insulin‐independent allograft recipients at 3, 6, and 12 months. Mean ± SE fasting serum glucose levels were normalized throughout the study period. Postprandial serum glucose profiles tended to increase by 12 months compared to 3 and 6 months, although peak glucose levels were not statistically different. Following pancreas transplantation, basal serum insulin levels were high at 3 months (163 ± 17 pM), 6 months (165 ± 22 pM), and 12 months (248 ± 54 pM,p= NS) in the Type 1 diabetic pancreas allograft recipients when compared to normal (25 ± 3 pM). We observed slight elevations in postprandial insulin and C‐peptide profiles at 12 months compared to 3 and 6 months. Following IV glucose and glucagon stimulation, serum insulin and C‐peptide levels as well as phases of insulin release did not differ over the 12‐month study period. Similarly, the glucose decay constant (KG) was nearly identical at 3, 6, and 12 months.In summary, 1 year following successful whole cadaveric, heterotopic pancreas transplantation in Type 1 diabetic recipients, fasting serum glucose remains normalized, while postprandial glucose tends to rise. This alteration in post‐mixed meal glucose tolerance is achieved at the expense of elevated basal and post‐stimulation insulin and C‐peptide levels, suggesting worsening of the insulin‐resistant state in such patients. The upward trend in glucose levels was observed only after mixed meal but not intravenous glucose stimulation. In addition, the acute first and second phase insulin release to both glucose and non‐glucose stimuli, which are more sensitive markers for beta‐cell dysfunction, were preserved 12 months following pancreas transplantation in Type 1 diabetic recipients.
The Prevalence of Hypercholesterolaemia and its Relationship With Albuminuria in Insulin‐dependent Diabetic Patients: An Epidemiological Study
Authors: Haaber A.B. , Kofoed‐Enevoldsen A. , Jensen T. 
Published: July 2009

To assess the prevalence of hypercholesterolaemia and its relationship with metabolic control and urinary albumin excretion in Type 1 diabetic patients, all 1577 insulin‐dependent patients attending the outpatient clinic at the Steno Memorial Hospital were studied. None had previously received lipid‐lowering drugs. Hypercholesterolaemia, defined as plasma concentration of cholesterol above 6.4 mmol I−1 was found in 156 patients (10%) (95%) confidence intervals (CI) 8.4–11.5%) compared with 11% in the Danish background population. Compared with the normolipidaemic diabetic patients, the hyperlipidaemic patients were older (42 vs 37 years: p < 0.001, 95% CI for difference in means 3–7 years), they had a higher glycosylated HbA1C (9.2 vs 8.6%, p < 0.001, 95% CI for difference in means 0.4–1.3%) and their urinary albumin excretion was 32 vs 12 mg 24 h−1, p < 0.001. Of the 1577 diabetic patients, 1084 patients (73%) had normal urinary albumin excretion (UAE < 30 mg 24 h−1), 255 (17%) had microalbuminuria (UAE 30–300 mg 24 h−1) and 136 (9%) had overt clinical nephropathy (UAE > 300 mg 24 h−1). The plasma concentration of cholesterol rose significantly with increasing urinary albumin excretion; normoalbuminuric 4.78 mmol I−1 ± 1.06 (mean ± SD); microalbuminuria 5.12 mmol I−1 ± 1.23 and macroalbuminuric: 4.89 mmol I−1 ± 1.38 (p < 0.001). The influence of metabolic control on the plasma level of cholesterol was of only minor clinical importance.Thus, even though patients with diabetic nephropathy have elevated plasma concentrations of cholesterol, the overall prevalence of hypercholesterolaemia in a large unselected group of insulin‐dependent diabetic patients is not higher than in the background population.
Education and Employment Experiences in Young Adults with Type 1 Diabetes Mellitus
Authors: Lloyd C.E. , Robinson N. , Fuller J.H. 
Published: July 2009

Educational attainment, employment experiences, and self‐esteem were measured using semi‐structured questionnaires in young adults with Type 1 diabetes mellitus and in a group of age/sex matched healthy controls. Results showed that subjects with diabetes and their matched controls obtained comparable qualifications at all levels. However, subjects with diabetes were less likely to feel competent with regard to their educational performance, and many of this group reported experiencing difficulties at school. There were no differences in the proportion of each group who had experienced unemployment, although this was explained more by social class and educational attainment. Whereas only a minority had decided to withhold information about their condition from their employers, one‐third of those with diabetes had experienced health‐related problems in obtaining employment.This study suggests that the educational achievements and employment experiences of young adults with diabetes may not differ from those of healthy controls. However subjective reports of difficulties in these areas may be associated with reduced self‐esteem. Confirmation of these findings should be carried out in a larger sample, using a prospective design.
Effect of Chronic ACE Inhibition on Glucose Tolerance and Insulin Sensitivity in Hypertensive Type 2 Diabetic Patients
Authors: Seghieri G. , Yin W. , Boni C. , Sanna G. , Anichini R. , Bartolomei G. , Ferrannini E. 
Published: July 2009

The question, of whether long‐term treatment of essential hypertension with angiotensin‐converting enzyme (ACE) inhibitors is capable of modifying glucose tolerance or insulin sensitivity in Type 2 (non‐insulin dependent) diabetes, is still unsolved. We studied 14 moderately overweight Type 2 diabetic patients with essential hypertension in stable metabolic control after a run‐in period and again after 3 months of antihypertensive treatment with the ACE inhibitor, Captopril. Glucose tolerance was tested with a 75‐g oral glucose load and insulin sensitivity was measured by the insulin suppression test, while dietary and drug treatment of the diabetes remained constant. In the whole group, mean blood pressure (MBP) fell progressively over 3 months from a baseline value of 123 ± 3 mmHg to a final value of 115 ± 2 mmHg (p < 0.005); in six patients, the change in MBP was < 5 mmHg (non‐responders), thus giving a clinical response rate of ˜60%. After treatment, fasting plasma glucose, insulin, free fatty acid (FFA), potassium, and glycated haemoglobin concentrations were unchanged from baseline. During the oral glucose tolerance test, the incremental glucose area‐under‐curve was 0.75 ± 0.05 mol 120 min I−1 before and 0.76 ± 0.06 mol 120 min I−1 after treatment (p = ns). Endogenous insulin response and suppression of plasma FFA levels were superimposable on the two occasions. During the insulin suppression test, steady‐state plasma glucose levels were 14.4 ± 1.3 vs 14.2 ±1.1 mmol I−1 before and after chronic ACE inhibition, respectively, at comparable hyperinsulinaemic plateaux (291 ± 21 vs 287 ± 14 pmol I−1). Neither endogenous (oral glucose) nor exogenous (insulin suppression test) insulin caused any change in plasma potassium concentrations. This resistance to the hypokalemic action of insulin was not affected by Captopril. The eight blood pressure responders, or the seven patients with less fasting hyperglycaemia, had similar baseline characteristics as the whole group, and likewise showed no significant treatment‐related change in glucose tolerance or insulin sensitivity.We conclude that chronic ACE inhibition does not change glucose tolerance, endogenous insulin response, and sensitivity of glucose disposal, lipolysis, and potassium metabolism to insulin in stable Type 2 diabetic patients whose glycaemic control by other means (diet and/or drugs) is held constant.
Morning versus Bedtime Isophane Insulin in Type 2 (Non‐insulin dependent) Diabetes Mellitus
Authors: Seigler D.E. , Olsson G.M. , Skyler J.S. 
Published: July 2009

Morning versus bedtime administration of NPH insulin was compared in 12 subjects with Type 2 diabetes and overt fasting hyperglycaemia. Subjects were studied at baseline (diet alone) and after 2 months on each of the two insulin programmes in a random crossover design, in which dosage was increased until at least one daily preprandial blood glucose was consistently in the range of 3.9 to 6.0 mmol l‐1. Mean (± SEM) daily total insulin dosage was equivalent for the morning (0.36 ± 0.03 units kg−1) and for the bedtime (0.37 ± 0.03 units kg−1) insulin administration schedules. Glycaemic control was improved on both insulin regimens, but was better on bedtime than morning insulin. Fasting plasma glucose (mmol I−1) was 12.0 ± 0.7 (baseline), 8.6 ± 0.7 (morning), and 4.6 ± 0.3 (bedtime), respectively. Mean 24 h plasma glucose (mmol I−1) was 13.3 ± 1.3, 9.0 ±0.7, and 7.8 ± 0.7. Glycated haemoglobin (%) was 7.65 ± 0.35, 6.23 ± 0.26, and 5.81 ± 0.32. The improvement of basal glycaemia is a consequence of increased basal metabolic clearance of glucose (baseline, 47.6 ± 3.1 ml m−2 min‐1; morning 63.5 ± 5.4, bedtime 103.5 ± 7.1). There was no change in hepatic glucose output.it is concluded that bedtime administration of intermediate acting insulin results in increased basal insulinaemia, leading to improved basal glycaemia and consequent improved overall metabolic control, compared to morning insulin administration. Therefore, bedtime may be the preferable timing of insulin therapy for patients with Type 2 diabetes and overt fasting hyperglycaemia.
Variations in the Management of Diabetic Ketoacidosis in Children
Authors: Edge J.A. , Dunger D.B. 
Published: July 2009

Cerebral oedema which develops during the treatment of diabetic ketoacidosis is an important cause of mortality and morbidity in children. We examined 25 management protocols from throughout the UK and related variations in fluid, bicarbonate, insulin, and potassium regimens to the incidence of cerebral oedema recalled in each centre. Treatment of shock ranged from 5 to 25 (median 20) ml kg‐1 plasma (5 recommended 0.9% saline only) over 10–60 min. Subsequent fluid regimens used 0.9% saline in 24 (0.45% saline in 1); 8 used 0.45% saline if hypernatraemia was present. The rehydration period ranged from 24 h (n = 20) to 48 h (n = 1) and was based on steady (n = 12) or irregular (n = 13) replacement. The quantity of potassium added to fluids was 20–80 (median 30) mmol I−1. Eight centres recalled having seen 1–5 (median 2) cases of cerebral oedema in the past 5 yr, 10 centres recalled none. Compared with the 10 centres without cerebral oedema, protocols from the 8 with cerebral oedema used more plasma to resuscitate (22 ± 3 (mean ± SD) vs 18 ± 4ml kg−1; p < 0.025), suggested larger maintenance fluid volumes for ages 6–9 yr (81 ± 2 vs 70 ± 11 ml kg−1 day−1; p < 0.005) and were more likely to change to 0.18% saline when blood glucose had fallen (8/8 vs 5/10) than 0.45% saline (0/8 vs. 5/10; p < 0.05).Free water overload may contribute to cerebral oedema. These data strengthen the case for a nationally agreed protocol and a prospective study of the antecedents to the development of cerebral oedema.