bluuebunny/crossref_metadata_2025_split huggingface dataset:
Symptoms of Acute Insulin-Induced Hypoglycemia in Humans With and Without IDDM: Factor-Analysis Approach
Authors: Hepburn David A , Deary Ian J , Frier Brian M , Patrick Alan W , Quinn John D , Fisher B Miles 
Published: March 2007

Objective
This study allocated the symptoms identified during acute hypoglycemia objectively to the autonomic or neuroglycopenic groups of symptoms by the use of factor analysis.

Research Design and Methods
Twenty-five nondiabetic subjects, 14 newly diagnosed insulin-dependent diabetic patients, and 16 insulin-dependent diabetic patients with diabetes &gt; 4 yr duration were studied. Acute hypoglycemia was induced with insulin (2.5 mU·kg−1 body wt·min−1 i.v.), and symptoms of hypoglycemia were recorded with a seven-point scale at regular time points throughout the studies. Factor analysis of the symptom scores at the time of the acute autonomic reaction with principal component analysis followed by Varimax rotation was used to separate those symptoms that might belong to neuroglycopenic and autonomic groups.

Results
Hypoglycemia was induced to a mean ± SE plasma glucose nadir of 1.3 ± 0.1 mM in nondiabetic subjects, to 2.0 ± 0.3 mM in newly diagnosed diabetic patients, and 1.4 ± 0.2 mM in patients with diabetes of &gt; 4 yr duration. The most frequently reported autonomic symptoms were sweating, trembling, and warmness, and the most frequently reported neuroglycopenic symptoms were inability to concentrate, weakness, and drowsiness. Neuroglycopenic symptoms were reported more commonly at the onset of hypoglycemia, which was identified by the development of symptoms. Factor analysis grouped trembling, anxiety, sweating, warmness, and nausea together, and this grouping was labeled an autonomic factor. A second factor was identified that included dizziness, confusion, tiredness, difficulty in speaking, shivering, drowsiness, and inability to concentrate, which was labeled a neuroglycopenic factor.

Conclusions
This study demonstrated the high frequency with which neuroglycopenic symptoms occur at the onset of hypoglycemia and the symptoms that could be used by an individual patient as a warning of the development of acute hypoglycemia, although the rapid reduction of plasma glucose is faster than experienced by the ambulant diabetic patient. Factor analysis assisted with the allocation of symptoms to either the autonomic or neuroglycopenic groupings, but the allocation of some symptoms remained undefined, and care must be taken when assessing symptoms such as hunger, weakness, blurred vision, and drowsiness when comparing the frequency of autonomic versus neuroglycopenic symptoms. To reduce the confusion resulting from the use of different symptom questionnaires in studies of hypoglycemia, a sample questionnaire is presented, the development of which was assisted by our analysis.
Relationship Between Prevalence of Impaired Glucose Tolerance and NIDDM in a Population
Authors: Dowse Gary K , Zimmet Paul Z , King Hilary 
Published: March 2007

Objective
To study the relationship between the prevalence of impaired glucose tolerance (IGT) and non-insulin-dependent diabetes mellitus (NIDDM) across populations of the Pacific Ocean region to assess whether variability in those two proportions followed some predictable pattern related to modernization of life-style and risk factor levels.

Research Design and Methods
Prevalence estimates from studies with 75-g oral glucose loads and World Health Organization criteria were age standardized.

Results
The linear correlation between IGT and NIDDM prevalence was poor (0.22 in men and 0.24 in women), although it was improved when the outlying data of Micronesian Nauruans and Australian Aborigines were excluded (r = 0.65, P &lt; 0.01 in men and r = 0.54, P &lt; 0.01 in women). However, an epidemicity index calculated as the percentage of total glucose intolerance (TGI) made up by IGT (i.e., IGT/TGI) had the strongest correlation with NIDDM prevalence (r = −0.81, P &lt; 0.001 in men and r = −0.77, P &lt; 0.001 in women) and also explained more of its variance, with no population having undue influence on the relationship. When IGT/TGI was plotted against NIDDM prevalence for the genetically homogeneous rural (relatively traditional) and urban (modernized) segments of five Pacific island populations, there was a clear tendency for IGT/TGI to decline as the prevalence of NIDDM increased in association with worsening risk factor levels. However, longitudinal data for the high prevalence population of Nauru demonstrated that at least in a stabilizing epidemic, changes in the prevalence of IGT and NIDDM may not be easily predictable.

Conclusions
The epidemicity index may be useful as an indicator of the potential for higher future NIDDM prevalence in whole populations. Populations will probably equilibrate at a certain NIDDM prevalence dependent on the strength of their genetic susceptibility to the disease and their degree of exposure to adverse environmental risk factors, including modern diet, physical inactivity, and obesity.
Multicenter Survey of Diabetic Pregnancy in France
Authors:   Gestation and Diabetes in France Study Group
Published: March 2007

Objective
To describe the medical care and outcome of diabetic pregnancy and gestational diabetes in France and study their associations with glycemic control.

Research Design and Methods
We performed a multicenter prospective survey with systematic collection of clinical and biological data (HbA1c analysis in a central laboratory) at five successive examinations and consecutive recruitment of women at any stage of pregnancy in 46 specialized centers from all parts of France. Pregnancies were followed to the end. There were 483 single pregnancies (232 women with insulin-dependent diabetes mellitus [IDDM], 78 with non-insulin-dependent diabetes mellitus [NIDDM], and 173 with gestational diabetes mellitus [GDM]), and 11 twin births (8 IDDM, 3 GDM).

Results
We observed 30 abortions (6%), 8 perinatal deaths (1.8%, 4 IDDM, 4 GDM), and 13 congenital malformations (3%). In the 11 twin pregnancies, there were 7 congenital malformations. Premature births and cesarean sections were found very frequently (42 and 61% IDDM, 29 and 55% NIDDM, 22 and 32% GDM, respectively). In the three groups, birth weight adjusted for gestational age was much &gt; national reference values. HbA1c levels during the first trimester were significantly higher in women who aborted (mean ± SE 7.1 ± 0.4 vs. 5.6 ± 0.1%, P &lt; 0.001) and those who gave birth to malformed infants (6.8 ± 0.4 vs. 5.9 ± 0.1%, P &lt; 0.05).

Conclusions
Perinatal mortality was slightly higher in diabetic women than the general population (1.8 vs. 1.2%), but the prematurity rate was much higher, possibly due to an interventionist policy in some centers. Fetal loss and congenital malformations were associated with poor glycemic control.
Reproducibility of Glucose and Insulin Responses to Mixed Meal in Type II Diabetic Patients
Authors: Le Floch Jean-Pierre , Baudin Eric , Escuyer Philippe , Wirquin Evelyne , Yomtov Bernard , Perlemuter Léon 
Published: March 2007

Objective
The reproducibility of glucose and insulin responses to a mixed meal were studied in 24 consecutive non-insulin-dependent (type II) diabetic patients, the diet of which matched the tested diet. Patients received their usual treatment throughout the study.

Research Design and Methods
A standardized diet was followed for 3 days, and responses were measured on the 2nd and 3rd days. Glucose and insulin responses were studied after lunches with the 180-min positive area under the curve, and were analyzed with paired ttest and Pearson's linear regression.

Results
Glucose responses did not vary (217 ± 50 vs. 217 ± 38 min × mM, NS) and were significantly correlated (r = 0.64, P &lt;0.01). Insulin responses did not vary (35,224 ± 5768 vs. 35,305 ± 7779 min ' pM, NS) and were strongly correlated (r = 0.83, P &lt;0.001).

Conclusions
These results suggest that glucose and insulin responses to a test meal are reproducible in type II diabetic patients.
Plasma Catecholamine Responses to Hypoglycemia in Children and Adolescents With IDDM
Authors: Hoffman Robert P , Singer-Granick Carol , Drash Allan L , Becker Dorothy J 
Published: March 2007

Objective
The goal of this study was to assess whether children and adolescents with insulin-dependent diabetes mellitus (IDDM) have decreased catecholamine responses to insulin-induced hypoglycemia as has been reported in adults and to explore the pathogenesis of the decreased response in terms of possible relationships to autonomic neuropathy or hyperinsulinism.

Research Design and Methods
A before-and-after trial on the effects of 3 days of intensive insulin therapy was conducted on 60 subjects with IDDM (age 15.4 ± 2.6 yr, duration of diabetes 7.8 ± 3.5 yr). The control group consisted of 5 children with non-growth hormone-deficient short stature (age 14.8 ± 3.2 yr). Hypoglycemia was induced with an intravenous insulin bolus (0.15–0.75 U/kg) after insulin withdrawal and 3 days of intensive insulin therapy in diabetic subjects on an inpatient basis to assess the role of hyperinsulinism in suppressing the catecholamine response to hypoglycemia. Control subjects were studied once and received an insulin bolus of 0.1 µU/kg. Autonomic neuropathy was assessed by computerized assessment of the basal R-R variation during inspiration and expiration and the pancreatic polypeptide response to hypoglycemia.

Results
Basal plasma catecholamine levels were lower in diabetic subjects after intensive insulin therapy than in control subjects (P = 0.008). The peak and incremental catecholamine responses after insulin withdrawal and intensive insulin therapy in IDDM subjects were significantly decreased compared with control subjects (P &lt; 0.001). Peak catecholamine responses to hypoglycemia in IDDM were decreased after intensive insulin therapy (P = 0.002). This was particularly true in those with plasma glucose nadir levels of &lt; 2.2 mmol (P &lt; 0.001). The diminished catecholamine responses were primarily due to decreased peak epinephrine responses after intensive insulin therapy compared with insulin withdrawal (P = 0.011). There were no significant correlations between the catecholamine response to hypoglycemia and age, duration of diabetes, pancreatic polypeptide, or R-R interval.

Conclusions
These results suggest that children and adolescents with IDDM after insulin withdrawal have diminished catecholamine response to hypoglycemia compared with control subjects and indicate that short-term intensive insulin therapy diminishes this response further. Thus, hyperinsulinism may play a role in suppressing the catecholamine response to hypoglycemia. There is no evidence for a clinical or subclinical role of autonomic neuropathy to explain the altered catecholamine responses.
Improvement of Insulin-Induced Glucose Disposal in Obese Patients With NIDDM After 1-Wk Treatment With d-Fenfluramine
Authors: Scheen André J , Paolisso Giuseppe , Salvatore Teresa , Lefèbvre Pierre J 
Published: March 2007

Objective
To study the short-term effects of the serotoninergic anorectic drug d-fenfluramine on insulininduced glucose disposal.

Research Design and Methods
A randomized double-blind placebocontrolled crossover trial with 1-wk treatment periods (2 × 15 mg/day d-fenfluramine) was conducted. Twenty obese subjects, 10 with normal oral glucose tolerance and 10 with non-insulin-dependent diabetes mellitus (NIDDM), were all treated with a weight-maintaining diet. Euglycemic-hyperinsulinemic glucose clamps with measurement of glucose kinetics with D-[3-3H]glucose were performed at either two (patients without NIDDM, 0.05 and 0.10 U · kg−1 · h−1) or three (patients with NIDDM, 0.05, 0.10, and 0.50 U · kg−1 · h−1) insulin delivery rates.

Results
In the n·ndiabetic subjects, no significant changes in any metabolic or hormonal parameter were measured in the basal state or during the clamp despite a slight reduction in body weight (−1.2 ± 0.5 kg, P &lt; 0.05). In the diabetic patients, no significant changes in body weight or basal plasma insulin levels were observed, but fasting blood glucose levels (8.0 ± 0.8 vs. 9.4 ± 1.1 mM, P &lt; 0.005) and plasma free fatty acid concentrations (1150 ± 227 vs. 1640 ± 184 µM, P &lt; 0.05) were significantly reduced after d-fenfluramine compared with placebo. During the clamp, insulin metabolic clearance rate (MCR) was similar after both placebo and d-fenfluramine; endogenous (hepatic) glucose production was similarly and almost completely suppressed, whereas glucose disposal was remarkably enhanced after cMenfluramine (average increase of glucose MCR 35 ± 12%, P &lt; 0.02).

Conclusions
Whatever the mechanism(s) involved, a 1-wk treatment with d-fenfluramine induces better blood glucose control and improves insulin sensitivity in obese patients with NIDDM independent of significant weight reduction; this last effect is not present in obese subjects with normal oral glucose tolerance.
Differential Effect of Diabetes Education on Self-Regulation and Life-Style Behaviors
Authors: Rubin Richard R , Peyrot Mark , Saudek Christopher D 
Published: March 2007

Objective
To examine the effect of diabetes education on self-regulation and life-style behaviors.

Research Design and Methods
Participants in an outpatient diabetes education program completed a protocol measuring several self-care behaviors and glycemic control at entry (n = 165) and 6 (n = 124) and 12 (n = 89) mo after the program.

Results
Improvement was noted at 6 mo for most self-care behaviors and glycemic control. At 12 mo, lower glycosylated hemoglobin levels were maintained (P &lt; 0.001) without increases in perceived hypoglycemia. Improvement was not maintained for those self-care behaviors that require change in life-style, i.e., diet and exercise. However, self-care behaviors that allow patients to self-regulate their glycemic control—self-monitoring of blood glucose and insulin dose self-adjustment—were improved at 12 mo over preprogram levels (P &lt; 0.001). Frequency of insulin self-adjustment continued to increase during the period between follow-ups.

Conclusions
The findings suggest that diabetes education is effective in promoting self-regulation behaviors, although it has less effect on traditional regimen behaviors such as diet and exercise.
Evolution of Glomerular Filtration Rate in Proteinuric NIDDM Patients
Authors: Friedman Rogério , Gross Jorge .L 
Published: March 2007

Objective
To evaluate, by means of a precise method, the rate of decline of glomerular filtration rate in proteinuric non-insulin-dependent diabetic (NIDDM) patients.

Research Degisn and Methods
The study was comprised of seven NIDDM patients who visited an outpatient clinic and had a 24-h urinary protein excretion rate ≥500 mg in the absence of heart failure, urinary tract infection, or other nephropathies.

Results
Glomerular filtration rate (51Cr-labeled EDTA, single-injection protocol) and 24-h proteinuria (turbidimetric method) were assessed at periodic intervals (2–6 mo). Correlation of the measurements with time (Pearson's r, with Student's t test used to assess the significance, α = 0.05) was used to evaluate the trend of evolution of glomerular filtration rate. Renal biopsies were performed in four patients. In three of four patients, renal histopathology was consistent with the diagnosis of diabetic nephropathy (in the 4th patient measurements were not satisfactory). Neither glomerular filtration rate nor proteinuria correlated significantly with time, except in one patient who had multiple myeloma.

Conclusions
The decline of glomerular filtration rate in proteinuric NIDDM patients is different from that observed in insulin-dependent diabetic patients, which is probably much slower.
Effect of Aldose Reductase Inhibition on Resistance to Ischemic Conduction Block in Diabetic Subjects
Authors: Price David E , Alani Shakir M , Wales John K 
Published: March 2007

Objective
To study the effect of aldose reductase inhibition with ponalrestat on resistance to ischemic conduction block (RICB) in diabetic subjects.

Research Design And Methods
Twenty-one healthy diabetic subjects without neuropathy were studied. Subjects were randomized to take either a double-blind trial of 600 mg ponalrestat or placebo once daily for 6 wk. The median nerve action potential (MNAP) and conduction velocity (NCV), before and after 20 min of forearm ischemia, were measured at the start and finish of the study.

Results
RICB (MNAP remaining after ischemia) decreased from 39.5 to 29.4% in the ponalrestat-treated group (P &lt; 0.05) and increased from 48.1 ± 10.2 to 49.5 ± 6.5% in the placebo-treated group. MNAP and NCV were unchanged in both groups.

Conclusions
Aldose reductase inhibition with ponalrestat partly reverses RICB in diabetes, perhaps by improving nerve hypoxia or reducing nerve energy substrates.
Hypoglycemia Due to Surreptitious Injection of Insulin: Identification of Insulin Species by High-Performance Liquid Chromatography
Authors: Given Burce D , Ostrega Diane M , Polonsky Kenneth S , Baldwin David , Kelley Richard I , Rubenstein Arthur H 
Published: March 2007

Objective
To identify the circulating species of insulin after separation by high-performance liquid chromatography (HPLC) in patients with factitious hypoglycemia.

Research Design and Methods
In three of four patients presented, the diagnosis of surreptitious insulin injection was made by documenting the presence of animal insulin in the circulation after separation of the circulating insulin forms by HPLC.

Results
Animal insulin was identified.

Conclusions
Thus, the identification of the circulating form of insulin in the circulation by HPLC may be a useful adjunct in the diagnosis of factitious hypoglycemia if animal insulin has been injected and if the simultaneously measured concentrations of insulin and C-peptide are inconclusive.
Kinetics of Zinc Status in Children With IDDM
Authors: Nakamura Toshiro , Higashi Akimasa , Nishiyama Soroku , Fujimoto Shigehiro , Matsuda Ichiro 
Published: March 2007

Objective
To ascertain zinc deficiency in patients with insulin-dependent diabetes mellitus (IDDM) and evaluate the relationship between zinc clearance and body height velocity.

Research Design and Methods
Six boys and 11 girls with IDDM and zincuria and glycosuria were studied. Study quality and specific descriptive information concerning relationship and outcome measurement were assessed.

Results
The values of total-body zinc clearance in IDDM patients were higher than in the control subjects (24.6 ± 1.8 vs. 15.1 ± 0.6 ml · kg−1.h−1, P &lt; 0.01). There was a negative correlation between body zinc clearance values and height velocity in IDDM patients.

Conclusions
Patients with IDDM have a secondary zinc deficiency, and normal growth may be stunted.
Clinic Attendance and Glycemic Control: Study of Contrasting Groups of Patients With IDDM
Authors: Jacobson Alan M , Adler Andrew G , Derby Laura , Anderson Barbara J , Wolfsdorf Joseph I 
Published: March 2007

Objective
To assess factors associated with attendance at a specialized clinic for diabetes care.

Research Design and Methods
Adults with insulin-dependent diabetes mellitus (IDDM) in poor (HbA1 ≥ to 12%) versus good (HbA1 ≤ 10%) control and with no known complications comprised the study group.

Results
Infrequent attenders were in worse glycemic control than regular attenders (χ 2 = 6.60, P ≤ 0.01) and held health beliefs that downplayed the importance of getting advice from physicians (P ≤ 0.002) or providing opinions to physicians about what might be done to improve their health (P ≤ 0.001).

Conclusions
Because infrequent attenders are more likely to be in poor glycemic control and thus at greater risk for diabetic complications, engaging them in regularly supervised treatment has important personal and public health implications. Additional studies are needed to understand why some diabetic patients limit their contact with medical providers and to develop more effective strategies for reversing this process. Initial findings from this study suggest that patient beliefs about the doctor-patient relationship may influence clinic attendance.
Reported Practice Behaviors for Medical Care of Patients With Diabetes Mellitus by Primary-Care Physicians in Pennsylvania
Authors: Jacques CHM , Jones Robert L , Houts Peter , Bauer Laurence C , Dwyer Kathleen M , Lynch James C , Maria Casale Toni San 
Published: March 2007

Objective
To compare the American Diabetes Association standards for the medical care of diabetic patients with reported care patterns.

Research Design and Methods
These standards were compared with reported care patterns obtained from a stratified random telephone survey of general practitioners, family physicians, and general internists in Pennsylvania. A total of 610 physicians completed the survey for a response rate of 73%.

Results
All primary-care physicians reported measurement of glycosylated hemoglobin, routine referrals to eye doctors, and patient self-monitoring of blood glucose &lt; recommended. Nearly all physicians performed foot exams, but the exams were infrequent for many of the physicians. Significant and independent differences (P &lt; 0.05) were noted between different groups of physicians. Older physicians and general practitioners reported patterns of care most different from the recommended standards for referral to eye doctors, measurement of glycosylated hemoglobin, and use of patient self-monitoring of blood glucose. General practitioners reported the lowest frequency of foot exams.

Conclusions
Educational programs on diabetes for primary-care physicians should focus on reported behaviors most different from recommended standards and may need to target subgroups of physicians to achieve a more uniform level of care for all diabetic patients.
Accuracy of a Filter Paper Method for Measuring Glycosylated Hemoglobin
Authors: Gay Elizabeth C , Cruickshanks Karen J , Chase H Peter , Klingensmith Georgeanne , Hamman Richard F 
Published: March 2007

Objective
–To compare glycosylated hemoglobin (GH) results obtained by filter paper fingerstick collection and mailed for assay by affinity chromatography with results from a venous sample assayed by ion-exchange chromatography (HbA1) in a local laboratory.

Research Design and Methods
–Fifty-eight volunteer subjects with insulin-dependent diabetes mellitus (IDDM), aged 5-24 yr, included patients at a referral-based IDDM clinic and subjects in an ongoing research study. We obtained two blood samples from each subject. One was collected by fingerstick onto filter paper, the other by venipuncture into a vacutainer. We sent filter paper samples to the Diabetes Research Laboratory (Univ. of Missouri, Columbia, MO) for analysis. Vacutainer samples were sent to the Clinical Chemistry Department of the Clinical Laboratory, University of Colorado Health Sciences Center.

Results
–Results were highly correlated (r = 0.89, P = 0.0001). Fifty-nine percent were classified identically when results were normalized to SD units and grouped to suggest levels of clinical concern.

Conclusions
–The filter paper method is a convenient, accurate measure of glycosylated hemoglobin in young people with IDDM. It should be considered a credible alternative research and clinical tool.