bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decreased red blood cell aggregation subsequent to improved glycaemic control in Type 2 diabetes mellitus
Authors: Chong‐Martinez B. , Buchanan T. A. , Wenby R. B. , Meiselman H. J. 
Published: December 2004

AbstractAims Reports of rheological changes following intensification of metabolic control are limited and not concordant. The present study was designed to test the hypothesis that intensification of management of Type 2 diabetes (T2DM) with diet, exercise and insulin improves haemorheological behaviour by reducing red blood cell (RBC) aggregation.Methods Blood was sampled from 55 subjects before and following 14 ± 3 weeks of intensified management. RBC aggregation was measured in vitro for cells in plasma or in an aggregating 70 kD dextran solution. Plasma viscosity and whole blood viscosity were also measured.Results During treatment, fasting glucose fell 27%, HbA1c fell 21%, and serum triglycerides and total cholesterol fell 28% and 12%, respectively (P < 0.0001 for each). The extent and strength of RBC aggregation in plasma fell by 10–13% (P < 0.002). Similar decreases of RBC aggregation were seen for cells suspended in dextran (P < 0.002). Plasma viscosity decreased by 3% (P < 0.02) and high shear blood viscosity by 6–7% (P < 0.0001). Changes of RBC aggregation in plasma and in dextran were significantly correlated, supporting a cellular rather than a plasmatic origin for these changes. However, there were no significant correlations between RBC aggregation changes and changes of fasting glucose, HbA1c, serum triglycerides, serum cholesterol, or plasma fibrinogen.Conclusions Intensified metabolic control results in a reduction of RBC aggregation that appears to be intrinsic to RBC. Since increased RBC aggregation can impair microcirculatory flow, it is possible that haemorheological factors may contribute to the reduction of microvascular complications resulting from improved metabolic control in T2DM.
How should peripheral neuropathy be assessed in people with diabetes in primary care? A population‐based comparison of four measures
Authors: Rahman M. , Griffin S. J. , Rathmann W. , Wareham N. J. 
Published: December 2004

AbstractAims To test the accuracy of four measures of peripheral diabetic neuropathy in a primary care population.Methods Type 2 diabetic (n = 544) and 544 non‐diabetic participants aged 45–76 years were randomly selected from general practice registers. Neuropathy was assessed using vibration threshold (VT) and scores for light touch, thermal sense and modified Michigan Neuropathy Screening Instrument questionnaire. These measures were assessed for variation with diabetes status, age, diabetes duration, HbA1c, and presence of retinopathy and nephropathy. Light touch, thermal sense and questionnaire scores were assessed against VT using ROC curve analysis.Results Only VT and light touch were different between diabetic and non‐diabetic groups (P = 0.02 and < 0.0001, respectively). All measures were significantly associated with diabetes duration and retinopathy, and all except questionnaire score (P = 0.14) with age. None was associated with nephropathy and only questionnaire score was associated with HbA1c (P = 0.033). VT varied as expected across scores of light touch (χ2 = 41.65, P = 0.0001), thermal sense (χ2 = 15.86, P = 0.015) and questionnaire (χ2 = 21.22, P = 0.047). Area under the curve values for light touch, thermal and questionnaire scores were 0.72 (95% confidence interval (CI) 0.63, 0.82), 0.63 (95% CI 0.52, 0.73) and 0.64 (95% CI 0.53, 0.74), respectively.Conclusions All measures had associations with risk factors for neuropathy, but light touch score (monofilament) had the strongest association with vibration threshold (the chosen gold standard) and thus appeared the most appropriate tool for use in primary care, because of its validity and simplicity of use.Diabet. Med. 20, 368–374 (2003)
Metabolic and cardiovascular effects of very‐low‐calorie diet therapy in obese patients with Type 2 diabetes in secondary failure: outcomes after 1 year
Authors: Dhindsa P. , Scott A. R. , Donnelly R. 
Published: December 2004

AbstractAims To evaluate the short‐term and 1‐year outcomes of an intensive very‐low‐calorie diet (VLCD) on metabolic and cardiovascular variables in obese patients with Type 2 diabetes (T2DM) and symptomatic hyperglycaemia despite combination oral anti‐diabetic therapy ± insulin, and to assess patient acceptability and the feasibility of administering VLCD treatment to this subgroup of patients in a routine practice setting.Methods Forty obese patients with T2DM (22 M, mean age 52 years, body mass index (BMI) 40 kg/m2, duration of T2DM 6.1 years) and symptomatic hyperglycaemia despite combination oral therapy (n = 26) or insulin + metformin (n = 14) received 8 weeks of VLCD therapy (750 kcal/day) followed by standard diet and exercise advice at 2–3‐month intervals up to 1 year. Insulin was discontinued at the start of the VLCD, and anti‐diabetic therapy was adjusted individually throughout the study, including (re)commencement of insulin as required.Results Immediate improvements in symptoms and early weight loss reinforced good compliance and patient satisfaction. After 8 weeks of VLCD, body weight and BMI had fallen significantly: 119 ± 19–107 ± 18 kg and 40.6–36.6 kg/m2, respectively, with favourable reductions in serum total cholesterol (5.9–4.9 mm), blood pressure (10/6 mmHg) and fructosamine (386 ± 73–346 ± 49 µm) (equates to an HbA1c reduction of approximately 1%). Sustained improvements were evident after 1 year, with minimal weight regain, e.g. mean body weight 109 ± 18 kg and BMI 37 ± 4 kg/m2. Glycaemic control tended to deteriorate after 1 year.Conclusions The absence of a control group is a major limitation, but the results indicate that 8 weeks of VLCD treatment may be effective and well tolerated in symptomatic obese patients with T2DM in secondary failure, producing sustained cardiovascular and metabolic improvements after 1 year. VLCD therapy is a treatment option that deserves greater consideration in this difficult‐to‐treat patient population.
An assessment of care of paediatric and adolescent patients with diabetes in a large district general hospital
Authors: Barton D. M. , Baskar V. , Kamalakannan D. , Buch H. N. , Gone K. , Wilson E. , Anderson J. , Abdu T. A. M. 
Published: December 2004

AbstractAims To assess the process of clinical care and outcomes of young patients with diabetes attending clinics at a large district general hospital.Methods Retrospective analysis of data obtained from 106 case notes of patients aged 12–22 years attending the paediatric, combined adolescent or adult diabetes clinics between 1998 and 2000. The frequency of follow‐up, rate of admission, glycaemic control, systolic blood pressure, weight change and screening for complications were assessed.Results The mean attendance rate was 78%. The admission rate was 91 admissions per 1000 patient years. Overall, the mean HbA1c was 9.1% with only 15% of paediatric and adolescent patients having mean HbA1c≤ 8.0%. Mean systolic blood pressure was 124 mmHg. There was a significant increase in obesity with mean weight for height at diagnosis increasing from 89% to 111% after 7 years of diabetes. Mean daily insulin dose was 1.51 U per kg body weight and decreased with increasing age. Screening for complications and associated conditions was variable: 91% for retinopathy, 86% for foot problems, 64% for thyroid dysfunction, 22% for coeliac disease and 10% for microalbuminuria. The overall rate of retinopathy was low at 4% of those screened.Conclusions Providing satisfactory care for young people with diabetes remains a difficult challenge. Although the complication rate observed was low in this group, the most important issues are the need for improvement in glycaemic control, weight gain and high drop‐out rate.Diabet. Med. 20, 394–398 (2003)
The cost‐effectiveness of continuous subcutaneous insulin infusion compared with multiple daily injections for the management of diabetes
Authors: Scuffham P. , Carr L. 
Published: December 2004

AbstractAimsTo estimate the cost effectiveness of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) for patients using insulin pumps.MethodsWe constructed a Markov model to estimate the costs and outcomes for patients with insulin‐dependent diabetes (IDDM) treated with CSII using an insulin pump compared with MDI. Key parameters were obtained from the published scientific literature. The primary outcome was quality‐adjusted life years (QALYs). Monte Carlo simulations were undertaken for 10 000 hypothetical patients over 8 years of monthly cycles (the expected life of a pump).ResultsOver an 8‐year period an average patient could expect to gain 0.48 [standard deviation (sd) 0.20] QALYs using CSII compared with MDI. The additional cost over 8 years for this gain was £5462 (sd£897). The incremental cost per QALY was £11 461 (sd£3656). CSII was most cost‐effective in patients who had more than two severe hypoglycaemic events per year and who required admission to hospital at least once every year. Cases where CSII might be not economically viable are cases where diabetes is well controlled with few severe hypoglycaemic events. Results were most sensitive to the number of hypoglycaemic events per patient and the utility weights used to estimate QALYs.ConclusionCSII is a worthwhile investment when targeted to those who might benefit most.Diabet. Med. 20, 586–593 (2003)
Safety and efficacy of insulin glargine (HOE 901) versus NPH insulin in combination with oral treatment in Type 2 diabetic patients
Authors:   HOE 901/2004 Study Investigators Group
Published: December 2004

AbstractAims A European, randomized, 29‐centre, open‐label study compared the safety and efficacy of two formulations of insulin glargine and neutral protamine Hagedorn (NPH) human insulin, in combination with oral agents, in patients with Type 2 diabetes mellitus (DM).Methods Two‐hundred‐and‐four patients with Type 2 DM, in whom oral treatment alone was inadequate, were randomized to insulin glargine with 30 µg/ml zinc [insulin glargine (30)], or insulin glargine with 80 µg/ml zinc [insulin glargine (80)] or NPH insulin subcutaneously once daily. Insulin was titrated to aim for fasting blood glucose (FBG) values between 4 and 7 mmol/l. All participants received oral therapy during the 3‐week titration phase and 1‐week maintenance phase of the trial.Results No differences between treatment groups were observed in adjusted mean fasting plasma glucose; significant decreases of 3.4 mmol/l, 3.5 mmol/l and 3.1 mmol/l were observed within the insulin glargine (30), insulin glargine (80) and NPH insulin groups, respectively (P < 0.0001 in each case). No differences between groups, but significant changes within groups, were observed in self‐monitored FBG, mean FBG, blood glucose profile, stability of FBG, nocturnal blood glucose, fasting serum C‐peptide, non‐esterified fatty acids, haemoglobin A1c, fructosamine and fasting serum insulin. A significantly greater proportion of NPH insulin patients experienced symptomatic nocturnal hypoglycaemia (19.1 NPH group vs. 7.3% glargine groups; P = 0.0123). Both insulins were well tolerated; one patient in each group experienced an injection site reaction.Conclusions Insulin glargine is as safe and effective as NPH insulin given once daily and in this study caused fewer episodes of nocturnal hypoglycaemia.Diabet. Med. 20, 545–551 (2003)
Hypertension in people with Type 2 diabetes: knowledge‐based diabetes‐specific guidelines
Authors:   Working Party of the International Diabetes Federation (European Region)
Published: December 2004

AbstractThe International Diabetes Federation (Europe) has updated these guidelines on hypertension management specifically in Type 2 diabetes in the light of recent results of the first prospective, randomized controlled studies to investigate clinical outcomes in people with diabetes and hypertension. The guidelines are knowledge based, i.e. based not only on evidence originating from clinical trials, but also from epidemiological and pathophysiological studies. A successful management strategy requires the following components:

Regular surveillance to detect developing hypertension and other cardiovascular (CV) risk factors.
Considering more frequent monitoring and review of CV risk factors if any single blood pressure (BP) measurement > 140/85 mmHg (or 130/75 if microalbuminuria); when appropriate, using ambulatory or home monitoring to establish the baseline BP.
Considering other CV risk factors, such as a raised albumin excretion rate, in setting the intervention threshold.
Individualizing the target BP in accordance with other CV risk factors.
Agreeing lifestyle and therapeutic interventions with the patient, with education and empowerment as required.
Implementing lifestyle modifications, including controlling calorie, salt and alcohol intake, increased physical activity, weight control and smoking cessation.
Therapeutic strategy: the primary goal of therapy is to reduce BP markedly. Combination therapy is often necessary, e.g. an angiotensin converting enzyme (ACE) inhibitor and a diuretic. Some classes are particularly useful for certain patients, notably longer‐acting ACE inhibitors, angiotensin 2 receptor antagonists (A2RAs) and calcium antagonists in those at risk of diabetic nephropathy, loop diuretics and thiazides in those at risk of hyperkalaemia, β‐blockers and calcium antagonists (except short‐acting dihydropyridines) in patients with angina, β‐blockers and ACE inhibitors after a myocardial infarction or in those with left ventricular dysfunction, and thiazide diuretics and long‐acting dihydropyridine calcium antagonists for isolated systolic hypertension. A2RAs should be particularly considered when ACE inhibitors are not tolerated. α1‐Blockers should not be considered first line in the absence of outcome data. Cost of drugs will modify these strategies in developing countries.
Monitoring response to therapies and, if target levels are not achieved, either intensifying drug therapy if the CV risk justifies it, or reassessing the target.
Maintaining a quality assurance strategy.

This strategy is summarized in a simple, practical management algorithm.
The impact of screening for Type 2 diabetes in siblings of patients with established diabetes
Authors: Farmer A. J. , Doll H. , Levy J. C. , Salkovskis P. M. 
Published: December 2004

AbstractBackground  Targeted screening for Type 2 diabetes has been proposed as a method of identifying people with, or at risk of, the disease in order to implement preventive care.Aim  To assess the changes in anxiety, well‐being, and cognitions associated with screening for Type 2 diabetes in people at increased risk of diabetes after 1 year; and to identify potential predictors of increased anxiety and lower well being over this period.Design and setting  One‐year follow up of a cohort of non‐diabetic siblings of those with Type 2 diabetes registered with general practitioners in Oxfordshire and Northamptonshire who were identified for participation in a programme to undertake sib‐pair genetic analysis.Methods  Potential families were selected through identification of people with Type 2 diabetes. Family members aged 35–74 years, who did not have diabetes and who were willing to participate in the study, completed measures before receiving the results of a fasting plasma glucose test, and 1 year later. Measures included the Spielberger State Anxiety Scale‐short form (SSAI‐SF), the Well‐Being Questionnaire 12 item scale (WBQ‐12), and measures of cognitions about developing diabetes. The Health Anxiety Inventory (HAI) was completed before receiving the results of the tests to assess its relationship with anxiety at 1 year.Results  A cohort of 431 individuals was identified, of whom 328 (76%) returned fully completed WBQ scales both initially and at 1 year. State anxiety measured with the SSAI‐SF fell from 34.5 (95% CI 33.4–35.6) to 32.3 (31.2–33.4) at 1 year (P < 0.0001). Mean WBQ‐12 scores rose (i.e. improved) from 26.8 (26.0–27.4) to 27.4 (26.7–28.1) (P = 0.008). SSAI‐SF and WBQ‐12 mean scores over 1 year did not differ between participants receiving a normal or an at‐risk test result. However, those receiving an at‐risk test result were more likely, at 1 year, to consider themselves at increased likelihood of developing diabetes (P < 0.001) and to report thinking about what it would be like to develop diabetes (P = 0.006). A score in the upper tertile of the initial HAI was associated with an increased level of anxiety at 1 year (adjusted odds ratio 2.0, 95% CI 1.2–3.4, P = 0.006).Conclusions  There is no evidence that an ‘at‐risk’ test result leads to sustained anxiety or reduced well being at 1 year compared with those receiving a normal test result. However, further studies are required to clarify levels of anxiety prior to screening to assess the overall impact of the process.Diabet. Med. **, ***–*** (2003)
Insulin sensitivity in physically fit and unfit children of parents with Type 2 diabetes
Authors: Ahn C. W. , Song Y. D. , Nam J. H. , Kim D. M. , Woo S. O. , Park S. W. , Cha B. S. , Lim S. K. , Kim K. R. , Lee J. H. , Lee H. C. , Huh K. B. 
Published: December 2004

AbstractAims  First‐degree relatives of patients with Type 2 diabetes mellitus (T2DM) are often reported to be insulin resistant. We wanted to identify early metabolic abnormalities in this condition, and determine whether they are altered by regular physical training.Methods  We measured insulin sensitivity using the euglycaemic glucose clamp technique and insulin response to oral glucose in 10 unfit (did not participate in routine physical exercise) offspring of T2DM parents and 10 unfit control subjects, and compared them with six fit (routinely swam for 3 h/day 5 days/week) offspring of T2DM parents and six fit controls with no family history of T2DM.Results  Unfit offspring had a higher plasma glucose response than the other three groups. The mean area under the glucose curve was also significantly higher in unfit offspring than in the other three groups (12.6 ± 0.6 vs. 10.4 ± 0.4, 9.6 ± 0.5, and 9.5 ± 0.7 mmol/l per hour for the unfit controls, fit offspring and fit controls, respectively; P < 0.05). The corresponding insulin response of unfit offspring was significantly higher at 60 min in the oral glucose tolerance test (OGTT) that that of fit offspring or fit controls. In addition, the mean area under the insulin curve was significantly greater in unfit offspring than in either fit offspring or fit controls (868 ± 172 vs. 294 ± 71, 287 ± 43 mmol/l per hour, respectively; P < 0.05). Moreover, the glucose disposal rate (GDR), measured using a euglycaemic clamp, was significantly lower in unfit and fit offspring than in unfit and fit controls (5.6 ± 0.3 vs. 8.6 ± 0.3 mg/kg per minute; P < 0.01 and 9.3 ± 0.9 vs. 12.1 ± 0.8 mg/kg per minute, respectively; P < 0.015), whereas the GDR was similar in unfit controls and fit offspring (8.6 ± 0.4 vs. 9.3 ± 0.9 mg/kg per minute; P > 0.05).Conclusion  These results support the concept that early metabolic abnormalities, as reflected by a decreased GDR (insulin sensitivity) in the offspring of T2DM patients, may be improved by increased physical fitness.
The long‐term renal and retinal outcome of childhood‐onset Type 1 diabetes
Authors: Harvey J. N. , Allagoa B. 
Published: December 2004

AbstractAims  To quantify the influence of childhood onset on long‐term renal and retinal outcome in Type 1 diabetes.MethodsWe used a population‐based diabetes register to identify all Type 1 patients diagnosed before age 15 from 1960 to 1982 and resident in a defined catchment area in 1999. Those diagnosed before age 5, aged 5–9 and 10–14 years were compared with a reference group diagnosed at age 21–25 years over the same period.ResultsCompared with adult‐onset controls, proteinuria occurred earlier (P = 0.02) and nephropathy outcome was worse (P = 0.008) in childhood‐onset diabetes. The risk of developing microalbuminuria was greater in childhood‐onset diabetes: odds ratio 2.6 (95% confidence interval 1.4–4.9, P = 0.003). The relative risk of established nephropathy was 3.8 (1.5–9.4, P = 0.005) with childhood onset. The number developing background retinopathy did not differ with age at onset but younger onset patients were more likely to need laser treatment: relative risk 2.1 (1.1–3.8, P = 0.02). This maintained visual outcome which was not significantly different between the various age at onset groups.ConclusionsPatients with onset of Type 1 diabetes before age 15 have substantially worse renal outcome and require more laser treatment than adult‐onset patients. Differences between those with onset before age 5, onset at 5–9 and 10–14 years are small compared with the difference between childhood onset and adult onset. Events in the teenage years therefore appear to have a major adverse effect on the risk of developing long‐term microvascular complications.
The Metabolic Syndrome is an independent predictor of cardiovascular disease in Type 2 diabetic subjects. Prospective data from the Verona Diabetes Complications Study
Authors: Bonora E. , Targher G. , Formentini G. , Calcaterra F. , Lombardi S. , Marini F. , Zenari L. , Saggiani F. , Poli M. , Perbellini S. , Raffaelli A. , Gemma L. , Santi L. , Bonadonna R. C. , Muggeo M. 
Published: December 2004

AbstractAims  To evaluate the cardiovascular risk associated with the presence of the Metabolic Syndrome in Type 2 diabetic subjects.Methods  Subjects with the Metabolic Syndrome, defined by WHO criteria, were identified in a large sample of non‐insulin‐treated Type 2 diabetic patients examined within the Verona Diabetes Complications Study (n = 946). At baseline and after a mean of 4.5 years follow‐up, cardiovascular disease (CVD) was assessed by medical history, physical examination, electrocardiogram (ECG) and echo‐duplex of carotid and lower limb arteries. Death certificates and medical records of subjects who died during the follow‐up were scrutinized in order to identify CVD deaths. In statistical analyses, CVD was considered as an aggregate end‐point, including fatal and non‐fatal coronary, cerebrovascular and peripheral vascular disease as well as ischaemic ECG abnormalities and vascular lesions at the echo‐duplex.Results  The proportion of subjects with the Metabolic Syndrome was very high (92.3%). At the baseline, 31.7% of subjects were coded positive for CVD, which was more prevalent in subjects with the Metabolic Syndrome (32.9 vs. 17.8%, P = 0.005). Among subjects free of CVD at the baseline (n = 559), CVD events during the follow‐up were significantly increased in patients with the Metabolic Syndrome as compared with those without it (19.9% vs. 3.9%, P < 0.001). Multiple logistic regression analysis showed that, along with sex, age, smoking and HbA1c, the presence of the Metabolic Syndrome independently predicted prevalent (OR 2.01, P = 0.045) and incident CVD (OR 4.89, P = 0.031).Conclusions  In Type 2 diabetes, the presence of the Metabolic Syndrome is associated with an almost 5‐fold increase in CVD risk.