bluuebunny/crossref_metadata_2025_split huggingface dataset:
Length rather than a specific allele of dinucleotide repeat in the 5′ upstream region of the aldose reductase gene is associated with diabetic retinopathy
Authors: Fujisawa T. , Ikegami H. , Kawaguchi Y. , Yamato E. , Nakagawa Y. , Shen G. ‐Q. , Fukuda M. , Ogihara T. 
Published: March 2003

Summary Aims To assess the possible contribution of a genetic factor to diabetic retinopathy. Methods (CA)n repeat length was investigated in the 5′ upstream region of the gene coding for aldose reductase (AR), which is a key enzyme of the polyol pathway and plays a role in hyperglycaemia‐induced tissue damage, in Japanese patients with Type 2 DM. Results The dinucleotide repeat length was significantly associated with proliferative diabetic retinopathy (PDR) (P=  0.029, Mann–Whitney U‐test); i.e. shorter alleles were more prevalent in the PDR group than in the control group. Conclusions (CA)n repeat length, rather than a specific allele, in the 5′ upstream region of the AR gene is associated with diabetic retinopathy. These data suggest that the AR locus plays a role in genetic susceptibility to diabetic retinopathy and that dinucleotide repeats in genomic DNA may be related to disease predisposition.
Comparison of questionnaire, breath carbon monoxide and urine cotinine in assessing the smoking habits of Type 2 diabetic patients
Authors: Ismail A. A. , Gill G. V. , Lawton K. , Houghton G. M. , MacFarlane I. A. 
Published: March 2003

Summary Aims Previous studies have suggested that the self‐reporting of smoking amongst diabetic patients is unreliable, and that objective markers such as breath carbon monoxide (CO) or urinary cotinine are needed. As these studies have been mostly in young Type 1 diabetic patients, the reliability of smoking history has been assessed in a large group of older Type 2 diabetic patients. Methods Two hundred and ninety‐nine Type 2 diabetic patients were investigated for smoking habits by unstructured questionnaire, breath CO, and urinary ratio. Results Mean age of the group was 63 (range 30–80) years and 41% were female. Direct questioning suggested 77 (26%) to be smokers, and of these 852 had raised (> 1 μg/mg) urinary cotinine–creatinine , and 71% raised (> 8 p.p.m.) breath CO. Assuming urinary cotinine–creatinine as the ‘gold standard’, the sensitivity, specificity and positive predictive values for questionnaire were 97%, 95% and 85%, respectively; and for breath CO they were 74%, 98%, and 93%. Conclusion It is concluded that at least in this population of Type 2 diabetic patients, a structured smoking history appeared to identify current smokers with good accuracy.
No association between birth weight and Type 1 diabetes mellitus – a twin‐control study
Authors: Kyvik K. O. , Bache I. , Green A. , Beck‐Nielsen H. , Buschard K. 
Published: March 2003

Summary Aims To investigate, by means of a twin‐control study, whether there is a relationship between birth weight and Type 1 diabetes mellitus. Methods In the youngest part (n = 20 888 pairs) of the Danish Twin Register, 95 twin pairs (26 monozygotic and 69 dizygotic) with Type 1 diabetes were identified. Information about birth weight and birth length, prematurity, maternal age and parity was obtained from midwives' records and from the Danish Medical Birth Registry and analysed using Student's two‐sided t‐test, Chi‐square test and logistic regression. Results Birth data were available for 83 diabetic and 51 healthy twin individuals, altogether 67 twin pairs (20 monozygotic and 47 dizygotic). Mean birth weight was 2537 g and 2565 g (NS) in monozygotic and dizygotic pairs and the corresponding length at birth 47.6 cm and 48.2 cm (NS). In pairs discordant for diabetes, the mean birth weight was 2538 g in twins with diabetes and 2549 g in twins without diabetes (NS). Logistic regression in discordant pairs showed no relationship between diabetes status and birth weight, birth length, birth order, sex or prematurity. Logistic regression in concordant vs. discordant pairs showed no effect of mean birth weight and birth length, maternal age, parity or weeks of prematurity. Conclusions There is no association between Type 1 diabetes mellitus and birth weight in this study. Furthermore, variables related to birth weight and length cannot explain why some pairs are concordant while other remain discordant.
Angiotensin‐converting enzyme inhibition by quinapril blocks the albuminuric effect of atrial natriuretic peptide in Type 1 diabetes and microalbuminuria
Authors: McKenna K. , Smith D. , Barrett P. , Glenn A. , Kesson C. M. , Connell J. , Thompson C. J. 
Published: March 2003

Summary Aims This study examined the effect of angiotensin‐converting enzyme inhibition, administered at doses with no effect on systemic blood pressure, on the albuminuric action of atrial natriuretic peptide (ANP). Methods Seven Type 1 diabetic patients with established microalbuminuria participated in a two limb, single‐blind, placebo controlled study. Subjects were administered quinapril 10 mg daily or placebo for 7 days prior to study. On the study day, subjects were euglycaemic clamped and subsequently fluid loaded (20 ml/kg tap water orally plus urinary losses). At steady state diuresis, a 1 h intravenous infusion of ANP 0.05 μg.kg−1.min−1 was administered. Urine was collected at 15‐min intervals for estimation of albumin–creatinine ratio (ACR). Results were analysed by
anova. Results Baseline mean arterial pressure was similar after pre‐treatment with quinapril and placebo (98.7 ± 3.8 vs. 100 ± 4.5 mmHg, mean ± sd, P > 0.5), and was unaltered by ANP infusion on either study day. Baseline ACR was similar on quinapril and placebo (P = 0.13). ANP infusion induced a rise in urine ACR with placebo (58.4 ± 40.2 to 393.6 ± 262.9 mg/mmol, P = 0.006), but not with quinapril (29.3 ± 10.7 to 81.5 ± 43 mg/mmol, P = 0.15). The urine ACR response to ANP infusion was higher with placebo than with quinapril (P = 0.02). Conclusions Quinapril blocks the albuminuric effect of intravenous infusion of ANP in subjects with Type 1 diabetes mellitus and established microalbuminuria. This action is independent of changes in mean arterial pressure and creatinine clearance.
Prevalence of symptoms of depression and anxiety in a diabetes clinic population
Authors: Lloyd C. E. , Dyer P. H. , Barnett A. H. 
Published: March 2003

Summary Aims To investigate the use of a short questionnaire to measure psychological symptoms in a busy clinic setting, and to examine the prevalence of these symptoms in adults with diabetes. The perceived need for psychological treatment services was also measured. Methods Adults (> 18 years) with either Type 1 or Type 2 diabetes were invited to complete a short demographic form and the Hospital Anxiety and Depression Scale (HADS) whilst waiting for their routine diabetes outpatients appointment. Complication status was measured via patients' medical records. Glycaemic control (HbA1c) was also recorded. Results A high response rate (96%) was achieved. Prevalence rates of psychological symptoms were high (overall 28% of study participants reported moderate–severe levels of depression or anxiety or both). Men were somewhat more likely to report moderate–severe depressive symptoms, whereas women reported more moderate–severe anxiety. A significant association between depression and poor glycaemic control was observed in the men, but not in the women. Regression analysis demonstrated that the interaction between sex and glycaemic control, HbA1c and sex were all significantly associated with depression and anxiety (R2 = 0.16 and 0.19, respectively). One‐third of subjects reported that at the moment they would be interested in receiving counselling or psychotherapy if it was currently available at the diabetes clinic.Conclusions This study has shown that the HADS is an appropriate questionnaire to use in a clinic setting in adults with diabetes. There may be a stronger association between glycaemic control and psychological symptomatology in men than in women. There remains a significant proportion of individuals with diabetes who require psychological support, which, if available, might help improve glycaemic control and thus overall wellbeing.
Role of islet autoimmunity in the aetiology of different clinical subtypes of diabetes mellitus in young north Indians
Authors: Singh A. K. , Bhatia E. , Dabadghao P. , Bhatia V. , Gellert S. A. , Colman P. G. 
Published: March 2003

Abstract Aims To determine the role of islet autoimmunity in the aetiology of different clinical subtypes of diabetes mellitus in young north Indian patients by measuring islet autoantibodies. Methods In a cross‐sectional study, 145 young patients with diabetes (onset < 30 years) were subdivided into the following categories: Type 1 diabetes (n = 83), malnutrition‐modulated diabetes mellitus (MMDM, n = 31) and fibro‐calculous pancreatic diabetes (FCPD, n = 31). MMDM subjects presented with emaciation and severe insulin‐requiring but ketosis‐resistant diabetes, while FCPD was associated with idiopathic chronic calcific pancreatitis. Antibodies to glutamic acid decarboxylase (GADA) and IA‐2 (IA‐2 A) were detected by immunoprecipitation of 35S‐labelled recombinant antigens and cytoplasmic islet cell antibody (ICA) by indirect immunofluorescence. Results GADA were present in a significant proportion (23%) of patients with MMDM. In contrast, IA‐2 A was increased only among patients with Type 1 diabetes (22%), but not MMDM (3%, P < 0.05). Among patients with a duration of diabetes < 2 years, GADA and/or IA‐2 A were found in 61% of Type 1 diabetic and 37% of MMDM patients (P < 0.01). MMDM patients who were positive for GADA had a shorter duration of diabetes, but did not differ in their age at onset of diabetes, body mass index, fasting plasma C‐peptide, or frequency of thyroid microsomal and parietal cell antibodies. FCPD subjects had the lowest prevalence of autoantibodies: IA‐2 and ICA were absent, while GADA were present in 7% (P < 0.05 vs. Type 1 diabetes). Conclusions GADA, though not IA‐2 A, were present in a substantial proportion of patients with the MMDM variant of diabetes, suggesting that islet autoimmunity may play a role in its pathogenesis. In contrast, none of the islet antibodies was increased in subjects with FCPD, making it likely that it is a secondary type of diabetes.
Dissociated sensory loss in diabetic autonomic neuropathy
Authors: Winkler A. S. , Ejskjaer N. , Edmonds M. , Watkins P. J. 
Published: March 2003

Summary Aims Clinical observation has led to the idea that there might be a distinctive form of selective sensory and autonomic neuropathy affecting patients with Type 1 diabetic mellitus with severe symptomatic autonomic neuropathy (Type 1‐DAN) and this study was conducted to evaluate the presence of such a neuropathy in Type 1‐DAN. Methods Nineteen Type 1 diabetic patients presenting for treatment of severe symptomatic autonomic neuropathy were examined (all had ≥ 2 autonomic symptoms; age 39.3 ± 10.2 years; duration of disease 25.6 ± 10.5 years). For comparison, 19 Type 1 diabetic patients with neuropathic foot ulcers (age 44.5 ± 6.6 years; duration of disease 26.7 ± 9.2 years), 14 clinically uncomplicated Type 1 diabetic patients (age 39.9 ± 5.6 years; duration of disease 22.9 ± 9.3 years) and 16 non‐diabetic healthy people as controls (age 39.3 ± 10.7 years) were also examined. Results The large fibre modalities (light touch and vibration perception) were better preserved in the Type 1‐DAN group than in the foot ulcer group. Thus, light touch sensation was normal in 11 out of 19 Type 1‐DAN patients compared to only three out of 19 foot ulcer patients (P < 0.01), and vibration perception was 24.9 ± 15.0 V and 40.5 ± 7.9 V, respectively (P < 0.002) with some of the Type 1‐DAN patients in the normal range. In contrast, the small fibre modalities, thermal perception and autonomic function, were grossly abnormal in both groups (hot thermal perception 14.1 ± 2.5°C and 12.6 ± 3.7°C; cold thermal perception 13.8 ± 2.7°C and 10.9 ± 4.7°C; heart rate variation 2.9 ± 1.5 beats/min and 4.8 ± 4.0 beats/min, respectively). Conclusions There is indeed a subgroup of Type 1 diabetic neuropathy patients who suffer from severe autonomic symptoms associated with a selective small fibre sensory and autonomic loss with relatively preserved large fibre sensory modalities.
Enhanced albuminuric response to atrial natriuretic peptide in normoalbuminuric patients with Type 1 diabetes mellitus – a pilot study
Authors: McKenna K. , Smith D. , Moore K. , Glen A. , Kesson C. M. , Thompson C. J. 
Published: March 2003

Summary Aims  To ascertain whether intravenous infusion of atrial natriuretic peptide (ANP) can induce microalbuminuria in patients with Type 1 diabetes mellitus (DM), as already demonstrated in patients with microalbuminuria, and to compare the albuminuric response to ANP infusion in Type 1 DM and a matched group of healthy non‐diabetic controls. Methods
Eight normoalbuminuric DM patients participated in a three limb, randomized, double‐blind, placebo‐controlled study. Subjects were kept euglycaemic by insulin infusion, and subsequently water‐loaded (20 ml/kg orally plus urinary losses). When in steady state, a 30‐min infusion of either placebo, ANP 0.025 μg.kg−1.min−1 or ANP 0.05 μg.kg−1.min−1 was administered intravenously. Urine was collected every 15 min for 90 min for the estimation of albumin–creatinine ratio (ACR). In addition, eight non‐diabetic volunteers received a single infusion of ANP 0.025 μg.kg−1.min−1. Results
ACR was unaltered by placebo in DM subjects (1.4 ± 0.7–1.7 ± 1.1 mg/mmol, mean ± sd, anova, P > 0.9), and by low dose ANP in controls (1.4 ± 0.9–2.6 ± 1.9 mg/mmol, P = 0.4). ACR increased with low dose ANP (1.3 ± 0.5–14.6 ± 13.6 mg/mmol, P = 0.02), and high dose ANP (1.3 ± 0.7–26.4 ± 31 mg/mmol, P = 0.01) in DM subjects. The ACR response to low dose ANP was greater in the DM than control subjects (P = 0.02). Conclusions  ANP increases urine albumin excretion rate in normoalbuminuric Type 1 DM patients, and this effect is more pronounced than in healthy volunteers.
Survey of dietetic provision for patients with diabetes
Authors: Nelson M. , Lean M. E. J. , Connor H. , Thomas B. J. , Lord K. , Hartland B. , Waldron S. , McGough N. , Walker L. , Ryan A. , Start K. 
Published: March 2003

SUMMARY Aims  To survey dietitians involved in diabetes care regarding the provisions for patients with diabetes.Methods  A national survey of 512 dietitians known to be engaged in provision of diabetes care was conducted in 1997 and 391 (76%) responded.Results  Nationally the median provision of dietetic care for diabetes reported was 10.7 h per 100 000 general population per week, but the provision was uneven ranging from 2.0 to 27.6 h per 100 000. Eighty‐five per cent of dietitians worked in areas where the provision was less than 22 h per 100 000 general population per week (the current recommended minimum standard). Dietetic provision was greater in secondary care (median 9.1 h per 100 000 general population per week) than in general practice, residential homes and other locations (median 4.4 h per 100 000 general population per week). Provision was greater in those areas in which a designated dietitian had responsibility for co‐ordinating the dietetic service for diabetes than in areas where the co‐ordinator was not a dietitian or where there was no co‐ordinator. Over 90% of dietitians reported following British Diabetic Association (BDA) recommendations regarding advice on carbohydrate, sugar, fat and fibre consumption, but only one‐third routinely advised on salt restriction. Of the 17% of dietitians who continue to use carbohydrate exchanges, all combine this method with other approaches. Of the recommendations made by the Clinical Standards Group, only 69% of dietitians reported seeing more than half of newly diagnosd adult patients within four weeks, and less than 50% reported offering half or more of their patients an annual review. Amongst the literature in current use, 98% of dietitians use BDA literature for teaching patients and 90% use BDA publications in their own education. Seventy‐six per cent of dietitians believed that there was a role for commercial slimming organizations in weight management of people with diabetesConclusions  Given the proven value of dietetic input in diabetes management, there would be advantages to correcting the regional inequalities in dietetic provision for diabetes care in the UK.
Preservation of sight in diabetes: developing a national risk reduction programme
Authors: Garvican L. , Clowes J. , Gillow T. 
Published: March 2003

SUMMARY Background  Early treatment for diabetic retinopathy is effective at saving sight, but dependent on pre‐symptomatic detection. Although 60% of people with diabetes have their eyes examined annually, few UK health authorities have systematic programmes that meet the British Diabetic Association's standards for sensitivity (> 80%) and specificity (> 95%). Screening is generally performed by general practitioners and optometrists, with some camera‐based schemes, operated by dedicated staff. The National Screening Committee commissioned a group to develop a model and cost estimates for a comprehensive national risk‐reduction programme.Ophthalmoscopy Evidence indicates that direct ophthalmoscopy using a hand‐held ophthalmoscope does not give adequate specificity and sensitivity, and should be abandoned as a systematic screening technique. Indirect ophthalmoscopy using a slit lamp is sensitive and specific enough to be viable, and widespread availability in high street optometrists is an advantage, but the method requires considerable skill.Photographic schemes The principal advantage of camera‐based screening is the capturing of an image, for patient education, review of disease progression, and quality assurance. Digital cameras are becoming cheaper, and are now the preferred option. The image is satisfactory for screening and may be transmitted electronically. With appropriate training and equipment, different professional groups might participate in programme delivery, based on local decisions.Cost issues Considerable resources are already invested in ad hoc screening, with inevitable high referral rates incurring heavy outpatient costs. Treatment for advanced disease is expensive, but less likely to be effective. The costs of a new systematic screening and treatment programme appear similar to current expenditure, as a result of savings in treatment of late‐presenting advanced retinopathy.Conclusion  A systematic national programme based on digital photography is proposed.
Gastric parietal cell antibodies are associated with glutamic acid decarboxylase‐65 antibodies and the HLA DQA1*0501‐DQB1*0301 haplotype in Type 1 diabetes mellitus
Authors: De Block C. E. M. , De Leeuw I. H. , Rooman R. P. A. , Winnock F. , Du Caju M. V. L. , Van Gaal L. F. , Registry The Belgian Diabetes 
Published: March 2003

SUMMARY Aims  To assess the prevalence of thyrogastric autoimmunity in relation to age, sex, β‐cell antibody status and HLA DQ haplotypes in Type 1 diabetes mellitus.Methods  One hundred and seventy‐one patients with Type 1 diabetes mellitus were studied (male/female 86/85; mean age 19 ± 11 years; duration of diabetes 5 ± 4 years). Islet cell antibodies (ICA) and parietal cell antibodies (PCA) were measured using indirect immunofluorescence; glutamic acid decarboxylase‐65 antibodies (GADA) by radiobinding assay and thyroid peroxidase antibodies (TPO) with an immunoradiometric assay (IRMA).Results  The majority of subjects (81.3%) showed one or more autoantibodies. The prevalence rates were: GADA 64.9%, ICA 46.2%, PCA 19.9% and TPO 19.3%. Patients with ICA+ ≥ 3 years after diagnosis had a higher prevalence of GADA (P = 0.03, odds ratio (OR) 2.66) and thyrogastric antibodies (P = 0.05, OR 2.23) than subjects ICA– after 3 years. PCA+ patients were older (P = 0.04), had a higher prevalence of GADA (P = 0.005, OR 3.89) and TPO (P = 0.05, OR 2.50) than PCA– subjects. Logistic regression analysis showed that PCA status was determined by the HLA DQA1*0501‐DQB1*0301 haplotype (β = 2.94, P = 0.04) and GADA status (β = 2.44, P = 0.041).Conclusions  Thyrogastric antibodies are highly prevalent in Type 1 diabetes mellitus, especially in patients with persisting ICA. Screening for gastric autoimmunity is particularly advised in patients who are positive for GADA and for the HLA DQA1*0501‐DQB1*0301 haplotype.
Incidence and risk factors for neonatal hypoglycaemia among women with gestational diabetes mellitus in South Auckland
Authors: Simmons D. , Thompson C. F. , Conroy C. 
Published: March 2003

SUMMARY Aims  To describe the incidence and risk factors for neonatal hypoglycaemia among the offspring of women with gestational diabetes mellitus (GDM) in South Auckland, New ZealandMethods  A retrospective audit was undertaken of singleton pregnancies delivered between 1991 and 1994. Data were obtained for 373 women and their deliveries (57 European, 76 Maori, 198 Pacific Islands, 42 other).Results  Pacific Islands women were most likely to have large babies with neonatal hypoglycaemia in spite of a high use of insulin. Postnatally Maori and Pacific Islands women had a high incidence of Type 2 diabetes mellitus (21.4, 21.7 vs. 4.3% Europeans, 12.0% others, P = 0.035). Babies experiencing hypoglycaemia were more likely to have a mother with past GDM (51.2 vs. 27.2%, P = 0.01) and greater hyperglycaemia (at diagnosis fasting 6.8 ± 1.7 vs. 5.7 ± 1.1 mmol/l, P < 0.001; finger‐prick glucose 5.7 ± 1.0 vs. 5.2 ± 0.8 mmol/l, P < 0.001). Macrosomia, Caesarian section and special care baby unit admission were more common in pregnancies complicated by neonatal hypoglycaemia.Conclusions  Maternal hyperglycaemia was a major contributing factor to neonatal hypoglycaemia in this population. Undiagnosed Type 2 diabetes was common among Maori and Pacific Islands women, confirming the need for earlier detection and treatment.
The effects of ulcer size and site, patient's age, sex and type and duration of diabetes on the outcome of diabetic foot ulcers
Authors: Oyibo S. O. , Jude E. B. , Tarawneh I. , Nguyen H. C. , Armstrong D. G. , Harkless L. B. , Boulton A. J. M. 
Published: March 2003

SUMMARY Aims  The outcome of foot ulcers is affected by wound depth, infection, ischaemia and glycaemic control. The aim of this study was to determine the effects of ulcer size, site, patient's age, sex and type and duration of diabetes on the outcome of diabetic foot ulcers.Methods  Diabetic patients with new foot ulcers presenting during a 12‐month period had demographics and ulcer characteristics recorded at presentation. Ulcers were followed‐up until an outcome was noted.Results  One hundred and ninety‐four patients (77% males) with a mean (± sd) age and duration of diabetes of 56.6 ± 12.6 and 15.4 ± 9.9 years, respectively, were included in the study. The majority of ulcers were neuropathic (67.0%) and present on the forefoot (77.8%) with a median (interquartile range) area of 1.5 (0.6–4.0) cm2. Amputations were performed for 15% of ulcers; 65% healed; 16% remained unhealed and 4% of patients died. The median (95% confidence interval) time to healing was 10 (8.8–11.6) weeks. Ulcer area at presentation was greater in the amputation group compared to healed ulcers (3.9 vs. 1.2 cm2, P < 0.0001). Ulcer area correlated with healing time (rs = 0.27, P < 0.0001) and predicted healing (P = 0.04). Patient's age, sex, duration/type of diabetes, and ulcer site had no effect on outcome.Conclusions  Ulcer area, a measure of ulcer size, predicts the outcome of foot ulcers. Its inclusion into a diabetic wound classification system will make that system a better predictor of outcome.