bluuebunny/crossref_metadata_2025_split huggingface dataset:
Joint liaison psychiatry–diabetes clinic: a new specialist service
Authors: Mitchell C. , Catalan J. , McIntosh C. , Feher M. D. 
Published: March 2003

Summary Aims  Specialist diabetes clinics have an established role in prevention and management of complications. As psychological problems are usually treated separately from diabetes centres, the role of a specialist psychiatrist within a teaching hospital was assessed. The aims of the study were to describe referral patterns, specific psychiatric conditions and treatments offered. Results  During weekly outpatient sessions over a 12‐month period, 31 patients were referred with a wide range of psychiatric diagnoses. One‐third of patients were seen on the day and two‐thirds within 2 weeks of referral. Treatments included anti‐depressant medication, counselling and cognitive behaviour therapy. Successful discharge was obtained in 10 subjects and eight were undergoing continued treatment. Conclusions  The range of specific diagnoses requiring psychiatric supervision supported the role of specifically trained personnel as seen in a joint liaison psychiatry–diabetes service.Keywords diabetes mellitus, joint clinic, liaison psychiatry
Adaptation of the Diabetes Health Profile (DHP‐1) for use with patients with Type 2 diabetes mellitus: psychometric evaluation and cross‐cultural comparison
Authors: Meadows K. A. , Abrams C. , Sandbæk A. 
Published: March 2003

SUMMARY Aims  To adapt the Diabetes Health Profile (DHP‐1) for use with English speaking patients with Type 2 diabetes mellitus and to evaluate the psychometric properties of the adapted measure in a UK and Danish sample of insulin, tablet and diet‐treated patients with Type 2 diabetes.Methods  Following linguistic adaptation using the forward–backward translation procedure, the 32‐item DHP‐1 was sent to 650 and 800 consecutively selected UK and Danish patients with Type 2 diabetes. Construct validity was assessed using principal axis factoring. Factor stability was assessed across language groups using the coefficient of congruence. Reliability was evaluated using Cronbach's alpha and multi‐trait analysis, including item convergent/discriminant validity. Subscale discriminant validity was assessed through known groups with one‐way
anova and post hoc Scheffe tests for multiple comparisons.Results  Eighteen items (56.25%) were retained following initial item analysis. A three‐factor solution accounting for 45.6% and 40.3% of the total explained variance was identified in the UK and Danish samples, respectively. Factors were interpreted as psychological distress (PD), barriers to activity (BA) and disinhibited eating (DE). Factor congruence between language groups ranged from 0.98 to 0.99 and Cronbach's alpha ranged between 0.70 and 0.88. Item scaling success for both language versions was 88.9%. BA scores discriminated between treatment groups in both language groups (F = 24.24, P < 0.001; F = 7.68, P < 0.001) and PD scores in the UK sample (F = 20.97, P < 0.001).Conclusions  The DHP‐18 developed for use with patients with Type 2 diabetes has been shown to have satisfactory internal reliability and validity and measurement equivalence across language groups.
What do patients with diabetes know about their tablets?
Authors: Browne D. L. , Avery L. , Turner B. C. , Kerr D. , Cavan D. A 
Published: March 2003

SUMMARY Aims  To assess knowledge about oral hypoglycaemic agents amongst patients with diabetes and non‐specialist healthcare professionals.Method  An anonymous questionnaire was used in two centres to assess knowledge about oral agents amongst 261 patients with Type 2 diabetes mellitus (mean age 64 years) and 102 health professionals (including doctors, nurses and pharmacists).Results  Only 15% of patients knew the correct mechanism of action of their medication and 62% took tablets correctly in relation to food. Only 10% of those taking a sulphonylurea knew it may cause hypoglycaemia and 20% of those taking metformin were aware of its gastrointestinal side‐effects. Twenty per cent forgot to take their tablets at least once a week and 5% omitted tablets because of hyperglycaemia. Only 35% of patients recalled receiving advice about their medication with only 1% receiving written advice. The healthcare professionals showed important gaps in their knowledge on dosage timing and mechanism of action, particularly with respect to metformin and acarbose.Conclusion  It is concluded that patients' and professionals' knowledge of oral hypoglycaemic agents is poor. More appropriate advice and information to patients from prescribers may improve patient understanding and hence compliance. Community pharmacists are ideally placed to reinforce this information.
Assessment of the non‐HLA‐DR‐DQ contribution to IDDM1 in British Caucasian families: analysis of LMP7 polymorphisms
Authors: McTernan C. L. , Stewart L. C. , Mijovic C. H. , Barnett A. H. 
Published: March 2003

SUMMARY Aims  Whilst HLA‐DRB1 and HLA‐DQ alleles contribute to IDDM1, the major determinant of genetic susceptibility to Type 1 diabetes mellitus, other major histocompatibility complex (MHC)‐encoded genes may also be involved. The LMP7 (large multifunctional proteasome 7) gene is a potential candidate. The aim of this study was to assess whether LMP7 confers susceptibility to Type 1 diabetes independently of linkage disequilibrium with HLA‐DRB1 and HLA‐DQ.Methods  The diallelic LMP7 polymorphism (LMP7*A or *B) was determined in 142 multiplex families from the British Diabetic Association Warren Repository. At least one parent was heterozygous for LMP7 in 112 families and these were informative for calculation of the statistic Tsp. This gives a valid χ2 test of the null hypothesis of no association or no linkage.Results  An excess of transmissions of LMP7*A was observed from parents to affected offspring and the Tsp statistic was significant for association in the presence of linkage. LMP7*A was in positive, and LMP7*B in negative, linkage disequilibrium with the HLA‐DRB1*03‐DQ2, DRB1*04‐DQ8 (group of all DRB1*04 subtypes), DRB1*0401‐DQ8 and DRB1*0404‐DQ8 haplotypes, although the linkage disequilibrium coefficient (Δ) value was not statistically significant for DRB1*0404‐DQ8. Analysis of HLA‐DR‐DQ‐LMP7 haplotypes and Tsp analysis of HLA‐matched‐homozygous parents showed no association between LMP7 alleles and Type I diabetes independent of linkage disequilibrium with HLA‐DR‐DQ haplotypes associated with increased risk of disease. A contribution of LMP7 alleles to susceptibility to Type 1 diabetes in subjects with low‐risk HLA‐DR‐DQ haplotypes could not be excluded.Conclusions  LMP7 alleles do not contribute to genetic susceptibility to Type 1 diabetes in subjects with high‐risk‐associated HLA‐DR‐DQ haplotypes.
HLA‐DQ polymorphism and degree of heteroplasmy of the A3243G mitochondrial DNA mutation in maternally inherited diabetes and deafness
Authors: Van Essen E. H. R. , Roep B. O. , Hart L. M. ′t , Jansen J. J. , Van den Ouweland J. M. W. , Lemkes H. H. P. J. , Maassen J. A. 
Published: March 2003

SUMMARY Aim  Maternally inherited diabetes and deafness (MIDD) associates with a mutation at position 3243 in mitochondrial DNA. Phenotypic expression of MIDD includes Type 1‐like and Type 2‐like diabetes. This study examined whether HLA‐DQ phenotype and the degree of heteroplasmy in leucocyte and oral mucosa DNA influence clinical expression of the 3242 mutation.Methods  In a group of 20 unrelated probands with MIDD, eight with Type 1‐like diabetes, 12 with Type 2‐like diabetes, HLA‐DQ type and degree of heteroplasmy for the 3243 mutation were determined. HLA‐DQA1/DQB1 phenotypes were categorized as predisposing, neutral or protective for autoimmune‐mediated Type 1 diabetes.Results  No differences were observed between Type 1 and Type 2‐like MIDD groups with respect to the cumulative frequency of protective and predisposing HLA‐DQ types. Predisposing HLA‐DQ types are more prevalent in MIDD patients than in the control population (P < 0.05). Degrees of heteroplasmy for the 3243 mutation showed large variations in patients, ranging from 1 to 52% in leucocyte DNA. A strong correlation was seen between heteroplasmy in leucocyte DNA and DNA from oral mucosa cells (r = 0.89, P < 0.001). No correlation was observed between the degree of heteroplasmy and diabetic phenotype, even when group size was extended with diabetic relatives of patients with MIDD. The age of diagnosis of diabetes was not correlated with heteroplasmy, but the degree of heteroplasmy tended to decrease with age.Conclusions  The phenotype of diabetes in MIDD appears to be independent of HLA‐DQ phenotype and degree of heteroplasmy in leucocyte and oral mucosa DNA indicating that other, as yet unknown, factors modulate clinical expression of the 3243 mutation.
Catecholamine levels and receptor expression in low protein rat offspring
Authors: Petry C. J. , Dorling M. W. , Wang C. L. , Pawlak D. B. , Ozanne S. E. 
Published: March 2003

SUMMARY Aims  Low birthweight in humans has been shown to lead to increased resting pulse rate in adult life, suggesting possible increased sympathoadrenal activity. The hypothesis that early growth restriction is associated with permanent alterations in catecholamine metabolism was tested.Methods  Circulating catecholamine concentrations (by radioimmunoassay) and adipocyte adrenoceptor expression from different fat depots (by Western blot) were estimated in 12‐week‐old male offspring of rat dams fed a reduced protein diet during pregnancy and lactation.Results  In the fed state, median (interquartile range) plasma adrenaline concentrations for male control and low protein offspring rats were: 0.65 (0.48–0.86) vs. 1.42 (0.89–1.87) nmol/l (P < 0.005), respectively. Equivalent noradrenaline concentrations were: 2.71 (2.16–3.46) vs. 3.45 (3.00–4.28) nmol/l (P < 0.05). After 24 h starvation, plasma adrenaline concentrations of controls rose to become similar to those of low protein offspring: 1.03 (0.95–1.31) vs. 1.41 (0.69–1.62) nmol/l (P = 0.3), respectively. Noradrenaline concentrations rose in both groups to become similar: 3.84 (3.33–4.54) vs. 4.32 (3.70–6.54) nmol/l (P = 0.3). In epididymal adipocytes adrenoceptor expression (relative to that of controls) was: α2A 0.79 (0.66–0.94) (P = 0.08), β1 2.60 (2.27–3.07) (P = 0.04), β3 1.37 (1.27–1.46) (P = 0.02). Similar‐pattern differences in adrenoceptor expression were observed in subcutaneous and intra‐abdominal adipocytes.Conclusions  These results are consistent with the suggestion that long‐term alterations in catecholamine metabolism are present in adult offspring of rats fed a reduced protein diet during pregnancy and lactation.
Microalbuminuria in patients with Type 2 diabetes mellitus from general practice: course and predictive value
Authors: De Grauw W. J. C. , Van De Lisdonk E. H. , Van Gerwen W. H. E. M. , Verstappen M. , Van Den Hoogen H. J. M. , Willems J. L. , Van Weel C. 
Published: March 2003

SUMMARY Aims  To assess the course of microalbuminuria in patients with Type 2 diabetes mellitus in general practice and the predictive value of urinary albumin concentration on all‐cause mortality, cardiovascular mortality and cardiovascular morbidity.Methods  Cohort study in Type 2 diabetic patients tested for microalbuminuria in 1992, and re‐tested in 1998. During follow‐up all cardiovascular morbidity and mortality were recorded.Results  Of the original sample of 317 patients, 163 patients were re‐tested. The mean change in urinary albumin concentration was +16.2 mg/l (range −122.0 to +602 mg/l). Seventy‐five per cent of the patients without microalbuminuria in 1992 still had no microalbuminuria in 1998 and 40% of those with microalbuminuria in 1992 reverted to normoalbuminuria in 1998. Cox survival analysis, stratified for age, showed that microalbuminuria at baseline resulted in a risk ratio of all‐cause mortality of 1.4 (95% confidence interval 0.8–2.7), of cardiovascular mortality of 1.2 (0.5–2.8) and of new cardiovascular events (including cardiovascular mortality) of 1.4 (0.8–2.3).Conclusions  In the majority of patients the change of urinary albumin excretion was small, but the range was wide. A weak non‐significant relationship between microalbuminuria and all‐cause mortality and cardiovascular morbidity was observed.
Impact of pregnancy on the progression of diabetic retinopathy in Type 1 diabetes
Authors: Temple R. C. , Aldridge V. A. , Sampson M. J. , Greenwood R. H. , Heyburn P. J. , Glenn A. 
Published: March 2003

AbstractAims  To evaluate the impact of pregnancy on the progression of diabetic retinopathy in women with Type 1 diabetes mellitus and to identify risk factors for the progression of retinopathy during pregnancy.Methods  One hundred and seventy‐nine pregnancies in 139 women with pregestational Type 1 diabetes were studied prospectively between January 1990 and December 1998. Dilated fundal examination was performed at booking, 24 weeks and 34 weeks or 4–6 weekly if retinopathy present at booking. Data were collected on glycaemic control (HbA1c) throughout pregnancy.Results  Progression to proliferative retinopathy was seen in four (2.2%) pregnancies while moderate progression was seen in a further five (2.8%) pregnancies. Progression of retinopathy was significantly increased in women with duration of diabetes 10–19 years compared with duration < 10 years (10% vs. 0%; P = 0.007) and in women with moderate to severe background retinopathy at booking (30% vs. 3.7%; P = 0.01). Although HbA1c at booking was higher (7.5% vs. 6.6%; P = 0.08) and the fall in HbA1c between booking and 24 weeks was greater (1.6% vs. 1.2%; P = 0.2) in those women showing progression of retinopathy, these changes were not significant.Conclusions  Progression of retinopathy in pregnancy was uncommon (5.0% pregnancies) but was significantly more common in women with duration of diabetes > 10 years and in women with moderate to severe retinopathy at baseline. Laser therapy was needed in 2.2% pregnancies, which is much lower than that reported in earlier studies.Diabet. Med. 18, 573–577 (2001)
Glucose‐induced release of tumour necrosis factor‐alpha from human placental and adipose tissues in gestational diabetes mellitus
Authors: Coughlan M. T. , Oliva K. , Georgiou H. M. , Permezel J. M. H. , Rice G. E. 
Published: March 2003

AbstractAims  The cytokine tumour necrosis factor‐alpha (TNF‐α) has been implicated in the pathogenesis of insulin resistance in Type 2 diabetes mellitus, but limited data are available in relation to gestational diabetes mellitus (GDM), a disease in which similar biochemical abnormalities exist. We investigated the effect of exogenous glucose on the release of TNF‐α from placental and adipose (omental and subcutaneous) tissue obtained from normal pregnant women, and women with GDM.Methods  Human tissue explants were incubated for up to 24 h and TNF‐α concentration in the incubation medium quantified by ELISA. The effect of normal (5 mmol/l) and high (15 and 25 mmol/l) glucose concentrations on the release of TNF‐α was assessed.Results  In placental and subcutaneous adipose tissues obtained from women with GDM (n = 6), TNF‐α release was significantly greater under conditions of high glucose compared with normal glucose (placenta, 25 mmol/l 5915.7 ± 2579.6 and 15 mmol/l 4547.1 ± 2039.1 vs. 5 mmol/l 1897.1 ± 545.5; subcutaneous adipose tissue, 25 mmol/l 423.5 ± 207.0 and 15 mmol/l 278.5 ± 138.7 vs. 5 mmol/l 65.3 ± 28.5 pg/mg protein; P < 0.05). In contrast, there was no stimulatory effect of high glucose on TNF‐α release by tissues obtained from normal pregnant women (n = 6) (placenta, 25 mmol/l 1542.1 ± 486.2 and 15 mmol/l 4263.3 ± 2737.7 vs. 5 mmol/l 5422.4 ± 1599.0; subcutaneous adipose tissue, 25 mmol/l 189.8 ± 120.4 and 15 mmol/l 124.5 ± 32.3 vs. 5 mmol/l 217.9 ± 103.5 pg/mg protein).Conclusions  These observations suggest that tissues from patients with GDM release greater amounts of TNF‐α in response to high glucose. As TNF‐α has been previously implicated in the regulation of glucose and lipid metabolism, and of insulin resistance, these data are consistent with the hypothesis that TNF‐α may be involved in the pathogenesis and/or progression of GDM.Diabet. Med. 18, 921–927 (2001)
Symptoms of hypoglycaemia in people with diabetes
Authors: McAulay V. , Deary I. J. , Frier B. M. 
Published: March 2003

AbstractThe symptoms of hypoglycaemia are fundamental to the early detection and treatment of this side‐effect of insulin and oral hypoglycaemic therapy in people with diabetes. The physiology of normal responses to hypoglycaemia is described and the importance of symptoms of hypoglycaemia is discussed in relation to the treatment of diabetes. The symptoms of hypoglycaemia are described in detail. The classification of symptoms is considered and the usefulness of autonomic and neuroglycopenic symptoms for detecting hypoglycaemia is discussed. The many external and internal factors involved in the perception of symptoms are reviewed, and symptoms of hypoglycaemia experienced by people with Type 2 diabetes are addressed. Age‐specific differences in the symptoms of hypoglycaemia have been identified, and are important for clinical and research practice, particularly with respect to the development of acquired hypoglycaemia syndromes in people with Type 1 diabetes that can result in impaired awareness of hypoglycaemia. In addition, the routine assessment of hypoglycaemia symptoms in the diabetic clinic is emphasized as an important part of the regular review of people with diabetes who are treated with insulin.Diabet. Med. 18, 690–705 (2001)
Genetic variants of insulin receptor substrate‐1 (IRS‐1) in syndromes of severe insulin resistance. Functional analysis of Ala513Pro and Gly1158Glu IRS‐1
Authors: Berger D. , Barroso I. , Soos M. , Yeo G. , Schafer A. J. , O'Rahilly S. , Whitehead J. P. 
Published: March 2003

AbstractAims To define further the role of IRS‐1 mutations in human syndromes of severe insulin resistance.Methods The IRS‐1 gene was scanned for mutations in 83 unrelated affected subjects and 47 unaffected individuals using fluorescent single‐strand conformation polymorphism (fSSCP) analysis. A novel heterozygous mutation, Gly1158Glu, was found in one affected subject. Four and two subjects were heterozygous for the previously reported variants Gly972Arg and Ala513Pro, respectively. The previously identified variant Gly819Arg was found in one affected and one unaffected subject. While Gly972Arg has been described to alter the signalling properties of IRS‐1, no functional studies of Ala513Pro or Gly1158Glu have been reported.Results Chinese hamster ovary (CHO) cells stably over‐expressing the insulin receptor were transiently transfected with vectors expressing either wild‐type, Glu1158 or Pro513 IRS‐1. A modest increase in insulin‐stimulated tyrosine phosphorylation of Glu1158 IRS‐1 was observed. However, this did not result in any significant change in the association of Grb2 or the p85α subunit of PI3‐kinase or of PI3‐kinase activity. In parallel studies, the Pro513 IRS‐1 variant was indistinguishable from wild‐type IRS‐1.Conclusions While subtle effects of these variants cannot be excluded in this system, it is unlikely that these variants are responsible for the extreme insulin resistance seen in the subjects harbouring them. Although IRS proteins play a central role in insulin signalling, functionally significant mutations in the IRS‐1 gene are a rare cause of human syndromes of severe insulin resistance.
Subclinical pain and thermal sensory dysfunction in children and adolescents with Type 1 diabetes mellitus
Authors: Abad F. , Díaz‐Gómez N. M. , Rodríguez I. , Pérez R. , Delgado J. A. 
Published: March 2003

AbstractAims To assess cutaneous thermal and pain thresholds in upper and lower limbs in neurologically asymptomatic children and adolescents, and to study the relationships of clinical parameters and these sensory thresholds in subclinical diabetic neuropathy.Methods Thirty‐five neurologically asymptomatic patients, aged 8–16 years, diagnosed with Type 1 diabetes mellitus (DM), and a control group of 35 healthy age‐matched subjects participated in the study. Warmth, cold, and heat‐induced pain thresholds were measured in the dorsum of the right arm and foot, using quantitative sensory testing (QST). Relevant clinical parameters, retrieved from medical records or measured at the QST session, were obtained for each patient.Results Compared with controls, diabetic patients had increased thresholds for warmth in the hand (P

=
0.002), and cold and warmth in the foot (P

=
0.015 and P

=
0.004, respectively). Of the diabetic patients, 43% showed abnormality of at least one sensory threshold. A significant correlation was observed for duration of diabetes and heat‐induced pain threshold in the hand (P = 0.045), but no correlation was found for age, height, weight, pre‐test blood glucose, age of onset, current insulin dose, and mean of glycosylated haemoglobin determinations of the previous 18 months. No significant correlation was found for other sensory thresholds.Conclusions Using QST, abnormal cutaneous thermal perception is a common finding, in both upper and lower limbs, in neurologically asymptomatic young diabetic patients. Heat‐induced pain threshold in the hand was correlated with the duration of the diabetes.
Clinical characteristics and outcome of pregnancy in women with gestational hyperglycaemia with and without antibodies to β‐cell antigens
Authors: Bo S. , Menato G. , Pinach S. , Signorile A. , Bardelli C. , Lezo A. , Marchisio B. , Gentile L. , Cassader M. , Massobrio M. , Pagano G. 
Published: March 2003

AbstractAims To evaluate the prevalence of β‐cell autoantibodies in women with gestational diabetes and impaired glucose tolerance, and identify clinical characteristics differentiating hyperglycaemic patients with and without autoantibodies.Methods One hundred and twenty‐three pregnant patients with gestational diabetes, 84 with impaired glucose tolerance and 290 with normoglycaemia were evaluated for anti‐islet cell antibodies, glutamic acid decarboxylase (GAD) autoantibodies, and the components of the metabolic syndrome.Results Autoantibody positivity was 8.9%, 17.9% and 0.3% in patients with diabetes, impaired tolerance and normoglycaemia, respectively. Hyperglycaemic patients with autoantibodies had lower body mass index, waist, weight gain at the time of the screening test and a lower percentage of previous pregnancies than those without autoantibodies. In addition, their fasting insulin values were significantly lower and inversely related to the presence of autoantibodies (odds ratio (OR) = 0.64; 95% confidence interval (CI) 0.42–0.96), the lowest values being found in anti‐GAD+ patients. Autoantibody‐positive women with diabetes were more frequently treated with insulin than negative patients (OR = 7.21; 95% CI 1.85–28.08).Conclusions Autoantibody‐positive women with gestational hyperglycaemia displayed fewer features of insulin resistance and required more frequent insulin therapy than negative women and presumably had presymptomatic Type 1 diabetes. If this conclusion is corroborated by the follow‐up of larger series, clinical and immunological distinction of types of gestational hyperglycaemia would be useful.