bluuebunny/crossref_metadata_2025_split huggingface dataset:
Absolute level and rate of change of albuminuria over 1 year independently predict mortality and cardiovascular events in patients with diabetic nephropathy
Authors: Yuyun M. F. , Dinneen S. F. , Edwards O. M. , Wood E. , Wareham N. J. 
Published: December 2004

AbstractAims To determine the nature of the association between baseline albuminuria and risk of all‐cause mortality and cardiovascular disease, and to determine if the rate of change of albuminuria from baseline over 1 year predicts these endpoints in patients with diabetic nephropathy.Methods Cohort study of 427 patients (161 Type 1 and 266 Type 2) with diabetic nephropathy defined as urinary albumin excretion (UAE) ≥ 30 mg/24 h at baseline (mean age 53.4 years). Patients were recruited at the time of referral to a diabetic nephropathy clinic and followed up annually for an average of 5 years. UAE rate was re‐measured at 1 year and the rate of change from baseline calculated.Results All‐cause mortality and cardiovascular disease increased significantly and continuously across quintiles of baseline UAE (P for linear trend < 0.001 in both outcomes). The rate of change of albuminuria over 1 year (log10) independently predicted all‐cause mortality (hazard ratio (95% confidence interval) 1.76 (1.39, 3.11)) and cardiovascular mortality (1.57 (1.13, 5.22)). Taken as a categorical variable, a rate of change of albuminuria ≥ 30% independently predicted mortality and cardiovascular events (2.07 (1.5, 4.30) and 1.89 (1.33, 4.06), respectively).Conclusions The rate of change of albuminuria over 1 year independently predicts mortality and cardiovascular disease in diabetic nephropathy and may have clinical utility as a risk marker in identifying a subgroup of patients at particular risk. The risk of these outcomes is continuous across the range of baseline albuminuria in patients with diabetic nephropathy.
Type 2 diabetes presenting as diabetic ketoacidosis in adolescence
Authors: Valabhji J. , Watson M. , Cox J. , Poulter C. , Elwig C. , Elkeles R. S. 
Published: December 2004

AbstractWe report two black adolescent subjects who presented with diabetic ketoacidosis, but who lacked autoimmune markers and demonstrated clinical and biochemical characteristics more typical of Type 2 diabetes, including obesity, acanthosis nigricans, positive family history for Type 2 diabetes, and Type 2 diabetic dyslipidaemia. Subsequent to acute presentation, insulin was discontinued in both subjects and excellent glycaemic control was achieved with metformin therapy alone. Four months following acute presentation, both had adequate C‐peptide responses to intravenous glucagon. Type 2 diabetes can present as diabetic ketoacidosis in obese adolescent subjects.Diabet. Med. 20, 416–417 (2003)
Amniotic fluid insulin levels and fetal abdominal circumference at time of amniocentesis in pregnancies with diabetes
Authors: Schaefer‐Graf U. M. , Kjos S. L. , Bühling K. J. , Henrich W. , Brauer M. , Heinze T. , Dudenhausen J. W. , Vetter K. 
Published: December 2004

AbstractAims Fetal hyperinsulinism is a strong predictor for excessive growth and fetopathy in pregnancies complicated by diabetes. We examined (i) the relationship between measurements of amniotic fluid insulin (AF insulin) and fetal abdominal circumference (AC) at the time of amniocentesis, and (ii) whether there is a threshold for fetal AC percentiles which can identify low vs. high‐risk levels of AF insulin without performing an amniocentesis.Methods In a retrospective study, AF insulin from 121 pregnant diabetic women (32 pregestational; 89 gestational) was measured during the 3rd trimester as part of a diabetes management protocol. AC measurements were transformed into a continuous variable of percentile growth for gestational age (Hadlock). Division of the cohort according to deciles or quartiles of AC percentiles was performed to identify a threshold AC with a significant increase in elevated AF insulin, previously defined as AF insulin ≥ 7 µU/ml. A receiver operator characteristic (ROC) curve was created and the negative predictive value (NPV) of the determined threshold was calculated.Results AF insulin levels were significantly correlated with the AC percentiles (r = 0.3, P = 0.0005) by linear regression. No AC threshold could reliably identify a moderate elevated AF insulin ≥ 7 µU/ml (NPV 77.2%), but an AC threshold ≥ 75th percentile could identify with fetal hyperinsulinism with an AF insulin ≥ 16 µU/ml. All 10 cases of AF insulin ≥ 16 µU/ml were identified with a NPV of 100% (74/74).Conclusions Our data indicate that an AC ≥ 75th percentile determined by a 3rd trimester ultrasound examination may discriminate between pregnancies at low vs. high risk for AF insulin ≥ 16 µU/ml. This AF insulin concentration corresponds to a level of hyperinsulinism reported to be associated with considerable neonatal and long term morbidity.Diabet. Med. 20, 349–354 (2003)
Plasma N‐terminal pro‐brain natriuretic peptide in Type 1 diabetic patients with and without diabetic nephropathy
Authors: Siebenhofer A. , Ng L. L. , Plank J. , Berghold A. , Hödl R. , Pieber T. R. 
Published: December 2004

AbstractAims Plasma N‐terminal pro‐brain natriuretic peptide (NT proBNP) is produced and released from cardiac ventricles; it is elevated in patients with heart failure, hypertension and chronic renal failure. This study aimed to examine the plasma levels of NT proBNP and their relationship in Type 1 diabetic patients with and without diabetic nephropathy.Methods We developed a non‐competitive immunoluminometric assay with in‐house antibodies to the N‐ and C‐terminal domains of NT proBNP. We compared NT proBNP levels between 47 normoalbuminuric patients (group 1), 12 microalbuminuric patients (group 2) and 12 patients with macroalbuminuria (group 3).Results There were significant differences in 24‐h systolic and diastolic blood pressure, diabetes duration, serum creatinine, LDL‐cholesterol and HbA1c between the three groups; other parameters did not differ significantly. NT proBNP (median and range) levels were 5 (0.75–68), 22 (0.75–82) and 23 (0.75–374) fmol/ml for groups 1–3, respectively. Log‐transformed data of NT proBNP were used to compare all three groups (P = 0.016). The Pearson correlation between NT proBNP and albuminuria (R = 0.27; P = 0.02) was positive; HbA1c (R = 0.25; P = 0.03) and age (R = 0.33; P = 0.005) correlated significantly as well. On the basis of multiple regression analysis, the adjusted difference remained significant between the three groups.Conclusions This is the first demonstration that NT proBNP levels are significantly higher in Type 1 diabetic patients with albuminuria. This may be caused by a down‐regulation of A‐type guanylate cyclase‐coupled natriuretic peptide receptors in renal tubules or by elevated NT proBNP levels leading to higher glomerular hydraulic pressure or higher capillary permeability and possibly increased albumin excretion. Further studies are required to investigate the potential role of NT proBNP in patients with diabetic nephropathy and such other co‐morbidities as cardiovascular disease.Diabet. Med. 20, 535–539 (2003)
Continuous glucose monitoring for treatment adjustment in diabetic pregnancies—a pilot study
Authors: Yogev Y. , Ben‐Haroush A. , Chen R. , Kaplan B. , Phillip M. , Hod M. 
Published: December 2004

AbstractAims To examine the efficacy of a continuous glucose monitoring (CGM) system for treatment adjustment in patients with diabetic pregnancy treated with insulin.Methods The study sample consisted of eight women with diabetic pregnancy, six with pre‐pregnancy Type 1 diabetes mellitus and two with gestational diabetes (GDM), all being treated with multiple daily insulin injections. Gestational age ranged from 24 to 32 weeks. Data derived from the Continuous Glucose Monitoring System (MiniMed) for 72 h were compared with fingerstick glucose measurements (six to eight times a day), and treatment was adjusted on the basis of the findings. Two to four weeks later, the patients were re‐evaluated with CGM.Results In the first part of the study, an average of 744 ± 33 glucose measurements was recorded for each patient with CGM. The mean total time of hyperglycaemia (glucose level > 7.7 mmol/l) undetected by the fingerstick method was 152 ± 33 min/day. Nocturnal hypoglycaemic events (glucose level < 2.7 mmol/l) were recorded in seven patients. Based on the additional information obtained by continuous monitoring, the insulin regimen was changed in all patients. CGM re‐evaluation after treatment adjustment showed a reduction in undetected hyperglycaemia to 89 ± 17 min/day and in nocturnal hypoglycaemic events, which were recorded in only one patient.Conclusions Continuous glucose monitoring may diagnose high blood glucose levels and nocturnal hypoglycaemic events that are unrecognized by intermittent blood glucose monitoring and could serve as a useful tool for the long‐term management of diabetic pregnancies. A large prospective study is needed to determine the clinical implications of this new monitoring technique.Diabet. Med. 20, 558–562 (2003)
Respiratory failure secondary to diabetic neuropathy affecting the phrenic nerve
Authors: Tang E. W. , Jardine D. L. , Rodins K. , Evans J. 
Published: December 2004

AbstractWe report a patient with Type 2 diabetes mellitus complicated by neuropathy affecting the phrenic nerves, resulting in fatal respiratory failure. Diabetic mononeuropathy is common and usually recovers spontaneously, but bilateral phrenic nerve involvement appears to be uncommon and difficult to treat. The pathology of diabetic mononeuropathy is not well understood and we believe this to be the first histological report of a phrenic nerve biopsy in this condition.Diabet. Med. 20, 599–601 (2003)
Type 2 diabetes mellitus: a disease of the innate immune system? An update
Authors: Crook M. 
Published: December 2004

AbstractA few years ago a hypothesis was proposed suggesting that elements of the innate immune system, such as acute phase reactants, contribute to the development of Type 2 diabetes mellitus. Acute phase reactants such as C‐reactive protein and sialic acid may thus predict risk of developing Type 2 diabetes mellitus, as well as being markers of diabetes microvascular and macrovascular complications. This article discusses these issues.
Body composition in adolescent girls with Type 1 diabetes
Authors: Ingberg C‐M. , Särnblad S. , Palmér M. , Schvarcz E. , Berne C. , Åman J. 
Published: December 2004

AbstractAims  To compare body composition in adolescent girls with Type 1 diabetes with healthy controls.Research design and methods  In this population‐based study, body composition was examined, using dual‐energy X‐ray absorptiometry (DXA) and skinfold measurements, in 18 adolescent post‐menarcheal females, 16–19 years of age, with Type 1 diabetes since childhood in comparison to age‐matched healthy control subjects.Results  Body mass index was 2.7 kg/m2 higher in diabetic patients (26.3 ± 2.6 vs. 23.6 ± 3.8; P < 0.05). The overweight consisted almost entirely of increased fat mass, as evaluated by both skinfold measurements and DXA. Bone mineral density did not differ between the two groups. In diabetic females, the distribution of the fat mass was increased in the upper part of the body. The fat distribution, expressed as the abdominal‐to‐leg ratio, was significantly correlated to glycated haemoglobin (HbA1c) (r = 0.69; P < 0.005), daily dosage of insulin expressed per kilogram body weight (r = 0.78; P < 0.0005) and total cholesterol (r = 0.60; P < 0.001).Conclusions  The observed overweight in adolescent females with Type 1 diabetes is explained by an increased fat mass. Abdominal fat accumulation was associated with poor glycaemic control, increased need for insulin and elevated blood lipids.Diabet. Med. **, ***–*** (2003)
Diabetes‐related inequalities in health status and financial barriers to health care access in a population‐based study
Authors: Gulliford M. C. , Mahabir D. , Rocke B. 
Published: December 2004

AbstractAims  We evaluated the relationship between diabetes, health status, household income and expenditure on health care in the general population in Trinidad.Methods  Multistage sampling of 300 households was used to select a sample of 548 adults aged ≥ 25 years. There were 64 (12%) who reported a diagnosis of diabetes. Comparison was made with 128 non‐diabetic controls who were frequency matched for age and sex.Results  Subjects with diabetes had lower income levels than non‐diabetic controls [income ≤ US$533 per month for 66% diabetes cases and 48% controls, test for trend P = 0.007]. Compared with controls, subjects with diabetes were less likely to have good or very good self‐rated health (diabetes 32%, controls 67%; P < 0.001), and more frequently reported long‐standing illness, limitation of activities, visual impairment, or self‐reported history of high blood pressure, angina or heart attack. Subjects with diabetes (11%) were less likely than controls (30%) to have private health insurance (P = 0.005). Diabetic subjects (35%) were more likely than controls (16%) to have incurred expenditure on doctors’ services in the last 4 weeks (P = 0.021).Conclusions  Diabetes is associated with worse health status and more frequent expenditure on medical services but greater financial barriers to access in terms of low income and lack of health insurance. Policies for diabetes should specifically address the problem of income‐related variations in risk of diabetes, health care needs and barriers to uptake of preventive and treatment services, otherwise inequalities in health from this condition may increase.
Association between smoking, insulin resistance and β‐cell function in a North‐western First Nation
Authors: Daniel M. , Cargo M. D. 
Published: December 2004

AbstractAims  Aboriginal peoples have a high prevalence of smoking and are at major risk for diabetes. The role of insulin resistance vs. compromised β‐cell function in the link between smoking and glycaemic disease is not clear. This study tested whether relations between insulin resistance and β‐cell function differ between current smokers, former smokers and non‐smokers, and if having diabetes modifies smoking‐related effects.Methods  A community‐based diabetes screening initiative was mounted for a North‐western First Nation (Interior Salishan) in rural British Columbia, Canada. Respondents were on‐reserve Aboriginal people (n = 156), all adults 18 + years. Glycaemic status was determined by oral glucose tolerance test. Fasting values for glucose and insulin were used to estimate β‐cell function and insulin resistance by homeostasis model assessment (HOMA). Analyses adjusted for age, sex, alcohol intake, education, body mass index and physical activity.Results  For normoglycaemic persons (n = 119) current smokers relative to non‐smokers had high β‐cell values [difference (95% confidence interval) 19.5 (17.1, 21.9)], while former smokers had low β‐cell values [difference −22.8 (−20.3, −25.3)] (P < 0.0001). For diabetic persons (n = 37) differences were of equivalent direction but greater magnitude (P < 0.0001). Insulin resistance was for normoglycaemic persons highest for current smokers, and for diabetic persons lowest for current smokers (P = 0.021).Conclusions  Former smoking is associated with low β‐cell function, and current smoking with high β‐cell function, independent of diabetes in the North‐western First Nation surveyed. Associations between smoking and insulin resistance vary according to glycaemic status. Smoking may have diametric acute and post‐cessation effects on β‐cell function and insulin resistance.
Diabetes control and complications: the role of glycated haemoglobin, 25 years on
Authors: Jeffcoate S. L. 
Published: December 2004

AbstractThe long‐term complications of diabetes have major consequences for individual subjects and growing healthcare delivery and cost implications for society. Evidence for the benefits of good glycaemic control, as monitored by glycated haemoglobin measurements, has been developed in the 25 years since they were introduced to the point where HbA1c assays play central roles in patient management, clinical guidance and audit, and clinical trial design. In this review this evidence is examined and three classes of uncertainty identified that diminish confidence in the effectiveness of these roles for HbA1c.

Analytical variability between different methods for HbA1c has restricted the application of clinical targets and this problem has recently been addressed by reference method standardization. There are two approaches to this which result in different HbA1c values and this discrepancy needs to be resolved.
Biological variability in HbA1c values between individuals also restricts its predictive role when applied to populations. The correlations between HbA1c measurements and various components of glycaemia (overall, fasting, postprandial) are still uncertain and differences in protein glycation and de‐glycation are greater between subjects than often thought. The influence of variability in erythrocyte life span is an area where research is needed, especially in diabetic subjects.
Clinical variability is the most important and complex area of uncertainty. A predictive link between HbA1c and clinical outcomes is not as clear‐cut as often stated. The correlation with the development of microvascular disease is well established in Type 1 diabetes, but in Type 2 subjects (90% of those with diabetes) the evidence that HbA1c monitoring is of value in predicting or preventing macrovascular disease is not strong, although it is the major cause of morbidity and early death in this group.

It is recommended that, as a matter of urgency, these issues be examined, particularly within the context of self‐care in diabetes.Diabet. Med. **, ***–*** (2003)
Association between fasting glucose and C‐reactive protein in middle‐aged subjects
Authors: Aronson D. , Bartha P. , Zinder O. , Kerner A. , Shitman E. , Markiewicz W. , Brook G. J. , Levy Y. 
Published: December 2004

AbstractAims  C‐reactive protein (CRP), a marker of subclinical inflammation, predicts the occurrence of coronary heart disease in healthy subjects. Hyperglycaemia is known to stimulate the release of inflammatory cytokines from various cell types and can lead to the induction and secretion of acute‐phase reactants by adipocytes. The aim of the present study was to determine the relation between glycaemic status and CRP in healthy subjects.Methods  We studied the relation of high‐sensitivity CRP to fasting glucose and other components of the metabolic syndrome in a population‐based cross‐sectional study (n = 1000; age 50 ± 9 years).Results  Plasma CRP levels increased continuously from the lowest quartile of normal fasting glucose level to impaired fasting glucose and to diabetes (ln CRP 0.47 ± 0.09, 0.95 ± 0.12, and 1.11 ± 0.13, respectively; Ptrend < 0.0001). Increasing CRP with higher fasting glucose levels was apparent even among subjects with fasting glucose in the normal range (Ptrend = 0.039), and subjects with fasting glucose level in the upper quartile of normal fasting glucose had higher CRP levels compared with subjects in the lower quartile (P = 0.035). There was a positive crude correlation between CRP and smoking, post‐menopausal hormone use, body mass index, fasting glucose, triglycerides, hypertension, and uric acid (r = 0.11–0.36, P = 0.002–0.0001). A negative correlation was found between CRP and HDL‐cholesterol (r = 0.12, P < 0.0001) and physical activity (r = 0.11, P = 0.002). After adjustment for potential confounders in a stepwise multivariate linear regression model, fasting glucose remained significantly and independently related to CRP levels (correlation coefficient 0.06; 95% confidence interval 0.014–0.11, P = 0.011).Conclusions  Fasting glucose is significantly and positively associated with plasma CRP in middle‐aged subjects. CRP levels increase continuously across the spectrum of fasting glucose, beginning in the lowest quartile of normal fasting glucose. This finding suggests that a proinflammatory effect may contribute to the adverse cardiovascular outcome associated with diabetes, impaired fasting glucose, and increasing glucose levels within the normal range.
Evidence for linkage on chromosome 4p16.1 in Type 1 diabetes Danish families and complete mutation scanning of the WFS1 (Wolframin) gene
Authors: Larsen Z. M. , Johannesen J. , Kristiansen O. P. , Nerup J. , Pociot F. ,   The Danish IDDM Epidemiology and Genetics Group and The Danish Study Group of IDDM in Childhood
Published: December 2004

AbstractAims  To investigate whether the WFS1 gene, the gene for Wolfram syndrome, is a susceptibility gene for more common forms of diabetes in the Danish population.Methods  One hundred and fifty‐two Danish Type 1 diabetes mellitus sib‐pair families were genotyped for two microsatellite markers situated within 5 cM of the WFS1 gene and analysed for linkage and association using the sib‐TDT. The entire coding region, the 5′UTR and 3′UTR of the WFS1 gene, were screened for mutations by direct sequencing in 29 selected Type 1 diabetes patients. Four of the identified mutations were tested for linkage and association in 255 Danish Type 1 diabetes families (including 103 simplex families).Results  Evidence for linkage to Type 1 diabetes was found as the second most frequent allele of the marker D4S394 were transmitted 137 times (T = 61%) and not transmitted 88 times to affected offspring (Puc = 0.0011). Twelve mutations were found in the coding region and three mutations in the 3′UTR. No evidence for linkage and association to Type 1 diabetes was found testing four of the identified amino acid substitutions.Conclusions  Evidence of linkage to Type 1 diabetes was observed in the Danish family collection. However, no evidence of linkage and association was observed for any of the analysed polymorphisms, suggesting that other variations must be responsible for the observed evidence of linkage in the region.Diabet. Med. 20, ***–*** (2003)
Nine weeks of bedtime diazoxide is well tolerated and improves β‐cell function in subjects with Type 2 diabetes
Authors: Qvigstad E. , Kollind M. , Grill V. 
Published: December 2004

AbstractAims  To test whether a bedtime dose of diazoxide can improve daytime β‐cell function without side‐effects in Type 2 diabetes.Methods  A double‐blind randomized study was performed in 27 Type 2 diabetic subjects (17 male, 10 female) who were treated with bedtime insulin and metformin. Subjects received either bedtime diazoxide, 100 mg, or placebo for 9 weeks. Duplicate C‐peptide glucagon tests were performed before and in the last days of intervention.Results  No side‐effects of diazoxide were detected. Treatment with diazoxide did not incur any increase in bedtime insulin. C‐peptide responses to glucagon tended to increase: 0.15 ± 0.06 nmol/l vs. −0.01 ± 0.04 nmol/l for placebo, P < 0.06 for difference. Corresponding effects on insulin were 66.2 ± 41.7 pmol/l for diazoxide vs. −84.2 ± 51.5 for placebo, P < 0.03. Treatment with diazoxide decreased fasting glucagon levels by 41% vs. placebo, P < 0.03. Glycated haemoglobin (HbA1c) levels were not affected, whereas levels of blood glucose post breakfast were higher during diazoxide (1.34 ± 0.43 mmol/l, P < 0.01 vs. placebo).Conclusions  Bedtime treatment with diazoxide in Type 2 diabetic subjects on bedtime insulin and metformin has no significant side‐effects, does not increase bedtime insulin supplementation, tends to ameliorate β‐cell function but fails to improve metabolic control.