bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recent advances in treatment of youth with Type 1 diabetes: better care through technology
Authors: Tamborlane W. V. , Bonfig W. , Boland E. 
Published: March 2003

AbstractWhile treatment of Type 1 diabetes mellitus (T1DM) in children and adolescents is especially difficult, recent technological advances have provided new therapeutic options to clinicians and patients. The urgency to achieve strict diabetes control and the introduction of new and improved insulin pumps have been accompanied by a marked increase in use of continuous subcutaneous insulin infusion (CSII) therapy in youth with diabetes. Results of clinical outcome studies indicate that CSII provides a safe and effective alternative to multiple daily injection (MDI) therapy, even when employed in a regular clinic setting in a large number of children. The safety and efficacy of CSII is further enhanced by the introduction of lispro and aspart insulin. The sharper peaks and shorter duration of action of these very rapid‐acting insulin analogues provides a means to achieve better control of post‐prandial hyperglycaemia with less late post‐prandial and nocturnal hypoglycaemia. Glargine insulin, a soluble and essentially peakless long‐acting insulin analogue, may provide a better basal insulin for MDI regimens, but there are limited published data with this agent in children with T1DM. A number of systems for pulmonary delivery of insulin are in development and preliminary results of Phase III studies have been promising. Like CSII, inhaled insulin allows the child to take bolus insulin doses before each meal without having to take a premeal injection. A major obstacle to effective treatment is that self‐monitoring of three to four blood glucose levels a day often misses the marked glycaemic excursions that characterize T1DM in young patients. On the other hand, new continuous glucose sensing systems provide a wealth of data that can be used to optimize basal and bolus therapy, regardless of how insulin is administered. Even more important, we may finally be at the threshold of development of a practically applicable artificial pancreas.Diabet. Med. 18, 864–870 (2001)
Influence of lipoprotein(a) on restenosis after femoropopliteal percutaneous transluminal angioplasty in Type 2 diabetic patients
Authors: Maca T. H. , Ahmadi R. , Derfler K. , Ehringer H. , Gschwandtner M. E. , Hörl W. , Katzenschlager R. , Müller‐Knespel E. , Koppensteiner R. , Schneider B. , Stümpflen A. , Ugurluoglu A. , Minar E. 
Published: March 2003

AbstractObjective  The influence of vascular morphology and metabolic parameters including lipoprotein(a) (Lp(a)) on restenosis after peripheral angioplasty has been compared in Type 2 diabetes (DM) vs. non‐diabetic patients (ND).Research design and methods  The clinical course and risk profile of 132 (54 DM vs. 78 ND) patients with peripheral arterial occlusive disease (PAD) were observed prospectively following femoropopliteal angioplasty (PTA). Clinical examination, oscillometry, ankle brachial blood pressure index (ABI) and the toe systolic blood pressure index (TSPI) were used during follow‐up. Duplex sonography and reangiography were also used to verify suspected restenosis or reocclusion.Results  At the time of intervention patients with DM had a lower median Lp(a) of 9 vs. 15 mg/dl (P < 0.01) in patients without diabetes. Recurrence within 1 year after PTA occurred in 25 diabetic (= 46%, Lp(a) 12 mg/dl) and 30 non‐diabetic (= 38%, Lp(a) 48 mg/dl) patients. DM patients with 1 year’s patency had a median Lp(a) of 7 vs. 11 mg/dl in non‐diabetic patients (P < 0.05). However, 12 months after angioplasty Lp(a) correlated negatively with the ABI (r = –0.44, P < 0.01) in diabetic and in non‐diabetic patients (r = –0.20, P < 0.05). The probability of recurrence after PTA continuously increased with higher levels of Lp(a) in each subgroup of patients.Conclusions  Our data indicate that Lp(a) is generally lower in those with peripheral arterial occlusive disease and Type 2 diabetes than in non‐diabetic individuals. The increased risk for restenosis with rising levels of Lp(a) is set at a lower Lp(a) in diabetes and may be more harmful for diabetic patients.
Gastric emptying in diabetes: clinical significance and treatment
Authors: Horowitz M. , O’Donovan D. , Jones K. L. , Feinle C. , Rayner C. K. , Samsom M. 
Published: March 2003

AbstractThe outcome of recent studies has led to redefinition of concepts relating to the prevalence, pathogenesis and clinical significance of disordered gastric emptying in patients with diabetes mellitus. The use of scintigraphic techniques has established that gastric emptying is abnormally slow in approx. 30–50% of outpatients with long‐standing Type 1 or Type 2 diabetes, although the magnitude of this delay is modest in many cases. Upper gastrointestinal symptoms occur frequently and affect quality of life adversely in patients with diabetes, although the relationship between symptoms and the rate of gastric emptying is weak. Acute changes in blood glucose concentration affect both gastric motor function and upper gastrointestinal symptoms. Gastric emptying is slower during hyperglycaemia when compared with euglycaemia and accelerated during hypoglycaemia. The blood glucose concentration may influence the response to prokinetic drugs. Conversely, the rate of gastric emptying is a major determinant of post‐prandial glycaemic excursions in healthy subjects, as well as in Type 1 and Type 2 patients. A number of therapies currently in development are designed to improve post‐prandial glycaemic control by modulating the rate of delivery of nutrients to the small intestine.
Insulin, insulin propeptides and intima‐media thickness in the carotid artery in 58‐year‐old clinically healthy men. The Atherosclerosis and Insulin Resistance study (AIR)
Authors: Bokemark L. , Wikstrand J. , Wedel H. , Fagerberg B. 
Published: March 2003

AbstractAims To examine the relationship between specific (intact) insulin, insulin propeptides and subclinical atherosclerosis.Methods A cross‐sectional study based on a stratified sampling of randomly selected, clinically healthy 58‐year‐old men (n = 391). Ultrasound examinations of the carotid arteries were performed with measurement of intima‐media thickness (IMT) in the common carotid artery and in the carotid artery bulb. Fasting, cross‐reacting plasma insulin (RIA), specific (intact) insulin, proinsulin, 32,33 split proinsulin and C‐peptide were measured.Results Plasma concentrations of cross‐reacting plasma insulin, specific insulin, proinsulin, 32,33 split proinsulin and C‐peptide were univariately associated with common carotid artery IMT. Established risk factors such as blood pressure, smoking, apoB, triglycerides, body mass index (BMI), and waist–hip ratio were also related to IMT. After adjustment for smoking, apoB, blood pressure and triglycerides, cross‐reacting plasma insulin, proinsulin and C‐peptide but not specific insulin and split 32,33 proinsulin remained associated with carotid artery IMT. No associations remained after adjustment for BMI.Conclusions Fasting plasma proinsulin, C‐peptide, and insulin by cross‐reacting RIA was associated with common carotid artery IMT independent of several conventional risk factors for atherosclerosis. The multicollinearity between the insulin peptides and propeptides makes it difficult to clarify the exact role of each peptide.
Is coeliac disease more prevalent in young adults with coexisting Type 1 diabetes mellitus and autoimmune thyroid disease compared with those with Type 1 diabetes mellitus alone?
Authors: Li Voon Chong J. S. W. , Leong K. S. , Wallymahmed M. , Sturgess R. , MacFarlane I. A. 
Published: March 2003

AbstractAim It is known that patients with Type 1 diabetes mellitus are more prone to develop coeliac disease and that autoimmune thyroid disease occurs more frequently in patients with coeliac disease. We therefore assessed whether coeliac disease, either known or occult, occurs more frequently in young/middle aged adults with Type 1 diabetes and coexisting autoimmune thyroid dysfunction than in adults with Type 1 diabetes alone.Methods The prevalence of known coeliac disease was assessed in 509 (301 males, aged 16–55 years) patients with Type 1 diabetes, 28 (5.5%) of whom had treated autoimmune thyroid disease. In a second study 38 patients with Type 1 diabetes and coexisting autoimmune thyroid disease along with 112 patients with Type 1 diabetes alone were then screened for coeliac disease using serum IgA endomysial antibodies and IgA gliadin antibodies.Results Seven of the 509 patients (1.4%) had been diagnosed with coeliac disease and two of these had later developed autoimmune thyroid disease (both hypothyroid). The subsequent screening exercise found that one of the 38 patients with both Type 1 diabetes and thyroid disease had positive endomysial antibodies on screening. However, duodenal biopsy was negative for coeliac disease. There were two patients with positive endomysial antibodies in the group of 112 patients with diabetes only. Both had duodenal biopsy but only one was consistent with coeliac disease.Conclusion The prevalence of known coeliac disease in this young adult Type 1 diabetes clinic in North‐west England was 7/509 (1.4%). Two of these seven patients with coeliac disease were from the group of 28 who had autoimmune thyroid disease as well. Therefore we suggest that patients with known coeliac disease and Type 1 diabetes should be screened for autoimmune thyroid disease. The second screening study then found 3/150 (2%) to have a serological marker for coeliac disease. However, patients with both Type 1 diabetes and autoimmune thyroid disease were not more likely to have occult coeliac disease compared with those with Type 1 diabetes only.
Neuropsychological functioning in older people with Type 2 diabetes: the effect of controlling for confounding factors
Authors: Asimakopoulou K. G. , Hampson S. E. , Morrish N. J. 
Published: March 2003

AbstractAims and methods Neuropsychological functioning was examined in a group of 33 older (mean age 62.40 ± 9.62 years) people with Type 2 diabetes (Group 1) and 33 non‐diabetic participants matched with Group 1 on age, sex, premorbid intelligence and presence of hypertension and cardio/cerebrovascular conditions (Group 2).Results Data statistically corrected for confounding factors obtained from the diabetic group were compared with the matched control group. The results suggested small cognitive deficits in diabetic people’s verbal memory and mental flexibility (Logical Memory A and SS7). No differences were seen between the two samples in simple and complex visuomotor attention, sustained complex visual attention, attention efficiency, mental double tracking, implicit memory, and self‐reported memory problems.Conclusions These findings indicate minimal cognitive impairment in relatively uncomplicated Type 2 diabetes and demonstrate the importance of control and matching for confounding factors.
Transforming growth factor‐beta 1, 2, 3 and receptor type I and II in diabetic foot ulcers
Authors: Jude E. B. , Blakytny R. , Bulmer J. , Boulton A. J. M. , Ferguson M. W. J. 
Published: March 2003

AbstractAims To study the distribution of transforming growth factor‐beta (TGF‐β) 1, 2 and 3, and TGF‐β receptor types I and II in diabetic foot ulcers, diabetic skin and normal skin by immunohistochemistry, immunofluorescence and Western blotting. We also compared the TGF‐βs with those of chronic venous ulcers.Methods Skin biopsies were obtained from the leg or the foot of non‐diabetic and diabetic subjects, and from the edge of diabetic foot ulcers and chronic venous ulcers. Distribution (by immunofluorescence and immunocytochemistry) of TGF‐β 1, 2 and 3 and TGF‐β receptors (RI and RII) was done by staining 8‐µm skin sections using appropriate antibodies. Protein levels of TGF‐β were measured by Western blot analysis.Results TGF‐β3 expression was increased in the epithelium at the edge of diabetic foot ulcers, being more intense than diabetic and normal skin (P = 0.03, 0.02, respectively), as was its expression in venous ulcers compared with normal skin. However, TGF‐β1 expression was not increased in diabetic foot ulcers and chronic venous ulcers, and was comparable to diabetic and normal skin. There was also no increase for the receptors in diabetic foot ulcers.Conclusion The lack of TGF‐β1 up‐regulation in both diabetic foot ulcers and venous ulcers may explain the impaired healing in these chronic wounds, and could represent a general pattern for chronicity.
Congenital anomalies in the offspring of women with Type 1, Type 2 and gestational diabetes
Authors: Farrell T. , Neale L. , Cundy T. 
Published: March 2003

AbstractAim To determine the frequency of major congenital anomalies in the offspring of women with gestational diabetes (GDM), classified according to their postpartum glucose tolerance status.Methods A prospective study of pregnancies in women with Type 1 diabetes (n = 221), Type 2 diabetes (n = 317) and GDM (n = 1822) between 1985 and 2000 (15 years). Congenital anomalies were detected by antenatal ultrasound or postnatal examination.Results The frequency of major congenital anomalies in the offspring was 5.9% (95% confidence interval (CI) 3.2–9.8) for women with Type 1 diabetes; 4.4% (95% CI 2.4–7.3) for women with Type 2 diabetes; and 1.4% (95% CI 0.9–2.0) for women with GDM. Two hundred and thirty‐seven women with GDM (13%) had diabetes diagnosed on early (6‐week) postpartum glucose tolerance testing. The frequency of major congenital anomalies in their offspring was 4.6% (95% CI 2.3–8.2), compared with 0.9% (95% CI 0.5–1.5) for the remainder of the GDM group (P < 0.0001).Conclusions GDM is not a homogeneous group with regard to the risk of major congenital anomalies. In those with diabetes on early postpartum testing, who are likely to have had unrecognized Type 2 diabetes antedating their pregnancy, the rate of major congenital anomalies is the same as for women with established Type 1 or Type 2 diabetes. In the remainder of the GDM group, the rate does not differ from the non‐diabetic background rate.
Serum fatty acid composition predicts development of impaired fasting glycaemia and diabetes in middle‐aged men
Authors: Laaksonen D. E. , Lakka T. A. , Lakka H.‐M. , Nyyssönen K. , Rissanen T. , Niskanen L. K. , Salonen J. T. 
Published: March 2003

AbstractAims Dietary fatty acid intake is reflected in serum fatty acid composition. Studies prospectively investigating serum fatty acids and development of impaired fasting glycaemia (IFG) or diabetes mellitus (DM) are largely lacking. We assessed the association of serum fatty acid composition with development of IFG or DM.Methods Middle‐aged normoglycaemic men (n = 895) participating in a prospective cohort study were followed up after 4 years.Results At baseline proportions of serum esterified and non‐esterified saturated fatty acids were increased and polyunsaturated fatty acids decreased in men who after 4 years had developed IFG (n = 56) or DM (n = 34). No differences in dietary fatty acid composition as recorded in 4‐day dietary records were noted. In logistic regression analyses adjusting for age; obesity; and fasting lipid, glucose and insulin concentrations, men with proportions of non‐esterified and esterified linoleate in the upper third had nearly half the risk for IFG or DM compared with the lower third. In covariate analyses, baseline non‐esterified linoleate proportions were associated with changes in fasting insulin and glucose concentrations over the 4‐year follow‐up. Baseline esterified fatty acid composition was also associated with changes in insulin.Conclusions High serum linoleate proportions decreased the risk of developing IFG or DM in middle‐aged men over a 4‐year follow‐up, possibly mediated in part by insulin resistance. These findings support recommendations to substitute vegetable fat for animal and dairy fat in the prevention of disturbances of glucose and lipid metabolism.
Congenital anomalies and first life year surveillance in Type 1 diabetic births
Authors: Vääräsmäki M. , Gissler M. , Ritvanen A. , Hartikainen A.‐L. 
Published: March 2003

AbstractAims To evaluate the rate of congenital anomalies (CA) and the reasons for mortality from 22 weeks of gestation until 1 year of age in births by Type 1 diabetic mothers.Methods Population‐based cohort study using combined data from four national health registers in Finland during 1991–1995, including 954 singleton pregnancies complicated by Type 1 diabetes.Results Sixty births (629/10 000) involved registered major CA, of which 68% (n = 41) were isolated and 22% (n = 13) multiple anomalies, and in six cases, a syndrome was diagnosed (10%). After the exclusion of syndromes, the total number of anomalies was 73. Of the malformed infants, 63% were boys. The total rate of deaths among births until 1 year of age was higher in diabetic than in non‐diabetic mothers (19.9/1000 vs. 8.1/1000): especially the rates of stillborns (odds ratio 2.4; 95% confidence interval 1.2–4.7) and post‐neonatal deaths (3.8; 1.6–9.2) were higher. Of perinatal mortality (PNM) from the 22nd gestational week to the age of 7 days (13.6/1000), 23% were due to CA, 23% to prematurity, and the rest were intrauterine, mostly unexplained, deaths. Respiratory distress syndrome was the main cause of death among infants.Conclusions The rate of CAs in Type 1 diabetic pregnancies is still high, but their proportion as a cause of PNM has decreased. Though PNM rate was low, post‐neonatal mortality was significantly increased, reflecting the shift of deaths from the perinatal period to a later age.
Neuropeptides and appetite control
Authors: Wilding J. P. H. 
Published: March 2003

AbstractObesity is important in the aetiology of type 2 diabetes, and presents a major barrier to its successful prevention and management. Obesity develops when energy intake exceeds energy expenditure over time. A complex system has evolved to maintain energy homeostasis, but this is biased towards weight gain. Meal size is controlled by a series of short‐term hormonal and neural signals that derive from the gastrointestinal tract, such as cholecystokinin whereas others may initiate meals, such as the recently discovered hormone, ghrelin. Other hormones such as insulin and leptin, together with circulating nutrients, indicate long‐term energy stores. All these signals act at several central nervous system (CNS) sites but the pathways converge on the hypothalamus, which contains a large number of peptide and other neurotransmitters that influence food intake. As energy deficit is most likely to compromise survival, it is not surprising that the most powerful of these pathways are those that increase food intake and decrease energy expenditure when stores are depleted. When energy stores are low, production of leptin from adipose tissue, and thus circulating leptin concentrations fall, leading to increased production of hypothalamic neurotransmitters that strongly increase food intake, such as neuropeptide Y (NPY), galanin and agouti‐related protein (AGRP) and decreased levels of α‐melanocyte‐stimulating hormone (α‐MSH), cocaine and amphetamine‐regulated transcript (CART) and neurotensin that reduce food intake and increase energy expenditure. The finding that mutations in leptin and POMC lead to severe early onset obesity in bumans has highlighted the importance of these peptides in humans. This new understanding may eventually lead to new treatments for obesity that will be of particular benefit in the prevention and treatment of type 2 diabetes.Diabet. Med. 19, 619–627 (2002)
Ultrasonography of plantar soft tissues thickness in young people with diabetes
Authors: Duffin A. C. , Lam A. , Kidd R. , Chan A. K. F. , Donaghue K. C. 
Published: March 2003

AbstractAims The aims of this study were to examine soft tissue changes in the skin and plantar aponeurosis of young people with Type 1 diabetes mellitus (T1DM) and to evaluate any relationship between any soft tissue changes, arch length, limited joint mobility (LJM) and plantar pressure.Methods The thickness of the skin on the plantar surface of the foot and plantar aponeurosis were examined using ultrasound in 216 young people with diabetes and 57 controls. Foot length, arch length, joint mobility, peak pressure and pressure time integrals were evaluated.Results Skin was not significantly thicker in the diabetic subjects. The plantar aponeurosis was significantly thicker in the diabetic subjects and was associated with foot size, male gender and subtalar joint (ST) LJM (P < 0.01). Males were nearly three times more likely to have thickened plantar aponeurosis.Conclusion Soft tissue thickening in young people with T1DM affects the deeper structures on the plantar surface of the foot rather than the skin. Thickening of the plantar aponeurosis was associated with LJM at the ST joint and male gender, but was not associated with plantar pressure or arch height changes. Plantar aponeurosis thickening does not appear to alter foot mechanics in young people with T1DM.Diabet. Med 19, 1009–1013 (2002)
The role of the growth hormone–insulin‐like growth factor axis in glucose homeostasis
Authors: Holt R. I. G. , Simpson H. L. , Sönksen P. H. 
Published: March 2003

AbstractHomeostatic mechanisms normally maintain the plasma glucose concentration within narrow limits despite major fluctuations in supply and demand. There is increasing evidence that the growth hormone (GH)–insulin‐like growth factor (IGF) axis may play an important role in glucose metabolism. GH has potent effects on intermediary metabolism, some of which antagonize the actions of insulin. In contrast, IGF‐I has insulin‐like actions, which are, in the case of glucose metabolism, opposite to those of GH. There is often deranged glucose metabolism in situations where GH is deficient or in excess. The clinical administration of GH or IGF‐I results in altered glucose metabolism and changes in insulin resistance. Despite these observations, the precise role of GH and IGF‐I and their interactions with insulin in controlling normal glucose homeostasis are unknown. In diabetes, GH secretion is abnormally increased as a result of reduced portal insulin resulting in impaired hepatic IGF‐I generation. Evidence suggests that this may contribute to the development of diabetic microvascular complications. IGF‐I ‘replacement’ in diabetes is under investigation and new methods of delivering IGF‐I as a complex with IGFBP‐3 offer exciting new prospects.Diabet. Med. 20, 3–15 (2003)