bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased sympathetic activity during sleep and nocturnal hypertension in Type 2 diabetic patients with diabetic nephropathy
Authors: Nielsen F. S. , Hansen H. P. , Jacobsen P. , Rossing P. , Smidt U. M. , Christensen N. J. , Pevet P. , Vivien‐Roels B. , Parving H. ‐H. 
Published: March 2003

Summary Aims To elucidate the putative factors involved in the blunted nocturnal blood pressure reduction in hypertensive Type 2 diabetic patients with diabetic nephropathy. Methods Extracellular fluid volume and fluid shift from interstitial to plasma volume (haematocrit), sympathetic nervous activity (plasma noradrenaline and adrenaline) and the internal ‘body clock’ (serum melatonin) were investigated in 31 hypertensive Type 2 diabetes mellitus (DM) patients with diabetic nephropathy (24 males, age 60 (45–73) years). All variables, except extracellular volume, were measured repeatedly with the patients lying awake in bed from 21:30 to 23:00 h (baseline) and during sleep from 23:00 to 07:00 h. Using the median nocturnal blood pressure reduction (8.4%) as a guide, the patients were divided into groups; group 1 with the highest and group 2 with the lowest nocturnal blood pressure reduction. Results Haematocrit decreased from baseline to the sleep period in group 1 by a mean (95% confidence interval (CI)) of 1.7 (0.3–3.1)%, but it increased by 0.5 (–1.0–1.9)% in group 2, mean difference (95% CI), –2.1 (–4.0 to –0.2)% (P = 0.029). Noradrenaline decreased from baseline to the sleep period, mean (95% CI), by 13.3 (0.0–25.0)% in group 1 but rose by 7.7 (–9.7–28.4)% in group 2, mean difference (95% CI), –19.6 (–35–0.0)% (P = 0.049). The nocturnal blood pressure change correlated to the nocturnal change in both noradrenaline (r = 0.51, P = 0.004) and haematocrit (r = 0.42, P = 0.018). Adrenaline remained constant in both groups. Extracellular fluid volume and plasma melatonin levels were comparable in the two groups. Conclusion Sustained adrenergic activity during sleep is associated with blunted nocturnal blood pressure reduction in hypertensive Type 2 DM patients with diabetic nephropathy, probably mediated through a lack of peripheral vasodilatation whereas changes in extracellular fluid volume distribution and melatonin secretion have no impact.
Relative activity and referral patterns for diabetes and non‐diabetes in general practice
Authors: Morgan C. LL. , Currie C. J. , Hunt J. , Evans J. D. , Rogers C. , Stott N. C. H. , Peters J. R. 
Published: March 2003

Summary Aims To describe and compare general practice (GP) activity for patients with and without diabetes using a survey of general practices representing over 10% of the Welsh population. Methods The Welsh GP Morbidity Database Project (GPMDP) collected data including demographic and lifestyle information and consultation data such as diagnosis, referral and surgical procedures. These data were analysed to establish the annual period prevalence of diabetes and compare the relative number of consultations and referrals. Results A total of 4182 diabetic patients were recorded (prevalence 1.41%) and accounted for 77 371 (4.4%) consultations. Patients with diabetes were four‐times more likely to be referred to community services (relative risk (RR) 4.1, 95% CI 3.7–4.7), in particular district nursing (RR 3.8, 1.9–7.7), optician services (RR 8.9, 5.0–15.7), chiropody (RR 8.2 6.4–10.5) and dietician services (RR 21.2, 17.6–25.5). Patients with diabetes were also more likely to be followed‐up in general practice (RR 6.7, 6.2–7.2) both within 1 month (RR 6.7, 6.2–7.2) and 1 month to 1 year (RR 9.7, 8.9–10.7). Emergency admissions were also more likely for patients with diabetes (RR 6.8, 6.2–7.5) as were elective admissions to general medicine (RR 5.6, 4.6–6.7), surgery (RR 1.8, 1.5–2.0) and opthalmology (4.2, 3.4–5.2). Conclusion The increased utilization of health services apparent in secondary care was confirmed in primary care. Further research is required to determine levels of community activity after initial referral.
Early social mixing and childhood Type 1 diabetes mellitus: a case–control study in Yorkshire, UK
Authors: McKinney P. A. , Okasha M. , Parslow R. C. , Law G. R. , Gurney K. A. , Williams R. , Bodansky H. J. 
Published: March 2003

Summary Aims Evidence from animal models shows an increased risk of Type 1 diabetes mellitus associated with the absence of early life exposure to pathogens. To test this ‘hygiene hypothesis’, patterns of social mixing and infections in the first year of life and the risk of developing autoimmune diabetes in childhood were examined. Methods Personal interviews were conducted with the mothers of 220 children with Type 1 diabetes (0–15 years) and 433 age/sex matched controls from a population‐based case control study in Yorkshire, UK. Social mixing including attendance at daycare, and infections occurring under 1 year of age were measures of exposure. Adjusted odds ratios (OR) were derived using conditional logistic regression. Results Frequency of attendance at daycare during the 1st year of life was inversely associated with childhood diabetes (OR 0.71, 95% confidence interval 0.51–1.00, P = 0.05), a finding not explained by mother's age, level of education or maternal diabetes. Increasing numbers of children in the daycare setting and numbers of sessions attended were significantly associated with increasing protection from diabetes. The strongest effect was observed in children with diabetes diagnosed aged 0–4 years. Conclusions Social mixing through attendance at daycare in early infancy appears to confer protection against the development of childhood diabetes. This may be mediated through exposure to infectious agent(s) as a significant dose–response effect was evident with increasing numbers of child ‘contacts’. These findings suggest early infectious exposure may play a role in the development of immunoregulatory mechanisms which protect against diabetes and further work is warranted.
Radicals and oxidative stress in diabetes
Authors: West I. C. 
Published: March 2003

SummaryRecent evidence is reviewed indicating increased oxidative damage in Type 1 and Type 2 diabetes mellitus as well as deficits in antioxidant defence enzymes and vitamins. Mechanisms are considered whereby hyperglycaemia can increase oxidative stress, and change the redox potential of glutathione and whereby reactive oxygen species can cause hyperglycaemia. It is argued that oxygen, antioxidant defences, and cellular redox status should now be regarded as central players in diabetes and the metabolic syndrome.
Effects of three months' diet after diagnosis of Type 2 diabetes on plasma lipids and lipoproteins (UKPDS 45)
Authors:   UK Prospective Diabetes Study (UKPDS) Group, Manley S. E. , Stratton I. M. , Cull C. A. , Frighi V. , Eeley E. A. , Matthews D. R. , Holman R. R. , Turner R. C. , Neil H. A. W. 
Published: March 2003

SUMMARY Aims  To assess the effect of diet on fasting plasma lipids and lipoproteins in patients with newly diagnosed Type 2 diabetes.Methods  A total of 2906 patients each underwent 3 months' diet therapy before allocation to therapy in a randomized controlled clinical trial. Lipids and lipoproteins were measured at diagnosis and after 3 months' diet.Results  The mean body weight at diagnosis was 83 kg. Weight decreased after diet by a mean of 4.5 kg; body mass index (BMI) decreased by 1.51 kg/m2; plasma glucose fell by 3 mmol/l from 11 mmol/l; and HbA1c by 2% from 9%. Triglyceride concentrations were reduced in men by −0.41 (95% confidence interval (CI) −0.47 to − 0.35) mmol/l from a geometric mean 1.8 (1 sd interval 1.0–3.0) mmol/l, and in women by −0.23 (−0.28 to −0.18) mmol/l from a similar level. Cholesterol decreased in men by −0.28 (−0.33 to −0.24) mmol/l from 5.5 (1.1) mmol/l, and in women by −0.09 (−0.14 to −0.04) mmol/l from 5.8 (1.2) mmol/l with corresponding changes in LDL cholesterol. HDL cholesterol increased in men by 0.02 (0.01 to 0.04) mmol/l and in women by 0.01 (0 to 0.02) mmol/l. Triglyceride concentration in the top tertile was reduced by 37% in men (> 2.1 mmol/l) and by 23% in women (> 2.2 mmol/l) with regression to mean accounting for 13% and 6%, respectively. Similarly cholesterol in the top tertile was reduced by 12% in men (> 5.8 mmol/l) and 7% in women (> 6.2 mmol/l) with 6% of the decrease in both men and women accounted for by regression to the mean.Conclusions  Initial dietary therapy in patients with newly diagnosed Type 2 diabetes substantially reduced plasma triglyceride, marginally improved total cholesterol and subfractions, and resulted in a potentially less atherogenic profile, although this did not eliminate the excess cardiovascular risk in patients with Type 2 diabetes.
Automated detection of microaneurysms in digital red‐free photographs: a diabetic retinopathy screening tool
Authors: Hipwell J. H. , Strachan F. , Olson J. A. , McHardy K. C. , Sharp P. F. , Forrester J. V. 
Published: March 2003

SUMMARY Aims  To develop a technique to detect microaneurysms automatically in 50° digital red‐free fundus photographs and evaluate its performance as a tool for screening diabetic patients for retinopathy.Methods  Candidate microaneurysms are extracted, after the image has been modified to remove variations in background intensity, by algorithms that enhance small round features. Each microaneurysm candidate is then classified according to its intensity and size by the application of a set of rules derived from a training set of 102 images.Results  When 3783 individual images were analysed and the results compared with the opinion of a clinical research fellow examining the same images, the program achieved a sensitivity of 81% and a specificity of 93% for the detection of images containing microaneurysms. Nine hundred and twenty‐five sets of 4 images per patient were then analysed and the total number of microaneurysms detected compared with the overall patient retinopathy grade derived by the clinician examining the same images. In this context, intended to mimic a screening situation, the program achieved a sensitivity of 85% and a specificity of 76% for the detection of patients with (any) retinopathy (positive predictive value 0.71, negative predictive value 0.88).Conclusions  An automated technique was developed to detect retinopathy in digital red‐free fundus images that can form part of a diabetic retinopathy screening programme. It is believed that it can perform a useful role in this context identifying images worthy of closer inspection or eliminating 50% or more of the screening population who have no retinopathy.
Evidence‐based patient information in diabetes
Authors: Mühlhauser I. , Berger M. 
Published: March 2003

SummaryPatient education in diabetes has been successful in training and motivating patients to assume a more active and independent role in monitoring and treating their disease resulting in an improvement of patient‐orientated outcomes. Traditionally, diabetes education has mainly aimed at increasing patient compliance to physician‐defined therapeutic goals and treatment strategies. To strengthen their rights and autonomy, patients need to become more involved in medical decision making with respect to their individual therapeutic goals, such as HbA1c and blood pressure, body weight, etc., as well as choosing whether they pursue these goals. The importance of patient participatation is particularly relevant to Type 2 diabetes. Even perfect, long‐term therapeutic co‐operation will not eliminate diabetic complications, only reduce the risk of developing them. The benefits, lack of benefits and unwanted effects of various interventions need to be communicated to the patient in an unbiased manner, so that he/she can make an informed choice with regard to different therapeutic goals and strategies. In diabetes, ways of presenting patients with unbiased information to enable them to make such informed decisions are not yet available. We present ways of how this might be achieved using data provided by the UKPDS. The concept of patient participation in medical decision making represents a fundamental challenge for the future development of diabetes care.
No reactive hypoglycaemia in Type 2 diabetic patients after subcutaneous administration of GLP‐1 and intravenous glucose
Authors: Vilsbøll T. , Krarup T. , Madsbad S. , Holst J. J. 
Published: March 2003

SUMMARY Aims  It has previously been shown that intravenous and subcutaneous administration of glucagon‐like peptide (GLP)‐1 concomitant with intravenous glucose results in reactive hypoglycaemia in healthy subjects. Since GLP‐1 is also effective in Type 2 diabetic patients and is presently being evaluated as a therapeutic agent in this disease, it is important to investigate whether GLP‐1 can cause hypoglycaemia in such patients.Methods  Eight Type 2 diabetic patients (age 54 (49–67) years; body mass index 31 (27–38) kg/m2; HbA1c 9.4 (7.0–12.5)%) and seven matched non‐diabetic subjects (HbA1c 5.5 (5.2–5.8)%, fasting plasma glucose 5.4 (5.0–5.7) mmol/l) were given a subcutaneous injection of 1.5 nmol GLP‐1/kg body weight (maximally tolerated dose), and 15 min later, plasma glucose (PG) was raised to 15 mmol/l with an intravenous glucose bolus.Results  Hypoglycaemia with a PG at or below 2.5 mmol/l was seen in five of the seven healthy subjects after 60–70 min, but PG spontaneously increased again, reaching 3.7 (3.3–4.0) mmol/l at 90 min. In the patients, PG fell slowly and stabilized at 8.6 (4.2–12.1) mmol/l after 80 min. In both groups, glucagon levels initially decreased, but later increased, exceeding basal levels in healthy subjects, in spite of persistent, high concentrations of GLP‐1 (P < 0.02).Conclusions  Subcutaneous GLP‐1 plus intravenous glucose induced reactive hypoglycaemia in healthy subjects, but not in Type 2 diabetic patients. Therefore, a GLP‐1‐based therapy would not be expected to be associated with an increased risk of hypoglycaemia in Type 2 diabetes mellitus.
Abnormal cardiovascular reflex tests are predictors of mortality in Type 2 diabetes mellitus
Authors: Chen H. S. , Hwu C. M. , Kuo B. I. , Chiang S. C. , Kwok C. F. , Lee S. H. , Lee Y. S. , Weih M. J. , Hsiao L. C. , Lin S. H. , Ho L. T. 
Published: March 2003

SUMMARY Aims  To determine whether diabetic autonomic neuropathy is an important factor contributing to mortality in Type 2 diabetes mellitus.Methods  Between 1989 and 1993, 431 men and 181 women with Type 2 diabetes were given diabetic autonomic neuropathy cardiovascular reflex (CVR) tests. These subjects were followed for the subsequent 5–9 years to assess mortality rates.Results  The prevalence rate of abnormal CVR tests was 46.1% in patients with the history of diabetes less than 5 years and up to 69.4% when the history of diabetes exceeded 20 years. During the follow‐up period from 1 January 1989 to 31 December 1997 (mean 7.7 years), a total of 135 participants died. The 8‐year survival rate for patients with abnormal CVR tests was 63.6% in males and 76.4% in females, compared with 80.9 and 93.3% for patients with normal CVR tests. The results were grouped as: group 1, normal CVR tests without postural hypotension (PHT); group 2, normal CVR tests with PHT; group 3, abnormal CVR tests without PHT; and group 4, abnormal CVR tests with PHT. The 8‐year survival rate was 85.4% in group 1, 80.9% in group 2, 74.5% in group 3 and 61.1% in group 4.Conclusion  Type 2 diabetic patients with abnormal CVR tests may have increased mortality, and those combined with postural hypotension have higher mortality than those without. Abnormal CVR tests may be important predictors of mortality in Type 2 diabetes mellitus.
Effect of troglitazone on urinary albumin excretion and serum type IV collagen concentrations in Type 2 diabetic patients with microalbuminuria or macroalbuminuria
Authors: Nakamura T. , Ushiyama C. , Suzuki S. , Shimada N. , Sekizuka K. , Ebihara L. , Koide H. 
Published: March 2003

SummaryAims  Troglitazone, a newly developed thiazolidinedione derivative, has been shown to ameliorate microalbuminuria in diabetic animal model and in human diabetic nephropathy in short‐term studies. The aim of the present study was to determine whether troglitazone or sulphonylurea affect micro‐ albuminuria, macroalbuminuria, or serum type IV collagen concentrations in patients with diabetic nephropathy.Methods  We studied 32 normotensive patients with type 2 diabetes mellitus associated with microalbuminuria (n = 16) or macroalbuminuria (n = 16) and 20 healthy controls. The patients were randomly assigned to one of two groups: those treated with glibenclamide (5.0 mg/day) (n = 8) and those treated with troglitazone (400 mg/day) (n = 8). They received the drug regimen for 12 months. Serum type IV collagen was measured with sandwich enzyme immunoassay.Results  Type IV collagen concentrations in macroalbuminuric patients were higher than those in microalbuminuric patients (P < 0.05) and healthy controls (P < 0.01). Troglitazone reduced urinary albumin excretion (UAE) in micro‐ albuminuric patients from 126 μg/min (range 58–180 μg/min) to 42 μg/min (range 14–80 μg/min) (P < 0.01) and also reduced serum type IV collagen levels gradually at 3, 6 and 12 months after treatment (P < 0.05). However, glibenclamide did not affect UAE and type IV collagen levels in micro‐ albuminuric diabetes patients. In addition, neither troglitazone nor gliben‐ clamide changed UAE and type IV collagen levels in macroalbuminuric patients.Conclusions  These data suggest that troglitazone is an effective treatment for renal injury in patients with early diabetic nephropathy.
Prediction of Type 2 diabetes in healthy middle‐aged men with special emphasis on glucose homeostasis. Results from 22.5 years' follow‐up
Authors: Bjørnholt J. V. , Erikssen G. , Liestøl K. , Jervell J. , Erikssen J. , Thaulow E. 
Published: March 2003

SUMMARY Aims  To study the glucose disappearance rate and fasting blood glucose as predictors of Type 2 diabetes in a 22.5‐year prospective follow‐up of 1947 healthy non‐diabetic men.Subjects and methods  Of a cohort of 2014 Caucasian men, the 1947 who had both fasting blood glucose < 110 mg/dl and an intravenous glucose tolerance test were included. A number of other physiological parameters were also determined at baseline. Multivariate Cox regression analyses were used to investigate the possible significance of the glucose disappearance rate and fasting blood glucose as predictors of Type 2 diabetes.Results  After 22.5 years' follow‐up, 143 cases of Type 2 diabetes had developed. Glucose disappearance rate and fasting blood glucose were moderately correlated (r = −0.32). Men in the lowest quartile of glucose disappearance rate and highest quartile of fasting blood glucose had markedly higher diabetes rates than all other men (P < 0.0001). After adjusting for each other, age, diabetes heredity, body mass index, physical fitness, triglycerides, cholesterol and blood pressure (Cox model), both glucose disappearance rate and fasting blood glucose remained major predictors of diabetesConclusions  Glucose disappearance rate and fasting blood glucose are, in spite of low intercorrelation, major long‐term predictors of Type 2 diabetes in healthy non‐diabetic Caucasian men.
Calcaneal ultrasonometry in patients with Charcot osteoarthropathy and its relationship with densitometry in the lumbar spine and femoral neck and with markers of bone turnover
Authors: Jirkovská A. , Kasalický P. , Bouček P. , Hosová J. , Skibová J. 
Published: March 2003

AbstractAims  To assess calcaneal ultrasonometry in Charcot osteoarthropathy (CO) and to compare it with densitometry measured by dual energy X‐ray absorptiometry (DEXA) and with bone remodelling markers.Patients and methods  A group of 16 diabetic patients in the acute stage of CO with a mean age (± sd) of 51 ± 13 years was compared with 26 sex‐ and age‐matched control subjects. Both calcaneal quantitative ultrasound (QUS) parameter stiffness and bone mineral density (BMD) measured in lumbar spine and femoral neck by DEXA were compared. Collagen type I cross‐linked C‐telopeptides (ICTP) were used for assessment of bone resorption.Results  Patients with acute CO had significantly lower stiffness of the calcaneus in the Charcot and non‐Charcot foot (both P < 0.001) and significantly lower femoral neck BMD (P < 0.05) in comparison with the control group. The T‐score of stiffness was significantly lower in the Charcot foot compared with the non‐Charcot foot (−3.00 ± 1.39 vs. −2.36 ± 1.12; P < 0.01) and significantly lower than the mean T‐score of BMD in the lumbar spine (−0.57 ± 1.28; P < 0.001) and femoral neck (−1.58 ± 1.24; P < 0.05). A significant difference in ICTP (8.49 ± 4.37 vs. 3.92 ± 2.55 ng/ml; P < 0.001) between patients with CO and the control group was found, and a significant correlation was demonstrated between ICTP and the T‐score of stiffness (r = −0.73; P < 0.01).Conclusion  The lower calcaneal QUS parameter stiffness in the Charcot foot in comparison with the control group, with the non‐Charcot foot and with BMD in the lumbar spine and femoral neck, and its association with increased bone resorption indicate that calcaneal ultrasonometry may be useful in diagnosing the acute stage of CO and in assessing the risk of foot fracture.Diabet. Med. 18, 495–500 (2001)
Association of lipoprotein(a) levels and apolipoprotein(a) phenotypes with coronary artery disease in Type 2 diabetic patients and in non‐diabetic subjects
Authors: Gazzaruso C. , Garzaniti A. , Falcone C. , Geroldi D. , Finardi G. , Fratino P. 
Published: March 2003

AbstractAims  We investigated whether in Type 2 diabetic patients lipoprotein(a) (Lp(a)) levels and apolipoprotein(a) (apo(a)) polymorphism are associated with angiographically documented coronary artery disease (CAD). We also examined whether there are differences in the distributions of Lp(a) levels and apo(a) phenotypes between CAD patients with and without diabetes.Methods  A hundred and seven diabetic patients with CAD, 274 diabetic patients without CAD, 201 non‐diabetic patients with CAD, and 358 controls were enrolled.Results  Diabetic patients with CAD showed Lp(a) levels (21.2 ± 17.7 vs. 15.1 ± 17.8 mg/dl; P = 0.0018) and a percentage of subjects with at least one apo(a) isoform of low molecular weight (MW) (67.2% vs. 27.7%; P = 0.0000) significantly greater than diabetic patients without CAD. Multivariate analysis showed that in diabetic patients Lp(a) levels and apo(a) phenotypes were significantly associated with CAD; odds ratios (ORs) of high Lp(a) levels for CAD were 2.17 (1.28–3.66), while ORs of the presence of at least one apo(a) isoform of low MW were 5.35 (3.30–8.60). Lp(a) levels (30.2 ± 23.7 vs. 21.2 ± 17.7 mg/dl; P = 0.0005) and the percentage of subjects with at least one apo(a) isoform of low MW (87.0% vs. 67.2%; P = 0.0001) were significantly higher in CAD patients without than in those with diabetes.Conclusions  Our data suggest that Lp(a) levels and apo(a) phenotypes are independently associated with CAD in Type 2 diabetic patients; thus both these parameters may be helpful in selecting diabetic subjects at high genetic cardiovascular risk. However, Lp(a) levels and apo(a) polymorphism seem to be cardiovascular risk factors less important in diabetic than in non‐diabetic subjects.Diabet. Med. 18, 589–594 (2001)