bluuebunny/crossref_metadata_2025_split huggingface dataset:
Driving and insulin – consensus, conflict or confusion?
Authors: Flanagan D. E. H. , Watson J. , Everett J. , Cavan D. , Kerr D. 
Published: March 2003

Abstract Aims All drivers requiring insulin treatment must be able to demonstrate satisfactory diabetic control and recognition of hypoglycaemic symptoms before being allowed to drive a motor vehicle. Clinicians have a duty to discuss fitness to drive with their patients. However, is the advice given consistent and in line with the regulations published by the Driver and Vehicle Licensing Authority (DVLA)? Methods Six ‘real‐life’ case scenarios were posted to clinicians (consultant diabetologists, specialist registrars and diabetes specialist nurses) within Wessex, UK. The identical cases were also sent to the DVLA for their comments. Results Sixty‐six doctors (36 consultants) and 70 diabetes specialist nurses were contacted by postal questionnaire of which replies were received from 17 consultants (47%), 17 specialist registrars (57%) and 39 diabetes specialist nurses (56%). Although there was general agreement in cases of hypoglycaemia unawareness, there was disagreement where patients had or were at risk of unstable control albeit for a short time. Conclusions Patients treated with insulin may receive conflicting information concerning their ability to drive.
Lipoproteins and low‐dose estradiol replacement therapy in post‐menopausal Type 2 diabetic patients: the effect of addition of norethisterone acetate
Authors: Owens D. , Collins P. B. , Johnson A. , Tomkin G. H. 
Published: March 2003

Abstract Aims Low‐dose continuous oestrogen/progestogen may increase patient compliance long‐term but the cardioprotective effects in diabetes are unknown. The aim of this study was to compare the effect of low‐dose oral oestrogen (1 mg, 17‐β‐estradiol) treatment with oestrogen (1 mg 17‐β‐estradiol) in combination with low‐dose (0.5 mg) continuous norethisterone acetate (NETA) on lipoproteins in Type 2 diabetic patients. Methods Thirty‐four post‐menopausal Type 2 diabetic patients in moderate control (mean haemoglobin A1c 7.7%) who had a serum oestradiol level of < 50 pg/ml were examined over a 6‐month period. Serum lipids, and lipoprotein composition of very low density lipoprotein (VLDL), low density lipoprotein (LDL) and high density lipoprotein (HDL) were measured. Serum lipoprotein(a) was determined by an ELISA method, LDL fatty acids by gas–liquid chromatography and LDL oxidizability by thiobarbituric acid reactive substances (TBARS assay). Cholesteryl ester transfer protein (CETP), and cell cholesterol were measured. Results There was a reduction in serum cholesterol on both treatments but no significant difference between treatment groups. LDL cholesterol decreased by 17% in each group. There was a no significant difference between the groups in serum VLDL or HDL cholesterol or serum triglycerides during the study. The change in lipoprotein(a) during the study was not significantly different between the groups. There was no significant difference in 4 h LDL oxidizability between groups. Although CETP increased with time in both groups there was no significant difference in the change between the groups. Conclusion In this small study, the addition of continuous low‐dose NETA did not reduce the potentially beneficial effects of low‐dose 17‐β‐estradiol on the progression of atherosclerosis in diabetes.
Acute hyperglycaemia causes elevation in plasma atrial natriuretic peptide concentrations in Type 1 diabetes mellitus
Authors: McKenna K. , Smith D. , Tormey W. , Thompson C. J. 
Published: March 2003

SUMMARY Aims  To examine the effect of acute hyperglycaemia on atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) concentrations in Type 1 diabetes.Methods  The study was two limb, randomized, and single‐blind. Eight Type 1 diabetes subjects were clamped at euglycaemia by intravenous infusion of insulin. When euglycaemia was established, the insulin infusion rate was left unaltered for the remainder of the protocol, and an intravenous infusion of either 500 ml 0.9% saline or 500 ml 10% dextrose was administered over 1 h. Blood was collected for estimation of plasma glucose, ANP and BNP concentrations at 30 min intervals for 2 h from the start of the infusion period. One week later, each subject received the alternate infusion. Results are expressed as mean ± standard deviation, and were analysed by anova.Results  Baseline plasma glucose (P = 0.8), ANP (P = 0.8) and BNP (P = 0.8) concentrations were similar on the study days. Plasma glucose rose with dextrose (6.1 + 0.5–15.1 + 2.8 mmol/l, P = 0.9). Plasma ANP concentrations were unaltered by saline infusion (76.5 ± 14.7–77.7 ± 15.2 pg/ml, P = 0.9), but increased with dextrose infusion (79 ± 14–134 ± 17.1 pg/ml, P < 0.0001), and were higher with dextrose than saline infusion (P < 0.0001). Plasma concentrations of BNP were not significantly altered by infusion of either dextrose (5.1 ± 3.9–9.3 ± 5.4 pg/ml, P = 0.63) or saline (4.3 ± 3.5–6 ± 5.2 pg/ml, P = 0.84).Conclusions  Plasma concentrations of ANP, but not BNP, rise in response to acute hyperglycaemia in Type 1 diabetes.
Type 2 diabetes mellitus in UK children – an emerging problem
Authors: Ehtisham S. , Barrett T. G. , Shaw N. J. 
Published: March 2003

SUMMARYAims Type 2 diabetes mellitus has never previously been described in UK children, although an increasing incidence in childhood is recognized in international studies. The prevalence of obesity in UK children is increasing and is a recognized risk factor for the development of diabetes. The aim of this study was to identify and characterize children with Type 2 diabetes in the West Midlands and Leicester.Methods Children were identified by contacting paediatricians responsible for diabetes in five hospitals. Details were collected on demographics, mode of presentation, investigations and treatment on a standard proforma.Results Eight girls were identified with Type 2 diabetes, aged 9–16 years and who were of Pakistani, Indian or Arabic origin. They were all overweight (percentage weight for height 141–209%) and had a family history of diabetes in at least two generations. They presented insidiously with hyperglycaemia and glycosuria without ketosis and five were asymptomatic. Islet cell antibodies measured in seven patients were negative. Four had acanthosis nigricans which is a cutaneous marker of insulin resistance and the other four had high plasma levels of insulin and/or C peptide. These patients are distinct from those with maturity‐onset diabetes of the young (MODY). All were initially managed with dietary measures, seven have been treated with oral anti‐diabetic agents of whom two have subsequently required insulin.Conclusions These are the first UK case reports of Type 2 diabetes in children. Paediatricians need to be aware of the risk of Type 2 diabetes developing in childhood in high‐risk ethnic groups, particularly in association with obesity and a positive family history.
Reducing hospital inpatient length of stay for patients with diabetes
Authors: Cavan D. A. , Hamilton P. , Everett J. , Kerr D. 
Published: March 2003

SUMMARY Aims  To ascertain the effect of routine review by a diabetes nurse advisor on length of stay for medical and surgical inpatients with diabetes.Methods  Inpatients with diabetes were identified prospectively from January 1997 until December 1998 (792 in 1997 and 819 in 1998). A new post of diabetes nurse advisor was introduced in January 1998 to optimize diabetes management. Length of stay was calculated retrospectively from hospital computer records.Results  Median length of stay in 1997 was 11 days in medicine and 8 days in surgery. In 1998, the nurse advisor made 1936 visits to 819 patients; median length of stay fell to 8 days in medicine and 5 days in surgery (P < 0.001). Bed occupancy by patients with diabetes fell from 6.8 to 4.0%. Mean length of stay across the hospital remained unchanged.Conclusions  The introduction of a ward‐based diabetes nurse advisor was associated with significant reductions in length of stay in inpatients with diabetes. Since this study was not a randomized study, other factors may have contributed to this change. However, the consistency of the reduction across specialities suggests the post itself had an important effect.
Intra‐urban differences in the prevalence of the metabolic syndrome in southern India – the Chennai Urban Population Study (CUPS No. 4)
Authors: Mohan V. , Shanthirani S. , Deepa R. , Premalatha G. , Sastry N. G. , Saroja R. 
Published: March 2003

SUMMARY Aims  To assess the influence of socioeconomic status on the prevalence of the metabolic syndrome in an urban south Indian population in Chennai.Methods  The Chennai Urban Population Study is an epidemiological study involving two residential colonies in Chennai (formerly Madras) in south India representing the middle and lower income groups. All individuals ≥ 20 years of age living in the colonies were invited to participate in the study. Of the total 1399 eligible subjects, 1262 individuals (479 belonging the middle income group colony and 783 from the low income group colony) participated in the study. The overall response rate was 90.2%. The main outcome measures were the prevalence rates of the various components of the metabolic syndrome.Results  There were significant differences in the socioeconomic status and lifestyle of the inhabitants of the two areas. The mean monthly income of the Tirumangalam (middle income) group (Rs8075 ± 3859) was significantly higher than the T. Nagar (low income) group (Rs1399 ± 916). The dietary profile of the middle income group showed higher intake of calories, fat and sugar compared to low income group (P < 0.001). The age‐standardized prevalence rates of the various components of the metabolic syndrome were significantly higher in the middle compared to the low income group – diabetes (12.4 vs. 6.5%), impaired glucose tolerance (7.5 vs. 2.9%), hypertension (14.9 vs. 8.4%), obesity (males 38 vs. 13.4%, females 33.1 vs. 24.2%), hypercholesterolaemia (24.2 vs. 14.2%) and hyperinsulinaemia (16.7 vs. 6.6%) P < 0.001). Although the prevalence of coronary artery disease and hypertriglyceridaemia were higher in the middle income group, the differences did not reach statistical significance. The relative odds ratio for diabetes and impaired glucose tolerance increased significantly with increase in income while hypercholesterolaemia, hypertriglyceridaemia, hypertension and coronary artery disease showed no significant changes. Logistic regression analysis revealed that geographical area (higher social class) had a strong association with the components of the metabolic syndrome even after inclusion of other risk factors like age and body mass index in the model.Conclusions  Significant differences exist in the prevalence of various components of the metabolic syndrome even within an urban environment and this appears to be influenced by socioeconomic status.
Human islet cell transplantation – future prospects
Authors: White S. A. , James R. F. L. , Swift S. M. , Kimber R. M. , Nicholson M. L. 
Published: March 2003

Summary Background  Islet transplantation has the potential to cure diabetes mellitus. Nevertheless despite successful reversal of diabetes in many small animal models, the clinical situation has been far more challenging. The aim of this review is to discuss why insulin‐independence after islet allotransplantation has been so difficult to achieve.Methods  A literature review was undertaken using Medline from 1975 to July 2000. Results reported to the International Islet Transplant Registry (ITR) up to December 1998 were also analysed.Results  Up to December 1998, 405 islet allotransplants have been reported the ITR. Of those accurately documented between 1990 and 1998 (n = 267) only 12% have achieved insulin‐independence (greater than 7 days). However with refined peri‐transplant protocols insulin indepedence at 1 year can reach 20%.Conclusions  There are many factors which can explain the failure of achieving insulin‐independence after islet allotransplantation. These include the use of diabetogenic immunosuppressive agents to abrogate both islet allo‐immunity and auto‐immunity, the critical islet mass to achieve insulin‐independence and the detrimental effects of transplanting islets in an ectopic site. However recent evidence most notably from the Edmonton group demonstrates that islet allotransplantation still has great potential to become an established treatment option for diabetic patients.
The relationship between active renin concentration and plasma renin activity in Type 1 diabetes
Authors: Valabhji J. , Donovan J. , Kyd P. A. , Schachter M. , Elkeles R. S. 
Published: March 2003

AbstractAims

Circulating activity of the renin‐angiotensin‐aldosterone system (RAAS) can be assessed by measuring plasma active renin concentration (ARE), as well as by measuring plasma renin activity (PRA). We aimed to assess the relationships between ARE and PRA in Type 1 diabetic compared with non‐diabetic control subjects. We also assessed concentrations of the active renin precursor, prorenin.Patients and methods

Thirty‐five Type 1 diabetic subjects and 34 non‐diabetic control subjects were assessed. Groups had similar ages, sex distributions, body mass indices, systolic and diastolic blood pressures. PRA was measured by radioimmunoassay of angiotensin I generation from endogenous substrate. ARE and total renin concentration (TRE) were measured by immunoradiometric assay (Nichols Institute Diagnostics, USA). Prorenin concentration was calculated as the difference between ARE and TRE.Results

PRA was significantly lower in Type 1 diabetic than in control subjects (0.8 (0.4–1.1) vs. 1.1 (0.9–1.9) pmol/ml per h; P < 0.005), while ARE was similar (17 (9–33) vs. 18 (15–25) mU/l; P = 0.548). PRA (loge transformed) correlated strongly with ARE in diabetic (r = 0.49; P = 0.003) and control subjects (r = 0.59; P = 0.0002), but there was significant vertical separation of the regression lines for the two groups (P < 0.0001). Prorenin concentrations were significantly higher in Type 1 diabetic subjects (249 (170–339) vs. 171 (153–219) mU/l; P = 0.005). Diabetic subjects with high prorenin concentrations (> 400 mU/l (control mean + 3 sd)) were more likely to have microalbuminuria (P = 0.027) and peripheral neuropathy (P = 0.049).Conclusions

Type 1 diabetes is associated with an altered relationship between ARE and PRA, such that ARE is higher for a given PRA compared with non‐diabetic control subjects. Both ARE and PRA are used to assess circulating RAAS activity. The altered relationship between the two in Type 1 diabetic subjects suggests that neither parameter alone is necessarily an adequate and reliable index of such activity. Higher prorenin concentrations, particularly in association with microvascular complications, were confirmed in the Type 1 diabetic subjects.Diabet. Med. 18, 451–458 (2001)
Association between symptoms of depression and glycaemic control may be unstable across gender
Authors: Pouwer F. , Snoek F. J. 
Published: March 2003

AbstractAims  Lloyd and colleagues (Diabetic Med 2000; 17, 198–202) have described an association between poor glycaemic control and moderate to severe depression in male but not in female diabetes patients. However, the validity of this study may be limited by its small sample size and the influence of uncontrolled confounders. Therefore, we set out to replicate this study by investigating the associations between depression and glycaemic control in larger samples, while controlling for potential confounders.Methods

Out‐patients with diabetes (n = 174) and 1437 patient members of the Dutch Diabetes Association (DDA) completed the Hospital Anxiety and Depression Scale. Demographic and clinical characteristics were obtained using medical records (out‐patients) or self‐report (DDA).Results

After controlling for number of complications, years of education and body mass index, depression showed significant, low positive correlations with HbA1c in three of the four female samples and in one of the four male samples. Only for out‐patients with Type 2 diabetes was the correlation between HbA1c and depression significantly higher for women when compared with men (0.19 vs. 0.04; P = 0.02).Conclusions

The association between depression and HbA1c may be stronger in women with Type 2 diabetes. Oestrogen levels and self‐care behaviours may play a mediating role in this association. Further research is required before we can conclude that the association between symptoms of depression and glycaemic control differs across gender.Diabet. Med. 18, 595–598 (2001)
Differential shared care for diabetes: does it provide the optimal partition between primary and specialist care?
Authors: Overland J. , Mira M. , Yue D. K. 
Published: March 2003

AbstractAims  To establish whether a system of differential shared care between general practitioners and specialists is compatible with patients receiving the level of care they require.Methods We sought to trace 200 shared care patients whose care had been kept at the general practitioner level after initial referral and compared them with a group of patients who had been re‐referred to the Royal Prince Alfred Hospital Diabetes Centre for specialist review.Results There were no significant differences in glycaemic, blood pressure and lipid levels of returned and non‐returned patients at initial assessment. However, non‐returned patients were less likely to have a history of macrovascular disease or risk factor (adjusted odds ratio (OR) 0.4; 95% confidence interval (CI) 0.2–0.6). Their referral letter was also more likely to emphasize their type and/or duration of diabetes (adjusted OR 4.6; 95% CI 2.5–8.4). Nearly half (47.1%) of the non‐returned group changed their doctor in the years following their initial specialist review, increasing their likelihood of not being re‐referred five‐fold (adjusted OR 5.0; 95% CI 2.9–8.8). At initial assessment, non‐returned patients were given less treatment recommendations (adjusted OR 0.5; 95% CI 0.3–0.7). Doctors registered with the Diabetes Shared Care Programme referred more patients than their non‐shared care counterparts. However, a higher proportion of these doctors (52.5% vs. 21.3%; χ2= 16.5, 1 d.f., P = 0.00005) were selective in whom they re‐referred.Conclusion  Differential shared care encourages appropriate referral to specialist services, without compromise to standards of care.Diabet. Med. 18, 554–557 (2001)
Efficacy and tolerance of intranasal insulin administered during 4 months in severely hyperglycaemic Type 2 diabetic patients with oral drug failure: a cross‐over study
Authors: Lalej‐Bennis D. , Boillot J. , Bardin C. , Zirinis P. , Coste A. , Escudier E. , Chast F. , Peynegre R. , Selam J‐L. , Slama G. 
Published: March 2003

AbstractAims  We have evaluated the local tolerance and the metabolic efficacy of a lyophilized nasal insulin preparation in 10 severely hyperglycaemic Type 2 diabetic patients.Methods  The study included two 4‐month randomized periods: (A) three preprandial doses of nasal insulin secondarily combined with one evening subcutaneous NPH if the desired glycaemic control was not achieved; (B) two NPH injections daily. We assessed: (i) diabetes control on monthly HbA1c levels and occurrence of hypoglycaemic events; (ii) local tolerance on clinical symptoms, rhinoscopy, nasal muco‐ciliary clearance and nasal biopsies; (iii) insulin absorption at months 0 and 4.Results  One patient was withdrawn because of cough and dizziness after each nasal application. HbA1c was not significantly different at month 4 (9.4 ± 0.5% vs. 8.8 ± 0.2%, A vs. B). Blood glucose control remained only fair in the majority of our patients. Nasal insulin was able to replace the daytime fraction of the subcutaneous insulin with a 18% efficacy. Side‐effects included transient nasal hyperactivity (pruritis, sneezing and rhinorrhoea) and chronic persistence of nasal crusts. Plasma insulin profiles were not significantly different between months 0 and 4.Conclusions  The utilization of nasal insulin (with or without NPH) was associated with similar diabetes control compared with NPH twice daily. Nasal insulin alone was able to achieve an adequate glycaemic control in three of the 10 patients.Diabet. Med. 18, 614–618 (2001)
Diabetes control deteriorates in girls at cessation of growth: relationship with body mass index
Authors: Tylleskär K. , Tuvemo T. , Gustafsson J. 
Published: March 2003

AbstractAim  Diabetic patients, particularly girls, often experience poor metabolic control during puberty and adolescence. The aim of this study was to investigate metabolic control during adolescence, especially in relation to pubertal stages, growth, insulin treatment and body mass index (BMI).Methods  We studied the records of 38 (consecutive) girls with prepubertal onset of Type 1 diabetes mellitus. Data from the age of 10 to 18–20 years were obtained with regard to glycaemic control, growth, age at menarche, final height and BMI, and analysed in relation to both chronological age and age at menarche.Results  HbA1c was lowest 3 years before menarche; mean (± sd) 7.6 (± 1.2). After the pubertal growth spurt, there was a marked impairment of metabolic control, the highest level of HbA1c occurring 3 years after menarche. Mean age at menarche was 13.3 (± 1.1) years and mean linear growth after menarche only 4.7 cm, giving a final height of 164.9 (± 5.3) cm which is 2.7 cm below the Swedish mean. During adolescence the degree of correlation between BMI and HbA1c continuously increased, pointing out the effect of body fat on metabolic control in this age group. The level of HbA1c at 10 years of age could not predict the metabolic control after cessation of puberty, but prepubertal BMI appears to be a risk factor for both obesity and poor glycaemic control in late adolescence.Conclusions  The highest HbA1c was found after cessation of growth. Prepubertal BMI is a possible predictor of metabolic control in adolescent diabetic girls.Diabet. Med. 18, 811–815 (2001)
Erythropoietin response to hypoxia in patients with diabetic autonomic neuropathy and non‐diabetic chronic renal failure
Authors: Bosman D. R. , Osborne C. A. , Marsden J. T. , Macdougall I. C. , Gardner W. N. , Watkins P. J. 
Published: March 2003

AbstractAims An erythropoietin (EPO)‐deficient anaemia is recognized in Type 1 diabetic patients with early nephropathy and symptomatic autonomic neuropathy (DN). The aim of this study was to determine whether the EPO response to hypoxia was deficient in order to clarify the mechanisms involved in this process.Methods Five Type 1 diabetic patients DN (age 39 (28–48) years (mean (range))) with EPO‐deficient anaemia (haemoglobin, Hb 10.6 (9.5–12.0) g/dl, EPO 5.0 (3.2–6.5) IU/l) and early diabetic nephropathy (persistent proteinuria 1161.6 (130–2835) mg/day, serum creatinine 97.6 (63–123) µmol/l)) were compared with nine normal subjects (age 31 (24–39) years, Hb 13.4 (11.8–15.7) g/dl, EPO 7.6 (5.6–10.3) IU/l) and four patients with non‐diabetic advanced chronic renal failure RF (proteinuria 2157.5 (571–4578) mg/day, serum creatinine 490.2 (406–659) µmol/l, Hb 10.3 (9.0–11.3) g/dl, EPO 4.6 (2.9–8.5) IU/l). The subjects were exposed to 6 h of hypoxia (inspired oxygen 11.6–12.6%) by breathing a gas mixture via a hood. Hourly serum EPO levels were measured.Results All groups showed a rise in EPO production after 2 h. The diabetic DN group achieved a similar maximal response to the normal subjects at 6 h (EPO 17.3 ± 5.4 vs. 17.8 ± 7.9 IU/l). The renal failure patients mounted an EPO response to hypoxia but at lower EPO levels.Conclusions Although the DN patients have inappropriately low EPO levels for the severity of their anaemia, they can mount an appropriate EPO response to moderate hypoxia. The mechanism underlying the EPO‐deficient anaemia present in some diabetic patients remains unclear.