bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of dobutamine stress echocardiography in detecting silent myocardial ischaemia in asymptomatic diabetic patients: a comparison with thallium scintigraphy and exercise testing
Authors: Penfornis A. , Zimmermann C. , Boumal D. , Sabbah A. , Meneveau N. , Gaultier‐Bourgeois S. , Bassand J. P. , Bernard Y. 
Published: March 2003

AbstractAims  Silent myocardial ischaemia is frequent in diabetic patients. The aim of this study was to compare the efficacy of thallium‐201 single‐photon emission computed tomography (201Tl SPECT) coupled with exercise stress testing (EST), and dobutamine stress echocardiography (DSE) in the detection of asymptomatic coronary artery disease.Methods  Fifty‐six asymptomatic diabetic patients, with a known duration of diabetes > 15 years for Type 1 and > 5 years for Type 2, having at least three added risk factors, but without rest ECG abnormalities, were enrolled in this prospective study. All of them were submitted to DSE with a maximum infusion rate of 40 µg/kg per min dobutamine ± i.v. atropine, and to 201Tl SPECT coupled with EST. Coronary angiography was performed if at least one test was abnormal.Results  Diabetic patients were 37 males and 19 females, aged mean (sd) 60 ± 10 years, 10 Type 1 and 46 Type 2, with a known duration of disease of mean (sd) 17 ± 9 years. Feasibility of DSE was 91%. No serious complication occurred during the test. Coronary angiography was performed in 26 patients (47%); 17 were abnormal (30% of the whole group): six patients had a one‐vessel, six a two‐vessel and five a three‐vessel disease. Predictive positive value was 69% for DSE, 75% for 201Tl SPECT and 60% for EST. DSE was falsely negative in four cases vs. eight for 201Tl SPECT and nine for EST.Conclusions  Asymptomatic coronary disease is common in diabetes associated with other risk factors. DSE appears useful in its detection and a good alternative to 201Tl SPECT.Diabet. Med. 18, 900–905 (2001)
Does ACE inhibition slow progression of glomerulopathy in patients with Type 2 diabetes mellitus?
Authors: White K. E. , Pinel N. , Cordonnier D. J. , Bilous R. W. ,   for the Diabiopsies Group
Published: March 2003

AbstractAims  To examine the effect of ACE inhibition on glomerular structure in Type 2 diabetic patients with nephropathy.Methods  Twenty‐two patients were randomized to receive either perindopril (PE) or placebo (PO) and biopsied at baseline and after 2 years. Nineteen patients completed the study and data on interstitial changes, examined by light microscopy, have already been published. Only 11 patients (five PE, six PO) had sufficient tissue at baseline and follow‐up to provide material for detailed electron microscopic examination.Results  At baseline, mean ± sd age (PE vs. PO) was 48 ± 12 vs. 45 ± 7 years; creatinine clearance 116 ± 24 vs. 128 ± 68 ml/min; median (range) proteinuria 0.7 (0.1–1.0) vs. 0.5 (0.07–3.9) g/24 h (P = NS for all). This cohort of 11 patients showed the same interstitial changes as the whole group. Between‐group analysis showed that the change in interstitial volume fraction was significantly greater in the PO compared with PE group (0.10 ± 0.07 vs. −0.001 ± 0.04, P = 0.020). There were no significant changes in proteinuria or glomerular structural parameters (mesangial volume fraction PO 0.40 ± 0.17 to 0.42 ± 0.21; PE 0.29 ± 0.08 to 0.28 ± 0.14) in either treatment group.Conclusions  Interstitial changes appear to be more sensitive to ACE inhibition than glomerulopathy. Larger patient groups and longer treatment periods are necessary in order to detect any possible impact of ACE inhibition on the glomerular changes in Type 2 diabetes mellitus.Diabet. Med. 18, 933–936 (2001)
Use of oral fluorescein angiography in the diagnosis of macular oedema within a diabetic retinopathy screening programme
Authors: Razvi F. M. , Kritzinger E. E. , Tsaloumas M. D. , Ryder R. E. J. 
Published: March 2003

AbstractAims  To assess if oral fluorescein angiography (OFA) is a suitable screening method to detect macular oedema in diabetic retinopathy.Methods  Eighty‐four diabetic patients were included in the study. They were from a consecutive series of patients attending the diabetic eye‐screening clinic, with retinopathy at the macula requiring ophthalmology assessment. All patients were subsequently examined in the eye hospital, by ophthalmologist slit lamp biomicroscopy assessment as the gold standard, followed by oral fluorescein angiography.Results  This study indicates a sensitivity of 92% and specificity of 81%. Only 4.8% of patients developed a minor reaction to oral fluorescein; 84.5% of images were of good quality.Conclusions  Oral fluorescein angiography is an efficient and highly sensitive tool for the detection of macular oedema. It can be used as an adjunct in the diabetic screening service to identify patients with oedema within a disc diameter of the macula. Ultimately it will ensure that only necessary and smaller numbers of patients are referred to ophthalmologists.Diabet. Med. 18, 1003–1006 (2001)
Adherence to prescribed oral hypoglycaemic medication in a population of patients with Type 2 diabetes: a retrospective cohort study
Authors: Donnan P. T. , MacDonald T. M. , Morris A. D. 
Published: March 2003

AbstractAims To evaluate the patterns and predictors of adherence in all patients with Type 2 diabetes in the community receiving treatment with a single oral hypoglycaemic drug. In particular, to test the hypothesis that one tablet per day is associated with better adherence than more than one.Methods The study design was a retrospective cohort study set in the Tayside region of Scotland (population approx. 400 000). Participants were residents of Tayside from 1 January 1993 until 31 December 1995 with at least 12 months of prescriptions of oral hypoglycaemic drugs (OHDs). The main outcome measures were adherence indices for sulphonylureas and metformin separately, adjusting for prescribing while hospitalized.Results Of the total 2920 subjects identified, adequate adherence (≥ 90%) was found in 31% of those prescribed sulphonylureas alone (n = 1329, median adherence = 300 days per year), and in 34% of those prescribed metformin alone (n = 528, median = 302 days per year). There were significant linear trends of poorer adherence with each increase in the daily number of tablets taken (p = 0.001) and increase in co‐medication (p = 0.0001) for sulphonylureas alone after adjustment for other factors.Conclusions In the community only one in three with Type 2 diabetes had adequate adherence to OHDs. One tablet per day administration was associated with greater adherence than multiple tablets. Poor adherence is a major obstacle to the benefit of complex drug regimens in the treatment of Type 2 diabetes.
Trends in the incidence of childhood diabetes in south Asians and other children in Bradford, UK
Authors: Feltbower R. G. , Bodansky H. J. , McKinney P. A. , Houghton J. , Stephenson C. R. , Haigh D. 
Published: March 2003

AbstractAims To investigate incidence rates and time trends, over 21 years, of Type 1 diabetes in a migrant population of south Asian children in Bradford, UK.Methods Children (0–14 years) living in the city of Bradford and diagnosed with Type 1 diabetes were selected from a population‐based region‐wide register. Between 1978 and 1998, 289 new‐onset cases were registered and classified as south Asian (Indian, Pakistani, Bangladeshi) or not, based on their full name using two different computer algorithms and visual inspection.Results Sixty‐six children (22.8%) were designated as south Asian with 223 (77.2%) remaining. The overall age–sex standardized incidence for south Asian and non‐south Asian children was 13.0 per 100 000 person years (95% confidence interval 9.9–16.2) and 12.9 (11.2–14.6), respectively. Rates were similar for south Asians at all ages, whereas for the mainly Caucasian children incidence differed significantly by age group (P < 0.001). An average annual increase in incidence of 4.3% (P = 0.001) was seen for all children compared with 6.5% in south Asians (P = 0.002) and 2.4% (P = 0.128) in non‐south Asians.Conclusions Children in south Asia have a low incidence of Type 1 diabetes but migrants to the UK have similar overall rates to the indigenous population. However, a more steeply rising incidence is seen in the south Asian population, and our data suggest that incidence in this group may eventually outstrip that of the non‐south Asians. Genetic factors are unlikely to explain such a rapid change, implying an influence of environmental factors in disease aetiology. The similarity in rates by age group in the south Asian population is notable.
Prognosis following first acute myocardial infarction in Type 2 diabetes: a comparative population study
Authors: Donnan P. T. , Boyle D. I. R. , Broomhall J. , Hunter K. , MacDonald T. M. , Newton R. W. , Morris A. D. ,   for the DARTS/MEMO Collaboration
Published: March 2003

AbstractAimsTo estimate the incidence of death and macrovascular complications after a first myocardial infarction for patients with Type 2 diabetes.Research designIn a retrospective, incidence cohort study in the Tayside Region of Scotland we studied all patients hospitalized with a diagnosis of first acute myocardial infarction from 1 April 1993 to 31 December 1994. The primary endpoint was time to death. Secondary endpoints were 2‐year incidence of hospital admission for angina, myocardial infarction, stroke, heart failure, coronary angiography, coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA).ResultsThe 147 patients with Type 2 diabetes had significantly worse survival with an increase in relative hazard of 67% compared with non‐diabetic patients. After adjustment for age, sex, smoking status, prior heart failure, prior angina, delay to hospitalization, site of infarction, drug therapy with aspirin, β‐blockers, streptokinase and hyperlipidaemia and treated hypertension, Type 2 diabetes was still associated with a 40% higher death rate compared with people without diabetes (P < 0.05) There was no significant difference in death rates in those aged over 70 years, but an indication of a trend in younger individuals with a four‐fold increase in death rate in those with diabetes aged < 60 years, compared with a rate ratio of 2.6 in those with diabetes aged 61–70 years.ConclusionsAmong hospitalized patients with first acute myocardial infarction, Type 2 diabetes mellitus is consistently associated with increased mortality and increased hospital admission for heart failure. The estimated 4‐year survival rate is only 50%. Our results indicate that younger subjects with Type 2 diabetes and acute myocardial infarction are a high‐risk group deserving of special study, and support the argument for aggressive targeting of coronary risk factors among patients with Type 2 diabetes.
Less severe hypoglycaemia, better metabolic control, and improved quality of life in Type 1 diabetes mellitus with continuous subcutaneous insulin infusion (CSII) therapy; an observational study of 100 consecutive patients followed for a mean of 2 years
Authors: Linkeschova R. , Raoul M. , Bott U. , Berger M. , Spraul M. 
Published: March 2003

AbstractAims To compare glycaemic control, occurrence of acute complications, and diabetes‐specific quality of life in Type 1 diabetic patients (on intensified conventional insulin treatment (ICT)) before and after initiation of CSII.Methods One hundred and three patients (58 women) started CSII between October 1995 and April 1999 in our department. The indication for CSII was optimization of metabolic control and improvement of flexibility of life style (OF group) in 60 patients (58%), and prevention of severe hypoglycaemia (HY group) in 43 patients. Mean age at initiation of CSII was 33 ± 11 years (OF 33 ± 10, HY 33 ± 11 (mean ± sd)), diabetes duration 18 ± 9 years (OF 16 ± 9, HY 20 ± 9). Three patients stopped CSII, mean duration of CSII of the remaining 100 patients was 1.8 ± 1.2 years. The occurrence of hypoglycaemia, ketoacidosis and skin abscesses was assessed retrospectively for the 12 months before starting CSII, and recorded continuously during CSII. Quality of life was assessed with a validated, diabetes‐specific questionnaire before and after CSII in 50 patients.Results The incidence of serious hypoglycaemia (any external help) was reduced from 1.23 (OF 0.0; HY 2.93) during ICT to 0.29 cases/patient per year (OF 0.09; HY 0.55) during CSII. The incidence of severe hypoglycaemia (SH) (treated with i.v. glucose or glucagon injection) fell from 0.70 (OF 0.0; SH 1.67) during ICT to 0.06 cases/patient per year (OF 0.02; HY 0.12) during CSII. HbA1c improved from 7.7 ± 1.1% to 7.2 ± 1.0% (P < 0.001) (OF 7.8% vs. 7.2%; HY 7.6% vs. 7.2%). During CSII the incidence of abscesses was 0.11 and of ketoacidosis 0.01 cases/patient per year. Quality of life assessments showed significant improvement in all parameters during CSII.Conclusions In our cohort of Type 1 diabetic patients, we observed a substantial decrease of hypoglycaemia along with a significant fall of HbA1c. Quality of life on CSII was improved when compared with ICT.
Serum fructosamine as a marker of 5‐year risk of developing diabetes mellitus in patients exhibiting stress hyperglycaemia
Authors: Wahid S. T. , Sultan J. , Handley G. , Saeed B. O. , Weaver J. U. , Robinson A. C. J. 
Published: March 2003

AbstractAims We examined whether the level of random serum glucose (RSG) in subjects exhibiting stress hyperglycaemia is a useful marker of the future risk of developing diabetes mellitus (DM), and whether serum fructosamine is of any additional value.Methods All non‐diabetic adults attending Accident and Emergency in 1994–1995, who had venesection, were studied. Serum fructosamine and RSG were routinely measured in all such patients. Using the laboratory biochemistry database the number of subjects with stress hyperglycaemia (RSG > 11.1 mmol/l) was determined, and their corresponding fructosamine values were recorded. The number of subjects who developed DM over the following 5 years was determined.Results Three hundred and seventeen patients had stress hyperglycaemia, and follow‐up data were available on 224 patients. Of these patients, 63 (28%) had developed DM over the 5 years follow‐up period. RSG and fructosamine levels at baseline of patients subsequently developing DM were (mean ± sd (range)) 16.7 ± 7.0 (11.2–55.0) mmol/l and 3.3 ± 0.6 (1.3–4.5) mmol/l, respectively. The patients who did not develop DM had a similar baseline RSG, 15.9 ± 3.3 (11.2–30.6) mmol/l; P = 0.170, but lower baseline fructosamine, 2.4 ± 0.4 (1.6–3.8) mmol/l; P < 0.001. Receiver‐operating characteristics showed that a serum fructosamine ≥ 2.8 mmol/l was a useful marker of the future risk of DM (75% sensitivity, 74% specificity, 53% positive and 88% negative predictive power).Conclusions The level of RSG in stress hyperglycaemia does not predict the future development of DM. Raised serum fructosamine is a more useful marker of future DM risk than RSG alone. Further prospective studies are needed.
Changes in treatment after the start of oral hypoglycaemic therapy in Type 2 diabetes: a population‐based study
Authors: Donnan P. T. , Steinke D. T. , Newton R. W. , Morris A. D. ,   for the DARTS/MEMO Collaboration
Published: March 2003

AbstractAimsTo determine the changes in oral hypoglycaemic therapy and the time to incidence of insulin therapy in people with Type 2 diabetes.MethodsA retrospective incidence cohort was constructed of 1305 subjects with Type 2 diabetes, who obtained a first prescription for oral hypoglycaemic medication between 1 July 1993 and 31 December 1994 in Tayside, Scotland. The primary endpoint of changes in oral hypoglycaemic therapy and time to insulin was determined up to the end of the follow‐up, on 31 December 1995.ResultsOverall, 9.4% of subjects switched to insulin, while 11% of those initially on sulphonylurea, and 6% of those initially on metformin switched to insulin therapy. Approximately three‐quarters (72%) remained on the same class of drug throughout the study period (median follow‐up 588 days). Only 9% died during the follow‐up and this did not differ appreciably by drug group. Males were more likely to switch to insulin compared with females (10.3% vs. 8.5%), and those who switched were slightly younger with a mean age of 58 years compared with a mean age of 60 years of those who did not switch. The median time of switching to insulin was 186 days or approximately 6 months for this cohort, giving a rate of switching to insulin of 5.84% per year. Poorer glycaemic control (HBA1c) and low body mass index (BMI) were associated with switching to insulin.ConclusionsFollowing initial therapy with oral hypoglycaemic medication in the population, switching to insulin occurred at a rate of 5.84% per year. Switching to insulin was associated with being younger, male, having low BMI and higher HbA1c.Diabet. Med. 19, 606–610 (2002)
Insulin: in search of a syndrome
Authors: Ferrannini E. , Balkau B. 
Published: March 2003

AbstractThe insulin resistance syndrome has been defined as the clustering of hypertension, dyslipidaemia and impaired glucose tolerance in subjects with high fasting plasma insulin concentrations. The latter are usually taken as a surrogate measure of insulin resistance of whole‐body glucose disposal. Although hyperinsulinaemia and insulin resistance are reciprocally related to one another, the association is not very strong. In the data‐pooling project of the European Group for the study of Insulin Resistance (EGIR), clamp‐derived insulin sensitivity (as the M value) and fasting plasma insulin concentrations were available in 1,308 non‐diabetic subjects with a wide range of age and body mass index. In this cohort, hyperinsulinaemia (as the upper quartile of fasting plasma insulin distribution in the non‐obese segment of the population) and insulin resistance (as the bottom quartile of M value in the same subgroup) were each present in ~40% of the whole population, but identified only partially overlapping (60%) subsets of individuals. When the subjects with insulin resistance but without hyperinsulinaemia (n = 198) were compared with the subjects with hyperinsulinaemia but without insulin resistance (n = 267), significant differences emerged in the respective clinical phenotypes. Thus, subjects with ‘pure’ insulin resistance had a more central fat distribution and presented evidence of excessive lipolysis and endogenous glucose production. In contrast, subjects with ‘pure’ hyperinsulinaemia had suppressed lipolysis, endogenous glucose production and insulin clearance, higher values of systolic blood pressure and lower values of serum HDL‐cholesterol concentrations. The only abnormality common to both phenotypes was the presence of raised serum triglycerides concentrations.This analysis indicates that hyperinsulinaemia and insulin resistance identify partially different subgroups of individuals in a non‐diabetic population, and suggests that hyperinsulinaemia and insulin resistance carry distinct pathogenic potential in terms of the components of the insulin resistance syndrome.
Symptom scoring systems to diagnose distal polyneuropathy in diabetes: the Diabetic Neuropathy Symptom score
Authors: Meijer J. W.G. , Smit A. J. , Sonderen E. V. , Groothoff J. W. , Eisma W. H. , Links T. P. 
Published: March 2003

AbstractAims To provide one of the diagnostic categories for distal diabetic polyneuro‐pathy,several symptom scoring systems are available, which are often extensive andlack in validation. We validated a new four‐item Diabetic Neuropathy Symptom (DNS) scorefor diagnosing distal diabetic polyneuropathy.Methods We compared score characteristics of the generally accepted NeuropathySymptom Score (NSS) with the DNS score, and tested construct validity,predictive value and reproducibility with the Diabetic Neuropathy Examinationscore, Semmes–Weinstein monofilaments and Vibration Perception Threshold(clinical standards) in 73 patients with diabetes (24 Type 1, 49 Type 2;43 male/30 female; mean age 57 years (19–90);mean diabetes duration 15 years (1–43)).Results Correlation between NSS and DNS score was high (Spearman r= 0.88). Patient scoreswere more differentiated on the DNS score. The relation of the NSS andDNS scores, respectively, with clinical standards was good (Spearman r= 0.21–0.60). Reproducibility ofthe DNS score was high (Cohen weighted κ 0.78–0.95). The DNSscore was easier to perform in clinical practice.Conclusions The DNS is validated, fast and easy to perform, with a high predictive valuewhen screening for diabetic polyneuropathy.Diabet. Med. 19, 962–965 (2002)
Tumour necrosis factor‐alpha plasma levels in elderly patients with Type 2 diabetes mellitus—observations over 2 years
Authors: Lechleitner M. , Herold M. , Dzien‐Bischinger C. , Hoppichler F. , Dzien A. 
Published: March 2003

AbstractAims The cytokine tumour necrosis factor‐alpha (TNF‐α) is involved in the development of obesity‐linked insulin resistance. TNF‐α plasma levels rise with increasing age and might thus also be related to metabolic control in Type 2 diabetes mellitus. We have studied the relationship of TNF‐α plasma levels to glycaemic control in elderly patients with Type 2 diabetes over 2 years.Methods Clinical and laboratory data of 53 patients (26 women, 27 men) with Type 2 diabetes (mean age 71.6 ± 5.6 years) were regularly evaluated over 2 years, and the relationship to anti‐diabetic treatment regimens analysed. TNF‐α plasma level was measured by a solid‐phase enzyme amplified sensitivity immunoassay.Results TNF‐α plasma levels increased significantly from 16.2 ± 9.6 pg/ml at baseline to 28.0 ± 13.8 pg/ml after 2 years (P = 0.028). HbA1c values also increased from 6.4 ± 1.2% to 7.7 ± 1.6% (P = 0.046). Mean body mass index of the patients remained almost constant, while a moderate increase in the percentage of body fat (34.5 ± 7.0% to 35.3 ± 6.9%; P= 0.061) and in waist–hip ratio was observed (0.86 ± 0.04 to 0.88 ± 0.04; P= 0.052). After adjustment for covariates multivariate analysis demonstrated that TNF‐α plasma levels are positively related to the HbA1c values of the whole study population at the baseline control and after 2 years. TNF‐α also revealed a positive correlation to the percentage of body fat.Conclusions In elderly patients with Type 2 diabetes TNF‐α plasma levels revealed a continuous increase during an observation period of 2 years. This increase in TNF‐α plasma levels might add another aspect to the worsening of glycaemic control in the progression of Type 2 diabetes.Diabet. Med. 19, 949–953 (2002)