bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations between smoking and β‐cell function in a non‐hypertensive and non‐diabetic populationSkaraborg Hypertension and Diabetes Project
Authors: Östgren C. J. , Lindblad U. , Ranstam J. , Melander A. , Råstam L. 
Published: March 2003

Summary Aims An increased risk for Type 2 diabetes in male and female smokers has been associated with insulin resistance. However, this might also be the result of an adverse effect on the β‐cell. The aim of the present study was to examine the association between smoking and β‐cell function. Methods A community‐based, cross‐sectional observation study. In 1994, a randomized age‐stratified sample of men and women aged ≥ 40 years in the city of Skara, Sweden, were invited to a survey of cardiovascular risk factors. In all, 1109 subjects participated (80%). After the exclusion of subjects with known hypertension or diabetes mellitus, 874 subjects remained to explore. Samples were drawn after an overnight fast. Lifestyle (smoking, physical activity, alcohol consumption) was assessed using a questionnaire. Insulin resistance and insulin secretion were estimated using the homeostasis model assessment (HOMA). Results Cigarette smoking men (n = 101) had a lower HOMA β‐cell value (58.1), than never‐smokers (n = 158, β‐cell value 90.1, P < 0.001). The difference remained with adjustments for age, body mass index, daily alcohol intake and physical exercise habits: 25.9 (95% confidence interval (CI) 9.7–38.8, P = 0.003). Correspondingly, in men the HOMA β‐cell value was lower in current smokers than in ex‐smokers (difference 24.3, 95% CI 11.1–35.2, P < 0.001). In women, no significant difference appeared in β‐cell function vs. different smoking status. There was no association between smoking status and insulin resistance. Conclusions At least in men, smoking may interfere with β‐cell function. The prevention of Type 2 diabetes should include strategies to stop smoking.
Distribution of autoantibodies to glutamic acid decarboxylase across the spectrum of diabetes mellitus seen in South Africa
Authors: Panz V. R. , Kalk W. J. , Zouvanis M. , Joffe B. I. 
Published: March 2003

SUMMARY Aims  This study investigated the association between glutamic acid decarb‐ oxylase antibodies (GAD‐AB) and Type 1, Type 2, pancreatic and lipoatrophic diabetes mellitus (DM) in South African patients.Methods  Four groups were selected: group A, 100 Black Type 1 DM patients (age at onset < 35 years, body mass index (BMI) < 27 kg/m2 and insulin dependent within 1 year of presentation); group B, 80 Black Type 2 DM patients (age at onset > 35 years, BMI > 27 kg/m2 and controlled on oral hypoglycaemic agents for at least 1 year after presentation); group C, 10 patients of varying ethnicity with DM or impaired glucose tolerance secondary to chronic pancreatitis; group D, five patients of varying ethnicity with DM associated with total lipodystrophy. Fifty healthy Black control subjects were also studied (group E). Serum GAD‐AB and random C‐peptide levels were measured by radioimmunoassay.Results  Mean C‐peptide concentration was significantly lower in Type 1 DM patients than Type 2 DM patients (P < 0.00001). Forty‐four patients with Type 1 DM were GAD‐AB‐positive compared to two patients with Type 2 DM. Two control subjects were also GAD‐AB‐positive. No patient in the other groups had a titre > 1 U/ml. Type 1 DM patients who were GAD‐AB‐positive did not differ from those who were GAD‐AB‐negative for age at onset, duration of DM or C‐peptide concentrations.Conclusions  Auto‐immune beta‐cell destruction has an important role in the pathogenesis of Type 1 DM amongst African patients. However, Type 2 African DM patients and other diabetes subtypes are largely GAD‐AB‐negative.
Post‐partum reclassification of glucose tolerance in women previously diagnosed with gestational diabetes mellitus
Authors: Costa A. , Carmona F. , Martinez‐Roman S. , Quintó L. , Levy I. , Conget I. 
Published: March 2003

SUMMARY Aims  To re‐evaluate post‐partum screening; fasting plasma glucose (FPG) vs. oral glucose tolerance test (OGTT) in Caucasian women with previous gestational diabetes mellitus (GDM).Methods  Once breast‐feeding had finished, an OGTT was performed in 120 women with previous GDM. They were classified according to World Health Organization (WHO) 1985 and American Diabetes Association (ADA) 1997 criteria. The kappa‐statistic measure of agreement was used to compared both diagnostic categories. A receiver–operating characteristic (ROC) curve studied the FPG as a test to detect abnormal glucose tolerance.Results  Identical diabetes prevalence (2%) but quite different intermediate categories (12% impaired glucose tolerance vs. 3% impaired fasting glucose) were observed with both criteria. The kappa‐statistic (scaled from 0 to 1) was 0.38 (fair agreement), P = 0.000. The ROC curve area of the FPG was 0.65.Conclusions  FPG is an unsatisfactory method of evaluating the glucose tolerance of Caucasian women with previous GDM. OGTT may be a better test for such a purpose.
Geographic and social factors are related to increased morbidity and mortality rates in diabetic patients
Authors: Weng C. , Coppini D. V. , Sönksen P. H. 
Published: March 2003

SUMMARY Aims  To investigate differences in metabolic control, access to healthcare, clinical outcomes and mortality rates in people from different cultural and ethnic backgrounds living in different geographical areas within central London.Methods  Out of a cohort of 610 patients living within the Greater London boundary and having a first visit to St Thomas' hospital in 1982–1985, 332 patients (54%) were reviewed in 1995, 186 patients (30%) died between 1982 and 1995 and 92 patients (16%) were lost to follow‐up. The patients' corresponding ‘electoral wards’ were ascertained in relation to postcodes of residence (Mapinfo). Each electoral ward has a Jarman ‘Underprivileged Area Score’ (UPA) so that patients can be clustered into prosperous, intermediate or deprived areas.Results  Patients living in deprived areas (n = 181) were older (61.3 years (95% confidence interval (CI) 59.5–63.1) vs. 58.6 years (95% CI 55.1–62.1), P = 0.01) and had a higher body mass index (29.2 kg/m2 (95% CI 28.4–30.0) vs. 25. 7 kg/m2 (95% CI 24.1–27.2), P = 0.003) and worse glycaemic control (HbA1 (%), 10.5 (95% CI 10.1–10.9) vs. 9.1 (95% CI 8.2–10.0), P = 0.003) than patients in prosperous areas (n = 59). Patients in deprived areas were more likely to be Caucasian (P < 0.005), and were less likely to be insulin‐treated (P = 0.004). Smoking was more prevalent in deprived areas (P = 0.02). The prevalence of microvascular complications was related to geographical location and the age–sex adjusted mortality rate was significantly higher in deprived than prosperous areas (2.6 vs. 1.91 per 100 person‐years).Conclusions  Environmental factors affect diabetes outcomes; increased morbidity and mortality rates in diabetic patients are related to socio‐economic and ethnic status.
Fasting plasma glucose as a screening test for gestational diabetes in a multi‐ethnic, high‐risk population
Authors: Agarwal M. M. , Hughes P. F. , Punnose J. , Ezimokhai M. 
Published: March 2003

SUMMARY Aims  Screening every pregnant woman for gestational diabetes mellitus (GDM), as widely recommended for high‐incidence populations, strains the healthcare system excessively. This study investigated the value of fasting plasma glucose (FPG) as an alternative to the more cumbersome oral glucose tolerance test (OGTT).Methods  One thousand six hundred and forty‐four pregnant women in a multi‐ethnic, high‐risk population were evaluated by the FPG as a screening test among two principal subgroups, i.e. women (n = 1276) at risk for GDM on clinical grounds and those women (n = 368) with a positive post 50‐g, 1‐h plasma glucose challenge test (GCT). Two threshold values for FPG ‘ruled in or ruled out’ a GDM diagnosis, which was confirmed by the 3‐h, 100‐g OGTT, using Carpenter's modified criteria as the ‘gold standard’.Results  In the women with a positive clinical history, at an optimal cut‐off value of FPG < 4.4 mmol/l to rule out GDM; a sensitivity of 94.7% was achieved, 21 (1.6%) women being false negatives. Using a FPG ≥ 5.3 mmol/l to rule in GDM; the specificity was 94.0% with 53 (4.2%) women being classified as false positives. FPG would have eliminated need for the OGTT in 50.9% pregnant women (misclassification rate 5.8%). In the positive GCT group, using similar cut‐offs for FPG, a sensitivity of 96.6% and specificity of 90.8% was achieved with a potential to avoid 51.6% OGTTs (misclassification rate 7.3%). The positive predictive value of the GCT was 31.8% compared to 80.2% for FPG at 5.3 mmol/l.Conclusions  While previously neglected as a screening test for GDM, in selected high‐risk populations the FPG offers a potentially simple, practical algorithm to screen for GDM by being cost‐effective and patient friendly. A wider application should be explored.
Limited impact of lifestyle education in patients with Type 2 diabetes mellitus and microalbuminuria: results from a randomized intervention study
Authors: Gæde P. , Beck M. , Vedel P. , Pedersen O. 
Published: March 2003

SUMMARY Aims  To assess the effect of intensified education on lifestyle (diet, exercise and smoking) as part of an intensified multifactorial intervention over a 4‐year period in patients with Type 2 diabetes mellitus with microalbuminuria.Methods  Patients, aged 45–65 years, were randomly assigned either to an intensive group focusing on change of behaviour as well as polypharmacological treatment (n = 80) or to a control group receiving conventional treatment (n = 80). Diet intervention focused on dietary fat and carbohydrate. Food intake was estimated by dietary history interviews and nutrients were calculated from food tables. Exercise and smoking habits were evaluated by interviews.Results  Mean follow‐up was 3.8 (sd 0.3) years. The decrease in total fat intake (% of energy intake) was larger in the intensive group as compared to the control group (41.2 (6.2) to 34.2 (6.0) vs. 41.9 (6.5) to 38.3 (6.4)%, P = 0,0001). The decrease in saturated fatty acids (% of total fat intake) was from 47 (4) to 44 (6)% with intensive therapy vs. 45 (5) to 46 (5)%, P = 0.001 and the increase in polyunsaturated fatty acids was from 14 (4) to 18 (6) vs. 16 (5) to 14 (4)%, P < 0.0001. Also the increase in carbohydrate was larger with intensive therapy. However, changes in exercise and smoking habits did not differ between groups.Conclusion  Despite the many resources invested in behaviour modification in this study, only modest changes were obtained in nutrient intake. Further studies are required to determine the best method of inducing long‐lasting changes in behaviour in Type 2 diabetic patients.
Factors affecting the use of dietetic services by patients with diabetes mellitus
Authors: Robson T. , Blackwell D. , Waine C. , Kennedy R. L. 
Published: March 2003

SUMMARY Aims  Dietary counselling is vital for patients with diabetes, yet many do not access professional advice. This study investigated the use of dietetic services by patients with diabetes within Sunderland Health District.Methods  Diabetic patients were identified from the laboratory module of the Hospital Information System (HIS). Eight thousand five hundred and ninety‐seven patients were identified, and cross referenced to dietetic records, producing a comprehensive database for analysis.Results  Only 58.8% of the sample had dietetic records. Those with records were more likely to be: older (63.8 vs. 61.7 years, P < 0.01); male (52.6% vs. 46.8%, P < 0.05); accessing hospital diabetes services (P < 0.001); to have lipids and renal function checked (both P < 0.001); and to have poor blood glucose control (HbA1c > 7.5% to 58.7% vs. 29.9%, P < 0.001). Frequent attenders were most likely to be women, those with poor control, and those with shorter duration of diabetes (P < 0.001). In a logistic regression model, duration of diabetes, insulin treatment, obesity and hyperlipidaemia were the main determinants of increased use.Conclusions  This study confirmed that many patients with diabetes do not make use of professional dietetic services, and has highlighted some of the routinely documented characteristics that are associated with use of dietetic services. There appears to be scope to improve uptake of dietetic services by patients with diabetes, and to investigate further individual factors that affect access and attendance.
Effects of preventative footwear on foot pressure as determined by pedobarography in diabetic patients: a prospective study
Authors: Lobmann R. , Kayser R. , Kasten G. , Kasten U. , Kluge K. , Neumann W. , Lehnert H. 
Published: March 2003

SUMMARY Aims  This study analysed the effects of specially manufactured insoles on foot pressures in diabetic patients during a 1‐year prospective observation period.Methods  We studied 81 type 2 diabetic patients without foot lesions. Using pedobarography three different regions of interest were examined: maximum peak pressure (MPP) of the total foot area, heel region and head of metatarsal bone I‐III. Eighteen patients with high risk pressure (MPP of total foot 474 ± 183 kPa; heel region 278 ± 147 kPa, metatarsal 389 ± 222 kPa) received optimal insole support. Sixty‐three patients as a control group (MMP of total foot 367.7 ± 157 kPa; heel 263.1 ± 127 kPa, metatarsal 339.9 ± 171 kPa) received conventional footwear.Results  After insole support a 30% pressure reduction of total foot MMP (474 ± 183 kPa vs. 290 ± 106 kPa) was achieved in the treatment group. After 6 months (324 ± 127 kPa) and 1 year (380 ± 190 kPa) a pressure reduction was found. Between the 6‐ and 12‐month controls plantar pressures again increased. In the control group a significant increase of all peak pressures occurred.Conclusions  Early insole support is successful in reducing plantar pressure. A repeated adjustment should be performed every 6 months to prevent foot pressure increases. The comparison of foot pressure development between the two groups showed constant levels in the treatment group. In the control group a marked increase of the pressure values was found. Identification and subsequent support of patients with high ulceration risk may help to reduce the high amputation rate.
An economic evaluation of atenolol vs. captopril in patients with Type 2 diabetes (UKPDS 54)
Authors: Gray A. , Clarke P. , Raikou M. , Adler A. , Stevens R. , Neil A. , Cull C. , Stratton I. , Holman R. ,   the UKPDS Group
Published: March 2003

AbstractAims To compare the net cost of a tight blood pressure control policy with an angiotensin converting enzyme inhibitor (captopril) or β blocker (atenolol) in patients with Type 2 diabetes.Design A cost‐effectiveness analysis based on outcomes and resources used in a randomized controlled trial and assumptions regarding the use of these therapies in a general practice setting.Setting Twenty United Kingdom Prospective Diabetes Study Hospital‐based clinics in England, Scotland and Northern Ireland.Subjects Hypertensive patients (n= 758) with Type 2 diabetes (mean age 56 years, mean blood pressure 159/94 mmHg), 400 of whom were allocated to the angiotensin converting enzyme inhibitor captopril and 358 to the β blocker atenolol.Main outcome measuresLife expectancy and mean cost per patient.ResultsThere was no statistically significant difference in life expectancy between groups. The cost per patient over the trial period was £6485 in the captopril group, compared with £5550 in the atenolol group, an average cost difference of £935 (95% confidence interval £188, £1682). This 14% reduction arose partly because of lower drug prices, and also because of significantly fewer and shorter hospitalizations in the atenolol group, and despite higher antidiabetic drug costs in the atenolol group.ConclusionsTreatment of hypertensive patients with Type 2 diabetes using atenolol or captopril was equally effective. However, total costs were significantly lower in the atenolol group.Diabet. Med. 18, 438–444 (2001)
Fulminant autoimmune Type 1 diabetes during interferon‐alpha therapy: a case of Th1‐mediated disease?
Authors: Bosi E. , Minelli R. , Bazzigaluppi E. , Salvi M. 
Published: March 2003

AbstractAim  A case of autoimmune Type 1 diabetes with some unique characteristics developing in a 29‐year‐old male during treatment with interferon‐alpha (IFN‐α) for chronic hepatitis C virus (HCV) hepatitis is reported.Patient and methods In this patient IFN‐α treatment was well tolerated and successful in the cure of hepatitis with eradication of HCV infection within 3 months, but at 8.5 months Type 1 diabetes appeared and insulin therapy was started and maintained thereafter. HLA class II molecular typing was determined and retrospective measurement of islet cell (ICA), glutamate decarboxylase (GADA), tyrosin phosphatase IA‐2 (IA‐2A) and insulin (IAA) antibodies was performed in serum samples obtained before and at 0.5, 1, 2, 3, 4, 5, 6, 8.5, 10 and 13 months after the beginning of IFN‐α treatment.Results Complete HLA class II typing was consistent with homozygosity for the HLA DRB *03011, DQA1 *0501, DQB1 *0201 haplotype. All autoantibodies were undetectable prior to IFN‐α therapy and remained undetectable up to 6 months of treatment; at 8.5 months, at the time of diabetes onset, ICA were detectable at low titre while GADA were present at high titre. Both ICA and GADA persisted at high levels in subsequent samples. IA‐2A remained undetectable in all serum samples, while IAA appeared only after treatment with exogenous insulin.Discussion This appears to be a case of autoimmune Type 1 diabetes induced by IFN‐α treatment and developing on a predisposed genetic background with an unusually rapid development of the autoimmune process as reflected by the absence of detectable autoantibodies up to 2.5 months prior to disease onset. In this example of fulminant Type 1 diabetes a pathogenic process unbalanced towards a Th1‐mediated autoimmune response is hypothesized.Diabet. Med. 18, 329–332 (2001)
Vibration perception threshold testing in patients with diabetic neuropathy: ceiling effects and reliability
Authors: Van Deursen R. W. M. , Sanchez M. M. , Derr J. A. , Becker M. B. , Ulbrecht J. S. , Cavanagh P. R. 
Published: March 2003

AbstractAims  To test the reliability of a new vibrometer (Maxivibrometer) which was constructed so that vibration perception threshold (VPT) could be determined without the disadvantage of the off‐scale measurements frequently experienced with the Biothesiometer.Methods  The two devices were compared and tested on a group of diabetic neuropathic subjects and a group of healthy, matched control subjects. VPT was tested on the plantar surface of the feet.Results  The Maxivibrometer gave an actual measurement in all cases even if subjects were severely neuropathic. The replication‐to‐replication and day‐to‐day intraclass correlation coefficients for the Maxivibrometer VPT were, except in one case, above 0.94, indicating excellent reliability. The Biothesiometer VPT could also be measured with excellent reliability but only within a limited range of mild to moderate neuropathy, so it appears to be an appropriate screening tool. The replication‐to‐replication intraclass correlation coefficient was 0.93.Conclusions  Because VPT could be measured over a wide range with the Maxivibrometer, it was demonstrated that loss of sensation in diabetic neuropathy can progress far beyond the maximum VPT value of the Biothesiometer. The wide measurement range and the excellent reliability make the Maxivibrometer a valuable research tool to quantify loss of sensation, particularly in the presence of severe neuropathy and to record changes over time.Diabet. Med. 18, 469–475 (2001)
The ADKnowl: identifying knowledge deficits in diabetes care
Authors: Speight J. , Bradley C. 
Published: March 2003

AbstractAims  To present the ADKnowl measure of diabetes‐related knowledge and evaluate its use in identifying the nature and extent of patient and health professional knowledge deficits.Method  The ADKnowl was used in a large‐scale study of 789 patients (451 treated with insulin and 338 treated with tablets and/or diet) attending for annual review at one of two hospital out‐patient diabetes clinicsResults  Knowledge deficits were apparent in the patients. For example, 57% did not recognize the inaccuracy of the statement ‘fresh fruit can be eaten freely with little effect on blood glucose levels’. Seventy‐five percent of patients did not know that it is advisable to trim toenails to the shape of the toe. Knowledge deficits were identified for many other areas of diabetes management, e.g. prevention of hypoglycaemia, avoidance of ketoacidosis. Sixteen health professionals at the clinics answered the same items. Contrary to recommendations, 25% of health professionals thought that fresh fruit could be eaten freely. Seventy‐five percent of health professionals did not know the current recommendations for trimming toenails. As expected, HbA1c did correlate with scores from two specific items, while HbA1c did not correlate with summed ADKnowl score.Conclusions  Patient knowledge deficits were identified. Some specific knowledge deficits among health professionals may be the cause of some patient knowledge deficits. The ADKnowl is a useful tool in assessing both patient and health professional knowledge deficits and is available for use in a context of continuing evaluation.Diabet. Med. 18, 626–633 (2001)
Diabetic neuropathic cachexia and acute bilateral cataract formation following rapid glycaemic control in a newly diagnosed Type 1 diabetic patient
Authors: Yuen K. C. J. , Day J. L. , Flannagan D. W. , Rayman G. 
Published: March 2003

AbstractIn patients with Type 1 diabetes mellitus (DM), the development of complications within the first few years of diagnosis is very unusual and the development of complications within weeks of commencement of insulin therapy is exceptional. Diabetic neuropathic cachexia, unlike the other more common neuropathies associated with diabetes, is a rare form of peripheral neuropathy characterized by profound weight loss, painful dysaesthesias over the limbs and trunk with spontaneous resolution usually occurring within a year. The morphologically distinct diabetic or metabolic cataract in patients with newly diagnosed Type 1 DM is also a rare complication. We describe the first case of a young man with newly diagnosed Type 1 DM who developed these two rare complications within 3 months of diagnosis and insulin therapy commencement. Rapid development of complications in this patient raises two possibilities, i.e. a probable link between the pathophysiology of these two complications following rapid glycaemic control, and a subset of patients with unusual susceptibility to complications. We re‐emphasize the need for vigilant monitoring of complications in young diabetic patients, even in the first few years of their disease. In particular, young patients with visual impairment should be evaluated carefully for evidence of treatable eye complications.Diabet. Med. 18, 854–857 (2001)