bluuebunny/crossref_metadata_2025_split huggingface dataset:
HOPE for patients with Type 2 diabetes: an application of the findings of the MICRO‐HOPE substudy in a British hospital diabetes clinic
Authors: Jones S. C. , Bowes P. D. , Hall E. , Connolly V. , Kelly W. F. , Bilous R. W. 
Published: March 2003

AbstractAims  The MICRO‐HOPE substudy demonstrated that when ramipril treatment was added to people with Type 2 diabetes and additional cardiovascular risk factors cardiovascular events were reduced by 25% in 4.5 years. We wished to determine the proportion of people with Type 2 diabetes and additional cardiovascular risk factors registered with a hospital diabetes service.Methods  Non‐proteinuric people (n = 1370) with Type 2 diabetes identified on our diabetes register were subject to analysis. Anticipated reductions in cardiovascular events due to ramipril treatment were based on reductions observed in the MICRO‐HOPE substudy.Results  Non‐proteinuric people (n = 1075 (78%)) with Type 2 diabetes had at least one additional cardiovascular risk factor. Twenty‐nine percent were already taking an angiotensin‐converting enzyme inhibitor. The remaining 764 patients were similar to ramipril‐treated participants in the MICRO‐HOPE substudy. Treatment with ramipril for 4.5 years would be anticipated to reduce cardiovascular deaths by 26, revascularization procedures by 19 and admissions for myocardial infarction and stroke by 18 and 26, respectively.Conclusions  Of non‐proteinuric people with Type 2 diabetes, 78% have additional cardiovascular risk factors. Only a small proportion currently receive treatment with an angiotensin‐converting enzyme inhibitor. The incidence of cardiovascular events could be reduced if more patients were treated with ramipril and other cardiovascular risk factors were addressed.Diabet. Med. 18, 667–670 (2001)
Glucose, insulin and lipid metabolism in rural Gambians exposed to early malnutrition
Authors: Moore S. E. , Halsall I. , Howarth D. , Poskitt E. M. E. , Prentice A. M. 
Published: March 2003

AbstractAims  There is now substantial evidence to suggest that susceptibility to certain non‐communicable diseases may be increased by early undernutrition. In rural Gambia, an annual hungry season reduces birth weight by 200–300 g and increases the prevalence of low birth weight (< 2500 g) from 11% to 24%. The aim of this study was to investigate whether fetal nutritional stress (using season of birth as a proxy measure for prenatal growth retardation) or early childhood malnutrition (using historical anthropometric records) had a residual influence on risk factors for cardiovascular disease in a cohort of rural Gambian adults.Methods  Two hundred and nineteen adults (mean age = 35.8 years; mean body mass index = 21.3 kg/m2; women = 181) for whom month of birth and infant anthropometric records were available participated in this study. Risk factors for cardiovascular disease were measured.Results  No differences were found between season of birth groups (hungry vs. harvest) and fasting measures of glucose, insulin, lipids, fibrinogen or cortisol, or against 30 and 120 min glucose and insulin levels following an oral glucose tolerance test, or blood pressure. Similarly, these risk factors for adult disease were not related to the subjects' weight‐for‐age as children.Conclusions  Moderate‐to‐severe fetal and childhood malnutrition in rural Gambia caused no detectable impairment of the glucose/insulin axis, or of other cardiovascular disease risk factors in adults remaining lean and fit on a low‐fat diet.Diabet. Med. 18, 646–653 (2001)
Deteriorating diabetic control through adolescence—do the origins lie in childhood?
Authors: Dabadghao P. , Vidmar S. , Cameron F. J. 
Published: March 2003

AbstractAims  To determine whether intra‐individual measures of diabetes control deteriorated through adolescence and whether HbA1c in late childhood was predictive of HbA1c after adolescence.Methods  Retrospective analysis of sequential 3–6 monthly data including HbA1c, height, weight, and total daily insulin dosage in 118 patients with Type 1 diabetes aged between 8.00 and 17.99 years between 1983 and 1999.Results  In females mean body mass index (BMI) increased sharply during adolescence but there was no significant increase in males. The mean total daily dose of insulin/weight (TDDI/W) increased sharply for females through puberty. Males exhibited a constant rate of increase in mean TDDI/W from pre‐ to post‐puberty. There was a constant increase in mean HbA1c for females, with an estimated increase from pre‐ to post‐puberty of 0.92%. In males there was only a slight increase from pre‐ to peri‐puberty and no change subsequently. Comparing pre‐puberty (8–9.99 years) and post‐puberty (15–17.99 years) in the total group, 47% of patients remained in the same mean HbA1c grouping, 37% had worsened control and 16% had improved control. Analysis of change in the absolute value of mean HbA1c showed that the majority of patients had mean HbA1c values that remained within ± 1% (54%) or ± 2% (82%) from pre‐ to post‐puberty. A significant proportion showed significantly worsening control with only a minority showing improved metabolic control from pre‐ to post‐puberty.Conclusions  The likelihood of a significant improvement in HbA1c from late childhood to adolescence is remote, with the majority of patients having either constant or deteriorating metabolic control.Diabet. Med. 18, 889–894 (2001)
Screening for diabetic retinopathy is well received by patients and may improve self‐management intentions
Authors: Eiser J. R. , Eiser C. , Riazi A. , Taylor D. J. , Hammersley S. , Tooke J. E. 
Published: March 2003

AbstractAims  To investigate patients' views of screening for diabetic retinopathy and the effects of the screening process on health beliefs and behavioural intentions.Setting  A retinal screening clinic at a GP surgery in SW England.Methods  Questionnaires administered before and immediately after screening by retinal photography.Results  One hundred patients attended (94% of those invited); 12 had Type 1 and 88 Type 2 diabetes. Over 90% found the information, and seeing their retinal photograph, helpful. Sixty‐three were found to have no problem and 37 had some type of eye problem detected. Overall, patients rated the news given at screening as better than expected (P < 0.001) and even those found to have problems mostly rated the news as good (P < 0.001). Detection of problems led patients to rate their recent eye health more negatively, but to be less pessimistic about future deterioration (P < 0.01). Patients with diabetes‐related eye problems were more likely (P < 0.05) to say that they both should and would make changes to their self‐management, but only after controlling for duration of diabetes. Those who had had diabetes longest declared least intention to change.Conclusions  Screening by retinal photography is acceptable to patients. Results suggest that screening modified health beliefs but had limited effect on behavioural intentions, with patients of longer disease duration being more reluctant to change their self‐management. Opportunities during retinal screening for advice on self‐management could be more effectively exploited.Diabet. Med. 18, 835–841 (2001)
An integrated mobile foot and retinal screening programme for people with Type 2 diabetes managed in primary care
Authors: Sampson M. J. , Shepstone L. , Greenwood R. H. , Harvey I. , Humphries J. , Heyburn P. J. , Temple R. C. , Dole G. 
Published: March 2003

AbstractAims To undertake a vascular and neurological assessment on the feet of all patients with Type 2 diabetes managed solely in local primary care.Methods A mobile screening podiatrist (working with an existing mobile retinal screening programme) screened a selected population of 4022 patients with Type 2 diabetes managed solely in 82 general practices. Doppler pressure assessments of peripheral vasculature, bioesthesiometer and monofilament assessment of peripheral neuropathy.Results This service was administratively simple to set up and integrated well with the retinal screening service and secondary care foot clinic, and was valued by the practices. Disease prevalences were 1.04% for foot ulceration, 19% for peripheral vascular disease and up to 29% for peripheral neuropathy.Conclusions This programme screens all patients with known diabetes managed solely in primary care within a district and describes foot morbidity and allows risk stratification. This pattern of service could be a useful template for discussing the diabetes National Service Framework with primary care groups.
Diagnosis of diabetes mellitus and intermediate glucose abnormalities in obese patients based on ADA (1997) and WHO (1985) criteria
Authors: Richard J.‐L. , Sultan A. , Daures J.‐P. , Vannereau D. , Parer‐Richard C. 
Published: March 2003

AbstractAim To assess the accuracy of the 1997 ADA criteria for diagnosing diabetes mellitus and related glucose disturbances in comparison with the reference WHO 1985 criteria in obese subjects.Patients and methods In 286 men and 881 women, 15–84 years of age, with obesity (body mass index (BMI) ≥ 30 kg/m2), an oral glucose tolerance test (OGTT) was carried out according to WHO standard. Patients were classified into three categories of glucose tolerance using WHO 1985 (Normal Glucose Tolerance (NGT), Impaired Glucose Tolerance (IGT) and Diabetes Mellitus (DM)) and ADA (Normal Fasting Glucose (NFG), Impaired Fasting Glucose (IFG) and DM) criteria. Prevalence of each category was compared and agreement between the two classifications was assessed. The relation between fasting plasma glucose value and diabetes, as diagnosed by WHO 1985 criteria, was studied using various regression models, cumulative frequency curves, Finch method and ROC curve.Results Compared with WHO 1985, ADA criteria strongly underestimated the prevalence rate of diabetes (3.7% vs. 10.6%) and intermediate glucose abnormalities (6.0% vs. 22.4%). Agreement between the two classifications was poor (κ= 0.23). Moreover, many patients defined as glucose‐intolerant by the WHO 1985 criteria were shifted to a more favourable metabolic status by ADA criteria. Thus, ADA criteria failed to detect 69% of WHO diabetic patients and 89% with IGT were considered as normal. According to the method, cut‐off value of fasting blood glucose for detecting WHO 1985‐diagnosed diabetes varied widely, from 5.3 to 6.3 mmol/l and none was satisfactory because of poor sensitivity and positive predictive value.Conclusion The ADA criteria do not appear to be a good substitute for those of the WHO 1985 at identifying diabetes and intermediate glucose abnormalities in an obese population. Since it appears impossible to determine a reliable cut‐off value for fasting blood glucose to identify diabetic obese subjects with sufficient sensitivity, our results justify the retention of the OGTT in clinical practice or for epidemiological studies.
Reproducibility of individualized coronary heart disease risk calculations in patients with diabetes mellitus
Authors: Lambert A. P. , Hunt M. A. , Day A. P. , Bayly G. R. , Dayan C. M. 
Published: March 2003

AbstractAims To determine prospectively, the reproducibility of individualized coronary heart disease (CHD) risk estimations in a high‐risk (diabetic) population.Methods One hundred and three patients attending a hospital diabetes clinic who were in the primary prevention category for CHD had measurements of cholesterol, HDL‐cholesterol and systolic blood pressure (SBP) performed in one of 13 general practices and then 2 weeks later in the hospital clinic. The data were combined with age, sex, smoking history and diabetic status data to produce a 10‐year CHD risk estimate for each occasion using the Framingham algorithm.Results The coefficients of variation for cholesterol, HDL and SBP were 6.0%, 9.4% and 7.0%, respectively. When classified by treatment thresholds of 15% and 30% 10‐year CHD risk, 88% of patients were classified in the same category on both occasions. Kappa values for the 15% and 30% risk thresholds were 0.71 and 0.82. This indicates good interobserver agreement for the estimation of CHD risk. The use of a single BP rather than the mean of two, resulted in seven of 206 estimations of CHD risk performed in 103 patients crossing a risk threshold, with 6/7 being placed in a higher risk category.Conclusions Estimation of CHD risk on a single occasion is sufficient to make robust treatment decisions based on risk thresholds. Use of a single BP measurement rather than the mean of two overestimates the risk category in around 3% of cases.
Intussusception in an adult patient with severe hyperglycaemia—a case report
Authors: McFarlane S. I. , Byrne K. , Shin J. , Williams R. 
Published: March 2003

AbstractAims To report a case of adult intussusception associated with and possibly induced by acute hyperglycaemia.Methods We present the first case report of adult intussusception with severe hyperglycaemia. Clinical and laboratory data together with radiological findings are presented with a brief review of the literature.Results A 20‐year‐old man with no past medical history presented with abdominal pain for 2 days. The patient was severely hyperglycaemic with blood glucose of 72.7 mmol/l (normal 3.3–6.1 mmol/l), a pH of 7.2 and serum potassium of 6.5 mmol/l (normal 3.5–5.0 mmol/l). He had a computed tomography (CT) scan of the abdomen that revealed small bowel intussusception. Upon treatment of his hyperglycaemia, the patient's abdominal pain completely resolved. Follow up abdominal CT revealed complete resolution of the previously detected intussusception.Conclusion Clinicians should be aware of the potential for the occurrence of intussusception in severely hyperglycaemic patients. Correction of hyperglycaemia could lead to resolution of the intussusception without surgical intervention. Possible effects of hyperkalaemia and/or acidosis on gastrointestinal motility should also be considered.
No increase in the prevalence of known diabetes between 1986 and 1999 in subjects 25–64 years of age in northern Sweden
Authors: Eliasson M. , Lindahl B. , Lundberg V. , Stegmayr B. 
Published: March 2003

AbstractAims A global increase in diabetes is predicted due to higher body weight and less physical activity. Over the period 1986–1999, the body mass index (BMI) of the adult population of northern Sweden increased from 25.3 to 26.2 and the prevalence of obesity (BMI ≥ 30) from 11% to 15%, although this was more distal than central adiposity. Our hypothesis was that this would lead to a higher prevalence of diabetes.Methods Four population surveys with new and independent cohorts of 2000 invited subjects, 25–64 years old, in 1986, 1990, 1994 and 1999. In the first three surveys an oral glucose tolerance test was carried out in 47%.Results Over the time period 1986–1999 there was no increase in the prevalence of known diabetes. No trends were noted in the finding of previously undiagnosed diabetes or impaired glucose tolerance over the period 1986–1994, although the confidence intervals are wide. Fasting, but not post‐load, glucose levels increased with 0.040 mmol/year (95% CI 0.026; 0.055) in men and 0.033 mmol/year (0.023; 0.044) in women.Conclusion In spite of a marked increase in BMI, we found no increased prevalence of known diabetes over a 13‐year observation period, although our data cannot exclude minor increases in undiagnosed diabetes. The development of more distal than abdominal obesity, a diet with less saturated fat and lower glycaemic index and fewer regular smokers in the population may contribute to this. The effects of obesity may thus be attenuated by other secular trends in society and highlight potential ways of curbing the worldwide increase in diabetes.
The oral glucose tolerance test reveals a high frequency of both impaired glucose tolerance and undiagnosed Type 2 diabetes mellitus in primary hyperparathyroidism
Authors: Procopio M. , Magro G. , Cesario F. , Piovesan A. , Pia A. , Molineri N. , Borretta G. 
Published: March 2003

AbstractAims To evaluate the frequency of impaired glucose tolerance (IGT)and undiagnosed diabetes mellitus together with the indices of insulinresistance (IR) in primary hyperparathyroidism (pHPT).Methods Out of 105 consecutive pHPT patients (F/M 78/27, asymptomatic/symptomatic68/37, age (mean ± sd) 60.7 ± 12.7 years,body mass index 25.2 ± 3.8 kg/m2,ionized calcium (iCa) 1.49 ± 0.16 mmol/l,parathormone 200.4 ± 233.9 pg/ml),59 without known diabetes mellitus and controls (n = 60)underwent an oral glucose tolerance test (OGTT, 75 g os).As indices of IR, homeostasis model assessment (HOMAIR)or OGTT data (insulin sensitivity index composite (ISI comp)) wereevaluated.Results In pHPT the prevalence of IGT (mean, 95% confidenceintervals (CI), 40.7%, 27.8–53.6) was higher thanin controls (25.0%, 13.7–36.3, P < 0.03). Similarly,the prevalence of undiagnosed diabetes mellitus was higher in pHPT(15.3%, 5.8–24.7) than in controls (5.0%, 0–10.7, P < 0.05). Moreover,the prevalence of IGT and undiagnosed diabetes was higher in pHPTthan that previously reported in the general population of Northern Italy(8.5% and 3.2%, respectively). The indices showedthat insulin resistance was higher in pHPT than in controls: HOMAIR (median, 95% CI,2.6, 2.5–3.9 vs. 1.7, 1.6–2.5, respectively; P < 0.003);ISI comp (3.5, 3.4–4.6 vs. 5.1, 4.9–7.2, respectively; P < 0.002).Conclusions Our data in a large and modern day pHPT series, with a preponderanceof asymptomatic patients, confirm increased insulin resistance andpre‐valence of IGT and undiagnosed diabetes.Diabet. Med. 19, 958–961 (2002)
The impact of atherosclerotic renovascular disease on diabetic renal failure
Authors: Nicholls A. J. 
Published: March 2003

AbstractAtherosclerotic renovascular disease (ARVD) is common in thegeneral population, and its prevalence increases with age. Parallelstudies show it is also common in patients with diabetes. The widespreaduse of angiotensin converting enzyme inhibitors and angiotensin receptorantagonists for heart and kidney disease might therefore expose arteriopathicdiabetic patients to potential harm if they had critical renal arterystenosis. This review looks at the natural history of ARVD in thediabetic and non‐diabetic populations: while it is common, it only rarelyleads to renal failure. Hence intervention to revascularize ischaemic kidneyson the basis of radiological appearances alone may subject somepatients to unnecessary therapy. Although untested by randomizedtrial, a policy of watchful waiting may be the simplest strategyfor most diabetic patients with suspected ARVD, reserving angiography andangioplasty (usually backed up by a stent) for those with an abruptdecline in renal function and no other cause for renal deterioration. Futureclinical trials may better define subgroups of patients who will trulybenefit from renal revascularization.
Prevalence of retinopathy differs with age at onset of diabetes in a population of patients with Type 1 diabetes
Authors: Kullberg C. E. , Abrahamsson M. , Arnqvist H. J. , Finnström K. , Ludvigsson J. 
Published: March 2003

AbstractAim The VISS study (Vascular complications in South‐east Sweden) investigates prevalence and incidence of vascular complications in a population with Type 1 diabetes, from a well‐defined geographical area and followed from diagnosis with HbA1c measurement.Method The study population comprised all 440 patients with Type 1 diabetes onset before the age of 36 years, onset during 1983–1987, and at the time of onset living within the counties of Jönköping, Kalmar or Östergötland. Retinopathy was examined with fundus photography 1994–1995, and classified according to a modified Airlie House protocol.Results Fundus photographs from 390 patients were evaluated. In 277 (71%) patients no retinopathy was seen. The prevalence of retinopathy increased from 11% among patients < 5 years old at diabetes onset, to 48% among those 15–19 years old at diabetes onset, and then decreased to 30% for patients 30–35 years old at diabetes onset (P for χ2 for linear trend for all ages 0.017, for age at onset 0–19 years P = 0.0003), without corresponding differences in duration or HbA1c between patients with different onset age. Patients with HbA1c in the highest quartile (> 8.3% HbA1c) had a relative risk of 2.4 (95% confidence interval (CI) 1.7–3.2) of having any retinopathy compared with patients with lower HbA1c, and a relative risk of 7.1 (95% CI 3.0–16.7) of having other forms of retinopathy than microaneurysms.Conclusion In patients with diabetes duration of 6–13 years, the prevalence of retinopathy is clearly related to glycaemic control. Furthermore, the risk of retinopathy varies with different age at onset, independently of differences in duration or glycaemic control.Diabet. Med. 19, 924–931 (2002)
Heterogeneity of non‐insulin‐dependent diabetes expressed as variability in insulin sensitivity, β‐cell function and cardiovascular risk profile
Authors: Birkeland K. I. , Kilhovd B. , Thorsby P. , Torjesen P. A. , Ganss R. , Vaaler S. , Hanssen K. F. 
Published: March 2003

AbstractAims The present study investigated the variability in insulin sensitivity and β‐cell function and their relationship to anti‐glutamic acid decarboxylase (GAD) positivity and the metabolic syndrome in a group of patients with non‐insulin‐dependent diabetes mellitus (NIDDM).Methods Fifty‐four subjects aged 59.5 ± 6.1 (mean ± sd) years with NIDDM for 7.9 ± 3.9 years referred to hospital due to poor glycaemic control, were investigated. Insulin sensitivity was determined by the euglycaemic hyperinsulinaemic glucose clamp technique as the glucose disposal rate relative to the insulin level obtained (GDRI), and also estimated with the homeostasis model assessment (HOMA‐S). β‐cell function was measured by assaying the fasting and glucagon‐stimulated C‐peptide levels and with the HOMA‐B.Results The insulin sensitivity varied 18‐fold between subjects when estimated with the clamp and six‐fold when estimated with HOMA‐S, and was lower the more criteria for the metabolic syndrome present (P = 0.0001 by anova). The β‐cell function varied four‐fold when measured as stimulated C‐peptide, and eight‐fold when estimated with the HOMA‐B. The levels of fasting C‐peptide and HOMA‐B values tended to be lower in anti‐GAD+ (n = 11) than in anti‐GAD–subjects (P = 0.06 and P = 0.08, respectively). From previously published coronary risk charts, we estimated the 10‐year risk of a coronary heart disease (CHD) event to be > 20% in 17 of 39 patients free from cardiovascular disease at the time of study, 16 of whom qualified for a diagnosis of the metabolic syndrome.Conclusions The wide variations in insulin sensitivity and β‐cell function found among subjects with NIDDM support the notion that the disorder is highly heterogeneous. Reduced insulin sensitivity was clearly related to the metabolic syndrome and an increased risk for CHD.