bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long‐term efficacy of Humalogã in subjects with Type 1 diabetes mellitus
Authors: Garg S. K. , Anderson J. H. , Perry S. V. , Mackenzie T. , Keith P. , Jennings M. K. , Hansen M. M. , Chase H. P. 
Published: March 2003

Summary Aims To evaluate the long‐term effectiveness of Humalog® insulin in lowering post meal glucose excursions. Methods Twenty young subjects with Type 1 diabetes mellitus (DM) who had received insulin‐lispro (Humalog®) for a least 1 year (mean ± SD 1.8 ± 1.6 years) were studied on two occasions, 3–14 days apart. They consumed a similar breakfast consisting of 450–600 kCal having fasted overnight. The same amount of human soluble Humulin® Regular or Humalog® insulin was given 10 min before the meal in a randomized, double‐blind fashion. Results Postprandial glucose excursions at 30, 60, and 120 min were significantly lower (P < 0.001,
ancova) when subjects received Humalog® as compared to human soluble insulin. Serum‐free insulin levels were significantly higher (P < 0.001,
anova) at 30 and 60 min when subjects received Humalog® as compared with human soluble insulin. Humalog® antibody levels after up to 5.4 years of receiving Humalog® insulin were not elevated beyond the values at 1 year. Conclusions We conclude that Humalog® insulin is effective in lowering postprandial glucose excursions even after up to 5.4 years of treatment.
What is the role of between meal snacks with intensive basal bolus regimens using preprandial lispro?
Authors: Kong N. , Ryder R. E. J. 
Published: March 2003

Summary Aims Hypoglycaemia avoidance for patients on intensive insulin regimens requires the eating of snacks between meals. Insulin lispro with its shorter action profile may permit omitting such snacks. Methods Ten Type 1 diabetes mellitus (DM) patients were rendered euglycaemic with a morning intravenous insulin infusion. Each was studied on six afternoons in random order, with previously determined equal doses of Humulin S (HS) injected at –30 min, or lispro injected at 0 min before a standard lunch. The snack was either eaten mid‐afternoon, combined with the lunch or omitted altogether. Results Lispro and lunch with a snack combined at 0 min gave equal control to HS at –30 min and lunch at 0 min with a mid‐afternoon snack. Lispro and lunch at 0 min with a mid‐afternoon snack gave a lower early postprandial glucose. At 120 min glucose (mean mmol/l ±sem) were 7.4 ± 0.8 vs. 7.0 ± 1.0 (P = 1.0) and 3.9 ± 0.5 (P = 0.045), respectively. The area under the insulin curve over the whole afternoon was similar for HS and lispro (13 193.3 ± 974.6 vs. 13 193.6 ± 809.9 mIU/min, P = 1.0) but with a greater peak for lispro than HS with lispro falling more rapidly. Despite significantly lower lispro levels after 180 min, intermediary metabolites concentrations were similar in all HS and lispro study days.Conclusions Lispro injected immediately before combined snack and lunch and with no subsequent snack achieves equivalent control to conventional regimens using HS –30 min before lunch and mid‐afternoon snack. Lispro taken with traditional meal patterns without dose reduction risks early postprandial hypoglycaemia and late hyperglycaemia.
Prevalence of autoantibodies to autonomic nervous tissue structures in Type 1 diabetes mellitus
Authors: Ejskjaer N. , Arif S. , Dodds W. , Zanone M. M. , Vergani D. , Watkins P. J. , Peakman M. 
Published: March 2003

Summary Aims The pathogenesis of diabetic autonomic neuropathy is multifactorial, but recent studies have suggested a link between the presence of autoantibodies to nervous tissue structures and severe, symptomatic autonomic neuropathy. The present study was designed to examine the true prevalence of these autoantibodies in a large clinic‐based population of Type 1 diabetic patients compared to nondiabetic controls. Methods The presence of complement fixing autoantibodies to vagus nerve (CF‐VN), sympathetic ganglion (CF‐SG) and adrenal medulla (CF‐ADM) was assessed by immunofluorescence in a large cohort of patients (n = 394) of varying duration of Type 1 DM (median 28 years, range 6 months to 73 years) and 160 age and sex‐matched nondiabetic control subjects.Results All three autoantibodies were frequently detected in Type 1 DM (CF‐VN, 22.1%; CF‐SG, 30.7%; CF‐ADM, 13.2%) but only rarely in healthy control subjects (4.4%, 4.4% and 3.1%, respectively; P < 0.0005 for all). There was no association between any of the autoantibodies and retinopathy (fundoscopy), peripheral somatic neuropathy (biothesiometry) or nephropathy (urinary albumin–creatinine ratio). Conclusions Our results on this large cohort establish the extensive presence of autonomic nervous tissue autoantibodies in Type 1 DM. Their role in reflecting, causing or predicting autonomic neuropathy remains to be determined.
Autonomic nerve function in adolescents with Type 1 diabetes mellitus: relationship to microalbuminuria
Authors: Clarke C. F. , Eason M. , Reilly A. , Boyce D. , Werther G. A. 
Published: March 2003

Summary Aims Thirty adolescent patients with Type 1 diabetes mellitus and microalbuminuria were studied for evidence of early autonomic neuropathy Methods Using tests involving cardiovascular and pupillary reflexes, the adolescents were compared with a normoalbuminuric group of patients with diabetes, who were matched for age, sex, puberty and duration of diabetes. Results There was an increased prevalence of autonomic nerve dysfunction in the patients with microalbuminuria. These patients had higher resting heart rates (86 beats/min in the microalbuminuric group vs. 77 beats/min in normoalbuminuric controls, P = 0.002), and impaired pupillary dilatation in darkness (pupillary diameter % 56.5% vs. 62.5%, P = 0.003). Patients with microalbuminuria also had poorer long term glycaemic control (mean HbA1c 8.7% vs. 7.8%, P = 0.002) and higher blood pressures (systolic 125 vs. 116 mmHg, P = 0.001; diastolic 69 vs. 62 mmHg, P = 0.0001; mean arterial pressure 90 vs. 83 mmHg, P = 0.002) than those with normal urinary albumin excretion. Conclusions Microalbuminuria and autonomic nerve dysfunction co‐exist in patients with Type 1 DM. Longitudinal studies will determine whether these findings have implications for the identification of patients at higher risk of progression of early renal complications.
Aspirin usage in a large teaching hospital diabetes clinic setting
Authors: Wood D. M. , Plehwe W. E. , Colman P. G. 
Published: March 2003

Summary Aim To document aspirin usage and the prevalence of large and small vessel complications in patients with diabetes mellitus (DM) attending the outpatient diabetes clinics of a large public hospital. Methods All patients attending diabetes outpatient clinics at The Royal Melbourne Hospital in Melbourne, Australia were surveyed over a 3‐month period. Results Complete data were available on 629 of 632 (296 male) patients surveyed. Of the 29.3% of patients who were suffering from one or more macrovascular complication (ischaemic heart disease, cerebrovascular disease or peripheral vascular disease), 63% were currently on aspirin treatment. Of those not on aspirin, 65% had no contra‐indication to aspirin treatment and a further 19% had only a relative contra‐indication of either aspirin or warfarin treatment recorded. Conclusions The published recommendations for the use of aspirin in patients with macrovascular disease were generally being followed in this clinic‐based population. However, a significant proportion of patients without a contra‐indication to treatment were still not receiving aspirin. The lack of clear evidence‐based guidelines for aspirin use may be a factor in its under‐prescription. This survey suggests clear evidence‐based guidelines should be established and disseminated.
Comparison of ADA and WHO screening methods for diabetes mellitus in obese patients
Authors: Mannucci E. , Bardini G. , Ognibene A. , Rotella C. M. 
Published: March 2003

Summary Aims To compare the performance of fasting glycaemia (FG) and oral glucose tolerance testing (OGTT) in screening for diabetes mellitus in obese patients. Methods A consecutive series of 528 (445 female, 83 male) obese (body mass index > 30 kg/m2) outpatients, aged 45.2 ± 14.3 years, was studied with FG and OGTT. The association of categories of glucose tolerance (diabetes and impaired glucose tolerance (IGT)) and fasting glycaemia (diabetes and impaired fasting glucose (IFG)) with hypertension and hyperlipidaemia were also assessed. Results Prevalence of diabetes and IGT were 20.1 and 22.9%, respectively. FG (> 7 mmol/l) had a sensitivity of 56.7%. Using FG > 6.1 mmol/l, and OGTT in those above the threshold, the sensitivity for diabetes would have been 89.6%, with a positive predictive value of 59.0%, but 68.8% of cases of IGT would not have been detected. Patients with impaired fasting glucose (FG of 6.1–7.0 mmol/l) showed lower insulin sensitivity and impaired β cell function, and a weaker association to hypertriglyceridaemia, when compared to IGT. Conclusion FG > 7.0 mmol/l does not show a sufficient sensitivity for the screening of diabetes in obese patients. FG > 6.1 mmol/l has a satisfactory sensitivity for diabetes, but not for IGT. IFG has different pathophysiological features than IGT and cannot be assumed to have the same prognostic value of IGT.
The use of digital cameras in a mobile retinal screening environment
Authors: Taylor D. J. , Fisher J. , Jacob J. , Tooke J. E. 
Published: March 2003

Summary Aims To assess how successfully digital camera technology might be incorporated into a mobile screening environment. Methods One hundred and ninety‐seven people had their fundi photographed using a Topcon/Imagenet digital system and 534 using a Canon CR5/Ris‐Lite system in addition to concurrent 45° CR4NM Polaroid photography. One hundred and eighteen randomly selected patients were also sent for 7 field stereo photography as a gold standard. An acceptability questionnaire was answered by a random sample of those photographed Results For the detection of any retinopathy, digital pictures had a sensitivity of 0.74 (95% confidence interval (CI) 0.68–0.80) whilst Polaroid was 0.72 (95% CI 0.66–0.78) and for referable retinopathy digital pictures had a sensitivity of 0.85 (95%CI 0.80–0.90) and Polaroid was 0.90 (95% CI 0.86–0.94). A concurrent ophthalmoscopic evaluation improved the sensitivity to 0.92 (95% CI 0.86–0.98) for detection of any retinopathy whilst the sensitivity at the referral level was improved to 0.95 (95% CI 0.91–0.99). Twenty‐nine of 176 respondents experienced flash discomfort with the Polaroid system with only four of 154 describing ‘some’ discomfort from the digital systems which have a lower flash power (10 W vs. 300 W) and a faster recovery time. Conclusions This study indicates that digital systems are a feasible and acceptable alternative to Polaroid‐based cameras for use in a mobile environment.
Effects of the new oral hypoglycaemic agent nateglinide on insulin secretion in Type 2 diabetes mellitus
Authors: Whitelaw D. C. , Clark P. M. , Smith J. M. , Nattrass M. 
Published: March 2003

Summary Aims The new non‐sulphonylurea oral hypoglycaemic agent nateglinide has been shown to enhance insulin secretion in animals and in healthy human volunteers and thus offers a potential advance in the treatment of Type 2 diabetes mellitus. This study examined whether nateglinide can enhance insulin secretion, and particularly the first phase insulin response, in patients with Type 2 diabetes. Methods A double‐blind, placebo‐controlled trial, examining the effects of a single oral dose of 60 mg nateglinide, given 20 min prior to an intravenous glucose tolerance test (IGTT), on insulin secretion in 10 otherwise healthy Caucasian men with recently diagnosed Type 2 diabetes (duration since diagnosis 0–44 months). Results Insulin secretion (both overall and first phase) was significantly increased by nateglinide (P < 0.001), as were C‐peptide (P < 0.001) and proinsulin (P < 0.001) secretion. Overall glucose concentrations following glucose challenge were lower after nateglinide than after placebo (P = 0.05). Conclusions Nateglinide significantly increases insulin secretion in Type 2 diabetic patients, in particular restoring the first phase insulin response. Further study is necessary to determine the effects of chronic administration on insulin secretion and blood glucose concentration.
Ketoacidosis in young adults is not related to the islet antibodies at the diagnosis of Type 1 diabetes mellitus – a nationwide study
Authors: Östman J. , Landin‐Olsson M. , Törn C. , Palmer J. , Lernmark Å. , Arnqvist H. , Björk E. , Bolinder J. , Blohmé G. , Eriksson J. , Littorin B. , Nyström L. , Scherstén B. , Sundkvist G. , Wibell L. 
Published: March 2003

AbstractAimsTo test the hypothesis that there is lower prevalence of islet antibodies in subjects with newly diagnosed Type 1 diabetes mellitus in young adulthood than in children is associated with less severe diabetes at time of diagnosis.MethodsThis investigation was based on a nationwide study (Diabetes Incidence Study in Sweden) of 15–34‐year‐old newly diagnosed diabetic subjects. During 1992–1993, all diabetic subjects (excluding secondary and gestational diabetes) were reported on standardized forms, with information about clinical characteristics at diagnosis. The study examined islet cell antibodies (ICA) by indirect immunofluorescence, and autoantibodies to glutamic acid decarboxylase (GADA), tyrosine phosphatase‐like antigen (IA‐2A) and insulin (IAA) as well as C‐peptide by radioimmunoassay.ResultsBlood samples were available from 78 patients with diabetic ketoacidosis (DKA) and 517 non‐acidotic patients. The prevalence of ICA (63% vs. 57%), GADA (63% vs. 66%), IA‐2A (35% vs. 44%) and IAA (20% vs. 15%) were very similar in patients with or without DKA. The median levels of the four autoantibodies did not differ between the two groups. High blood glucose (P < 0.001) and low C‐peptide levels (P < 0.001) were the only parameters found to be related to DKA.ConclusionsThe similarities in findings of newly diagnosed diabetic patients with or without DKA regarding ICA, GADA, IA‐2A and IAA suggest that there is no relationship between the expression of antigenicity and the severity of β‐cell dysfunction. The lower prevalence of the four autoantibodies in 15–34‐year‐old diabetic subjects compared with previous findings in children is not explained by misclassification of diabetes type.
Plasma concentrations of VCAM‐1 and ICAM‐1 are elevated in patients with Type 1 diabetes mellitus with microalbuminuria and overt nephropathy
Authors: Clausen P. , Jacobsen P. , Rossing K. , Jensen J. S. , Parving H. ‐H. , Feldt‐Rasmussen B. 
Published: March 2003

SUMMARY Aims  Elevated urinary albumin excretion is associated with macrovascular atherosclerotic complications in Type 1 diabetes mellitus. Adhesion molecules mediate leucocyte adhesion to the endothelium early in the atherosclerotic process. The present study tests the hypothesis that microalbuminuria and diabetic nephropathy are associated with elevated plasma concentrations of soluble vascular adhesion molecule (sVCAM)‐1, soluble intercellular adhesion molecule (sICAM)‐1, and soluble E‐selectin (sE‐selectin) aiming to illustrate factors of potential pathogenetic relevance for the excess cardiovascular disease in diabetic patients with renal complications.Methods  Soluble adhesion molecule concentrations were measured by enzyme‐linked immunosorbent assays (ELISA) in healthy controls (n = 16) and in 59 Type 1 diabetic patients: group 1 – patients with normoalbuminuria (n = 16); group 2 – patients with microalbuminuria (n = 15); group 3 – patients with macroalbuminuria and normal serum creatinine (n = 15), group 4 – patients with macroalbuminuria and moderately elevated serum creatinine (n = 13).Results  Plasma concentrations of sVCAM‐1 and sICAM‐1 were similar in healthy controls and normoalbuminuric Type 1 diabetic patients, but the concentrations were increased by the presence of microalbuminuria and overt nephropathy (P < 0.001 and P < 0.0001, anova). Concentrations of sE‐selectin did not differ between diabetic patients and controls.Conclusions  Plasma concentration of sICAM‐1 is elevated in Type 1 diabetic patients with microalbuminuria and the concentrations of sICAM‐1 as well as sVCAM‐1 are elevated in patients with macroalbuminuria and normal s‐creatinine. The elevated plasma concentrations of these soluble adhesion molecule concentrations in patients with renal complication can be of pathogenetic importance for the development of atherosclerosis and plasma soluble adhesion molecule concentrations may provide additional information on cardiovascular risk.
The prevalence of diabetes, association with cardiovascular risk factors and implications of diagnostic criteria (ADA 1997 and WHO 1998) in a 1996 community‐based population study in Hong Kong Chinese
Authors: Janus E. D. , Wat N. M. S. , Lam K. S. L. , Cockram C. S. , Siu S. T. S. , Liu L. J. , Lam T. H. ,   on behalf of the Hong Kong Cardiovascular Risk Factor Steering Committee
Published: March 2003

SUMMARY Aims  While the American Diabetes Association (ADA) 1997 diagnostic criteria advocate the use of fasting plasma glucose only, the World Health Organization (WHO) criteria retain the use of the standard oral glucose tolerance test (OGTT). The present study evaluated the relative merit of the respective diagnostic criteria in Chinese.Methods  Data collected for the Hong Kong Cardiovascular Risk Factor Prevalence Study was analysed. This was a representative population‐based study, conducted from 1995 to 1996 among 2900 Chinese subjects aged 25–74 years using a 75‐g OGTT.Results  The prevalence of diabetes (known plus unknown) was 6.2% (95% confidence interval 5.3–7.1%), 9.2% (8.1–10.3%), and 9.8% (8.7–10.9%) based on ADA 1997, WHO 1985 and WHO 1998 criteria, respectively, with a very high prevalence in older subjects. The 2451 subjects classified as normal under ADA 1997 criteria were heterogenous: 15.3% had impaired glucose tolerance; 2.1% had diabetes under WHO 1998 criteria. These latter two smaller groups had cardiovascular risk profiles comparable to that found among the impaired fasting glucose subjects (under ADA), but worse than that among the concordant normal glucose tolerance subjects.Conclusions  The ADA criteria underestimate both diabetes prevalence and cardiovascular risk in this population. Hence fasting glucose alone is an inadequate approach and OGTT should be retained to identify at‐risk individuals in both clinical diagnosis and epidemiological studies.
Impact of the Xba1‐polymorphism of the human muscle glycogen synthase gene on parameters of the insulin resistance syndrome in a Danish twin population.
Authors: Fenger M. , Poulsen P. , Beck‐Nielsen H. , Vaag A. 
Published: March 2003

SUMMARY Aims  To establish the impact on the insulin resistance syndrome of the intron 14 Xba1‐polymorphism in human muscle glycogen synthase (GYS1).Methods  Parameters related to the insulin resistance syndrome were measured in 244 monozygotic twins and 322 dizygotic twins with or without impaired glucose tolerance. In addition a standard oral glucose tolerance test (OGTT) was performed. The twins were genotyped for Xba1‐polymorphism in GYS1 intron 14.Results  The allele frequency of Xba1 non‐cutters (A1) was 0.95 and of cutters (A2) was 0.05. Of the 566 twins examined, 90.0% had the genotype A1A1 and the remainder had the genotype A1A2. No A2A2‐genotypes were detected. In 11 genotypic discordant dizygotic twin pairs the insulin resistance was significantly increased in the twins carrying the A1A2 genotype regardless of sex (HOMA index 1.81 (A1A1) vs. 2.57 (A1A2), P < 0.05). Diastolic blood pressure was increased in female carriers of the A2‐allele with impaired glucose tolerance or Type 2 diabetes mellitus (79 ± 1 vs. 94 ± 4 mmHg, P < 0,01). Apart from a marginal increased waist‐to‐hip ratio, no other elements of the insulin resistance syndrome were associated with the polymorphism.Conclusions  The Xba1‐polymorphism of the human muscle glycogen synthase gene is correlated to insulin resistance and to diastolic blood pressure. The polymorphism does not involve any known transcription factor or any structural change in GYS1, and these correlations are therefore most probably caused by linkage to other functional polymorphisms in GYS1 or other gene polymorphisms on chromosome 19.
Post‐challenge hyperglycaemia relates more strongly than fasting hyperglycaemia with carotid intima‐media thickness: the RIAD Study
Authors: Hanefeld M. , Koehler C. , Henkel E. , Fuecker K. , Schaper F. , Temelkova‐Kurktschiev T. 
Published: March 2003

SUMMARY Aims  Only scarce information exists on the distribution and atherosclerosis risk in different types of hyperglycaemia at diabetes detection. This study aimed to analyse the occurrence of isolated fasting (IFH), isolated post‐challenge (IPH) and combined hyperglycaemia (FH/PH) among subjects detected to have diabetes and the association of these types of hyperglycaemia with cardiovascular risk factors and carotid intima‐media thickness (IMT).Methods  A total of 785 middle‐aged subjects of the Risk Factors in Impaired Glucose Tolerance (IGT) for Atherosclerosis and Diabetes (RIAD) study underwent a 75‐g oral glucose tolerance test and examination of various atherosclerosis risk factors. IMT was measured by B‐mode ultrasound.Results  One hundred and nineteen (15.2%) asymptomatic diabetic subjects were detected: of these, 35.3% with IFH, 26% with IPH and 38.7% with FH/PH. The level of risk factors was higher in diabetic vs. non‐diabetic subjects. HbA1c and cardiovascular risk factors were in the same range for IFH and IPH except for active plasminogen activator inhibitor (PAI)‐1 which was significantly higher in IFH. A higher risk burden was found in the FH/PH group vs. both IFH and IPH. IMT was as follows: non‐diabetic subjects 0.85 ± 0.18 mm, IFH 0.91 ± 0.20 mm, IPH 0.94 ± 0.18 mm, FH/PH 0.98 ± 0.17 mm (P < 0.05 vs. non‐diabetes). 2 h post‐challenge glucose (2hPG) correlated more closely (r = 0.23, P < 0.001) to IMT than fasting plasma glucose (FPG) (r = 0.14, P = 0.004). The importance of 2hPG was confirmed by the direct comparison of FPG and 2hPG in a three dimensional analysis. A significant increase of IMT was only observed in the subgroups with abnormal post‐challenge hyperglycaemia for both combinations with normal FPG and IFG. FPG category did not significantly add to IMT in either group of post‐challenge hyperglycaemia. Regression analysis in the whole sample revealed 2hPG but not FPG as a significant determinant of IMT. Further significant risk factors were age, male sex, total cholesterol, HDL‐cholesterol and hypertension.Conclusions  The RIAD study population at high risk for Type 2 diabetes mellitus, post‐challenge hyperglycaemia was found to relate more strongly than fasting hyperglycaemia with carotid IMT.