bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interaction between the Asn291Ser variant of the LPL gene and insulin resistance on dyslipidaemia in high risk individuals for Type 2 diabetes mellitus
Authors: Klannemark M. , Suurinkeroinen L. , Orho‐Melander M. , Groop L. , Taskinen M. ‐R. 
Published: March 2003

SUMMARY Aims   Lipoprotein lipase (LPL) is a major regulator of triglyceride clearance. A genetic variant of the LPL gene on chromosome 8p22, Asn291Ser, has previously been associated with dyslipidaemia and an increased frequency of cardiovascular disease as well as familial disorders of lipoprotein metabolism. The aim of this study was to test whether the phenotypic expression of the LPL Asn291Ser variant is dependent upon glucose tolerance and insulin resistance. Therefore, the Asn291Ser variant was examined in 192 patients with Type 2 diabetes, 278 subjects with normal glucose tolerance who are first degree relatives of patients with Type 2 diabetes and 226 healthy control spouses without family history of diabetes.Methods  The subjects were genotyped with an allele‐specific mini‐sequencing method. Insulin resistance was estimated using the homeostasis model assessment (HOMA) index.Results   The frequency of the Asn/Ser genotype was significantly increased in normoglycaemic subjects with hypertriglyceridaemia (> 1.7 mmol/l), and was associated with dyslipidaemia and increased systolic blood pressure. There was a significant interaction between Asn291Ser and insulin resistance in normoglycaemic subjects, indicating that dyslipidaemia is more severe in Asn/Ser carriers with reduced insulin sensitivity. The frequency of the Asn/Ser genotype was not increased in diabetic subjects with hypertriglyceridaemia, but was associated with increased systolic blood pressure.Conclusions   The Asn/Ser genotype of the LPL gene is associated with dyslipidaemia in normoglycaemic subjects, and the dyslipidaemic phenotype is more severe in insulin‐resistant subjects. This association is not seen in diabetic subjects.
Autoantibodies to glutamic acid decarboxylase in diabetic patients from a multi‐ethnic Australian community: the Fremantle Diabetes Study
Authors: Davis T. M. E. , Zimmet P. , Davis W. A. , Bruce D. G. , Fida S. , Mackay I. R. 
Published: March 2003

SUMMARY Aims  To investigate ethnic/racial differences in the prevalence of serum antibodies to glutamic acid decarboxylase (GADA) and ICA512/IA‐2 in diabetic patients from a large, urban community.Methods  A cross‐sectional sample of 1381 diabetic patients aged 11–98 years, representing 61% of those identified in a postcode‐defined population base of 120 097 people were studied. Diabetes was classified on clinical grounds. Serum GADA and anti‐ICA512/IA‐2 were measured by radioimmuno‐precipitation assay.Results  Anglo‐Celts formed 62% of the sample, southern Europeans 18%, other Europeans 8% and Asians 3%. GADA prevalence in Type 1 and Type 2 diabetes mellitus was 46.0% and 4.2%, respectively, amongst Anglo‐Celts and 22.2% and 1.7% in southern Europeans. The prevalence of anti‐ICA512/IA‐2 in Type 1 diabetes was 17.4% and, in a sample of 233 patients with Type 2 diabetes, 0.8%. GADA‐positive Type 2 patients had a lower body mass index and greater glycosylated haemoglobin, and were more likely to be taking insulin, than GADA‐negative Type 2 diabetic subjects (P < 0.05), consistent with the phentoype of latent autoimmune diabetes of adults (LADA). In both Type 1 and Type 2 diabetes, there was a strong inverse association between GADA and serum triglycerides (P < 0.001).Conclusions  The relatively low GADA prevalence in Anglo‐Celt patients with Type 1 diabetes is a feature of this community‐based study and suggests that GADA levels do fall with time, given the older age of the sample and a relatively long period between diagnosis and sampling. Southern Europeans had an even lower GADA prevalence, regardless of diabetes type. Variations in GADA frequency in diabetic patients of differing European ethnicity has implications for clinical management and healthcare planning.
Predictors of mortality and end‐stage diabetic complications in patients with Type 1 diabetes mellitus on intensified insulin therapy
Authors: Mühlhauser I. , Overmann H. , Bender R. , Jörgens V. , Berger M. 
Published: March 2003

SUMMARYAims To assess predictors of mortality and end‐stage diabetic complications in patients with Type 1 diabetes mellitus on intensified insulin therapy.Methods A cohort of 3674 patients (insulin treatment before age 31) who had participated in a 5‐day in‐patient group treatment and teaching programme for intensification of insulin therapy between 9/1978 and 12/1994 were re‐assessed after 10 ± 3 (mean ± sd) years.Results Vital status and data on blindness, amputations, and renal replacement therapy were documented for 97% patients; 7% patients had died, 1.3% had become blind, 2% had amputations and 4.6% started renal replacement therapy. Using the Cox proportional hazards model, the following risk factors of mortality as assessed at baseline were identified: nephropathy (at least macroproteinuria), hazard ratio 3.8 (95% confidence interval 2.6–5.6); smoking, 1.9 (1.4–2.6); diabetes duration, 1.5 (1.2–1.8) for a difference of 10 years; serum cholesterol, 1.1 (1.0–1.2) for a difference of 1 mmol/l; lower social status, 1.4 (1.1–1.8) for a difference of 1 out of 3 levels; age, 1.3 (1.1–1.6) for a difference of 10 years; male sex, 1.4 (1.1–1.9); systolic blood pressure, 1.1 (1–1.2) for a difference of 10 mmHg. For the combined endpoint – blindness or amputations or renal replacement therapy – predictors were: nephropathy, foot complications, HbA1c, smoking, cholesterol, systolic blood pressure, retinopathy, hypertension, and social status.Conclusion In Type 1 diabetic patients who start intensified insulin therapy, nephropathy remains the strongest predictor of mortality and end‐stage complications. Glycosylated haemoglobin is a risk factor of end‐stage complications but not of mortality. Conventional risk factors comparable to the general population, particularly smoking become operative as predictors of both mortality and end‐stage complications.
Coronary heart disease risk assessment in diabetes mellitus–‐a comparison of PROCAM and Framingham risk assessment functions
Authors: Game F. L. , Jones A. F. 
Published: March 2003

SummaryAims  To assess any differences between coronary heart disease (CHD) risks calculated by the Framingham equation and those calculated by the PROCAM equation in men with and without diabetes mellitus, and whether any such differences are associated with the hypertriglyceridaemia of diabetes mellitus.Methods  Clinical and biochemical data collected from 1774 men seen in either general practice, a hospital diabetes or lipid clinic. CHD risks were calculated by both the Framingham and PROCAM functions and comparisons made between those patients with and those without diabetes.Results  Of the 1774 men only 996 fulfilled the criteria for assessment by the PROCAM equation and thus further analysis. Patients with diabetes mellitus had significantly higher serum triglyceride levels than those without (1.9 mmol/l vs. 1.7 mmol/l). Median annual CHD risks calculated by the Framingham function were 1.7% in the patients with and 1.32% in the patients without diabetes mellitus, whereas those calculated by the PROCAM function were 0.77% and 0.6%, respectively. Bland–Altman difference plots showed that in both groups of patients the PROCAM equation systematically underestimated risk in comparison with the Framingham equation at low levels of risk but overestimated at higher levels of risk. The shape of the plots in each group of patients was, however, similar.Conclusion  There were no systematic differences between CHD risks calculated by the two different equations in patients with diabetes compared with those without, despite the higher serum triglyceride levels associated with diabetes. Restrictions in the use of the PROCAM function meant that only 56% of the original cohort could be assessed in this way. Thus the Framingham equation remains the most suitable method of CHD risk prediction for UK patients with and without diabetes mellitus.
Normalization of pregnancy outcome in pregestational diabetes through functional insulin treatment and modular out‐patient education adapted for pregnancy
Authors: Howorka K. , Pumprla J. , Gabriel M. , Feiks A. , Schlusche C. , Nowotny C. , Schober E. , Waldhoer T. , Langer M. 
Published: March 2003

AbstractAim  To investigate whether modular out‐patient group education for flexible, Functional Insulin Treatment (FIT) adapted for pregnancy can eliminate diabetes‐associated neonatal complications in pregestational diabetes.Research design and methods  Outcome analysis of the modular out‐patient group education and FIT based on separate insulin dosages for fasting, eating or correcting hyperglycaemia in 76 consecutive pregnancies (in 20 cases first after conception) of 59 patients with pregestational diabetes (Type 1 diabetes, n = 54). Controls: (a) diabetic pregnancies: historical controls; (b) non‐diabetic pregnancies: retrospective case‐controlled study; (c) population‐based data of all Austrian newborns registered within the respective time period.Results  HbA1c of 113 ± 18% of mean value (= 100%) of non‐diabetic, non‐pregnant population (103 ± 14% during the last pregnancy trimester), and self‐monitored blood glucose of 5.6 ± 0.7 mmol/l (5.3 ± 0.7 mmol/l during the last trimester) was achieved throughout all FIT pregnancies. Severe hypoglycaemia occurred in 14 pregnancies. The gestational age at delivery was 39.2 ± 1.5 weeks (four cases (5.4%) < 37 weeks) with a birth weight of 3305 ± 496 g. Four newborns (5.3%) were above the 90th, and nine (11.8%) below the 10th percentile for weight of reference population‐based data. Hypoglycaemia was recorded in six newborns (8%). Malformations were found in two infants whose mothers booked for diabetes FIT education only after conception. The caesarean delivery rate was 25%. In comparison with historical diabetic pregnancy controls we demonstrated a reduction in major complications, and compared with non‐diabetic women, a lowering of diabetes‐related neonatal complication rates to general population levels.Conclusions  Structured, comprehensive, modular out‐patient group education promoting self‐choice of insulin dose for flexible, normal eating prior to conception normalizes pregnancy outcome in diabetes.Diabet. Med. 18, 965–972 (2001)
Maternal transmission of diabetes
Authors: Alcolado J. C. , Laji K. , Gill‐Randall R. 
Published: March 2003

AbstractType 2 diabetes mellitus represents a heterogeneous group of conditions characterized by impaired glucose homeostasis. The disorder runs in families but the mechanism underlying this is unknown. Many, but not all, studies have suggested that mothers are excessively implicated in the transmission of the disorder. A number of possible genetic phenomena could explain this observation, including the exclusively maternal transmission of mitochondrial DNA (mtDNA). It is now apparent that mutations in mtDNA can indeed result in maternally inherited diabetes. Although several mutations have been implicated, the strongest evidence relates to a point substitution at nucleotide position 3243 (A to G) in the mitochondrial tRNAleu(UUR) gene. Mitochondrial diabetes is commonly associated with nerve deafness and often presents with progressive non‐autoimmune β‐cell failure. Specific treatment with Coenzyme Q10 or L‐carnitine may be beneficial. Several rodent models of mitochondrial diabetes have been developed, including one in which mtDNA is specifically depleted in the pancreatic islets. Apart from severe, pathogenic mtDNA mutations, common polymorphisms in mtDNA may contribute to variations of insulin secretory capacity in normal individuals. Mitochondrial diabetes accounts for less than 1% of all diabetes and other mechanisms must underlie the maternal transmission of Type 2 diabetes. Possibilities include the role of maternally controlled environments, imprinted genes and epigenetic phenomena.
Predictivity of thyroid autoantibodies for the development of thyroid disorders in children and adolescents with Type 1 diabetes
Authors: Kordonouri O. , Deiss D. , Danne T. , Dorow A. , Bassir C. , Grüters‐Kieslich A. 
Published: March 2003

AbstractAims To investigate the prevalence of thyroid autoantibodies and their significance for the development of thyroid disorders in children and adolescents with Type 1 diabetes.Methods Antibodies to thyroglobulin (anti‐TG) and thyroperoxidase (anti‐TPO) were measured in 216 patients (113 boys; median age 12.9 years (range 1–22 years)) with Type 1 diabetes (diabetes duration 2.5 years (0–14 years)) in a cross‐sectional study. Sixteen patients with significantly elevated anti‐TPO titres were followed longitudinally (6.0 years (4–13 years)) including the measurement of anti‐TPO, anti‐TG, T3, T4, thyroid‐stimulating hormone (TSH) and ultrasound assessment.Results Twenty‐two patients (10.0%) had significantly elevated titres of anti‐TPO, 19 (8.7%) of anti‐TG and 13 (5.9%) of both autoantibodies. Girls had more frequently elevated anti‐TPO antibodies than boys (P < 0.05). Eight of 16 patients (50%) developed thyroid disorders defined by a TSH elevation (≥ 4.5 µU/ml) and/or sonographic thyroid abnormalities during a median time of 3.5 years (2–6 years) after first detection of anti‐TPO positivity. They were characterized by higher levels of anti‐TPO (P = 0.001) and a more frequent coexistence of anti‐TG antibodies (P = 0.002) than those with no development of thyroid disorder even after an observation period of 5.5 years (5–10 years).Conclusions Because 50% of children with diabetes and significant titres of anti‐TPO develop thyroid problems within 3–4 years, examinations of thyroid antibodies should be performed yearly. In cases of significant antibody titres, thyroid function tests and ultrasound assessment are recommended in order to minimize the risk of undiagnosed hypothyroidism in these patients.
Charcot neuroarthropathy of the knee in Type 1 diabetes: treatment with total knee arthroplasty
Authors: Lambert A. P. , Close C. F. 
Published: March 2003

AbstractBackground Charcot neuroarthropathy is well recognized in diabetes, although it typically affects the joints of the forefoot and ankle. Neuroarthropathy affecting the knee in diabetes is extremely rare. The surgical options for treatment of Charcot neuroarthropathy remain poorly defined, particularly the use of arthroplasty with knee involvement.Methods We describe a case of neuroarthropathy of the knee in a patient with Type 1 diabetes. We also describe the successful management of the disorder with total knee arthroplasty—only the third such description.Results The case illustrates some of the typical radiological features of this uncommon condition, which may aid early diagnosis and limit morbidity.
Continuous intraperitoneal insulin infusion in patients with ‘brittle’ diabetes: favourable effects on glycaemic control and hospital stay
Authors: DeVries J. H. , Eskes S. A. , Snoek F. J. , Pouwer F. , Van Ballegooie E. , Spijker A. J. , Kostense P. J. , Seubert M. , Heine R. J. 
Published: March 2003

AbstractAims To evaluate the effects of continuous intraperitoneal insulin infusion (CIPII) using implantable pumps on glycaemic control and duration of hospital stay in poorly controlled ‘brittle’ Dutch diabetes patients, and to assess their current quality of life.Methods Thirty‐three patients were included. Glycaemic control was retrospectively assessed with HbA1c levels acquired before implantation, 1 year later and at long‐term follow up of 58 months. Duration of hospital stay the year before and the year following first implantation was extracted from hospital records. Determinants of long‐term glycaemic response were sought. Self‐report questionnaires were administered at 58 months follow‐up only, to assess current psychopathology and quality of life.Results Mean HbA1c decreased from 10.0 ± 2.3% to 9.0 ± 1.8% (P = 0.039) 1 year after implantation and stabilized at 9.0 ± 1.6% (P = 0.023) during long‐term follow‐up. Median number of hospital days in the 20 patients suffering from hospital admission before implantation decreased from 45 the year before implantation to 13 the year after (P = 0.005). Patients with a higher baseline HbA1c showed a larger long‐term response (P < 0.001). Relatively low levels for quality of life were found, as well as a higher than expected number of patients with psychiatric symptoms.Conclusions CIPII proved effective in complex patients with a history of poor control and hospital admission. Despite a substantial long‐term improvement in glycaemic control and diminished hospital stay, normal levels of glycaemic control and quality of life were not attained.
Physical activity and cause‐specific mortality in men with Type 2 diabetes/impaired glucose tolerance: evidence from the Whitehall study
Authors: Batty G. D. , Shipley M. J. , Marmot M. , Davey Smith G. 
Published: March 2003

AbstractAimsGiven that studies of individuals with Type 2 diabetes or impaired glucose tolerance indicate that physical activity has a normalizing effect on several indices of coronary heart disease (CHD) risk—including body weight, blood pressure, blood lipids, and cardiorespiratory fitness—it is plausible that activity may reduce CHD incidence in this group in the long term. The aim of the present analysis was to explore this hypothesis using data from a prospective observational study.MethodsWe examined the relation of two indices of physical activity—walking pace and leisure activity—to total mortality, CHD, and other cardiovascular diseases in a 25‐year follow‐up of 6408 male British Civil Servants who underwent an oral glucose tolerance test at study entry.ResultsIn 352 men who were identified as having Type 2 diabetes or impaired glucose tolerance (diabetes/IGT) at baseline, 215 had died at follow‐up and, in 6056 normoglycaemics, 2550 deaths had occurred. The two indices of physical activity were inversely related to all‐cause, CHD, and other cardiovascular disease mortality in both normoglycaemics and in men with diabetes/IGT. Although these associations were attenuated somewhat after statistical adjustment for a range of covariates, the majority held, suggesting an independent effect for physical activity. The gradient of the activity–mortality association was steeper in individuals with diabetes/IGT in comparison with the normoglycaemics, with the linear trend across activity levels for CHD risk differing markedly in the analyses of both walking pace (P‐value for interaction test = 0.05) and leisure activity (P‐value = 0.02).ConclusionsThe findings of the present analysis of men with Type 2 diabetes/IGT provide support for those from a small number of other studies of persons with Type 2 diabetes suggesting that this group may benefit from physical activity in terms of CHD risk reduction.
A family history of Type 2 diabetes is associated with increased plasma levels of C‐reactive protein in non‐smoking healthy adult women
Authors: Pannacciulli N. , De Pergola G. , Giorgino F. , Giorgino R. 
Published: March 2003

AbstractAims The aim of our study was to test whether a family history of Type 2 diabetes (FH) in women is associated with plasma C‐reactive protein (CRP).Methods CRP plasma levels were measured in 162 women, aged 18–60 years; 95 had a positive family history of Type 2 diabetes in a parent or grandparent (FH+), and 67 gave no family history of this disease (FH−). Other measurements included: central fat accumulation, as evaluated by waist circumference; insulin resistance, as calculated by homeostatic model assessment (HOMAIR); systolic and diastolic blood pressure; and fasting concentrations of glucose, insulin, and lipids.Results CRP plasma levels were significantly higher in FH+ than in FH− subjects. Moreover, CRP was independently associated with age, body mass index, waist circumference, HOMAIR, and FH.Conclusions Our study, performed in a selected population of women free from well‐known risk factors for atherothrombosis, demonstrates that subjects with a family history of Type 2 diabetes have higher CRP plasma levels than age‐ and BMI‐matched controls with no family history. Our results show that a family history of Type 2 diabetes is an independent contributor of CRP concentrations, in addition to age, total fatness, central fat accumulation, and insulin resistance.Diabet. Med. 19, 689–692 (2002)
Ambulatory blood pressure monitoring: is it necessary for the routine assessment of hypertension in people with diabetes?
Authors: Strachan M. W. J. , Gough K. , McKnight J. A. , Padfield P. L. 
Published: March 2003

AbstractAims The British Hypertension Society (BHS) has recommended that, for people with diabetes, the target ‘clinic’ blood pressure should be < 140/80 mmHg. Ambulatory monitoring of blood pressure (ABPM) is used widely in the assessment of hypertension and the BHS has recommended that the target ‘awake’ ambulatory blood pressure for people with diabetes should be < 130/75 mmHg. The purpose of the present study was to determine the utility of ABPM in the assessment of hypertension in patients with diabetes, over and above a careful ‘clinic’ measurement of blood pressure.Methods The records of 540 patients with diabetes who underwent ABPM (using SpaceLabs monitors) were retrospectively analysed. With respect to current BHS recommendations, the positive and negative predictive values of ‘clinic’ blood pressure (measured by trained nurses using mercury sphygmomanometers) on ‘awake’ ambulatory blood pressure (ABP) were calculated.Results The positive predictive value of the ‘clinic’ BP, its ability to detect patients whose ABP was above BHS targets, was 99%. The negative predictive value of ‘clinic’ blood pressure was 27%.Conclusions With regard to current BHS guidelines, ABPM is generally unnecessary in the assessment of hypertension in patients with diabetes, provided careful ‘clinic’ measurements of blood pressure are made.
The evaluation of screening policies for diabetic retinopathy using simulation
Authors: Davies R. , Roderick P. , Canning C. , Brailsford S. 
Published: March 2003

AbstractAims To develop a model for evaluating screening strategies and to use it to determine the cost effectiveness of varying the screening method and the screening interval.Methods A discrete event simulation was designed, validated and run for a population of 500 000. Most parameters were derived from peer‐reviewed publications.Results Standard methods of screening save up to 50% of the potential sight years lost. They give up to 85% of the sight years saved by an idealized gold standard programme using mydriatic seven‐field photography reported by an ophthalmologist. The mobile camera, used for annual screening and 6‐month follow‐up after the detection of background retinopathy, had an estimated cost of £449 200 per year with £2842 per sight year saved. It is less efficient to screen Type 2, rather than Type 1 diabetes mellitus patients, but they contributed to almost three‐quarters of the sight years saved.Conclusions The model can evaluate screening intervals and methods on a national or health authority basis. Results indicate that it appears more cost effective to continue to screen outside an ophthalmology clinic, until treatment is needed. Programmes with annual screening, and more frequent screening for those with background retinopathy, are robust to realistic fluctuations in compliance and screening sensitivity.