bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intensive lipid‐lowering strategy in patients with diabetes mellitus
Authors: Kanters S. D. J. M. , Algra A. , De Bruin T. W. A. , Erkelens D. W. , Banga J. ‐D. 
Published: March 2003

Summary Aims To assess the feasibility of an intensive lipid‐lowering strategy in diabetic subjects pursuing target plasma lipid levels. Methods Patients with diabetes mellitus (DM), Type 1 or 2, with plasma lipid levels exceeding target values (LDL‐cholesterol < 2.6 mmol/l, triglycerides < 1.7 mmol/l, HDL‐cholesterol > 0.9 mmol/l for men and > 1.1 mmol/l for women) were eligible. After 6–12 weeks of diet and glycaemic control, lipid‐lowering medication (simvastatin/gemfibrozil/acipimox) was prescribed in steps of incremental dosages and combinations for 30 weeks. Results Of all eligible clinic patients, 25% initially responded and finally 12% were entered. Thirty‐six patients with Type 1 and 59 with Type 2 DM were studied. Mean baseline lipid levels in Type 1 and Type 2 diabetic subjects were: LDL‐cholesterol 3.6 and 3.7 mmol/l, triglycerides 1.7 and 2.2 mmol/l, HDL‐cholesterol for men 1.1 and 1.0 mmol/l, and for women 1.4 and 1.2 mmol/l, respectively. All three target values were reached in 66% of the patients. LDL‐cholesterol was reduced by 1.2 mmol/l in Type 1 and 1.3 mmol/l in Type 2 diabetic patients and triglycerides by 0.7 mmol/l and 1.1 mmol/l, respectively. HDL‐cholesterol increased by 0.15 mmol/l and 0.34 mmol/l in men and women with Type 1 diabetes mellitus, respectively. The cholesterol–triglyceride ratio decreased significantly in VLDL in Type 1 diabetes and in IDL in Type 2 diabetes and increased significantly in HDL in Type 2 DM. Conclusions A minority of subjects eligible for intensive lipid lowering agreed to participate in a feasibility study, suggesting a potentially large compliance problem for a general lipid‐lowering programme in a diabetes clinic. Nevertheless, intensive lipid lowering with drug combinations can attain the recommended target lipid levels in 66% of subjects with diabetes. With this strategy the plasma lipoprotein composition shifts towards a less atherogenic profile. Subjects with diabetes should therefore receive lipid‐lowering therapy tailored to reach target levels, rather than standard dosages, in order to reduce atherogenic risk.
Effect of pravastatin on erythrocyte rheological and biochemical properties in poorly controlled Type 2 diabetic patients
Authors: Miossec P. , Zkhiri F. , Pariès J. , David‐Dufilho M. , Devynck M. A. , Valensi P. E. 
Published: March 2003

Summary Aims The rheological properties of erythrocytes are impaired in diabetes mellitus, especially because of changes in their membrane lipid composition. In hypercholesterolaemic patients, lowering plasma cholesterol is associated with an improvement of the erythrocyte rheological parameters. The aim of this study was to investigate the relationship between erythrocyte deformability, plasma lipids, lipid membrane composition and cytosolic cations in poorly controlled Type 2 diabetic patients and to test the effects of a cholesterol‐lowering treatment on these parameters. Methods We compared 37 poorly controlled Type 2 diabetic patients with 26 controls. In 22 of the diabetic patients who showed an impairment in erythrocyte deformability (filtration index > 10.5 on the Hanss’ haemorheometer), a double‐blind randomized trial compared the effect of the inhibitor of HMG CoA reductase pravastatin 20 mg per day for 4 months vs. placebo on the erythrocyte parameters. Results Compared with controls, diabetic patients had higher filtration index (FI), erythrocyte sodium and calcium contents and lower free cholesterol–phospholipids ratio in erythrocyte membranes. Erythrocyte sodium content correlated positively with the FI and the membrane free cholesterol–phospholipids ratio. In the pravastatin‐treated group (11 patients), fibrinogen decreased significantly, FI reached a normal value (< 10) in six patients. Four of the five other patients who still had abnormal FI after 4 months of treatment had either a high plasma triglycerides (≥ 4.60 mmol/l) or a high plasma fibrinogen (≥ 4 g/l) level at baseline. Only two of the 11 placebo‐treated patients achieved a normal FI. Conclusion These data suggest that in poorly controlled Type 2 diabetic patients there is a link between the chemical composition and the rheological properties of erythrocytes. Erythrocyte deformability may be improved by lowering plasma cholesterol with a statin.
Effects of 3‐week oral treatment with the antioxidant thioctic acid (α‐lipoic acid) in symptomatic diabetic polyneuropathy
Authors: Ruhnau K. ‐J. , Meissner H. P. , Finn J. ‐R. , Reljanovic M. , Lobisch M. , Schütte K. , Nehrdich D. , Tritschler H. J. , Mehnert H. , Ziegler D. 
Published: March 2003

SummaryAims To evaluate the efficacy and safety of short‐term oral treatment with the antioxidant thioctic acid (TA) on neuropathic symptoms and deficits in patients with Type 2 diabetes mellitus with symptomatic polyneuropathy. Methods Patients were randomly assigned to oral treatment with 600 mg of TA t.i.d. (n=  12) or placebo (n=  12) for 3 weeks. Neuropathic symptoms (pain, burning, paraesthesiae, and numbness) in the feet were scored at weekly intervals and summarized as a Total Symptom Score (TSS). The Hamburg Pain Adjective List (HPAL) and the Neuropathy Disability Score (NDS) were assessed at baseline and day 19. Results At baseline the TSS, HPAL, and NDS were not significantly different between the groups. The TSS in the foot decreased from baseline to day 19 by − 3.75 ± 1.88 points ( −  47%) in the TA group and by − 1.94 ± 1.50 points ( −  24%) in the placebo group (P=  0.021 for TA vs. placebo). The total HPAL score decreased from baseline to day 19 by − 2.20 ± 1.65 points ( − 60%) in the TA group and by − 0.96 ± 1.32 points ( − 29%) in the placebo group (P=  0.072 for TA vs. placebo). The NDS decreased by − 0.27 ± 0.47 points in the TA group, whereas it slightly increased by + 0.18 ± 0.4 points in the placebo group (P=  0.025 for TA vs. placebo). No differences between the groups were noted regarding the rates of adverse events. Conclusions These preliminary findings indicate that oral treatment with 600 mg of TA t.i.d. for 3 weeks may improve symptoms and deficits resulting from polyneuropathy in Type 2 diabetic patients, without causing significant adverse reactions.
Intra‐individual variability and longitudinal changes in glycaemic control in patients with Type 1 diabetes mellitus
Authors: Jorde R. , Sundsfjord J. 
Published: March 2003

Summary Aims Patients with Type 1 diabetes mellitus (DM) appear to have remarkably stable HbA1c levels, regardless of the need for improvement. The purpose of the present study was therefore to study predictors of intra‐individual variability of the HbA1c level together with changes in HbA1c over time. Methods Hospital records of patients with Type 1 DM seen at our diabetes clinic from February 1992 to May 1997 were reviewed for HbA1c measurements and clinical data. In the main study, 214 patients who had been on insulin for more than 1 year, and in a sub‐study, 14 patients newly started on insulin, were included. Results The coefficient of variation (CV) of the intra‐individual HbA1c measurements, after at least 1 year of insulin, was 8.8 ± 3.7% (mean ± sd). There was a positive association between the CV and the HbA1c measurement at inclusion in the study (P < 0.05), and also a negative association between the CV and age (P < 0.05). Fifty per cent of the patients had a difference between first and last HbA1c below 1%, and 83.6% had a difference below 2%. In the sub‐study, there was a positive association between the mean HbA1c value the first year on insulin (excluding the first 3 months) and the last HbA1c measurement (P < 0.01). Conclusions The HbA1c levels in individual patients remain remarkably stable over time. Furthermore, the HbA1c level shortly after starting insulin is a predictor of future glycaemic control.
Influence of a familial history of diabetes on the clinical characteristics of patients with Type 2 diabetes mellitus
Authors: Bo S. , Cavallo‐Perin P. , Gentile L. , Repetti E. , Pagano G. 
Published: March 2003

SUMMARY Aims  To evaluate the roles of maternal and paternal diabetes and diabetes in relatives other than parents on the clinical characteristics in Type 2 diabetes mellitus.Methods  A total of 2113 Type 2 diabetic patients were recruited, and those with diabetic mothers, diabetic fathers, diabetic relatives other than parents and no known diabetic relatives, were considered separately.Results  The prevalence of diabetes in the mother, father and other relatives was 25.5, 6.5 and 21.2%, respectively. No difference in the clinical characteristics was found in patients with diabetes in the mother or father. Patients with parental diabetes were significantly younger, with higher LDL‐cholesterol, prevalence of retinopathy and lower age at diabetes diagnosis than those without familial diabetes; on multiple logistic regression, only age (P = 0.0003), age at diabetes diagnosis (P = 0.0014) (inverse association), and LDL‐cholesterol (P = 0.030) remained significantly associated with parental diabetes. Patients with diabetic relatives other than parents displayed significantly higher total and LDL‐cholesterol, prevalence of retinopathy and lower age at diabetes diagnosis that those with no known diabetic relatives; on multiple logistic regression, only age at diabetes diagnosis was inversely associated with diabetes in relatives other than parents (P = 0.013).Conclusions  The data do not indicate a different influence of maternal and paternal diabetes on the clinical characteristics of Type 2 diabetic patients, while there is evidence that parental diabetes brings to an earlier onset of the disease and higher LDL‐cholesterol values; the presence of diabetes in relatives other than parents constituted a small risk for earlier manifestation of the disease.
Beta blocker prescribing differences in patients with and without diabetes following a first myocardial infarction
Authors: Younis N. , Burnham P. , Patwala A. , Weston P J. , Vora J P. 
Published: March 2003

SUMMARY Aims  To document the prescribed usage of beta blockers in patients with and without diabetes mellitus discharged from hospital following a first myocardial infarction.Methods  All patients with diabetes and a group of patients matched for age and sex without diabetes, admitted with a documented first myocardial infarction during the period 1995–1999 at the Royal Liverpool University Hospital, Liverpool, UK were audited.Results  Data were available on 201 patients with diabetes and 199 patients without diabetes. No significant differences existed between the diabetic and non‐diabetic groups for age and sex. Twenty‐three per cent of patients with diabetes were prescribed a beta blocker compared to 52% of non‐diabetic patients (P < 0.01). Patients with diabetes had a higher frequency of perceived contraindications than patients without diabetes (36 vs. 27%, P < 0.001). Thirty‐five per cent of patients with diabetes and 18% of non‐diabetic patients had no contraindication to the use of beta blocker but were not prescribed one (P < 0.001).Conclusions  Although beta blockers can provide useful benefits in patients with diabetes following a myocardial infarction, this study suggests that a significant proportion of patients with diabetes and without a contraindication to treatment are still not receiving beta blockers after myocardial infarction.
Short‐term Acipimox decreases the ability of plasma from Type 2 diabetic patients and healthy subjects to stimulate cellular cholesterol efflux: a potentially adverse effect on reverse cholesterol transport
Authors: Dullaart R. P. F. , Van Tol A. 
Published: March 2003

AbstractAims  To evaluate the effect of short‐term administration of the anti‐lipolytic agent, Acipimox, on the ability of plasma to stimulate cellular cholesterol removal, which represents one of the first steps in the anti‐atherogenic process of reverse cholesterol transport.Methods  Eight male Type 2 diabetic patients and eight healthy subjects were studied after a 12‐h fast at baseline, after 24 h of Acipimox administration, 250 mg every 4 h, and again after 1 week (recovery). Plasma lipids, apolipoprotein AI, phospholipid transfer protein (PLTP) activity, pre‐β high‐density lipoproteins (HDL) in incubated plasma and efflux of radiolabelled cholesterol from Fu5AH rat hepatoma cells to plasma were measured at each time point.Results  Acipimox lowered plasma triglycerides in diabetic patients (P = 0.001) and healthy subjects (P = 0.002), whereas plasma non‐esterified fatty acids were decreased in diabetic patients (P = 0.001) compared with the averaged values at baseline and recovery. Acipimox decreased HDL cholesterol in healthy subjects (P = 0.007) and plasma apolipoprotein AI in both groups (P = 0.001 for diabetic patients; P = 0.008 for healthy subjects). Not only plasma PLTP activity (P = 0.001 for diabetic patients; P = 0.01 for healthy subjects), but also pre‐β HDL in incubated plasma (P = 0.001 for diabetic patients; P = 0.03 for healthy subjects) and cellular cholesterol efflux to plasma (P = 0.04 for diabetic patients; P = 0.005 for healthy subjects) were lowered by Acipimox in both groups.Conclusions  Short‐term Acipimox administration impairs the ability of plasma from Type 2 diabetic patients and healthy subjects to stimulate cellular cholesterol efflux, in conjunction with alterations in HDL parameters and in PLTP activity. If the impairment of cellular cholesterol efflux to plasma is sustained with long‐term treatment, this potentially adverse effect should be considered when treating diabetic dyslipidaemia with Acipimox.Diabet. Med. 18, 509–513 (2001)
Obstetric and diabetic care for pregnancy in diabetic women: 10 years outcome analysis, 1985–1995
Authors: Hadden D. R. , Alexander A. , McCance D. R. , Traub A. I. 
Published: March 2003

AbstractAim  Ten‐year outcome analysis of all pregnancies in diabetic women in a population of 1.5 million people.Methods  Ascertainment of patients through the regional obstetrical computer, and by direct contact with each obstetrical unit. Retrospective assessment of early miscarriage of pregnancy from hospital records. Data are presented for the six smallest obstetrical units, the four smaller district hospitals, two larger teaching hospitals and for the regional referral centre.Results  Nine hundred and eighty‐six fetal outcomes were identified, 753 in mothers treated with insulin before the pregnancy, 131 in mothers in whom insulin was started for the first time during the pregnancy and 102 in mothers treated by diet only. Overall perinatal mortality rates were 35.8 per 1000 for those mothers booked and delivered at a local maternity unit, 28.9 per 1000 for those booked and delivered at the regional centre, but 75.0 per 1000 for those who had booked locally but were transferred to the centre mid‐pregnancy. Information on blood glucose control before and during pregnancy was relatively poorly documented. For the available data at the regional centre, only 160 of the 416 mothers had an identifiable preconception HbA1c measurement (mean 7.9%, range 3.3–16.8%): at booking 360 of these mothers had a mean HbA1c of 7.5% and by the third trimester mean HbA1c was 6.3% (range 3.3–13.2%).Conclusions  The outcome of pregnancy in a diabetic mother in Northern Ireland remains a higher risk than for the general population. There is evidence that results in the regional centre are better, but problems arise when transfers occur mid‐pregnancy. Measurement and recording of blood glucose control at all stages before and during pregnancy is incomplete.Diabet. Med. 18, 546–553 (2001)
Acceleration of diabetic retinopathy in pregnancy: a case report
Authors: Joseph S. E. , McHugh D. , Blott M. , Amiel S. A. , Watkins P. J. 
Published: March 2003

AbstractAims Diabetic retinopathy can deteriorate during pregnancy. This usually manifests itself as an increase in the number of background retinopathy lesions, notably the appearance of new cotton wool spots, predominantly during the first trimester. The changes are usually attributed to the rapid attainment of tight glycaemic control during pregnancy. We present a case report of catastrophic deterioration in retinopathy during a period of stable glycaemic control.Results J.P. had normal fundoscopic appearance at booking and during the early part of pregnancy. She experienced rapid deterioration in visual acuity secondary to cystoid macular oedema and vitreous haemorrhage during the third trimester of pregnancy. Her glycaemic control was stable at that stage and had not changed when compared with earlier stages of pregnancy. She required three sessions of intrapartum laser therapy and postpartum vitrectomy.Conclusions  The case highlights the importance of regular retinal surveillance in a diabetic pregnancy, even in the absence of sudden improvements in glycaemic control.Diabet. Med. 18, 675–678 (2001)
Beta‐cell function evaluated by HOMA as a predictor of secondary sulphonylurea failure in Type 2 diabetes
Authors: Taverna M. J , Pacher N. , Bruzzo F. , Slama G. , Selam J. L. 
Published: March 2003

AbstractBackground and aims  Secondary failure to oral hypoglycaemic agents, a common evolution of long‐standing Type 2 diabetes, is usually assessed by non‐standardized indices requiring fine clinical assessment, including hyperglycaemia resistant to maximum doses of sulphonylureas despite appropriate diet and follow‐up. The goal of this study was to evaluate if HOMA, a modelized plasma insulin/glucose ratio allowing simple evaluation of residual insulin secretion and sensitivity, is a better predictor of the insulin requiring stage than clinical indices.Materials and methods  HOMA was measured in 84 Type 2 diabetic patients aged 58 ± sd 6 years, with diabetes duration 11 ± 4 years, hospitalized because of hyperglycaemia resistant to maximal doses of sulphonylureas (e.g. glibenclamide ≥ 15 mg/day), with no apparent external reason for hyperglycaemia. Despite reinforced appropriate diet recommendations, 62 of these patients remained hyperglycaemic (insulin‐requiring group).Results  Age, duration of diabetes, body mass index (BMI) and HOMA value for insulin sensitivity (71 ± 6% vs. 76 ± 7%, normal values 59–161%) were comparable in the two groups. HbA1c was higher (10.0 ± 0.2% vs. 8.3 ± 0.3%, P < 0.001) and HOMA insulin secretion values lower (25 ± 2% vs. 43 ± 6%, normal values 70–150%, P < 0.01) in the insulin‐requiring group. Of the following potential predictors: HbA1c > 8%, duration of diabetes ≥ 10 years, HbA1c combined with diabetes duration, insulin sensitivity ≤ 40%, insulin secretion ≤ 20%, the latter showed the best positive predictivity (86% patients with low insulin secretion were insulin‐requiring).Conclusions  (i) HOMA is a simple and good predictor of the insulin‐requiring stage in Type 2 diabetes mellitus; (ii) this stage of diabetes is characterized by a further decline of insulin secretion rather than of insulin sensitivity.Diabet. Med. 18, 584–588 (2001)
Glucose counterregulation in Type 2 diabetes mellitus
Authors: De Galan B. E. , Hoekstra J. B. L. 
Published: March 2003

AbstractGlucose counterregulatory failure and hypoglycaemia unawareness frequently complicate treatment of Type 1 diabetes mellitus, especially when aiming for intensive metabolic control. Since tight metabolic control reduces microvascular long‐term complications in Type 2 diabetes mellitus, the integrity of glucose counterregulation in Type 2 diabetic patients is important. Using a Medline search, we identified 12 studies in which counterregulatory responses to insulin‐induced hypoglycaemia were compared between Type 2 diabetic patients and appropriate controls. A review of these studies showed that some patients with Type 2 diabetes mellitus develop mild counterregulatory dysfunction and reduced awareness of insulin‐induced hypoglycaemia. Some studies suggested an association between counterregulatory impairment and intensity of metabolic control. We speculate that the relatively low frequency of (severe) hypoglycaemic events in Type 2 diabetes may explain why glucose counterregulation remains unaffected in most patients. We hypothesize that residual β‐cell reserve and insulin resistance provide protection against severe hypoglycaemia and limit impaired counterregulation.Diabet. Med. 18, 519–527 (2001)
Insulin‐treated diabetes and driving in the UK
Authors: Gill G. , Durston J. , Johnston R. , MacLeod K. , Watkins P. 
Published: March 2003

AbstractDiabetes, and particularly insulin‐treated diabetes, has important implications for motor vehicle driving, largely because of its association with potential hypoglycaemia. For this reason, most countries operate some driving restrictions on insulin‐treated diabetic patients, as well as systems of intermittent reassessment of hypoglycaemic risk. In the UK, regulations are operated by the Driver and Vehicle Licensing Agency (DVLA), which is an agency of the Department of the Environment, Transport and the Regions (DETR). They are supported by an Expert Panel which advises the Secretary of State on diabetes‐related issues relating to fitness to drive. The patient organization Diabetes UK is also concerned with diabetes and driving issues, largely from a position of lobbying policy‐influencers and supporting individual cases. All parties involved with diabetes and driving issues recognize the need for more research on the subject, as the current literature is flawed in design, though no convincing excess of accidents amongst diabetic drivers has been conclusively demonstrated. Currently in the UK, Class 2 vehicles (large trucks and passenger vehicles) are barred to diabetic drivers on insulin. European law has recently extended this to so‐called C1 (large vans and small lorries) and D1 (minibuses) vehicles, though the law has recently been revised to allow individual consideration for potential diabetic C1 drivers on insulin treatment. Diabetes and insulin‐treated diabetes is an emotive and difficult issue, for which a stronger evidence base is urgently needed.
Retinopathy in latent autoimmune diabetes of adults: the Fremantle Diabetes Study
Authors: Balme M. , McAllister I. , Davis W. A. , Davis T. M. E. 
Published: March 2003

AbstractAims To determine the prevalence of retinopathy and its associations in patients diagnosed clinically with Type 2 diabetes and serum antibodies to glutamic acid decarboxylase (GADA) from a community‐based sample.Methods In a case‐control design, 24 GADA‐positive Type 2 patients from the Fremantle Diabetes Study (FDS) cohort were recruited and matched as closely as possible for age, sex and diabetes duration with 72 GADA‐negative Type 2 patients from the FDS. Each patient had a detailed clinical and biochemical assessment including slit lamp biomicroscopy and colour fundus photography with Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) grading.Results The GADA‐positive patients had a significantly higher HbA1c (median (interquartile range); 8.4 (7.3, 9.6)%) than those who were GADA‐negative (7.2 (6.5, 8.1)%: P = 0.002). The overall prevalence of retinopathy amongst the 96 subjects was 26.0%. The majority (92%) of the retinopathy detected was mild and non‐proliferative. GADA‐positive patients had double the retinopathy prevalence of the GADA‐negative group (41.7% vs. 20.8%; P = 0.044). In a logistic regression model, diabetes duration, HbA1c, systolic blood pressure and current smoking were each significantly and independently predictive of retinopathy (P < 0.025), but GADA status was not.Conclusions These data show that GADA‐positive patients have an increased prevalence of retinopathy compared with GADA‐negative controls with Type 2 diabetes from an urban Australian community. This increased prevalence is due mainly to relatively poor glycaemic control in the GADA‐positive group.