bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of a hospital diabetes specialist nursing service: a randomized controlled trial
Authors: Davies M. , Dixon S. , Currie C. J. , Davis R. E. , Peters J. R. 
Published: March 2003

SUMMARY Aims  To evaluate the effectiveness and cost implications of a hospital diabetes specialist nursing service.Methods  We conducted a prospective, open, randomized, controlled trial of standard in‐patient care for adults with diabetes, with and without the intervention of a diabetes specialist nursing (DSN) service. The setting was a single UK university hospital.Subjects  were unselected patients referred to the hospital DSN service. Primary outcome measures were length of hospital stay and patterns of readmission (frequency and time to first readmission). Secondary outcome measures were subjects' diabetes‐related quality of life, diabetes knowledge score, satisfaction with treatment, and GP and community care contacts following discharge. Costs were estimated from the hospital and published sources.Results  Median length of stay was lower in the intervention group (11.0 vs. 8.0 days, P < 0.01). Readmission rates were the same in the two groups (25%), and mean time to readmission was similar in the two groups, although slightly less in the control group (278 vs. 283 days, P = 0.80). The cost per patient for nursing input was £38.94. However, when the reduced length of stay was accounted for, the intervention produced a mean cost per admission of £436 lower than that of the control group (P = 0.19). Patients in the intervention group were more knowledgeable regarding their diabetes and more satisfied with their care.Conclusions  Diabetes specialist nurses are potentially cost saving by reducing hospital length of stay (LOS). There was no evidence of an adverse effect of reduced LOS on re‐admissions, use of community resources, or patient perception of quality of care.
Comparison between repaglinide and glipizide in Type 2 diabetes mellitus: a 1‐year multicentre study
Authors: Madsbad S. , Kilhovd B. , Lager I. , Mustajoki P. , Dejgaard A. ,   for the Scandinavian Repaglinide Group
Published: March 2003

AbstractAims To evaluate the long‐term effectiveness and safety of repaglinide, a novel prandial glucose regulator, in comparison with glipizide in the treatment of patients with Type 2 diabetes.Methods Diet or tablet‐treated patients with Type 2 diabetes (n = 256; age 40–75 years, body mass index (BMI) 20–35 kg/m2, HbA1c 4.2–12.8%), without signs of severe microvascular or macrovascular complications, were included in this double‐blind, multicentre, parallel‐group comparative trial. Patients were randomized at a 2:1 ratio to repaglinide, 1–4 mg at mealtimes, or glipizide, 5–15 mg daily.Results  Changes in fasting blood glucose (FBG) and HbA1c during the 12 months of treatment showed a significant difference in favour of repaglinide. In oral hypoglycaemic agents (OHA)‐naive patients, HbA1c decreased in the repaglinide and glipizide groups by 1.5% and 0.3%, respectively (P < 0.05 between groups). Fasting blood glucose decreased in the repaglinide group by 2.4 mmol/l and increased in the glipizide group by 1.0 mmol/l (P < 0.05 between groups). In the study population as a whole, repaglinide was able to maintain glycaemic control (HbA1c level) during the 1‐year study period, whereas control deteriorated significantly with glipizide. Change in HbA1c from baseline was significantly better with repaglinide than with glipizide after 12 months (P < 0.05). In addition, FBG deteriorated significantly in the glipizide group compared with the repaglinide group (P < 0.05). No patients in either group experienced a major hypoglycaemic event; the number of patients experiencing minor hypoglycaemia was similar in the repaglinide and glipizide groups (15% and 19%, respectively).Conclusions Repaglinide, given as a prandial glucose regulator, is shown to be an effective and safe treatment of patients with Type 2 diabetes, and is better than glipizide in controlling HbA1c and FBG levels, overall, and in OHA‐naive patients.Diabet. Med. 18, 395–401 (2001)
Skin microvascular vasodilatory capacity in offspring of two parents with Type 2 diabetes
Authors: Lee B. C. , Shore A. C. , Humphreys J. M. , Lowe G. D. , Rumley A. , Clark P. M. , Hattersley A. T. , Tooke J. E. 
Published: March 2003

AbstractAims  Microvascular dysfunction occurs in Type 2 diabetes and in subjects with fasting hyperglycaemia. It is unclear whether this dysfunction relates to dysglycaemia. This study investigated in normogylcaemic individuals whether a genetic predisposition to diabetes, or indices of insulin resistance including endothelial markers, were associated with impaired microvascular function.Methods  Maximum microvascular hyperaemia to local heating of the skin was measured using laser Doppler flowmetry in 21 normoglycaemic subjects with no family history of diabetes (Group 1) and 21 normoglycaemic age, sex and body mass index‐matched offspring of two parents with Type 2 diabetes (Group 2).Results  Although Group 2 had normal fasting plasma glucose and glucose tolerance tests, the 120‐min glucose values were significantly higher at 6.4 (5.3–6.6) mmol/l (median (25th – 75th centile)) than the control group at 4.9 (4.6–5.9) mmol/l (P = 0.005) and the insulinogenic index was lower at 97.1 (60.9–130.8) vs. 124.0 (97.2–177.7) (P = 0.027). Skin maximum microvascular hyperaemia (Group 1: 1.56 (1.39–1.80) vs. Group 2: 1.53 (1.30–1.98) V, P = 0.99) and minimum microvascular resistance which normalizes the hyperaemia data for blood pressure (Group 1: 52.0 (43.2–67.4) vs. Group 2: 56.0 (43.7–69.6) mmHg/V, P = 0.70) did not differ in the two groups. Significant positive associations occurred between minimum microvascular resistance and indices of the insulin resistance syndrome; plasminogen activator inhibitor type 1 (Rs = 0.46, P = 0.003), t‐PA (Rs = 0.36, P = 0.03), total cholesterol (Rs = 0.35, P = 0.02), and triglyceride concentration (Rs = 0.35, P = 0.02), and an inverse association with insulin sensitivity (Rs = −0.33, P = 0.03).Conclusions  In normoglycaemic adults cutaneous microvascular vasodilatory capacity is associated with features of insulin resistance syndrome, particularly with plasminogen activator inhibitor type 1. A strong family history of Type 2 diabetes alone does not result in impairment in the maximum hyperaemic response.Diabet. Med. 18, 541–545 (2001)
Drinking water composition and childhood‐onset Type 1 diabetes mellitus in Devon and Cornwall, England
Authors: Zhao H. X. , Mold M. D. , Stenhouse E. A. , Bird S. C. , Wright D. E. , Demaine A. G. , Millward B. A. 
Published: March 2003

AbstractAims  Previous studies have reported inconsistent results on the association between some compositions (e.g. nitrate) in domestic water and the risk of childhood‐onset Type 1 diabetes mellitus. This study aimed to examine the relationship between nitrate, zinc and magnesium in drinking water and the risk of childhood‐onset Type 1 diabetes mellitus.Methods  The study covers the Cornwall and the former Plymouth Health Authority Regions in the far south‐west of England. Five hundred and seventeen children, aged 0–15 years, diagnosed with Type 1 diabetes mellitus between 1975 and 1996, were identified for inclusion in the study. Domestic water data (nitrate, Zn, Mg, Cu, Al, Ca, Fe and Mn) between 1993 and 1997 were provided by South‐west Water Plc, UK, for each of the 40 Water Supply Zones in which the subjects had been resident at the time of diagnosis. The standardized incidence ratio (SIR) of the disease was calculated for each Water Supply Zone using the UK 1991 census population data. The relationship between the SIR of the disease and the water quality indicators in thirds (three strata of low, medium and high concentrations) was examined by χ2 test for trend and Poisson regression analysis.Results  The initial analyses by χ2 test for trend on the relation of SIRs and drinking water compositions suggested that copper, magnesium and nitrate might have some protective effects, but Poisson regression analyses showed that only zinc and magnesium were significant factors. The data suggest that the incidence rate of childhood diabetes is significantly lower when the concentrations of zinc and magnesium in the domestic drinking water are in the range 22.27–27.00 µg/l (incidence rate ratio (IRR), 0.76; 95% CI, 0.59–0.97) and greater than 2.61 mg/l (IRR, 0.72; 95% CI, 0.58–0.91), respectively.Conclusions  Our findings suggest evidence of a possible association between zinc and magnesium in the domestic drinking water and childhood diabetes in the far south‐west of England. However, these possible protective effects of zinc and magnesium in domestic drinking water warrant further confirmation.Diabet. Med. 18, 709–717 (2001)
Post‐prandial insulin lispro vs. human regular insulin in prepubertal children with Type 1 diabetes mellitus
Authors: Tupola S. , Komulainen J. , Jääskeläinen J. , Sipilä I. 
Published: March 2003

AbstractAims  To study whether post‐prandial insulin lispro (PL) could be used as a part of insulin therapy instead of premeal human regular insulin (HR) in prepubertal children with Type 1 diabetes mellitus (Type 1 DM).Patients and methods  In this open, randomized cross‐over study patients used either PL or HR at breakfast and at dinner. After a 1‐month screening period, patients were randomized to treatment with PL or HR for 3 months and then they crossed over to the other insulin for an additional 3 months. The patients were 24 prepubertal children with Type 1 DM (median age 6.2 years, duration of diabetes 37 months). Home monitoring of 1‐day glucose profiles at meals (premeal, 1 h and 2 h after breakfast and after dinner) and HbA1c were measured before randomization, before cross‐over, and at the last visit. Data on hypoglycaemic episodes were collected at each of the seven visits. The variables were compared between the two treatments.Results  Of the patients 22/24 completed the study. There were no major differences in the glucose excursions between PL and HR after breakfast (mean ± sd: 1‐h PL 3.7 ± 4.7 vs. HR 2.9 ± 3.9 mmol/l, P = 0.3; 2‐h −0.9 ± 5.4 vs. 0.3 ± 4.5 mmol/l, P = 0.2, respectively) or after dinner (1‐h PL −2.5 ± 4.8 vs. HR −0.4 ± 3.7 mmol/l, P = 0.07, 2‐h −4.1 ± 5.2 vs. −0.7 ± 5.0 mmol/l, P = 0.05, respectively). Mean change of HbA1c was similar in both treatment groups (PL 0.2 ± 0.8% vs. HR −0.4 ± 0.7%, P = 0.1). The frequency of hypoglycaemic episodes was 4.9 per patient per month during treatment with PL, and 4.4 during HR (P = 0.3).Conclusion  Treatment with post‐prandial lispro as a meal insulin is as effective and safe as traditional treatment with regular insulin in young children.Diabet. Med. 18, 654–658 (2001)
Improved glycaemic control by addition of glimepiride to metformin monotherapy in Type 2 diabetic patients
Authors: Charpentier G. , Fleury F. , Kabir M. , Vaur L. , Halimi S. 
Published: March 2003

AbstractAim  To compare the effect of glimepiride in combination with metformin with monotherapy of each drug on glycaemic control in Type 2 diabetic patients.Design and methods  Randomized, double‐blind, double‐dummy, parallel‐group multicentre study conducted in France. Type 2 diabetic patients aged 35–70 years inadequately controlled by metformin monotherapy 2550 mg daily for at least 4 weeks were randomized to either metformin, glimepiride or metformin and glimepiride.Results  Three hundred and seventy‐two patients aged 56 ± 8 years were treated for 5 months. Combination treatment was significantly more efficient in controlling HbA1c (% change + 0.07 ± 1.20 for metformin, + 0.27 ± 1.10 for glimepiride, −0.74 ± 0.96 for combination treatment, P < 0.001), fasting blood glucose (FBG) (mmol/l change + 0.8 ± 0.4 for metformin, + 0.7 ± 3.1 for glimepiride and −1.8 ± 2.2 for combination treatment, P < 0.001) and post‐prandial blood glucose (PPBG) (mmol/l change + 1.1 ± 5.9 for metformin, + 0.1 ± 5.1 for glimepiride and −2.6 ± 3.9 for combination treatment, P < 0.001) than either glimepiride or metformin alone. There was no significant difference between metformin or glimepiride monotherapy with respect to the change in HbA1c or FBG; however, glimepiride was significantly more effective than metformin in reducing PPBG. The incidence of symptomatic hypoglycaemia was higher in the combination group than in either monotherapy group (P = 0.039).Conclusions  Addition of glimepiride to metformin in Type 2 diabetic patients inadequately controlled by metformin alone resulted in superior glycaemic control compared with glimepiride or metformin monotherapy.Diabet. Med. 18, 828–834 (2001)
The short insulin tolerance test lacks validity in adolescents with Type 1 diabetes
Authors: Särnblad S. , Kroon M. , Åman J. 
Published: March 2003

AbstractAims The short insulin tolerance test (SITT) has been found to be a simple and valid method for determining insulin sensitivity in healthy adults and patients with Type 2 diabetes. In this study we evaluated the reproducibility and validity of SITT in 16 adolescents with Type 1 diabetes.Methods Thirteen patients underwent two SITT and eight patients were examined with both SITT and a euglycaemic hyperinsulinaemic clamp. At the SITT insulin sensitivity was measured from the slope of arterialized blood glucose concentrations determined for 16 min after an intravenous bolus injection of short‐acting insulin, 0.1 U/kg body weight, and expressed as glucose disappearance rate (KITT).Results There was a significant correlation between the insulin sensitivity estimations made at the two SITT (r = 0.73, P = 0.003). The reproducibility was low, however, with a coefficient of variation of 38.7%. KITT showed a strong inverse correlation to the fasting blood glucose concentration (r = −0.74, P < 0.0001). We found no correlation between insulin sensitivity measured by SITT and that measured by the euglycaemic clamp.Conclusions We conclude that the short insulin tolerance test cannot be used in adolescent patients with Type 1 diabetes for a simple estimation of insulin sensitivity.
The effect of subclinical hypothyroidism on metabolic control in children and adolescents with Type 1 diabetes mellitus
Authors: Mohn A. , Di Michele S. , Di Luzio R. , Tumini S. , Chiarelli F. 
Published: March 2003

AbstractAims Associated autoimmune phenomena might influence metabolic control in children and adolescents with Type 1 diabetes mellitus. A retrospective case control study was performed in order to explore the effect of subclinical hypothyroidism on metabolic control in Type 1 diabetes mellitus.Patients and methods For this purpose each patient with Type 1 diabetes and subclinical hypothyroidism (cases) was matched for age, duration of disease and, if possible, for sex, with two to three diabetic patients without hypothyroidism (controls). Parameters of metabolic control such as HbA1c, total insulin requirement and frequency of symptomatic hypoglycaemia were retrieved for 12, 6 and 3 months before and after diagnosis of hypothyroidism.Results Thirteen patients (two male/11 female) patients were diagnosed with subclinical hypothyroidism and were matched with 31 controls (nine male/22 female). There was no difference (mean and range) in terms of age (11.9 years (4.4–18.1) vs. 11.7 years (3.5–18.1), P = 0.9) and duration of disease (5.1 years (1.2–10.5) vs. 4.38 years (0.9–10.8), P = 0.6) between the two groups. There was no difference in HbA1c and total insulin requirement between the two groups at any time point of assessment (anovaP = 0.8 and P = 0.1, respectively). Patients with hypothyroidism had significantly more symptomatic hypoglycaemic episodes during the 12 months before diagnosis (anovaP = 0.05), increasing progressively during this time period and reaching a peak at time 0 (5.5 ± 0.4 vs. 1.6 ± 0.1 episodes/month, P = 0.01). No difference could be detected within 6 months of starting substitution therapy (2.4 ± 0.2 vs. 1.6 ± 0.1 episodes/week, P = 0.8).Conclusions These data suggest that subclinical hypothyroidism is associated with an increased risk of symptomatic hypoglycaemia. The prompt introduction of substitution therapy is recommended as it reduces its frequency.
Age‐related increase in haemoglobin A1c and fasting plasma glucose is accompanied by a decrease in β cell function without change in insulin sensitivity: evidence from a cross‐sectional study of hospital personnel
Authors: Yates A. P. , Laing I. 
Published: March 2003

AbstractAims To examine the influence of age on glucose homeostasis in a population of healthy, non‐diabetic hospital personnel.Methods One hundred and twenty female and 71 male non‐diabetic individuals (fasting plasma glucose < 7.0 mmol/l) were fasted overnight prior to blood sampling. Glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and fasting plasma insulin (FPI) were measured using a BioRad Diamat automated HPLC, a Hitachi 747 analyser and a sensitive in‐house radioimmunoassay, respectively. Mathematical modelling of the fasting glucose and insulin pairs (homeostasis model assessment (HOMA)) generated indices of pancreatic β cell function, HOMA‐B and tissue insulin sensitivity HOMA‐S.Results Spearman rank correlation analysis showed that in the whole group there was a significant negative correlation between age and HOMA‐B (rs= −0.218, P = 0.0022) and a significant positive correlation between age and both HbA1c (rs= 0.307, P = 0.0001) and FPG (rs= 0.26, P = 0.0003). There was no correlation between age and either FPI (rs= −0.08, P = 0.266) or HOMA‐S (rs= 0.024, P = 0.75). Analysis by gender showed the above associations to be present in the females (rs= −0.243, P = 0.0076; rs= 0.304, P = 0.0007; rs= 0.32, P = 0.0004 for age vs. HOMA‐B, HbA1c, and FPG, respectively). Again there was no correlation of age with FPI or insulin sensitivity. In the males there was a significant correlation of HbA1c with age (rs= 0.35, P = 0.002), but no significant correlation of age with any of the other parameters.Conclusions Glycaemic control deteriorates with age in healthy, non‐diabetic individuals. Age‐related rises in FPG and haemoglobin A1c result from a small but steady decline in pancreatic β cell function.Diabet. Med. 19, 254–258 (2002)
Antibodies to GAD in Japanese patients classified as Type 2 diabetes at diagnosis. High titre of GAD Ab is a predictive marker for early insulin treatment—report of west Japan (Kyushu, Yamaguchi, Osaka) study for GAD Ab(+) diabetes
Authors: Takino H. , Yamasaki H. , Abiru N. , Sera Y. , Abe T. , Kawasaki E. , Yamaguchi Y. , Eguchi K. , Kanazawa Y. , Nagataki S. ,   14 participating centres
Published: March 2003

AbstractAim We evaluated the prevalence of GAD Ab in Japanese Type 2 diabetic patients treated with oral hypoglycaemic agents (OHA) and/or diet and followed GAD Ab(+) patients to assess the usefulness of GAD Ab as a marker for future insulin treatment prospectively.Methods A total of 2658 Japanese Type 2 diabetic patients treated by OHA and/or diet were randomly selected between April 1996 and December 1998. The clinical characteristics at entry were assessed and patients were followed for 1–3 years.Results The overall prevalence of GAD Ab among Type 2 diabetic patients was 2.0%. Forty‐five had a history of diabetes of ≤ 5 years (short history) while those with duration > 5 years (long history) totalled nine. Among them, 47% of patients with a short history did not require insulin in the follow‐up period. However, none of those with a long history required insulin treatment within 2 years. Comparison of patients based on GAD titre in those with short history showed that 33% of patients in the high‐titre group (≥ 20 U) required no insulin treatment in the first year of follow‐up. In contrast, this proportion was 80% in the first and 67% in the second year in the low‐titre group (< 20 U).Conclusions The prevalence of GAD Ab in Japanese patients with a short and long history of diabetes was 2.8% and 0.9%, respectively. The presence of GAD Ab in Japanese Type 2 diabetic patients with a short history of diabetes is a marker for early insulin treatment.
Patient‐assessed health outcome measures for diabetes: a structured review
Authors: Garratt A. M. , Schmidt L. , Fitzpatrick R. 
Published: March 2003

AbstractAims To identify available disease‐specific measures of health‐related quality of life (HRQL) for diabetes and to review evidence for the reliability, validity and responsiveness of instruments.Methods Systematic searches were used to identify instruments. Instruments were assessed against predefined inclusion and exclusion criteria. Letters were sent to authors requesting details of further instrument evaluation. Information relating to instrument content, patients, reliability, validity and responsiveness to change was extracted from published papers.Results The search produced 252 references. Nine instruments met the inclusion criteria: Appraisal of Diabetes Scale (ADS), Audit of Diabetes‐Dependent Quality of Life (ADDQoL), Diabetes Health Profile (DHP‐1, DHP‐18), Diabetes Impact Measurement Scales (DIMS), Diabetes Quality of Life Measure (DQOL), Diabetes‐Specific Quality of Life Scale (DSQOLS), Questionnaire on Stress in Diabetic Patients‐Revised (QSD‐R), Diabetes‐39 (D‐39) and Well‐being Enquiry for Diabetics (WED). The shortest instrument (ADS) has seven items and the longest (WED) has 50 items. The ADS and ADDQoL are single‐index measures. The seven multidimensional instruments have dimensions covering psychological well‐being and social functioning but vary in the remainder of their content. The DHP‐1 and DSQOLS are specific to Type 1 diabetes patients. The DHP‐18 is specific to Type 2 diabetes patients. The DIMS and DQOL have weaker evidence for reliability and internal construct validity. Patients contributed to the content of the ADDQoL, DHP‐1/18, DQOL, DSQOLS, D‐39, QSD‐R and WED. The authors of the ADDQoL, DHP‐1/18, DQOL, DSQOLS gave explicit consideration to content validity. The construct validity of instruments was assessed through comparisons with instruments measuring related constructs and clinical and sociodemographic variables. None of the instruments has been formally assessed for responsiveness to changes in health.Conclusions Five of the diabetes‐specific instruments have good evidence for reliability and internal and external construct validity: the ADDQoL, DHP‐1/18, DSQOLS, D‐39 and QSD‐R. Instrument content should be assessed for relevance before application. The instruments should be evaluated concurrently for validity and responsiveness to important changes in health.
Risk of developing diabetes is inversely related to lung function: a population‐based cohort study
Authors: Engström G. , Janzon L. 
Published: March 2003

AbstractAim To investigate whether reduced lung function is a risk factor for developing diabetes.Methods Non‐diabetic men (n = 382) from the population‐based cohort ‘Men Born in 1914’ were examined with spirometry at age 55 years. The cohort was re‐examined at 68 years. Diabetes and fasting plasma glucose at follow‐up were studied in relation to vital capacity (VC) and forced expiratory volume (FEV1.0) at baseline.Results Fifteen men developed diabetes during the follow‐up. The percentage with diabetes in the 1st, 2nd, 3rd and top quartile of vital capacity were 7%, 5%, 2%, and 1%, respectively (P for trend = 0.01). Fasting glucose (log transformed, mmol/l) at follow‐up was 1.63 ± 0.16, 1.62 ± 0.18, 1.61 ± 0.11 and 1.60 ± 0.11, respectively (P for trend = 0.11). The longitudinal associations between VC and diabetes (P = 0.001) and log glucose (P = 0.036) were significant after adjustments for several potential confounders. FEV1.0 at baseline showed similar associations with diabetes at follow‐up.Conclusions The risk of developing diabetes is inversely associated with pulmonary function among middle‐aged men.