bluuebunny/crossref_metadata_2025_split huggingface dataset:
Augmentation of central arterial pressure in Type 2 diabetes
Authors: Brooks B. A. , Molyneaux L. M. , Yue D. K. 
Published: March 2003

SummaryAims  Aortic systolic blood pressure has been shown to be augmented in Type 1 diabetes, indicative of more rapid pulse wave reflection due to increased arterial stiffness. This abnormality is more pronounced in diabetic males. The aim of this study was to examine the effects of diabetes on augmentation of aortic systolic pressure in subjects with Type 2 diabetes.Methods  Radial artery pressure waveforms were obtained non‐invasively by applanation tonometry. A central aortic waveform can be derived using a transfer function obtained from previous studies during cardiac catheterization. A total of 88 subjects with Type 2 diabetes (51 men and 37 women, aged 55.8 years (interquartile range (IR) 49.7–64.1), duration of diabetes 7.5 years (IR 2.4–12.4), HbA1c 7.6% (IR 6.6–8.7)) and 85 controls subjects (40 men and 45 women, aged 55.3 years (IR 44.2–66.4)) were studied. The central aortic waveform allowed determination of the: (i) aortic augmentation index and (ii) subendocardial viability ratio.Results  Similar to Type 1 diabetic subjects, patients with Type 2 diabetes had a significantly higher aortic augmentation index (136.1 ± 18.0% vs. 128.3 ± 19.2%, t = 2.8, P = 0.006) and lower subendocardial viability ratio (137.4 ± 25.0% vs. 155.1 ± 25.9%; t = 4.6, P = 0.0001) compared with controls. Multivariate analysis identified diabetes as an important determinant of aortic augmentation index (t = 4.0, P = 0.0001). The higher aortic augmentation index was due mainly to the male cohort (t = 2.6; P = 0.01) and was not apparent for females with diabetes (P = 0.2).Conclusions  Type 2 diabetes is characterized by higher augmentation of aortic systolic pressure and unfavourable ratio of myocardial perfusion to cardiac workload. These results are consistent with increased arterial stiffness. The age‐related progression of arterial stiffness is similar in Type 1 and Type 2 diabetes. Anti‐hypertensive agents that reduce wave reflection and augmentation may help to prevent systolic hypertension and cardiac hypertrophy in diabetes.
TBI or not TBI: that is the question. Is it better to measure toe pressure than ankle pressure in diabetic patients?
Authors: Brooks B. , Dean R. , Patel S. , Wu B. , Molyneaux L. , Yue D. K. 
Published: March 2003

AbstractAims Measurement of ankle blood pressure is a simple method of assessing lower limb arterial blood supply. However, its use in diabetes has been questioned due to the presence of medial artery calcification. Measurement of toe blood pressure has been advocated as an alternative but it is technically more difficult. The aim of this study was to obtain information to guide clinicians as to when pressure measurements should be taken at the toe.Methods Ankle brachial index (ABI) and toe brachial index (TBI) were measured by Doppler ultrasound, or photoplethysmography on 174 subjects with diabetes and 53 control subjects. The Bland and Altman method, and the Cohen's method of measuring agreement between two tests were used to compare ABI with TBI.Results The mean differences between ABI and TBI in control and diabetic subjects are 0.40 ± 0.13 and 0.37 ± 0.15, respectively. Nearly all diabetic patients with an ABI < 1.3 have an ABI–TBI gradient falling within the normal range established from the non‐diabetic cohort. In contrast, the majority of diabetic subjects with an ABI ≥ 1.3 have ABI–TBI differences outside this range. When patients are categorized according to ABI and TBI, there is also good agreement between the tests when ABI is low or normal (84% and 78% agreement, respectively), but not when ABI is elevated.Conclusion

In the majority of patients with diabetes, assessment of TBI conveys no advantage over ABI in determining perfusion pressure of the lower limbs. Only in those patients with overt calcification, which gives an ABI ≥ 1.3, are toe pressure measurements superior. This guideline should simplify assessment and treatment of diabetic patients with disease of the lower limbs.Diabet. Med. 18, 528–532 (2001)
Lighting up insulin action
Authors: Tavaré J. M. , Fletcher L. M. , Oatey P. B. , Tyas L. , Wakefield J. G. , Welsh G. I. 
Published: March 2003

SummaryUnderstanding the mechanism of insulin action remains one of the most important challenges in modern medical biology. Recent advances in cell imaging techniques, increased processing power of computers and the internet, and the introduction of novel fluorescent reagents such as green fluorescent proteins (GFPs) have revolutionized our ability to scrutinize insulin action by time‐lapse microscopy at the single‐cell level. This article outlines some of the advances made in the authors' laboratory, with particular reference to imaging the movements of the insulin‐sensitive glucose transporter, GLUT4, and the generation of phosphoinositide lipids.
Adverse metabolic and cardiovascular risk following treatment of acute lymphoblastic leukaemia in childhood; two case reports and a literature review
Authors: Amin P. , Shah S. , Walker D. , Page S. R. 
Published: March 2003

AbstractWe report two patients who survived childhood acute lymphoblastic leukaemia (ALL) following treatment with chemotherapy, total body irradiation (TBI) and bone marrow transplantation (BMT). The first case presented with an acute cerebral infarction at 23 years of age and was found to have non‐ketotic diabetes and gross mixed hyperlipidaemia; the second presented with non‐ketotic diabetes, hypertension, proteinuria and dyslipidaemia at age 16 years. The association of glucose intolerance with other vascular risk factors in young adult survivors of BMT was recently highlighted in a follow‐up study of 23 survivors of BMT [1], but none presented with such gross mixed hyperlipidaemia. The improving survival rates of childhood malignancy over the last two decades will present adult physicians with patients who have accelerated vascular risk at a young age who will require early treatment to modify it.Diabet. Med. 18, 849–853 (2001)
Population‐based survey and analysis of trends in the prevalence of diabetic nephropathy in Type 1 diabetes
Authors: Harvey J. N. , Rizvi K. , Craney L. , Messenger J. , Shah R. , Meadows P. A. 
Published: March 2003

AbstractAims  To determine the prevalence of the various stages of diabetic nephropathy in Type 1 diabetes in a population‐based survey. To make direct comparison with results from previous published studies to assess current trends.Methods  Identification of all Type 1 patients using a population‐based diabetes register. Urine samples for albumin assay were obtained at clinic visit and by postal request. Prevalence rates were calculated specifically for direct comparisons with previously published surveys.Results  This study and European data from the 1990s show a clear reduction in the cumulative prevalence of microalbuminuria and established nephropathy compared with surveys from Copenhagen (1985), Pittsburgh (1986–8) and Boston (1992). In North Wales in 1999 the overall cumulative prevalence of microalbuminuria was 27.2% (95% confidence interval (CI) 24.3–30.1%) and established nephropathy was 9.6% (7.7–11.5%). Comparisons with data from EURODIAB and from Spain indicated similar results, although the prevalence of microalbuminuria was lower in North Wales than in the EURODIAB study. Significantly lower rates of nephropathy were seen in more recent Swedish cohorts. Diabetic nephropathy remains more common in males. Microalbuminuria before 10 years duration of diabetes was seen at all post‐pubertal ages.Conclusions  Rates of nephropathy in Europe in the 1990s are lower than a decade ago. Modern methods of management are therefore associated with demonstrable benefit at the population level. The lowest rates of nephropathy are associated with optimum glycaemic control in Swedish data, indicating the importance of metabolic in addition to haemodynamic factors.Diabet. Med. 18, 998–1002 (2001)
Surrogate estimates of insulin sensitivity in Chinese diabetic patients and their offspring
Authors: Kuo C. S. , Hwu C. M. , Kwok C. F. , Hsiao L. C. , Weih M. J. , Lee S. H. , Lee Y. S. , Ho L. T. 
Published: March 2003

AbstractAims To evaluate the relationship between surrogate measures of insulin sensitivity and results from euglycaemic insulin clamp in Chinese diabetic patients and their offspring.Methods The study included 59 volunteers from 20 diabetic families. Each participant completed a 75‐g oral glucose tolerance test (OGTT) and a euglycaemic insulin clamp. We tested the correlation of surrogate measures of insulin sensitivity with M‐values and M/I ratios (the amount of glucose infused during 90–120 min of the clamp was defined as M, and the mean values of plasma insulin during 90–120 min as I) from the euglycaemic insulin clamp. These measures included fasting insulin (FPI), insulin at 120 min of OGTT, insulin area under the curve of OGTT, fasting glucose‐to‐insulin ratio, homeostasis model assessment for insulin sensitivity (HOMA‐IR and HOMA %S) and the Matsuda–DeFronzo index from OGTT.Results The Matsuda–DeFronzo index closely correlated to M‐value and M/I in 21 diabetic, 38 non‐diabetic individuals and the 59 participants overall (with M‐value, r = 0.68, 0.84 and 0.84; with M/I, r = 0.71, 0.72 and 0.75, respectively, all P < 0.001). Without OGTT, HOMA %S was a good surrogate index for diabetic (correlated to M‐value and M/I, r = 0.71 and 0.68, P = 0.001) and for non‐diabetic subjects (to M‐value, r = 0.73; to M/I, r = 0.55, both P < 0.001). FPI was as good as HOMA %S and Matsuda–DeFronzo index.Conclusions The Matsuda–DeFronzo index, HOMA %S and FPI are good surrogate estimates of insulin sensitivity in Chinese diabetic subjects and their offspring.
Diabetes care in Kilimanjaro region: clinical presentation and problems of patients of the diabetes clinic at the regional referral hospital—an inventory before structured intervention
Authors: Neuhann H. F. , Warter‐Neuhann C. , Lyaruu I. , Msuya L. 
Published: March 2003

AbstractBackground In order to improve care for diabetic patients in a developing country at the regional referral hospital for the Northern zone of Tanzania, a specialized clinic was established in November 1996.Aim The aim of this study was to provide a situational analysis about the problems of the diabetic patient population treated at the hospital. For all patients who registered at the clinic a questionnaire was completed about personal data, diabetes history, symptoms, treatment, eating habits and psycho‐social aspects of the disease. Results from patients who registered between November 1996 and December 1998 were analysed.Results Data from 474 diabetic patients (46% female) were obtained. Mean age was 53.75 (± 16; range 4–88 years), 15% were classified Type 1, 75% Type 2 and 10% remained unclassified. A body mass index of < 25 was recorded in > 80% of the Type 1 and approx. 50% of the Type 2 patients. Among complications, numbness of the legs was mentioned by 44%, hypertension was diagnosed in about 25%, retinopathy in 14%, foot ulcers in 10% and nephropathy in 7.5% of the patients. About 50% of the patients saw their disease as a big physical and psychological problem. Monthly cost for an average insulin‐treated patient equalled around 25% of the minimal wage.Conclusion Diabetes care in a developing country needs to address the specific background of the patient population, their needs, the medical problems and the social constraints. Active participation of the patients can help to overcome some of the difficulties.
Insulin resistance in non‐diabetic subjects is associated with increased incidence of myocardial infarction and death
Authors: Hedblad B. , Nilsson P. , Engström G. , Berglund G. , Janzon L. 
Published: March 2003

AbstractAimsTo compare the incidence of myocardial infarction and death in non‐diabetic subjects with and without insulin resistance.MethodsPopulation‐based prospective cohort study, in Malmö, Sweden, of 4748 non‐diabetic subjects (60% women), aged 46–68 years, with no history of myocardial infarction or stroke. The prevalence of insulin resistance was established by the homeostasis model assessment (HOMA) and defined as values above the sex‐specific 75th percentile (1.80 for women and 2.12 for men). Incidence of myocardial infarction and death is based on record linkage with local and national registers. Cox’s proportional hazards model was used to assess the influence of insulin resistance after adjustment for age, sex, hyperglycaemia, raised arterial blood pressure, dyslipidaemia, central obesity, smoking and leisure‐time physical activity.ResultsSixty‐two subjects suffered a coronary event, and 93 subjects died during the 6‐year follow‐up period. Insulin resistance was after adjustment for other factors included in the insulin resistance syndrome and other potential confounders, associated with an increased incidence of coronary events (relative risk (RR) 2.18; 95% confidence interval (CI) 1.22–3.87;P = 0.008) and deaths (RR 1.62; 1.03–2.55;P = 0.038).ConclusionsInsulin resistance, as assessed by the HOMA method, was in this cohort of middle‐aged non‐diabetic subjects associated with an increased incidence of myocardial infarction and death. This risk remained when smoking, low physical activity and factors included in the insulin resistance syndrome were taken into account in a stepwise regression model.Diabet. Med. 19, 470–475 (2002)
The assessment of insulin resistance in man
Authors: Wallace T. M. , Matthews D. R. 
Published: March 2003

AbstractBackground Insulin resistance exists when a normal concentration of insulin produces a less than normal biological response. The ability to measure insulin resistance is important in order to understand the aetiopathology of Type 2 diabetes, to examine the epidemiology and to assess the effects of intervention.Methods We assess and compare methods of measurement and have undertaken a literature review from 1966 to 2001.Results Quantitative estimates of insulin resistance can be obtained using model assessments, clamps or insulin infusion sensitivity tests. There is considerable variation in the complexity and labour intensity of the various methods. The most well‐established methods are the euglycaemic clamp, minimal model assessment and homeostatic model assessment (HOMA). No single test is appropriate under all circumstances.Conclusions There are a number of well‐established tests used to measure insulin resistance: the choice of method depends on the size and type of study to be undertaken. Although the so‐called ‘gold‐standard’ test, the euglycaemic clamp, is useful for intensive physiological studies on small numbers of subjects, a simpler tool such as HOMA is more appropriate for large epidemiological studies. It is important to be aware that most techniques measure stimulated insulin resistance whereas HOMA gives an estimate of basal insulin resistance. Caution should be exercised when making comparisons between studies due to variations in infusion protocols, sampling procedures and hormone assays used in different studies.
Is multidisciplinary learning effective among those caring for people with diabetes?
Authors: Munro N. , Felton A. , McIntosh C. 
Published: March 2003

AbstractThe role of multi‐professional learning for those providing clinical services to people with diabetes has yet to be defined. Several assumptions are generally made about education in the context of multi‐professional settings. It is argued that different professions learning together could potentially improve professional relationships, collaborative working practices and ultimately standards of care. Greater respect and honesty may emerge from a team approach to learning with a commensurate reduction in professional antagonism. Personal and professional confidence is reportedly enhanced through close contact with other professionals during team‐based learning exercises. We have examined current evidence to support multidisciplinary learning in the context of medical education generally as well as in diabetes education. Previous investigation of available literature by Cochrane reviewers, aimed at identifying studies of interprofessional education interventions, yielded a total of 1042 articles, none of which met the stated inclusion criteria. Searches involving more recent publications failed to reveal more robust evidence. Despite a large body of literature on the evaluation of interprofessional education, studies generally lacked the methodological rigour needed to understand the impact of interprofessional education on professional practice and/or health care outcomes. Nevertheless, planners continue to advocate, and endorse, joint training between different groups of workers (including nurses, doctors and those in professions allied to medicine) with the objective of producing an integrated workforce of multidisciplinary teams. Whilst the concept of multi‐professional learning has strong appeal, it is necessary for those responsible for educating health care professionals to demonstrate its superiority over separate learning experiences.
Cardiovascular autonomic reactivity is decreased in adolescents with Type 1 diabetes
Authors: Riihimaa P. H. , Suominen K. , Knip M. , Tapanainen P. , Tolonen U. 
Published: March 2003

AbstractAims To characterize autonomic nervous system function by means ofthe heart rate and blood pressure responses to various stimuli in relationto pubertal maturation in patients with Type 1 diabetes mellitus (DM).Methods One hundred out of 138 eligible patients at the Out‐patient Diabetes Clinicand 100 healthy control subjects were examined in terms of cardiovascularparameters at rest, during deep breathing and when standing. Heartrate variabil‐ity was analysed with time domain,frequency domain and fractal dimension parameters. Tanner pubertalstaging was performed before the examinations.Results The time domain parameters of heart rate variability at restor during standing did not significantly differ between the patientsand controls in total or at pubertal stages. In the spectral analysis ofheart rate variability the very low frequency band was decreasedin the patients during standing (P = 0.023).The increase in the very low frequency (P = 0.013)and low frequency (P = 0.031) spectralpowers upon changing from a supine position to standing was attenuatedin the patients in total, while no significant differences wereobserved within the Tanner pubertal stages between patients and controls.Heart rate variability during deep breathing was decreased in the patientswith distal polyneuropathy (P = 0.006).Conclusions Although cardiovascular integrity is in the main well preserved inadolescent patients with Type 1 DM, these patients are prone toattenuated autonomic nervous system reactivity.Diabet. Med. 19, 932–938 (2002)
The status of diabetes control in Asia—a cross‐sectional survey of 24 317 patients with diabetes mellitus in 1998
Authors: Chuang L.‐M. , Tsai S. T. , Huang B. Y. , Tai T. Y. 
Published: March 2003

AbstractAims To establish the status of diabetes control in Asia, the Diabcare‐Asia 1998 study collected data from 230 diabetes centres in Bangladesh, People's Republic of China, India, Indonesia, Malaysia, Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Thailand and Vietnam from March to December 1998.Methods Data were obtained either by patient interview during the enrolment visit or by reviewing medical records for the most recent laboratory assessment and clinical examinations. Blood samples were also collected during patients’ visits for central assessments of HbA1c (normal range 4.7–6.4%).Results The mean of centrally measured HbA1c was 8.6 ± 2.0% for 18 211 patients (82% of the analysis population). Of the patients with central HbA1c measurements, the majority (55%) had values exceeding 8%, indicative of poor glycaemic control. The prevalence of retinopathy, microalbuminuria and neuropathy was also higher in the group of patients with higher HbA1c. Based on the findings from central HbA1c measurements and reported local HbA1c assessments, it also appears that more patients with poor glycaemic control did not have access to glycated haemoglobin measurements. Mean HbA1c of the diabetic populations in Bangladesh, Indonesia, Korea, Malaysia and Taiwan were significantly lower (all P = 0.0001, except P = 0.0007 for Malaysia), while that of China, India, Philippines and Vietnam was significantly higher (all P = 0.0001) than the grand mean.Conclusions In our study population of the Asian diabetes patients treated at diabetes centres, more than half were not well controlled. The prevalence of diabetic microvascular complications was higher in the group of patients with higher HbA1c. Further therapeutic actions to improve glycaemic control are required to prevent chronic diabetic complications.Diabet. Med. 19, 978–985 (2002)
Heritability of features of the insulin resistance syndrome in a community‐based study of healthy families
Authors: Freeman M. S. , Mansfield M. W. , Barrett J. H. , Grant P. J. 
Published: March 2003

AbstractAims To investigate genetic and environmental influences on anthropometric, metabolic and fibrinolytic traits of the insulin resistance syndrome (IRS) in a population not characterized by a high degree of insulin resistance.Methods We recruited 537 adults from 89 randomly ascertained healthy families of white north European origin from the general population. We used maximum likelihood analysis to estimate the heritabilities and effects of environmental covariates on traits of the IRS in these families.Results Adjusted for age, sex and body mass index, the traits showed considerable heritability. For waist–hip ratio, heritability was 15%. The heritabilities of fasting glucose, insulin and estimated insulin resistance were 20%, 23% and 23%, respectively. Heritabilities were 20%, 24% and 43% for triglycerides, LDL‐cholesterol and HDL‐cholesterol, respectively. For PAI‐1 Ag and t‐PA Ag they were 20% and 26%. Covariates explained 20–25% of the variance of lipids and insulin resistance and 35–36% of fibrinolytic factors. Childhood household influences significantly affected variance for waist–hip ratio (4%), fasting insulin (11%) and estimated insulin resistance (12%).Conclusions These family data demonstrate significant genetic influence on anthropometric, fibrinolytic and glucose‐related traits of the IRS in a healthy white North European population.Diabet. Med. 19, 994–999 (2002)