Diabetes Research and Clinical Practice

The clinical use of the 10g monofilament and its limitations: A review

Liang S. Tan — 2010-07-23

Abstract: Background: Diabetes mellitus is one of the most prevalent chronic diseases worldwide including Singapore. The 10g monofilament is commonly used by clinicians to examine diabetic patients for neuropathy due to its low cost and convenience. The aim of this literature review is to evaluate the use of the monofilament and the factors that affect its diagnostic value.Methods: A systematic search of AMED, Medline, EMBASE and Cinahl databases was conducted to identify English language articles from 1990 to 2009 which investigated the use of the monofilament.Results: A total of 34 studies were identified, consisting of 24 observational studies, 8 prospective studies, 1 review article and 1 randomised controlled trial. 6 recurrent themes emerged from these 34 studies.Conclusions: The 10g monofilament remains a useful clinical tool for detecting severe neuropathy and hence identifying patients at increased risk of ulceration and amputation. However, a consensus on the protocol in the use of the monofilament needs to be reached. Further research regarding the effects of environmental conditions on the accuracy of the monofilament is also essential.

Newly diagnosed hyperglycemia and stress hyperglycemia in a coronary intensive care unit

2010-08-02

Abstract: Aims: To determine prevalence of newly diagnosed hyperglycemia (NDH) among patients with acute coronary disease, inquire relationship of stress hyperglycemia (SH) with functional outcomes.Methods: Admission (APG) and first morning fasting plasma glucose (FPG) measurements were obtained, capillary glucose measurements (CGM) every 6-h within first day were performed—Group 1: Normoglycemics. Group 2: NDH cases: No known diabetes, APG>200mg/dl and/or FPG>126 and/or any of CGM>200. Group 2a: unrecognized glycemic disorder, HbA1c>6.0%. Group 2b: stress hyperglycemia, HbA1c<6.0%. Group 3: Recognized diabetes. Duration of ICU stays, APACHE-II scores were recorded. Logistic regression analysis was performed using ICU stay as dependent variable and age, groups, co-morbidities, problems in hospital, APACHE-II scores, CGMs were used as independent risk factors.Results: There were 255 (51.6%) in Group 1, 82 (16.6%) in Group 2; 37 (7.5%) cases in Group 2a, 45 (9.1%) in Group 2b and 157 (31.8%) in Group 3. Group 2b spent longer time in ICU, had higher APACHE-II scores (p=0.0001, p=0.0001). Regression analysis demonstrated SH as an independent risk factor for duration of ICU stay (OR: 2.8, 95% CI: 1.3–6.2).Conclusions: Hyperglycemia was present in 48.4%; 16.6% had NDH, 9.1% had SH. Poor functional conditions of SH cases pointed that they need to be considered carefully.

Physical activity and health-related quality of life in individuals with prediabetes

2010-08-23

Abstract: Objective: The objective of this study was to determine if differences existed in health-related quality of life (HRQoL) between individuals with prediabetes who are physically active (i.e., achieving ≥600METmin per week) compared to those who are inactive.Method: Individuals with prediabetes (N=232) residing in Northern Alberta, Canada completed a mailed questionnaire assessing self-reported PA, and health-related quality of life in August–September 2008.Results: Thirty-eight percent of individuals with prediabetes were meeting prediabetes PA guidelines. Covarying on age, gender, income, smoking and BMI, a significant multivariate analysis of covariance model [Wilks’ λ=0.967, F(2,224)=3.791, p<.05] indicated those achieving PA guidelines reported higher Physical Health (Mean diff=2.7, p<.05, ES=.27) and Mental Health (Mean diff=3.0, p<.05, ES=.31) compared to those not achieving PA guidelines.Conclusion: These findings demonstrate people with prediabetes who achieve prediabetes PA guidelines have higher levels of physical and mental HRQoL than people who are inactive. Further, these results support the rationale for developing strategically designed PA programs for individuals with prediabetes.

Continuous interstitial glucose monitoring in non-diabetic subjects with end-stage renal disease undergoing maintenance haemodialysis

2010-08-12

Abstract: Haemodialysis improves uraemia-induced insulin sensitivity and is therefore likely to induce significant changes in circulating glucose concentrations in end-stage renal disease (ESRD). We aimed to assess clinically relevant circulating glucose changes in patients undergoing chronic maintenance haemodialysis using continuous interstitial monitoring. We investigated 14 non-diabetic ESRD subjects aged 40.6±2.4 years. Participants were examined 24-h day pre-dialysis, during the index dialysis session and 24-h post-dialysis with simultaneous measurement of capillary blood glucose and continuous interstitial glucose (CGMS). Participants performed five capillary blood glucose measurements the day before dialysis, and 10 during and after dialysis. Mean capillary blood glucose was 128±20mg/dl the day before, 93±8mg/dl during haemodialysis, and 105±13mg/dl after haemodialysis. There was a significant trend towards lower blood glucose during the session from 105±16mg/dl to a 3rd hour nadir of 83±15mg/dl (Anova F=2.89, p=0.029). No hypoglycaemia was recorded. Interstitial glucose profile was comparable to capillary glucose profile. Glucose concentrations varied significantly from 126±13mg/dl before to 112±12mg/dl after haemodialysis respectively (p=0.006). This study provides evidence for the use of CGMS in ESRD and haemodialysis, and demonstrates significant changes in glucose concentrations during and after haemodialysis that would guide treatment monitoring and adjustments.

Effect of a continuous diabetes lifestyle intervention program on male workers in Korea

2010-07-12

Abstract: Aims: This study was conducted to compare the effects of two years of lifestyle intervention to no intervention or one year of intervention on diabetes risk factors in male workers with impaired fasting glucose (IFG) or diabetes.Methods: We conducted a randomized lifestyle intervention trial designed to alter personal lifestyles among 123 industrial male workers (CG; control group, n=75; OIG; one-year intervention group, n=23; TIG; two-year intervention group, n=25). The intervention consisted of two parts, the main program (face-to-face counseling five times/12 weeks) and a follow-up program (e-mail counseling ten times/30 weeks). Assessments included biochemical characteristics, anthropometry and nutrient intake at baseline and after two years.Results: After two years, systolic blood pressure, HOMA-IR, HDL cholesterol and total energy intake (p<0.05) were reduced in the OIG group, while weight, body mass index, waist circumference, blood pressure, fasting plasma glucose (FPG), HbA1c and nutrient intake (total energy, carbohydrate, protein and sodium) were significantly decreased (p<0.05, respectively) in the TIG group. When compared to the CG, subjects in OIG and TIG showed significant improvements in the level of FPG and HbA1c (p<0.05).Conclusions: Continuous lifestyle intervention for two years is more effective at improving diabetes risk factors than OIG.

Periodontal disease and risk for neuropathic foot ulceration in type 2 diabetes

Luciana Abrao, Juliana Kliemann Chagas, Helena Schmid — 2010-07-16

Abstract: Aims: Diabetic neuropathy (DN) has been associated with oral dryness, tooth loss and an increased risk for foot ulceration, but the association between periodontal problems and DN has not been fully elucidated. This study investigated whether the risk for neuropathic foot ulceration (DM-NFUR) was associated with periodontal disease (PD) in patients with type 2 diabetes mellitus.Methods: This cross-sectional study examined 122 patients with type 2 diabetes for PD; findings were compared with results for presence of DM-NFUR. PD severity was classified as none/mild (NM-PD), moderate/severe (MS-PD) and edentulous (E).Results: NM-PD was found in 40.2% patients; MS-PD, in 32.0%; and 27.8% were edentulous. DM-NFUR was detected in 18.4% of the patients in the NM-PD group, in 68.2% in the MS-PD group, and in 61.8% of completely edentulous individuals. PD was significantly correlated with DM-NFUR (p≤0.001). After adjustment for sex, age, diabetes duration, dental health care and education, PD and edentulism were independently associated with DM-NFUR (odds ratioadjusted; 6.6; 95% CI 2.3–18.8; p≤0.001, and odds ratioadjusted 4.9; 95% CI 1.6–15.3; p≤0.01).Conclusions: Patients with DM-NFUR have substantially more MS-PD and edentulism. Further studies should evaluate whether diabetic neuropathy is a risk factor for PD.

The impact of health insurance coverage on pediatric diabetes management

2010-07-14

Abstract: Aims: To examine the association between health insurance coverage, insulin management plans, and their impact on diabetes control in a pediatric type 1 diabetes mellitus clinic population.Methods: Retrospective cohort design drawn from the medical records of the Pediatric Endocrinology Clinic at the University of Louisville, Kentucky.Results: Out of 701 patients, 223 had public insurance, and 478 had private insurance. 77% of publically insured used two or three injections per day vs. 40% private. Conversely, 58% of privately insured used a multiple daily injection (MDI) plan or insulin pump (vs. 21%). 84% of MDI patients had private insurance with 93% using insulin pens compared with 38% of publically insured. Mean HbA1c was 8.6% for privately insured vs. 9.8% public, p<0.0001. Privately insured MDI and pump patients had the lowest HbA1cs.Conclusions: Insurance type had a significant effect on the insulin management plan used and was the most significant factor in overall diabetes control. Limitations on insulin pen use and number of glucose test strips may play a role in the decreased use of MDI/insulin pumps by publicly insured patients. Addressing factors related to insurance type, including availability of resources, could substantially improve diabetes control in those with public insurance.

Association between the -634C/G polymorphisms of the vascular endothelial growth factor and retinopathy in type 2 diabetes: A meta-analysis

Tongfeng Zhao, Jiangpei Zhao — 2010-06-30

Abstract: Aims: To investigate the association of vascular endothelial growth factor (VEGF) -634C/G polymorphism with retinopathy in type 2 diabetes.Methods: 8 studies with 1183 cases and 1057 controls were included. Allelic and genotypic comparisons between cases and controls were evaluated.Results: Our meta-analysis did not suggest a significant association of the -634C/G polymorphism with diabetic retinopathy (DR) and proliferative diabetic retinopathy (PDR) (P>0.05). The pooled odds ratios (ORs) for allelic frequency comparison, recessive model comparison, dominant model comparison, and additive model showed that the -634C/G polymorphism is significantly associated with nonproliferative diabetic retinopathy (NPDR): OR=1.61 [95% confidence interval (CI, 1.23, 2.10)], P=0.0005, Pheterogeneity=0.38, OR=2.24 [95% CI (1.15, 4.39)], P=0.02, Pheterogeneity=0.24, OR=1.87 [95% CI (1.01, 3.48)], P=0.05, Pheterogeneity=0.16, and OR=2.91 [95% CI (1.33, 6.39)], P=0.008, Pheterogeneity=0.26, respectively. However, in sensitivity analyses, we only detected a marginally significant association of the C allele with NPDR: OR=1.54 [95% CI (1.00, 2.39)], P=0.05, Pheterogeneity=0.17.Conclusions: Our meta-analysis does not support the association of the VEGF -634C/G polymorphism with DR and PDR. Significant association between this polymorphism and NPDR was detected in this meta-analysis. However, this association is not robust and could be due to chance.

Candesartan attenuates fatty acid-induced oxidative stress and NAD(P)H oxidase activity in pancreatic β-cells

Yukie Saitoh, Wang Hongwei, Hiroaki Ueno, Masanari Mizuta, Masamitsu Nakazato — 2010-07-30

Abstract: Angiotensin II receptor blockers (ARBs) have been shown to decrease insulin resistance in obese diabetic animal models and reduce the risk of new-onset diabetes in hypertensive patients. In the present study, we studied whether candesartan, an ARB, can exert a direct effect against fatty acid-induced oxidative stress in pancreatic β-cells. The effect of candesartan on lipotoxicity was evaluated using mouse insulin-secreting clonal cell, MIN6 and isolated mouse pancreatic islets. Intracellular insulin and triglyceride content, uncoupling protein-2 (UCP-2) mRNA expression, reactive oxygen species, protein kinase C (PKC) and NAD(P)H oxidase activity were examined. Candesartan recovered decreased insulin content in MIN6 exposed to 25mM glucose with 0.5mM palmitate (P<0.01). Candesartan tended to decrease intracellular triglyceride accumulation in cells exposed to 25mM glucose with 0.5mM palmitate. Palmitate-induced up-regulation of UCP-2 mRNA levels was suppressed by candesartan in a dose-dependent manner. Candesartan decreased palmitate-induced reactive oxygen species accumulation in MIN6 cells by 23% and in mouse islets by 59%. Candesartan also decreased palmitate-induced PKC activity by 21% and NAD(P)H oxidase activity by 37% in MIN6 cells. These findings indicated that candesartan attenuated fatty acid-induced oxidative stress and NAD(P)H oxidase activity in pancreatic β-cells.

The changes of visfatin in serum and its expression in fat and placental tissue in pregnant women with gestational diabetes

Yao Ma, Yan Cheng, Jue Wang, Haidong Cheng, Shufeng Zhou, Xiaotian Li — 2010-07-12

Abstract: Objectives: To elucidate the main source of circulating visfatin and its potential roles in pathogenesis of gestational diabetes mellitus (GDM).Methods: We examined serum concentrations of visfatin with ELISA and its expression in subcutaneous adipose tissue, visceral adipose tissue and placenta with RT-PCR and western blot both in women with GDM and normal pregnant controls at term. Moreover, BeWo cells were treated with tumor necrosis factor-α (TNF-α) and then the intra- and extra-cellular changes of visfatin expression were measured.Results: Serum visfatin concentrations were significantly higher in women with GDM than controls, which reduced obviously three days after delivery compared with antepartum. Visfatin expressions in placenta were significantly higher in GDM women than controls but there was no difference in its expressions in adipose tissue between the two groups. Moreover, serum visfatin concentrations correlated positively with its expressions in placenta, rather than adipose tissue. We demonstrated that visfatin secretion from BeWo cells was significantly increased but the intracellular expression was decreased at 48h incubation with TNF-α in a dose-depended way.Conclusions: The oversecretion of visfatin from placenta, probably induced by the elevated TNF-α level, contributes to the increased serum visfatin concentrations in women with GDM.

Acceleration of diabetic wound healing by collagen-binding vascular endothelial growth factor in diabetic rat model

2010-07-28

Abstract: Aims: Vascular endothelial growth factor (VEGF) is an important active protein for the induction of angiogenesis and plays an important role in the tissue regeneration of diabetic wounds. In this study, we used collagen-binding VEGF in a diabetic rat model to investigate the effects of this new method.Methods: We produced a fusion protein (CBD-VEGF) consisting of VEGF and a collagen-binding domain (CBD), which allowed VEGF to bind to collagen. The diabetic rat models were made by injected streptozocin (STZ) peritoneally and removed full thickness skin on the back. All the rats were randomly divided into 3 groups: PBS group (n=24), NAT-VEGF group (n=24), and CBD-VEGF group (n=24). After model establishment, the dissolved drugs were evenly given on the wounds using syringe. The healing rates were calculated and compared among the groups and the tissues of the wound were taken and evaluated for histological analysis.Results: The CBD-VEGF group showed better result in wound healing rate, better vascularization and higher amount of VEGF in the wound granulation tissue compared with NAT-VEGF group and control.Conclusions: Topical application of CBD-VEGF can promote diabetic wound healing in rat model, which could potentially provide a better therapeutic option for diabetic wounds.

NF-κB binding activity and pro-inflammatory cytokines expression correlate with body mass index but not glycosylated hemoglobin in Chinese population

Lan He, Ming He, Xiaohong Lv, Dan Pu, Peihe Su, Zhiquan Liu — 2010-07-15

Abstract: Aims: Chronic inflammation is linked to type 2 diabetes (T2DM), so we investigated correlations between obesity, blood glucose levels, and inflammation in T2DM patients.Methods: Peripheral blood mononuclear cells (PBMCs) were collected from 40 T2DM patients (27 men, 13 women; mean age 49.63 years), and 10 non-diabetic controls (all men; mean age 38.60 years). Inflammation was measured as DNA-binding activity of nuclear factor κB (NF-κB), a key transcription factor in inflammation. Protein levels of NF-κB subunit p65, and NF-κB inhibitor IκBα were assessed by Western blot. Transcript levels for p65, IκBα, and the NF-κB target genes TNF-α, MMP-9, IL-6, IL-8, and IL-18 were measured by real-time PCR. Body mass index (BMI) and glycohemoglobin were measured for all the subjects.Results: NF-κB DNA-binding activity, p65 and IκBα protein levels, and expression of IL-6, TNFα and MMP-9 were significantly higher in PBMCs from T2DM patients, than from non-diabetic controls. NF-κB binding was significantly positively associated with both BMI and homeostasis model assessment of insulin resistance (HOMA-IR).Conclusions: Inflammation was observed in PBMCs in T2DM patients in a Chinese population, and correlated independently with obesity and blood glucose levels. Lack of correlation with glycohemoglobin suggested that moderate-term blood glucose control did not mitigate inflammation.

Candida-associated denture stomatitis in type 2 diabetes mellitus

2010-07-20

Abstract: Objective: To describe the clinical appearance of Candida-associated denture stomatitis (DS) in subjects with type 2 diabetes (T2DM). The relationships between the types of DS, oral complaints and associated conditions were assessed in terms of glycemic control as determined by glycated hemoglobin (HbA1c) measurements.Materials and methods: Demographic and clinical data were obtained from questionnaires and oral examinations of 110 edentulous patients with T2DM and 50 control subjects.Results: Type II DS commonly occurred in diabetics (57.3% vs 30%; p=0.002) together with DS related oral complaints (60.9% vs 24%; p<0.001) compared with controls. Burning sensation of the mouth (BS) was the most common complaint. Dryness of the oral mucosa (DOM) (50.9% vs 6%; p<0.001), angular cheilitis (26.4% vs 8%; p=0.01) and glossitis (27.3% vs 6%; p=0.003) occurred more frequently in diabetics. Oral complaints and associated conditions of DS coincided with elevated HbA1c levels (p<0.001). Diabetics with extensive type of inflammation had higher HbA1c levels than type I/III DS subjects (p<0.001).Conclusions: Diffuse type of inflammation was associated with T2DM. BS and DOM were the most common oral complaints. Inadequately controlled diabetes with Candida-associated DS was linked to a high incidence of an extensive type of inflammation, oral complaints and associated conditions.

Incretin action maintains insulin secretion, but not hepatic insulin action, in people with impaired fasting glucose

2010-08-16

Abstract: Aims: To determine whether altered GLP-1 activity contributes to the abnormal endogenous glucose production (EGP) and insulin secretion characteristic of people with impaired fasting glucose (IFG).Methods: People with IFG (n=10) and normal glucose tolerance (NGT; n=13) underwent assessment of EGP (via [6,6-2H2]-glucose infusion). Parameters of whole body insulin action and secretion were estimated by IVGTT and OGTT. Measures of EGP and insulin secretion were made before and after sitagliptin administration.Results: EGP was not different at baseline (glucose Ra; 1.47±0.08 vs. 1.46±0.05mg/kg/min, IFG vs. NGT, p=0.93). However, when differences in circulating insulin were accounted for (EGPXSSPI; 20.2±2.1 vs. 14.4±1.0AU, vs. NGT, p=0.03) the hepatic insulin resistance index was significantly higher in IFG. Baseline insulin action (Si; 2.3±0.1×10−4/μU/ml vs. 3.5±0.4×10−4/μU/ml, p=0.01, IFG vs. NGT) and secretion (DI; 587±81×10−4/min vs. 1171±226×10−4/min, p=0.04, IFG vs. NGT) were impaired in IFG when evaluated by the IVGTT, but not by OGTT (insulin sensitivity 4.52±1.08×10−4dl/kg/min vs. 6.73±1.16×10−4dl/kg/min, IFG vs. NGT, p=0.16; indices of basal (Φb), static (Φs), dynamic (Φd), and total (Φt) insulin secretion, p>0.07). Sitagliptin did not change EGP or insulin secretion in either group.Conclusions: Incretin action maintained insulin secretion, but not hepatic insulin action, in people with IFG.

Correlation between glucose fluctuations and carotid intima-media thickness in type 2 diabetes

2010-06-04

Abstract: Aims: To evaluate the relationship between blood glucose fluctuations and carotid atherosclerosis (AS) in type 2 diabetic patients.Methods: A case-control study included 36 patients with type 2 diabetes and 10 controls. According to the levels of carotid intima-media thickness (CIMT), 36 diabetic patients were classified into two groups, the diabetes mellitus without atherosclerosis (DM−AS, n=20) and diabetes mellitus with atherosclerosis (DM+AS, n=16). The glucose excursions were assessed by the following parameters obtained from continuous glucose monitoring system for 72h: the mean blood glucose (MBG) and its standard deviation (SD), the area under the ROC curve when the blood glucose was higher than 7.8mmol/L (AUC7.8), the mean amplitude of glycemic excursion (MAGE), the mean of daily differences (MODD), and the largest amplitude of glycemic excursion (LAGE).Results: The levels of MBG, SD, MAGE, LAGE, and AUC7.8 were gradually increased with the progression of atherosclerosis (P<0.05). The Spearman's correlation analysis showed that the CIMT was correlated to the age (R=0.58, P<0.001), the duration (R=0.50, P<0.001), the MAGE (R=0.34, P=0.021), and the LAGE (R=0.31, P=0.035).Conclusion: These results suggest that glucose fluctuations may accelerate atherogenesis in older type 2 diabetic patients who had a longer duration.

The potential impact and optimal cut-points of using glycated haemoglobin, HbA1c, to detect people with impaired glucose regulation in a UK multi-ethnic cohort

2010-07-15

Abstract: Introduction: Recommended diagnostic cut-points to detect impaired glucose regulation (IGR, also termed prediabetes: impaired fasting glucose and/or impaired glucose tolerance based on WHO 1999 criteria) are HbA1c 6.0–6.4% and 5.7–6.4% from an International Expert Committee and American Diabetes Association, respectively. We investigated the impact on prevalence/phenotype from using these criteria compared to IGR detected on oral glucose tolerance testing (OGTT) and determined optimal HbA1c cut-points for IGR in a multi-ethnic cohort.Methods: Analysis of 8696 participants in the LEADER study of primary care individuals aged 40–75 years without diabetes, in Leicestershire (UK) who underwent OGTT and had HbA1c measured.Results: Use of OGTT detected less people with IGR (n=1407, 16.2%) compared to HbA1c 6.0–6.4% (n=1610, 18.5%) and HbA1c 5.7–6.4%(n=3904, 44.9%), a 1.1- and 2.8-fold increase in prevalence, respectively. There were 930 (10.7%) and 534 (6.1%) people with IGR on OGTT not detected using HbA1c 6.0–6.4% and 5.7–6.4%, respectively. From ROC curve analysis, the optimal cut-point for detecting IGR in white Europeans was HbA1c≥5.8%, sensitivity/specificity 61.5%/67.9%, but in south Asians HbA1c≥6.0%, sensitivity/specificity 63.8%/69.4%.Conclusion: Recommended HbA1c cut-points to detect IGR significantly increase numbers detected, however introduce a change in people identified. Using HbA1c 6.0–6.4% lacks sensitivity in white Europeans, but is a reasonable option in south Asians.

Are active sun exposure habits related to lowering risk of type 2 diabetes mellitus in women, a prospective cohort study?

Pelle G. Lindqvist, Håkan Olsson, Mona Landin-Olsson — 2010-07-12

Abstract: Aim: An inverse relationship exists between vitamin D levels and diabetes mellitus. However, little is known about the correlation of sun exposure habits and type 2 diabetes mellitus (DM).Methods: A South Swedish cohort study comprising 1000 women from each age group between 25 and 64 (n=40,000) drawn from the Southern Swedish population registry 1990–1992. At the inception of the study 74% answered the inquiry (n=29,518) and provided detailed information on their sun exposure habits and other variables. A follow-up inquiry was sent 2000–2002 which 24,098 women answered. The mean follow-up time was 11 years. Logistic regression analysis was used and the main outcome was the relationship between type 2 DM and sun exposure habits.Results: Our findings indicated that women with active sun exposure habits were at a 30% lower risk of having DM, as compared to those with non-active habits. There was an inverse relation between this risk reduction and BMI.Conclusion: Our investigation gives possible epidemiological explanation to ethnic and seasonal differences in type 2 DM and metabolic control. The study supports that sunlight is involved in the glucose metabolism.

Diabetes incidence for all possible combinations of metabolic syndrome components

Gregory A. Nichols, Edward J. Moler — 2010-07-14

Abstract: Aims: Because metabolic syndrome (MetS) is defined as any three of five criteria, not all persons with MetS have the same risk factors. Whether the combinations of criteria confer equal diabetes risk is unknown.Methods: We identified 58,056 non-diabetic adults age >=30 with all MetS components measured in 2003–2004. We estimated age- and sex-adjusted diabetes incidence over 5 years for all possible combinations of MetS components.Results: The overall incidence rate of diabetes was 12.5/1000 person-years (95% CI 12.1–12.9). Although incidence increased with the MetS factor count, incidence varied by >9-fold in patients with 3 risk factors, >5-fold in patients with 4 factors, and >54-fold in patients with <3 factors. All two-factor combinations that included hyperglycemia had higher incidence rates than three- or four-factor combinations that did not. For example, incidence in patients with only hyperglycemia and obesity was 21.7/1000 person-years (95% CI 17.4–27.1), compared to 11.4 (9.8–13.4) among those with four components without hyperglycemia.Conclusions: Diabetes risk increases exponentially with MetS factor count, but varies substantially depending upon which factors are present. Hyperglycemia, regardless of the presence of MetS, is a much stronger predictor of incident diabetes than MetS without hyperglycemia.

Habitual intake of dairy products influences serum 1,5-anhydroglucitol levels independently of plasma glucose

Masafumi Koga, Jun Murai, Hiroshi Saito, Mikio Mukai, Soji Kasayama — 2010-07-15

Abstract: 1,5-Anhydroglucitol (1,5-AG), a marker of glycemic control state, is reabsorbed via SGLT (sodium glucose cotransporter)-4 (SLC5A9) at renal proximal tubules. SGLT4 is responsible for reabsorption of mannose, fructose, galactose, glucose, and 1,5-AG. Thus, based on our hypothesis that serum 1,5-AG levels are influenced by diet, we investigated whether eating habits influence serum 1,5-AG levels. In total, 330 subjects (158 males and 172 females) with normal glucose tolerance participated. Relationships between serum 1,5-AG levels and eating habits (intake of meats, fish, soybean products, eggs, dairy products, fruit, vegetables, and salt) surveyed by questionnaire were investigated. Stepwise multivariate regression analysis revealed that habitual intake of dairy products was a significant negative explanatory variable for serum 1,5-AG levels. Serum 1,5-AG levels were lower in subjects with habitual intake of dairy products than in those without. On the other hand, HbA1C, glycated albumin, fasting plasma glucose, and OGTT 2-h plasma glucose were not different between the subjects of these two groups.In conclusion, habitual intake of dairy products was associated with low serum 1,5-AG levels, independently of plasma glucose levels.

Erratum to “Interaction between HNF4A polymorphisms and physical activity in relation to type 2 diabetes-related traits: Results from the Quebec Family Study” [Diabetes Res. Clin. Pract. 84 (2009) 211–218]

2010-07-12

The publisher regrets that the names of the authors appeared in the incorrect order in the original version of the paper. The correct version appears above. The publisher would like to apologise for any inconvenience caused.

Erratum to “Comparison of clinical-metabolic monitoring and outcomes and coronary risk status in people with type 2 diabetes from Australia, France and Latin America” [Diabetes Research and Clinical Practice 2010;88:7–13]

2010-07-12

The publisher regrets that some of the affiliations for the authors were incorrect in the originally published version of this paper. The correct affiliations appear above. Also, two errors appeared in the paper and these are corrected below.

Celebrating World Diabetes Day and preparing for the battles ahead

2010-10-01

Aspirin for people with diabetes: A misleading inference in a recent meta-analysis?

2010-08-02

In our opinion, the meta-analysis conducted by Zhang et al. raises doubts as to the degree to which the studies selected met their inclusion criteria, something that would limit the validity of these researchers’ results.

Response to Letter to Editor from Dr. Martín-Carrillo

Chun Yu Zhang — 2010-08-02

Dr. Martín-Carrillo pointed out the weakness of our meta-analysis on the effect of aspirin for primary prevention of cardiovascular events in patients with diabetes. The inclusion of ETDRS and HOT trials was based on the fact of small proportion of patients with pre-existing established cardiovascular events in these two trials. A recent meta-analysis published on Br Med J by De Berardis et al. included the ETDRS, and the ETDRS and HOT trials were also part of the expert consensus document on related issue . We agree that including these two trials would limit the validity of our research's results, and an individual meta-analysis excluded the patients with a history of cardiovascular disease can pinpoint the effect of aspirin for primary prevention of cardiovascular events in diabetes more corrected. Without these two trials in the analysis, we found that aspirin significantly reduced the incidence of stroke (RR 0.70, 95% CI 0.53–0.92; p=0.01), but did not affect major cardiovascular events (RR 0.93, 95% CI 0.78–1.10; p=0.41), cardiovascular mortality (RR 0.84, 95% CI 0.33–2.16; p=0.72), and myocardial infarction (RR 0.85, 95% CI 0.54–1.33; p=0.47).

Autoantibodies found in type-2 diabetes with AIT test may be associated with its nephropathic complication

EelG-You Park, Think-You Kim — 2010-06-01

We read the interesting article by Arababadi et al. reporting type-2 diabetes mellitus (DM) and its nephropathic complication might be autoimmune disease, based on the increased concentration of IFN-γ and IL-17A which were known to be associated with autoimmune disease . We have been studying about autoantibodies, another method to investigate connection of a disease with autoimmunity, through which we experienced relationship between autoimmunity and type-2 DM.

Progression of cardiac autonomic dysfunction in newly detected type 2 diabetes

Viveka P. Jyotsna, Achouba Ksh Singh, K.K. Deepak, V. Sreenivas — 2010-05-10

In a study among recently detected type 2 diabetes, parasympathetic dysfunction was found in 44.2% and sympathetic dysfunction in 51.9% diabetics . Among nondiabetic healthy controls, these figures were 11.9% and 22.1%, respectively . We looked at the progression of cardiac autonomic neuropathy in recently detected diabetic patients, to assess any improvement and to what factors it correlates.

Higher recent A1C in diabetic patients with acute non-ST elevation myocardial infarction as compared to other critical illnesses

2010-07-12

Admission plasma glucose even after adjustment for A1C has been found to be an important prognostic factor associated with higher mortality in some studies . Elevated A1C has been shown to be a predictor for in-hospital mortality as well as deep sternal wound infection after coronary artery bypass grafting . We performed a retrospective case-control study and examined the relationship between recent A1C and the diagnosis of acute Non-ST Elevation Myocardial Infarction (NSTEMI). The case group comprised of persons with diabetes mellitus and acute NSTEMI (as classified by the treating physicians). The control group comprised of persons with diabetes mellitus and an admitting diagnosis other than NSTEMI (e.g. COPD exacerbation, sepsis, trauma, etc.).

Improvement of psoriatic arthritis by pioglitazone treatment in a type 2 diabetic patient

2010-06-21

Psoriatic arthritis (PsA) is a chronic inflammatory joint disease associated with psoriasis and has a high prevalence of type 2 diabetes mellitus (T2DM) . Recent studies have revealed an anti-inflammatory effect of pioglitazone; this agent is therefore expected to affect both arthritis activities of PsA and impaired insulin sensitivity. This is the first report showing that pioglitazone treatment improves joint symptoms as well as insulin resistance in a patient with T2DM and PsA.

Diabetes research and clinical practice

James A. Dunbar, Prasuna Reddy, Kevin Mc Namara, Edward D. Janus — 2010-07-01

Simmons et al. neatly summarise many of the challenges in real-world implementation of diabetes prevention programs . They reported our preliminary Greater Green Triangle Diabetes Prevention Program (GGT DPP) findings and here we add important final results . All CVD risk was reduced by 16% and diabetes risk by an imputed 40%. Depression is important in predicting non-completers of the program but completers improved their mental health .

Sample stability for the measurement of hemoglobin A1c

Mariella Mercadanti, Alberta Caleffi, Giovanni Targher, Giuseppe Lippi — 2010-06-21

According to the American Diabetes Association (ADA), the measurement of hemoglobin A1c (HbA1c) can be used for diagnosing diabetes and it should also be performed routinely in all patients with diabetes at initial assessment and then as part of continuing care . Little is known, however on preanalytical variables influencing test results . In particular, the storage of samples might be necessary for a variety of reasons, including delayed transfer of the specimens from peripheral collection centers and/or clinics to the core laboratory where the measurement is performed, instrument malfunction, re-testing and clinical retrospective studies.

Identification of metabolic syndrome using decision tree analysis

2010-07-12

Abstract: This study employs decision tree as a decision support system for rapid and automated identification of individuals with metabolic syndrome (MS) among a Thai population. Results demonstrated strong predictivity of the decision tree in classification of individuals with and without MS, displaying an overall accuracy in excess of 99%.

Clinical determinants of aspirin resistance in diabetes

2010-08-18

Abstract: Recent studies indicate that not all diabetic subjects benefit from aspirin therapy. Our objective is to characterize diabetic subjects with aspirin resistance using urine thromboxane, and VerifyNow measures. Our results suggest that cardiovascular disease, microalbuminuria, poor diabetes control, and increased waist circumference help identify aspirin resistance in diabetes.