Diabetes Research and Clinical Practice

2010-02-01

The status of national diabetes programmes: A global survey of IDF member associations

Ruth Colagiuri, Robyn Short, Alexandra Buckley — 2009-11-18

Abstract: The 42nd World Health Assembly (1989) issued a global call to action on the prevention and control of diabetes. Four regional diabetes declarations followed – Europe, the Americas, the Western Pacific, and Africa – which paved the way for national diabetes programmes (NDPs) in many countries.As a result of the UN Resolution on Diabetes (2006), the International Diabetes Federation (IDF) resolved to reinvigorate NDPs and established a Task Force for this purpose. Despite the growth of NDPs over the past 20 years, no formal global evaluation of their status appears to have been undertaken. Consequently, in 2008, the Task Force conducted a baseline survey of IDF member associations (n=202) worldwide seeking information on the existence, scope and status of NDPs. The survey achieved a 47% response rate with 61% of respondents indicating their country had an NDP. Of these, 83% had a prevention component, and 96% had type 2 diabetes as the most commonly occurring focus.Overall, the survey indicated a strong core of cohesive national action on diabetes worldwide but highlighted the need for a concerted effort to develop and implement comprehensive national prevention and care plans aimed at reducing the personal, familial and societal burden of diabetes.

International Diabetes Federation: An update of the evidence concerning the prevention of type 2 diabetes

R.K. Simmons, N. Unwin, S.J. Griffin — 2009-11-13

Abstract: This article aims to provide an updated summary of diabetes prevention efforts by reviewing relevant literature published between 2007 and 2009. These include results from the long-term follow-up of diabetes prevention trials and the roll-out of community-based interventions in “real world” settings. Some countries have begun to implement population-based strategies for chronic disease prevention, but investment in developing and evaluating population-level interventions remains inadequate. By focussing on the “small change” approach and involving a number of different agencies, it may be possible to shift the population distribution of risk factors for diabetes and cardiovascular disease in a favourable direction. The cost-effectiveness of primary prevention strategies for type 2 diabetes has not been universally demonstrated. Some of the uncertainties relating to screening for diabetes have now been resolved but longer-term data on hard cardiovascular outcomes are still needed. In summary, individual countries should aim to develop and evaluate cost-effective, setting-specific diabetes risk identification and prevention strategies based on available resources. These should be linked to initiatives aimed at reducing the burden of cardiovascular disease, and complemented with population-based strategies focusing on the control and reduction of behavioural and cardiovascular risk factors by targeting their key determinants.

On what evidence-base do we recommend self-monitoring of blood glucose?

Hubert Kolb, Kerstin Kempf, Stephan Martin, Michael Stumvoll, Rüdiger Landgraf — 2009-11-19

Abstract: Self-monitoring of blood glucose (SMBG) has been considered one major breakthrough in diabetes therapy because, for the first time, patients were able to determine their blood glucose levels during daily life. It seems obvious that this must be of advantage to disease management and clinical outcome, but it has become a nightmare for those trying to provide evidence. Randomised controlled trials have yielded inconsistent results on a benefit of SMBG-based treatment strategies not only in type 2 but – surprisingly – also in type 1 and gestational diabetes. Despite this, SMBG is being considered indispensible in intensive insulin treatment, but is being debated for other clinical settings. When considering the non-RCT based reasons for recommending SMBG in type 1 and gestational diabetes it becomes apparent that the same reasons also apply to type 2 diabetes.

Plasma sRAGE is not associated with urinary microalbumin excretion in type 2 diabetic nephropathy at the early stage

2009-11-30

Abstract: Aims: The interaction of advanced glycation end products (AGEs) and the receptor for advanced glycation end products (RAGE) has played an important role in the pathogenesis of diabetic nephropathy. In the present study, we measured the relationship of plasma soluble isoform of RAGE (sRAGE) and urinary microalbumin excretion in the early stage of type 2 diabetic nephropathy.Methods: 180 patients with early stage of type 2 diabetic nephropathy were recruited into the study. Plasma sRAGE and the characterized AGE carboxymethyllysine (CML) were measured by enzyme-linked immunosorbent assay.Results: Plasma sRAGE positively correlated with the level of CML (R=0.22, P=0.03) while sRAGE was not significantly correlated with the urinary mAlb/Cr (R=0.15, P=NS). On stepwise linear regression analysis, AGE and GFR were the main independent determinants of plasma sRAGE concentration.Conclusion: Plasma sRAGE is not significantly associated with urinary microalbumin excretion in the early stage of diabetic nephropathy while it is correlated positively with circulating AGE and negatively with glomerular filtration rate (GFR).

Effects of antioxidants on glucose-induced oxidative stress and endoplasmic reticulum stress in endothelial cells

2009-11-26

Abstract: Aim: Hyperglycemia-induced endothelial cell dysfunction can be the result of increased oxidative stress and concomitant increase in endoplasmic reticulum (ER) stress. To test the extent of coupling between these two stresses, the effect of antioxidant vitamins on glucose-induced oxidative stress and ER stress in endothelial cells were studied.Methods: Human umbilical vein endothelial cells (HUVEC) were treated with physiological (5.5mM) or supra-physiological (27.5mM) dextrose concentrations, and ER stress and oxidative stress were measured. Additional experiments were carried out in HUVEC over-expressing exogenous glucose transporter-1 (Glut-1) and treated with 5.5mM dextrose.Results: Supra-physiological dextrose concentrations increased both ER stress and oxidative stress. However, while oxidative stress could be effectively inhibited with alpha-tocopherol and ascorbic acid, these antioxidants had no effect on ER stress. Increasing intracellular glucose levels by exogenous expression of Glut-1 in endothelial cells also increased oxidative stress and ER stress. Whereas the oxidative stress in these cells was reduced with alpha-tocopherol and ascorbic acid and dimethylsulfoxide, the ER stress could not be ameliorated with alpha-tocopherol and ascorbic acid.Conclusions: These results indicate that ER stress can be uncoupled from oxidative stress and antioxidants can ameliorate the latter without altering the ER stress induced by hyperglycemia.

Evaluation of podocyte lesion in patients with diabetic nephropathy: Wilms’ tumor-1 protein used as a podocyte marker

2009-12-07

Abstract: Introduction: The reduction of podocyte number and density per glomerulus has been linked to the development of proteinuria and the progression of disease in patients with diabetic nephropathy (DN). However, it has been recognized that measurement of podocyte number by light microscope is quite difficult because of the complexity of both podocyte and glomerular structure, which is not suitable for clinical research. In our research institute, we used WT1 as podocyte marker to evaluate the podocyte lesion.Methods: In our experiment, we selected the C-terminal antibody of WT1 to stain the nuclei and the N-terminal antibody of WT1 to stain the cytoplasma of podocytes. Forty patients were enrolled with type 2 diabetes and proven to have DN by renal biopsy analysis. DN patients were classified into three groups based on the degree of proteinuria: microalbuminuria (n=10, 30–300mg/24h), overt proteinuria (n=15, 0.5–3.5g/24h), and heavy proteinuria (n=15, >3.5g/24h).Results: The results demonstrated that the podocyte number was markedly decreased in patients with DN (30–51% reduction). There was a significant negative correlation between the proteinuria and both podocyte density and number. The cover area density of podocyte cytoplasma in glomerulus was also significantly decreased in all DN patients (39–80% reduction). A significant inverse correlation was observed between the cover area density and the degree of proteinuria. The correlation coefficient (r=−0.85) was much higher than that between proteinuria and podocyte density (r=−0.56) or podocyte number (r=−0.36).Conclusion: In conclusion, podocyte damage occurred in patients with DN, even in the early stage and became more dramatic during the course of proteinuria progression. WT1 staining, using the polyclonal antibody to stain the nuclei and monoclonal antibody to stain the cytoplasma of podocytes together, is a valuable alternative technique in the study of podocyte injury.

Plasma apelin levels and apelin/APJ mRNA expression in patients with gestational diabetes mellitus

2009-11-19

Abstract: Aims and methods: Apelin is a novel adipokine identified as an endogenous ligand of the G protein-coupled receptor APJ. In this study we compared plasma apelin concentrations in 101 patients with gestational diabetes (GDM) and 101 women with normal glucose tolerance (NGT) between 24 and 32 weeks of gestation (Group 1), as well as in 20 women with GDM and 16 subjects with NGT at term (Group 2). Apelin and APJ mRNA expression in subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT) and placental tissue were also measured in Group 2, using quantitative real-time PCR.Results: There were no significant differences in plasma apelin levels between the women with GDM and NGT (Group 1: 1555.6 [1281.2–1804.2]pg/ml vs 1656.5 [1430.2–1852.1]pg/ml, Group 2: 1607.9 [1453.4–1768.7]pg/ml vs 1493.8 [1316.8–1956.7]pg/ml) nor in apelin and APJ mRNA expression in SAT, VAT and placental tissue. Apelin mRNA expression was approximately 10 fold higher in placental than in adipose tissue (p<0.0001). Apelin and APJ mRNA expression correlated significantly in SAT (R=0.45, p=0.03), VAT (R=0.69, p=0.003) and placental tissue (R=0.37, p=0.03).Conclusions: No associations between circulating apelin or apelin/APJ mRNA expression and GDM or the indices of insulin resistance were noted in our study.

Involvement of the cholinergic pathway in glucocorticoid-induced hyperinsulinemia in rats

Nágela Angelini, Alex Rafacho, Antonio Carlos Boschero, José Roberto Bosqueiro — 2009-12-07

Abstract: Aims: We investigated the contribution of the cholinergic nervous system to dexamethasone-induced insulin resistance and hyperinsulinemia in rats.Methods: Seventy-day-old Wistar male rats were distributed in groups: control (CTL), vagotomized (VAG), and sham operated (SHAM). On the 90th day of life, half of the rats were treated daily with 1mg/kg of dexamethasone for 5 days (CTL DEX, VAG DEX, and SHAM DEX).Results: In the presence of 8.3mM glucose plus 100μM carbachol (Cch), isolated islets from CTL DEX secreted significantly more insulin than CTL. Cch-enhancement of secretion was further increased in islets from VAG CTL and VAG DEX than SHAM CTL and SHAM DEX, respectively. In CTL DEX islets, M3R and PLCβ1 and phosphorylated PKCα, but not PKCα, protein content was significantly higher compared with each respective control. In islets from VAG DEX, the expression of M3R protein increased significantly compared to VAG CTL and SHAM DEX. Vagotomy per se did not affect insulin resistance, but attenuated fasted and fed insulinemia in VAG DEX, compared with SHAM DEX rats.Conclusion: These data indicate an important participation of the cholinergic nervous system through muscaric receptors in dexamethasone-induced hyperinsulinemia in rats.

Plasminogen activator inhibitor-1 (PAI-1) activity and retinal vascular calibre in type 2 diabetes

L. Brazionis, J. Yau, K. Rowley, C. Itsiopoulos, K. O’Dea, T.Y. Wong, A. Jenkins — 2009-12-14

Abstract: Objective: To describe relationships of retinal vascular calibre with plasminogen activator inhibitor-1 (PAI-1) and other cardiovascular risk factors in people with type 2 diabetes.Methods: We recruited 112 community-based persons aged 44–83years with type 2 diabetes, photo-documented retinal status using a digital fundus camera, and measured traditional and novel vascular risk factors. Retinal arteriolar and venular calibre and the arterio–venous ratio (AVR) were determined from fundus photographs using a validated computer-assisted method.Results: In adjusted linear regression models, PAI-1 activity was strongly associated with all measures of retinal vascular calibre: positively with arterioles (p=0.005) and AVR (p=0.001), and inversely with venules (p=0.001). In addition, wider arterioles were independently associated with waist-hip ratio (p<0.0001), HDL-C (p=0.015), and lower systolic blood pressure (p=0.042), whereas narrower venules were associated with older age and a higher albumin excretion rate. Neither arteriolar nor venular calibre was associated with plasma total homocysteine or C-reactive protein concentration.Conclusion: Retinal vascular calibre is independently associated with PAI-1 activity in type 2 diabetes. This finding supports a role for PAI-1 activity in the microvasculature of persons with type 2 diabetes and may explain the link between retinal vascular calibre and cardiovascular disease.

Peripheral endomorphin-1 levels are suppressed in diabetic patients

2009-12-21

Abstract: Background: Endomorphins are endogenous ligands selective for μ-opioid receptors, which have been reported to stimulate appetite and regulate glucose homeostasis. But there are no reports about changes in peripheral endomorphin-1 (EM-1) levels in diabetic patients. The aim of this study was to measure plasma EM-1 levels in fasting and postprandial conditions in diabetic patients.Methods: After an overnight fast, 38 patients (mean age, 67±8 years; 17 males and 21 females) and 22 healthy volunteers (mean age, 64±9 years; 9 males and 13 females) received a standard breakfast meal with total energy content of 476.1kcal. Blood samples were drawn from each subject in heparinized tubes before breakfast and 2h postprandially. Plasma concentrations of EM-1 were measured by radioimmunoassay (RIA).Results: Comparing with healthy volunteers, EM-1 levels were significantly lower in diabetic patients at both time-points (fasting: 48.38±14.13pg/ml vs. 72.71±19.62pg/ml, p<0.0001; postprandial: 39.80±12.28pg/ml vs. 62.93±21.95pg/ml, p=0.0001). When compared with fasting levels, the postprandial concentrations of EM-1 decreased in both diabetic patients, as well as healthy controls. The absolute value of decrease was not significantly different between the two groups.Conclusions: Peripheral EM-1 levels were suppressed in diabetic patients and the levels decreased postprandially in both diabetic and healthy volunteers. This implies that EM-1 concentration has correlation with the change in glucose level. Thus, EM-1 could play a role in energy metabolism.

Patient-reported tolerability issues with oral antidiabetic agents: Associations with adherence; treatment satisfaction and health-related quality of life

Michael F. Pollack, Fanta W. Purayidathil, Susan C. Bolge, Setareh A. Williams — 2009-12-28

Abstract: Aims: The study's aim was to quantify prevalence of tolerability issues among patients with T2DM currently treated with OADs and to assess its association with treatment adherence, satisfaction and health-related quality of life (HRQL).Methods: Data were collected from the 2006–2008 US National Health and Wellness Survey and the Ailment Panel of Lightspeed Online Research, an internet-based questionnaire. Participants (N=2074) self-reported a diagnosis of T2DM, were >18 years of age and currently taking >1 OADs but not insulin, and spoke English.Results: The majority (71.7%) experienced at least 1 tolerability issue in the past 2 weeks; 49.7% experienced >2. Tolerability issues included signs/symptoms of hypoglycemia (57.2%), constipation/diarrhea (28%), headaches (25.6%), weight gain (22.9%) and water retention (21.0%). There was a significant association between the number of tolerability issues and both the likelihood of non-adherence (r=0.20, p<0.01) and reduced treatment satisfaction (r=−0.42, p<0.01). Each additional tolerability issue was associated with 28% greater likelihood of medication non-adherence. Constipation/diarrhea (b=−0.02, p<0.01) and symptoms of hypoglycemia (b=−0.08, p<0.01) were significantly associated with lower HRQL scores.Conclusions: Optimizing OAD therapy of T2DM by improving tolerability may increase patient satisfaction, medication adherence and HRQL, and may increase the likelihood of attaining treatment goals.

Aspirin for primary prevention of cardiovascular events in patients with diabetes: A meta-analysis

2009-10-26

Abstract: Background: To systematically review trials concerning the benefit and risk of aspirin therapy for primary prevention of cardiovascular events in patients with diabetes mellitus.Methods: We searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. Eligible studies were prospective, randomized controlled trials of aspirin therapy for primary cardiovascular prevention in patients with diabetes with follow-up duration at least 12 months.Results: 7 trials included 11,618 individuals with diabetes. Aspirin therapy was not associated with a statistically significant reduction in major cardiovascular events (relative risk [RR] 0.92, 95% confidence interval [CI] 0.83–1.02, p=0.11). Aspirin use also did not significantly reduce all-cause mortality (0.95, 95% CI 0.85–1.06; p=0.33), cardiovascular mortality (0.95, 95% CI 0.71–1.27; p=0.71), stroke (0.83, 95% CI 0.63–1.10; p=0.20), or myocardial infarction (MI) (0.85, 95% CI 0.65–1.11; p=0.24). There was no significant increased risk of major bleeding in aspirin group (2.46, 95% CI 0.70–8.61; p=0.16). Meta-regression suggested that aspirin agent could reduce the risk of stroke in women and MI in men.Conclusions: In patients with diabetes, aspirin therapy did not significantly reduce the risk of cardiovascular events without an increased risk of major bleeding, and showed sex-specific effects on MI and stroke.

Analysis of continuous patient data from the Czech National Register of patients with type 1 and type 2 diabetes using insulin pump therapy

2009-10-26

Abstract: Aim: Patient data from the Czech National Register of patients treated with Continuous Subcutaneous Insulin Infusion (CSII) were evaluated to compare treatment indication, efficacy and safety with specific regard to the type of diabetes (T1 vs. T2).Methods: Evaluation was done on complete data sets of at least 3 years from patients with either T1 diabetes (n=730, 93.1%) or T2 diabetes (n=54, 6.9%) between 1995 and 2006.Results: HbA1c decreased from 9.65 (±0.07) and 9.66 (±0.05) for T1 and T2 respectively to 8.24 (±0.07) for T1 and 8.52 (±0.27) for T2 after 1 year of treatment, 8.34 (±0.07) and 8.54 (±0.26) after 2 years and 8.44 (±0.07) and 8.71 (±0.25) after 3 years (adjusted mean values, ±SEM). This reduction is significant for both diabetes types. Results gathered from the safety analysis revealed almost comparable results for both patient groups (rates of adverse events of 42.5 and 34.8 for T1 and T2, per 100 patients and year).Conclusion: Both patient groups achieved substantial reduction of HbA1c. Safety evaluation showed that fewer patients with T2 diabetes were affected by adverse events. According to that CSII treatment for patients with T2 diabetes is similarly effective with a slightly better safety profile.

Neuropsychological status of elderly patients with diabetes mellitus

2009-10-30

Abstract: Aim: Diabetes mellitus (DM) is an important risk factor for Alzheimer's disease (AD) but the relationship between DM and amnestic mild cognitive impairment (aMCI), characterized by isolated memory loss, is unclear. We studied the prevalence of MCI in DM patients.Methods: Neuropsychological status was evaluated using the Rivermead Behavioral Memory Test (RBMT) and the Mini Mental State Examination (MMSE). Subjects consisted of 103 consecutive diabetic patients hospitalized for diabetic education. Patients with severe diabetic complications or cerebrovascular accidents were excluded.Results: Neuropsychological evaluation of DM patients showed that 71% were normal (MMSE score ≥24 and RBMT score ≥15), 5% had amnestic MCI (aMCI) (MMSE score ≥24 and RBMT score <15) and the remaining 23% had dementia (MMSE score <24). The percentage of patients with dementia was significantly higher in the DM group than in the control group (p<0.04). RBMT score and HbA1c were mildly correlated in diabetic patients.Conclusion: High blood sugar may cause deterioration in not only memory function but also other cognitive domains in elderly patients with DM. Monitoring the neuropsychological status of this patient population is important.

Diabetic Nephropathy Remission and Regression Team Trial in Japan (DNETT-Japan): Rationale and study design

2009-11-05

Abstract: The prevalence of end-stage renal disease (ESRD) is uprising in the paralleled with the increase of chronic kidney disease (CKD) patients. Diabetic nephropathy (DN) is the most important underlying disease of CKD and a leading cause of ESRD in Japan. Intensified multifactorial intervention in patients with type 2 diabetes with microalbuminuria slows the progression to nephropathy, and progression of retinopathy and autonomic neuropathy. However, further studies are needed to establish the effect of intensified multifactorial treatment on DN with overt proteinuria. In this trial, doctors and co-medicals collaborate to treat the DN patients to prevent the deterioration of DN by multifactorial intensive therapy. Diabetic Nephropathy Remission and Regression Team Trial in Japan (DNETT-Japan) is an open, randomized controlled trial to evaluate the efficacy of renal protection of multifactorial intensive therapy in type 2 diabetes patients with overt proteinuria (urinary albumin-to-creatinine ratio ≥300mg/g creatinine). The study has a targeted enrollment of 600 Japanese patients, and divided into two protocols by renal insufficiency (protocol A: serum creatinine: <1.2mg/dl in male and <1.0mg/dl in female, and protocol B: serum creatinine: 1.2–2.5mg/dl in male and 1.0–2.5mg/dl in female). The patients were allocated standard treatment or intensive multifactorial treatment. Intensive treatment was a stepwise implementation of behavior modification, pharmacological therapy targeting hyperglycaemia, hypertension, dyslipidaemia, and proteinuria. The primary outcome is the proteinuria in protocol A and the composite endpoint of time to the first occurrence of doubling of serum creatinine, ESRD (the need for chronic dialysis, or renal transplantation) or death in protocol B. The follow-up period is 5 years and the study ends in 2014.

Association between plasma high-sensitivity C-reactive protein and insulin resistance and white matter lesions in Japanese type 2 diabetic patients

2009-11-23

Abstract: The presence of white matter lesions (WML) is an important prognostic factor for the development of stroke. High-sensitivity C-reactive protein (HSCRP), which is associated with diabetes, has been flagged as a novel predictor for cerebrovascular events. This preliminary study was therefore designed to test the hypothesis that the presence of WML correlates with HSCRP and insulin resistance in type 2 diabetic patients not receiving insulin treatment.Based on brain magnetic resonance imaging (MRI) findings, 102 type 2 diabetic patients were divided into two groups; a WML-positive group (59±6 years, mean±SD, n=40) and a WML-negative group (58±6 years, n=62). The level of blood glucose was assessed by fasting plasma glucose (FPG), fasting immunoreactive insulin (F-IRI), homeostasis model assessment (HOMA) index, and Hemoglobin A1c (HbA1c).The body mass index was higher in the WML-positive group than in the WML-negative group (p<0.05). Plasma levels of triglycerides were higher while high-density lipoprotein cholesterol (HDL-C) was lower in the WML-positive group than in the WML-negative group (p<0.01 and p<0.005, respectively). Fasting plasma glucose (p<0.005), insulin concentrations (p<0.0001), HOMA index (p<0.0001), and HSCRP (<0.0001) levels were higher in the WML-positive group than in the WML-negative group. Multivariate logistic analysis revealed that WML was independently predicted by the high HSCRP and insulin resistance (p<0.005, p<0.0005, respectively).The results of this preliminary study indicate that the presence of WML was associated with the high HSCRP and insulin resistance in these Japanese patients with type 2 diabetes mellitus; larger cohort studies are warranted to confirm these findings.

Masked hypertension, nocturnal blood pressure and retinopathy in normotensive patients with type 1 diabetes

2009-11-19

Abstract: Aim: To analyze the prevalence of masked hypertension and its possible association with microvascular complications in patients with type 1 diabetes (T1D).Methods: A cross-sectional study was conducted in 188 consecutive normotensive patients at the office with T1D without renal replacement therapy or previous renal transplant. All patients were assessed regarding the presence of diabetic retinopathy (DR) (direct and indirect fundoscopy), urinary albumin excretion rate (immunoturbidimetry), and ambulatory blood pressure monitoring (ABPM) (Spacelabs 90207).Results: Masked hypertension was observed in 14 (13.6%) out of 103 clinical normotensive patients and in 7.4% of the entire cohort. Twenty-three percent of patients with clinical normotension had masked nocturnal hypertension. DR was associated with night systolic and diastolic BP [OR of each 5mmHg change 1.41 (95%CI: 1.09–1.83, P=0.009) and 1.40 (95%CI: 1.02–1.93, P=0.04), respectively] and with masked nocturnal hypertension [OR: 3.23 (95%CI: 1.29–8.11, P=0.01)].Conclusions: In T1D patients with clinic BP<130/80mmHg, masked hypertension and especially masked nocturnal hypertension are present. Normotensive patients with nocturnal BP>120/70mmHg have higher presence of DR, and only will be identified through ABPM.

Evaluation of a simple policy for pre- and post-prandial blood glucose self-monitoring in people with type 2 diabetes not on insulin

2009-12-02

Abstract: Background and aims: Since there is no agreement on regimens of self-monitoring of blood glucose (SMBG) in type 2 diabetes not on insulin, we evaluated the effects of a simple SMBG policy taking into account compliance.Methods and results: 273 type 2 diabetic patients not on insulin with HbA1c >7% attending our Diabetes Clinic and already using SMBG were randomized as follows: Group A, one BG profile/month with fasting and post-prandial values; Group B, one BG profile every 2 weeks with pre- and post-prandial values. Patients were followed-up by the same team every 3 months with the same education and treatment policies. At 3 and 6 months, SMBG profiles were evaluated and HbA1c measured. SMBG was carried out as recommended by 73% of Group A and 44% of Group B patients. In compliant patients, HbA1c and BG were unchanged in Group A whereas in Group B fasting, pre-prandial and two out of three post-prandial BG values were reduced and HbA1c decreased from 8.09±0.84% to 7.60±0.73% (p<0.001). The influence on BG control was similar for the two policies when compliance was not considered.Conclusions: The more intensive SMBG policy considered is associated with improvements in glycaemic control in compliant subjects.

Evaluation and comparison of guidelines for the management of people with type 2 diabetes from eight European countries

2009-11-23

Abstract: Methods: The most recent nationally recognised guidelines for type 2 diabetes from eight European countries (Belgium, England/Wales, France, Germany, Ireland, Italy, the Netherlands and Sweden) were compared. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was used for quality assessment. Details of recommendations for key process and outcome indicators were also extracted. Appraisal and data extraction were conducted independently by two researchers.Results: AGREE domain scores varied between guidelines, including a range of 31–95% for rigour of development. The highest mean domain scores were for Scope and Purpose (81%) and Clarity and Presentation (85%); the lowest was for Stakeholder Involvement (49%). Specific recommendations, including targets relating to intermediate outcomes, were broadly similar. However, at detailed level, there were variations, particularly in terms of the level of information provided, for example, only two countries’ guidelines provided cut-off points in relation to risk associated with waist circumference.Implications: Our findings suggest that there are some areas of good practice relating to guideline development where more attention is needed. Despite a substantial degree of consensus for specified targets, observed differences at detailed level suggest a lack of consistency in relation to some aspects of the information provided to clinicians across Europe.

Hypomagnesaemia is associated with diabetes: Not pre-diabetes, obesity or the metabolic syndrome

David Simmons, Supriya Joshi, Jonathan Shaw — 2009-12-09

Abstract: Aims: The mechanism for the association between diabetes and hypomagnesaemia remains uncertain. This study aimed to test whether hypomagnesaemia is present in pre-diabetes, obesity and the metabolic syndrome.Methods: 1453 adults from randomly selected households from rural Victoria, Australia, attended for biomedical assessment. Serum magnesium concentrations, hypomagnesaemia defined using local laboratory criteria (<0.70mmol/l), and defined by the bottom quintile of serum magnesium concentrations, were compared in different diabetes pre-cursor states including metabolic syndrome using ATP III criteria.Results: The mean serum magnesium was 0.84±0.06mmol/l and 25 (1.7%) had a low magnesium. Mean magnesium was lower among those with known diabetes than those with new diabetes, impaired glucose tolerance (IGT), impaired fasting glucose (IFG) and normal subjects (0.79 (0.78–0.81) vs 0.83 (0.81–0.86); 0.84 (0.82–0.85); 0.84 (0.82–0.86); 0.85 (0.84–0.85)mmol/l). After adjusting for confounders, and compared with those without diabetes, hypomagnesaemia was 10.51 (1.37–80.60)-fold more common with new diabetes, 8.63 (2.20–33.90)-fold more common with known diabetes, 6.77 (1.75–26.17)-fold more common among those taking anti-hypertensive medication but with no difference to those with IGT/IFG (0.90 (0.10–8.10)).Conclusion: Diabetes is associated with hypomagnesaemia, but not its pre-cursor states.

Development and validation of a risk-score model for subjects with impaired glucose tolerance for the assessment of the risk of type 2 diabetes mellitus—The STOP-NIDDM risk-score

2009-12-21

Abstract: Aims: To develop a risk-score model, based on available clinical data to assess absolute risk of type 2 diabetes among people with impaired glucose tolerance (IGT).Methods: Data from the study to prevent non-insulin dependent diabetes mellitus (STOP-NIDDM) investigating acarbose treatment in individuals with IGT were used to develop multivariable Cox proportional hazards model for the time to onset of diabetes. The final model equation was externally validated using data from the Finnish Cardiovascular Risk Factor (FINRISK) population.Results: The risk-score model included the variables acarbose treatment, gender, serum triglyceride level, waist circumference, fasting plasma glucose, height, history of cardiovascular disease (CVD) and hypertension. The final model yielded an area under the receiver-operating-characteristic curve (AUCROC) of 0.64 when applied to people with IGT in the STOP-NIDDM, and 0.84 and 0.90 when applied to FINRISK population with IGT alone and IGT and normal glucose tolerance combined, respectively; AUCROC is a measure of the discriminatory power of the model (1, perfect discrimination).Conclusions: The STOP-NIDDM risk-score is a simple and validated tool that can identify high-risk individuals with IGT who would benefit most from type 2 diabetes or CVD prevention strategies, such as lifestyle management or early acarbose treatment.

Trends in lower extremity amputations in people with and without diabetes in England, 1996–2005

Eszter Panna Vamos, Alex Bottle, Azeem Majeed, Christopher Millett — 2009-12-21

Abstract: Aims: To examine trends in non-traumatic lower extremity amputations over a 10-year-period in people with and without diabetes (DM) in England.Methods: All individuals admitted to NHS hospitals for non-traumatic amputations between 1996 and 2005 in England were identified using hospital activity data. Postoperative and 1-year mortality were examined between 2000 and 2004.Results: There was a reduction in minor and major amputations during the study period. The number of type 1 DM- and non-DM-related minor amputations decreased by 11.4% and 32.4%, respectively, while the number of type 2 DM-related minor amputations almost doubled. The incidence of type 1- and non-DM-related minor amputations decreased from 1.5 to 1.2 and from 8.1 to 5.1/100,000 population, respectively, while type 2 DM-related amputations increased from 2.4 to 4.1/100,000 population. The number of type 1- and non-DM-related major amputations declined by 41% and 22%, respectively, whereas type 2 DM-related amputations increased by 43%. The incidence of type 2 DM-related amputations increased from 2.0 to 2.7/100,000 population. Overall perioperative and 1-year mortality did not significantly change between 2000 and 2004.Conclusions: While several factors may explain the increase in type 2 DM-related LEAs, these findings highlight the importance of diabetes prevention strategies and controlling risk factors for LEAs in people with diabetes.

Glucose tolerance, insulin resistance and insulin secretion in young south Indian adults: Relationships to parental size, neonatal size and childhood body mass index

2010-02-01

Abstract: Objective: To study the relationship of newborn size and post-natal growth to glucose intolerance in south Indian adults.Research design and methods: 2218 men and women (mean age 28 years) were studied from a population-based birth cohort born in a large town and adjacent rural villages. The prevalence of adult diabetes mellitus [DM] and impaired glucose tolerance [IGT], and insulin resistance and insulin secretion (calculated) were examined in relation to BMI and height at birth, and in infancy, childhood and adolescence and changes in BMI and height between these stages.Results: Sixty-two (2.8%) subjects had Type 2 diabetes (DM) and 362 (16.3%) had impaired glucose tolerance (IGT). IGT and DM combined (IGT/DM) and insulin resistance were associated with low childhood body mass index (BMI) (p<0.001 for both) and above-average BMI gain between childhood or adolescence and adult life (p<0.001 for both). There were no direct associations between birthweight or infant size and IGT/DM; however, after adjusting for adult BMI, lower birthweight was associated with an increased risk.Conclusions: The occurrence of IGT and Type 2 DM is associated with thinness at birth and in childhood followed by accelerated BMI gain through adolescence.

Identification of two novel variants in PRKAG2 gene in Tunisian type 2 diabetic patients with family history of cardiovascular disease

2009-12-21

Abstract: We report the identification of two novel polymorphisms in the PRKAG2 gene and preliminary association study between 5′-UTR and exon 1 polymorphisms with susceptibility to type 2 diabetes. No association with type 2 diabetes was identified. However, one of these newly identified polymorphisms (p.Ser20Ile) is likely associated with cardiac disease.

Overcoming barriers to diabetes care: Perceived communication issues of healthcare professionals attending a pilot Diabetes UK training programme

Kylie Mosely, Aysha Aslam, Jane Speight — 2009-12-31

Abstract: As part of our evaluation of the Diabetes UK Careline workshop “Overcoming barriers to diabetes care”, we received feedback from 18 healthcare professionals. Generally, they felt competent in identifying patients’ psychosocial issues but less knowledgeable/skilled in handling them. Lack of time, privacy and support were barriers to addressing patients’ psychosocial concerns.

A Telemedicine system based on Internet and short message service as a new approach in the follow-up of patients with gestational diabetes

2009-12-31

Abstract: To evaluate the feasibility of a Telemedicine system based on Internet and short message service in the follow-up of patients with gestational diabetes. Compared to control group, Telemedicine group reduced 62% the number of unscheduled face-to-face visits, and 82.7% in the subgroup of insulin-treated patients, improving patient satisfaction, and achieving similar pregnancy and new born outcomes.

Diabetes Research and Clinical Practice

Contents

The status of national diabetes programmes: A global survey of IDF member associations

International Diabetes Federation: An update of the evidence concerning the prevention of type 2 diabetes

On what evidence-base do we recommend self-monitoring of blood glucose?

Plasma sRAGE is not associated with urinary microalbumin excretion in type 2 diabetic nephropathy at the early stage

Effects of antioxidants on glucose-induced oxidative stress and endoplasmic reticulum stress in endothelial cells

Evaluation of podocyte lesion in patients with diabetic nephropathy: Wilms’ tumor-1 protein used as a podocyte marker

Plasma apelin levels and apelin/APJ mRNA expression in patients with gestational diabetes mellitus

Involvement of the cholinergic pathway in glucocorticoid-induced hyperinsulinemia in rats

Plasminogen activator inhibitor-1 (PAI-1) activity and retinal vascular calibre in type 2 diabetes

Peripheral endomorphin-1 levels are suppressed in diabetic patients

Patient-reported tolerability issues with oral antidiabetic agents: Associations with adherence; treatment satisfaction and health-related quality of life

Aspirin for primary prevention of cardiovascular events in patients with diabetes: A meta-analysis

Analysis of continuous patient data from the Czech National Register of patients with type 1 and type 2 diabetes using insulin pump therapy

Neuropsychological status of elderly patients with diabetes mellitus

Diabetic Nephropathy Remission and Regression Team Trial in Japan (DNETT-Japan): Rationale and study design

Association between plasma high-sensitivity C-reactive protein and insulin resistance and white matter lesions in Japanese type 2 diabetic patients

Masked hypertension, nocturnal blood pressure and retinopathy in normotensive patients with type 1 diabetes

Evaluation of a simple policy for pre- and post-prandial blood glucose self-monitoring in people with type 2 diabetes not on insulin

Evaluation and comparison of guidelines for the management of people with type 2 diabetes from eight European countries

Hypomagnesaemia is associated with diabetes: Not pre-diabetes, obesity or the metabolic syndrome

Development and validation of a risk-score model for subjects with impaired glucose tolerance for the assessment of the risk of type 2 diabetes mellitus—The STOP-NIDDM risk-score

Trends in lower extremity amputations in people with and without diabetes in England, 1996–2005

Glucose tolerance, insulin resistance and insulin secretion in young south Indian adults: Relationships to parental size, neonatal size and childhood body mass index

Identification of two novel variants in PRKAG2 gene in Tunisian type 2 diabetic patients with family history of cardiovascular disease

Overcoming barriers to diabetes care: Perceived communication issues of healthcare professionals attending a pilot Diabetes UK training programme

A Telemedicine system based on Internet and short message service as a new approach in the follow-up of patients with gestational diabetes