International Journal of Diabetes Mellitus - Articles in Press

Endogenous endophthalmitis secondary to pyogenic liver abscess - Corrected Proof

Musleh Saleh Al-Amri — 2010-02-10

Abstract: A 55year old male presented with abdominal pain and vomiting, followed by a sudden onset of left eye pain, with decreased visual acuity. After clinical and laboratory examinations, the patient was diagnosed with endogenous endophthalmitis, secondary to pyogenic liver abscess, secondary to Klebsiella pneumonia.The patient was managed with intravitreal injection of vancomycin and ceftazidime for 2weeks, which afforded a resolution.Cases of endogenous endophthalmitis pyogenic liver abscess are more commonly reported in the Far East. K. pneumonia primary liver abscess, particularly those associated with metastatic infection, are more commonly reported in Taiwan and are community acquired . This paper reports the first case of endogenous endophthalmitis pyogenic liver abscess in the Middle East.

Type 2 diabetes mellitus red zone - Corrected Proof

Khalid Al-Rubeaan — 2010-02-04

Mapping type 2 diabetes mellitus in the whole globe is both interesting and striking when looking at the actual number of affected people with type 2 diabetes mellitus. Calculating the number of diabetic patients using the prevalence of this disease and the total number of targeted population of any given community, provides a good estimate of the number of people affected by the disease. More than 50% of the global number of diabetic patients inhabit a specific geographical area. This area is located in the northern tropical zone, involving North Africa, and the southwest, southern, southeast and eastern part of Asia. It could be labeled as a type 2 diabetes mellitus red zone, which has variable human and land geography. The diabetes red zone occupies less than 20% of the total land global surface area, but at the same time, is inhabited by more than 50% of the total human population .

Dealing with anxiety: A pilot cognitive behavioural therapy program for diabetic clinic outpatient attendees - Corrected Proof

Gillian Evans, Terry J. Lewin, Kerry Bowen, Julia Lowe — 2010-02-01

Abstract: Aims: To assess a group-based cognitive behaviour therapy [CBT] program in diabetes.Methods: Sixty people with diabetes were randomly allocated to either immediate (29) or 3months delayed (31) CBT groups.Results: DASS scores were reduced by 0.37 standardised [effect-size] units [P<0.01], with a tendency for more marked reductions in anxiety and stress [0.60] among those for whom treatment had been delayed whose HbA1C fell by 0.93% . ADDQoL scores also improved in the short-term but these changes did not persist at 6months.Conclusions: The CBT program led to short-term improvements in anxiety, depression, stress and quality of life.

Biological evaluation of (3β)-STIGMAST-5-EN-3-OL as potent anti-diabetic agent in regulating glucose transport using in vitro model - Corrected Proof

2010-02-01

Abstract: Aim: Insulin resistance is characterized by alterations in insulin signaling components thereby resulting in reduced glucose uptake. The mechanistic role of (3β)-stigmast-5-en-3-ol in augmenting glucose uptake to overcome insulin resistance is deciphered in this study.Main methods: L6 myotubes, rat skeletal muscle model have been used to check the effect of (3β)-stigmast-5-en-3-ol, a plant phytosterol isolated from the ethyl acetate extract of Adathoda vasica on glucose transport. The influence of (3β)-stigmast-5-en-3-ol on various cellular targets of insulin signaling cascade has been evaluated using inhibitors on glucose uptake as well as gene and protein expression to unravel the mechanistic action in triggering glucose uptake.Results: (3β)-stigmast-5-en-3-ol promoted glucose uptake in a dose dependent manner under insulin resistant condition. As assessed by inhibitor studies using Genistein (IRTK inhibitor) and Wortmannin (PI3K inhibitor), gene expression and protein expression studies using specific primers and antibodies, an activation of IR-β, IRS-1, PI3K, AKT/PKB, PKC by both the crude and (3β)-stigmast-5-en-3-ol were observed. This suggested that (3β)-stigmast-5-en-3-ol induced glucose uptake functions through the PI3K dependent pathway in L6 myotubes. Both, the crude and (3β)-stigmast-5-en-3-ol activates GLUT 4 transport (evident from increased mRNA levels and redistribution of GLUT4 from intracellular membrane to plasma membrane through translocation studies). Confocal microscopy revealed a substantial increase in redistribution of FITC tagged GLUT4 throughout the cells.Conclusion: Our results emphasize the insulin-like effect of (3β)-stigmast-5-en-3-ol in stimulating glucose transport in vitro and provide evidence in its beneficial role possessing antidiabetic property apart from its existing cholesterol lowering efficacy.

Dietary fiber psyllium based hydrogels for use in insulin delivery - Corrected Proof

Baljit Singh, Nirmala Chauhan — 2010-01-22

Abstract: The present article is related to the development of psyllium based oral insulin delivery systems that could release insulin in a controlled and sustained manner. Psyllium is a medicinally important gel, forming glucose lowering dietary fiber and drug delivery system developed by its functionalization will have the double potential of curing diabetes. Psyllium and acrylamide/methacrylamide based hydrogels were prepared, and the effect of pH on the release dynamics of insulin from drug loaded hydrogels has been studied to evaluate the drug release mechanism. Non-Fickian diffusion mechanism has been observed for the release of insulin in the pH 7.4 buffer.

I27L Polymorphism in hepatocyte nuclear factor-1α gene and type 2 diabetes mellitus: A meta-analysis of studies about orient population (Chinese and Japanese) - Corrected Proof

2010-01-21

Abstract: Aims: The aim of the study was to investigate the relationship between I27L variant of HNF-1α gene and type 2 diabetes mellitus (T2DM) in an/the oriental population.Methods: We recruited 149 T2DM patients and 96 non-diabetes controls from China. The I27L polymorphism in HNF-1α gene was detected by PCR–RFLP analysis. A mete-analysis of previously published studies on I27L and T2DM of orient population and our new study was performed. Databases of MEDLINE, CBM, and the Cochrane Library (CD-ROM) were electronically searched from January 1980 to April 2008. Analysis was performed by RevMan 4.2 software which was downloaded from website of Cochrane collaboration.Results: (1). The genotype distribution of I27L/exon1 polymorphism in the HNF-1α gene was in Hardy–Weinberg equilibrium (χ2=2.34, 0.05

Mitochondrial tRNALeu(UUR) gene mutation and maternally inherited diabetes mellitus in Pakistan population - Corrected Proof

Khalid Siddiqui — 2010-01-20

I had the chance to read the article published in your journal Vol. 1, Issue 1, dated April 2009, entitled “Mitochondrial tRNALeu(UUR) gene mutation and maternally inherited diabetes mellitus in Pakistan population”, by Naveed et al. . I found this article very interesting, and it could be applicable when looking at gene mutation in maternal inherited diabetes and deafness, in particular, in an identified ethnic group, in this case Pakistani nationals. This ethnic group is known for its high consanguinity rate and prevalence of type 2 diabetes .

Clinical assessment of insulin action during late pregnancy in women at risk for gestational diabetes: Association of maternal glycemia with perinatal outcome - Corrected Proof

2010-01-18

Abstract: Objective: We prospectively evaluated differences in fasting- and oral glucose tolerance test (OGTT)-derived indices of insulin action in Caucasian (Cau) and African-American (AA) pregnant women and compared them with obstetric outcomes.Study design: IRB-approved prospective study in 171 pregnant women undergoing a 3-h OGTT. Mathematical modeling was used to evaluate insulin response, insulin activity and glucose tolerance in fasting and postglucose ingestion state. Insulin sensitivity indices derived from fasting (HOMA-IR) and glucose-stimulated values (SIOGTT) were compared. An insulin sensitivity-secretion index (IS-SI) was calculated from the product of the SIOGTT and early-phase insulin secretion.Results: Forty-nine patients had gestational diabetes (GDM), 28 had gestational impaired glucose tolerance (GIGT) and 94 had normal glucose tolerance after an abnormal glucose challenge test (NGT-abnGCT). Insulin sensitivity was lowest in women with GDM. In all groups, pregnant AA women were significantly more insulin resistant than Cau women, based on both HOMA-IR and SIOGTT, but had enhanced insulin secretion compared to their Cau counterparts. The mean IS-SI progressively improved for all women from GDM to GIGT to NGT-abnGCT. Women with NGT-abnGCT had a higher prevalence of large-for-gestational age (LGA) newborns and significantly higher cesarean section rate.Discussion: Insulin measures along with glucose determinations during OGTT testing in pregnant women at risk for diabetes provide valuable information that varies according to race. We observed that pregnant women with a lesser degree of glucose tolerance abnormality during pregnancy who receive no intervention have a higher risk for LGA infants and significantly increased C-section rate (ClinicalTrials.gov number, NCT006874791).

Fluctuations in glycosylated hemoglobin (HbA1C) as a predictor for the development of diabetic nephropathy in type 1 diabetic patients - Corrected Proof

Jocelyn Eid Fares, Mona Kanaan, Monique Chaaya, Sami T. Azar — 2010-01-18

Abstract: Objective: The incidence of diabetic nephropathy is higher in type 1 diabetic patients with associated risk factors. The within individual fluctuations in HbA1C and its effect on the development of nephropathy was not previously studied. The purpose of this study is to examine whether HbA1C fluctuations are a predictor of the development of diabetic nephropathy independent of mean HbA1C and other risk factors.Methods: One hundred and seventeen patients (64 females and 53 males) were recruited and followed up regularly at least every 3months. The “fluctuations” in HbA1C over time was assessed. HbA1C fluctuation was defined as an increase in HbA1C of more than 2% between two consecutive measurements, or an increase of more than 1% at 2 points in time.Results: Incipient nephropathy was present in 18 and absent in 99 patients. Mean HbA1C was significantly higher in nephropathy than in non-nephropathy patients. The effect of fluctuations on nephropathy appeared to be more significant in patients with poor metabolic control (HbA1C⩾8%).Conclusion: T1D patients who have a similar mean HbA1C may progressively behave differently in terms of developing nephropathy, depending on the fluctuations in HbA1C. This effect seems to be more pronounced among those who have higher values of HbA1C.

Author response: Diphenylhydantoin and insulinoma - Corrected Proof

Lara Al-Khoury Nabbout — 2010-01-14

Thank you for your comment. In this paper, we reported our own experience with diphenylhydantoin (DPH). On the basis of this experience, as well as the wide literature search that we conducted, we personally believe that DPH is superior to the most widely used medication (Diazoxide) in suppressing insulin secretion, Refs. . Our article is published in the category of a Case Report, based upon personal experience, and is not intended to generate recommendations or guidelines. We suggest considering DPH as a temporary therapeutic measure in the preoperative period of patients with insulinoma, as well as an alternative measure for inoperable insulinomas, something that has already been successfully done by others .

Should capillary blood glucose measurements be used in population surveys? - Corrected Proof

2010-01-07

Abstract: Objective: To determine the accuracy and appropriateness of capillary blood glucose testing in population surveys.Materials and methods: Capillary blood glucose using the Rochec ACCU-CHEK instrument and Advantage 11 Test Strips was compared to a laboratory instrument. Three independent cross-sectional risk factor surveys (n=1432) and baseline individuals from the Greater Green Triangle Diabetes Prevention Project (n=341) provided both fasting plasma and capillary blood glucose measurements. Accuracy of capillary glucoses was assessed using the ISO 15197 standard. The median age of the participants was 71years, ranging from 25 to 84years. There were 799 males and 974 females.Results: Capillary glucose method had poorer precision at lower concentrations (CV: 9.50%, mean=3.09mmol/L, CV: 4.90%, mean=16.78mmol/L, n=233 replicates). Individual discrepancies were seen across the measuring range (2.8–19.9mmol/L, n=1773). In total, 94.5% of results fell within the minimum acceptable accuracy standards. This was slightly short of the 95% of results required to meet the ISO 15197 standard. The prevalence of diabetes in the study population using glucose ⩾7.0mmol/L was 2.4% (95%CI 1.8–3.3%) according to fasting plasma glucose and 2.8% (2.1–3.8%) according to fasting capillary glucose. The lower WHO-defined cut-off of 6.1mmol/L for capillary blood glucose testing gave a prevalence of 10.7% (9.0–12.5%).Conclusions: This study of matched capillary and plasma glucose results concludes that while it is appropriate to use fasting capillary glucose levels to determine the prevalence of diabetes in populations, it should not be used to reliably diagnose diabetes in individuals.

Significance of spirometry in diabetic patients - Corrected Proof

Sultan Ayoub Meo — 2010-01-07

Abstract: Spirometry is a widely used pulmonary function test (PFT), ideally suited to describing the effects of obstruction or restriction on lung function. It is a powerful diagnostic tool that plays a significant role in the early diagnosis of lung damage and its associated structures. It is also used to monitor the therapeutic efficacy of various treatment regimes and the course of the disease. The spirometric parameters have gained more popularity when it has been reported that impaired Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 s (FEV1) are emerging novel risk factors for type 2 diabetes mellitus. These spirometric parameter derangements have been evident on spirometry long before the clinical diagnosis of diabetes mellitus or insulin resistance. In spite of this, spirometry is not used routinely as part of a management system in diabetic patients. Its role is neither fully explored, nor fully utilized to achieve quality of life when managing diabetes mellitus. The aim of the present review is to highlight the evidence based significance of spirometry in the light of peer reviewed published literature. It may serve as a brief reference for diabetes management teams to enable spirometry to be included in the algorithm of the routine assessment of diabetic patients.

Diphenylhydantoin and insulinoma - Corrected Proof

Viroj Wiwanitkit — 2010-01-06

Editor, I read the recent publication on the use of diphenylhydantoin for treatment of insulinoma by Nabbout et al. with great interest . Nabbout et al. concluded as follows: “We believe that DPH is a potent inhibitor of insulin secretion and, thus, is suitable as a temporary therapeutic measure in the preoperative period of patients with insulinoma, as well as an alternative to surgery for those who are not surgical candidates .” There are some sporadic reports on the success of using diphenylhydantoin . However, there is a need for more evidence to reach this statement. Success in a few cases might not warrant the efficacy of this new therapeutic approach for insulinoma.

Metabolic syndrome in type 1 diabetes - Corrected Proof

Sujoy Ghosh, Andrew Collier, Mario Hair, Iqbal Malik, Tarik Elhadd — 2009-11-30

Abstract: Objectives: The aim of this study was to assess the prevalence and effects of the presence of metabolic syndrome in patients with type 1 diabetes.Research design and methods: Retrospective analysis of data from a one year period of patients attending annual review clinic was undertaken. Body weight, height and blood pressure were measured along with assessment of micro-/macro-vascular complications. HbA1c, urea, cholesterol, triglyceride, urinary albumin: creatinine ratios were also measured. Patients were divided into those with and those without metabolic syndrome.Results: Data from 365 type 1 diabetic patients was analysed. Hundred and twelve had metabolic syndrome. There was no difference according to gender or smoking. Type 1 diabetic patients with metabolic syndrome had longer duration of diabetes, were significantly older, heavier, had higher blood pressure, higher triglyceride and lower HDL cholesterol levels. There were significant increases in mean BMI, urea, serum creatinine, urinary albumin: creatinine ratio, cholesterol and triglyceride in the group with metabolic syndrome even after controlling for both age and duration of diabetes. Neuropathy and macro-vascular complications were commoner in patients with metabolic syndrome. Patients with metabolic syndrome were more likely to be on statins, ACE inhibitors and angiotensin receptor blockers and had a significantly higher mean insulin dosage requirement per kg.Conclusions: This study highlights the importance of the presence of the metabolic syndrome in patients with type 1 diabetes. It shows that metabolic syndrome is associated with a higher incidence of diabetes-related complications, a need for higher insulin doses and a more aggressive multifactorial intervention.

The challenge of undiagnosed pre-diabetes, diabetes and associated cardiovascular disease - Corrected Proof

Ved V. Gossain, Saleh Aldasouqi — 2009-11-26

Abstract: Objective: To present the challenges of undiagnosed pre-diabetes, diabetes and associated cardiovascular disease.Results: A substantial number of people with diabetes and pre-diabetes remain undiagnosed worldwide. Without preventive measures, pre-diabetes progresses to overt diabetes at the rate of approximately 5% per year. Both diabetes and pre-diabetes are associated with vascular complications.Conclusion: Undiagnosed pre-diabetes and diabetes is a major health problem, and we recommend widespread screening for diabetes. An international expert committee has recommended that HbA1c be used for the diagnosis of diabetes. Further studies are needed before HbA1c can be used as a diagnostic test for gestational diabetes.

Clinical significance of urinary Monocyte Chemoattractant Protein-1 (uMCP-1) in Indian type 2 diabetic patients at different stages of diabetic nephropathy - Corrected Proof

Priyanka Tilak, Zenith Khashim, Satyavani Kumpatla, Mary Babu, Vijay Viswanathan — 2009-11-23

Abstract: Objective: Monocyte Chemoattractant Protein-1 (MCP-1) is the strongest known chemotactic factor for monocytes and is upregulated in diabetic nephropathy. So measuring urinary MCP-1 is of great significance in the diagnosis and intervention of early diabetic nephropathy. This study aims at determining the levels of urinary MCP-1 (uMCP-1) at different stages of diabetic nephropathy and to see its correlation with other parameters in Indian type2 diabetic subjects.Materials and methods: A total of 64 (M:F; 40:24) type 2 diabetic subjects were divided into three groups based on their renal function and were compared with non-diabetic controls (Group 1) n=20 (M:F; 13:7). The study groups were Group 2 (normoalbuminuria) n=16, Group 3 (microalbuminuria) n=23 and Group 4 (macroalbuminuria) n=25. Demographic, anthropometric and biochemical details were recorded for all the subjects. Urinary MCP-1 levels were measured by using solid phase ELISA method.Results: Mean levels of uMCP-1 in subjects with type 2 diabetes were significantly higher than in controls (p<0.05). The levels of uMCP-1 in type 2 diabetic subjects increased gradually with deteriorating renal function (p=0.006). There was a significant difference in urinary MCP-1 levels between Group 2 and Group 1 (p<0.001). Levels of uMCP-1 were significantly higher in subjects with eGFR <60ml/min compared to eGFR >60ml/min (p=0.008). uMCP-1 levels correlated positively with uACR or uPCR (r=0.551, p<0.0001), urea (r=0.43, p<0.0001) and creatinine (r=0.478, p<0.0001). A negative correlation between uMCP-1 and eGFR (r=−0.338, p=0.006) was noted.Conclusion: Our study demonstrated that urinary MCP-1 levels increased gradually in type 2 diabetic subjects with deteriorating renal function. It is significantly associated with the other risk factors of diabetic nephropathy.

Influence of atazanavir on the pharmacodynamics and pharmacokinetics of gliclazide in animal models - Corrected Proof

S.K. Mastan, K. Eswar Kumar — 2009-11-13

Abstract: Background: The objective of this study was to investigate the effect of atazanavir on the pharmacodynamics and pharmacokinetics of gliclazide in rats (normal and diabetic) and rabbits to evaluate the safety and effectiveness of the combination.Methods: Blood samples were analysed for blood glucose by GOD/POD method, serum gliclazide levels by HPLC method and insulin by Radio Immuno Assay method.Results: In combination, atazanavir significantly enhanced the pharmacodynamic activity and altered the pharmacokinetic parameters of gliclazide in animal models.Conclusions: The interaction between atazanavir and gliclazide appears to be pharmacokinetic interaction at metabolic level in animal models.

Peripheral neuropathy in type-II diabetic patients attending diabetic clinics in Al-Azhar University Hospitals, Egypt - Corrected Proof

Khaled Kasim, Morsy Amar, Abdel Aziz El Sadek, Said Abdel Gawad — 2009-11-09

Abstract: Background: Peripheral neuropathy (PN) is a common neurological complication in patients with diabetes mellitus (DM) which affects their quality of life.Objective: To determine the frequency of PN and the risk factors associated with its occurrence in the studied diabetic patients.Subjects and methods: A cross sectional study was conducted in Al-Azhar University Hospitals, Cairo, Egypt. The study recruited 300 patients with type-II DM who attending the outpatient diabetic clinics in the studied hospitals, from October 1st 2005 through January 2006. A clinical neurological examination was conducted for all patients using the Michigan Neuropathy Diabetic Scoring (MNDS) criteria for diagnosis of PN. Subsequently, we considered patients with PN as study cases, and those without PN as controls to assess the risk factors associated with PN. Statistical analysis including multivariate logistic regression analysis was done.Results: The frequency of PN among the studied subjects was 29.7%. Related risk factors were: older age above 60years (odds ratio (OR)=73.0; 95% confidence interval (CI)=14.2–377.2), associated moderate to severe hypertension (OR=10.2; 95% CI=2.8–38.0) and associated ischemic heart disease (IHD) (OR=3.80; 95% CI=1.50–9.80), poor control of DM (OR=9.1; 95% CI=2.6–32.1), and duration of DM. The risk of PN, however, was significantly reduced among married patients and those reported high educational and family income levels.Conclusions: Diabetic PN is a considerable complication of DM. The related risk factors were old age, prolonged and poorly controlled DM and associated medical disorders.

Chronic complications of diabetes mellitus in newly diagnosed patients - Corrected Proof

Iraj Heydari, Vida Radi, Sara Razmjou, Afsaneh Amiri — 2009-10-09

Abstract: The prevalence of Diabetes Mellitus (DM) has increased in recent decades. This study was designed to determine retinopathy, neuropathy, nephropathy, hypertension and hyperlipidemia and their interdependence in newly diagnosed diabetic patients. In this study, 200 consecutive newly diagnosed patients were evaluated and screening tests for retinopathy, neuropathy, nephropathy, hypertension and hyperlipidemia were undertaken.The frequency of positive screening tests for hyperlipidemia, hypertension, neuropathy, nephropathy and retinopathy was found to be 73.5%, 58.5%, 52%, 10%, and 6% respectively.A significant proportion of newly diagnosed diabetic patients have signs of these chronic complications.