A case-control study of physical activity and non-insulin dependent diabetes mellitus (NIDDM). the San Luis Valley Diabetes Study

PURPOSE: The purpose of this study was to examine the association between physical activity and non-insulin dependent diabetes mellitus (NIDDM). METHODS: We conducted a population-based case-control study in Hispanic and non-Hispanic white men and women, ages 20-74. A total of 167 cases with NIDDM and 1100 controls with normal glucose tolerance were included. All subjects completed an oral glucose tolerance test. RESULTS: Persons with recently diagnosed NIDDM reported significantly lower levels of physical activity than control subjects. For total metabolic units, the odds ratio for subjects in the highest tertile compared to those in the lowest tertile was 0.60 (95% confidence interval (CI) = 0.37-0.98) after adjusting for age, sex, ethnicity, and family history of diabetes. The adjusted odds ratio for persons reporting high levels of vigorous activity (at least three times per week for 20 minutes) was also less than 1, but was not statistically significant (odds ratio (OR) = 0.73, 95% CI = 0.47-1.14). Similar adjusted odds ratios were observed for high versus low levels of self-assessed work activity (OR = 0.50, 95% CI = 0.34-0.74) and leisure time physical activity (OR = 0.62, 95% CI = 0.44-0.90). Further adjustments for body mass index attenuated the strength of the association between physical activity and NIDDM. This is consistent with the hypothesis that obesity is one consequence of physical inactivity that puts individuals at increased risk for NIDDM. The association of physical activity and NIDDM was stronger in Hispanic than in non-Hispanic white subjects, although this difference was not statistically significant. CONCLUSIONS: High levels of physical activity are associated with lower odds of NIDDM and this relationship may be stronger in Hispanic subjects.     

Cost-effectiveness of the primary prevention of non-insulin dependent diabetes mellitus

Non-insulin dependent diabetes mellitus (NIDDM) is a chronic disease, with increasing prevalence widely reported. NIDDM is associated with high rates of morbidity and premature mortality and is the cause of high health service use. There is clinical, epidemiological and scientific evidence that NIDDM is potentially preventable through weight loss, enhanced fitness and nutrition modification. The research question addressed in this article is whether the prevention of NIDDM is cost-effective compared with other possible uses of our health care resources and whether some approaches to NIDDM prevention are more cost-effective than others. Program types analysed are surgery, group behavioural program, media campaign, general practitioner (family physician) lifestyle advice, and intensive diet and behavioural programs. Target groups include seriously obese persons, women with previous gestational diabetes, over-weight men and all adults. Expected diabetes years and life years were modelled for hypothetical intervention and control cohorts and used, with information on program cost, to derive estimates of cost-effectiveness, expressed as cost per diabetes year avoided and cost per life year gained. Markov modelling was used to track states of normal glucose tolerance, impaired glucose tolerance (IGT) and NIDDM for intervention and control cohorts. Expected life years were calculated through application of age and gender specific mortality vectors, adjusted for diabetic state and weight loss. Expected savings in health care costs from NIDDM prevention were based on estimated annual cost of NIDDM management and were used to derive net cost-effectiveness ratios. The group program for overweight men and media programs were identified as extremely worthwhile, generating estimated net savings in health care resources, while reducing diabetes incidence and extending life expectancy. The behavioural/diet programs for high risk groups were found to be highly cost-effective relative to other health care programs, at an estimated net cost per life year saved of between A1000 (US720) and A2600 (US1900). Surgery performed poorest, but still well at A4600 (US3300) net cost per life year saved, if targeted at persons with IGT. We conclude that the primary prevention of NIDDM can be highly cost-effective. The development and funding of pilot programs for NIDDM prevention is recommended to test these findings and address the increasing incidence of NIDDM.Keywords: cost-effectiveness; non-insulin dependant diabetes mellitus; primary prevention      

An audit of diabetes control, dietary management and quality of life in adults with type 1 diabetes mellitus, and a comparison with nondiabetic subjects

OBJECTIVES: The study's objective was to audit current diet and disease management in a community-based sample of people with type 1 diabetes. METHODS: The study involved adults with type 1 diabetes and control subjects. Reported amounts of dietary intake were collected. Indices of diabetes control were determined by standard methods. Quality of life of both groups was assessed with appropriate measures. Results were compared between two groups. RESULTS: Mean HbA(1c) concentration was 8.5% (SD 2.21%) for women with diabetes and 8.6% (SD 1.91%) for men. There was no significant difference between the diabetic and control subjects in self-reported energy intake and macronutrient intake, with the exception that the contribution of saturated fatty acid to energy intake was higher in male controls than in male diabetics. There was no association between dietary intakes and glycemic control in diabetic subjects. Anthropometric measurements, blood pressure and plasma lipids in patients were within normal range and not significantly different from the controls. Plasma fibrinogen concentration was higher in patients. Diabetic subjects did not have a diminished quality of life. CONCLUSIONS: Dietary management in these patients was generally focused on controlling carbohydrate intake. Most had suboptimal diabetes control.     

Predicting physical quality of life among a multiethnic sample of breast cancer survivors

Background  

This study aims to test the utility and applicability of the physical quality of life (PQOL) model based on the Contextual Model of Health-Related Quality of Life (HRQOL). Specifically, this study focuses on investigating the different patterns in the structural model of PQOL according to four major U.S. ethnic groups and the mediating effects of psychological well-being between the systemic-level constructs and PQOL.     

Peripheral insensate neuropathy--a tall problem for US adults?

The relation between height and lower extremity peripheral insensate neuropathy among persons with and without diabetes was examined by use of the 1999-2002 US National Health and Nutrition Examination Survey with 5,229 subjects aged 40 or more years. A monofilament was used to determine whether any of three areas on each foot were insensate. Peripheral insensate neuropathy was defined as the presence of one or more insensate areas. Its prevalence was nearly twice as high among persons with diabetes (21.2%) as among those without diabetes (11.5%; p < 0.001). Men (16.2%) had 1.7 times the prevalence of peripheral insensate neuropathy as did women (9.4%), but the difference was not significant after adjustment for height. Greater height was associated with increased peripheral insensate neuropathy prevalence among persons with and without diabetes (p < 0.001). This association was characterized by a sharp increase in prevalence among persons who were taller than 175.5 cm. Peripheral insensate neuropathy risk was significantly higher among those taller than 175.5 cm (adjusted odds ratio = 2.3, 95% confidence interval: 1.5, 3.5). The authors conclude that body height is an important correlate of peripheral insensate neuropathy. This association largely accounts for the difference in peripheral insensate neuropathy prevalence between men and women. Height may help health-care providers to identify persons at high risk of peripheral insensate neuropathy.     

Microsatellite polymorphism in the heme oxygenase-1 gene promoter is associated with iron status in persons with type 2 diabetes mellitus

BACKGROUND: High iron stores are known to cause type 2 diabetes mellitus in persons with hemochromatosis. However, it is not clear whether moderately elevated iron stores predict the risk of type 2 diabetes in healthy persons. Heme oxygenase (HO) 1 expression is increased when intracellular iron increases. Furthermore, HO shows a microsatellite polymorphism in its gene promoter that could be related to its expression and activity. OBJECTIVES: We aimed to determine the length of (GT)(n) repeats in the HO1 gene promoter by using capillary electrophoresis and HO enzymatic activity in mononuclear cells (MNCs) from adult diabetes patients. We also aimed to assess the relation between these results and iron stores. DESIGN: We studied 99 patients with type 2 diabetes mellitus and 90 nondiabetic (control) subjects. We determined iron status (serum iron, ferritin, and transferrin receptor), HO activity, and micropolymorphism. RESULTS: One diabetes patient and 5 control subjects had iron deficiency anemia. No iron overload was detected in either group. Diabetes patients had significantly greater iron stores (P < 0.0001), total body iron (P < 0.001), and HO activity (P < 0.001) than did control subjects. A positive association between serum iron and HO activity was seen in the diabetes patients (P < 0.0001). Allelic frequency did not differ significantly between diabetes patients and control subjects; however, the frequency of the SM genotype was significantly higher and that of the SS and MM genotypes was significantly lower in the diabetes patients than in control subjects (P < 0.001 for all). CONCLUSIONS: Type 2 diabetes patients carrying short (GT)(n) repeats may have higher ferritin values and greater HO enzymatic activity and may have greater susceptibility to diabetes than may those with long (GT)(n) repeats.     

Serum lipids, lipoproteins, and apolipoproteins and the excessive occurrence of coronary heart disease in non-insulin-dependent diabetic patients

Serum lipids, lipoproteins, and major apolipoproteins and their association with previous myocardial infarction were studied in patients with non-insulin-dependent diabetes mellitus (NIDDM) and nondiabetic subjects in East and West Finland in 1982-1984. NIDDM patients had higher age-adjusted serum triglyceride and apolipoprotein B levels and a higher apolipoprotein B/apolipoprotein A-I ratio, lower serum high density lipoprotein (HDL) cholesterol and apolipoprotein A-1 levels, and a lower HDL cholesterol/apolipoprotein A-1 ratio than nondiabetic subjects. With a few exceptions, these differences persisted after adjustment for body mass index, alcohol intake, physical activity, smoking, and hypertension, which suggests that the atherogenic serum lipoprotein pattern in NIDDM is an inherent feature of the disease. In general, the association of serum lipids, lipoproteins, and apolipoproteins with myocardial infarction was similar in nondiabetic subjects and NIDDM patients, although it was somewhat stronger in the diabetic subjects. A low serum HDL cholesterol/apolipoprotein A-1 ratio, which was closely linked to high serum triglyceride level, seemed to be more consistently related to myocardial infarction in NIDDM patients than in nondiabetic subjects. Serum lipids, lipoproteins, and apolipoproteins, either separately or in various combinations, could only to a small extent explain the higher prevalence of myocardial infarction in diabetic subjects compared with nondiabetic subjects when tested in multivariate analysis with other cardiovascular risk factors as background variables. The association between serum lipoproteins and myocardial infarction was largely similar in East and West Finland, two areas that differ markedly with respect to the occurrence of coronary heart disease.     

Increased prevalence of clinical gallbladder disease in subjects with non-insulin-dependent diabetes mellitus

The association between non-insulin-dependent diabetes mellitus (NIDDM) and the prevalence of gallbladder disease remains controversial. The authors investigated this association in 1,250 men and 1,656 women from the San Antonio Heart Study (1984-1988) a population-based study of diabetes and cardiovascular disease. A total of 68% of the subjects were Mexican American, a population at high risk for both gallbladder disease and NIDDM. Gallbladder disease was assessed by self-report, and the prevalence of diabetes was determined using National Diabetes Data Group criteria. NIDDM was significantly associated with gallbladder disease in Mexican-American men and women and in non-Hispanic white women. After adjustment for age, body mass index, ratio of waist-to-hip circumference, and ethnicity, using multiple logistic regression, the odds of gallbladder disease in women was 1.6 times higher if NIDDM was present (odds ratio = 1.60, 95% confidence interval 1.08-2.37). Mexican-American women also had a significantly increased prevalence of gallbladder disease relative to non-Hispanic white women (odds ratio = 2.21, 95% confidence interval 1.50-3.28). In nondiabetic women, fasting insulin was significantly related to prevalence of gallbladder disease in univariate analyses, but not in multivariate analyses. The authors conclude that women with diabetes have an increased prevalence of gallbladder disease relative to nondiabetic women and that this association is not explained by the greater adiposity or unfavorable body fat distribution of the diabetic subjects.     

Perceived quality of life: a neglected component of adolescent health assessment and intervention.

The contribution of the construct of perceived quality of life (PQOL) to adolescent health assessment and promotion is discussed. Theory, measurement, and correlates of PQOL in adolescence are reviewed, with a focus on the incremental validity of PQOL data in relationship to more traditional pathology-based health indices. Similar to Diener's proposal, which pertained exclusively to adults, we call for the inclusion of PQOL data in national databases that monitor adolescent health outcomes.     

Glucose and insulin responses to dietary chromium supplements: a meta-analysis

BACKGROUND: Several authors, mostly on the basis of nonrandomized studies, have suggested dietary trivalent chromium supplementation as an attractive option for the management of type 2 diabetes and for glycemic control in persons at high risk of type 2 diabetes. OBJECTIVE: The study aimed to determine the effect of chromium on glucose and insulin responses in healthy subjects and in individuals with glucose intolerance or type 2 diabetes. DESIGN: The study design was a systematic review and meta-analysis of randomized clinical trials (RCTs). RESULTS: The authors identified 20 reports of RCTs assessing the effect of chromium on glucose, insulin, or glycated hemoglobin (Hb A(1c)). This review summarizes data on 618 participants from the 15 trials that reported adequate data: 193 participants had type 2 diabetes and 425 were in good health or had impaired glucose tolerance. The meta-analysis showed no association between chromium and glucose or insulin concentrations among nondiabetic subjects. A study of 155 diabetic subjects in China showed that chromium reduced glucose and insulin concentrations; the combined data from the 38 diabetic subjects in the other studies did not. Three trials reported data on Hb A(1c): one study each of persons with type 2 diabetes, persons with impaired glucose tolerance, and healthy subjects. The study of diabetic subjects in China was the only one to report that chromium significantly reduced Hb A(1c). CONCLUSIONS: Data from RCTs show no effect of chromium on glucose or insulin concentrations in nondiabetic subjects. The data for persons with diabetes are inconclusive. RCTs in well-characterized, at-risk populations are necessary to determine the effects of chromium on glucose, insulin, and Hb A(1c).     

The relationship between active living and health-related quality of life: income as a moderator

This study used a moderator model to examine the relationship between active living and the physical components of health-related quality of life [i.e. overall physical component of quality of life (PQOL), physical functioning and ability to fulfill physical role] among a randomly selected sample of rural residents (n = 407) from the Midwestern US. Results showed that active living was associated with greater increases in health-related quality of life for those reporting lower income. The effect size of the relationship between active living and the PQOL for the low-income group was over 2 times the effect size for the high-income group. For physical functioning, the effect size of active living for the low-income group was greater than 3 times the effect size for the high-income group. Although active living behaviors have been demonstrated to be less prevalent among those of low socioeconomic status, this group may have the most to gain from these activities. Findings highlight the need for increased and specifically targeted promotion of active living interventions.     

A prospective study of postmenopausal estrogen therapy and subsequent incidence of non-insulin-dependent diabetes mellitus.

The potential influence of postmenopausal estrogen therapy on the subsequent development of non-insulin-dependent diabetes mellitus (NIDDM) is relatively unexplored, despite postulated effects of these hormones on glucose tolerance. We examined the association between postmenopausal hormone use and the subsequent incidence of NIDDM in a prospective cohort of 21,028 postmenopausal US women aged 30 to 55 years and free of diagnosed diabetes, cardiovascular disease, and cancer in 1976. During 12 years of follow-up (422,991 person-years), we confirmed 1249 cases of NIDDM. Current users of postmenopausal hormones had a relative risk of NIDDM of 0.80 (95% confidence interval, 0.67 to 0.96) as compared with never users, after adjustment for age and body mass index (BMI). Past users of these hormones had an age- and BMI-adjusted relative risk of 1.07 (0.93 to 1.23). These results were not materially altered by multivariate adjustment for age, BMI, family history of diabetes, and coronary risk factors. Comparable results were obtained when the analysis was restricted to symptomatic NIDDM as the outcome. We observed no appreciable modification of these associations by family history of diabetes or category of BMI. Duration of current or past use of postmenopausal hormones and dose of conjugated estrogen were not significantly related to incidence of NIDDM. Type of hormone (estrogen alone, progesterone alone, or combination) also did not appear to influence NIDDM risk. These prospective data indicate that postmenopausal hormone therapy is unlikely to be associated with a material increase in the incidence of NIDDM among women.     

Syndrome X: Is it for real?

The term syndrome X has been applied to the association of hypertension, non-insulin-dependent diabetes mellitus (NIDDM), android obesity, insulin resistance, and dyslipidemia. In this paper, based on population samples from Tecumseh, Michigan, and Hiroshima, Japan, characterized by persons ≥40 years of age, we examine the validity of regarding this constellation of traits as a true syndrome, i.e., an array of traits with a single, unifying pathophysiology underlying its components. Data were not available on insulin resistance and dyslipidemia, and obesity was expressed as body mass index (BMI) without the division into android and non-android types. The four ethnic-gender data sets were analyzed on the basis of two age classes, age ≥40 years and age ≥50 years, and two obesity classes, BMI ≥27 and ≥30. A simple χ² test of goodness-of-fit under a model of independence revealed non-random associations between hypertension, NIDDM, and BMI which were in part attributable to an excess of persons with all three traits. However, when the four data sets were subjected to separate log-linear analyses of the three-way association tables, none of the three-factor interaction terms (i.e., syndrome X) was significant. High significance was, however, observed in the two-factor interaction term for BMI*hypertension. It is concluded that the significant association between these three traits is driven by the BMI*hypertension interaction, and there is no evidence in these data sets of a significant role for a syndrome X. Genet. Epidemiol. 15:19–32,1998. © 1998 Wiley-Liss, Inc.     

Diabetes mellitus and risk of Alzheimer's disease and dementia with stroke in a multiethnic cohort

Research on the relation between diabetes mellitus and dementia has produced conflicting results, and the relation has not been investigated among Blacks and Hispanics. In this study, Cox proportional hazards models were used to analyze longitudinal data from 1,262 elderly subjects without dementia at baseline (1991-1996) who were followed for an average of 4.3 years between 1992 and 1997. Outcomes were incident Alzheimer's disease and dementia associated with stroke. The prevalence of diabetes was 20% at baseline. The adjusted relative risk of Alzheimer's disease among persons with diabetes as compared with those without diabetes was 1.3 (95% confidence interval (CI): 0.8, 1.9). The adjusted relative risk for the composite outcome of Alzheimer's disease and cognitive impairment without dementia (without stroke) in subjects with diabetes was 1.6 (95% CI: 1.2, 2.1). The adjusted relative risk of stroke-associated dementia in persons with diabetes was 3.4 (95% CI: 1.7, 6.9). Among Blacks and Hispanics, approximately one third of the risk of stroke-associated dementia was attributable to diabetes (33% (95% CI: 31, 36) and 36% (95% CI: 33, 37), respectively), as compared with 17% (95% CI: 13, 22) among Whites. The finding of an association between diabetes and the composite outcome of Alzheimer's disease and cognitive impairment without dementia (without stroke) is consistent with prior reports of a modest relation between diabetes and Alzheimer's disease.     

Frequent salad vegetable consumption is associated with a reduction in the risk of diabetes mellitus

This cross-sectional study was undertaken to investigate the association between the reported frequency of consumption of vegetables and fruits, the choice of staple carbohydrate, and glucose intolerance. One thousand one hundred twenty-two subjects aged 40-64 years in a population-based study underwent an oral glucose tolerance test, and their food consumption was assessed using a food-frequency questionnaire. The crude prevalence of undiagnosed non-insulin-dependent diabetes mellitus (NIDDM) was 4.5%, and that of impaired glucose tolerance (IGT) 16.8%. The age-standardized prevalence rates were 2.3 and 11.2%, respectively. Frequent consumption of vegetables throughout the year was inversely associated with the risk of having NIDDM (odds ratio [OR] = 0.16; 95% confidence interval [CI] = 0.04-0.69). This association was maintained after adjustment for age, gender, and family history. Vegetable consumption during the summer months had a much weaker inverse association with the risk of having NIDDM that failed to reach statistical significance. A nonsignificant inverse association between frequent consumption of fruits and NIDDM was observed. Frequent self-reported pasta and rice consumption was associated with a reduction in the risk of having IGT and NIDDM. (OR = 0.62, 95% CI = 0.44-0.87, and OR = 0.51, 95% CI = 0.27-0.99, respectively) but this relationship was not independent of age. Whether these associations reflect specific effects of particular nutrients or are a reflection of the patterning of lifestyle factors remains to be determined.     

Does breastfeeding influence risk of type 2 diabetes in later life? A quantitative analysis of published evidence

BACKGROUND: Observational evidence suggests that having been breastfed in infancy may reduce the prevalence of type 2 diabetes in later life. OBJECTIVE: The objective was to examine the influence of initial breastfeeding on type 2 diabetes and blood glucose and insulin concentrations. DESIGN: A systematic review of published studies identified 1010 reports; 23 examined the relation between infant feeding and type 2 diabetes in later life or risk factors for diabetes. Risk factors in infants were examined separately from those in children and adults. All estimates were pooled by using fixed-effect models; differences <0 and ratios <1 imply a beneficial effect of breastfeeding. RESULTS: Subjects who were breastfed had a lower risk of type 2 diabetes in later life than did those who were formula fed (7 studies; 76 744 subjects; odds ratio: 0.61; 95% CI: 0.44, 0.85; P = 0.003). Children and adults without diabetes who had been breastfed had marginally lower fasting insulin concentrations than did those who were formula fed (6 studies; 4800 subjects; percentage difference: -3%; 95% CI: -8%, 1%; P = 0.13); no significant difference in fasting glucose concentrations was observed. Breastfed infants had lower mean preprandial blood glucose (12 studies; 560 subjects; mean difference: -0.17 mmol/L; 95% CI: -0.28, -0.05 mmol/L; P = 0.005) and insulin (7 studies; 291 subjects; mean difference: -2.86 pmol/L; 95% CI: -5.76, 0.04 pmol/L; P = 0.054) concentrations than did those who were formula fed. CONCLUSION: Breastfeeding in infancy is associated with a reduced risk of type 2 diabetes, with marginally lower insulin concentrations in later life, and with lower blood glucose and serum insulin concentrations in infancy.     

Effectiveness of Medical Nutrition Therapy Provided by Dietitians in the Management of Non–Insulin-Dependent Diabetes Mellitus: A Randomized, Controlled Clinical Trial

Objective To assess the the effect of medical nutrition therapy (MNT) provided by dietitians on medical and clinical outcomes for adults with non–insulin-dependent diabetes mellitus (NIDDM), and to compare MNT administered according to practice guidelines nutrition care (PGC) to MNT administered with basic nutrition care (BC).Design A prospective, randomized, controlled clinical trial of two levels of MNT on metabolic control in persons newly diagnosed with or currently under treatment for NIDDM was conducted at diabetes centers in three states (Minnesota, Florida, and Colorado). BC consisted of a single visit with a dietitian; PGC involved an initial visit with a dietitian followed by two visits during the first 6 weeks of the study period. Data were collected at entry to the study and at 3 and 6 months.Subjects Results are reported for 179 men and women aged 38 to 76 years: 85 assigned randomly to BC and 94 to PGC. This represents 72% of the 247 subjects enrolled. An additional 62 adults with NIDDM at one site who had no contact with a dietitian were identified as a nonrandom comparison group.Outcomes Medical outcome measures included fasting plasma glucose (FPG), glycated hemoglobin (HbA_1c), and serum lipid levels. Clinical outcomes included weight, body mass index, waist-to-hip ratio, and changes in medical therapy.Statistical analyses Initial analysis of the discrete variables was done using the χ² statistic with Yates' correction. Initial analysis of continuous variables was done by analysis of variance. The changes in variables between time periods were analyzed by paired t test, and comparisons between groups were analyzed using a t test for independent groups.Results At 6 months, PGC resulted in significant improvements in blood glucose control as indicated by FPG and HbA_1c levels and BC resulted in significant improvements in HbA_1c level. Participants assigned to the PGC group had a mean FPG level at 6 months that was 10.5% lower than the level at entry, and those in the BC group had a 5.3% lower value. Among subjects who had diabetes for longer than 6 months, those who received PGC had a significantly better HbA_1c level at 3 months compared with those receiving BC. The comparison group showed no improvement in glycemic control over a comparable 6 months. PGC subjects had significant improvements in cholesterol values at 6 months, and subjects in both the PGC and the BC groups had significant weight loss.Conclusions MNT provided by dietitians resulted in significant improvements in medical and clinical outcomes in both the BC and PGC groups and is beneficial to persons with NIDDM. Persons with a duration of diabetes longer than 6 months tended to do better with PGC than with BC. Because of the upward trend in glucose levels after 3 months, ongoing MNT by dietitians is important for long-term metabolic control. J Am Diet Assoc. 1995; 95:1009-1017.     

Catalytic amounts of fructose may improve glucose tolerance in subjects with uncontrolled non-insulin-dependent diabetes

BACKGROUND: It was suggested that acute ingestion of small amounts of fructose can improve glucose homeostasis. AIM: To study the effect of a long-term tri-daily supplementation of catalytic amounts of fructose on glucose tolerance of subjects with type 2 diabetes (NIDDM). METHODS: A double-blind, placebo-controlled study. Twenty-six subjects with uncontrolled NIDDM as indicated by high levels of hemoglobin A1C (Hgb(A1c)) and 2-h postprandial glucose levels >200 mg% were assigned to either fructose or maltodextrin supplementation (7.5 g) tri-daily after each main meal. The subjects were challenged with a fixed meal and blood was drawn for determining levels of glucose, insulin and triglycerides before and 2 h after meal at baseline and 1 month after study entry. Blood was drawn for total cholesterol, high-density and low-density lipoprotein cholesterol (LDL-c), fructosamine and Hgb(A1C) before study entry and at 1, 2 and 3 months into the study. RESULTS: No changes were observed in the difference between postprandial and pre-meal glucose, insulin or triglyceride levels in each group or between groups. No significant statistical differences were found in weight, total cholesterol, LDL-c and high-density lipoprotein cholesterol (HDL-c) in each group or between groups along the study period. After 1 month fructosamin levels decreased in the fructose-supplemented group but not in the maltodextrin-supplemented group (P<0.052). Hgb(A1C) levels decreased with time in both groups but were significantly lower at 2 months in the fructose group as compared to the maltodextrin group (P<0.03). CONCLUSIONS: Subjects with NIDDM may benefit from daily supplementation of catalytic amounts of fructose in their diet.