Association between self-monitoring of blood glucose and diet among minority patients with diabetes

Background: Self‐monitoring of blood glucose (SMBG) is used to regulate glucose control. It is unknown whether SMBG can motivate adherence to dietary recommendations. We predicted that participants who used more SMBG would also report lower fat and greater fruit and vegetable consumption. Methods: The present study was a cross‐sectional study of 401 primarily minority individuals living with diabetes in East Harlem, New York. Fat intake and fruit and vegetable consumption were measured with the Block Fruit/Vegetable/Fiber and Fat Screeners. Results: Greater frequency of SMBG was associated with lower fat intake (r_s = ?0.15; P < 0.01), but not fruit and vegetable consumption. The effects of SMBG were not moderated by insulin use; thus, the relationship was significant for those individuals both on and not on insulin. A significant interaction was found between frequency of SMBG and changing one’s diet in response to SMBG on total fat intake. The data suggest that participants who use SMBG to guide their diet do not have to monitor multiple times a day to benefit. Conclusion: The present study found that the frequency of SMBG was associated with lower fat intake. Patients are often taught to use SMBG to guide their self‐management. This is one of the first studies to examine whether SMBG is associated with better dietary intake.     

Self‐monitoring in Type 2 diabetes: a randomized trial of reimbursement policy

Aim Self‐monitoring of blood glucose is often considered a cornerstone of self‐care for patients with diabetes. We assessed whether provision of free testing strips would improve glycaemic control in non‐insulin‐treated Type 2 diabetic patients. Methods Adults with Type 2 diabetes, excluding those with private insurance or using insulin, were recruited through community pharmacies and randomized to receive free testing strips for 6 months or not; all patients received similar baseline education and a glucose meter. Primary outcome was change in HbA_1c over 6 months. Results We randomized 262 patients (131 intervention and 131 control subjects). Mean age was 68.4 years (sd 10.9), 48% were male, mean duration of diabetes was 8.2 years (sd 7.2), 97% used oral glucose‐lowering agents and mean baseline HbA_1c was 7.4% (sd 1.2). After 6 months, we observed no difference in HbA_1c between intervention and control patients, after adjusting for baseline HbA_1c[adjusted difference 0.03, 95% confidence interval (CI) ?0.16, 0.22; P = 0.78]. A per protocol analysis of study completers (152/262; 60%) yielded similar results. Intervention patients reported testing 0.64 days per week more often than control subjects (95% CI 0.18, 1.10; P = 0.007), although testing was not associated with better glycaemic control (Pearson r = ?0.10, P = 0.12). Conclusions Reducing financial barriers by providing free testing strips did not improve glycaemic control in patients with Type 2 diabetes not using insulin. Our results question the value of policies that reduce financial barriers to testing supplies in this population.     

PREVIEW (Prevention of Diabetes Through Lifestyle Intervention and Population Studies in Europe and Around the World) study in children aged 10 to 17 years: Design,methods and baseline results

Insulin resistance (IR) in adolescence is associated with type 2 diabetes mellitus [T2DM]. The PREVIEW (Prevention of Diabetes Through Lifestyle Intervention and Population Studies in Europe and Around the World) study assessed the effectiveness of a high‐protein, low‐glycaemic‐index diet and a moderate‐protein, moderate‐glycaemic‐index diet to decrease IR in insulin‐resistant children who were overweight or obese. Inclusion criteria were age 10 to 17 years, homeostatic model assessment of IR (HOMA‐IR) ≥2.0 and overweight/obesity. In 126 children (mean ± SD age 13.6 ± 2.2 years, body mass index [BMI] z‐score 3.04 ± 0.66, HOMA‐IR 3.48 ± 2.28) anthropometrics, fat mass percentage (FM%), metabolic characteristics, physical activity, food intake and sleep were measured. Baseline characteristics did not differ between the groups. IR was higher in pubertal children with morbid obesity than in prepubertal children with morbid obesity (5.41 ± 1.86 vs 3.23 ± 1.86; P = .007) and prepubertal and pubertal children with overweight/obesity (vs 3.61 ± 1.60, P = .004, and vs 3.40 ± 1.50, P < .001, respectively). IR was associated with sex, Tanner stage, BMI z‐score and FM%. Fasting glucose concentrations were negatively associated with Baecke sport score (r = ?0.223, P = .025) and positively with daytime sleepiness (r = 0.280, P = .016) independent of sex, Tanner stage, BMI z‐score and FM%. In conclusion, IR was most severe in pubertal children with morbid obesity. The associations between fasting glucose concentration and Baecke sport score and sleepiness suggest these might be possible targets for diabetes prevention.     

Increased Red Cell Sodium Lithium Countertransport Activity,Total Exchangeable Sodium,and Hormonal Control of Sodium Balance in Normoalbuminuric Type 1 Diabetes

The relationship between erythrocyte sodium lithium countertransport activity (SLC), total exchangeable sodium (NaE), and hormonal control of renal function was examined in 40 normotensive, normoalbuminuric, non-neuropathic Type 1 diabetic subjects, of whom 8 had elevated SLC (> 0.40 mmol Li h^?1l^?1 rbc). Eleven health controls with normal SLC, who were of comparable age, body mass, and blood pressure were also studied. By contrast with healthy controls, SLC in Type 1 diabetes was not associated with plasma renin activity (PRA), aldosterone, systolic blood pressure or lean body mass. SLC was also unrelated to atrial natriuretic peptide (ANP) (Type 1 diabetes only) and NaE. NaE was not correlated with any other variables. The relationships between PRA and aldosterone in healthy controls were retained in Type 1 diabetes (R² 0.37 supine, p = 0.00001, and 0.27 ambulant, p = 0.0005), as were respective direct and inverse relations between vasopressin and ANP and both PRA (r_s 0.54 to 0.57, r_s ?0.43 to ?0.53), and aldosterone (r_s 0.78 to 0.80, r_s ?0.71 to ?0.80). Fasting free serum insulin and vasopressin were both inversely related to ANP (r_s ?0.91 and ?0.71, respectively). In the absence of autonomic dysfunction, hypertension or early nephropathy in Type 1 diabetes, increased SLC or exchangeable sodium were unrelated to each other or with hormonal control of sodium balance, but the homeostatic factors controlling hormonal interaction appear to be maintained. The interaction between insulin and hormonal control of sodium and water balance may be modified by circulating free insulin concentrations.     

Association between plasma osteoprotegerin concentrations and urinary albumin excretion in Type 2 diabetes

Aims Osteoprotegerin (OPG) is a recently identified inhibitor of bone resorption. Recent studies indicate that OPG is also associated with endothelial dysfunction in Type 2 diabetes. The aim was to investigate the relationship between plasma OPG levels and urinary albumin excretion (UAE) in Type 2 diabetic patients. Methods This study included 154 newly diagnosed Type 2 diabetic patients and 46 healthy subjects. Plasma OPG and 24‐h UAE were measured. High‐resolution ultrasound was used to measure flow‐mediated (endothelium‐dependent arterial) dilation (FMD). Results Compared with the normoalbuminuric subgroup, OPG levels in the microalbuminuric subgroup were significantly higher, and OPG levels in macroalbuminuria subgroup were significantly higher than those in the normoalbuminuria and albuminuria subgroups. Multiple regression analysis showed that only FMD (r = ?0.26), C‐reactive protein (r = 0.23), fasting blood glucose (r = 0.25), 2‐h blood glucose (r = 0.21), HbA_1c (r = 0.28), UAE (r = 0.27) and retinopathy (r = 0.27) were significant factors associated with OPG. Pearson’s correlation analyses showed a positive correlation between OPG and logUAE (r = 0.440) and negative correlations between OPG and FMD (r = ?0.284), and between FMD and logUAE (r = ?0.602). Conclusions Plasma OPG levels are significantly associated with UAE in Type 2 diabetic patients.     

Physical Development in Estonian Children with Type 1 Diabetes

This cross-sectional study describes the physical development of 62 diabetic patients who comprised one-third of all 10–17-year-old Estonian children with Type 1 diabetes. Diabetic children were shorter than healthy Estonian children with a mean corrected height standard deviation score (SDS) of −0.78 ± 1.37. Diabetic children living in rural areas were significantly shorter than urban diabetic children (p < 0.05). A significant negative correlation was found between the duration of diabetes and the corrected height SDS (p < 0.01; r = −0.36). Current glycated haemoglobin (HbA₁) (mean 11.7 ± 2.2 %) was inversely correlated to insulin dosage (p = 0.01) and to availability of home blood glucose monitoring (p = 0.03). Stepwise regression analysis showed that duration of diabetes (p = 0.02) and urban or rural abode (p = 0.04), but not age at onset of diabetes, current HbA₁ level, availability of home blood glucose monitoring or socio-economic status, influenced significantly corrected height standard deviation score (SDS). Despite having the same body mass index, diabetic children, especially girls, had thicker biceps and triceps skinfolds than controls. Estonian teenage diabetic children were shorter than healthy children and had increased biceps and triceps skinfold thickness without being overweight. Duration of disease was the predominant adverse influence on growth.     

Symptoms of depression prospectively predict poorer self‐care in patients with Type 2 diabetes

Aims To examine prospectively the association of depression symptoms with subsequent self‐care and medication adherence in patients with Type 2 diabetes mellitus. Methods Two hundred and eight primary care patients with Type 2 diabetes completed the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS) and the Summary of Diabetes Self‐Care Activities (SDSCA) at baseline and at follow‐up, an average of 9 months later. They also self‐reported medication adherence at baseline and at a follow‐up. Results Baseline HANDS scores ranged from 0 to 27, with a mean score of 5.15 ± 4.99. In separate linear regression models that adjusted for baseline self‐care, patients with higher levels of depressive symptoms at baseline reported significantly lower adherence to general diet recommendations and specific recommendations for consumption of fruits and vegetables and spacing of carbohydrates; less exercise; and poorer foot care at follow‐up (β ranging from ?0.12 to ?0.23; P < 0.05). Similarly, each one‐point increase in baseline HANDS score was associated with a 1.08‐fold increase in the odds of non‐adherence to prescribed medication at follow‐up (95% confidence interval 1.001, 1.158, P = 0.047). Increases in depression scores over time also predicted poorer adherence to aspects of diet and exercise. Conclusions Depressive symptoms predict subsequent non‐adherence to important aspects of self‐care in patients with Type 2 diabetes, even after controlling for baseline self‐care. Although the relationship between symptoms of depression and poorer diabetes self‐care is consistent, it is not large, and interventions may need to address depression and self‐care skills simultaneously in order to maximize effects on diabetes outcomes.     

Psychosocial Characteristics in Relation to Disordered Eating Attitudes in Greek Adolescents

The study explores possible links between eating attitudes in Greek adolescents and certain psychosocial characteristics such as self‐esteem, empathy and anxiety. A total of 202 students (109 boys and 93 girls), 15–18 years old, have been recruited. The following questionnaires were used: the Eating Attitudes Test (EAT‐26), the State‐Trait Anxiety Inventory, the Self‐Perception Profile for Adolescents, the Multidimensional Body‐Self‐Questionnaire‐Overweight Preoccupation and the Index of Empathy of Children and Adolescents. The EAT‐26 revealed that 18.3% of the total sample of students (12.8% of boys and 24.7% of girls) reported having disordered eating attitudes. Adolescents with disordered eating attitudes had significantly higher levels of anxiety and scored less in self‐reported physical appearance and romantic appeal. Empathy and global self‐esteem did not differ significantly between the two groups. Adolescents with disordered eating attitudes have certain psychosocial characteristics which differentiate them from the students with healthier eating attitudes. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Disease-associated anti-bovine serum albumin antibodies in Type 1 (insulin-dependent) diabetes mellitus are detected by particle concentration fluoroimmunoassay,and not by enzyme linked immunoassay

Summary We recently developed a particle concentration fluoroimmunoassay for the measurement of serum antibodies to bovine serum albumin in patients with Type 1 (insulin-dependent) diabetes mellitus. We observed elevated IgG-anti-bovine serum albumin antibodies in 100% of newly-diagnosed diabetic children and in 2.5% of matched control children. Here we compare the fluoroimmunoassay and the more commonly available enzyme linked immunoassay technique, exchanging coded serum samples from 40 newly-diagnosed diabetic children and 179 control children between two laboratories. Particle concentration fluoroimmunoassay detected elevated IgG-anti-bovine serum albumin antibodies in all diabetic children, enzyme immunoassay in 25% (p <0.0001). Fluoroimmunoassay detected elevated levels in 2.2% and enzyme immunoassay in 10% of control children (p <0.002). Elevated IgA-antibovine serum albumin antibodies in patients were slightly more often detected by fluoroimmunoassay than by enzyme immunoassay, while in control children enzyme immunoassays detected elevated levels three times more often (p <0.01). Values measured in either assay showed overall no correlation in either patient (IgG: r_s = 0.28; IgA: r_s = 0.11) or control sera (IgG: r_s = 0.02; IgA: r_s = -0.05). Fluoroimmunoassay for IgG was 100% disease-sensitive (enzyme immu-noassay: 25%, p <0.0001) and more disease-specific (IgG; p <0.02). Our findings demonstrate that these assay techniques detected distinct subsets of anti-bovine serum albumin antibodies with little (IgG) or some (IgA) overlap. In fluoroimmunoassay procedures, antigen: antibody binding occurs within 1–2 min while hours are allowed in an enzyme immunoassay. Antibodies with high on-off binding rates typical for immune responses following hyperimmunization are therefore measured preferentially by particle concentration fluoroimmunoassay and it is these antibodies which appear to be associated with diabetes. These observations emphasize the need for epidemiological surveys to validate immunoassay procedures used for clinical purposes.     

Reliability and validity of a novel Haemophilia‐specific Self‐Efficacy Scale

Higher self‐efficacy in chronic disease patients is associated with higher development of self‐management skills and increased quality‐of‐life. Quantification and monitoring of self‐efficacy is therefore of importance. Self‐efficacy in haemophilia patients has received little attention due to lack of standardized scales. To validate the novel Haemophilia‐specific Self‐Efficacy Scale (HSES) in haemophilia patients on prophylactic home treatment, haemophilia patients aged 1–18 years on prophylactic treatment ≥1 year were included from three Dutch Haemophilia Treatment Centres. The HSES consists of 12 items, relating to perceptions of the ability to function on a day‐to‐day basis with regard to patient's disease. Retest was performed in a subsample. Validity was proven by the General Self‐Efficacy Scale and by the health‐related quality‐of‐life assessment tool Haemo‐QoL. Data were analysed from 53 children (response 75%), with a mean age of 9.8 years (SD 4.0). Mean total scale score of HSES was 55.5 (SD 4.7; range 38–60), with a ceiling effect of 17%. The HSES showed adequate internal consistency (Cronbach's alpha 0.72) and good test–retest reliability (Intra‐Class‐Correlation coefficient 0.75; P < 0.01; n = 37). The convergent validity was adequate as haemophilia‐specific self‐efficacy correlated significantly with general self‐efficacy (r = 0.38; P < 0.01). High HSES scores correlated significantly with quality‐of‐life as measured by the Haemo‐QoL (r = ?0.42; P ≤ 0.01). The novel HSES is a reliable and valid tool to assess self‐efficacy in paediatric haemophilia patients on prophylactic home treatment. High self‐efficacy correlated with higher quality‐of‐life, further underlining the importance to standardly assess, monitor and improve self‐efficacy.     

Does Self‐Esteem Mediate the Relationship between Interpersonal Problems and Symptoms of Disordered Eating?

It has been proposed that interpersonal problems play a role in the maintenance of disordered eating because of an adverse effect on self‐esteem, which in turn encourages the pursuit of achievement in the valued domain of weight and shape. This study aimed to identify the types of interpersonal problems that are associated with disordered eating and to determine whether self‐esteem mediates the relationship between interpersonal problems and eating disorder symptoms. Female university students (n = 227) completed the Inventory of Interpersonal Problems‐32, Eating Disorder Examination Questionnaire and Rosenberg Self‐Esteem Scale. Regression analysis identified two forms of interpersonal problems that were associated with disordered eating: difficulties being sociable and being too dependent on the opinion of others. Self‐esteem mediated the relationship between interpersonal problems and overevaluation of weight and shape but did not mediate the relationship between interpersonal problems and dietary restraint. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Decreased Sialidase Activity in Mononuclear Leucocytes of Type 1 Diabetic Subjects: Relationship to Diabetic Complications and Glycaemic Control

Leucocyte surface sialic acid content influences surface charge, deformability, and leucocyte-endothelial interaction. Abnormal leucocyte structure and function contributes both to microvascular damage and diabetic complications. The aim of this study was to investigate altered leucocyte SA metabolism in diabetic subjects and measure lysosomal sialidase which regulates leucocyte surface sialylation. We examined 26 Type 1 (insulin-dependent) diabetic subjects with retinopathy, 26 Type 1 diabetic subjects without complications, and 38 matched normal control subjects. Sialidase was assayed in freshly prepared sonicates of pure mononuclear leucocytes (MNLs), using the fluorometric substrate 4-methyl-umbelliferyl-N-acetylneuraminic acid. In the subjects with diabetes there was a significant negative correlation between MNL sialidase activity and both HbA_1c (r_s = 0.37, p = 0.007) and fructosamine (r_s = ?0.31, p = 0.026). MNL sialidase activity was significantly decreased in diabetic subjects with clinical evidence of complications compared to control subjects. HbA_1c was significantly higher (p = 0.036) in diabetic patients with complications compared to those without. The observed decrease in MNL sialidase activity related to diabetic control may be important in the pathogenesis of vascular damage. Diabetes-associated changes in sialylation of functional cell surface glycoconjugates may have important clinical consequences.     

Planning a Social Activity to Improve Psychological Well‐being and Quality of Life of Hemodialysis Patients: A Pilot Study

We aimed to investigate the impact of social activity on anxiety‐depression, self‐esteem and quality of life in hemodialysis patients. Ninety‐one patients were recruited to the current study. Of these, 31 patients wanted to take part in a theater play, while 60 patients (group C) did not. Thirty‐one patients were randomly assigned to two groups: Group A (N = 15) started activities immediately and group B (N = 16) was assigned to a waiting list to be included in the activity of theater acting four months later. Beck Depression Inventory, Beck Anxiety Inventory, Rosenberg Self‐esteem Scale and World Health Organization Quality of Life Scale short form (WHOQOL‐BREF) were used to compare psychological parameters and quality of life of the groups before and after the social activity. The patients who were younger, more literate, and wealthier, had longer disease duration, and who were feeling physically and psychologically well, were willing to participate in social activity. The impact of social activity was evaluated between group A and C. After the social activity, there were significant differences in terms of depression (P = 0.008), self‐esteem (P = 0.003), and physical (P = 0.04) and psychological (P = 0.05) sub‐dimensions of quality of life between the groups. The depression score of the patients in group A decreased while their self‐esteem increased, but the increase in the physical and psychological sub‐dimension scores of quality of life scale did not reach statistical significance. This pilot study showed that social activity primarily improved depression and self‐esteem in hemodialysis patients.     

Dipeptidyl‐peptidase IV inhibitor is effective in patients with type 2 diabetes with high serum eicosapentaenoic acid concentrations

Aims/Introduction: Eicosapentaenoic acid (EPA) stimulates glucagon‐like peptide‐1 (GLP‐1) secretion in mice. We investigated the relationship between serum EPA concentrations and the efficacy of dipeptidyl‐peptidase IV (DPP‐4) inhibitor in patients with type 2 diabetes. Materials and Methods: Serum EPA concentrations were measured in 62 consecutive patients with type 2 diabetes who were newly given DPP‐4 inhibitor as a monotherapy or as an add‐on therapy to oral hypoglycemic agents. The dosage of oral hypoglycemic agents was maintained during the observation period. After 24 weeks of treatment with DPP‐4 inhibitor, we evaluated the relationships between a decrease in hemoglobin A1c from baseline and serum EPA concentrations, as well as age, sex, body mass index (BMI), hemoglobin A1c at baseline and usage of antidiabetic concomitant drugs. Results: Hemoglobin A1c was significantly decreased from 8.1 ± 1.1% to 7.2 ± 1.0% by DPP‐4 inhibitor. A decrease in hemoglobin A1c correlated with BMI (r = ?0.396, P = 0.0013), age (r = 0.275, P = 0.0032), hemoglobin A1c at baseline (r = 0.490, P < 0.0001) and log EPA (r = 0.285, P = 0.0246). Multiple regression analysis showed that BMI (β = ?0.419, P = 0.0002), hemoglobin A1c at baseline (β = 0.579, P < 0.0001) and log EPA (β = 0.220, P = 0.0228) were independent determinants of decrease in hemoglobin A1c. Conclusions: DPP‐4 inhibitor is effective in patients with type 2 diabetes with high serum EPA concentrations. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2012.00220.x , 2012)     

Variation of Diabetes Mellitus Prevalence in General Practice and Its Relation to Deprivation

This is an observational study to compare age standardized diabetes prevalences and relate these to socio-economic measures of deprivation. It includes data from eight general (family) practices in the Bristol, UK, area with no ethnic minorities affecting diabetes prevalence. A total population of 71 599 was covered, including 181 Type 1 and 901 Type 2 diabetic patients, 91 of whom were controlled with insulin, 499 with oral hypoglycaemics, and 311 with diet alone. Actual Type 1 and Type 2 diabetes prevalences were standardized to what they would be if each practice had the UK national age profile. Total standardized diabetes prevalence varied from 1.31 % to 2.51 % (p < 0.001) and Type 2 diabetes prevalence from 0.97 % to 2.29 % (p < 0.001). There was no significant variation in the prevalence of Type 1 diabetes. The Spearman rank correlation coefficient indicated a significant association between standardized diabetes prevalence and two measures, the Jarman and Townsend indices, of deprivation in the electoral ward where each practice was situated. Total standardized diabetes prevalence was significantly correlated with each of the Jarman and Townsend indices (r_s = 0.76, p < 0.05). Standardized Type 2 diabetes prevalence was similarly significantly correlated to each deprivation index (r_s = 0.74, p < 0.05). Type 2 diabetes prevalence is affected by socio-economic factors with implications for health targets and capitation based budgets.     

Self‐liking and self‐competence: relationship to symptoms of anorexia nervosa

Self‐esteem has been hypothesised to play a pivotal role in the development and treatment, and outcome of anorexia nervosa (AN). Though this relationship is typically investigated by considering self‐esteem as a unitary construct, research suggests that this comprises of two related but distinct components of self‐liking and self‐competence. This study investigates the association between self‐liking, self‐competence, and symptomatology of AN through the course of a defined treatment episode in 77 women. Self‐liking was significantly associated with laxative abuse. Self‐competence was significantly associated with elevated ineffectiveness, perfectionism and interpersonal distrust. Although self‐competence and eating disturbance severity significantly improved over the treatment episode, one in three participants reported a reduced self‐like or self‐competence. Changes in both self‐competence and self‐liking at the end of treatment was associated with changes in drive for thinness. Such findings have implications for treatment models concerned with improving self‐esteem. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.     

Lack of concordance between plasma markers of cardiovascular risk and intima-media thickness in patients with type 2 diabetes

Aim: Endothelial dysfunction, oxidative stress and systemic inflammation play an important role in the enhanced cardiovascular risk in diabetes. Carotid intima‐media thickness (IMT), a widely accepted marker of subclinical atherosclerosis, is known to be increased in patients with type 2 diabetes. The relationships between plasma markers of cardiac risk and carotid IMT are not well known. We therefore studied a group of patients with type 2 diabetes to evaluate the relationships between plasma markers of cardiac risk and carotid IMT. Design and patients: We measured carotid IMT and the levels of soluble endothelial adhesion molecules [sE‐selectin, intercellular cell adhesion molecule‐1 (sICAM‐1) and vascular cell adhesion molecule‐1 (sVCAM‐1)], C‐reactive protein (CRP) and 8‐isoprostane in 40 patients with type 2 diabetes without clinical macrovascular complications (HbA_1c < 10%, duration of diabetes < 12 years) and 25 healthy subjects. We then examined the correlations between these plasma markers, carotid IMT and various clinical and biochemical parameters. Results: Diabetic patients had higher plasma sE‐selectin (p = 0.03), sICAM‐1 (p = 0.05), CRP (p = 0.047) and 8‐isoprostane (p = 0.001) concentrations than control subjects. Mean IMT values were identical (0.63 ± 0.02 mm) in diabetic (range, 0.40–0.92 mm) and healthy subjects (range, 0.45–0.85 mm). In diabetic patients, stepwise multivariate analysis showed that HbA_1c and plasma glucose were independent predictors of sE‐selectin (r² = 0.19 and r² = 0.17, p < 0.01, respectively), whereas waist circumference and body mass index (BMI) were predictors of sICAM‐1 (r² = 0.27, p = 0.001 and r² = 0.22, p = 0.002, respectively). Waist circumference was the only predictor of CRP (r² = 0.2, p < 0.01), and systolic blood pressure was the only predictor of 8‐isoprostane (r² = 0.19, p = 0.006). In control subjects, similar analysis showed that plasma glucose and waist circumference were predictors of sE‐selectin and sICAM‐1, respectively (r² = 0.2, p < 0.05). Conclusions: These results indicate that some well‐controlled type 2 diabetic patients free of clinical macrovascular complications have elevated plasma markers of cardiovascular risk without having increased IMT. The elevation of plasma markers of endothelial cell activation (sE‐selectin and s‐ICAM‐1) or inflammation (CRP) and oxidative stress (8‐isoprostane) in diabetics vs. controls is distinct from and cannot be explained simply by differences in the burden of atherosclerosis as assessed by carotid IMT.     

Antibodies to a Mr-64000 islet cell protein in Swedish children with newly diagnosed Type 1 (insulin-dependent) diabetes

Summary Sera from 40 Swedish children diagnosed as having Type 1 (insulin-dependent) diabetes mellitus during a one year period along with 40 age and geographically matched control subjects were tested for antibodies to a M_r-64000 islet protein by immunoprecipitation of ³⁵S-methionine-labelled rat islet amphiphilic proteins. Of the 40 diabetic patients, 29 (73%) were found to be positive whereas all 40 control subjects were negative. Samples were also tested for titres of islet cell cytoplasmic antibodies by indirect immunofluorescence on frozen sections of human pancreas. In the diabetic group, 30 of the 40 patients (75%) were positive for islet cell cytoplasmic antibodies compared with 2 of the 40 control subjects (5%). A comparison of levels of antibodies to the M_r-64000 protein with islet cell cytoplasmic antibodies revealed a weak (r _s=0.46), but significant (p<0.01) correlation between the two tests. There was no effect of age or sex on levels of antibodies to the M_r-64000 protein. These results in population-based diabetic children and control subjects demonstrate a high frequency of antibodies to the M_r-64000 protein at the time of clinical onset.     

Levels of fetuin-A relate to the levels of bone turnover biomarkers in male and female patients with type 2 diabetes

Objective To evaluate the relationship of plasma fetuin‐A levels with markers of bone turnover in male and female type 2 diabetic subjects. Background Fetuin‐A, which is a serum protein produced by the liver and promotes bone mineralization, is an independent risk factor for type 2 diabetes, whilst type 2 diabetes is associated with an increased incidence of osteoporosis or fractures. It is not known how fetuin‐A levels relate to parameters of bone metabolism in type 2 diabetes. Design and patients Eighty patients with type 2 diabetes [40 men and 40 women matched for age, body mass index (BMI) and time since diagnosis of diabetes] were studied. Fetuin‐A together with metabolic parameters and levels of serum carboxy‐terminal telopeptide of type 1 collagen (C‐telopeptide), osteocalcin, procollagen type 1 amino‐terminal propeptide (P1NP), bone alkaline phosphatase (ALP) and sex hormones was determined in all participants. Results Fetuin‐A levels did not differ significantly between male and female diabetic subjects. In a model adjusted for age, BMI, fatty liver index (FLI), time since diagnosis of diabetes, HbA _1c , antidiabetic and lipid‐lowering drug therapies, smoking, total serum protein, creatinine, gamma glutamyl‐transferase, parathyroid hormone, C‐reactive protein, glomerular filtration rate, and presence of micro‐, cardio‐, and peripheral vascular diabetic complications, fetuin‐A showed a significant positive association with levels of bone ALP (r = 0·71, P = 0·006) in men. In women, fetuin‐A was significantly negatively associated with C‐telopeptide (r = ?0·60, P = 0·03) levels. Conclusions Results suggest an independent association of fetuin‐A levels with markers of bone turnover in male and female patients with type 2 diabetes. More studies are needed to determine whether fetuin‐A could serve as a new marker for fracture risk or osteoporosis in type 2 diabetes and to explore its potential sexually dimorphic effects.