Borderline Diabetics Research Articles

The Role of Diabetes-Related Self-Management in Type II Diabetes Mellitus and Impact on HbA1c

Background: The most important factor in controlling diabetes is self-management behaviour and its development is the first step toward helping the patients to successfully control their disease. The current study was conducted so as to investigate self-management behaviour and its Impact on HbA1c. Methods: This study was carried out on 220 type-2 diabetic patients in 2020. The data was gathered through demographic and diabetes self-management questionnaire (DSMQ) and it included 16 items at four dimensions. The data analysed by independent t-test, One-way ANOVA, Multiple Linear Regression and Logistic Regression. Results: There was a significant relationship between gender and physical activity, diet, and diabetic self-management (P-value> 0/001). Also, there was a significant relationship between economic status and glycemic control, diet, and diabetic self-management (P-value>0/05). In addition, family history of the disease and glycemic control, diet, and diabetic self-management were found to be meaningfully related (P-value> 0/05). Smoking and glycemic control on the one hand and diabetic self-management and BMI, on the other, experienced meaningful relationship (P-value >0/05). The most adverse effects were among patients who had unfavourable or minimum self-management: 10.7% kidney complications and 17.9% visual impairment (P-value>0/05). Dietary control is the strongest predictor of HbA1c in all diabetics and people with borderline self-management and diabetics without complications (P-value> 0/000). Conclusion: Diabetes-related self-management predicted HbA1c levels and type-2 diabetic complications and intervention programmes crucial in increasing patients’ awareness, learning, and participation.

Chlorella ingestion suppresses resistin gene expression in peripheral blood cells of borderline diabetics

Type 2 diabetes can lead to arteriosclerosis, renal damage, retinopathy, and several other serious complications. To prevent or delay the progression of this disease, considerable attention has been paid to improve exercise and dietary habits. Chlorella ingestion can reportedly reduce high blood glucose and cholesterol levels in mice and humans, although no studies have critically evaluated the effects of Chlorella on human borderline diabetics. Thus, we conducted a randomized, double-blind placebo-controlled test with volunteer borderline diabetics. We recruited 57 subjects and randomly divided into a Chlorella ingestion group (n=28) and a Placebo ingestion group (n=29). Blood samples were collected every 4 weeks for laboratory tests. Gene expression analyses using peripheral blood cell RNA were performed before and 12 weeks after the trial. A total of 252 genes showed changed expression levels between these two groups. Six of these were type 2 diabetes-associated genes, including resistin, an insulin resistance inducer that exhibited markedly reduced expression with Chlorella ingestion (P=0.01). Resistin mRNA expression significantly correlated with changes in HbA1c and TNF-α and IL-6 levels, all of which are strongly associated with glucose metabolism and/or inflammation. Chlorella ingestion may be useful in preventing or ameliorating the course of type 2 diabetes development. In addition, gene expression analysis may be a means to investigate the effects of foods and supplements in humans.

Cost of Diabetes in the Kingdom of Saudi Arabia, 2014

Objective: Diabetes mellitus is a major burden in the Kingdom of Saudi Arabia (KSA). We estimated the direct cost of diabetes in KSA and the future cost accounting for currently undiagnosed and borderline diabetics. Methods: We used a bottom-up approach to determine the direct cost of diabetes mellitus in KSA at the population level using Saudi Ministry of Health (MOH) cost data for medications, health visits, laboratories, and hospitals. We used Saudi Health Interview Survey (SHIS) national data to estimate the number of people categorized as gestational, those with borderline diabetes (glucose intolerant), diagnosed, undiagnosed, controlled, and uncontrolled diabetics. Results: We estimate that the current cost of diabetes is at 17 billion Riyals. We also estimate that if those who are undiagnosed joined the treatment pool, the future cost would increase to 27 billion Riyals. Moreover, we estimate that if those with glucose intolerance (pre-diabetes) progress at the current observed rate to become diabetics, the future cost would be 43 billion Riyals. Conclusion: With such a high cost, the projected growth of the Saudi population, and aging, KSA will face a tremendous strain on its human and financial resources. Prevention and control of diabetes mellitus should be the main focus in years to come.

Evaluation of Food–drug Interaction of Guava Leaf Tea

Guava leaf tea (GLT) contains guava leaf polyphenol (Gvpp), which regulates the absorption of dietary carbohydrate from the intestines. Borderline diabetics, who are at high risk of development of diabetes, take GLT to suppress a rapid increase of blood sugar level after meals. However, patients with diabetes in whom diabetic drugs or warfarin as a blood thinner are prescribed also take GLT with the expectation of glycemic control. Therefore, we studied whether GLT had potential for inhibition or induction of cytochrome P450 (CYP) and an influence on the action of warfarin. Extract of guava leaf (GvEx) consists of carbohydrate and polyphenols, which are Gvpp, quercetin, and ellagic acid. These polyphenols, but not GvEx, showed a certain level of inhibition of human-cDNA-expressed CYPs. In a comparison of GLT and grapefruit juice, GLT showed weaker inhibition of CYP activities and of midazolam 1'-hydroxylation than grapefruit juice. Furthermore, neither liver weight nor CYP3A expression in the liver was changed in rats that received GvEx for 90 days compared with the control group. When rats were concomitantly treated with GLT and warfarin, the prolongation of clotting time of blood by warfarin was not influenced. These data suggest that GLT is unlikely to interact with drugs.

Aspartame-Acesulfame K-containing Low-Energy Erythritol Sweetener Markedly Suppresses Postprandial Hyperglycemia in Mild and Borderline Diabetics

In diabetic patients, compliance to diet therapy has been an ongoing concern. We thus examined the effects of an aspartame-and acesulfame K-containing sweetener (PZ) on postprandial hyperglycemia in mild and borderline diabetics. In two sets of crossover, randomized, placebo-controlled, double-blind tests, subjects with mild or borderline diabetes were challenged with meals consisting of white rice, and two side dishes flavored with PZ (PZ meal) or sugar (Control meal); or with sweets flavored with PZ (PZ sweets) or sugar (Control sweets). The use of PZ (PZ meal and PZ sweets) significantly reduced postprandial levels, particularly at 1 h, of blood glucose and insulin when compared to sugar (Control meal and Control sweets). The results demonstrated that PZ as a sugar substitute enabled the suppression of postprandial hyperglycemia in mild or borderline diabetics without compromising palatability, sweetness or patient QOL.

Insulin resistance in diabetics and non-diabetics with impaired triglyceride removal.

Endogenous triglyceride turnover has been measured in patients with normotriglyceridemia or with hypertriglyceridemia using the radioglycerol labelling technique. In parallel, a 50 g oral glucose tolerance test was performed (blood glucose, serum insulin, free fatty acids). Non-diabetics, borderline diabetics, and overt diabetics were included. In the non-diabetics, insulin levels were negatively correlated with fractional catabolic rates for triglycerides, whereas no correlation with triglyceride synthesis rates existed. Patients with low fractional catabolic rates for triglycerides have significantly higher insulin and free fatty acid concentrations, pointing to an association between impairment of triglyceride removal and insulin resistance. There is no typical kinetic pattern of triglyceride metabolism in non-insulin-dependent diabetes mellitus.

Immunosuppressive Treatment of Idiopathic Focal Segmental Glomerulosclerosis: A Five-Year Follow-Up Study

Background/Aims: Focal segmental glomerulosclerosis (FSGS) is a common type of glomerular disease that can lead to chronic renal failure. Various therapeutic regimens have been used in nephrotic FSGS patients. The effect of treatment with prednisolone alone or its combination with azathioprine and cyclosporin and parameters related to a poor outcome are studied. Methods: Fifty-one patients with idiopathic FSGS and a follow-up period of 5 years were included. Twenty-five were treated with prednisolone alone (1 mg/kg BW/day) or combination of prednisolone (0.5 mg/kg BW/day) with azathioprine (2 mg/kg BW/day) or cyclosporine (3 mg/kg BW/day) in gradually reduced doses whereas 26 patients received no immunosuppressive drugs. Lower prednisolone dose regimens were used as initial treatment in obese, borderline diabetics or patients with bone disease. The clinical course was estimated using the end-points of 50% or doubling of baseline serum creatinine and/or end-stage renal failure. The contribution of clinical and histological parameters in the clinical outcome was estimated by univariate and multivariate analyses. Results: Increase of baseline serum creatinine by 50% during the follow-up period was observed in 2 treated and 9 untreated patients (8% vs. 35%, p = 0.03) whereas doubling of serum creatinine in 2 and 5 patients respectively (8% vs. 19%, p = NS). End-stage renal failure developed in 4 of 51 patients (8%), 2 treated and 2 untreated (p = NS). Parameters related to a poor outcome were baseline serum creatinine and severity of glomerulosclerosis (multivariate analysis OR = 1.08, p = 0.01). Most of patients (68%) who reached end-points had persistent nephrotic syndrome during the follow-up. Remission of nephrotic syndrome was observed more frequently among treated (75 vs. 30.7%, p = 0.05). Prednisolone alone was followed by remission of nephrotic syndrome in 62.5% whereas combination of lower prednisolone dose with azathioprine and cyclosporin in 80 and 85.7% of patients. No serious side-effects were observed. Conclusion: This and previous studies suggest that steroid and/or immunosuppressive therapy have a role in amelioration of the clinical course and remission of nephrotic syndrome in patients with FSGS A combination of low predisolone dose with cyclosporine could be used as initial treatment in patients with higher risk for side-effects from the usual prednisolone dose.

Is hypoglycaemia a marker for increased long-term mortality risk in patients with coronary artery disease? An 8-year follow-up.

No information is available regarding the association between low plasma glucose levels and cause-specific and all-cause mortality in patients with coronary artery disease (CAD). We aimed to investigate the relationship between hypoglycaemia and all-cause, cardiovascular and cancer mortality in a large population of patients with CAD. Patients were recruited from the BIP (Bezafibrate Infarction Prevention) registry, a secondary prevention prospective multicentre randomized, placebo-controlled, double-blind trial aimed to assess the efficacy of bezafibrate in reduction of coronary events. The study included 14,670 CAD patients aged 45-74, divided into six groups: (1) hypoglycaemic (up to 69 mg/dl); (2) low normal (70-79 mg/dl); (3) euglycaemic (80-109 mg/dl); (4) impaired fasting glucose (IFG) (110-125 mg/dl); (5) borderline diabetics (126-139 mg/dl); (6) diabetics (> or 140 mg/dl). Patients comprised 131 with hypoglycaemia (0.9%), 731 with low normal glucose (5%), 9308 euglycaemic (63.4%), 1577 with IFG (10.7%), 617 borderline diabetics (4.2%) and 2306 diabetics (15.7%). Over a mean 8-year follow-up, crude all-cause mortality was higher in both diabetic (31.8%) and hypoglycaemic groups (25.2%) as compared with euglycaemics (14.9%; P<0.0001); CAD mortality was higher in diabetic and borderline groups (17.8 and 13.3%, respectively, versus 7.9% in euglycaemics; P<0.0001). The highest prevalence of cancer mortality was documented in the hypoglycaemic group (6.1 versus 2.9% in euglycaemics; P<0.02). Actuarial survival curves showed the lowest mortality in euglycaemic and low normal groups; the highest was seen in diabetic and hypoglycaemic patients. Intermediate values were found in borderline and IFG patients. After adjustment for variables, a significantly higher mortality rate was seen in hypoglycaemics when compared with euglycaemics (P<0.0001). Hypoglycaemia was identified as a predictor of increased all-cause and cancer mortality with a hazard ratio (HR) of 1.84 [95% confidence interval (CI) 1.29-2.61] and 2.26 (95% CI 1.12-4.57), respectively, but not of increased CAD mortality, with HR 1.30 (95% CI 0.73-2.29). Over a mean 8-year follow-up, hypoglycaemia emerges as a marker for substantially increased all-cause and cancer mortality among patients with CAD presenting with low fasting glucose levels.

Clinical impact of borderline and undiagnosed diabetes mellitus in patients with coronary artery disease

The present study was aimed to evaluate the prevalence and prognostic significance of unrecognized and newly defined borderline diabetes (with fasting blood sugar 126 to 139 mg/dl) by the American Diabetes Association criteria in coronary patients over a 7.7-year follow-up. Both undiagnosed and newly diagnosed borderline diabetes were associated with an unfavorable metabolic profile. The mortality of the borderline diabetics tended to be higher than in their nondiabetic counterparts. but this tendency did not reach statistical significance. A significant excess in long-term mortality was observed among the undiagnosed diabetes group.

Pattern and Factors Associated with Glycemic Control of Saudi Diabetic Patients

The pattern and factors which can be associated with the glycemic control of Saudi adult diabetic patients were examined in this study. Confirmed diabetic patients from all regions of Saudi Arabia constituted the study population. Random blood glucose <10 mmol/L and >10 mmol/L was used to categorize patients into good and poor glycemic control patients, respectively. There were 613 confirmed non-insulin dependent diabetic patients (NIDDM), 50% with good glycemic control. Patients with poor glycemic control were significantly older than patients with good glycemic control (51.5 vs. 47 years, P=0.0001). The insulin-treated diabetic population amounted to 13%, compared with 43% and 44% for oral agent and diet, respectively. The rate of insulin users among poor glycemic control diabetic population was 18%, compared with 50% for oral agents. There was a significant relationship between glycemic control and age, and treatment modalities of DM. Subjects who had good glycemic control of DM were younger and following a diet regimen, while those who had poor glycemic control were older and on insulin treatment. Multivariate analysis comprising 415 individuals was conducted to find out the factors that can potentially influence, or may be associated with, the control of DM. The association of insulin therapy with poor glycemic control is not a cause-effect relationship. Insulin therapy in our study population is underutilized, given the high rate of poor glycemic control and high rate of relative occurrence of complication among the Saudi diabetic population. There is a need to address the importance of maintaining good glycemic control, and the reason for the low rate of insulin users. Close periodic monitoring of glycemic control, utilizing laboratories and home glucose monitoring devices, is required. Effective implementation of these measures, in addition to diabetes education, will have an impact on the future outcome of the Saudi diabetic population.

Vascular dysfunction in diabetes mellitus

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Practical management of diabetic patients with coronary heart disease

Practical Diabetes InternationalVolume 8, Issue 5 p. 198-201 Review ArticleFree Access Practical management of diabetic patients with coronary heart disease J A Adiotomre MRCP, J A Adiotomre MRCP Medical Registrar Department of General Medicine, Bassetlaw District General Hospital, WorksopSearch for more papers by this authorDr R L Blandford MD MRCP, Corresponding Author Dr R L Blandford MD MRCP Consultant Physician Department of General Medicine, Bassetlaw District General Hospital, WorksopBassetlaw District General Hospital, Kilton, Worksop, Notts S81 0BDSearch for more papers by this author J A Adiotomre MRCP, J A Adiotomre MRCP Medical Registrar Department of General Medicine, Bassetlaw District General Hospital, WorksopSearch for more papers by this authorDr R L Blandford MD MRCP, Corresponding Author Dr R L Blandford MD MRCP Consultant Physician Department of General Medicine, Bassetlaw District General Hospital, WorksopBassetlaw District General Hospital, Kilton, Worksop, Notts S81 0BDSearch for more papers by this author First published: September/October 1991 https://doi.org/10.1002/pdi.1960080510AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References 1 West KM. The epidermatology of diabetes and its vascular lesions. Elsevier, New York, 1978 2 Kannel WB, McGee DL. Diabetics and cardiovascular risk factors. The Framingham Study. Circulation, 1979; 59: 8 3 Jarrett RJ, McCartney P, Keen H. The Bedford survey: ten year mortality rates in newly diagnosed diabetics, borderline diabetics and normoglycaemic control and risk indices for coronary heart disease in borderline diabetics. Diabetologia, 1982; 22: 79 4 Root HF, Bland EF, Gordon WH. Coronary atherosclerosis in diabetes mellitus. A post mortem study. Journal of American Medical Association, 1939; 113: 27 5 Jenczto D, Czyzyk A, Kopazynski J, et al. Risk factors of cardiovascular death in diabetic patients. Diabetic Medicine, 1991; 8: S100-3 6 Mogensen GE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity onset diabetes. New England Journal of Medicine, 1984; 310: 356 7 Scheidt-Nave C, Barret-Connor E, Wingard DL. Resting electrocardiographic abnormalities suggestive of asymptomatic ischaemic heart disease associated with non-insulin-dependent diabetes mellitus in a defined population. Circulation, 1990; 81: 899 8 Bradley RF, Schonfied A. Diminished pain in diabetic patients with acture myocardial infarction. Geriatrics, 1962; 17: 322 9 Deanfield JE, Selwyn AP, Chierchia S, et al. Myocardial ischaemia during daily life in patients with stable angina: its relation to symptoms and heart rate changes. Lancet, 1983; 2: 753 10 Mitchell JRA, Schwartz C. In: Aterial disease. Blackwell, Oxford. 1965 11 Nelson RG, Sievers ML, Knowles WC, et al. Low incidence of fatal coronary heart disease in pima Indians despite high prevalence of non-insulin-dependent diabetes. Circulation, 1990; 81/3: 987 12 Pentecost BL. Diabetes and heart attacks. Medicographia, 1983; S, S1: 5 13 Kjekshus J, Gilpin E, Calj G, et al. Diabetic patients and beta-blockers after acute myocardial infarction. European Heart Journal. 1990; 11(1): 43 14 Harrower ADB, Clarke BF. Experience of coronary care in diabetes. British Medical Journal, 1976; 1: 126 Volume8, Issue5September/October 1991Pages 198-201 ReferencesRelatedInformation

Cardiovascular and pupillary light reflexes in subjects with abnormal glucose tolerance

It is well known that in diabetes mellitus autonomic neuropathy frequently develops. This is usually determined by the cardiovascular reflex. Furthermore, even in borderline cases that have not become overt diabetes, we have already reported the presence of autonomic neuropathy as assessed by the pupillary light reflex. However, a relationship between the impairments of the cardiovascular and pupillary light reflexes is not clear, especially in people with abnormal glucose tolerance. In the present study diabetics were divided into three groups according to the results of their cardiac beat-to-beat variation (BBV) tests and Schellong tests; group I had no abnormality of these cardiovascular reflexes, group II had abnormal BBV scores and normal Schellong test scores, and group III had abnormal responses to both tests. People with borderline diabetes (B-DM) were free from any impairment of their cardiovascular reflexes. We examined their pupillary light reflexes. Age-matched non-diabetics were also studied as a control, The following results were obtained. (1) Compared to controls, (a) diabetics, but not borderline diabetics, had smaller pupils before photic stimulation (A1) and lower maximum dilatation velocities (VD). These illustrate sympathetic function; (b) diabetics and borderline diabetics had lower amplitudes of constriction (A3) and maximum constriction velocities (VC). These illustrate parasympathetic function; (c) borderline diabetics and those diabetics belonging to group III experienced a lower pupillary constriction rate. (2) Diabetics (a) had lower A1 values than did people with B-DM; (b) in group III had lower A3, VC and VD values than did people with B-DM; and (c) in group III had lower A1 and VD values than those in group I and lower A3 and VC values than those in groups I and II. These observations support the existence of parasympathetic neuropathy in B-DM. They indicate that the pupillary light reflex worsens with the progression of cardiovascular reflex abnormalities. In particular, when the cardiovascular reflex indicates remarkable sympathetic impairment, both the sympathetic and parasympathetic components of the pupillary light reflex become more predominantly disturbed.

A 10 year follow-up of diabetes in a rural area of Japan using the 50 g oral glucose tolerance test.

We performed a 10 year follow-up study on diabetics using the 50 g oral glucose tolerance test in a rural area of Japan. In untreated borderline diabetics, high or normal insulin responders became normal for glucose tolerance 10 years later. However, low insulin responders became overt diabetics or remained borderline diabetics. Therefore, insulinogenic index was considered to be one of the most valuable indexes in the prospective investigation of untreated borderline diabetics.

The Bedford Survey: Ten year mortality rates in newly diagnosed diabetics, borderline diabetics and normoglycaemic controls and risk indices for coronary heart disease in borderline diabetics

Mortality rates from coronary heart disease and from all causes have been ascertained over ten years in three groups of people participating in the Bedford Survey--newly-diagnosed diabetics, borderline diabetics and control subjects with normal glucose tolerance. Age corrected mortality rates, from all causes and coronary heart disease, were highest in the diabetics and intermediate in the borderline diabetics and in both groups were similar in men and women. When statistical allowance was made for baseline differences in age, blood pressure and obesity, female borderline diabetics still had a significantly increased risk over their controls of death from 'all causes'. Much of the difference appeared to be due to a relative excess of deaths due to coronary heart disease. It is concluded that borderline diabetes (or impaired glucose tolerance) is associated with a relatively greater increase in mortality risk in women than men. During the 10-year follow-up of the Bedford borderline diabetics, coronary heart disease morbidity and mortality rates were similar in men and women. Age at entry to the study was the major independent and significant predictor of mortality from all causes. The level of systolic blood pressure and current cigarette smoking at baseline were statistically significant predictors only of mortality due to coronary heart disease.

Serum proteins of Macaca nigra. Identification and changes in nondiabetic and diabetic monkeys.

Serum proteins of Macaca nigra were separated by agarose gel electrophoresis. Proteins identified were: albumin, alpha 1-globulin, alpha 2-macroglobulin, haptoglobin, beta 1C-globulin, and gamma 1- and gamma 2-globulins. Diabetic M. nigra had decreased gamma 2-globulin; borderline diabetics had increased beta 3-globulin.

Glycohemoglobin and glucose tolerance tests compared as indicators of borderline diabetes.

We concurrently measured glycohemoglobin and performed 3-h oral (100 g) glucose tolerance tests on 69 ambulatory patients suspected of having abnormal carbohydrate metabolism. The patients were divided into two groups: (a) The 37 patients for whom the results were normal had plasma glucose concentrations of 0.70--1.15 milligram during fasting and 0.70--1.23 g/L 2 h after glucose ingestion. (b) Borderline diabetics exceeded one or both of these limits. The range of glycohemoglobin in the normal group was 3.0--4.7% of total hemoglobin. Of the 21 borderline diabetics, 11 had increased glycohemoglobin (4.8--8.0%). The difference in tolerance test results between borderline diabetics with and without increased glycohemoglobin was insufficient to predict the status of glycohemoglobin. We suggest a tentative definition for latent diabetes: increased glycohemoglobin in the presence of normal or borderline-abnormal glucose concentration in plasma collected during fasting.

Glucose Tolerance and Blood Pressure in Two Population Samples: Their Relation to Diabetes Mellitus and Hypertension

The relationship between blood pressure and the blood sugar concentration measured two hours after a 50 g oral glucose load has been examined in two population surveys-the Whitehall and Bedford Surveys. In the Whitehall Survey, which was conducted in men above the age of 40, there was a positive, significant correlation between blood sugar and blood pressure (systolic and diastolic) which was independent of common associations with age, body mass index (BMI) and heart rate. In the Bedford Survey, systolic blood pressures were significantly higher in newly detected diabetics and borderline diabetics, both men and women, than in normoglycaemic controls after adjustment of blood pressures for age and BMI. However, in the stratified random sample of the cooperating Bedford population, only amongst women was the blood sugar significantly and independently correlated with the systolic blood pressure. Evidence is presented and discussed that autonomic, neurohumoral factors may play some part in the pathogenesis of maturity onset diabetes.

HYPERGLYCÆMIA AND DIABETES MELLITUS

Recommended criteria for the diagnosis of maturity-onset diabetes mellitus based on glucose tolerance tests vary considerably; none are derived from long-term observations of the further development of different degrees of glucose intolerance. Evidence from several epidemiological investigations suggests that the risk of specific diabetic complications becomes important only in people with capillary wholeblood sugar concentrations exceeding 200 mg/dl 2 hours after a 50 g oral glucose load, who have overnight fasting blood-sugar concentrations usually exceeding 110 mg/dl. Lesser degrees of glucose intolerance may, nevertheless, indicate an additional risk of atherosclerotic arterial disease. Assessment of "borderline diabetics" should, therefore, include an evaluation of other known risk factors for arterial disease and any treatment programme should be determined in the light of these as well as by the degree of glycæmia.

Peripheral glucose uptake during the oral glucose-tolerance test in normal and obese subjects and borderline and frank diabetics.

Glucose uptake by the forearm muscle tissues has been studied during the 50-g oral glucose-tolerance test in 103 subjects. Thirty-seven were classified as normal (2-h blood-sugars below 120 mg per cent), 28 as borderline diabetics (2-h blood-sugars between 120 and 200 mg per cent), and 38 as diabetics (2-h blood-sugars above 200 mg per cent). The results confirmed earlier observations that glucose uptake is reduced in obesity and diabetes. The normal and borderline groups were indistinguishable. In both, glucose uptake was inversely correlated with the degree of obesity (glucose uptake = 0·898–0·193×skinfold thickness for the normal and 1·055–0·255×skiofold thickness for the borderline group). In the diabetic group this relationship had broken down. Glucose uptake was not related to age, the peak blood-sugar level, or in the normal and borderline groups to the blood-flow.