Diagnosis Of Non-insulin-dependent Diabetes Mellitus Research Articles

Effect of direct renin inhibition on vascular function after long-term treatment with aliskiren in hypertensive and diabetic patients.

We tested the hypothesis that chronic treatment with the direct renin inhibitor aliskiren improves vascular function in resistance and conduit arteries of type two diabetic and hypertensive patients. Sixteen patients with mild essential hypertension and with a previous diagnosis of noninsulin-dependent diabetes mellitus were included in the study. Patients were then randomized to aliskiren (150 mg once daily, n = 9), or ramipril (5 mg once daily, n = 7). Each patient underwent a biopsy of the subcutaneous tissue and small arteries were dissected and mounted on a pressurized micromyograph to evaluate endothelium dependent vasorelaxation in response to acetylcholine ± N omega-nitro-L-arginine methyl ester hydrochloride in vessels precontracted with norepinephrine. Endothelial function has been quantified also in large conduit arteries by flow-mediated dilation. A similar office blood pressure-lowering effect was observed with the two drugs, although changes in DBP were not statistically significant in the ramipril group. Aliskiren significantly improved endothelium-dependent relaxation in subcutaneous resistance arteries, as well as increased flow-mediated dilation in conduit arteries, whereas the effects induced by ramipril did not reach statistical significance. Only aliskiren significantly increased the expression of p1177-endothelial nitric oxide synthase in the endothelium. Both aliskiren and ramipril had a negligible effect on markers of oxidative stress. Aliskiren restored endothelial function and induced a more prompt peripheral vasodilation in hypertensive and diabetic patients possibly through the increased production of nitric oxide via the enhanced expression and function of the active phosphorylated form of endothelial nitric oxide synthase.

Mody-3: Novel HNF1A Mutation and the Utility of Glucagon-Like Peptide (GLP)-1 Receptor Agonist Therapy

An estimated 1 to 2% of cases of diabetes mellitus have a monogenic basis; however, delayed diagnosis and misdiagnosis as type 1 and 2 diabetes are common. Correctly identifying the molecular basis of an individual's diabetes may significantly alter the management approach to both the patient and his or her relatives. We describe a case of mature onset diabetes of the young (MODY) with sufficient evidence to support the classification of a novel HNF1A (hepatocyte nuclear factor-1-α) mutation as a cause of MODY-3. A 21-year-old Caucasian female presented to our office with a diagnosis of noninsulin-dependent diabetes mellitus (NIDDM) at age 10; glycemia was initially managed with oral antidiabetic (OAD) agents and insulin detemir. The patient reported a strong family history of early-onset NIDDM in both her mother and maternal grandmother, both of whom eventually required insulin therapy to control glycemia. The patient's medical and family history were highly suggestive of maturity-onset diabetes of the young (MODY), and genetic testing was performed. Genetic screening detected a mutation p. Arg200Trp in the HNF1A gene in the patient, her mother, and maternal grandmother, suggesting a diagnosis of MODY-3. This finding resulted in a change of antidiabetic therapy in all 3 patients, including the addition of once-daily liraglutide therapy, which helped improve their glycemic control. Our case report supports the classification of the p. Arg200Trp mutation as a cause of MODY-3. The findings also suggest that glucagon-like peptide-1 (GLP-1) receptor agonist therapy may be of value in managing glycemia in patients with MODY-3.

Clinical characteristics of patients with the initial diagnosis of NIDDM with positivity for antibodies to glutamic acid decarboxylase.

The measurement of islet cell antibodies (ICA) and antibodies to glutamic acid decarboxylase (GAD-Ab) is clinically useful in evaluating patients with insulin-dependent diabetes mellitus (IDDM). Our objective was to correlate the clinical characteristics of patients with non-insulin-dependent diabetes mellitus (NIDDM) who exhibited positivity for GAD-Ab vs. patients who were negative for this enzyme. The serum level of GAD-Ab was measured by radiobinding assay (RBA) using pig brain GAD. The prevalence of GAD-Ab in the 181 patients was low; the 8 involved subjects (4.4%) were all females. The NIDDM patients who were GAD-Ab-positive were significantly younger, experienced diabetes onset at an early age, had a shorter duration of diabetes, a shorter interval between diabetes onset to initiation of insulin therapy, a lower body mass index (BMI), a lower serum C-peptide value, and required a higher dose of insulin. A higher proportion of the GAD-Ab-positive patients was receiving insulin therapy. Clinical characteristics of patients with NIDDM who were positive for GAD-Ab differed significantly from those of the patients negative for GAD-Ab. The profile of the GAD-Ab-positive patients with NIDDM resembled that of those with IDDM.

Presence of diabetes related complication at the time of NIDDM diagnosis: an important prognostic factor.

We studied the short-term natural history of patients with newly diagnosed non-insulin dependent diabetes mellitus (NIDDM), and the prognostic role of history of NIDDM related complication at the time of first NIDDM diagnosis in relation to the development of a new complication or death. We performed a cohort study using data from the General Practice Research Database in the UK. We identified patients aged 30 to 74 years with a newly diagnosed NIDDM between 1990 and 1992 and followed them from the day of NIDDM diagnosis until June 1995. Among the 1077 patients identified, 437 (41%) developed a NIDDM complication during the follow-up. NIDDM complications were more frequent among males and in the elderly. Sixty-seven percent of the study cohort was initially free of any complication while the remaining 360 patients presented already one or more NIDDM complication at the time of their NIDDM diagnosis. History of diabetic related complication was associated with an increased risk of developing a new NIDDM complication (RR: 1.8; 95% CI: 1.5-2.2). Mortality was also greater among patients with history of NIDDM complication (RR: 1.5; 95% CI: 1.0-2.2). Patients with a history of any disorder related to diabetes before their clinical diagnosis of NIDDM are at increased risk of developing a NIDDM complication after the NIDDM diagnosis, as well as at increased risk of dying compared to diabetic patients with no history.

Management of newly diagnosed non-insulin-dependent diabetes mellitus in the primary care setting: effects of 2 years of gliclazide treatment— the diadem study

Five thousand five hundred seventy-two newly diagnosed non—insulin-dependent diabetes mellitus (NIDDM) patients (3,225 men and 2,347 women; mean age, 58.5 years) were recruited through the General Practitioners (GPs) network in France. All had persistent hyperglycemia after a preliminary 3-month period with dietary and life-style modification. Gliclazide (80 to 320 mg/d) was then prescribed as diabetic pharmacotherapy for 2 years. Additional therapy for hypertension and dyslipidemia was started if necessary. The aim of the study was mainly to determine the feasibility of a GP-directed protocol for the monitoring and treatment of newly diagnosed NIDDM patients, and to assess the effectiveness of diabetic therapy in this cohort. Diabetes was diagnosed in 78% of the cohort during routine screening. Among the women, 6.5% had a history of gestational diabetes. Eighteen percent of the patients had a parental history of diabetes, and the dominant maternal role in the genesis of NIDDM was confirmed. High blood pressure (Joint National Committee V criteria) was found at inclusion in 38.8% of the whole cohort. Hyperlipidemia was known in 44.6%. A history of stroke was present in 1.6% of the patients, and coronary heart disease (CHD) in 6.3%. These data support the relationship between the atherogenic state and development of NIDDM. Microalbuminuria defined as urinary albumin excretion (UAE) of at least 20 mg/L was found in 29.6% of the patients, and retinopathy in 9.8%. Among the included patients, 23% did not complete the study and were excluded from the efficacy analysis. Of these, 14% (808 patients) had only baseline evaluation data and 9% (499 patients) withdrew later. Comparison of mean baseline and final results in study completers uncovered a significant improvement in fasting blood glucose ([FBG]) 182 ± 48 v 137 ± 40 mg/dL), post prandial blood glucose ([PPBG] 209 ± 68 v 162 ± 52 mg/dL), and hemoglobin A 1c ([HbA 1c] 8.7% ± 2.5% v 7.3% ± 2.0%). A slight improvement in total cholesterol (228 ± 44 v 222 ± 41 mg/dL), body mass index ([BMI] 28.5 ± 4.7 v 27.9 ± 4.5 kg/m 2), and waist to hip ratio (0.99 ± 0.1 v 0.98 ± 0.1) was observed. There was a decrease in the percentage of patients with high blood pressure (38.5% v 30.7%). A mild increase in the prevalence of retinopathy (10.2% v 11.8%) was noted during the study, while the incidence of microalbuminuria remained unchanged (30.2% v 29.5%). In conclusion, the data indicate that the GPs involved in this study were able to successfully monitor and manage NIDDM patients in accordance with a standardized protocol. Gliclazide appeared to be an effective and well-tolerated treatment. The high prevalence of chronic diabetic complications at diagnosis emphasizes the delay encountered in reaching the diagnosis of NIDDM and the problems associated with this delay. In addition to the classic risk factors for NIDDM exhibited in this patient cohort, we have identified CHD and a maternal genetic component as further potential predicting factors.

Ketoacidosis in Apache Indians With Non—Insulin-Dependent Diabetes Mellitus

Although more classically associated with insulin-dependent diabetes mellitus, diabetic ketoacidosis (DKA) can occur in some patients with non-insulin-dependent diabetes mellitus (NIDDM). To better define the clinical features that may be associated with ketoacidosis in patients with NIDDM, we reviewed the medical histories of Apache Indians with NIDDM who had been treated for an episode of DKA. Cases of ketoacidosis among patients with NIDDM were identified at 2 separate Apache Indian reservations. Chart data were used to confirm and characterize the diagnosis of NIDDM, the metabolic disturbances associated with DKA, and the historical features of the patients. Among 724 patients with NIDDM, 17 patients experiencing at least 1 episode of DKA were identified. The mean (+/-SD) age at the time of the episode was 40.8 +/- 13.9 years. The patients were predominantly male (15[88%]), with a mean (+/-SD) body mass index (calculated as the weight in kilograms divided by the square of the height in meters) of 24.9 +/- 4.4 kg/m2. Causes of DKA included infections (8[47%]) and omission of treatment (3/15[20%]). Concurrent abuse of alcohol was noted in 4 (27%) of the patients. In addition, a lifetime history of alcohol abuse was noted in 15 (94%) of 16 patients. This report confirms the growing recognition that DKA occurs in some patients with NIDDM. The present study also adds male sex, alcohol abuse, and relatively low body mass index as clinical factors that may play a role in the development of DKA in this setting.

Menopause in normal and uncomplicated NIDDM women: physical and emotional symptoms and hormone profile

Objective: To compare the physical characteristics, emotional symptoms and metabolic conditions of menopausal women with and without non insulin dependent diabetes mellitus (NIDDM). Methods: We studied 100 menopausal women 45–72 years of age, 51 with and 49 without NIDDM, in a cross-sectional design. Biological characteristics were collected and emotional symptoms were assessed with a modified Hamilton and Bech-Rafaelsen scale, scoring depression, anxiety, non specific symptoms of depression (NSSD) and the empty nest syndrome (ENS). Weight, body mass index (BMI), waist/hip and abdomen/hip ratios and percent of body fat were registered. The sulfoconjugated form of the dehydroepiandrosterone (DHEAS), follicle stimulating hormone (FSH), cortisol and fasting, as well as postprandial insulin/glucose ratios, were measured in blood. Results: Women with NIDDM had earlier mean age for menopause, more central obesity and less peripheral fat; they had also more prevalent emotional symptoms than non diabetic menopausal women. In women with NIDDM, symptoms were associated with years since diagnosis and with BMI. In non diabetic menopausal women schooling and attitudes to sexuality were associated with symptoms. FSH was inversely associated with BMI in both diabetic and non diabetic women; postprandial insulin/glucose ratio was correlated with central obesity in the group without NIDDM and cortisol with sitting systolic blood pressure (SBP) in the group with NIDDM. Conclusion: The diagnosis of NIDDM and its metabolic conditions were associated with an increased frequency of some symptoms in menopausal women.

Double-masked, placebo-controlled, dose-ranging study of troglitazone 10 to 200 mg once daily in non—insulin-dependent diabetes mellitus

Troglitazone is an insulin action-enhancing agent currently being investigated clinically for the treatment of non—insulin-dependent diabetes mellitus (NIDDM). Dose-ranging studies of the metabolic effects of troglitazone in NIDDM patients at doses of up to 800 mg/d have shown effective glycemic control, good tolerability, and favorable effects on dyslipidemic profiles. To determine the minimum effective dose of troglitazone required to achieve glycemic control in NIDDM, 10-mg, 30-mg, 100-mg, and 200-mg doses of troglitazone were administered once daily for 16 weeks in this double-masked, placebo-controlled, parallel-group, dose-ranging study. A total of 284 patients of both sexes (mean age, 60 years; range, 35 to 84 years) with a diagnosis of NIDDM and two consecutive fasting capillary blood glucose levels of 7 to 15 mmol/L, within 4 mmol/L of each other, were randomized to treatment. After 16 weeks of treatment an adjusted geometric mean glycated hemoglobin A 1c (Hb A 1c) value of 7.6% was seen in the 200-mg group compared with 8.2% in the placebo group, resulting in a statistically significant 7% overall reduction in Hb A 1c compared with placebo. Reductions in Hb A 1c in the other treatment groups were not statistically significant when compared with placebo. A definite linear dose-response relationship over the range of 10 to 200 mg of troglitazone for adjusted geometric mean fasting serum glucose level was seen during the 16-week treatment period; doses of 30, 100, and 200 mg showed statistically significant reductions compared with placebo after 16 weeks of treatment. Both adjusted geometric mean fasting serum insulin and proinsulin levels were lower for troglitazone 200 mg compared with placebo at all visits. A 10% reduction in insulin and a 16% reduction in proinsulin compared with placebo were seen at week 16, with only the latter reaching statistical significance. Troglitazone was well tolerated at all doses. The incidence and nature of adverse events were similar for all doses of troglitazone and placebo, with no hypoglycemic events occurring in any study group. This study demonstrated that troglitazone 200 mg once daily may be considered the minimum effective dose for establishing glycemic control in NIDDM

Current and future trends in therapy for dyslipidemias.

To characterize the atherogenic lipoprotein profile and discuss its implications in terms of treatment. Findings from large clinical trials and personal series of patients are reviewed, and the effectiveness of various interventions is assessed. A cost analysis of management of patients with dyslipidemias is offered. The dyslipidemia associated with non-insulin-dependent diabetes mellitus (NIDDM) is similar to low-density lipoprotein (LDL) pattern B. This atherosclerosis susceptibility trait--which typically consists of a preponderance of small dense LDL particles, intermediate-density lipoprotein, slightly increased triglycerides, and inappropriately low high-density lipoprotein type 2-- tends to precede the actual diagnosis of NIDDM and to identify a group with increased risk for cardiovascular events. It also usually signifies a group with good responses to treatment, including arteriographic evidence of regression of coronary artery disease. In general, niacin and fibrates are superior to statins for treatment of patients with LDL pattern B. Lipid management has been proved to be a cost-effective treatment strategy. Therapeutic options that lower triglyceride-rich lipoproteins and small dense LDL should be recommended in patients with NIDDM.

The global epidemiology of non-insulin-dependent diabetes mellitus and the metabolic syndrome

Non-insulin-dependent diabetes mellitus (NIDDM) constitutes about 85% of all cases of diabetes in developed countries and it has now reached epidemic proportions in many developing nations, as well as disadvantaged groups in developed countries, e.g., Mexican- and African-Americans and Australian Aborigines and Torres Strait Islanders. The diagnosis of NIDDM is usually made after the age of 50 years in Europids, but it is seen at much younger age in these high prevalence populations, which also include Pacific Islanders, Native Americans, and migrant Asian Indians and Chinese. There is enormous variation in NIDDM prevalence between populations, and exceptionally high rates have been documented in populations who have changed from a traditional to a modern lifestyle, e.g., American Pima Indians, Micronesians, and other Pacific Islanders, Australian Aborigines, migrant Asian Indians, and Mexican-Americans. Over the next decade, following the initial phase of the NIDDM epidemic, macro- and microvascular complications will emerge as a major threat to future public health throughout the world with huge economic and social costs. The major cause of death in NIDDM is macrovascular disease (coronary artery, peripheral vascular, and cerebrovascular), which accounts for at least two-thirds of NIDDM mortality. A key strategy in reducing macrovascular disease lies in the better understanding of the Deadly Quartet or Metabolic Syndrome. New data suggest that hyperleptinemia rather than hyperinsulinemia may play an important and central role in the genesis of the cardiovascular disease risk factor cluster that constitutes the Metabolic Syndrome.

Prevalence of the Trp64Arg missense mutation of the β 3-adrenergic receptor gene in Japanese subjects

Prompted by the recent findings that a tryptophan to arginine (Trp64Arg) mutation in the β 3-adrenergic receptor gene was associated with an earlier onset of non-insulin-dependent diabetes mellitus (NIDDM) in Pima Indians, with abdominal obesity and insulin resistance in Finns, and with an increased capacity to gain weight in French whites, we studied the prevalence of this mutation in 231 diabetic and 95 nondiabetic Japanese subjects and assessed its contribution to the development of obesity and NIDDM. The allelic frequencies of the mutation were 0.18 in diabetic and 0.23 in nondiabetic subjects, showing no significant difference between the two groups ( P = .067). In nondiabetic subjects, body mass index (BMI) did not differ between those with and without the mutation (22.2 ± 3.5 v 21.4 ± 3.2 kg/m 2, P = .252). In NIDDM subjects, BMI at the time of study and maximal BMI before the start of treatment did not differ between those with and without the mutation (22.8 ± 2.6 v 23.2 ± 3.7 kg/m 2, P = .678, and 24.7 ± 2.6 v 24.9 ± 3.1 kg/m 2, P = .277). Homozygotes for the mutation did not have trends to have increased BMI in either diabetic or nondiabetic subjects. The age at diagnosis of NIDDM also did not differ between the two groups (48.8 ± 9.9 v 47.8 ± 12.5 years, P = .796). Fasting serum cholesterol and triglyceride levels and systolic and diastolic blood pressure before the start of treatment did not differ between NIDDM subjects with and without the mutation. In conclusion, although the Trp64Arg mutation is not uncommon in Japanese, it does not appear to be associated with obesity, NIDDM, age at diagnosis of NIDDM, or dyslipidemia. Our results suggest that the mutation has minor effects, if any, on the development of obesity and NIDDM in Japanese.

Cardiovascular Events and Correlates in the Veterans Affairs Diabetes Feasibility Trial

The risks and benefits of intensive therapy in non-insulin-dependent diabetes mellitus (NIDDM) need to be defined. In preparation for a long-term trial, a feasibility study of 153 men in 5 medical centers compared standard vs intensive insulin therapy. To assess the rate of development of new cardiovascular events and their correlates. Patients with a mean +/- SD age of 60 +/- 6 years and diagnosis of NIDDM for 7.8 +/- 4.0 years were randomly assigned to a standard (1 insulin injection every morning) or to an intensive treatment arm (stepped plan from 1 evening injection of insulin, alone or with glipizide, to multiple daily injections) designed to attain near-normal glycemia levels. A 2.07% separation of glycosylated hemoglobin (HbA1c) was sustained for a mean follow-up of 27 months (P < .001). Predefined cardiovascular events were assessed by a committee unaware of treatment assignment. Mild and moderate hypoglycemic events were more frequent in the intensive than in the standard treatment arm (16.5 vs 1.5 per patient per year, respectively). Mean insulin dose was 23% lower in the standard treatment arm (P < .001). There were 61 new cardiovascular events in 24 patients (32%) in the intensive treatment arm and in 16 patients (20%) in the standard treatment arm (P = .10). There was no difference in total and cardiovascular mortality (n = 5 and n = 3 in the intensive and standard treatment arms, respectively) or in new events in patients with cardiovascular history (n = 10 in each arm). In Cox regression analysis, the only significant correlate for new cardiovascular events was previous cardiovascular disease (P = .04). Entering in the analysis any baseline cardiovascular abnormality, the regression model indicated a lower HbA1c level prior to the event as the only correlate for new cardiovascular events (P = .05). A long-term prospective trial is needed to assess the risk-benefit ratio of intensive insulin therapy for NIDDM in patients who require it.

Alzheimer's Disease and Non‐Insulin‐Dependent Diabetes Mellitus: Common Features Do Not Make Common Bedfellows

Alzheimer's Disease and Non‐Insulin‐Dependent Diabetes Mellitus: Common Features Do Not Make Common Bedfellows

Increased incidence of non-insulin-dependent diabetes mellitus among adolescents

To determine whether a rise in the diagnosis of non-insulin- dependent diabetes mellitus (NIDDM) has accompanied the rise in obesity in the pediatric population, as it has among adults. Medical records of 1027 consecutive patients from birth to age 19 years with a diagnosis of diabetes from 1982 to 1995 at a regional, university-affiliated pediatric diabetes referral center were reviewed and classified according to criteria of the National Diabetes Data Group. The number of patients with a diagnosis of NIDDM rose from approximately 4% of new diagnoses of diabetes in patients from birth to age 19 years before 1992, to 16% in 1994. Among patients 10 to 19 years of age, NIDDM accounted for 33% of diagnoses of diabetes in 1994. The incidence of adolescent NIDDM in Greater Cincinnati increased tenfold, from 0.7/100,000 per year in 1982 to 7.2/100,000 per year in 1994. The mean (+/- SD) age and body mass index at presentation were 13.8 +/- 1.9 years and 37.7 +/- 9.6 kg/m2, respectively. The overall female/male ratio was 1.7:1, and female patients were seen 1 year earlier than male patients (p < 0.01). Male subjects had a higher body mass index than female subjects (p < 0.05). A first-degree relative with NIDDM was identified for 65% of patients. At presentation, 21% of the patients had had a diagnosis of at least one other condition associated with obesity. There is an increasing incidence of NIDDM among adolescents in Greater Cincinnati, accompanying the national rise in adolescent obesity. Obesity and strong family histories of NIDDM are important risk factors. Because NIDDM leads to long-term morbidity, the prevention of obesity as well as early identification of overt disease, is critical.

Diabetic retinopathy at the time of diagnosis of NIDDM in South Indian subjects

Several studies from the U.K. and the U.S. have shown that retinopathy was present at diagnosis of non-insulin dependent diabetes mellitus (NIDDM) indicating the likelihood of a latent phase of hyperglycaemia for a long period. This study looked for the prevalence of retinopathy at diagnosis of NIDDM in South Indian subjects who have a fairly high prevalence of diabetes and also a high rate of undetected diabetes. One thousand NIDDM subjects with varying duration of diabetes underwent detailed opthalmoscopic examination for retinopathy. It was noted that the prevalence of retinopathy increased linearly with duration of diabetes. Among the 60 newly diagnosed NIDDM, 4 (6.7%) subjects had background diabetic retinopathy. Using a weighted linear regression analysis with percentage of retinopathy in relation to duration, it was estimated that hyperglycaemia could have been present 4.1 years prior to the diagnosis of NIDDM. Although the prevalence of retinopathy at diagnosis in South Indian NIDDM was lower than the other reported values, in view of the high prevalence of diabetes in Indians, a large number of patients would have the risk of microangiopathy even before diagnosis of diabetes is made.

GAD Antibodies in NIDDM: Ten-year follow-up from the diagnosis

To study the frequency of antibodies to glutamic acid decarboxylase (GAD) and islet cell antibodies (ICAs) and their predictive value with respect to the development of insulin deficiency in 133 newly diagnosed middle-aged patients with non-insulin-dependent diabetes mellitus (NIDDM) and in 126 control subjects and to study the persistence of GAD antibodies in diabetic patients during the follow-up. The study participants consisted of a well-characterized group of 133 middle-aged newly diagnosed patients with NIDDM and 126 control subjects. The follow-up examinations were performed 5 and 10 years after the baseline. The development of absolute and relative insulin deficiency was based on a stimulated C-peptide level that was undetectable or < 0.70 nmol/l, respectively. GAD antibodies were measured retrospectively from stored samples. The overall prevalence of GAD antibody and ICA positivity at the time of diagnosis was 9.0 and 3.8% in diabetic patients and 1.6 and 0% in the control population, respectively. During the 10-year follow-up, 3 (2.3%) and 10 (7.5%) of the diabetic patients developed absolute and relative insulin deficiency, respectively. Of these, two (67%) and six (60%) had been GAD antibody-positive at the time of diagnosis. The sensitivity and specificity of the GAD antibody to predict absolute or relative insulin deficiency were 67 vs. 94% and 60 vs. 95%, while corresponding figures for ICA were 33 vs. 97% and 20 vs. 98%, respectively. The negative predictive value of GAD antibody testing was higher than positive predictive value (97 vs. 50%). During the follow-up, low-grade GAD antibody positivity showed an evanescent nature, whereas the high levels were quite persistent. In an unselected population of newly diagnosed NIDDM patients, the prevalence of latent autoimmune diabetes in adults was < 10%. While GAD antibody and ICA measured at the time of diagnosis of NIDDM are equally specific predictors of subsequent insulin dependency, the GAD antibody may have a higher sensitivity. Therefore, measurements of GAD antibody may aid the clinician in the choice of treatment of these patients.

Prevalence of diabetes and hypertension in a rural population of Bangladesh.

OBJECTIVE--To determine the prevalence of non-insulin-dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT), and hypertension in a rural community of Bangladesh. RESEARCH DESIGN AND METHODS--A cluster sampling of 1,005 subjects > 15 years of age in the rural community of Dohar was investigated. Capillary blood glucose of fasting and 2 h after 75 g oral glucose (2hBG) were estimated. World Health Organization criteria were used for diagnosis of NIDDM and IGT. Blood pressure, height, and weight were also measured. RESULTS--The crude prevalence of NIDDM was 2.1% (men 3.1, women 1.3%) and IGT was 13.3% (men 14.4, women 12.4%). Age-adjusted (30-64 years of age) prevalence was 2.23% (95% confidence interval [CI] 1.01-3.45) for NIDDM and 15.67% (95% CI 12.59-18.75) for IGT. Prevalence of hypertension with systolic blood pressure (sBP) > or = 140 mmHg was 10.5% and with diastolic blood pressure (dBP) > 90 mmHg was 9.0%. Increased age was the risk factor for NIDDM, IGT, and hypertension; whereas increased BMI showed inconsistent association with them. Relative risk for sBP with higher BMI ( < 22.0 vs. > or = 22.1) was 1.94 with CI 1.55-2.43 and for dBP it was 2.2 with CI 1.40-3.46. Correlation of sBP was significant with age, BMI, and 2hBG. Similar correlation was also observed with dBP. CONCLUSIONS--High prevalences of NIDDM, IGT, and hypertension were observed among rural subjects. Increased age was shown to be an important risk factor for all these disorders, whereas BMI-associated risk was significant with NIDDM and hypertension but not with IGT.

The lived experience of Native Americans with diabetes within a transcultural nursing perspective.

The purpose of this study was to advance transcultural nursing knowledge based on the lived experiences of Native Americans with non-insulin dependent diabetes mellitus (NIDDM). The phenomenological qualitative research method was used to discover Native Americans lived experiences. Data was gathered in rural Oklahoma through non-structured interviews and clinical observations of Native Americans with NIDDM. The interviews were transcribed and analyzed for themes and patterns of similar statements among informants. Six major thematic categories were identified: reactions to NIDDM, responses to loss of health, identification with others, fear associated with the disease process, peace related to the diagnosis of NIDDM, and grieving associated with the diagnosis of NIDDM. The informants' experiences were reconstructed into transformed meanings that characterized the lifeworld of Native Americans with NIDDM.

SEQUENTIAL CHANGES IN SERUM INSULIN CONCENTRATION DURING DEVELOPMENT OF NON-INSULIN-DEPENDENT DIABETES

Changes in serum insulin concentrations during deterioration of glucose tolerance were studied in 81 Pima Indians who worsened from normal to impaired glucose tolerance (IGT); 44 who changed from IGT to non-insulin-dependent diabetes mellitus (NIDDM); 27 who were seen at diagnosis of NIDDM and 1·4-8·5 years later; and 11 subjects who were seen at each of these stages. When their glucose tolerance was normal, subjects who later developed NIDDM had higher fasting and post-load insulin concentrations than controls of similar age and body mass index who did not become diabetic. Onset of IGT or NIDDM was associated with a further increase in fasting insulin concentrations, although a deterioration from IGT to NIDDM was associated with little change in insulin responses to oral glucose in spite of increased blood glucose. After the onset of NIDDM, both fasting and post-load insulin concentrations diminished. These longitudinal data show that, as glucose tolerance worsens, insulin and glucose concentrations in individuals follow the inverted-U-shaped relation previously reported in cross-sectional population studies.

Epidemiology of persistent proteinuria in type II diabetes mellitus. Population-based study in Rochester, Minnesota.

Clinical risk factors for nephropathy were assessed in a population-based study of Rochester, Minnesota, residents with diabetes mellitus initially diagnosed between 1945 and 1969 (incidence cohort). The 1031 Rochester residents with non-insulin-dependent diabetes mellitus (NIDDM) were followed through their complete medical records in the community to 1 January 1982. The prevalence of persistent proteinuria was 8.2% at the diagnosis of NIDDM. Among those initially free of persistent proteinuria, the subsequent incidence was 15.3/1000 person-yr. Twenty years after the diagnosis of diabetes, the cumulative incidence of persistent proteinuria was 24.6%. A proportional hazards model identified the following risk factors for persistent proteinuria in NIDDM: elevated initial fasting blood glucose (P less than .01); older age at onset of diabetes (P less than .01); male gender (P = .05); and presence of macrovascular disease (P = .05), diabetic retinopathy (P = .05), or glycosuria (P = .07) at the diagnosis of diabetes. Separate analyses controlling for attained age indicated no association between duration of NIDDM and the incidence of persistent proteinuria. Stratified analysis of the two most significant risk factors (fasting blood glucose and age) indicated that hyperglycemia was a stronger risk factor for proteinuria in younger diabetic subjects, perhaps because of a competing risk of death in the elderly diabetic patient. In contrast to a recently described decreasing secular trend of proteinuria in Danish insulin-dependent diabetes mellitus patients, there was no decrease over the past 40 yr in proteinuria risk in this NIDDM incidence cohort.