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We conducted three single‐day point type 2 diabetes prevalence surveys of all inpatient clinical records in November 2013, 2014 and 2016. The prevalence of diabetes was 19.7–25.3%. The majority (63.4–76%) had type 2 diabetes. Twenty‐one percent (n = 21) in 2013, 12% (n = 9) in 2014 and 22.6% (n = 21) in 2016 were diagnosed with diabetes during hospital admission; 41.8% (n = 41) in 2013, 46.7% (n = 35) in 2014 and 51.6% (n = 48) in 2016 required insulin. The high prevalence of diabetes among inpatients mandates active detection and specialist management of diabetes during the admission. [ABSTRACT FROM AUTHOR]

Abstract: Background: Diabetes increases morbidity and mortality of lung transplantation. However, the reported prevalence of diabetes varies post‐transplantation partly due to lack of detection protocols. Aim: To determine the prevalence of diabetes in patients (i) waitlisted for lung transplant and (ii) early post‐transplantation. Methods: We analysed patients on the St Vincent's Heart Lung database from 1 April 2014 to 30 September 2015 on the waitlist (Study 1) and those transplanted (Study 2). Standard of care required all non‐diabetic patients to have an oral glucose tolerance test (modified for patients with cystic fibrosis (CF) to screen for CF‐related hyperglycaemia (CFRH) (plasma glucose ≥8.2 mmol/L at 60 or 90 min). Results: Study 1 included 114 patients (32 with CF and 82 without CF). Of 30 CF patients with glycaemic data, 27 (90%) had abnormal glucose metabolism: 18 had diabetes and nine had CFRH. In 50 patients without CF, 20 (40%) had abnormal glucose metabolism: eight had diabetes and 12 had impaired fasting glucose and/or impaired glucose tolerance. Study 2 included 78 transplanted patients (25 with CF and 53 without CF). Fourteen CF patients had pre‐existing diabetes and seven had pre‐existing CFRH. All but one patient were diagnosed with diabetes post‐transplantation. Hence, diabetes prevalence in CF patients post‐transplantation was 96%. Among 53 transplanted patients without CF, seven (13%) had abnormal glucose metabolism but 30 (57%) were diagnosed with post‐transplant diabetes. Conclusion: There is a high prevalence of diabetes in lung transplant patients. Earlier endocrine participation in lung transplant services is likely to lower diabetes‐related morbidity and mortality further. [ABSTRACT FROM AUTHOR]

Objective: To investigate the reproducibility of the plasma glucose (PG) response to exercise in subjects with type 1 diabetes on a nonintensive insulin regimen.Research Design and Methods: Subjects cycled for 45 min at 50% VO(2max) on two occasions (studies 1 and 2) either 1 h after lunch and usual insulin (protocol A) or after overnight fasting without morning insulin (protocol B). Identical diet, activity, and insulin (twice daily neutral and intermediate) were maintained before and during each study day. A total of 13 type 1 diabetic subjects (6 men and 7 women, BMI 24.0 +/- 0.9 kg/m(2) [means +/- SE], age 42.6 +/- 2.7 years, diabetes duration 14.1 +/- 2.8 years) completed protocol A, and 7 (3 men and 4 women, BMI 25.8 +/- 1.3 kg/m(2), age 39.7 +/- 1.3 years, diabetes duration 14 +/- 4.4 years) completed protocol B.Results: In protocol A (fed), the fall in PG during exercise was 4.5 +/- 1.0 and 5.0 +/- 0.8 mmol/l in studies 1 and 2, respectively, whereas in protocol B (fasted), it was 0.6 +/- 0.8 and 3.4 +/- 1.6 mmol/l. Regression analysis of the change in PG in protocol A in study 1 versus study 2 showed poor reproducibility (r(2) = 0.12, P = 0.25) despite uniform conditions. In protocol B, the fall in PG was more reproducible (r(2) = 0.81, P = 0.006). In fed subjects, there was better (P = 0.01) and clinically useful reproducibility of the PG at exercise completion (r(2) = 0.77, P = 0.0001) compared with preexercise.Conclusions: These results indicate poor reproducibility of the change in PG during exercise after feeding in type 1 diabetes on nonintensive insulin regimens but reasonable reproducibility when fasting. Exercise apparently decreases the glycemic variability after feeding, so that PG concentrations after exercise seek a reproducible "target." Thus, the absolute PG level after a typical bout of exercise in the fed state should be a good guide to carbohydrate or insulin adjustment on subsequent occasions. [ABSTRACT FROM AUTHOR]

The effect of insulin administration on immune complex (IC) formation in diabetic patients was analysed in vivo and in vitro. Firstly, serial studies of IC status were performed over a mean period of 18 months in 44 diabetic patients. 37 of whom were receiving standard insulin therapy. Thirty patients changed to monocomponent (C) insulin while seven commenced MC insulin after tablet failure. The other seven patients remained on standard insulin throughout the study. Secondly, nine patients had serial measurements of IC over a 6-8 h period following a routine morning dose of MC insulin; eight control subjects were similarly studied. The insulin content of IC in insulin treated patients was assessed in vitro by examining, (a) the selective precipitation of antibody bound insulin by 3% polyethylene glycol (PEG) and (b) the insulin specificity of antisera raised against PEG precipitates of IC positive sera. The longitudinal study of circulating IC showed no significant changes apart from an isolated fall in IgA containing IC at 6 months after changing therapy (P<005). No short term change in IC was observed after MC insulin administration. The precipitability of antibody bound insulin in insulin treated patients was not significantly different lo that seen in non-insulin treated patients or normal sera. Antisera to PEG precipitates of diabetic sera showed no significant specificity for insulin, although they showed marked reactivity with other plasma components (such as immunoglobulins and complement components). It is concluded that administered insulin plays little or no role in IC formation in insulin treated diabetic patients. [ABSTRACT FROM AUTHOR]

Keywords: Diabetes mellitus, type 2; Hospital medicine EN Diabetes mellitus, type 2 Hospital medicine 95 95 1 07/21/20 20200715 NES 200715 I B In reply b i I B : b i We thank Fourlanos and colleagues for their comments regarding our cluster randomised trial, which demonstrated that emergency department screening for diabetes and hyperglycaemia alone did not improve identification of diabetes, documentation of follow-up plans, or hospital outcomes. Early intervention for diabetes in medical and surgical inpatients decreases hyperglycemia and hospital-acquired infections: a cluster randomized trial. [Extracted from the article]

The Diabetes Control and Complications Trial and United Kingdom Prospective Diabetes Study (UKPDS) trials have provided evidence for the pivotal importance of optimizing glycaemic control to prevent complications in type 1 and 2 diabetes mellitus. Both patients and diabetes professionals consider lifestyle change and appropriate medication as cornerstones for achieving good glycaemic control. The frequent reversals in the recommended diabetic diet in the past century warn that in the nutritional area the hypotheses are many, but the proofs are few. In type 1 diabetes, the patient is still advised to spread out carbohyrate foods during the day with three short-acting insulin injections at meal times to minimize postprandial hyperglycaemia. In type 2 diabetes, weight loss is the major target, because 80% of patients are overweight or obese. However, it is salutory to note that in the UKPDS trial, no modality of treatment delayed the relentless deterioration of glycaemic control in type 2 diabetes, the extent of which was predicted by the insulin secretion. Controversy still exists regarding whether lowering the dietary fat enhances weight loss of itself and whether dietary carbohydrate, fat and fibre influence insulin sensitivity and glycaemia. The American Diabetes Association’s evidence-based recommendations currently offer a choice between a high carbohyrate and modified fat diet, with monounsaturated fat replacing the saturated fat instead of carbohydrate. The role of omega-3 fatty acids in man is not resolved. The reason for the surprising lack of definitive evidence lies in the limitations of nutritional research. Under-reporting of diet is common and dietary assessment tools are often inaccurate. Sustained weight loss is unattainable by the majority of patients, perhaps because of the strongly genetic nature of obesity and the sedentary lifestyle. Compliance may be improved by suggesting small, sustained dietary changes, setting small weight loss... [ABSTRACT FROM AUTHOR]

The article focuses on the survey conducted at the Fremantle Hospitat and Fiona Stanley Hospital in Australia regarding the hospital patients who develop diabetes while in the hospital.

A letter to the editor is presented in response to the article "Trends in diabetes: sounding the alarm" by Etienne Krug and colleagues that was published in the April 9, 2016 issue.

The article comments on an article about the effect of insulin resistance on the manifestations of metabolic syndrome (MS) in renal disease. The presence of MS doubles coronary heart disease mortality. Insulin resistance is considered important in the pathogenesis of MS. The gold standard measure is the hyperinsulinemic, euglycemic clamp. The fasting insulin will correlate with insulin resistance. Patients with renal failure have reduced renal elimination of insulin and reduced renal gluconeogenesis, which explain why diabetes control often improves in renal failure.

Focuses on a study which compared at-risk first-degree relatives of type 2 diabetic subjects with control subjects without family history of diabetes. Levels of intramyocellular lipid triglyceride in the at-risk group in soleus; Primary cause of established whole-body insulin resistance.

Editorial. Reports the increasing incidence of type 2 diabetes among second and third generation Japanese. Genetic factors; Prediction of type 2 diabetes in second generation Japanese; Features that distinguish diabetes in the second and third generations.

Contends that type 1 diabetes is not associated with increased central abdominal obesity. Absence of relationship between insulin resistance in type 1 diabetes and increased central abdominal adiposity; Benefits of targeting insulin resistance in reducing excess coronary risk in type 1 diabetes.

Aims: Analyze cosegregation of aniridia and diabetes to identify genetic criteria for detection and early treatment of diabetes-susceptible aniridia patients.Methods: We assessed a two-generation family: three individuals with aniridia, two previously diagnosed as type 2 diabetes. One individual with aniridia, with unknown diabetes status, was evaluated by oral glucose tolerance test. Genetic analysis of aniridia-associated genes was performed on all available family members. Candidate genes were functionally tested by gene silencing in MIN6 pancreatic β-cells.Results: A 25 year old male with aniridia had a diabetic oral glucose tolerance test despite a normal fasting blood glucose. A 484-630 kb deletion ∼120 kb distal to PAIRED BOX 6 (PAX6) showed dominant cosegregation with aniridia and diabetes in all affected family members. The deleted region contains regulatory elements for PAX6 expression and four additional coding regions. Knockdown of two of the deleted genes (Dnajc24 or Immp1l) with Pax6 impaired glucose-stimulated insulin secretion.Conclusions: We demonstrate dominant cosegregation of diabetes and aniridia with a deletion distal to PAX6, which is clinically distinct from the mild glucose intolerance previously reported with PAX6 coding mutations. Asymptomatic aniridia individuals appear at risk of diabetes (and its complications) and could benefit from earlier diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: Insulin resistance and hyperinsulinemia are features of obesity, non-insulin-dependent diabetes mellitus, and other disorders. Skeletal muscle is a major site of insulin action, and insulin sensitivity may be related to the fatty-acid composition of the phospholipids within the muscle membranes involved in the action of insulin. Methods: We determined the relation between the fatty-acid composition of skeletal-muscle phospholipids and insulin sensitivity in two groups of subjects. In one study, we obtained samples of the rectus abdominis muscle from 27 patients undergoing coronary artery surgery; fasting serum insulin levels provided an index of insulin sensitivity. In the second study, a biopsy of the vastus lateralis muscle was performed in 13 normal men, and insulin sensitivity was assessed by euglycemic-clamp studies. Results: In the patients undergoing surgery, the fasting serum insulin concentration (a measure of insulin resistance) was negatively correlated with the percentage of individual long-chain polyunsaturated fatty acids in the phospholipid fraction of muscle, particularly arachidonic acid (r = -0.63, P<0.001); the total percentage of C20-22 polyunsaturated fatty acids (r = -0.68, P<0.001); the average degree of fatty-acid unsaturation (r = -0.61, P<0.001); and the ratio of the percentage of C20:4 n-6 fatty acids to the percentage of C20:3 n-6 fatty acids (r = -0.55, P<0.01), an index of fatty-acid desaturase activity. In the normal men, insulin sensitivity was positively correlated with the percentage of arachidonic acid in muscle (r = 0.76, P<0.01), the total percentage of C20-22 polyunsaturated fatty acids (r = 0.76, P<0.01), the average degree of fatty-acid unsaturation (r = 0.62, P<0.05), and the ratio of C20:4 n-6 to C20:3 n-6 (rho = 0.78, P = 0.007). Conclusions: Decreased insulin sensitivity is associated with decreased concentrations of polyunsaturated fatty acids in skeletal-muscle phospholipids, raising the possibility that changes in the fatty-acid composition of muscles modulate the action of insulin. (N Engl J Med 1993;328:238-44.) [ABSTRACT FROM AUTHOR]