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Background: Measures of regional adiposity have been proposed as alternatives to the measurement of body mass index (BMI) for identifying persons at risk of future disease. Objective: The objective was to compare the magnitudes of association of BMI and alternative measurements of adiposity with coronary heart disease, diabetes, and cardiovascular disease risk factors and all-cause mortality. Design: Data from 4 cohorts of adults [3937 women from the British Women's Heart and Health Study (BWHHS); 2367 and 1950 men from phases 1 and 3, respectively, of the Caerphilly Prospective Study (CAPS); 403 men and women from the Boyd Orr Study; and 789 men and women from the Maidstone-Dewsbury Study] were analyzed. Results: The magnitudes of associations of BMI with incident coronary heart disease and cardiovascular disease risk factors were similar to those with measurements of central adiposity [waist circumference (WC), waist-hip ratio (WHR), or waist-height ratio (WHtR)] and more direct measurements of fat mass (bioimpedance/skinfold thickness). In CaPS (men only), there was no strong evidence of differences in the strengths of association with incident diabetes between BMI, WC, WHR, and WHtR (P for heterogeneity > 0.49 for all). In the BWHHS (women only), there was statistical evidence that WC [hazard ratio (HR): 2.35; 95% CI: 2.03, 2.73] and WHtR (HR: 2.29; 95% CI: 1.98, 2.66) were more strongly associated with diabetes than with BMI (HR: 1.80; 95% CI: 1.59, 2.04) (P for heterogeneity < 0.02 for both). Central adiposity measurements were positively associated with all-cause mortality, as was BMI, but only when those with a BMI (in kg/[m.sup.2]) Conclusion: No strong evidence supports replacing BMI in clinical or public health practice with other adiposity measures. Am J Clin Nutr 2010;91:547-56. doi: 10.3945/ajcn.2009.28757.

The imperative for healthcare organizations to improve quality of care and reduce costs has taken on increased importance in recent years, particularly as the debate regarding how our nation's healthcare [...]

Objective. To assess relationships between self-assessed control over life events, subjective beliefs about longevity, time and risk preference, and other factors on use of recommended care for diabetes mellitus (DM), self-assessed control of diabetes, general health, and laboratory measures of HbA1c levels. Data Sources. Health and Retirement Study (HRS) and 2003 HRS Diabetes Study (HRS-DS). Study Design. We used logit and ordered logit analyses to assess use of recommended care, and subjective and objective measures of health outcomes. Data Collection. Secondary analysis of HRS and HRS-DS data. Principal Findings. Individuals with higher self-assessed control over life events and higher subjective probabilities of living 10 years engaged in more recommended DM care practices and had better self-assessed DM control and general health. However, these beliefs did not influence HbA1c levels. More highly educated and cognitively able persons were more likely to follow care recommendations. There were differences by race/ethnicity in health outcomes, but not in health investment among Hispanics. Conclusions. Individuals&apos; beliefs about control over life events and longevity influenced health investment and subjective health outcomes, although these beliefs did not translate into differences in HbA1c levels. Hispanics may realize lower returns on health investments, at least for diabetes care. Key Words. Diabetes mellitus, self-management, patient preferences, Diabetes mellitus (DM) prevalence is rising (Mokdad et al. 2000; Bagust et al. 2001). Adherence of diabetes patients to recommended care can markedly reduce complication rates. In the U.K. Prospective [...]

Practice recommendations * Routinely screen adult patients with a sustained blood pressure >135/80 mm Hg for type 2 diabetes (SOR: B). * Closely monitor pregnant women with 1 or more [...]

[ILLUSTRATION OMITTED] Do you inject yourself four times a day with a drug that will save your life? Do you have to remember to take tablets at set times every […]

One thing is certain--everything in life changes. The field of medicine is certainly not exempt from this axiom. In fact, health care changes and evolves so frequently that it is [...]

Jon, a 25-year-old research technician, was brought to the hospital's Accident and Emergency Unit by his two flatmates. His friends said he had been complaining of feeling generally unwell the […]

This article reviews many of the key incretin clinical trials, with a focus on the efficacy and safety of glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors compared [...]

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1744-618X.2008.00084.x Byline: Mary Ann Lavin (1) Keywords: Nursing diagnosis; human response; diagnostic tests; nomenclature; diabetes mellitus; laboratory; analysis Abstract: This brief indicates how methods used by the National Academy of Clinical Biochemistry (NACB) in the development of its guidelines and recommendation for the laboratory analysis in the diagnosis and management of diabetes mellitus may be applied to advance nomenclature, clinical practice, and research development within nursing. Specifically, human response diagnoses require the identification of accurate tests to confirm or reject the diagnoses. Each test needs to be described in terms of its use, rationale, analytical, and emerging considerations. Accurate test development will move nursing nomenclature, clinical practice, and research forward. Author Affiliation: (1)Saint Louis University School of Nursing, St. Louis, MO. Article note: Author contact: lavinma@slu.edu

Islets are composed mostly of [beta]-cells, and therefore stem cell research has concentrated on generating purified [beta]-cells, neglecting the other endocrine cell types in the islet. We investigated the presence [...]

Islet cell autoantibodies are strongly associated with the development of type 1 diabetes. The appearance of autoantibodies to one or several of the autoantigens--GAD65, IA-2, or insulin--signals an autoimmune pathogenesis of [beta]-cell killing. A [beta]-cell attack may be best reflected by the emergence of autoantibodies dependent on the genotype risk factors, isotype, and subtype of the autoantibodies as well as their epitope specificity. It is speculated that progression to [beta]-cell loss and clinical onset of type 1 diabetes is reflected in a developing pattern of epitope-specific autoantibodies. Although the appearance of autoantibodies does not follow a distinct pattern, the presence of multiple autoantibodies has the highest positive predictive value for type 1 diabetes. In the absence of reliable T-cell tests, dissection of autoantibody responses in subjects of genetic risk should prove useful in identifying triggers of islet autoimmunity by examining seroconversion and maturation of the autoantibody response that may mark time to onset of type 1 diabetes. The complexity of the disease process is exemplified by multiple clinical phenotypes, including autoimmune diabetes masquerading as type 2 diabetes in youth and adults. Autoantibodies may also provide prognostic information in clinically heterogeneous patient populations when examined longitudinally., ISLET CELL AUTOANTIBODIES Autoantibodies are created by the immune system when it falls to distinguish between 'self' and 'nonself.' It is normally trained to recognize and ignore the body's own [...]

Glycogen is an important component of whole-body glucose metabolism. MGSKO mice lack skeletal muscle glycogen due to disruption of the GYS1 gene, which encodes muscle glycogen synthase. MGSKO mice were 5-10% smaller than wild-type littermates with less body fat. They have more oxidative muscle fibers and, based on the activation state of AMP-activated protein kinase, more capacity to oxidize fatty acids. Blood glucose in fed and fasted MGSKO mice was comparable to wild-type littermates. Serum insulin was lower in fed but not in fasted MGSKO animals. In a glucose tolerance test, MGSKO mice disposed of glucose more effectively than wild-type animals and had a more sustained elevation of serum insulin. This result was not explained by increased conversion to serum lactate or by enhanced storage of glucose in the liver. However, glucose infusion rate in a euglycemic-hyperinsulinemic clamp was normal in MGSKO mice despite diminished muscle glucose uptake. During the clamp, MGSKO animals accumulated significantly higher levels of liver glycogen as compared with wild-type littermates. Although disruption of the GYS1 gene negatively affects muscle glucose uptake, overall glucose tolerance is actually improved, possibly because of a role for GYS1 in tissues other than muscle., After a meal, glucose is distributed into various tissues of the body where it can be utilized as an energy source or stored as glycogen (1). Glycogen is a branched [...]

Leptin inhibits insulin secretion and preproinsulin gene expression in pancreatic [beta]-cells, but signal transduction pathways and molecular mechanisms underlying this effect are poorly characterized. In this study, we analyzed leptin-mediated signal transduction and preproinsulin gene regulation at the molecular level in pancreatic 13-cells. Leptin stimulation led to janus kinase (JAK)2-dependent phosphorylation and nuclear translocation of the transcription factors signal transducer and activator of transcription (STAT)3 and STAT5b in INS-1 [beta]-cells. Leptin also induced mRNA expression of the JAK-STAT inhibitor suppressor of cytokine signaling (SOCS)3 in INS-1 [beta]-cells and human pancreatic islets in vitro and in pancreatic islets of ob/ob mice in vivo. Transcriptional activation of the rat SOCS3 promoter by leptin was observed with concomitant leptin-induced STAT3 and STAT5b DNA binding to specific promoter regions. Unexpectedly, SOCS3 inhibited both basal and STAT3/5b-dependent rat preproinsulin 1 gene promoter activity in INS-1 cells. These results suggest that SOCS3 represents a transcriptional inhibitor of preproinsulin gene expression, which is induced by leptin through JAK-STAT3/5b signaling in pancreatic J3-cells. In conclusion, although SOCS3 is believed to be a negative feedback regulator of JAK-STAT signaling, our findings suggest involvement of SOCS3 in a direct gene regulatory pathway downstream of leptin-activated JAK-STAT signaling in pancreatic [beta]-cells., The hormone leptin is the product of the obese (ob) gene, primarily produced by white adipose tissue (1) and typically circulates in proportion to body fat mass (2). Leptin acts [...]

To investigate the role of the Sry/hydroxymethylglutaryl box (Sox) transcription factors in the development of the pancreas, we determined the expression pattern of Sox factors in the developing mouse pancreas. By RT-PCR, we detected the presence of multiple Sox family members in both the developing pancreas and mature islets and then focused on two factors, Sox2 and Sox4. The expression field of Sox2, which plays a role in the maintenance of some stem cell populations, included the developing duodenum, but Sox2 was specifically excluded from the pancreatic buds. In contrast, Sox4 was detected broadly in the early pancreatic buds and eventually became restricted to the nuclei of all islet cells in the adult mouse. Mice homozygous for a null mutation of the sox4 gene showed normal pancreatic bud formation and endocrine cell differentiation up to embryonic day 12.5. Beyond that date, cultured pancreatic explants lacking sox4 failed to form normal islets. Instead, a markedly reduced number of endocrine cells were found scattered through the explant. We show here that several Sox transcription factors are expressed in the developing pancreas and in the islet, and that one of these factors, Sox4, is required for the normal development of pancreatic islets., Scattered through the exocrine pancreas, the islets of Langerhans are highly organized clusters of endocrine cells comprised of four distinct cell types: the glucagon-secreting [alpha]-cells, the insulin-secreting [beta]-cells, the somatostatin-secreting [...]

The development of islet cell transplantation as a cure for diabetes is limited by the shortage of human donor organs. Moreover, currently used grafts exhibit a marginal [beta]-cell mass with an apparently low capacity for [beta]-cell renewal and growth. Although duct-associated nonendocrine cells have often been suggested as a potential source for [beta]-cell production, recent work in mice has demonstrated the role of [beta]-cells in postnatal growth of the pancreatic [beta]-cell mass. The present study investigated whether the [beta]-cell mass can grow in implants that are virtually devoid of nonendocrine cells. Endocrine islet cells were purified from prenatal porcine pancreases (gestation >110 days) and implanted under the kidney capsule of nude mice. [beta]-Cells initially presented with signs of immaturity: small size, low insulin content, undetectable C-peptide release, and an inability to correct hyperglycemia. They exhibited a proliferative activity that was highest during posttransplant week 1 (2.6 and 5% bromodeoxyuridine [BrdU]-positive [beta]-cells 4 and 72 h posttransplant) and then decreased over 20 weeks to rates measured in the pancreas (0.2% BrdU-positive cells). [beta]-Cell proliferation in implants first compensated for [beta]-cell loss during posttransplant week 1 and then increased the [beta]-cell number fourfold between posttransplant weeks 1 and 20. Rates of [alpha]-cell proliferation were only shortly and moderately increased, which explained the shift in cellular composition of the implant ([beta]-cell 40 vs. 90% and [alpha]-cell 40 vs. 7% at the start and posttransplant week 20, respectively). [beta]-Cells progressively matured during the 20 weeks after transplantation, with a twofold increase in cell volume, a sixfold increase in cellular insulin content, plasma C-peptide levels of 1-2 ng/ml, and an ability to correct diabetes. They became structurally organized as homogenous clusters with their secretory vesicles polarized toward fenestrated capillaries. We concluded that the immature [beta]-cell phenotype provides grafts with a marked potential for [beta]-cell growth and differentiation and hence may have a potential role in curing diabetes. Cells with this phenotype can be isolated from prenatal organs; their presence in postnatal organs needs to be investigated., Islet cell transplantation has long been considered as a potential cure for diabetes (1,2). A transplantation protocol has been reported that has achieved a consistent insulin independence that has been [...]

Abstract Objective To evaluate and synthesize the evidence on the effect of Ayurvedic therapies for diabetes mellitus. Design Systematic review of trials. Measurements and main results We found no study [...]

Diabetes is somewhat analogous to glaucoma, another chronic medical condition with which optometrists have considerable experience. Both diseases are chronic and without a cure. Both carry serious long-term risk of [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2005.05.018 Byline: Prakash C. Deedwania (a), Vivian A. Fonseca (b) Keywords: Diabetes; Metabolic syndrome; Glucose intolerance; Cardiovascular disease Abstract: As the prevalence of diabetes continues to increase worldwide, diabetes-related macrovascular morbidity and mortality are becoming major health care problems. Epidemiologic evidence suggests this relationship begins early in the progression from normal glucose tolerance to frank diabetes. This report reviews this epidemiologic evidence linking early stages of glucose dysregulation with cardiovascular disease and discusses the results of major clinical trials demonstrating that lifestyle or pharmacologic intervention can reduce the incidence of diabetes in high-risk individuals. These observations indicate that early identification and aggressive treatment of subjects with impaired fasting glucose or impaired glucose tolerance have the potential to reduce both the incidence of diabetes and its related cardiovascular disease. Three clinical trials are being conducted to test whether early pharmacotherapy can reduce or delay the incidence of diabetes, and their results may well begin to shift the treatment paradigm toward earlier intervention. Author Affiliation: (a) Division of Cardiology, Department of Medicine, Veterans Affairs Central California Health Care System, University of California San Francisco Medical Education Program, Fresno, Calif (b) Diabetes Program, Tulane University Medical Center, New Orleans, La Article History: Received 4 February 2005; Revised 4 May 2005; Accepted 4 May 2005

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2005.07.054 Byline: Jaime Davidson Keywords: Adherence; Barriers; Frequency; Hypoglycemia; Implementation; Self-monitoring of blood glucose Abstract: Despite the increasing prevalence of diabetes, improved understanding of the disease, and a variety of new medications, glycemic control does not appear to be improving. Self-monitoring of blood glucose (SMBG) is one strategy for improving glycemic control; however, patient adherence is suboptimal and proper education and follow-up are crucial. Patients need to understand why they are being asked to self-test, what their glycemic targets are, and what they should do based on the results of self-monitoring. Patients also must be taught proper technique and must be given specific recommendations regarding frequency and timing for self-monitoring. Situations in which SMBG is essential or should be more frequent include self-adjustment of insulin doses, changes in medications, lack of awareness of hypoglycemia, gestational diabetes, illness, or when hemoglobin A.sub.1c (HbA.sub.1c) values are above target. SMBG should include postprandial monitoring to identify glycemic excursions after meals, to indicate the need for lifestyle adjustments, and to provide patient feedback on dietary choices. Author Affiliation: University of Texas Southwestern Medical School, and Endocrine and Diabetes Associates of Texas, Dallas, Texas, USA Article Note: (footnote) Publication of this article was made possible through editorial support from Health Learning Systems and an educational grant from LifeScan, Inc.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2005.07.053 Byline: Lawrence Blonde (a), Andrew J. Karter (b) Keywords: Frequency; Meal-related monitoring; Meta-analysis; Postprandial; Self-monitoring of blood glucose Abstract: Many people with diabetes are falling short of attaining or maintaining glycemic goals. Self-monitoring of blood glucose (SMBG) is among the many strategies proposed to address the problem. SMBG complements hemoglobin A.sub.1c (HbA.sub.1c) testing by providing specific information regarding the effects of diet, exercise, and medications on glycemia. Although the importance of self-monitoring is appreciated for insulin-using patients, evidence is still emerging in support of self-monitoring for patients with type 2 diabetes managed with oral agents or diet. Evaluating the available evidence requires a good understanding of the study design and methodology. Although several clinical trials involving SMBG have been insufficiently powered to detect clinically meaningful differences in HbA.sub.1c, recent meta-analyses have reproducibly supported the benefit of self-monitoring in non-insulin-treated patients. Although additional work is needed to establish optimal frequency and timing of SMBG, these studies can serve as a basis for conservative recommendations to guide patients and their healthcare providers. Author Affiliation: (a) Ochsner Diabetes Clinical Research Unit, Section on Endocrinology, Diabetes and Metabolic Diseases, Ochsner Clinic Foundation, New Orleans, Louisiana, USA (b) Division of Research, Kaiser Permanente, Oakland, California, USA Article Note: (footnote) Publication of this article was made possible through editorial support from Health Learning Systems and an educational grant from LifeScan, Inc.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2005.07.052 Byline: Eric Renard Keywords: Glycemic control; Glycemic excursions; Hemoglobin A.sub.1c; Hypoglycemia; Self-monitoring of blood glucose; Urine glucose Abstract: Several methods, each with differing utility and limitations, exist for monitoring glycemic control. Hemoglobin A.sub.1c (HbA.sub.1c) is considered the standard measure of long-term glycemic control, and HbA.sub.1c levels are strongly associated with complications of diabetes. However, HbA.sub.1c does not provide 'real-time' information about individual hyperglycemic or hypoglycemic excursions. Urine glucose testing is noninvasive and inexpensive, but it is dependent on the patient's individual renal threshold and can only detect glucose concentrations above this threshold. As such, urine testing cannot be recommended for diabetes management that aims for near-normoglycemia. Self-monitoring of blood glucose (SMBG) complements HbA.sub.1c by providing real-time blood glucose data. It is an educational tool for both patients and their healthcare providers to understand the effects of diet, exercise, and medications on day-to-day glycemic control. However, guidelines from various international diabetes organizations vary in their level of specificity regarding the frequency and timing of self-monitoring. SMBG should be implemented for all patients as part of an overall diabetes management plan that includes specific instruction on how, when, and why to test. Author Affiliation: Department of Endocrinology, Diabetes, and Metabolism, Montpellier I University, Montpellier, France, and Lapeyronie Hospital, Montpellier, France Article Note: (footnote) Publication of this article was made possible through editorial support from Health Learning Systems and an educational grant from LifeScan, Inc.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2005.07.055 Byline: Richard M. Bergenstal (a), James R. Gavin (b) Keywords: Consensus conference; Glycemic control; Glycosylated hemoglobin; Self-monitoring of blood glucose; Glucose monitoring; Glucose profile Abstract: Self-monitoring of blood glucose (SMBG) is an underutilized but integral part of disease management for patients with both type 1 and type 2 diabetes. Guidelines on the recommended frequency and timing of SMBG vary among international diabetes associations, and patients are often unaware of actions they should take in response to SMBG results. In response to this, a global consensus conference of recognized diabetes experts convened to clarify the role of SMBG as a tool to help optimize glycemic control (e.g., complementing information provided by hemoglobin A.sub.1c, detecting postprandial excursions, identifying glucose patterns, and providing patients feedback on lifestyle and medications) while minimizing hypoglycemia and maintaining quality of life. The consensus panel also sought to reinforce the importance of appropriate and systematic patient and provider response to the collected SMBG data. A set of 16 consensus statements was approved by the panel. This article presents the 16 statements together with some brief rationale for their inclusion. Author Affiliation: (a) International Diabetes Center, Minneapolis, Minnesota, USA.sup.[cor] (b) Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA

The diagnosis of artherosclerotic CAD in a female athlete who does not smoke or have diabetes suggests congenital defect in lipoprotein metabolism such as defect in the LDL receptor or familial dysbetalipoproteinemia. If CAD is diagnosed in women athletes, they should be provided. Strategies to prevent atherosclerotic coronary disease in older female athletes should be directed toward management of the basic atherosclerotic risk factors.

The eye reacts in a limited number of ways to different disease processes. As eye doctors, we are most commonly confronted with the ocular manifestations of diabetes and hypertension. However, [...]

Signs and Symptoms Diabetes mellitus is the most common endocrine disorder and is defined as a group of disorders that exhibit a defective or deficient insulin secretory process, glucose underutilization [...]

Objectives. Health care organizations often measure processes of care using only administrative data. We assessed whether measuring processes of diabetes care using administrative data without medical record data is likely to underdetect compliance with accepted standards for certain groups of patients. Data Sources/Study Setting. Assessment of quality indicators during 1998 using administrative and medical records data for a cohort of 1,335 diabetic patients enrolled in three Minnesota health plans. Study Design. Cross-sectional retrospective study assessing hemoglobin A1c testing, LDL cholesterol testing, and retinopathy screening from the two data sources. Analyses examined whether patient or clinic characteristics were associated with underdetection of quality indicators when administrative data were not supplemented with medical record data. Data Collection/Extraction Methods. The health plans provided administrative data, and trained abstractors collected medical records data. Principal Findings. Quality indicators that would be identified if administrative data were supplemented with medical records data are often not identified using administrative data alone. In adjusted analyses, older patients were more likely to have hemoglobin A1c testing underdetected in administrative data (compared to patients Conclusions. Diabetes quality indicators may be underdetected more frequently for elderly and black patients and the physicians, clinics, and plans who care for such patients when quality measurement is based on administrative data alone. This suggests that providers who care for such patients may be disproportionately affected by public release of such data or by its use in determining the magnitude of financial incentives. Key words. Quality measurement, quality indicators, diabetes care, In recent years, efforts to measure and improve the quality of care have expanded to include care for chronic medical conditions, such as diabetes mellitus, that are primarily treated in [...]

Snapshots can reveal only a small, often indistinct, portion of a landscape. Any brief consideration of a topic as far-reaching and complex as diabetes is bound to suffer from the [...]