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  • 1
    Electronic Resource
    Electronic Resource
    A comparison of the artificial pancreas (glucose controlled insulin infusion system) and a manual technique for assessing insulin sensitivity during euglycaemic clamping (1984)
    Springer
    Diabetologia 26 (1984), S. 420-425 
    Details
    ISSN: 1432-0428
    Keywords: Glucose clamping ; artificial pancreas ; insulin infusion ; insulin sensitivity ; glucose disposal
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Two main methods are available for assessing insulin sensitivity with the hyperinsulinaemic euglycaemic clamp technique: one employs a glucose-controlled insulin infusion system (the Biostator) with automatic feedback control; the second depends on frequent glucose measurement and the use of an algorithm and a pocket calculator (‘manual’) to determine the glucose infusion rate. The amount of glucose infused is a measure of insulin sensitivity. The efficiency of the two methods was compared in nine normal subjects (seven lean, two obese). After an overnight fast subjects were infused with insulin at 50 mU · kg-1 · h-1 for 2 h; this rate was doubled during the first 10 min for the manual technique. Blood glucose averaged 4.7 ± 0.1 and 4.8 ± 0.1 mmol/l from 0 to 120 min for Biostator and manual techniques and did not deviate significantly from the desired level. Variability of the clamp was also similar over the same period (coefficient of variation 5.1 ±0.6% and 6.4 ±0.7%, Biostator and manual). Glucose infused to maintain steady state from 60 to 120 min was higher, however, with the manual than the Biostator method (5.7±0.6 versus 4.4 ± 0.6 mg·kg-1·min-1, p〈 0.01) even when the loading dose was omitted, although the two methods correlated closely (p〈 0.05). Glucose infusion rate varied more from minute to minute with the Biostator (coefficient of variation 28.8 ± 3% versus 12.2 ± 2.1%). Steady-state serum insulin levels (30–120 min) were the same during both methods. Thus both methods give effective clamping but the manual method is simpler and shows less variability in glu cose insulin infusion rate.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00262213
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  • 2
    Electronic Resource
    Electronic Resource
    Book reviews (1991)
    Springer
    Diabetologia 34 (1991), S. 845-846 
    Details
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00408365
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  • 3
    Electronic Resource
    Electronic Resource
    The association of dietary fibres with glucose tolerance is partly explained by concomitant intake of thiamine: The Hoorn Study (1998)
    Springer
    Diabetologia 41 (1998), S. 1168-1175 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Dietary fibre ; thiamine ; thiamine deficiency ; glucose tolerance test ; sex ; insulin resistance ; human
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Epidemiologic studies have shown an association between the intake of dietary fibres and 2-h glucose values. Food rich in dietary fibres is often also rich in thiamine. Animal studies have shown that thiamine deficiency can induce glucose intolerance. Our aim was to investigate the association between fibre consumption and thiamine intake on the one hand and glucose tolerance on the other hand. We used data from the Hoorn Study, a study of glucose tolerance among 1008 men and 1188 women, aged 50–75 years, without diabetes. In linear regression analyses, fibre intake was inversely associated with fasting glucose. There was also an inverse association between fibre intake and 2-h glucose but it disappeared for the greater part after adjustment for fasting glucose. Fibre intake appeared to be strongly correlated with thiamine intake, and this correlation explained the remaining part of the association between fibre intake and 2-h glucose. Thiamine intake appeared to have a strong and relevant association with 2-h glucose, which was independent of fibre intake and fasting glucose. This association was borderline after adjustment for potential confounders. In women, but not in men, the effect of thiamine intake on 2-h glucose seemed to be modified by fibre intake, independent of potential confounders. In conclusion, part of the association between fibre intake and glucose tolerance is possibly attributable to concomitant thiamine intake. [Diabetologia (1998) 41: 1168–1175]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250051047
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  • 4
    Electronic Resource
    Electronic Resource
    Substitution of night-time continuous subcutaneous insulin infusion therapy for bedtime NPH insulin in a multiple injection regimen improves counterregulatory hormonal responses and warning symptoms of hypoglycaemia in IDDM (1998)
    Springer
    Diabetologia 41 (1998), S. 322-329 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Nocturnal hypoglycaemia ; night-time CSII ; hypoglycaemia unawareness ; strategy against hypoglycaemia.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In patients with insulin-dependent diabetes mellitus (IDDM) good glycaemic control confers an enhanced risk of hypoglycaemia. Nocturnal hypoglycaemia occurs frequently and contributes to the syndrome of hypoglycaemia unawareness. In order to avoid nocturnal hypoglycaemia we substituted night-time continuous subcutaneous insulin infusion (CSII) therapy in 14 patients with well-controlled IDDM using a multiple injection regimen for the more variable bedtime NPH insulin. During a stepwise hypoglycaemic clamp we studied the effect of this regimen on counterregulatory hormonal responses, warning symptoms and cognitive function. In addition, we investigated the incidence of daytime hypoglycaemia and the acceptability of night-time CSII treatment. CSII was associated with a lower frequency of hypoglycaemia (mean ± SEM): 16.1 ± 3.1 vs 23.6 ± 3.3) episodes during the last 6 weeks of treatment, p = 0.03 (CSII vs NPH)) with maintenance of good glycaemic control (HbA1c 7.2 ± 0.2 vs 7.1 ± 0.2 %, p = 0.2). Hypoglycaemic thresholds for the growth hormone response and for autonomic symptoms were lower for CSII treatment than for NPH treatment. Of 14 patients 6 decided to continue with the nocturnal CSII treatment. In conclusion, nocturnal CSII improves warning symptoms and counterregulatory hormonal responses to hypoglycaemia and is an acceptable treatment strategy for patients suffering from hypoglycaemia unawareness, as demonstrated in this acute feasibility study. [Diabetologia (1998) 41: 322–329]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050910
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  • 5
    Electronic Resource
    Electronic Resource
    Peripheral arterial disease in relation to glycaemic level in an elderly Caucasian population: the Hoorn Study (1995)
    Springer
    Diabetologia 38 (1995), S. 86-96 
    Details
    ISSN: 1432-0428
    Keywords: Key words Non-insulin-dependent diabetes mellitus ; impaired glucose tolerance ; specific insulin ; peripheral arterial disease ; epidemiology ; population-based survey ; Caucasians.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We investigated the cross-sectional association between peripheral arterial disease and glycaemic level in an age, sex, and glucose tolerance stratified random sample from a 50–74-year-old Caucasian population. Subjects treated with oral hypoglycaemic agents or insulin were classified as having known diabetes mellitus (KDM) (n = 67). Using two oral glucose tolerance tests, and based on World Health Organisation criteria, all other participants were categorized as having a normal (NGT) (n = 288), an impaired (IGT) (n = 170), or a diabetic (NDM) (n = 106) glucose tolerance. Prevalence rates of ankle-brachial pressure index less than 0.90 were 7.0 %, 9.5 %, 15.1 % and 20.9 % in NGT, IGT, NDM and KDM subjects, respectively (chi-square test for linear trend: p 〈 0.01). Prevalence rates of any peripheral arterial disease (ankle-brachial pressure index 〈 0.90, at least one monophasic or absent Doppler flow curve or vascular surgery) were 18.1 %, 22.4 %, 29.2 % and 41.8 % in these categories (chi-square test for linear trend: p 〈 0.0001). The prevalence of any peripheral arterial disease was higher in KDM and NDM than in NGT (p 〈 0.03, p 〈 0.0001, respectively), whereas no statistically significant difference was demonstrated between IGT and NGT. The same applied when using the ankle-brachial pressure index criterion. Logistic regression analyses showed that any arterial disease was significantly associated with HbA1 c, fasting and 2-h post-load plasma glucose after correction for cardiovascular risk factors (odds ratios and 95 % confidence intervals 1.35; 1.10–1.65 per %, 1.20; 1.06–1.36 and 1.06; 1.01–1.12 per mmol/l, respectively), whereas it was not associated with fasting and 2-h post-load specific insulin. Ankle-brachial pressure indices were not associated with either plasma glucose parameters or insulin in univariate or multivariate analyses. In conclusion, parameters of glucose tolerance are independently associated with any peripheral arterial disease, whereas insulin is not. [Diabetologia (1995) 38: 86–96]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050257
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  • 6
    Electronic Resource
    Electronic Resource
    Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study (1997)
    Springer
    Diabetologia 40 (1997), S. 1334-1340 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Structured diabetes care ; NIDDM ; primary care ; diabetes education ; insulin therapy ; hypoglycaemia ; well-being.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In primary care it is difficult to treat the growing number of non-insulin-dependent diabetic (NIDDM) patients according to (inter)national guidelines. A prospective, controlled cohort study was designed to assess the intermediate term (2 years) effect of structured NIDDM care in general practice with and without ’diabetes service' support on glycaemic control, cardiovascular risk factors, general well-being and treatment satisfaction. The ’diabetes service', supervised by a diabetologist, included a patient registration system, consultation facilities of a dietitian and diabetes nurse educator, and protocolized blood glucose lowering therapy advice which included home blood glucose monitoring and insulin therapy. In the study group (SG; 22 general practices), 350 known NIDDM patients over 40 years of age (206 women; mean age 65.3 ± SD 11.9; diabetes duration 5.9 ± 5.4 years) were followed for 2 years. The control group (CG; 6 general practices) consisted of 68 patients (28 women; age 64.6 ± 10.3; diabetes duration 6.3 ± 6.4 years). Mean HbA1 c (reference 4.3–6.1 %) fell from 7.4 to 7.0 % in SG and rose from 7.4 to 7.6 % in CG during follow-up (p = 0.004). The percentage of patients with poor control (HbA1 c 〉 8.5 %) shifted from 21.4 to 11.7 % in SG, but from 23.5 to 27.9 % in CG (p = 0.008). Good control (HbA1 c 〈 7.0 %) was achieved in 54.3 % (SG; at entry 43.4 %) and 44.1 % (CG; at entry 54.4 %) (p = 0.013). Insulin therapy was started in 29.7 % (SG) and 8.8 % (CG) of the patients (p = 0.000) with low risk of severe hypoglycaemia (0.019/patient year). Mean levels of total and HDL-cholesterol (SG), triglycerides (SG) and diastolic blood pressure (SG + CG) and the percentage of smokers (SG) declined significantly, but the prevalence of these risk factors remained high. General well-being (SG) did not change during intensified therapy. Treatment satisfaction (SG) tended to improve. Implementation of structured care, including education and therapeutic advice, results in sustained good glycaemic control in the majority of NIDDM patients in primary care, with low risk of hypoglycaemia. Lowering cardiovascular risk requires more than reporting results and referral to guidelines. [Diabetologia (1997) 40: 1334–1340]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050829
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  • 7
    Electronic Resource
    Electronic Resource
    Absorption kinetics and action profiles of mixtures of short-and intermediate-acting insulins (1984)
    Springer
    Diabetologia 27 (1984), S. 558-562 
    Details
    ISSN: 1432-0428
    Keywords: Insulin therapy ; soluble insulin ; NPH insulin ; lente insulin ; human insulin ; insulin miscibility ; insulin absorption ; insulin action ; glucose clamp
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The effects of mixing short- and intermediate-acting insulins (lente and NPH) on plasma insulin levels and action profiles, assessed by the euglycaemic clamp technique, were studied in 10 volunteers. Four protocols were used: (1) comparison between two semi-synthetic human soluble insulins in seven subjects (0.22 IU/kg); (2) assessment of insulin levels and action profiles of lente insulin in six subjects and of NPH insulin in five subjects (0.33 IU/kg); (3) comparison between mixtures of soluble with lente insulin and soluble with NPH insulin, administered immediately after mixing, in eight subjects (0.55IU/kg, 40% short-acting); (4) same mixtures, administered 2 days after preparation, in seven subjects. No differences in insulin levels and action profiles during the first 4 h after injection were found between both short-acting insulins and the soluble + NPH insulin mixtures. After the administration of NPH insulin, plasma insulin levels rose slightly faster in comparison with lente insulin, with no significant differences between the action profiles for either insulin. Onset of action was delayed after soluble + lente insulin, both when administered immediately after mixing and to a greater extent when stored for 2 days before administration. After the latter procedure, the onset of action was markedly retarded and only slightly faster than after lente insulin alone. We conclude, therefore, that mixing soluble with NPH insulin in a ratio of 2:3 does not affect the absorption kinetics of soluble insulin, whereas the onset of action is delayed when soluble is combined in the syringe with lente insulin, even when administered immediately after mixing.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00276967
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  • 8
    Electronic Resource
    Electronic Resource
    Peripheral arterial disease in relation to glycaemic level in an elderly Caucasian population: the Hoorn Study (1995)
    Springer
    Diabetologia 38 (1995), S. 86-96 
    Details
    ISSN: 1432-0428
    Keywords: Non-insulin-dependent diabetes mellitus ; impaired glucose tolerance ; specific insulin ; peripheral arterial disease ; epidemiology ; population-based survey ; Caucasians
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We investigated the cross-sectional association between peripheral arterial disease and glycaemic level in an age, sex, and glucose tolerance stratified random sample from a 50–74-year-old Caucasian population. Subjects treated with oral hypoglycaemic agents or insulin were classified as having known diabetes mellitus (KDM) (n=67). Using two oral glucose tolerance tests, and based on World Health Organisation criteria, all other participants were categorized as having a normal (NGT) (n=288), an impaired (IGT) (n=170), or a diabetic (NDM) (n=106) glucose tolerance. Prevalence rates of ankle-brachial pressure index less than 0.90 were 7.0%, 9.5%, 15.1% and 20.9% in NGT, IGT, NDM and KDM subjects, respectively (chi-square test for linear trend:p〈0.01). Prevalence rates ofany peripheral arterial disease (ankle-brachial pressure index 〈0.90, at least one monophasic or absent Doppler flow curve or vascular surgery) were 18.1%, 22.4%, 29.2% and 41.8% in these categories (chi-square test for linear trend:p〈0.0001). The prevalence ofany peripheral arterial disease was higher in KDM and NDM than in NGT (p〈0.03,p〈0.0001, respectively), whereas no statistically significant difference was demonstrated between IGT and NGT. The same applied when using the anklebrachial pressure index criterion. Logistic regression analyses showed thatany arterial disease was significantly associated with HbA1c, fasting and 2-h postload plasma glucose after correction for cardiovascular risk factors (odds ratios and 95% confidence intervals 1.35; 1.10–1.65 per %, 1.20; 1.06–1.36 and 1.06; 1.01–1.12 per mmol/l, respectively), whereas it was not associated with fasting and 2-h post-load specific insulin. Ankle-brachial pressure indices were not associated with either plasma glucose parameters or insulin in univariate or multivariate analyses. In conclusion, parameters of glucose tolerance are independently associated withany peripheral arterial disease, whereas insulin is not. [Diabetologia (1995) 38: 86–96]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02369357
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  • 9
    Electronic Resource
    Electronic Resource
    Intra-individual variation of glucose, specific insulin and proinsulin concentrations measured by two oral glucose tolerance tests in a general Caucasian population: the Hoorn Study (1996)
    Springer
    Diabetologia 39 (1996), S. 298-305 
    Details
    ISSN: 1432-0428
    Keywords: Intra-individual variation ; glucose ; specific insulin ; proinsulin ; oral glucose tolerance test ; reproducibility
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We studied the intra-individual variation in plasma glucose, specific serum insulin and serum pro-insulin concentrations, measured by two 75-g oral glucose tolerance tests in an age, sex, and glucose tolerance stratified random sample from a 50–74-year-old Caucasian population without a history of diabetes mellitus. The intra-individual variation was assessed by the standard deviation of the test-retest differences (SDdif). For subjects with normal (n=246), impaired glucose tolerance (n=198), and newly detected diabetes (n=80) classified at the first test, the following (SDdif/median level of individual average scores) were found: fasting glucose: 0.4/5.4, 0.5/5.9 and 0.7/7.2 mmol/l; 2-h glucose: 1.3/5.6, 1.8/8.5 and 2.3/12.8 mmol/l; fasting insulin: 23/76, 32/89 and 30/ 116 pmol/l; 2-h insulin: 190/303, 278/553 and 304/626 pmol/l; fasting proinsulin: 4/8, 6/13 and 9/18 pmol/l; 2-h proinsulin: 19/49, 23/84 and 33/90 pmol/l, respectively. In both glucose, proinsulin and insulin concentrations the total intra-individual variation was predominantly determined by biological variation, whereas analytical variation made only a minor contribution. The SDdif can easily be interpreted, as 95% of the random test-retest differences will be less than 2 · SDdif, or in terms of percentage, less than (2 · SDdif/median level of individual average scores) · 100. Therefore, for subjects with normal glucose tolerance, 95% of the random test-retest differences will be less than 15% (fasting glucose), 46% (2-h glucose), 61% (fasting insulin), 125% (2-h insulin), 100% (fasting proinsulin) and 78% (2-h proinsulin) of the median value of the individual average scores. No substantial independent association of either age, gender or obesity with the intra-individual variation in glucose, proinsulin, or insulin concentrations was found.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00418345
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  • 10
    Electronic Resource
    Electronic Resource
    Intra-individual variation of glucose, specific insulin and proinsulin concentrations measured by two oral glucose tolerance tests in a general Caucasian population: the Hoorn Study (1996)
    Springer
    Diabetologia 39 (1996), S. 298-305 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Intra-individual variation ; glucose ; specific insulin ; proinsulin ; oral glucose tolerance test ; reproducibility.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We studied the intra-individual variation in plasma glucose, specific serum insulin and serum proinsulin concentrations, measured by two 75-g oral glucose tolerance tests in an age, sex, and glucose tolerance stratified random sample from a 50–74-year-old Caucasian population without a history of diabetes mellitus. The intra-individual variation was assessed by the standard deviation of the test-retest differences (SDdif). For subjects with normal (n = 246), impaired glucose tolerance (n = 198), and newly detected diabetes (n = 80) classified at the first test, the following (SDdif/median level of individual average scores) were found: fasting glucose: 0.4/5.4, 0.5/5.9 and 0.7/7.2 mmol/l; 2-h glucose: 1.3/5.6, 1.8/8.5 and 2.3/12.8 mmol/l; fasting insulin: 23/76, 32/89 and 30/116 pmol/l; 2-h insulin: 190/303, 278/553 and 304/626 pmol/l; fasting proinsulin: 4/8, 6/13 and 9/18 pmol/l; 2-h proinsulin: 19/49, 23/84 and 33/90 pmol/l, respectively. In both glucose, proinsulin and insulin concentrations the total intra-individual variation was predominantly determined by biological variation, whereas analytical variation made only a minor contribution. The SDdif can easily be interpreted, as 95 % of the random test-retest differences will be less than 2 · SDdif, or in terms of percentage, less than (2 · SDdif/median level of individual average scores) · 100. Therefore, for subjects with normal glucose tolerance, 95 % of the random test-retest differences will be less than 15 % (fasting glucose), 46 % (2-h glucose), 61 % (fasting insulin), 125 % (2-h insulin), 100 % (fasting proinsulin) and 78 % (2-h proinsulin) of the median value of the individual average scores. No substantial independent association of either age, gender or obesity with the intra-individual variation in glucose, proinsulin, or insulin concentrations was found. [Diabetologia (1996) 39: 298–305]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00418345
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