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  • 1
    Electronic Resource
    Electronic Resource
    Islet cell antibodies and diabetes mellitus in Pima Indians (1979)
    Springer
    Diabetologia 17 (1979), S. 161-164 
    Details
    ISSN: 1432-0428
    Keywords: American Indians ; autoimmunity ; diabetes mellitus ; islet cell antibodies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Pancreatic islet cell antibodies and 12 other autoantibodies were measured at the time of diabetes diagnosis in 46 Pima Indians, aged 17–47 years, and in 46 age-sex matched non-diabetic controls. Islet cell antibodies were found in only two diabetics, aged 20 and 25, compared with none of 46 controls. Neither of the subjects with islet cell antibodies had other autoantibodies. At least one type of autoantibody was found in 14 (30%) of the diabetics and in 14 controls, but none was significantly associated] with diabetes. This study indicates that diabetes in the Pima Indians, even those with an onset below 25 years of age, is almost entirely of type II, in that the disease is not associated with islet cell antibodies, ketoacidosis, or insulin dependence.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01219743
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  • 2
    Electronic Resource
    Electronic Resource
    Glycated haemoglobin predicts progression to diabetes mellitus in Pima Indians with impaired glucose tolerance (1994)
    Springer
    Diabetologia 37 (1994), S. 252-256 
    Details
    ISSN: 1432-0428
    Keywords: Follow-up study ; glycated Hb ; HbA1c ; IGT ; Pima Indians
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Glycated haemoglobin could offer several practical advantages over the OGTT for assessing glucose metabolism. Initial cross-sectional studies (1983–1985) on 381 subjects (mostly Pima Indians) described the relationship between HbA1c (a specific glycated Hb) and the OGTT. We performed follow-up OGTTs and HbA1c measurements on 257 of these same subjects 1.6–6.1 years later. Subjects were again grouped according to both the result of the OGTT (normal, IGT or diabetes, by WHO criteria) and HbA1c result (normal or elevated based on mean ± 1.96 SD of normal). Of 66 subjects with IGT at baseline, 47 (71%) had normal HbA1c and 19 (29%) had elevated HbA1c. Twentysix (39%) of these subjects had diabetes at follow-up. Of these subjects with IGT, a significantly greater percentage of subjects with elevated HbA1c at baseline (68%) showed worsening to diabetes than those with a normal HbA1c (28%); (chi-square=7.8, df=1, p〈0.01). Thus, in subjects with IGT, glycated Hb may be a useful predictor of progression to diabetes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00398051
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  • 3
    Electronic Resource
    Electronic Resource
    Glycated haemoglobin predicts progression to diabetes mellitus in Pima Indians with impaired glucose tolerance (1994)
    Springer
    Diabetologia 37 (1994), S. 252-256 
    Details
    ISSN: 1432-0428
    Keywords: Key words Follow-up study, glycated Hb, HbA1 c, IGT, Pima Indians.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Glycated haemoglobin could offer several practical advantages over the OGTT for assessing glucose metabolism. Initial cross-sectional studies (1983–1985) on 381 subjects (mostly Pima Indians) described the relationship between HbA1 c (a specific glycated Hb) and the OGTT. We performed follow-up OGTTs and HbA1 c measurements on 257 of these same subjects 1.6–6.1 years later. Subjects were again grouped according to both the result of the OGTT (normal, IGT or diabetes, by WHO criteria) and HbA1 c result (normal or elevated based on mean ±1.96 SD of normal). Of 66 subjects with IGT at baseline, 47 (71 %) had normal HbA1 c and 19 (29 %) had elevated HbA1 c. Twenty-six (39 %) of these subjects had diabetes at follow-up. Of these subjects with IGT, a significantly greater percentage of subjects with elevated HbA1 c at baseline (68 %) showed worsening to diabetes than those with a normal HbA1 c (28 %); (chi-square =7.8, df =1, p〈0.01). Thus, in subjects with IGT, glycated Hb may be a useful predictor of progression to diabetes. [Diabetologia (1994) 37: 252–256]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00398051
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  • 4
    Electronic Resource
    Electronic Resource
    Association of the glycogen synthase locus on 19q13 with NIDDM in Pima Indians (1996)
    Springer
    Diabetologia 39 (1996), S. 314-321 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Non-insulin-dependent diabetes mellitus ; insulin resistance ; skeletal muscle glycogen synthase gene ; association ; Pima Indians.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Skeletal muscle glycogen synthase (encoded by GYS1 on chromosome 19q13.3) is the rate-limiting enzyme in insulin-mediated non-oxidative glucose disposal. Our previous studies have demonstrated an impairment of insulin-stimulated GYS1 activities in insulin-resistant Pima Indians, and associations of non-insulin-dependent diabetes mellitus (NIDDM) with the GYS1 locus were reported recently in Finnish and Japanese populations. We have performed linkage and association analyses of GYS1 and seven additional DNA markers on 19q with NIDDM, and with parameters of insulin action in the Pima Indians. We have found a significant association of NIDDM with GYS1 genotypes (p = 0.009), and with common GYS1 alleles (p = 0.022) in the Pima Indians. We have performed a detailed comparative analysis of the GYS1 gene, mRNA, and protein product in insulin-sensitive and insulin-resistant Pima Indians. No mutations in GYS1 coding sequences were detected; nor did we find alterations of GYS1 mRNA expression or of its basal enzymatic activity in insulin-resistant Pima Indians. These results contrasted with a 25 % reduction of immunoreactive protein in insulin-resistant subjects as detected by Western blotting with an antibody specific for the C-terminal end of GYS1 (t -test p = 0.024; Wilcoxon's rank-sum test, p = 0.04). Because no mutations were detected in the DNA encoding this epitope, the difference in immunoreactivity may reflect post-translational modification(s) of the protein rather than a difference in the gene itself, or it could have occurred by chance. We conclude that our data do not indicate alterations in the GYS1 gene as the cause for the observed association, and that a different locus near GYS1 may be the contributing genetic element. [Diabetologia (1996) 39: 314–321]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00418347
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  • 5
    Electronic Resource
    Electronic Resource
    Plasma lipoproteins and the incidence of abnormal excretion of albumin in diabetic American Indians: The Strong Heart Study (1998)
    Springer
    Diabetologia 41 (1998), S. 1002-1009 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Lipoproteins ; albuminuria ; nephropathies ; Type II diabetes ; Strong Heart Study.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Animal studies suggest that lipids are risk factors for kidney diseases. Some prospective studies and clinical trials have reported predictive effects of lipoproteins on different stages of diabetic nephropathy in humans. We examined lipoprotein abnormalities to determine if they predict abnormal urinary excretion of albumin ( ≥ 30 mg albumin/g creatinine), using logistic regression. We followed 671 American Indians (211 men, 460 women) with Type II diabetes for a mean of 3.9 years (range 1.7–6.2). Participants were aged 45–74 years. They had normal excretion of albumin and normal serum creatinine at baseline. 67 men and 144 women developed abnormal excretion of albumin. In models controlled for age, treatment with oral hypoglycaemic agents or insulin, HbA1 c, study site, degree of Indian heritage, mean arterial blood pressure, albumin excretion at baseline and duration of diabetes, a high HDL cholesterol was a protector for abnormal excretion of albumin in women [odds ratio (OR) comparing the 90th with the 10th percentile = 0.56, 95 % confidence interval (CI) = 0.32–0.98], but not in men (OR = 1.5, 95 % CI = 0.66–3.4). Further adjustment for obesity, insulin concentration, alcohol consumption or physical activity did not change the results. There was a tendency for high values of VLDL and total triglyceride and small LDL size to predict abnormal excretion of albumin in women only. We conclude that low HDL cholesterol was a risk factor for abnormal excretion of albumin in women, but not in men. Sex hormones may be responsible for sex differences in the association between HDL cholesterol and abnormal excretion of albumin. [Diabetologia (1998) 41: 1002–1009]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250051023
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  • 6
    Electronic Resource
    Electronic Resource
    Pre-diabetic blood pressure predicts urinary albumin excretion after the onset of Type 2 (non-insulin-dependent) diabetes mellitus in Pima Indians (1993)
    Springer
    Diabetologia 36 (1993), S. 998-1001 
    Details
    ISSN: 1432-0428
    Keywords: Albuminuria ; risk factors ; blood pressure ; Type 2 (non-insulin-dependent) diabetes mellitus ; Pima Indians
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Blood pressure was measured in 490 non-proteinuric Pima Indians from the Gila River Indian Community in Arizona at least 1 year before the diagnosis of Type 2 (non-insulin-dependent) diabetes mellitus. Urine albumin concentration was measured in the same subjects 0–24 years (mean 5 years) after diabetes was diagnosed. Prevalence rates of abnormal albumin excretion (albumin-to-creatinine ratio ≥100 mg/g) after the onset of Type 2 diabetes were 9%, 16%, and 23%, respectively, for the lowest to highest tertiles of pre-diabetic mean blood pressure. When controlled for age, sex, duration of diabetes and pre-diabetic 2-h post-load plasma glucose concentration, higher pre-diabetic mean blood pressure predicted abnormal urinary excretion of albumin after the onset of diabetes. This finding suggests that the higher blood pressure seen in diabetic nephropathy is not entirely a result of the renal disease, but may precede and contribute to it.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02374490
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  • 7
    Electronic Resource
    Electronic Resource
    The association of physical activity with obesity, fat distribution and glucose intolerance in Pima Indians (1993)
    Springer
    Diabetologia 36 (1993), S. 863-869 
    Details
    ISSN: 1432-0428
    Keywords: Physical activity ; obesity ; fat distribution ; glucose intolerance ; Pima Indians ; exercise
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The relationships between physical activity, obesity, fat distribution and glucose tolerance were examined in the Pima Indians who have the highest documented incidence of non-insulin-dependent diabetes. Fasting and 2-h post-load plasma glucose concentrations, body mass index, and waist-to-thigh circumference ratios were determined in 1054 subjects aged 15–59 years. Current (during the most recent calendar year) and historical (over a lifetime) leisure and occupational physical activity were determined by questionnaire. Current physical activity was inversely correlated with fasting and 2-h plasma glucose concentrations, body mass index and waist-to-thigh ratios for most sex-age groups even when diabetic subjects were excluded. Controlled for age, obesity and fat distribution, activity remained significantly associated with 2-h plasma glucose concentrations in males. In subjects aged 37–59 years, individuals with diabetes compared to those without reported significantly less leisure physical activity during the teenage years (median hours per week of activity, 9.1 vs 13.2 for men; 1.0 vs 2.2 for women). Controlled for body mass index, sex, age and waist-to-thigh ratio, subjects who reported low levels of historical leisure physical activity had a higher rate of diabetes than those who were more active. In conclusion, current physical activity was inversely related to glucose intolerance, obesity and central distribution of fat, particularly in males. Subjects with diabetes were currently less active and reported less historical physical activity than non-diabetic subjects. These findings suggest that activity may protect against the development of non-insulin-dependent diabetes both directly and through an influence on obesity and fat distribution.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400363
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  • 8
    Electronic Resource
    Electronic Resource
    Glucose, insulin concentrations and obesity in childhood and adolescence as predictors of NIDDM (1994)
    Springer
    Diabetologia 37 (1994), S. 617-623 
    Details
    ISSN: 1432-0428
    Keywords: Key words Diabetes mellitus, risk factors, glucose, insulin, childhood
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Metabolic abnormalities antedate the development of non-insulin-dependent diabetes mellitus (NIDDM) by some years. How these metabolic abnormalities relate to the genetic component of the disease and to the subsequent prediction of diabetes is unknown. The present study was designed to examine the association of parental diabetes with relative weight, fasting and 2-h plasma glucose and fasting and 2-h serum insulin in childhood, and to identify which of these variables were most predictive of subsequent NIDDM. Subjects comprised 1258 Pima Indians aged 5–19 years with normal glucose tolerance participating in a longitudinal population-based study. Age-sex-adjusted values of relative weight, fasting and 2-h glucose and fasting and 2-h insulin were positively associated with parental diabetes. Only one of 138 subjects with two non-diabetic parents developed diabetes. Among 1120 subjects with at least one diabetic parent, 101 (9.0 %) developed diabetes during a mean follow up of 8.4 years. Fasting insulin was a significant predictor of diabetes, but did not add to the predictive value of relative weight. Relative weight and 2-h and fasting plasma glucose were the variables most predictive of NIDDM in childhood and adolescence. Against a background of parental diabetes, high fasting insulin concentrations predict diabetes, compatible with the hypothesis that insulin resistance is an early metabolic abnormality leading to NIDDM. In this study, however, its predictive power did not add significantly to that of relative weight, with which it was correlated. Both relative weight and 2-h plasma glucose in youth in those with diabetic parents are highly predictive of subsequent diabetes, and these may be the best measures currently available for identifying high-risk subjects in whom preventive measures might be targeted. [Diabetologia (1994) 37: 617–623]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00403382
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  • 9
    Electronic Resource
    Electronic Resource
    Glucose tolerance and mortality, including a substudy of tolbutamide treatment (1997)
    Springer
    Diabetologia 40 (1997), S. 680-686 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Impaired glucose tolerance ; mortality ; tolbutamide ; ischaemic heart disease ; clinical trial.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Mortality according to glucose tolerance was studied to determine the prognosis of impaired glucose tolerance. Among 2500 persons tested in a community screening programme in 1962–1965 and followed-up for mortality to the end of 1987, age-sex-adjusted mortality rates were 37.9 ± 1.9, 53.6 ± 4.2, and 70.1 ± 3.6 deaths per 1000 person-years ( ± SE) in those with normal glucose tolerance, impaired glucose tolerance, and diabetes by World Health Organization criteria at baseline. Age-sex-adjusted mortality rates due to ischaemic heart disease were 14.3 ± 1.1, 16.3 ± 2.4, and 25.8 ± 2.0 deaths per 1000 person-years, respectively. Using criteria predating those of the World Health Organization 147 men with abnormal glucose tolerance were entered into a randomized clinical trial in which 49 were treated with tolbutamide for approximately 10 years. Those treated had lower mortality rates from all causes (mortality rate ratio = 0.66, 95 % confidence interval = 0.39, 1.10) and from ischaemic heart disease (mortality rate ratio = 0.42, 95 % confidence interval = 0.16, 1.12) than those not receiving tolbutamide. Thus mortality rates are increased in persons with impaired glucose tolerance and diabetes, and the small clinical trial suggests that tolbutamide may be beneficial in men with abnormal glucose tolerance. [Diabetologia (1997) 40: 680–686]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050734
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  • 10
    Electronic Resource
    Electronic Resource
    Increasing prevalence of Type II diabetes in American Indian children (1998)
    Springer
    Diabetologia 41 (1998), S. 904-910 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Prevalence ; epidemic ; children ; Type II diabetes ; obesity ; diabetic pregnancy.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Until recently, Type II diabetes was considered rare in children. The disease is, however, increasing among children in populations with high rates of Type II diabetes in adults. The prevalence of Type II diabetes was determined in 5274 Pima Indian children between 1967 and 1996 in three 10-year time periods, for age groups 5–9, 10–14 and 15–19 years. Diabetes was diagnosed using World Health Organisation criteria, based on an oral glucose tolerance test. The prevalence of diabetes increased over time in children aged 10 years and over: in boys from 0 % in 1967–1976 to 1.4 % in 1987–1996 in the 10–14 year old age group, and from 2.43 % to 3.78 % for age group 15–19 and in girls from 0.72 % in 1967–1976 to 2.88 % in 1987–1996 in the 10–14 year old age group, and from 2.73 % to 5.31 % for age group 15–19 years. Along with the increase in the prevalence of Type II diabetes (p 〈 0.0001), there was an increase in weight (calculated as percentage of relative weight, p 〈 0.0001), and in frequency of exposure to diabetes in utero (p 〈 0.0001). The increasing weight and increasing frequency of exposure to diabetes in utero accounted for most of the increase in diabetes prevalence in Pima Indian children over the past 30 years. Type II diabetes is now a common disease in American Indian children aged 10 or more years and has increased dramatically over time, along with increasing weight. A vicious cycle related to an increase in the frequency of exposure to diabetes in utero appears to be an important feature of this epidemic. [Diabetologia (1998) 41: 904–910]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250051006
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