An audit of diabetes control, dietary management and quality of life in adults with type 1 diabetes mellitus, and a comparison with nondiabetic subjects

OBJECTIVES

The study's objective was to audit current diet and disease management in a community-based sample of people with type 1 diabetes.

METHODS

The study involved adults with type 1 diabetes and control subjects. Reported amounts of dietary intake were collected. Indices of diabetes control were determined by standard methods. Quality of life of both groups was assessed with appropriate measures. Results were compared between two groups.

RESULTS

Mean HbA(1c) concentration was 8.5% (SD 2.21%) for women with diabetes and 8.6% (SD 1.91%) for men. There was no significant difference between the diabetic and control subjects in self-reported energy intake and macronutrient intake, with the exception that the contribution of saturated fatty acid to energy intake was higher in male controls than in male diabetics. There was no association between dietary intakes and glycemic control in diabetic subjects. Anthropometric measurements, blood pressure and plasma lipids in patients were within normal range and not significantly different from the controls. Plasma fibrinogen concentration was higher in patients. Diabetic subjects did not have a diminished quality of life.

CONCLUSIONS

Dietary management in these patients was generally focused on controlling carbohydrate intake. Most had suboptimal diabetes control.

Use of dolomite phosphate rock (DPR) fertilizers to reduce phosphorus leaching from sandy soil

There is increasing concern over P leaching from sandy soils applied with water-soluble P fertilizers. Laboratory column leaching experiments were conducted to evaluate P leaching from a typical acidic sandy soil in Florida amended with DPR fertilizers developed from dolomite phosphate rock (DPR) and N-Viro soil. Ten leaching events were carried out at an interval of 7 days, with a total leaching volume of 1,183 mm equivalent to the mean annual rainfall of this region during the period of 2001-2003. Leachates were collected and analyzed for total P and inorganic P. Phosphorus in the leachate was dominantly reactive, accounting for 67.7-99.9% of total P leached. Phosphorus leaching loss mainly occurred in the first three leaching events, accounting for 62.0-98.8% of the total P leached over the whole period. The percentage of P leached (in the total P added) from the soil amended with water-soluble P fertilizer was higher than those receiving the DPR fertilizers. The former was up to 96.6%, whereas the latter ranged from 0.3% to 3.8%. These results indicate that the use of N-Viro-based DPR fertilizers can reduce P leaching from sandy soils.

Effect of Race on the Occurence of Posttransplant Diabetes in Kidney Transplant Recipients Treated With Early Steroid Discontinuation

INTRODUCTION

Early steroid discontinuation (within 5 days after transplant) has been associated with a lower incidence of posttransplant diabetes mellitus (PTDM). A retrospective study was done to assess the incidence of PDTM in relation to racial groups in kidney transplant recipients who received early steroid discontinuation.

METHODS

Between January 2002 and January 2004, 125 consecutive, primary adult kidney transplant recipients (51 cadaveric donor, 74 living donor) were performed at the University of Illinois at Chicago. The first 34 recipients were treated with steroid maintenance therapy, while the remaining 91 underwent early steroid discontinuation. Group A (n = 91) had steroids discontinued on postoperative day 6 and maintenance immunosuppression consisting of tacrolimus and mycophenolate mofetil. Group B (n = 34) received the same immunosuppression but was maintained on steroids indefinitely. Induction consisted of Thymoglobulin in African-Americans; all others received Simulect.

RESULTS

At 1 year, patient and graft survivals were similar in both groups; there was a trend for reduction of acute rejection rates in group A (4% vs 12%). The incidence of PTDM was significantly lower in group A (7%) compared to group B (26%; P = .0209). The incidence of PTDM in group A was limited to Hispanic patients. African-Americans and Caucasians in group A did not experience PTDM (P = .005 compared to African-Americans in group B).

CONCLUSION

A steroid-free protocol virtually eliminated the incidence of PTDM in African-Americans and Caucasians but had no effect on the development of PTDM in Hispanic recipients. Alternative immunosuppression may benefit this population.

Whole-body pre-cooling does not alter human muscle metabolism during sub-maximal exercise in the heat

Muscle metabolism was investigated in seven men during two 35 min cycling trials at 60% peak oxygen uptake, at 35 degrees C and 50% relative humidity. On one occasion, exercise was preceded by whole-body cooling achieved by immersion in water during a reduction in temperature from 29 to 24 degrees C, and, for the other trial, by immersion in water at a thermoneutral temperature (control, 34.8 degrees C). Pre-cooling did not alter oxygen uptake during exercise (P > 0.05), whilst the change in cardiac frequency and body mass both tended to be lower following pre-cooling (0.05 < P < 0.10). When averaged over the exercise period, muscle and oesophageal temperatures after pre-cooling were reduced by 1.5 and 0.6 degrees C respectively, compared with control (P < 0.05). Pre-cooling had a limited effect on muscle metabolism, with no differences between the two conditions in muscle glycogen, triglyceride, adenosine triphosphate, creatine phosphate, creatine or lactate contents at rest, or following exercise. These data indicate that whole-body pre-cooling does not alter muscle metabolism during submaximal exercise in the heat. It is more likely that thermoregulatory and cardiovascular strain are reduced, through lower muscle and core temperatures.

Outdoor air pollution and children's respiratory symptoms in the steel cities of New South Wales

OBJECTIVE

To investigate the relationship between outdoor air pollution and the respiratory health of children aged 8 to 10 years.

DESIGN

A cross-sectional survey (between October 1993 and December 1993) of children's health and home environment. Summary measures of particulate pollution (levels of particles with an aerodynamic diameter less than 10 microns [PM10] each 6th day) and SO2 (daily mean and maximum hourly values) were estimated for each area (using air quality monitoring station data from July 1993 to June 1994). SETTING AND SURVEY PARTICIPANTS: Parents of 3023 primary school children (Years 3, 4 and 5) from industrial and non-industrial areas with air quality monitoring stations in the Hunter and Illawarra regions of New South Wales.

MAIN OUTCOME MEASURES

Reported occurrence of four or more chest colds, four or more attacks of wheezing, and night-time cough without a cold for more than two weeks, all within the previous 12 months.

RESULTS

77% response rate, ranging by area from 66% to 88%. The average annual outdoor air pollution for the nine areas was 18.6-43.7 micrograms/m3 for PM10 and 0.16-0.90 parts per hundred million for SO2. The proportion of children reported to have the main outcome symptoms were: chest colds, 3.0%-9.7%; night cough, 12.3%-30.5%; and wheeze, 3.4%-11.3%. There was no significant association with SO2, but a significant increase in the odds of symptoms per 10 micrograms/m3 increase in PM10 on chest colds (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.12-1.82) and night-time cough (OR, 1.34; 95% CI, 1.19-1.53), but not wheeze. Passive smoking was significantly associated with chest colds but not with the other symptoms. Maternal allergy was associated with all three respiratory symptoms, most strongly with wheeze.

CONCLUSION

These results provide evidence of health effects at lower than expected levels of outdoor air pollution in the Australian setting. They also suggest differences in contributions of environmental and hereditary factors to cough and chest colds compared with wheeze.

The metabolic profile of glucose tolerant women who have had large for gestational age babies

The possibility has been raised that women who have had large for gestational age infants, while glucose tolerant during pregnancy by conventional testing, may still have a subtle abnormality of carbohydrate metabolism. We have examined, some time after the completion of a pregnancy, the fasting levels of glucose, insulin and lipids in a group of women, glucose tolerant during pregnancy, who had a large for gestational age infant compared to a very carefully matched control group of women who had an appropriate for gestational age infant. No significant differences were found. These findings suggest that women who have a large for gestational age infant do so for a variety of reasons not related to maternal carbohydrate metabolism.

Free fatty acids and gestational diabetes mellitus

Dyslipidaemia is a common finding in the syndrome of gestational diabetes mellitus (GDM). Free fatty acids (FFA) can cause insulin resistance and have a toxic effect on beta cell function. GDM is a syndrome due to insulin resistance and the purpose of this study was to examine FFA levels in pregnancy. For this purpose samples were taken from 44 consecutive women with GDM and 36 consecutive controls. The women with GDM had similar levels of insulin, triglycerides and total cholesterol to the controls but a significant elevation in FFA; 0.70 (0.33) mmol/L versus 0.29 (0.12) mmol/L (p < 0.0001).

Renal computed tomography with 3-dimensional angiography and simultaneous measurement of plasma contrast clearance reduce the invasiveness and cost of evaluating living renal donor candidates

Renal computed tomography (CT), 3-dimensional CT angiography (3D-CTA), and simultaneous measurement of glomerular filtration rate (GFR) by x-ray fluorescence determination of plasma contrast clearance (PCC) are alternatives to intravenous urography (IVU), renal arteriography (RA), and 24-hr urine creatinine clearance (CrCl) for evaluation of renal structure and function in living renal donor (LRD) candidates. To determine if CT, 3D-CTA, and PCC provide data comparable to IVU, RA, and CrCl, both methods were used to evaluate 23 LRD candidates. Costs were also compared. Conventional RA identified 19 accessory arteries and one case of medial fibroplasia. Each of these anomalous vessels was recognized on 3D-CTA. Venous anatomy was more clearly delineated on 3D-CTA than the venous phase of conventional RA. CT demonstrated 3 benign cysts and a single, small intraparenchymal calcification in 3 renal units. GFRs measured by PCC and CrCl were 91 +/- 4 and 132 +/- 7 ml/min/1.73m2, respectively (r = 0.64, P < 0.05). Total cost for CT/3D-CTA/PCC was 46% less than that of IVU/RA/CrCl and 40% less than RA/CrCl. CT/3D-CTA/PCC provided reliable structural and functional data at substantially less cost, discomfort, and inconvenience to the living renal donor candidate. As such, CT/3D-CTA/PCC is superior to conventional methods for evaluation of the living renal donor candidate.

Pregnancy outcomes in women without gestational diabetes mellitus related to the maternal glucose level. Is there a continuum of risk?

OBJECTIVE

To examine selected pregnancy outcomes in women without gestational diabetes mellitus to see whether there was a continuum of risk related to the maternal glucose level.

RESEARCH DESIGN AND METHODS

Consecutive women attending two prenatal clinics and three obstetricians in private practice were tested for GDM at the beginning of the third trimester using a 75-g glucose load in the fasting state. The rate of induction, the number of assisted deliveries, the presence of pregnancy-induced hypertension, fetal birth weights, and morbidity were examined with respect to the maternal 2-h glucose level.

RESULTS

Data were available for 1,441 women with a 2-h glucose level < 8.0 mmol/l (144 mg/dl). For each 1.0 mmol/l (18 mg/dl) increase in the glucose level, the odds in favor of an assisted delivery increased by 15.2%, and the odds in favor of the baby being admitted to a special care nursery (SCN) increased by 22.6%. There was no significant association between maternal glucose levels and the probability of either pregnancy-induced hypertension or a large-for-gestational-age (LGA) baby after adjustment for other variables.

CONCLUSIONS

In normal women there is a continuum of risk related to the maternal glucose level 2 h after a glucose tolerance test for the probability of having an assisted delivery and the likelihood of the baby being admitted to an SCN. The chance of having pregnancy-induced hypertension or a LGA baby also increased as the maternal glucose level increased but could be largely explained by an increasing body mass index.

Local injury information, community participation and injury reduction

Better injury prevention is now a national health priority in Australia. Applying the health promotion strategies of the Ottawa Charter to injury prevention forms the basis of the World Health Organization's worldwide Safe Communities program. Taking such a community-focused approach has led to quantifiable reductions in injuries in several overseas countries, particularly in Scandinavia where falls of up to 30 per cent in particular injuries have been reported over a three-year period. In the Illawarra area of New South Wales, data from local hospital emergency departments have been used as the basis for a 'community information' strategy, in an attempt to replicate this overseas experience in an Australian setting. Reductions of 17 per cent in attendances by children for injuries (P < 0.001) and a 14 per cent fall in accident-related hospital admissions of children (not statistically significant) have been observed over the course of the four-year intervention. Problems of community definition and external confounding influences outside the control of the project make it difficult to confirm a causal relationship. However, community information forms one important component in a comprehensive local injury-reduction strategy.

In vitro formation of HDL-2 from HDL-3 and triacylglycerol-rich lipoproteins by the action of lecithin:cholesterol acyltransferase and cholesterol ester transfer protein

In order to study the factors responsible for the formation of high-density lipoprotein subfraction-2 (HDL-2), very-low-density lipoproteins (VLDL) and HDL-3 were mixed and incubated with purified bovine milk lipoprotein lipase, human serum lecithin:cholesterol acyltransferase, cholesteryl ester transfer protein and mixtures thereof. The results can be summarized as follows: Incubation of HDL-3 and VLDL for 24 h at 37 degrees C without enzymes did not cause any significant change in the protein:lipid ratio or in the flotation constant of the HDL. Cholesteryl ester transfer protein treatment caused only an exchange of part of the HDL cholesteryl esters with VLDL triacylglycerols. Lipoprotein lipase caused a slight shift of HDL-hydrated density to lower values; HDL-2b, however, was not formed. Incubation of HDL-3 and VLDL with lecithin:cholesterol acyltransferase or mixtures of lecithin:cholesterol acyltransferase and lipoprotein lipase reduced the HDL-protein:lipid ratio and increased the HDL-flotation rate. The newly formed HDL resembled that of native HDL-2a. The incubation of HDL-3 and VLDL with lecithin:cholesterol acyltransferase and cholesteryl ester transfer protein caused a shift of the HDL-3 into an HDL-2b-like fraction. Particles resembling HDL-2b in the analytical ultracentrifuge were also formed if VLDL + HDL-3 were incubated with lipoprotein lipase or lipoprotein lipase + cholesteryl ester transfer protein in a medium containing low amounts of albumin, insufficient for binding all liberated fatty acids during hydrolysis. The incubation of mixtures of HDL-3 and chylomicrons enriched with apoAI in the presence of lecithin:cholesterol acyltransferase and cholesteryl ester transfer protein caused the formation of HDL-2-like particles which resembled those of native HDL-2 also with respect to the apoAI/AII ratio.

The management of spina bifida cystica

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THE DISCRETENESS-OF-CHARGE EFFECT IN ELECTRIC DOUBLE LAYER THEORY

The Stern–Grahame–Devanathan theory of the electrical double layer in aqueous systems is modified to include the so-called discreteness-of-charge effect of Esin and Shikov and Ershler. This provides an explanation of a number of phenomena which are at variance with the Stern theory. A simple method of incorporating the above effect into the Stern theory is suggested by the work of Grahame and is equivalent in principle to the discrete-ion approximation employed by the Russian authors. It is shown that the effect can be interpreted in terms of a 'self-atmosphere' potential at the counterions adsorbed in the Stern layer. This provides a new term in the energy of an adsorbed ion, which is very nearly proportional to the surface density of these ions and which had hitherto been included in the specific adsorption potential in the Stern adsorption isotherm. This energy is not small and accounts for the conclusion reached by Grahame that the adsorption potential varies strongly with the surface charge. Grahame found that the potential at the plane separating the compact and diffuse parts of the double layer in the solution phase (i.e. the outer Helmholtz plane) at the mercury –aqueous electrolyte interface displays a maximum as the potential across the interface is varied, and this property is reproduced by the theory. The effect of ion size on the adsorption isotherm is also considered.