Studies In Newly Diagnosed Diabetes

Several interventions have been evaluated in individuals with newly diagnosed type 1 diabetes, in an attempt to interdict the disease process and preserve B-cell function. Interpretation of these has been complicated by a number of factors. Early studies often used 'remission' as an outcome, based on cessation of insulin therapy or very low doses of insulin. In fact, there was even a recommended definition of remission promulgated52. Yet, most recent investigations have focused more on...

Urine Glucose Measurement

Perhaps the first diagnostic test for diabetes was described in ancient China with the observation that ants were attracted to the urine of persons with diabetes. The London physician Thomas Willis (1621-1675) noted that diabetic urine tasted 'wondrous sweet' and in 1766 another Englishman, Matthew Dobson, demonstrated the chemical presence of sugar in diabetic urine and observed that serum from diabetics was sweet-tasting. By the 1840s, such chemical tests as Fehling's were developed for sugar...

Evidence For Matching The Fpg Threshold With The 2 H Pg Threshold

One part of the justification for lowering the fasting glucose diagnostic threshold is to identify the same percentage of the population as identified by the 2 h cut-point. This implies that the 2 h cut-point is the criterion that best identifies individuals at risk of developing complications as a result of hyperglycaemia. However, in many populations the tests identify different individuals33,34,35. The 1985 WHO criteria selected the fasting and 2 h cut-offs on estimates of the thresholds for...

Evolution Of The Classification Of Diabetes

Over 2000 years ago two Indian physicians, Charaka and Sushruta1 were the first to recognise that diabetes is not a single disorder. Throughout history renowned scientists and physicians such as Galen, Avicenna, Paracelcus and Maimonides have made reference to diabetes2. During the eighteenth and nineteenth centuries a less clinically symptomatic variety of the disorder was again noted. It was identified by heavy glycosuria, often detected in later life and commonly associated with overweight...

Preamble

Prevention of type 1 diabetes currently resides at around the same level as peace on earth eminently desirable, theoretically possible, not as yet demonstrated. Jay Skyler has ably summarised the evidence that p-cell function can be influenced by therapies introduced at the time of diagnosis of type v diabetes. The immune intervention most convincingly shown to prolong p-cell function following diagnosis is cyclosporine, but its effects are usually transient and the risk of nephrotoxicity...

Clinical nonrandomized studies

There is one non-randomized pharmacological intervention which provides limited additional insight into the utility of sulfonylureas. Ratzmann et al. assigned 27 subjects to the sulfonylurea glibeclamide and diet (n 27, 2 mg day) or diet alone (n 18) in a non-randomized two-year study201. The diet included 30 dietary fat, and limited energy intake only slightly. At 1 and 2 years, no weight loss occurred in either group. In the analysis, they stratified subjects by level of insulin response to...

Prevention Of Obesity

Studies that aim to reduce obesity or prevent it from developing are relevant to the prevention of type 2 diabetes, since obesity is one of the major modifiable risk factors. Like diabetes, overweight and obesity have been the outcomes for a large number of clinical trials and observational studies exploring risk factors for their development and reduction. Comprehensive reviews of obesity prevention issues and approaches have been published13,163,262-264 and it is not possible to review them...

References

Atkinson MA, Maclaren NK 1994 The pathogenesis of insulin dependent diabetes mellitus. New England Journal of Medicine 331 1428-1436. 2. Skyler JS 1987 Immune intervention studies in insulin-dependent diabetes mellitus. Diabetes Metabolism Reviews 3 1017-1035. 3. Pozzilli P 1988 Immunotherapy in type 1 diabetes. Diabetic Medicine 5 734-738. 4. Harrison LC, Campbell IL, Colman PG, Chosich N, Kay TWH, Tait BD, Bartholomeusz RK, DeAizpurua HJ, Joseph JL, Chu S, Kielczynski WE 1990 Type 1...