Biomedical subjects

R P Stolk

Publications and source records attributed to R P Stolk.

At least 19 recordsLinked to original sources

PubMed2005

Is a single definition of the metabolic syndrome appropriate?--A comparative study of the USA and Asia.

The metabolic syndrome has been identified as an increasingly important precursor to cardiovascular diseases in many Asian populations. Our objective was to compare the contribution of component risk factors to the diagnosis of the metabolic syndrome, as defined by the Third report of the National Cholesterol Education Program Expert Panel Adult Treatment Panel (NCEP-ATPIII), in the US and selected Asian populations. Nationally representative survey data from Hong Kong, Taiwan, Thailand and the US were used. Analyses were restricted to men and women aged > or = 35 years. The age-standardized prevalence of the NCEP-ATPIII defined metabolic syndrome was highest in the US (31% in men, 35% in women), and lowest in Taiwan (11% in men, 12% in women). The component risk factors that defined the presence of the metabolic syndrome varied between countries. As expected, abnormal waist circumference was considerably more prevalent among individuals with the metabolic syndrome in the US (72% in men, 94% in women) compared with their Asian counterparts, but substantial variation was also observed between the Asian populations (13-22% in men, 38-63% in women). Furthermore, the relative contribution of other risk factors to the metabolic syndrome was also substantially different between countries. The NCEP-ATPIII definition identifies a heterogeneous group of individuals with the metabolic syndrome in different populations.

Blood Pressure↗

PubMed2005

Fat distribution is strongly associated with plasma glucose levels and diabetes in Thai adults-the InterASIA study.

AIMS/HYPOTHESIS: Asian populations have high risks of disease at low levels of BMI and weight, possibly because of high rates of abdominal obesity. In such populations, waist circumference and WHR (measures of fat distribution) may better capture the effects of adiposity. METHODS: The strengths of the associations between different measures of adiposity and glucose levels and diabetes were investigated in the Thai component of the International Collaborative Study of Cardiovascular Disease in Asia (InterASIA), a multi-stage cross-sectional survey of risk factors in Thai adults aged 35 years or over. The analyses included 5,302 men and women. RESULTS: All four measures of adiposity were positively associated with plasma glucose and the odds of having diabetes (all p<0.001), but the associations were stronger for measures of fat distribution. The age- and sex-adjusted fasting plasma glucose level increased linearly across each fifth of weight, BMI, waist and WHR by 0.12 mmol/l (SE 0.02), 0.12 (0.02), 0.17 (0.02) and 0.16 (0.02), respectively. The corresponding odds ratios for diabetes were 1.41 (95% CI 1.27-1.56), 1.43 (1.28-1.59), 1.64 (1.47-1.83) and 1.70 (1.52-1.90), respectively. Multivariate analyses incorporating different combinations of adiposity measures, as well as analyses of receiver operating characteristics, confirmed the greater predictive value of measures of fat distribution. CONCLUSIONS/INTERPRETATION: Waist circumference and WHR were more strongly associated with fasting plasma glucose and diabetes than were weight and BMI. These measures of abdominal adiposity are likely to be more useful for assessing the obesity-related risk of cardiovascular diseases in Asian populations.

Adipose Tissue↗

PubMed2005

Insulin treatment and cardiovascular disease; friend or foe? A point of view.

BACKGROUND: Several observational studies have shown that higher insulin levels are associated with an increased risk of cardiovascular disease. If higher endogenous insulin levels are causally related to cardiovascular disease, one might expect an increased risk of cardiovascular disease in patients treated with insulin, as this results in high circulating insulin levels. Such risk elevation might counteract the benefits of tight glucose control. Our objective was to explore the relationship between insulin therapy and cardiovascular disease in Type 1 and Type 2 diabetes mellitus using information from available literature. SUMMARY OF COMMENT: Several experimental studies in animals and humans support the presence of a harmful effect of insulin on the vascular endothelium. In prospective follow-up studies increased insulin dosage was associated with increased risks of cardiovascular disease, although confounding by indication could not be excluded. Randomized controlled trials in diabetic patients, comparing conventional with intensive glucose-lowering treatment, although showing a reduction in microvascular disease, showed no significant difference in the incidence of cardiovascular disease. The results with respect to exposure to insulin are, however, difficult to interpret due to insufficient information on exposure to insulin levels as well as confounding by glycaemic control and body mass index. In addition, these studies were not designed to address the question whether higher insulin use relates to increased cardiovascular risk. CONCLUSION: Published research provides conflicting evidence as to whether exposure to high levels of exogenous insulin in diabetes mellitus affects the risk of cardiovascular disease. The currently available studies have a number of serious methodological restraints that limit accurate interpretation and conclusions in this area.

Diabetes Mellitus, Type 1↗

PubMed2004

Insulin monotherapy versus combinations of insulin with oral hypoglycaemic agents in patients with type 2 diabetes mellitus.

BACKGROUND: It is unclear whether patients with type 2 diabetes who have poor glycaemic control despite maximal oral hypoglycaemic agents (OHAs) should be commenced on insulin as monotherapy, or insulin combined with oral hypoglycaemic agents (insulin-OHA combination therapy). OBJECTIVES: To assess the effects of insulin monotherapy versus insulin-OHA combinations therapy. SEARCH STRATEGY: Eligible studies were identified by searching MEDLINE, EMBASE, and The Cochrane Library. Date of last search: May 2004. SELECTION CRITERIA: Randomised controlled trials (RCTs) with 2 months minimum follow-up duration comparing insulin monotherapy (all schemes) with insulin-OHA combination therapy. DATA COLLECTION AND ANALYSIS: Data extraction and assessment of study quality were undertaken by three reviewers in pairs. MAIN RESULTS: Twenty RCTs (mean trial duration 10 months) including 1,811 participants, with mean age 59.8 years and mean known duration of diabetes 9.6 years. Overall, study methodological quality was low. Twenty-eight comparisons in 20 RCTs were ordered according to clinical considerations. No studies assessed diabetes-related morbidity, mortality or total mortality. From 13 studies (21 comparisons), sufficient data were extracted to calculate pooled effects on glycaemic control. Insulin-OHA combination therapy had statistically significant benefits on glycaemic control over insulin monotherapy only when the latter was applied as a once-daily injection of NPH insulin. Conversely, twice-daily insulin monotherapy (NPH or mixed insulin) provided superior glycaemic control to insulin-OHA combination therapy regimens where insulin was administered as a single morning injection. In more conventional comparisons, regimens utilising OHAs with bedtime NPH insulin provided comparable glycaemic control to insulin monotherapy (administered as twice daily, or multiple daily injections). Overall, insulin-OHA combination therapy was associated with a 43% relative reduction in total daily insulin requirement compared to insulin monotherapy. Of the 14 studies (22 comparisons) reporting hypoglycaemia, 13 demonstrated no significant difference in the frequency of symptomatic or biochemical hypoglycaemia between insulin and combination therapy regimens. No significant differences in quality of life related issues were detected. Combination therapy with bedtime NPH insulin resulted in statistically significantly less weight gain compared to insulin monotherapy, provided metformin was used +/-sulphonylurea. In all other comparisons no significant differences with respect to weight gain were detected. REVIEWERS' CONCLUSIONS: Bedtime NPH insulin combined with oral hypoglycaemic agents provides comparable glycaemic control to insulin monotherapy and is associated with less weight gain if metformin is used.

Diabetes Mellitus, Type 2↗

PubMed2004

Long-term effects of self-management education for patients with Type 2 diabetes taking maximal oral hypoglycaemic therapy: a randomized trial in primary care.

AIMS: Education is an essential part of the management of patients with Type 2 diabetes, but the long-term effects are unclear and not well investigated in primary care. METHODS: Fifty-four patients (39-75 years) treated with maximal dosages of oral hypoglycaemic agents, needing to start insulin (HbA(1c)> or = 7.0%), were randomly allocated to a 6-month educational programme by a diabetes nurse (DN group) or usual care (UC group). Main outcome measures were HbA(1c), number of patients with HbA(1c) < 7.0%, and number of patients treated with insulin 18 months after baseline. RESULTS: Six weeks after the intervention HbA(1c) levels had improved from 8.2 (1.1) to 7.2 (1.3) in the DN group, and from 8.8 (1.5) to 8.4 (1.7) in the UC group. Adjusted for baseline values, at 6 weeks HbA(1c) improved 0.7% (95% confidence interval 0.1, 1.4) more in DN than in UC. Of the patients in DN, 60% reached HbA(1c) < 7.0% compared with 17% in UC (P < 0.01). However, at 18 months there were no significant differences for HbA(1c), number of patients with HbA(1c) < 7.0%, or number treated with insulin. CONCLUSIONS: Education was effective in improving glycaemic control and in delaying the need for insulin therapy in patients treated with maximal oral hypoglycaemic therapy. The reduced effect after 1 year was probably due to the discontinuation of the educational programme. Short-term education should not be offered without regular reinforcements integrated into standard diabetes care.

Aged↗

PubMed2004

Initiation of glucose-lowering therapy in Type 2 diabetes mellitus patients in general practice.

AIM: The purpose of this study was to investigate which factors determine the initiation of glucose-lowering therapy in patients with Type 2 diabetes mellitus in general practice and their future glycaemic control. METHODS: All incident Type 2 diabetic patients in the general practices in a Dutch middle-sized town from 1994 to 2000 were identified. Factors associated with initiation of glucose-lowering therapy were obtained from clinical files and examined by Cox's regression analyses. Using anova, the associations between clinical characteristics at diagnosis and future glycaemic control were investigated. RESULTS: In total, 603 newly diagnosed patients with Type 2 diabetes mellitus were included in the study. In the first month following diagnosis, 319 (53%) started with oral therapy. One, two and three years after diagnosis of diabetes, the cumulative incidences were 71% (95% CI 66-73%), 75% (71-79%) and 81% (77-84%), respectively. Age, gender, body weight, blood pressure, history of cardiovascular disease or total serum cholesterol values were not associated with time to start of drug therapy. An increased plasma glucose level at diagnosis was strongly related to faster initiation of drug therapy and worse future glycaemic control. Immediate initiation of glucose-lowering medication was not related to future glycaemic control. CONCLUSION: This study shows that the initial severity of diabetes, assessed by the degree of hyperglycaemia at time of diagnosis, is a major factor in determining the time to start of glucose-lowering drugs and the likelihood of achieving target levels of glycaemic control in the future, independent of glucose-lowering strategy. Therefore, patients with high glucose levels at diagnosis need close monitoring from the beginning of their disease.

Diabetes Mellitus, Type 2↗

PubMed2004

Assessing peripheral arteries in South African black women with type 2 diabetes mellitus.

OBJECTIVES: To determine the value of ankle and toe blood pressure indices and pedal pulse palpation in the assessment of peripheral arterial disease in subjects with type 2 diabetes mellitus (DM). DESIGN: Cross-sectional study. SUBJECTS: A convenience sample of 85 female subjects with type 2 DM underwent a series of peripheral vascular assessments at the diabetes clinic of a community hospital. OUTCOME MEASURES: Palpation of the pedal pulses, Doppler-derived ankle brachial systolic blood pressure indices, photo plethysmographic-derived toe brachial systolic blood pressure indices and antero-posterior radiographs of both feet. RESULTS: Mean values were 1.15 (standard deviation (SD): 0.17) and 0.76 (SD: 0.17) for ankle brachial index (ABI) and toe brachial index (TBI) respectively. The differences between the two indices increased from 0.36 (95% confidence interval (CI): 0.32-0.41) to 0.58 (95% CI: 0.46-0.70) depending on whether ABI was less or greater than 1.3. The correlation coefficient for left versus right foot was 0.62 and 0.71 for ABI and TBI respectively. The relationship between ABI and TBI is non-linear with a cut point close to 1.3. Both ABI and TBI were significantly lower in subjects who had both pedal pulses absent on palpation. CONCLUSIONS: The relationship between ABI and TBI is linear below an ABI of 1.3. but with a wide 95% prediction interval. If both pedal pulses are absent the ABI is significantly diminished compared with when both pulses are present, even though not necessarily below 0.9.

Aged↗

PubMed2003

Quality of life of patients with type I diabetes mellitus.

The objective of this study was to assess health related quality of life (QOL) in patients with type I diabetes mellitus (DMT1) and to compare their QOL with the QOL of persons of comparable age in the general population. Furthermore we wanted to investigate which factors mostly influence QOL. In a Dutch cohort of 281 patients with DMT1 QOL was assessed using two generic instruments: the EuroQol and the RAND-36. We performed regression analyses to investigate relationships between several demographic (e.g. sex, age, marital status) and diabetes-specific variables (e.g. HbA1c, frequency of insulin injection, presence of acute and chronic complications) and QOL. The Spearman rank correlations between RAND-36 domains and EuroQol were analysed. RAND-36 results showed, for almost all domains, a QOL comparable with persons of comparable age in the general population. In contrast the QOL measured with the EuroQol was lower for subjects with DMT1. Hyperglycaemic complaints and macrovascular complications had a profound negative influence on QOL. Most correlations between the RAND-36 results and the EuroQol results corresponded with our expectations. Longitudinal data and comparison with results of several diabetes-specific questionnaires should help to establish which instrument might be most appropriate to measure QOL in patients with DMT1.

Adult↗

PubMed2003

Improving glycaemic control in patients with Type 2 diabetes mellitus without insulin therapy.

AIMS: In general practice at least 30% of those with Type 2 diabetes do not achieve good glycaemic control. We studied the effect of improving oral glucose-lowering medication in a primary care setting in patients treated with oral hypoglycaemic agents without satisfactory glycaemic control. METHODS: We provided flowcharts to general practitioners and outreach visits by trained facilitators, who checked adherence to the protocol. Fifty-two Dutch general practices with 2140 Type 2 diabetes mellitus (DM) patients recruited 288 patients < or = 75 years old inadequately controlled (HbA1c >7%) by diet or oral medication. Outcome measures were decrease of HbA1c, number of patients with HbA1c < or = 7%, and non-compliance rate. RESULTS: After a mean of 3.3 consultations over 14 weeks, 209 patients were following the protocol fully with a reduction in HbA1c from 8.7% to 6.7% (P<0.001). One hundred and fifty-eight patients (55%) achieved HbA1c < or =7%, and 51 (18%) persisted with HbA1c >7% unless fasting blood glucose < or =7 mmol/l (n=18) or a maximum of medication (n=33). Seventy-nine patients (27%) did not adhere to the protocol, mostly due to loss of motivation and non-attendance. CONCLUSIONS: A simple flowchart and relatively little support by trained facilitators results in improved glycaemic control.

Administration, Oral↗

PubMed2002

Primary and secondary prevention in cardiovascular disease: an old-fashioned concept?

OBJECTIVE: Is the concept of primary and secondary cardiovascular prevention an old-fashioned concept that needs to be re-defined? DESIGN: Discussion paper. RESULTS: Cardiovascular prevention means reduction of absolute risk for cardiovascular disease (CVD), irrespective of clinical stage. CONCLUSION: For the calculation of an individual probability to develop CVD all factors that contribute to the risk must be taken into account, including previous CVD events.

Adult↗

PubMed2002

Angiographic distribution of lower extremity atherosclerosis in patients with and without diabetes.

AIMS: To determine differences in the anatomic site of atherosclerosis in the lower extremity between patients with and patients without diabetes. DESIGN: Cross-sectional study of patients who underwent angiography of both legs because of symptoms of intermittent claudication, rest and/or night pain, ulceration or gangrene. METHODS: The angiographies of 37 patients with diabetes and 37 patients without diabetes, matched for age, sex and smoking behaviour, were evaluated using the Bollinger scoring system. RESULTS: The mean (sd) Bollinger score in the upper leg (from the abdominal aorta to and including the superficial femoral artery) was higher (P = 0.01) for patients without diabetes (35.3 (22.8)) than for patients with diabetes (23.3 (16.1)). In the lower leg (from the popliteal artery to the posterior tibial artery) patients with diabetes tended to have a higher score than patients without diabetes: 47.4 (34.2) and 37.6 (32.9), respectively (P = 0.22). CONCLUSION: This angiographic study confirms the clinical notion that lower limb atherosclerosis in diabetes is more severe in distal segments of the lower extremity, while the proximal segments remain less attenuated compared with patients without diabetes.

Aged↗

PubMed2002

Resource consumption and costs in Dutch patients with type 2 diabetes mellitus. Results from 29 general practices.

AIMS: The aims of this study were to estimate the costs incurred by Dutch patients with Type 2 diabetes, examine which patient and/or treatment characteristics are associated with costs, and estimate the medical and non-medical costs of patients with Type 2 diabetes in The Netherlands. METHODS: Twenty-nine Dutch general practitioners provided information on all Type 2 diabetes patients in their practice (n = 1371), information on demography, clinical characteristics, treatment type, the presence of complications and the type and amount of medical consumption during the previous 6 months. Medical costs were analysed using multivariate linear regression. Estimates of costs seen in The Netherlands were based on these results plus information from other sources regarding costs of end-stage renal disease, appliances, travel and productivity loss. RESULTS: Although only 9% of patients were hospitalized within the previous 6 months, hospitalization costs represented one-third of the medical costs, drug costs 40% and ambulatory costs 26%. Patients using insulin, patients with macrovascular complications only or in combination with microvascular complications incurred higher medical costs than other patients. Age and hyperlipidaemia were also positively related to medical costs. When these results were combined with other data sources, we estimated that patients with Type 2 diabetes are responsible for pound365 500 000 (1 271 000 000 guilders) or 3.4% of the relevant parts of health care costs in 1998. The non-medical costs (travel costs, productivity costs) are limited: 52 500 000 (183 000 000 guilders). CONCLUSIONS: Independent determinants of the medical costs of Type 2 diabetes in The Netherlands include age, complications, insulin use and hyperlipidaemia.

Age of Onset↗

PubMed2002

Use of fluorquinolones is associated with a reduced risk of coronary heart disease in diabetes mellitus type 2 patients.

AIMS: The aim of the present study was to investigate whether use of specific antibiotic drugs decreases the risk of coronary heart disease in diabetes mellitus type 2 patients. METHODS AND RESULTS: Data were obtained from the PHARMO Record Linkage System comprising pharmacy records and hospitalizations for all 450,000 residents of eight Dutch cities. In a nested case-control study among diabetes mellitus type 2 patients, 244 cases with a first hospitalization for coronary heart disease and 686 controls without coronary heart disease matched on age, sex, calendar time, and registration date in PHARMO RLS were selected. Use of antibiotic drugs among cases and controls was determined over 3 years prior to the event. Use of fluorquinolones for more than 14 days compared to no use of fluorquinolones was associated with a lower risk of coronary heart diseases (OR(adj)=0.30 (95%CI: 0.12-0.75)). No association between tetracycline, macrolide and lincosamide treatment, or other antibiotic drugs (penicillins, cephalosporines, sulphonamides and trimethoprim), and the risk of coronary heart disease was found. CONCLUSION: Our results suggest that treatment with fluorquinolones in doses commonly prescribed in routine clinical practice is associated with a reduction in the risk of coronary heart diseases among diabetes mellitus type 2 patients.

Aged↗

PubMed2002

The metabolic syndrome in black hypertensive women--waist circumference more strongly related than body mass index.

OBJECTIVE: To examine the association between measures of obesity and features of the metabolic syndrome in treated black female hypertensive subjects. DESIGN: Cross-sectional study. SETTING: An urban primary health care centre in Mamelodi, Pretoria. SUBJECTS: Women with hypertension and without known diabetes mellitus or secondary causes of hypertension. In total 124 women participated, with a mean age of 56.9 years (standard deviation (SD) 11.0) and mean body mass index (BMI) of 34.1 kg/m2 (SD 8.1). MAIN OUTCOME MEASURES: Blood pressure, glucose, insulin and lipid levels. RESULTS: Waist circumference and waist-hip ratio were more strongly associated with insulin, uric acid, glucose and triglycerides than was BMI. Statistically significant associations were found between waist circumference and low high-density lipoprotein HDL cholesterol (standardised regression coefficient -0.006, standard error of the mean (SEM) 0.002), log triglycerides (0.007, SEM 0.003), uric acid (0.002, SEM 0.001) and log insulin (0.012, SEM 0.003). BMI was only significantly associated with uric acid (0.002, SEM 0.002) and log insulin (0.009, SEM 0.004). CONCLUSION: In a group of black hypertensive women measures of central obesity were more strongly associated with components of the metabolic syndrome than BMI.

Black People↗

PubMed2001

Consequences of asymptomatic bacteriuria in women with diabetes mellitus.

BACKGROUND: Women with diabetes mellitus (DM) have asymptomatic bacteriuria (ASB) more often than women without DM. It is unknown, however, what the consequences of ASB are in these women. OBJECTIVE: To compare women with DM with and without ASB for the development of symptomatic urinary tract infections (UTIs), renal function, and secondary complications of DM during an 18-month follow-up period. METHODS: In this multicenter study we monitored women with DM with and without ASB for the development of symptomatic UTIs, renal function, and secondary complications (ie, retinopathy, neuropathy, microvascular, or macrovascular diseases). Data on the first 18-month follow-up period are presented. RESULTS: At least 1 uncontaminated urine culture was available from 636 women (258 with type 1 DM and 378 with type 2 DM). The prevalence of ASB at baseline was 26% (21% for those with type 1 DM and 29% for those with type 2 DM). Follow-up results were available for 589 (93%) of the 636 women. Of these 589 women, 115 (20%) (14% with type 1 DM and 23% with type 2 DM) developed a symptomatic UTI. Women with type 2 DM and ASB at baseline had an increased risk of developing a UTI during the 18-month follow-up (19% without ASB vs 34% with ASB, P =.006). In contrast, there was no difference in the incidence of symptomatic UTI between women with type 1 DM and ASB and those without ASB (12% with ASB vs 15% without ASB). However, women with type 1 DM and ASB had a tendency to have a faster decline in renal function than those without ASB (relative increase in serum creatinine level 4.6% vs 1.5%, P = 0.2). CONCLUSION: Women with type 2 DM and ASB have an increased risk of developing a symptomatic UTI than those without ASB.

Adolescent↗

PubMed2001

Experts' opinions on the profile of optimal care for patients with diabetes mellitus type 2 in the Netherlands.

BACKGROUND: The St. Vincent Declaration has resulted in discussions and initiatives on optimal diabetes care during recent years. Both are based on two sources of knowledge: evidence and experience. We wanted to reveal the experience based knowledge in the Netherlands to identify essential elements or prerequisites for high quality type 2 diabetes care. METHODS: A group of 56 experts on diabetes care were invited to fill in a questionnaire. This included a ranking of 18 elements on the organization of diabetes care and 9 on patient education. RESULTS: The response rate was 87.5%. With regard to the organization of care 'active patient participation', 'protocolized care' and 'patient education' were evaluated as the most important. The integration in daily diabetes care was seen as the most important aspect of patient education. Optimal diabetes patient education would include five sessions (range: 1-10) of 1 h (range: 0.25-3) with active follow-up. The most appropriate disciplines for patient education are the diabetes nurse (chosen by 93% of the experts) and the dietician (77%). CONCLUSIONS: Optimal care for diabetes mellitus type 2 consists of structured care with integrated patient education. The majority of the experts indicated that this is not optimally organized within the Netherlands.

Attitude of Health Personnel↗

PubMed2001

Validity and reproducibility of ultrasonography for the measurement of intra-abdominal adipose tissue.

OBJECTIVE: We studied the validity and reproducibility of a new abdominal ultrasound protocol for the assessment of intra-abdominal adipose tissue. MEASUREMENTS: Intra-abdominal adipose tissue was assessed by CT, MRI, anthropometry and ultrasonography on a single day. By ultrasonography the distance between peritoneum and lumbar spine was measured using a strict protocol, including the location of the measurements, pressure on the transducer and respiration. All measurements were repeated after 3 months. RESULTS: The study population consisted of 19 overweight patients with a body mass index (BMI) of 32.9 kg/m(2) (s.d. 3.7), intra-abdominal adipose tissue on CT 140.1 cm(2) (s.d. 55.9), and a mean ultrasound distance of 9.8 cm (s.d. 2.5). There was a strong association between the CT and ultrasonographic measures: Pearson correlation coefficient was 0.81 (P<0.001). The correlation between ultrasound and waist circumference was 0.74 (P<0.001), the correlation between CT and waist circumference was 0.57 (P=0.01). Ultrasound appeared a good method to diagnose intra-abdominal obesity: the area under the ROC curve was 0.98. During the follow-up period of 3 months, the patients lost on average almost 3 kg of body weight. The correlation coefficient between changes in intra-abdominal adipose tissue assessed by CT and ultrasound was 0.74 (P<0.001). The correlation coefficient of the mean ultrasound distance assessed by two different sonographers at baseline was 0.94 (P<0.001), the mean difference 0.4 cm (s.d. 0.9), and the coefficient of variation 5.4%, indicating good reproducibility of the ultrasound measurements. CONCLUSIONS: The results of this validation study show that abdominal ultrasound, using a strict protocol, is a reliable and reproducible method to assess the amount of intra-abdominal adipose tissue and to diagnose intra-abdominal obesity.

Abdomen↗

PubMed2001

Ethnic differences in C-peptide levels and anti-GAD antibodies in South African patients with diabetic ketoacidosis.

To determine differences between Black and White South Africans with diabetic ketoacidosis (DKA) and between Black patients on insulin vs. those on oral agents presenting with DKA, post stabilization fasting C-peptide levels and anti-glutamic acid decarboxylase (GAD) antibodies were measured together with serum glucose, acid base and urine ketones on admission. Of 60 patients with diabetic ketoacidosis (DKA) (76 admissions), the 43 Black patients had a higher BMI (23.1 vs. 20.0 kg/m(2), p=0.05) than did the 17 White patients, were more often newly diagnosed (37% vs. 1%, p=0.03), and a greater proportion of Black patients had fasting C-peptide levels >0.3 nmol/l (28% (10/36) vs. 0%, p=0.03). Of these 10 Black patients, eight were anti-GAD-negative. Thirteen Black patients (33%) were anti-GAD-positive vs. 10 (67%) White patients (p=0.03). There was no statistically significant difference in anti-GAD positivity between Black patients on oral agents or those on insulin. Most patients (5/7) admitted on oral agents had negative C-peptide levels after stabilization. Our results suggest that in patients presenting with DKA, a quarter of Black South Africans have C-peptide levels regarded as being indicative of type 2 DM and are less frequently anti-GAD-antibody-positive than are White South Africans.

Adult↗