Predicting factors of hypoglycaemia in elderly type 2 diabetes patients: Contributions of the GERODIAB study.

The burden of hypoglycaemia is important, particularly in elderly type 2 diabetes (T2D) patients. Unfortunately, however, few studies are available concerning this population. GERODIAB is a prospective, multicentre, observational study that aims to describe the 5-year morbidity and mortality of 987 T2D patients aged 70 years and older. After analyzing the frequency of and factors associated with hypoglycaemia in the 6 months prior to study inclusion, it was found that hypoglycaemia was associated with retinopathy, lower levels of LDL cholesterol and altered mini-Geriatric Depression Scale (GDS) scores.

Orthostatic hypotension is associated with more severe hypertension in elderly autonomous diabetic patients from the French Gerodiab study at inclusion.

UNLABELLED: Orthostatic hypotension (OH) has deleterious effects on patients' cardiovascular prognoses. The combination of increased age and diabetes adds to the risk of OH. The aim of the study was to describe the elderly diabetic population relative to the degree of hypertension, the occurrence of complications, medications and cognitive function. METHODS: In the Gerodiab study (a 5-year French multicentre, prospective, observational study), a total of 987 type 2 diabetic autonomous patients, aged 77±5 years, were recruited between June 2009 and July 2010. Clinical blood pressure measurements were taken supine and then after 1, 3 and 5minutes in a standing position. OH was defined as a decrease in systolic blood pressure (SBP) of at least 20mmHg and/or a decrease in diastolic blood pressure (DBP) of at least 10mmHg at any of the measurements while standing. RESULTS: At inclusion 301 (30.5%) patients had OH; SBP and DBP at rest were higher in patients with OH than in those without (146±21/78±11mmHg vs. 138±17/72±10mmHg; P<0.001). Individuals with OH exhibited higher pulse pressure (PP) than individuals without (68±18 vs. 65±15mmHg; P<0.05). A significant increase in waist-to-hip ratio was recorded in those with OH versus patients without (P<0.01). Despite more severe hypertension (SBP>160mmHg at inclusion; P<0.01), no significant difference was recorded in the mean number of antihypertensive drugs (1.7±1.1), or in the class of antihypertensive drugs, including beta-blockers (P=0.19) and diuretics (P=0.84). Patients with OH were more likely to have a history of peripheral arterial disease and amputations (31% vs. 24%, P<0.05, and 3.3% vs. 1.5%, P=0.056). There was no significant association between OH and history of peripheral neuropathy (P=0.37), stroke, heart failure or ischemic heart disease. In multivariate analysis, OH remained associated with severe hypertension (P<0.01), increased waist-to-hip ratio (P<0.05) and amputations (P<0.05). CONCLUSION: About one-third of elderly, autonomous diabetic patients had OH. They had more severe hypertension, with higher SBP, DBP and PP at rest. However, the number of anti-hypertensive drugs did not differ compared to patients without OH. This could reflect the medical teams' fears about intensifying treatment.

Influence of dialysis on the glucose profile in patients with diabetes: usefulness of continuous glucose monitoring.

We sought to investigate the impact of dialysis on glucose profiles of diabetic patients using continuous glucose monitoring (CGM). The study included 33 hemodialyzed patients with diabetes (14 females and 19 males; mean age: 66±8 years; patients with type 2 diabetes: 30; mean duration of dialysis: 3.8±2.6 years) who were under insulin treatment. After a run-in period, CGM was performed for 48 h, including a dialysis session. Three CGM sessions were proposed for each patient over a 3-month period. CGM results were analyzed during and after dialysis at 6 different time points. Moreover, data were analyzed in 7 different day periods according to meals. Of the 99 CGM available, 21 were excluded because of technical issues or patient refusal. The CGM results indicated that mean glucose values (7.5±2.5 mmol/l vs. 9.4±1.9 mmol/l; p<0.001) and variability indices (p<0.001) were lower, whereas the frequency of hypoglycemia (4.4±9.6% vs. 2.1±7.9%; p<0.001) was higher during hemodialysis sessions. Significant differences were observed in glucose values only before and 2 h after breakfast (p<0.001). Compared with other day periods, glucose values were lower during the second half of the night and higher before and after dinner (p<0.001). In summary, CGM allows the identification of a particular glucose profile in hemodialyzed diabetic patients. CGM seems feasible and clinically useful for the analysis of glucose profiles in this group of patients.

Retinopathy, nephropathy, peripheral neuropathy and geriatric scale scores in elderly people with Type 2 diabetes.

AIMS: To analyse the relationships between retinopathy, nephropathy, peripheral neuropathy and geriatric scale scores in elderly people with Type 2 diabetes. METHODS: GERODIAB is the first French multi-centre, prospective, observational study designed to assess the influence of glycaemic control on mortality and morbidity through a 5-year follow-up study in people with Type 2 diabetes aged 70 years and older. In this report the relationships at baseline between retinopathy, nephropathy and peripheral neuropathy, and five geriatric scale scores in 987 people, using bivariate and multivariate analyses are analysed. RESULTS: Retinopathy (26%) was significantly associated with impaired scores on the Mini Geriatric Depression Scale, the Mini Nutritional Assessment and the Instrumental Activities of Daily Living scale. Logistic regression showed that the duration of diabetes, BMI, Mini Geriatric Depression Scale, hypoglycaemia and HbA1c were associated with retinopathy (concordance 69.1%; P < 0.001). Nephropathy (47.4%, including 34.8% with Modification of Diet in Renal Disease < 60 ml/min) was significantly associated with impaired Activities of Daily Living and Instrumental Activities of Daily Living scale scores. Using the logistic model, the most significant factors were age, duration of diabetes, triglycerides, HDL cholesterol, hypoglycaemia, hypertension and BMI (concordance 66.3%; P < 0.001). Peripheral neuropathy (28.2%) was associated with impaired scores on the Mini Mental State Examination, Activities of Daily Living, Instrumental Activities of Daily Living and Mini Geriatric Depression Scales. In the logistic model, diastolic blood pressure, duration of diabetes and the Instrumental Activities of Daily Living, Mini Geriatric Depression Scale and Mini Mental State Examination scales were included (concordance 69.8%; P < 0.001). CONCLUSION: In this specific sample, classical microvascular complications of diabetes were found to be associated with impaired geriatric scale scores. This highlights the benefits of systematic assessment in elderly people with Type 2 diabetes.

GERODIAB: Glycaemic control and 5-year morbidity/mortality of type 2 diabetic patients aged 70 years and older: 1. Description of the population at inclusion.

AIMS: The GERODIAB study is the first French multicentre, prospective, observational study that aims, through a 5-year cohort follow-up, to evaluate the link between glycaemic control and morbidity/mortality of type 2 diabetic (T2D) patients aged 70 years and older. This first report describes the study population at inclusion. PATIENTS AND METHODS: A total of 987 T2D autonomous patients, aged ≥70 years, were recruited between June 2009 and July 2010 at 56 investigator centres. Their general parameters, diabetes characteristics and standard geriatric parameters were recorded. RESULTS: The patients' mean age was 77±5 years, with 65.2% aged 75 years or more. The mean BMI was close to 30 kg/m(2). Hypertension was found in 89.7% of patients, and 85.0% had at least one cholesterol abnormality. The mean duration of the diabetes was around 18 years, and the mean HbA(1c) level was about 7.5%. During the previous six months, 33.6% of patients had experienced one or several hypoglycaemias. Also, 26% of patients presented with diabetic retinopathy, 37.3% had a GFR<60 mL/min, 31.2% had coronary insufficiency, 10.1% had heart failure, 15.8% had cerebrovascular involvement and 25.6% had peripheral vascular disease of the lower extremities. In addition, 30.5% of patients had orthostatic hypotension, 12.4% had malnutrition and 28.8% had cognitive impairment, all of which were often diagnosed at inclusion. Three-quarters of patients were taking an oral antidiabetic drug and nearly six in every 10 patients were using insulin. CONCLUSION: This population can be considered representative of elderly, autonomous T2D patients, and its follow-up should clarify the link between glycaemic control and mortality/morbidity.

Advantages to using capillary blood beta-hydroxybutyrate determination for the detection and treatment of diabetic ketosis.

Ketone body determination is indicated in all diabetic patients when the risk of ketotic decompensation exists. New methods of screening for ketosis, in particular capillary blood ketone body determination, provide analytical, technical and clinical advantages compared to the conventional ketonuria. It is proposed that a diabetic patient with hyperglycaemia (capillary blood glucose > 2.50 g.l(-1)) and capillary blood ketone bodies exceeding 0.5 mmol.l(-1) requires therapeutic management. For values greater than 3 mmol.l(-1) or in case of more serious clinical symptoms, hospitalisation is indicated, considering the high probability of ketoacidotic decompensation. The advantages of capillary blood ketone body determination including easy use, and rapid and objective results may improve management of the diabetic patient, especially in emergency situations. However, prescription by a physician of capillary blood ketone body determination should be offered to targeted populations that have a high risk of ketoacidotic decompensation, after providing education to patients that is above all aimed at preventing this metabolic complication. In this context of determining ketone bodies in capillary blood, the term "capillary blood ketone bodies" is therefore preferable to the term "capillary blood beta-hydroxybutyrate determination". Indeed, it appears more appropriate, simple, descriptive and significant both for health-care staff and for patients.

Interest of Clinitek Microalbumin in screening for microalbuminuria: results of a multicentre study in 302 diabetic patients.

A prospective survey was performed in 302 consecutive diabetic outpatients from 3 French diabetic centres to study the sensitivity and specificity of screening for microalbuminuria using Clinitek Microalbumin. Urinary samples with positive (at least one +) proteinuria, hematuria, leucocyturia, or nitrates using the Multistix strip were excluded from the study. Results obtained with Clinitek Microalbumin were compared to those observed with the reference method of the biological laboratory of the centre on the same urinary sample. A positive result was defined as an albumin-to-creatinine ratio > or =30 mg/g. Results were described in terms of sensitivity, specificity, positive and negative predictive values and likelihood ratio. Agreement rates were compared with the Kappa test. In the study population, 48 patients (17%) had a positive microalbuminuria with reference assay. However, different rates were found in each site (25%, 11%, and 15%, respectively, p<0.001). Using the Clinitek Microalbumin, a positive result was found among 86 patients (29%), (39%, 26%, and 23%, respectively). A good agreement was observed in the population as a whole (81%, K=0.47 +/- 0.06) and in each site (77%, 81%, 84%, respectively). Sensitivity was 79% (82%, 80%, 75%), specificity 81% (76%, 81%, 85%), positive predictive value 46% (53%, 35%, 46%), negative predictive value 95% (93%, 97%, 95%), and positive likelihood ratio 4.2 (3.4, 4.3, 5.0, respectively). Due to the excellent negative predictive value, these results suggest that Clinitek Microalbumin is a good screening test for microalbuminuria. Positive results should be confirmed using a reference assay.

Management of diabetic patients by general practitioners in France 1997: an epidemiological study.

To describe the characteristics of diabetic patients, the associated risk factors, the complications of the disease and its management by general practitioners (GPs) in France, a randomised sample of French GPs was asked to record data on all consecutive diabetic patients attending a regular visit within 3 months. Data were obtained by interview, clinical examination and usual follow-up complementary examinations of the patients. Patients were classified into 3 groups:, patients treated with insulin and considered to have type 1 diabetes, [2i], insulin-treated patients expected to have type 2 diabetes, [2d], patients with type 2 diabetes and not treated with insulin. Data from 7540 diabetic out-patients were recorded by 3084 GPs: 657 patients (8.7%) belonged to group 1, 1383 patients (18.3%) to group 2i and 5351 (71.0%) to group 2d. Patients, including 53.7%, [2i] 54.1%, and [2d] 56.5% of men, were (mean +/- SE) 58.8 +/- 0.7, [2i] 63.4 +/- 0.3, and [2d] 63.9 +/- 0.2 years old, respectively. Duration of diabetes was 15.9 +/- 0.4, [2i] 11.4 +/- 0.2, and [2d] 10.1 +/- 0.1 yr. The last fasting blood glucose level (laboratory assay) was 1.61 +/- 0.02, [2i] 1.68 +/- 0.01, and [2d] 1.61 +/- 0.01 g/L, and the last HbA1c 8.5 +/- 0.1, [2i] 8.1 +/- 0.1, and [2d] 7.8 +/- 0.1%, respectively. Tobacco smoking was observed in 19.2%, [2i] 13.1%, and [2d] 12.6% of the patients, hypertension in 39.6%, [2i] 55.9%, and [2d] 58.6%, micro- or macro-albuminuria in 18.6%, [2i] 11. 2%, and [2d] 9.5%, retinopathy in 31.1%, [2i] 12.9%, and [2d] 8.6%, and history of coronary artery disease in 16.3%, [2i] 15.0%, and [2d] 12.8%. Self-monitoring of blood glucose was performed by 93.2%, [2i] 37.9%, and [2d] 16.9% of the patients. During the previous 12 months, a visit had been performed with a diabetologist in 54.0%, [2i] 20.7%, and [2d] 12.9% of the patients, with an ophthalmologist in 62.9%, [2i] 51.5%, and [2d] 49.4%. These results underline the specific characteristics of French diabetic patients. A high prevalence of uncontrolled risk factors, mainly hypertension, contrasts with a relatively low frequency of micro- and macro-angiopathy, maybe underestimated by non-systematic routine follow-up. Closer collaboration between GPs and specialists should be developed to improve the management and care of diabetic patients in France.

Biologic material in needles and cartridges after insulin injection with a pen in diabetic patients.

OBJECTIVE: To evaluate the frequency of non-inert material, including cells, in needles and cartridges after insulin injection with pen-like devices in diabetic patients. RESEARCH DESIGN AND METHODS: A prospective study was conducted in 120 insulin-treated diabetic patients who used pen-like devices. The patients, 46 women and 74 men, were 20-77 years old; 60% had type 1 diabetes, and 38% were overweight. Duration of diabetes ranged from 1 month to 40 years, and insulin therapy ranged from 1 month to 30 years. Insulin injection was performed by a trained nurse, using the patient's usual pen and cartridge. A cytopathological examination was performed on the material obtained from the needle and found in the cartridge after centrifugation. All slides were read by a single investigator. RESULTS: In 62% of the patients, non-inert material was found, including squamous (32%) and epithelial (58%) cells. Biologic material was found in 30% of the needles and 58% of the cartridges, and in both needle and cartridge in 25% of the population. Biologic material was found more frequently in patients who had a longer duration of diabetes, who were treated with insulin for a longer time, and who performed injection in the thighs or upper arms (P < 0.05). In multivariate analysis, the presence of biologic material was associated with the duration of diabetes (R2 = 0.09; P < 0.01). CONCLUSIONS: Our data suggest that biologic material can be trapped in the delivery system, including the cartridge, after an insulin injection with a pen-like device. Our results emphasize the strict need for individual use of insulin delivery systems, including cartridges and nonrefillable pens, especially in clinics and hospitals.

Evidence of non-inert material in needles and cartridges following a single insulin injection with a pen.

Preliminary results of an observational study are described in 50 unselected diabetic patients treated with insulin pens. The study was conducted to detect the presence of unexpected material in needles and cartridges after a single insulin injection. The injection was done by a trained nurse with the patient's usual pen and insulin cartridge. Cytopathological examination was performed on the material obtained from the needles and found in cartridges after centrifugation. Non-inert material was found in 28% of needles and 58% of cartridges, including squama (18 and 50% respectively) and epithelial cells (20 and 42% respectively). These data, which suggest a non-passive capture of biological material into the delivery system after injection, emphasise the rule of strictly individual use of insulin delivery systems, including cartridges. The precise impact of self-injection of this non-inert material on individuals during repeated pen injections remains uncertain.

[Validation of a questionnaire for the evaluation of the quality of life in menopause]. / Réduction d'un questionnaire d'évaluation de la qualité de vie en ménopause.

A 15 item-questionnaire designed and weighted by experts has been validated in terms of acceptability, validity, reproducibility and responsiveness. This French original tool allows a precise clinical evaluation of quality of life in menopausal women and of its changes with hormonal therapy.

Cost-effectiveness of screening for microalbuminuria using immunochemical dipstick tests or laboratory assays in diabetic patients.

To analyse the cost-effectiveness ratio of screening for microalbuminuria in diabetic patients using either dipstick tests or laboratory assays, 506 diabetic patients were screened for microalbuminuria using both a traditional laboratory assay (strategy I) or a laboratory assay only in the case of a positive dipstick result (strategy II). Dipstick pre-screening was considered positive if at least one of the tests performed by the two different operators showed an albumin excretion rate > 20 micrograms min-1. It was performed using a new dipstick, Micral-Test, designed to distinguish low albumin concentrations. Biological assay was the reference method. Costs were related to laboratory assays (strategy I) or to dipstick tests and laboratory assays for positive results (strategy II). The loss of effectiveness was related to false negative results of strategy II. The double dipstick pre-screening showed a sensitivity of 90.8% and a specificity of 80.1%. Its predictive value was 97% for a negative result and 55.6% for a positive result. False positive results were associated with elevated urinary volumes. Compared with strategy I, strategy II showed a sensitivity of 90.8%, a specificity of 100%, and predictive values of 100% and 97.5%, respectively, for positive and negative results. In a fictitious cohort of 10,000 patients, strategy II yielded a gain of 16,750 pounds on the first year, which decreased to 5345 pounds after 30 years. The loss in effectiveness was estimated at 2.38 quality adjusted life years of a diabetic patient (QALYd) initially, and decreased to 0.91 QALYd after 30 years, the annual cost-effectiveness ratio being close to 6600 pounds QALYd-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Reversibility of thyroid dysfunction induced by recombinant alpha interferon in chronic hepatitis C.

OBJECTIVE: Thyroid dysfunction has been reported as a complication of interferon therapy. The aim of our study was to assess the risk factors and reversibility of thyroid disorders induced by interferon therapy. DESIGN: Prospective study. PATIENTS: A series of 68 patients with chronic hepatitis C completed a therapeutic trial of interferon alpha 2b (IFN), randomized for dose adaptation, lasting for 24 weeks. MEASUREMENTS: TSH and autoantibodies against thyroid were looked for at (-2) weeks and 24 weeks in all patients. Blood samples obtained at (-2), 12, and 24 weeks were stored for additional hormonal studies in patients who developed thyroid dysfunction. Such patients with thyroid dysfunction were followed up for at least one year. RESULTS: Only one out of 68 patients had abnormal TSH levels, and two had thyroid autoantibodies prior to interferon therapy. Eight patients (12%) developed thyroid dysfunction (five hypothyroidism and three hyperthyroidism) during treatment. In four patients (all of them with thyroid dysfunction, P < 0.001) antimicrosomal, antithyroglobulin, and/or anti-TSH receptor antibodies appeared during interferon therapy. All patients recovered normal thyroid function within 1.5 years after interferon withdrawal. No pretreatment risk factor was identified. The patients with thyroid dysfunction did not significantly differ from the others as regards the dose of interferon they received or the rate of normalization of transaminases. CONCLUSION: (i) A 12% incidence of thyroid dysfunction was observed under interferon therapy; (ii) secondary appearance under interferon therapy of elevated thyroid autoantibodies was a risk factor; (iii) the thyroid disorders induced by interferon were reversible.

Smell dysfunction and related factors in diabetic patients.

OBJECTIVE: To analyze smell function in diabetic patients and healthy control subjects, with reference to individual characteristics and major complications of the disease. RESEARCH DESIGN AND METHODS: A cross-sectional study of smell recognition in 68 diabetic patients and 30 control subjects without known cause of smell impairment was conducted. Smell was studied using a kit of flavors that patients were asked to recognize, leading to a smell recognition score ranging from 0 (no recognition) to 20 (perfect recognition). Demographic and clinical data, and the electrogustometric threshold were recorded in both groups. Metabolic control and degenerative complications were studied in diabetic patients. RESULTS: The SRS was significantly lower in diabetic patients than in control subjects (12.4 +/- 0.5 vs. 15.1 +/- 0.5, P < 0.001). By use of univariate and multivariate analyses, this difference could not be explained by individual factors such as age, sex, body mass index, blood pressure, or tobacco or alcohol consumption but was related to diabetes. SRS correlated with EGT (r = 0.70, P < 0.001). In the diabetic group, SRS was associated with age (r = 0.29, P < 0.05), duration of diabetes (r = 0.27, P < 0.05), microalbuminuria (12.2 +/- 0.8 vs. 14.4 +/- 0.9, P < 0.05), peripheral neuropathy (10.3 +/- 1.0 vs. 14.1 +/- 0.9, P < 0.01), and EGT (r = 0.39; P < 0.001). By use of multivariate analysis, the strongest association was found with EGT (R2 = 0.15). CONCLUSIONS: These results suggest that smell recognition is impaired in patients with diabetes mellitus. Smell dysfunction is associated with age and degenerative complications of diabetes, suggesting a degenerative mechanism related to diabetes.

[Glycemic index of foods]. / Index glycémique des aliments.

The glycaemic index of foods describes the hyperglycaemic effect of isolated foods. It is measured by the ratio of the area under the glycaemic curve observed after ingestion of a 50 gram carbohydrate dose of the tested food to the area observed after ingestion of the same amount of a reference food (white bread). The glycaemic index classification provides an approach of the diabetic diet based on the glucose response to foods. Widely accepted when applied to isolated foods, its clinical utility during mixed meals remains discussed. The improvement of the average metabolic control which can be expected from its use is modest. However, its major interest could be observed during snacks and meals in order to control precisely post-prandial glucose variations, in association with blood glucose self-monitoring. As it allows high sweet taste-low-glycaemic index-carbohydrate foods to be consumed, it could significantly improve the quality of life of diabetic patients.

Early detection of diabetic patients at risk of developing degenerative complications using electric gustometry: a five-year follow-up study.

OBJECTIVES: Taste impairment has been reported during the course of diabetes. Although a degenerative mechanism has been suspected, the natural history of taste disorders in diabetes remains unknown. The purpose of this study was to describe the five-year evolution of electric gustometry in diabetic patients compared to healthy control subjects and with reference to degenerative complications of the disease. METHODS: Electrogustometry was studied initially and after 5 years in 73 diabetic out patients and 25 control subjects. None of them had any known cause of taste impairment other than diabetes. Diabetic patients and control subjects did not differ for demographic data and confounding factors. RESULTS: After five years, the electrogustometric threshold (EGT) significantly increased (51 +/- 6 vs 95 +/- 11 microA; p < 0.001), whereas slight changes occurred in control subjects (23 +/- 4 vs 25 +/- 5 microA; NS). Frequency of electric hypogeusia (EGT > or = 100 microA) increased from 11 to 46% in diabetic patients (p < 0.001), but did not vary in control subjects (4%). EGT was not strongly associated with individual factors such as blood pressure, tobacco and alcohol consumption, but correlated with age (p < 0.001). In the diabetic group, higher EGT were observed in patients treated with insulin (p < 0.001). EGT and its changes were associated with degenerative complication (p < 0.001), but neither with metabolic control, nor with duration of diabetes. Using multivariate analyses, the strongest associations were found with peripheral neuropathy and microalbuminuria (28 to 45% of variance explained; p < 0.001). The predictive value of initial hypogeusia on neuropathy at follow-up was 88% for a positive test and 63% for a negative one. CONCLUSIONS: These results suggest that the taste nerves transduction function is impaired during the course of diabetes. This impairment is associated with an increased occurrence of degenerative complications, leading to suspect a similar pathophysiological mechanism. Electric gustometry could be an interesting test for early screening for diabetes complications.

Influence of non-carbohydrate foods on glucose and insulin responses to carbohydrates of different glycaemic index in type 2 diabetic patients.

In order to study the influence of non-carbohydrate foods on responses to carbohydrates during mixed meals, 30 Type 2 (non-insulin-dependent) diabetic patients followed a standardized diet for 5 consecutive days. On days 2, 3, 4, and 5, four different lunches were eaten in a randomized order. Lunches consisted of rice or glucose (50 g carbohydrate) eaten either alone, or as part of a mixed meal (32 g protein, 20 g fat). Glucose and insulin levels prior to the lunches did not differ significantly. Glucose and insulin responses differed (p less than 0.001), responses to rice being lower than responses to glucose, and responses to the meal plus rice lower than responses to the meal plus glucose. The ratios of glucose responses to rice and glucose (glycaemic index) were similar (alone, 47 +/- 4%; meal, 47 +/- 4%; NS). The ratios of the insulin responses did not differ (78 +/- 8 vs 96 +/- 7%; NS). The blood glucose responses to mixed meals were lower than responses to the carbohydrates eaten alone, the ratios being similar (rice, 52 +/- 3%; glucose, 58 +/- 5%; NS). Serum insulin responses were however higher, and the ratios differed (172 +/- 13 vs 138 +/- 14%; p = 0.05). These results suggest that the glycaemic index of isolated carbohydrate foods can predict the relative response to mixed meals in the same individuals with Type 2 diabetes. They also support the insulin secretagogue effect of non-carbohydrate foods, which may vary according to the source of carbohydrate in the meal.

Reproducibility of glucose and insulin responses to mixed meal in type II diabetic patients.

OBJECTIVE: The reproducibility of glucose and insulin responses to a mixed meal were studied in 24 consecutive non-insulin-dependent (type II) diabetic patients, the diet of which matched the tested diet. Patients received their usual treatment throughout the study. RESEARCH DESIGN AND METHODS: A standardized diet was followed for 3 days, and responses were measured on the 2nd and 3rd days. Glucose and insulin responses were studied after lunches with the 180-min positive area under the curve, and were analyzed with paired t test and Pearson's linear regression. RESULTS: Glucose responses did not vary (217 +/- 50 vs. 217 +/- 38 min x mM, NS) and were significantly correlated (r = 0.64, P less than 0.01). Insulin responses did not vary (35,224 +/- 5768 vs. 35,305 +/- 7779 min x pM, NS) and were strongly correlated (r = 0.83, P less than 0.001). CONCLUSIONS: These results suggest that glucose and insulin responses to a test meal are reproducible in type II diabetic patients.