Background: The aim of this study was to investigate the relationship between 2-hour insulin concentration and fasting plasma glucose concentration (FPG) in a population-based sample of Indigenous Australians. Methods: Data collected from 2930 adults with unknown diabetic status were analyzed using three non-linear modeling methods: locally weighted regression (LOESS), generalized additive models (GAM), and fractional polynomial (fracpoly) regression procedures. Results: Log fasting insulin and log 2-hour insulin had nonlinear relationships with FPG. All models indicated a consistent fit for 2-hour insulin response across FPG values of 3.5–5.8 mmol/l. GAM and fracpoly regressions overlapped across FPG values of 3.5–13 mmol/l. The LOESS model had a slightly different pattern from FPG of 5.8-17 mmol/l. For all models, log 2-hour insulin concentration increased across FPG values from 3.5–7.0 mmol/l and decreased for FPG >7.0 mmol/l. Conclusions: The 7.0 mmol/l FPG diagnostic cut-off represents the start of a diminishing second-phase insulin response to glucose, indicating that pancreatic output begins to decline at this FPG level. These results provide strong physiological rationale, beyond rising rates of clinical complications, for the revised fasting glucose diagnostic criterion of 7.0 mmol/l. Further research is needed to evaluate whether similar relationships exist for other high- and low-risk populations.

Background: Diabetic patients with hyperglycaemia show oxidative stress and increased formation of advanced glycation endproducts (AGEs) which increases their susceptibility to chronic complications. Aged garlic extract has antioxidant properties and prevents the formation of AGEs in vitro. This study investigated the effects of dietary intervention with Kyolic® aged garlic extract on glycaemia, lipidaemia and oxidative stress in diabetic patients. Methods: Blood samples were collected from 48 diabetic patients on recruitment, after one month and then monthly following an intake of 3000 mg of aged garlic extract daily over a period of 3-months. Samples were analysed for glucose, glycated haemoglobin and lipid profile using automated analyses. Low molecular weight AGEs were measured using a fluorometric method. Lipid hydroperoxides and total antioxidant status were determined using colorimetric kit methods. Results: Intervention with aged garlic extract did not affect blood glucose, glycated haemoglobin or the lipid profile but serum triacylglycerol concentrations declined after 3-months of intervention (P< 0.05). Aged garlic extract intake did reduce levels of serum AGEs although this was not significant. Lipid hydroperoxide, an indicator of oxidative stress, was significantly reduced following intake of aged garlic extract (P<0.05). Conclusion: Aged garlic extract may therefore protect against the harmful effects of AGEs and oxidative stress thus further investigations are needed to fully evaluate the benefits of long-term consumption of aged garlic extract, in particular its effects on tissue AGEs and oxidative stress.

Background: Antihypertensive drugs including thiazide diuretics, beta blockers (BB), calcium channel blockers (CCB), reninangiotensin inhibitors or vasodilators produce elevated blood glucose (hyperglycemia) (>70-99 mg/dL). Hyperglycemia is more common and severe with thiazide diuretics than with BB, CCB, ACEI or ARB drugs. Questions have been raised about the mechanism and risk of drug-induced hyperglycemia. Method: We present here four patients treated with diuretics who developed hyperglycemia - fasting blood glucose (FBG) > 126 mg/ dL (7 mmol/L) diagnostic of diabetes. Three patients had hypertension and one, congestive heart failure (CHF). Three patients had no diabetes, one gave 8 to 10 year history of diabetes. One patient received no diuretic therapy and his glucose level was normal with insulin and oral hypoglycemic agent treatment. Subsequently, he became hypertensive and was treated with a thiazide diuretic but no antidiabetic agents. He then developed new-onset diabetes. Results: All patients showed hyperglycemia above FBG criteria for diabetes. 2-hour postprandial blood glucose (2hPPG) was not diagnostic of diabetes in three patients. Two patients were prescribed antidiabetic therapy which was stopped with no worsening of hyperglycemia although diuretic therapy continued. In two patients diuretic was discontinued. Hyperglycemia abated in one, while in the other, hyperglycemia worsened requiring Glargine insulin. Conclusion: Hyperglycemia is common in patients with hypertension or CHF treated with a thiazide diuretic alone or in combination with other diuretics. Although by definition the term new-onset diabetes may be used to connote hyperglycemia, in reality diabetes induced by diuretics is not diabetes as 2hPPG does not usually exceed 200 mg/dL (11.1 mmol/L), and patients show no evidence of any vascular complications. It may be more appropriate to define elevated glucose associated with diuretic "hyperglycemia" rather than new-onset diabetes. The real issue is that use of thiazide diuretics is imperative in blood pressure control especially in resistant hypertension. Even with new-onset diabetes, thiazide diuretics are commonly found to be safe, reducing risk of stroke, heart attack, and renal failure characteristic of uncontrolled hypertension. Therefore, risks of new-onset diabetes, induced by diuretic therapy, will be difficult to ascertain because of hypertension for which thiazide diuretic is widely used.

Background: Prevention of diabetic complications requires good glycaemic control. This study aimed to provide type 2 diabetes patients with remote active care and glycaemic control through the use of videophone technology without the need for them to attend hospital. The literature recommends additional research to study the impact of technical innovations on improved disease self-management and medical outcome. This is the only study to be conducted in Turkey concerning patient monitoring using videophone technology. The aim of the study was to establish the effectiveness of the use of videophone technology in the glycaemic control of patients with diabetes living in remote areas. Methods: This is a prospective, randomized control study using the systematic sampling method (using half ratio), in which 24 patients were chosen for the Experimental Group (EG) and another 24 for the Control Group (CG). All of the patients agreed to participate in the study. Patients in the CG received routine care, while the glycaemic control and consultations for patients in the EG were conducted using videophone technology. The patients were monitored by videophone for a total of 6 months. The HbA1c and blood glucose values recorded over the 6 month monitoring period were analyzed to determine the effectiveness of using a videophone. Results: The mean age of the individuals in the EG was 54.41 ± 8.54 years (Min=43 Max=78) and in the CG it was 57.25 ± 9.61 (Min=40 Max=77). In both groups, 50% of the individuals were men and 50% were women. When the two groups were compared, it was was found that the preprandial blood glucose levels of the diabetic patients in the EG (mean 159.48 ± 40.71mg/dl) were lower by 13.55 ± 52.89 mg / dl than the preprandial blood glucose levels of the diabetic patients in the CG (mean 173.03 ± 65.07 mg/dl). It was determined at the end of the six-month monitoring that the A1c levels of the individuals in the EG were significinatly lowered by 0.49% in total, and that the A1c levels of the individuals in the CG were higher by 0.17 % in total. Conclusions: It was shown that videophone technology can be useful in the glycaemic control of diabetic patients in Turkey.

Background: Wolfram syndrome is a genetic condition, which is typically inherited in autosomal recessive fashion, characterized by the combination of diabetes mellitus and optic atrophy. It is along a spectrum which encompasses DIDMOAD (Diabetes insipidus, diabetes mellitus, optic atrophy, and deafness). Profound hypoglycemic unawareness can be seen in this condition but is not commonly described as an associated feature in the literature. Case report: A 16 year old female with history of presumed type 1 diabetes presented to urology clinic with urinary incontinence. She was found to have profound dilation of the bladder and was admitted for bladder decompression. During the course of admission she was found to also have diabetes insipidus and optic atrophy. She had several severe hypoglycemic episodes with profound hypoglycemia unawareness during this admission. Genetic testing for Wolfram syndrome was positive. As an outpatient she was placed on a continuous glucose monitor to help manage her hypoglycemia. Addtionally, psychiatric support to manage her associated depression was an important aspect of her therapy. As her depression improved so did her ability to comply with the necessary therapies. Conclusions: Wolfram syndrome is a rare syndrome that has been well described. However, patients with this syndrome have frequent hypoglycemia unawareness and severe hypoglycemia likely related to the neurologic deterioration that occurs at the molecular level in the pathogenesis of Wolfram syndrome. Strategies must be put in to place to help prevent and quickly treat these hypoglycemic events.