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  • 1
    ISSN: 1432-1203
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Summary Members of three families with maturity onset diabetes of youth (MODY) and seven with “common” type 2 diabetes were typed for six DNA markers (H-RAS, INS, HBBC, PTH, CALC1, CAT) on the short arm of chromosome 11. Using conventional pairwise linkage analysis, close linkage in the MODY families was excluded for all six markers. By multipoint analysis and a genetic map of the short arm of chromosome 11, MODY was excluded from a region of at least 35 and up to 60 centiMorgans (cM) on the short arm of chromosome 11. Multipoint analysis in the type 2 families also excludes linkage to the INS, H-RAS region of at least 3 and up to 30 cM. This study using multipoint linkage analysis in non-insulin dependent diabetes provides strong evidence against a role for mutations in or around the insulin gene in the causation of MODY or type 2 diabetes in the families studied.
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  • 2
    Electronic Resource
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    Springer
    Diabetologia 13 (1977), S. 93-97 
    ISSN: 1432-0428
    Keywords: Basal insulin secretion ; hypoglycaemia ; basal plasma glucose ; diabetes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The plasma insulin response to both a small increase and decrease in the plasma glucose has been studied in normal and diabetic, non-obese subjects. In a second investigation the plasma insulin concentrations were measured during a gradual reduction of the raised fasting plasma glucose of diabetes to normal levels. In both studies, diabetic patients were found to have a markedly impaired response of the fasting plasma insulin to small changes in plasma glucose. These results do not support the suggestion that stimulated and not basal insulin secretion is impaired in diabetes. Both modes of secretion are probably via the same B-cell release mechanism, which is deficient in diabetes. There was a gradation of response between maturity onset and juvenile onset diabetics.
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  • 3
    ISSN: 1432-0428
    Keywords: Basal insulin secretion ; adrenalin ; alpha blockade ; glucose ; insulinoma ; malignant insulinoma ; proinsulin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Basal insulin secretion has been thought to be via a different mechanism from stimulated insulin secretion, partly because it is not similarly suppressed by adrenalin. However, adrenalin normally causes hyperglycaemia, but if it is infused while the plasma glucose is kept constant there is marked suppression of insulin secretion. Sympathetic stimulation modulates basal insulin secretion, and alpha adrenergic blockade impaired the suppression of insulin secretion in response to hypoglycaemia. Four of five benign insulinomas had marked suppression of insulin secretion by adrenalin, but one malignant and one benign insulinoma had little suppression. Both had a raised proportion of their basal plasma insulin as proinsulin, and the impaired suppression of secretion by adrenalin probably signified an undifferentiated tumour.
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  • 4
    ISSN: 1432-0428
    Keywords: Diabetes ; lipids ; diabetic retinopathy ; cholesterol ; triglycerides ; diabetic nephropathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Diurnal profiles of total and lipoprotein cholesterol and triglycerides were measured in 11 insulin-dependent diabetic subjects without retinopathy, 10 with background and 10 with proliferative retinopathy. The groups were closely matched for age and duration of diabetes. Total cholesterol levels were higher in patients with proliferative (5.6±0.5 mmol/l) than background (5.1±0.7 mmol/l) or no retinopathy (4.6±0.8 mmol/l, trend test; p 〈 0.003), due to raised levels of low density lipoprotein (LDL) cholesterol (3.8±0.9, 3.2±0.6 and 2.8±0.8 mmol/l respectively; p 〈 0.02). High density lipoprotein (HDL) levels were similar in patients with and without retinopathy and HDL/ LDL ratios were lower with more severe retinopathy (p 〈 0.025). Cholesterol levels were similar in diabetic subjects without retinopathy and in 12 normal subjects. Triglyceride levels were not related to retinopathy and no measure of plasma lipids correlated with HbA1 or 24-h mean plasma glucose. Total and LDL cholesterol were weakly inversely correlated with creatinine clearance but the association with retinopathy was independent of this effect.
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  • 5
    ISSN: 1432-0428
    Keywords: Diabetes ; therapy ; diet ; insulin therapy ; sulphonyl-urea ; biguanide ; epidemiology ; body weight ; fasting plasma glucose
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A multi-centre, prospective randomised study of the therapy of maturity-onset diabetes has been started, and we report progress of the first 286 patients with 1-year followup. Newly presenting patients (aged 25–65 years inclusive) were initially treated by diet and divided into three categories. (1) Forty-one patients (14%) were ‘primary diet failure’ in that they continued to have symptoms or their fasting plasma glucose remained 〉15 mmol/l. Their therapy was allocated randomly to insulin, chlorpropamide or glibenclamide, and doses adjusted to try to maintain a fasting plasma glucose 〈6 mmol/l. Insulin produced a similar decrease in fasting plasma glucose to sulphonylurea therapy (median fasting plasma glucose fell from 15.4 to 8.0 mmol/l and from 15.5 to 8.6 mmol/l, respectively). (2) After 3–4 months diet, 161 patients (56%) were asymptomatic but had a fasting plasma glucose 〉6 mmol/l. In the ‘main randomisation’ their therapy was allocated to diet only, or diet plus chlorpropamide, glibenclamide or a basal insulin supplement from ultralente insulin. On diet alone, fasting plasma glucose remained constant over 1-year follow-up (from 7.7 to 7.6 mmol/l), whereas it was reduced significantly by insulin (from 8.0 to 6.4 mmol/l), chlorpropamide (8.6 to 6.1 mmol/l) and glibenclamide (7.8 to 6.5 mmol/l). On diet alone, weight remained unchanged over 1 year but increased significantly on insulin, chlorpropamide or glibenclamide (median change ideal body weight +3.5%, +4% and +4%, respectively). Obese patients (〉20% over ideal weight) did not differ from normal weight diabetic subjects in either fasting plasma glucose or weight changes. Insulin therapy was associated with few hypoglycaemic episodes, with 8% of patients on ultralente insulin alone reporting an episode compared with 7% on chlorpropamide. Fifty-one patients (86%) randomised to insulin remain on it lyear later. (3) After 3–4 months on diet, 84 patients (30%) after dieting had a fasting plasma glucose 〈6 mmol/l. During the following year on diet alone 34 patients were less well controlled with a fasting plasma glucose 〉6 mmol/l and were included in a ‘delayed randomisation’. Thus 83% of all patients entered into the study had their therapy randomised by 1 year. Insulin and sulphonylurea therapy are equally effective in reducing glycaemia, and the study is being extended to determine if either therapy will prevent the complications of diabetes or have untoward long-term side effects.
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  • 6
    ISSN: 1432-0428
    Keywords: Quantitative morphometry ; amyloid ; diabetes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Quantitative morphometry of the pancreases of five ‘maturity-onset’ diabetic subjects has demonstrated more amyloid in islets of the head, body and tail (where it was found in a mean 29% of the islets occupying a mean 11% islet area) than in islets of the ‘pancreatic-polypeptide-rich’ lobule of the head (where amyloid was found in a mean of 3% of the islets occupying a mean of 0.7% islet area, both p〈 0.005). The nonuniform amyloid distribution may relate to the hormone content of the islet; the head and tail contained significantly more A, B and D-cells than the pancreatic-polypeptide-rich lobule in both non-diabetic subjects (n = 8) and diabetic patients (n = 5; p〈0.005). This result is compatible with the previous suggestion that amyloid may be derived from insulin or its precursors.
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  • 7
    ISSN: 1432-0428
    Keywords: Genetics ; Type 2 (non-insulin-dependent) diabetes ; insulin receptor ; linkage analysis ; maturity onset diabetes of the young
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The possibility of linkage between the human insulin receptor gene locus and diabetes was examined in three Type 2 (non-insulin-dependent) diabetic families and one family with maturity onset diabetes of the young. Insulin receptor gene haplotypes were established using BglII, Rsal and Sstl restriction enzyme digests of genomic DNA from all available family members. The digested DNA was subjected to agarose gel electrophoresis, Southern blotted, and hybridised to 32P-labelled human insulin receptor gene cDNA. In the pedigree with maturity onset diabetes of the young, formal linkage analysis allowed exclusion of close linkage between the insulin receptor locus and diabetes (logarithm of the odds for linkage versus non-linkage was −5.35 at recombination fraction of 0.01). This confirms the absence of linkage between insulin receptor and diabetes which has been reported in two similar pedigrees. In the three Type 2 diabetic families there were a minimum of 4 recombinants between the insulin receptor locus and diabetes, which makes a direct role for insulin receptor defects unlikely. The importance of using realistic estimates of penetrance when performing linkage analysis in a disease with a late age of onset is emphasised. In contrast to the one previous linkage analysis study of the insulin receptor gene, no specific association of diabetes with the rare Sstl Sl(-) allele was observed in either the maturity onset diabetes of the young or the Type 2 diabetic families.
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  • 8
    ISSN: 1432-0428
    Keywords: Linkage ; islet amyloid
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Type 2 (non-insulin-dependent) diabetes is associated with the deposition of islet amyloid. The major formative peptide, islet amyloid polypeptide, has recently been characterised and an abnormality of the structure or expression of this gene is a possible candidate for the inherited component of Type 2 diabetes. A restriction fragment length polymorphism of the gene has been identified with Pvu II. To study the relationship between the islet amyloid polypeptide gene and Type 2 diabetes, two distinct genetic approaches have been undertaken. Firstly, non-linkage has been demonstrated in four pedigrees, with four normoglycaemic first degree relatives having an allele associated with diabetes in other family members, and one affected relative not having the putatively associated allele. The LOD score taking age-related penetrance into account was −1.68, making linkage unlikely (p=0.02). Secondly, in a population-based restriction fragment length polymorphism survey, no linkage disequilibrium of the alleles was found between a population of unrelated Caucasian subjects with Type 2 diabetes and a normal population. A mutation in or near the islet amyloid polypeptide gene is thus unlikely to be a common cause of Type 2 diabetes.
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  • 9
    ISSN: 1432-0428
    Keywords: Non-insulin-dependent diabetes mellitus ; genetic epidemiology ; genetic linkage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Non-insulin-dependent diabetes mellitus (NIDDM) has a substantial genetic component, but the mode of inheritance and the molecular basis are unknown. We have undertaken segregation analysis of NIDDM after studying 247 subjects in 59 Caucasian nuclear pedigrees ascertained without regard to family history of the disorder. The analyses were performed using POINTER and COMDS, which are computer programs which apply statistical models to the data. POINTER analysis was performed defining the phenotype as a presence or absence of hyperglycaemia. Among single locus hypotheses, the analyses rejected a recessive model and favoured a dominant model, but could not statistically show that this fitted better than a mixed model (a single locus against a polygenic background) or a polygenic model. COMDS analysis assumed a continuum of hyperglycaemia from normality to NIDDM, classified family members into a series of diathesis classes with increasing plasma glucose levels and compared the distribution with that found by screening the normal population. This analysis improved the likelihood of a dominant single locus model and suggested a gene frequency of 7.4%. It raised the possibility of a second locus, but cannot identify or exclude a polygenic model. In conclusion, two types of segregation analyses rejected a recessive model and favoured a dominant model of inheritance, although they could not statistically show that this fitted better than the polygenic model. The results raised the possibility of a common dominant gene with incomplete penetrance, but genetic analysis of NIDDM needs to take into account the likelihood of polygenic inheritance with genetic heterogeneity.
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  • 10
    ISSN: 1432-0428
    Keywords: Key words Glucagon-like peptide-1 receptor, non-insulin-dependent diabetes mellitus, maturity onset diabetes of the young, polymerase chain reaction, linkage analysis.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Glucagon-like peptide-1 (GLP-1) is a hormone derived from the preproglucagon molecule that is secreted by intestinal L cells and stimulates insulin secretion from betacells. The GLP-1 receptor is a candidate gene for diabetes mellitus, as mutations may induce the impaired insulin response that is a characteristic feature of NIDDM. To study the relationship between the GLP-1 receptor gene and NIDDM, linkage of a microsatellite polymorphism flanking the GLP-1 receptor gene with diabetes was investigated in three Caucasian families with MODY and in the nuclear families of 12 NIDDM probands. A cumulative LOD score −8.50 excludes linkage in these MODY pedigrees. A LOD score of −1.24 in the NIDDM nuclear pedigrees makes linkage improbable. Mutations in or near the GLP-1 receptor gene are unlikely to be the major cause of the inherited predisposition to NIDDM in Caucasian pedigrees, but we cannot exclude a role for this locus in a polygenic model or a major role in some pedigrees. [Diabetologia (1994) 37: 721–724]
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