OBJECTIVE -The aim of this study was to determine whether premeal pulmonary delivery of rapid-acting, dry-powder insulin (Exubera) plus Ultralente could provide glycemic control comparable to a conventional insulin regimen in type 1 diabetes.RESEARCH DESIGN AND METHODS -Three hundred thirty-five subjects were randomly assigned to receive either premeal inhaled insulin plus bedtime Ultralente or two to three injections of regular and NPH insulin for 24 weeks. The primary end point was a change in HbA 1c . RESULTS -Mean decreases inHbA 1c values were comparable for inhaled (8.1-7.9%) and conventional groups (8.1-7.7%) (adjusted treatment group difference 0.16% [95% CI Ϫ0.01 to 0.32]). There were greater reductions for inhaled versus conventional regimen in fasting and postprandial plasma glucose (adjusted mean change differences Ϫ25.17 and Ϫ30.28 mg/dl, respectively [95% CI Ϫ43.39 to Ϫ6.95 and Ϫ54.58 to Ϫ5.97, respectively]). Hypoglycemia (events/subject month) was lower for the inhaled (8.6) versus the conventional (9.0) group (risk ratio,). In subjects receiving inhaled insulin, increased insulin antibody levels were observed, but there were no associated clinical or laboratory changes. Adverse events were comparable between groups. Mild to moderate cough was more frequent in the inhaled insulin group (27 vs. 5%) but decreased during the treatment. Pulmonary function tests were not different between the groups except for a greater decrease in carbon monoxide diffusing capacity in the inhaled insulin group. Treatment satisfaction was greater in the inhaled than in the conventional group.CONCLUSIONS -Inhaled insulin is effective, well tolerated, and well accepted in patients with type 1 diabetes and provides glycemic control comparable to that with a conventional insulin regimen. Diabetes Care 27:2622-2627, 2004T he long-term benefits of tight metabolic control in prevention and reduction of microvascular complications of type 1 diabetes are well established (1,2). In type 1 diabetes, lack of acceptance of continuous subcutaneous insulin delivery or multiple daily injections represents barriers to the achievement of optimal HbA 1c values.Pulmonary insulin delivery represents an alternative route of insulin administration (3,4), eliminating the need for preprandial injections. Inhaled insulin is absorbed more rapidly and is cleared at a faster rate than human regular insulin injected subcutaneously (4). A novel drypowder insulin formulation and aerosol delivery device have recently been developed. Pharmacodynamic data from a randomized, open-label, comparative, single-dose study using this system showed that the onset of action of inhaled insulin is similar to that observed with insulin lispro, whereas duration of action is slightly longer (5). A small phase two study has also demonstrated that inhaled insulin given 10 min before mealtimes, combined with a long-acting insulin injection at bedtime, is an effective and well-tolerated alternative to preprandial subcutaneous insulin injections in type 1 diabetes (6). ...

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Essential oils of Artemisia absinthium L. and Tanacetum vulgare L. were extracted by three methods, a microwave assisted process (MAP), distillation in water (DW) and direct steam distillation (DSD), and tested for their relative toxicity as contact acaricides to the two spotted spider mite, Tetranychus urticae Koch. All three extracts of A. absinthium and of T. vulgare were lethal to the spider mite but to variable degrees. The LC50 obtained from the DSD oil of A. absinthium was significantly lower (0.04 mg/cm2) than that of the MAP (0.13 mg/cm2) and DW (0.13 mg/cm2) oil of this plant species. DSD and DW extracts of T. vulgare were more toxic (75.6 and 60.4% mite mortality, respectively, at 4% concentration) to the spider mite than the MAP extract (16.7% mite mortality at 4% concentration). Chromatographic analysis indicated differences in composition between the more toxic DSD oil of A. absinthium and the other two extracts of this plant, indicating that a sesquiterpene (C15H24) compound present in the DSD oil and absent in the other two may enhance the toxicity of the DSD oil. Chemical analysis of the T. vulgare extracts indicated that beta-thujone is by far the major compound of the oil (>87.6%) and probably contributes significantly to the acaricidal activity of the oil.

OBJECTIVE -The purpose of this study was to evaluate the long-term (2-year) safety and efficacy of inhaled human insulin (Exubera [insulin human (rDNA origin)] inhalation powder) (EXU) in adult patients with type 1 diabetes. , indicating that the significant difference between the treatment groups in FEV 1 developed during the first 3 months and was not progressive thereafter. Adverse event profiles were similar except for a higher incidence of cough (usually mild and unproductive) in patients receiving EXU (37.6 vs. 13.1%) that decreased to 1.3% by month 24. Glycemic control was sustained in both groups (adjusted mean treatment difference in change from baseline A1C at month 24 0.25 Ϯ 0.07% [0.13-0.37]). Although the overall hypoglycemic events were comparable between groups (4.0 vs. 3.8 events/subject-month), the incidence of severe hypoglycemic events was lower with EXU than with SC insulin (2.8 vs. 4.1 events/100 subject-months, risk ratio 0. RESEARCH DESIGN AND METHODS

OBJECTIVE -To assess the prevalence of undiagnosed diabetes and glucose intolerance in individuals Ն40 years of age who contacted their family physician for routine care.RESEARCH DESIGN AND METHODS -The study used a stratified randomized selection of family physicians across Canada that was proportional to provincial and urban/rural populations based on Statistics Canada Census data (1996). Consecutive patients Ն40 years of age were screened for diabetes. If a casual fingerprick blood glucose was Ͼ5.5 mmol/l, the patient returned for a fasting venous blood glucose test. If the fasting blood glucose was 6.1-6.9 mmol/l, a 2-h 75-g post-glucose load venous blood glucose was obtained. Results of these tests were used to classify patients in diagnostic categories.RESULTS -Data were available for 9,042 patients. Previously undiagnosed diabetes was discovered in 2.2% of the patients, and new glucose intolerance was found in an additional 3.5% of patients. Overall, 16.4% of patients had previously known diabetes. The decrease in fasting plasma glucose criterion from 7.8 to 7.0 mmol/l resulted in a 2.2% versus a 1.6% prevalence of new diabetes. Several risk factors were reported in a significantly greater proportion of patients with new glucose intolerance and either new and known diabetes compared with the normal glucose tolerance group of patients. CONCLUSIONS -Routine screening for diabetes by family physicians is justified in patients Ն40 years of age, given the finding of previously undiagnosed diabetes in 2.2% of these patients and newly diagnosed glucose intolerance in an additional 3.5% of these patients. Another 16.4% of primary care patients Ն40 years of age have known diabetes. This has important implications regarding health resources and physician education.

OBJECTIVETo compare the effects of a eucaloric diet higher in carbohydrate/lower in fat versus lower in carbohydrate/higher in monounsaturated fat on postmeal triglyceride (TG) concentrations and other cardiovascular disease risk factors in nonobese subjects with type 1 diabetes and in good glycemic control.RESEARCH DESIGN AND METHODSIn a parallel group design study, 30 subjects were randomly assigned and completed one of the two eucaloric diets. Assessments included: BMI, blood pressure, A1C, plasma lipids, and markers of oxidation, thrombosis, and inflammation. At 6 months, subjects were hospitalized for 24 h to measure plasma TG excursions.RESULTSThere were no significant differences between groups other than decreased plasminogen activator inhibitor 1 (PAI-1) levels and weight gain in the lower-carbohydrate/higher–monounsaturated fat group. During the 24-h testing, the lower-carbohydrate/higher–monounsaturated fat group had a lower plasma TG profile.CONCLUSIONSA diet lower in carbohydrate/higher in monounsaturated fat could offer an appropriate choice for nonobese type 1 diabetic individuals with good metabolic and weight control.

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