OBJECTIVE -To determine, for individuals with type 2 diabetes and microalbuminuria, the effects of 6 weeks of meals containing plant-based protein (PP) versus meals with predominantly animal-based protein (AP) on renal function and secondarily on glycemia, lipid levels, and blood pressure.RESEARCH DESIGN AND METHODS -In a randomized crossover trial, we compared 6 weeks of meals containing only PP with meals containing primarily AP (60% animal, 40% plant) in 17 subjects with type 2 diabetes and microalbuminuria treated with diet and/or oral antidiabetic agents. Protein content was equivalent to the average American diet, and calories provided weight maintenance. Nutrients were equivalent between the two diets. Meals were prepared and packaged by a metabolic kitchen staff and were sent home weekly. At the beginning and end of each 6-week period, subjects were studied for 36 h on a metabolic unit.RESULTS -There were no significant differences between diets for glomerular filtration rate, renal plasma flow, albumin excretion rate, total cholesterol, HDL cholesterol, triglyceride area under the curve (AUC), glucose and insulin AUC, HbA 1c, blood pressure, or serum amino acids. For both diets, at the end of the treatment periods as compared with baseline, total cholesterol was significantly lower (PP and AP: from 4.75 to 4.34 mmol/l, P Ͻ 0.01), HbA 1c had significantly improved (PP: from 8.1 to 7.5%, P Ͻ 0.01; AP: from 7.9 to 7.4%, P Ͻ 0.01), and diastolic blood pressure was significantly lower (PP: from 83 to 80 mmHg, P Ͻ 0.02; AP: from 82 to 78, P Ͻ 0.02).CONCLUSIONS -There is no clear advantage for the recommendation of diets containing only PP rather than diets containing protein that is primarily animal-based for individuals with type 2 diabetes and microalbuminuria. There are, however, potential lipid, glycemic, and blood pressure benefits for following a carefully constructed, weight-maintaining, healthy diet, regardless of protein source. Diabetes Care 25:1277-1282, 2002O ne of the risk factors in type 2 diabetes for progression to diabetic nephropathy, renal failure, and early cardiovascular morbidity and mortality (1-6) is microalbuminuria. Therapies that reverse or delay the progression of microalbuminuria include normalization of blood pressure with ACE inhibitors (7) and angiotensin II receptor blockers (8) and improved blood glucose control (9,10). More problematic is the effectiveness of reducing the amount of dietary protein to at least 0.8 -1.0 g ⅐ kg body wt Ϫ1 ⅐ day Ϫ1 (11) or changing the type of protein. Studies performed in normoalbuminuric individuals with diabetes have suggested that changing the composition of the diet by altering the source of protein from animal to plant, either acutely in the setting of a standard test meal (12) or for up to 4 weeks (13), might produce beneficial renal effects. However, in another acute study, individuals with type 1 or type 2 diabetes and microalbuminuria showed no significant change in renal function when given plant-based protein (PP) versus animal-based...

No abstract

Insulin lispro [Lys (B28), Pro (B29) human insulin] is a rapidly absorbed analog that has diminished tendency to self-associate. In four open-label, 1-year-long international randomized trials, we contrasted the immunogenicity of insulin lispro versus regular human insulin (RHI) in patients previously treated with insulin who had IDDM or NIDDM. Using a self-blank subtraction assay, we assessed sera for the presence of insulin-specific antibodies (ISA), insulin lispro-specific antibodies (LSA), and cross-reactive antibodies (CRA). Basal insulin needs were provided either with human ultralente (UL) or NPH insulins. After 2 to 4 weeks of therapy with RHI plus UL or RHI plus NPH, 50% of patients were randomly assigned to begin insulin lispro or continue on RHI. At baseline, few pretreated patients had LSA (0-4%) and approximately 10% had ISA, whereas 41-45% of patients with IDDM and 23-27% of patients with NIDDM had CRA (IDDM vs. NIDDM, P < 0.001). Within studies, no significant differences were noted over time in ISA, LSA, or CRA attributable to the type of short-acting insulin. When data were pooled, inconsistent changes were noted in ISA and LSA (LSA were greater in NIDDM vs. IDDM at baseline, P = 0.001, and ISA were greater in IDDM vs. NIDDM at 6 months, P = 0.007). Significant levels of CRA were more common in IDDM at all times (P < 0.001, P = 0.022, and P = 0.002 at baseline, 6 months, and 12 months, respectively). For patients receiving insulin lispro, no significant changes occurred in antibody status among IDDM and NIDDM patients throughout the study (became positive, remained positive, became negative, or remained negative). IDDM patients were more likely to develop or maintain CRA levels (P = 0.008 vs. NIDDM), whereas antibody levels were comparable among positive individuals. No evidence was noted that insulin lispro differs in immunogenicity from RHI in previously treated IDDM and NIDDM patients.

No abstract

This article samples and analyzes teacher knowledge about attitudes toward, and utilization of school guidance programs. 208 secondary school teachers were selected to represent 18 secondary schools in a 4-state area. These schools had functioning guidance programs under the direction of a certified counselor. Opinion-type questionnaires were administered. Additional data were collected through follow-up interviews. Findings are summarized and comparisons are made, where appropriate, with the results of an earlier study of pupil opinions of high school guidance programs. HIS STUDY represents an attempt to