OBJECTIVE—To investigate the effect of meal-related self-monitoring of blood glucose on glycemic control and well-being in non-insulin-treated type 2 diabetic patients. RESEARCH DESIGN AND METHODS—This 6-month study, which included 6 months of follow-up, adopted a prospective, multicenter, randomized controlled design. Subjects were randomized to two groups: one group used a blood glucose-monitoring device, kept a blood glucose/eating diary, and received standardized counseling; the control group received nonstandardized counseling on diet and lifestyle. The primary efficacy parameter was the change in HbA1c. Secondary efficacy variables included changes in body weight, lipids, and microalbumin and changes in treatment satisfaction and well-being. RESULTS—In the per-protocol analysis, the use of a self-monitoring blood glucose device significantly reduced HbA1c levels by 1.0 ± 1.08% compared with 0.54 ± 1.41% for the control group (P = 0.0086); subgroup analysis showed three types of responders. Body weight, total cholesterol, and microalbumin improved when using a glucometer, but there was no statistically significant difference between the two groups. Treatment satisfaction increased in both groups to a similar extent (P = 0.9). Self-monitoring resulted in a marked improvement of general well-being with significant improvements in the subitems depression (P = 0.032) and lack of well-being (P = 0.02). CONCLUSIONS—Meal-related self-monitoring of blood glucose within a structured counseling program improved glycemic control in the majority of non-insulin-treated type 2 diabetic patients in this study. The finding of three types of responders will be important for future planning of counseling and educational interventions.

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In 21 female Beagle dogs an experimental pancreatitis was induced by injection of bile into the pancreatic duct system. Beside controls, dogs received 62.5 micrograms/h cyclic somatostatin (SRIF) a continuous i.v. infusion starting with a bolus of 250 micrograms 15 minutes before or 2 hours after bile injection. Following blood parameters were determined: lipase, amylase, blood count, minerals, glucose, insulin, gastrin, secretin and CCK. Two controls died within 24 hours, the others were sacrificed after 48 hours. All pancreata were examined morephologically. The controls developed all clinical signs of acute hemorrhagic pancreatitis, whereas all SRIF-treated dogs were in much better general condition. Lipase and amylase increased in all groups. In the controls insulin, gastrin and secretin remained unchanged and CCK rose slightly. SRIF-treatment diminished insulin, CCK and the test meal-induced increase of secretin. At autopsy the pancreata of the controls were nearly entirely apoplectic. The SRIF-treated dogs showed less damage of the pancreas and no severe hemorrhagic necrosis was noted. The beneficial effect of SRIF cannot only be due to an interaction with intestinal hormones. An additional direct protective effect on the exocrine parenchyma is proposed to exist.

The aim of the present study was to investigate if thymusaplastic nude mice and rats are favorable as recipients for transplantation of human fetal pancreas. Twenty human fetal pancreases were transplanted subcutaneously to 20 nude mice, and six human fetal pancreases were transplanted to six rats. The xenografts showed histotypical development of islets of Langerhans. Insulin, glucagon, somatostatin, and pancreatic polypeptide immunoreactivities were also seen in very early stages of the transplant development within the monolayered ducts. With the described "epigastric pouch technique" in rats, we co-ld demonstrate a new in vivo method for selective stimulations and simultaneous blood sampling from tissue-isolated xenografts. Transplantation of human fetal pancreas to the brachioradial muscle of an insulin-dependent patient in combination with a kidney transplant revealed that rejection crises of the kidney led to necrosis of the pancreas transplant, whereas rejection of the kidney was overcome by steroid pulse therapy.