Highlights of the day

Classification and Diagnosis of Diabetes Mellitus

The diagnosis and classification of diabetes has historically been controversial, and not until 1979 was some worldwide consensus achieved. Even then, the American National Diabetes Data Group and World Health Organisation criteria were not identical. In an attempt to resolve the confusion, the American Diabetes Association last year proposed a revised classification and diagnostic criteria.

These proposals do away with the familiar terms non-insulin dependent and insulin-dependent, replacing them with type 1 (beta cell defect, usually autoimmune) and type 2 (insulin resistance with an insulin secretory defect), thus shifting the focus from mode of treatment to aetiology. Perhaps more importantly, the committee also changed the diagnostic criteria, lowering the fasting plasma glucose criterion to 7.0 mmol/l or more, and no longer recommending the use of the oral glucose tolerance test - which is little used in practice to diagnose diabetes. The hope is that these changes will make the diagnosis easier, and thus more likely to be made - a commendable objective as a third to a half of all cases are undiagnosed. Furthermore, the 7 mmol/l fasting glucose cut off corresponds reasonably well to the two hour cut off value in the oral glucose tolerance test and, more importantly, to the future incidence of diabetic complications. The impact of these changes remains to be fully assessed, but two conclusions are emerging: in many populations fewer people will have diagnosable diabetes than before; and, disturbingly, there is less than 50 % correspondence between the two sets of criteria.

Cardiovascular Risk Factors

Papers today suggest that high blood insulin levels (hyperinsulinemia) may be a risk factor for heart disease. Professor Laakso and the collaborators from the University of Kuopio analyzed health data obtained from 970 men over a period of 22 years to collect data; participants were between the ages of 34 and 64 years old when the monitoring began in 1971. It was found, within five years of the beginning of the study, that men with the highest insulin levels, as determined at an initial physical examination, were about three times more likely to suffer a heart attack, compared to men with the lowest blood insulin levels. It was noted, however, that the increased risk declined over the course of the study, with the overall heart attack risk among men with the highest blood insulin levels being 1.6-times that of those with the lowest levels over the course of the study.

Islet Transplantation: Recent Advances

Studies suggest that kidney disease associated with Type I diabetes may be reversed by means of a pancreas transplant. Researchers in Italy have followed eight Type I diabetics for 10 years after the patients underwent pancreas transplants; none of the patients had undergone kidney transplants previously. The study found that, while all patients still showed signs of kidney disease five years into the study, most measurements of kidney function had significantly improved in the patients at 10 years. All patients were able to stop injecting insulin after the pancreas transplants and normal blood sugar levels were maintained throughout the 10-year study period. It is suggested that insulin treatment remains the preferred treatment for Type I diabetes, and that pancreas transplants should be considered only for those patients in whom glucose control is extremely difficult to achieve.

The Scientific Program today:

Hall A - Sports Palace 9:00 - 10:30
OP1 Indices of Glucose-Intolerance

1 CONGET I. (E) Impact of the application of new American Diabetes Association diagnostic criteria. Features of the impaired fasting glucose category.
2 FALIP R. (E) Retrospective analysis of oral glucose tolerance tests applying the new ADA diagnosis criteria.
3 SHAW J.E. (AUS) IGT or IFG predicting NIDDM. Who is right, W.H.O. or A.D.A.?
4 VACCARO O. (I) Clinical significance of the new diagnostic category of impaired fasting glucose: A prospective analysis.
5 MOHAN V. (India) Should fasting plasma glucose levels be lowered further in the diagnosis of diabetes?
6 TASSONE F. (I) Fasting blood glucose is not the baseline in type 2 diabetes: Relevance for therapy.

Hall 7 - Congress Palace 9:00 - 10:30
OP2 Therapeutic Aspects of Diabetic Nephropathy

7 GAEDE P. (DK) The Steno type-2 study: Intensive multifactorial intervention delays progression in diabetic micro- and macroangiopathy in microalbuminuric type 2 diabetic patients.
8 CHATURVEDI N. (UK) When should ACE inhibitors be used in IDDM patients? A combined analysis of clinical trials.
9 EBBEHØJ E. (DK) Early ACE-i intervention in microalbuminura: 24h BP, renal function, and exercise changes.
10 WILKINSON-BERKA J.L. (AUS) Bosentan normalizes blood pressure, but is not renoprotective in the diabetic REN-2 rat.
11 NIELSEN S. (DK) Losartan modifies glomerular hyperfiltration and insulin sensitivity in type 1 diabetes.
12 SAWICKI P.T. (D) Effect of intensified antihypertensive treatment on mortality in diabetic nephropathy.

Hall 6 - Congress Palace 9:00 - 10:30
OP3 Experimental and Clinical Islet Transplantation

13 LALAIN S. (F) In vitro xenorecognition of adult pig pancreatic islet cells by CD4+ and CD8+ lymphocytes from type 1 diabetic or healthy subjects.
14 JAHR H. (D) Functional monitoring of antigen-presenting cells in isolated human, porcine, and rodent islets.
15 KING A. (S) Effects of interleukin-1b and tumour necrosis factor-a on microencapsulated rat pancreatic islets.
16 VARKONYI T.T. (H) Influence of long-term pancreatic islet graft function on development of late diabetic complications.
17 SAUDEK F. (CZ) The impact of pancreas and kidney transplantation on late diabetic complications and quality of life.
18 SMETS Y.F.C. (NL) Effect of pancreas-kidney transplantation on mortality in type 1 diabetic patients with end-stage renal failure.

Hall 5 - Congress Palace 9:00 - 10:30
OP4 Diabetes and Pregnancy - Clinical Aspects

19 GARCIA-PATTERSON A. (E) Transient increase of insulin requirements in early pregnancy of women with type 1 diabetes mellitus.
20 ALDRIDGE V.J. (UK) Reduced insulin requirements in early pregnancy in IDDM.
21 BRONISZ A. (PL) Hemostasis in pregnants with type 1 diabetes mellitus in perinatal period.
22 ROSSING K. (DK) The influence of pregnancy on renal function loss in insulin dependent diabetic patients with diabetic nephropathy.
23 CARVALHEIRO M. (Portugal/USA) Metabolic abnormalities in women with prior GDM.
24 KERENYI Z. (H) Prior gestational diabetes: Early manifestation and/or predictor of a metabolic cardiovascular syndrome.

Hall Verdi - Hotel Fira 9:00 - 10:30
OP5 T-Cells in Type 1 Diabetes

25 MARTI M. (E) Analysis of the T cells isolated from a diabetic pancreas.
26 DIONISI S. (I/USA) IA-2 and insulin reactive islet infiltrating T-lymphocytes in human autoimmune diabetes.
27 DOSCH H.-M. (CAN/USA) Islet T cell auto-antigens targeted early or late in pre-diabetes.
28 DURINOVIC-BELLO I. (D) Early proinsulin T-cell-epitopes in type-1-diabetes.
29 BUSCHARD K. (DK/S/NL) Immunomodulation of insulin-specific autoreactive T-cells by sulfatide variable expressed in beta cells.
30 AYDEMIR D. (TR) The Fas/APO-1 surface antigen expression and IL-1ß secretion in preclinical and different clinical stages of type 1 diabetes.

Hall Rubi-Zafir - Hotel Fira 9:00 - 10:30
OP6 Defect Insulin Signalling Yields Insulin Resistance

31 BUSCH A.K. (DK) Protein kinase C mediates hyperglycemia induced insulin resistance through serine phosphorylation of IRS-1.
32 MOSTHAF L. (DK) The insulin receptor is degraded by specific protein kinase C isoforms.
33 KROOK A. (S/USA) Insulin-stimulated Akt kinase activity is reduced in skeletal muscle from insulin resistant NIDDM subjects.
34 MEI J. (CDN) Role of cell-permeable ceramides in regulating glucose transport and lipogenesis by insulin in 3T3-L1 adipocytes.
35 HUSNI N.R. (USA) Tumor necrosis factor alpha and oleic acid alter calcium signal transduction in fibroblasts from type 1 diabetics.
36 BAYNES K.C.R. (UK) Molecular analysis of p85a phosphoinositide 3-kinase in severe insulin resistance.

Hall Rossini - Hotel Fira 9:00 - 10:30
Meet the Expert Session
Ele Ferrannini (I): Evaluating Insulin Resistance

Hall Vivaldi - Hotel Fira 9:00 - 10:30
Meet the Expert Session
Å. Lernmark (USA): How to find early Type 1 Diabetes

Break 10:30 - 11:00

Hall A - Sports Palace 11:00 - 13:00
State of the Art Symposium
"Classification and Diagnosis of Diabetes Mellitus"

Chairpersons: J. Nerup (DK); P. Zimmet (AUS)

The Need for new Diagnostic Criteria of Diabetes
K.G.M.M. Alberti (UK)
Is there a Need for new Diagnostic Criteria of Diabetes?
K. Borch-Johnsen (DK)
There is a Need for a new Classification of Diabetes
J.R. Gavin (USA)
Is there a Need for a new Classification of Diabetes?
T.R. Pieber (A)

Hall 7 - Congress Palace 11:00 - 13:00
State of the Art Symposium
"Cardiovascular Risk Factors"

Chairpersons: K. Pyörälä (FIN); H. Keen (UK)

Cardiovascular Mortality and Morbidity: Importance of Glycaemic Control
M. Laakso (FIN)
Coronary Artery Disease in Type 1 and Type 2 Diabetes
E. Eschwege (F)
Cardiovascular Disease in Type 1 and Type 2 Diabetes
J. Stamler (USA)
Peripherial Vascular Disease: Lower Extremity Amputations
J. Apelquist (S)

Hall Verdi - Hotal Fira 11:00 - 13:00
State of the Art Symposium
"Evidence-based Medicine and Outcomes Research in Diabetes"

Chairpersons: M. Berger (D); C. Berne (S)

How much of Diabetes Care is evidence-based?
R. Williams (UK)
Continuous Quality Development: The St. Vincent Experience
H. Bergrem (N)
Diabetes Outcomes Research: The PORT Experience
R. Hayword (USA)
Centre Effects on Diabetes Outcomes
I. Mühlhauser (D)

Poster Session and Lunch 13:00 - 15:00

New Poster Event (A) 15:15 - 16:45

Hall 7 - Congress Palace 15:00 - 16:30
OP7 Antigens and Antibodies in Type 1 Diabetes

37 THIVOLET C. (F) Active immune regulation following oral CTB-insulin prevents diabetes in NOD mouse.
38 SÖHNLEIN P. (D/FIN) Evidence for immunoglobulin epitope spreading in GAD65 during the prediabetic period of type 1 diabetes.
39 RICHTER W. (D) Three human GAD65-specific IDDM-related antibodies isolated from an antibody phage display library.
40 SCHENKER M. (D/USA) Early expression and high prevalence of islet autoantibodies for DR3/4 heterozygous offspring of parents with type 1 diabetes: The Babydiab Study.
41 WILLIAMS A.J.K. (UK/USA) Could epitope masking explain why proinsulin autoantibodies are less closely associated with IDDM than insulin autoantibodies?
42 PUJOL-BORREL R. (E) Evidence for the expression in humans of islet autoantigens by a subset of thymic epithelial cells.

Hall 6 - Congress Palace 15:00 - 16:30
OP8 Ion Channel Activity in ß-cells

43 RUTTER G.A. (UK) Dynamic imaging of sub-plasma membrane [ATP] in b-cells with a SNAP25. firefly luciferase chimaera.
44 GRIBBLE F.M. (UK) Interaction of MgATP with the sulphonylurea receptor subunit activates ATP sensitive K-channels.
45 ÄMMÄLÄ C. (S/UK/FIN/USA) Impaired function of human b-cells due to a novel SUR1 gene mutation.
46 ASHCROFT F.M. (UK) Mechanism of KATP channel inhibition by ATP.
47 RENSTRÖM E. (S/Israel) Physical interaction between secretory granules and L-type calcium channels is required for fast exocytosis in b-cells.
48 MACFARLANE W.M. (UK) The generation of glucose-responsive human insulin-secreting cells by transfecting PHHI-derived islet cells with PDX1, KIR6.2 and SUR-1.

Hall 5 Congress Palace 15:00 - 16:30
OP9 Exercise

49 ZIERATH J.R. (S/N) Exercise leads to improved insulin action through over expression of key proteins in glucose metabolism.
50 TAKALA T.O. (FIN) Comparison of insulin action on heart and skeletal muscle glucose uptake in weight lifters and runners.
51 LARMOLA K. (FIN) Effects of exercise and insulin on muscle glucose uptake in athletes and normal subjects.
52 ARDILOUZE JL. (CDN) Type 2 diabetic patients have to exercise every day.
53 ROBINSON-PLEADWELL M. (CDN) A comparison of glucose and insulin excursions after insulin lispro or humulin R followed by moderate exercise.
54 RABASA-LHORET R. (CDN) Glucose homeostasis during a post-prandial exercise in intensively-treated type 1 diabetics (Db1) subjects treated with the basel-bolus insulin regimen (Ultralente-Lispro (LP)).

Hall Verdi - Hotel Fira 15:00 - 16:30
OP10 Lipids and Late Complications

55 BLAAUWWIEKEL E.E. (NL) Apolipoprotein E genotype is a determinant of low density lipoprotein cholesterol and of its response to a low cholesterol diet in IDDM patients with elevated urinary albumin excretion.
56 HERNANDEZ C. (E) Relationship between lipoprotein(a) phenotypes and albumin excretion rate in diabetic patients.
57 DESRUMAUX C. (F) Phospholipid transfer protein (PLTP) mass concentration in NIDDM.
58 MORO E. (I) Glycation increases electronegative LDL subfraction and accelerates LDL oxidation in type II diabetic patients.
59 SANCHEZ-QUESADA J.L. (E) Electronegative LDL proportion is related to non-enzymatic glycation in IDDM but not in NIDDM.
60 CARLSSON M. (S) High free fatty acids in the offspring are associated with a parental history of cardiovascular disease.

Hall Rubi-Zafir - Hotel Fira 15:00 - 16:30
OP11 Retinopathy

61 BURGOS R. (E) Vitreous levels of IGF-1 and IGFBP1/IGFBP3 in proliferative diabetic retinopathy: A case-control study.
62 SPRANGER J. (D) Increase of IGF-1/2 and IGF-BP3 results from blood retina barrier breakdown in proliferative diabetic retinopathy.
63 GIANNINI S. (I) IGFBP-4/IGFBP-5 ratio regulates the IGF-I effects on human retinal endothelial cells (HREC).
64 AZIZ W. (UK) Levels of soluble TGF-ß receptor-CD105 and vascular endothelial growth factor in the plasma and vitreous of diabetic patients with proliferative retinopathy.
65 MORAVSKI C.J. (AUS) Retinal neovascularization in the rodent is influenced by local renin-angiotensin.
66 KANAZAWA Y. (J) Relation between advanced glycation end products and vascular endothelial growth factor receptor in diabetic eyes.

Hall Rossini - Hotel Fira 15:00 - 16:30
OP12 GLP

67 BURCELIN R. (CH) Treatment of NIDDM based on transplantation of encapsulated cells secreting a GLP-1 analogue.
68 LUQUE M.A. (E) A possible mediator in the glycogenic effect of GLP-1 in human skeletal muscle.
69 GUTNIAK M.K. (S/USA/DK) Different mode of action by GLP-1 given before or after a meal.
70 BROCK B. (DK) Indirect evidence of down regulation of the GLP-1 receptor caused by long term exposure to GLP-1.
71 ZUECO J.A. (E) Coexpression of glucagon-like peptide-1 receptor, vasopression and oxytocin mRNAs in neurons of rat supraoptic and paraventricular nuclei.
72 DEACON C.F. (DK) Glucagon-like peptide-1 (9-36)amide does not desensitise conscious pigs to the anti-hyperglycaemic action of GLP-1.

Hall Diamant - Hotel Fira 15:00 - 16:30
Meet the Expert Session
J. Kitzmiller (USA): Pregnancy in the Diabetic Woman with Late Diabetic Complication

Hall Vivaldi - Hotel Fira 15:00 - 16:30
Meet the Expert Session
V.A. Koivisto (FIN): Regular Insulin versus Quick Acting Analogues in Clinical Practice

Break 16:45 - 17:00

New Poster Event (B) 17:00 - 18:30

Hall 7 - Congress Palace 17:00 - 18:30
OP13 Epidemiology of Type 1 Diabetes

73 VÄÄNÄNEN S. (FIN) Increasing incidence of childhood IDDM worldwide - the meta-analysis of the incidence trend data.
74 PATTERSON C.C. (EUROPE) Recent trends in the incidence of type 1 diabetes in European children.
75 JONER G. (N) Clustering of type 1 diabetes mellitus in Norway.
76 BRUNO G. (I) Effect of Sardinian heritage on risk and age at onset of type 1 diabetes: A case-control study.
77 SOLTESZ G. (H/UK/S) Decreased prevalence of atopy in diabetic children.
78 DAHLQUIST G. (S/H/UK) Vitamin D supplement and risk for type 1 diabetes in childhood.

Hall 6 - Congress Palace 17:00 - 18:30
OP14 Islet Metabolism and Insulin Release

79 HUTTON J.C. (USA/UK) Cloning and characterization of an islet-specific glucose-6-phosphatase.
80 ETO K. (J) A pivotal role of NADH shuttles in glucose-induced insulin secretion from ß cells.
81 ORTSÄTER H. (S) Synchronous oscillations in oxygen tension and insulin release of individual mouse islets.
82 LEAHY J.L. (USA) Impaired pyruvate metabolism and gluocose oxidation in fatty acid cultured islets.
83 STRAUB S.G. (USA) The role of the PKC isoform epsilon in the augumentation of insulin release by glucose and palmitate.
84 ESSER V. (USA) A new genetic rat model of severe insulin deficiency without insulitis.

Hall 5 - Congress Palace 17:00 - 18:30
OP15 Cellular Mechanism of Vascular Dysfunction

85 BAUMGARTNER-PARZER S.M. (A) Qualitative differences in stimulus dependent gene and protein expression in apoptosis of endothelial cells.
86 RÖSEN P. (D) NF-kB activation by high glucose is involved in induction of apoptosis in human umbilical vein endothelial cells (HUVEC).
87 MCMULLEN C.B.T. (UK) Glucose activation of NFkB in vascular smooth muscle cells.
88 CATHERWOOD M.A. (UK) The role of glucose in redox status alterations in vascular smooth muscle cells.
89 GRUNBERGER G. (USA) Hyperglycemia and vascular smooth muscle cell signaling.
90 ROY S. (USA) High glucose-induced fibronectin overexpression in pericytes is modulated by antisense oligonucleotides.

Hall Verdi - Fira Palace 17:00 - 18:30
OP16 Lipids and Insulin Resistance

91 RIEMENS S.C. (NL) Plasma phospholipid transfer protein activity is related to insulin resistance: Impaired acute lowering by insulin in obese NIDDM patients.
92 BÄVENHOLM P. (S/USA) Fatty acid oxidation in man is regulated by malonyl CoA levels in muscle.
93 STINGL H. (A/USA) The role of free fatty acids for postabsorptive endogenous glucose production and gluconeogenesis in man.
94 GUTIERREZ C. (E) Soluble TNF-a receptor 1 and 2 levels circulate in proportion to total and LDL-cholesterol levels.
95 JACOB S. (D) Insulin sensitivity is related to skeletal muscle lipid content in healthy non-diabetic subjects.
96 SJÖSTRAND M. (S) Glycerol in human skeletal muscle is high even under hyperinsulinemic conditions.

Hall Rubi-Zafir - Hotel Fira 17:00 - 18:30
OP17 Glycation

97 PUGLIESE G. (I/USA) Accelerated diabetic glomerulopathy in galectin-3 / AGE-receptor-3 knockout mice.
98 LETO G. (I/USA) Induction of glomerular / mesangial galectin-3 / AGE-receptor-3 expression by the diabetic milieu.
99 MAKITA Z. (J) Possible significance of non-carboxymethyllysine advanced glycation end-products in serum of type 2 diabetic patients.
100 HUDSON B.I. (UK) Novel polymorphisms in the coding region of the receptor for advanced glycation end products (RAGE) gene.
101 SOULIS T. (AUS/DK) A novel inhibitor of advanced glycation endproduct formation inhibits in vivo mesenteric vascular hypertrophy in experimental diabetes.
102 BERG T.J. (N/DK) Left ventricular diastolic function is associated with serum levels of advanced glycation end products in IDDM patients.

Hall Rossini - Hotel Fira 17:00 - 18:30
OP18 Immunology and Diabetic Pregnancy<

103 KLEMETTI P. (FIN) IL-4 and IFN-g secretion by cord blood mononuclear cells in newborns with HLA-DQB1 risk alleles for IDDM.
104 CARDELLINI G. (I) Gestational and non-insulin-dependent diabetic pregnancies share a same prevalence of autoimmune and genetic disorders.
105 FERBER K.M. (D) The predictive value of HLA markers for the development of islet autoantibodies and IDDM postpartum in GDM-women.
106 ALBAREDA M. (E/I) Prevalence and predictive value of GAD and IA2 antibodies in a group of women with gestational diabetes mellitus related to ICA.
107 CORCOY R. (E) Prevalence and titer of islet cell antibodies increase after delivery in women with gestational diabetes.
108 LAPOLLA A. (I) A study on T-cell receptor g-d in gestational diabetes mellitus.

Hall Diamant - Hotel Fira 17:00 - 18:30
Meet the Expert Session
R.G. Bretzel (D): Islet Transplantation: Recent Advances

Hall Vivaldi - Hotel Fira 17:00 - 18:30
Meet the Expert Session
P.A. Halban (CH): Islets and Insulin Secretion