Summary Background:  Patients with diabetes mellitus are at an increased risk of thyroid disease. The frequency of thyroid dysfunction in diabetic patients is higher than that of the general population and up to a third of patients with type‐1 diabetes (T1DM) ultimately develop thyroid dysfunction. Unrecognised thyroid dysfunction may impair metabolic control and add to cardiovascular disease risk in diabetic patients. Aims:  Our aims were to review the current literature on the association between thyroid dysfunction and diabetes mellitus, to highlight relevant clinical implications, and to examine present thyroid disease screening strategies in routine diabetes care. Results:  The pleiotropic effects of thyroid hormones on various metabolic processes are now better understood. Uncontrolled hyperthyroidism in diabetic patients may trigger hyperglycaemic emergencies while recurrent hypoglycaemic episodes have been reported in diabetic patients with hypothyroidism. Furthermore, thyroid dysfunction may amplify cardiovascular disease risk in diabetic patients through inter‐relationships with dyslipidaemia, insulin resistance and vascular endothelial dysfunction. However, the significance of subclinical degrees of thyroid dysfunction remains to be clarified. While these developments have implications for diabetic patients a consensus is yet to be reached on optimal thyroid screening strategies in diabetes management. Conclusions:  The increased frequency of thyroid dysfunction in diabetic patients and its likely deleterious effects on cardiovascular and metabolic function calls for a systematic approach to thyroid disease screening in diabetes. Routine annual thyroid testing should be targeted at diabetic patients at risk of thyroid dysfunction such as patients with T1DM, positive thyroid autoantibodies or high‐normal TSH concentrations.

Abstract. Siegrist J, Peter R, Cremer P, Seidel D. (University of Düsseldorf and Ludwig Maximilians University of Munich, Germany). Chronic work stress is associated with atherogenic lipids and elevated fibrinogen in middle-aged men. J Intern Med 1997; 242: 149-56.Objectives. To examine the association between a model of chronic work stress (high efforts in combination with low rewards) and two risk factors of coronary heart disease, low-density-lipoprotein (LDL)-cholesterol and fibrinogen. Design. A cross-sectional study in a group of 179 healthy middle-aged (48.5 Ϯ 4.5) male middle managers. Setting. A large car-producing enterprise in Germany. Results. After adjustment for relevant covariates, logistic regression analysis showed independent effects of a composite measure of high effort and low reward at work on the prevalence of elevated (upper tertile, i.e. Ն160 mg dL -1 ) LDL-cholesterol (prevalence odds ratio (POR) ϭ 3.57; 95% confidence intervals (CI): 1.24-10.20) and on elevated (upper quintile, i.e. Ն420 mg dL -1 ) plasma fibrinogen (POR ϭ 6.71 (CI: 1.57-28.76). Apart from this core measure, cigarette smoking, overweight and alcohol consumption were the covariates with the relatively strongest contributions to the multivariate model. Conclusions. Results give preliminary evidence on an independent association of chronic work stress with atherogenic lipids and with elevated fibrinogen in an occupationally homogeneous group of healthy middle-aged men.

Aims/hypothesis: The pharmacokinetic and pharmacodynamic properties of biphasic insulin aspart (BIAsp 30) (30% soluble, 70% protaminated insulin aspart [IAsp]) and insulin glargine (IGlarg) were compared. Methods: Twelve people with type 2 diabetes took part in two 24-h isoglycaemic clamp studies, 1 week apart. Patients were randomised to treatment with 0.5 U/kg of BIAsp 30 (0.25 U/kg at 08.30 h and 0.25 U/kg at 20.30 h) or 0.50 U/kg IGlarg at 08.30 h. Both insulins were given by subcutaneous injection into the anterior abdominal wall. The plasma glucose, glucose infusion rates, plasma insulin and C-peptide concentrations were measured. Results: All 12 patients were men; mean (±SD) age was 58.8 (8.9) years, BMI 31.0 (3.0) kg/m 2 and HbA 1c 7

OBJECTIVE -To study the effects of exercise on the absorption of the basal long-acting insulin analog insulin glargine (Lantus), administered subcutaneously in individuals with type 1 diabetes.RESEARCH DESIGN AND METHODS -A total of 13 patients (12 men, 1 woman) with type 1 diabetes on a basal-bolus insulin regimen were studied.125 I-labeled insulin glargine at the usual basal insulin dose was injected subcutaneously into the thigh on the evening (2100) before the study day on two occasions 1 week apart. Patients were randomly assigned to 30 min intense exercise (65% peak oxygen uptake [VO 2peak ]) on one of these visits. The decay of radioactive insulin glargine was compared on the two occasions using a thallium-activated Nal gamma counter. Blood samples were collected at regular intervals on the study days to assess plasma glucose and insulin profiles. RESULTS -No significant difference was found in the125 I-labeled insulin glargine decay rate on the two occasions (exercise vs. no exercise; repeated-measures ANOVA, P ϭ 0.548). As expected, a significant fall in plasma glucose was observed over the exercise period (area under curve above fasting [⌬AUC] glucose: Ϫ0.39 Ϯ 0.11 vs. Ϫ1.30 Ϯ 0.16 mmol ⅐ l Ϫ1 ⅐ h Ϫ1 ; nonexercise vs. exercise; P ϭ 0.001), but insulin levels did not differ significantly on the two occasions (⌬AUC insulin: Ϫ2.1 Ϯ 3.9 vs. 1.5 Ϯ 6.2 pmol ⅐ l Ϫ1 ⅐ h Ϫ1 ; nonexercise versus exercise; P ϭ 0.507).CONCLUSIONS -An intense 30-min period of exercise does not increase the absorption rate of the subcutaneously injected basal long-acting insulin analog insulin glargine in patients with type 1 diabetes. Diabetes Care 28:560 -565, 2005

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