bluuebunny/crossref_metadata_2025 huggingface dataset:
Glycemic Control Continues to Deteriorate After Sulfonylureas Are Added to Metformin Among Patients With Type 2 Diabetes
Authors: Cook Michael N. , Girman Cynthia J. , Stein Peter P. , Alexander Charles M. , Holman Rury R.
Published: March 2007

OBJECTIVE—To describe the course and predictors of glycemic control among patients with type 2 diabetes after sulfonylureas (SUs) are added to metformin (MF).

RESEARCH DESIGN AND METHODS—Patients (n = 2,220) treated with MF monotherapy for >90 days before initiating MF plus SU combination therapy between January 1998 and March 2004 were studied in a retrospective analysis of electronic medical records from U.K. primary care practices using the General Practice Research Database. Median glycoslyated hemoglobin A1c (A1C) before and after SU initiation was described, and patient characteristics were evaluated as predictors of time until A1C ≥8.0% or glucose-lowering therapy was intensified (by starting insulin or adding a third oral agent).

RESULTS—At 6 months post-SU initiation, median A1C resumed deteriorating at a somewhat comparable rate to that observed on MF monotherapy. Higher pre-SU A1C, younger age, female sex, shorter diabetes duration, higher serum creatinine, and being an ex-smoker predicted time until A1C ≥8.0% or glucose-lowering therapy was intensified in various analyses. Median A1C was 9.5% when therapy was intensified. A1C ≥8.0% was estimated to occur in 85% of patients 4 years after SU initiation and in 68% 4 years after initially achieving A1C <7% on MF plus SU therapy.

CONCLUSIONS—In this population, glycemic control is improved following the addition of SUs to MF, but deterioration resumes as early as 6 months. The high proportion of patients remaining on MF plus SU therapy despite having A1C ≥8.0% suggests that there are significant barriers to starting insulin or adding a third agent when treatment goals are not achieved with this combination.
Frequency, Severity, and Morbidity of Hypoglycemia Occurring in the Workplace in People With Insulin-Treated Diabetes
Authors: Leckie Alastair M. , Graham Mairi K. , Grant Joan B. , Ritchie Peter J. , Frier Brian M.
Published: March 2007

OBJECTIVE—Hypoglycemia was examined in regularly employed people with insulin-treated diabetes to ascertain the frequency and consequences of this problem in the workplace.

RESEARCH DESIGN AND METHODS—A prospective 12-month survey of 243 employed people (age range 20–69 years) with insulin-treated diabetes was performed to record the frequency, severity, and morbidity of hypoglycemia occurring at work. Details of hypoglycemic episodes included time of day, place, activity, causation, blood glucose, treatment, and morbidity. Serial HbA1c measurements were recorded.

RESULTS—A total of 1,955 mild (self-treated) episodes of hypoglycemia (8 per person per annum) and 238 severe (requiring external help) episodes (0.98 per person per annum) were recorded. Of the severe hypoglycemic episodes, 148 (62%) occurred at home, 35 (15%) occurred at work in 27 (11%) people (0.14 episodes per person per annum), and 54 (23%) occurred elsewhere; 52% of severe episodes occurred during sleep. Of the severe hypoglycemic episodes reported, adverse events were described in 54 (23%), with 29 losing consciousness (14%), 21 having a seizure (9%), 4 (2%) sustaining a head injury, 5 (2%) suffering another injury, 3 (1%) injuring someone else, and 2 (1%) damaging property. Severe hypoglycemia in the workplace was associated with six episodes of minor soft-tissue injuries.

CONCLUSIONS—In this cohort, severe hypoglycemia in the workplace was uncommon and seldom caused disruption or serious morbidity. On the basis of the frequency and severity of hypoglycemia observed in the present study, restriction of employment opportunities for most people with insulin-treated diabetes may be difficult to justify.
Caffeinated Coffee, Decaffeinated Coffee, and Caffeine in Relation to Plasma C-Peptide Levels, a Marker of Insulin Secretion, in U.S. Women
Authors: Wu Tianying , Willett Walter C. , Hankinson Susan E. , Giovannucci Edward
Published: March 2007

OBJECTIVE—Coffee consumption is associated with reduced risk of type 2 diabetes, but the mechanism is not clearly understood. Elevated C-peptide, as a marker of insulin secretion, has been linked to insulin-resistant type 2 diabetes. In this study, we examined consumption of caffeinated and decaffeinated coffee and total caffeine in relation to concentrations of plasma C-peptide.

RESEARCH DESIGN AND METHODS—Plasma C-peptide concentrations were measured in a cross-sectional setting among 2,112 healthy women from the Nurses’ Health Study I who provided blood samples in 1989–1990. Consumption of caffeinated and decaffeinated coffee and total caffeine was assessed using a semiquantitative food-frequency questionnaire in 1990.

RESULTS—Intakes of caffeinated and decaffeinated coffee and caffeine in 1990 were each inversely associated with C-peptide concentration in age-adjusted, BMI-adjusted, and multivariable-adjusted analyses. In multivariable analysis, concentrations of C-peptide were 16% less in women who drank >4 cups/day of caffeinated or decaffeinated coffee compared with nondrinkers (P < 0.005 for each). Women in the highest quintile compared with the lowest quintile of caffeine intake had 10% lower C-peptide levels (P = 0.02). We did not find any association between tea and C-peptide. The inverse association between caffeinated coffee and C-peptide was considerably stronger in obese (27% reduction) and overweight women (20% reduction) than in normal weight women (11% reduction) (P = 0.005).

CONCLUSIONS—Our findings suggest a potential reduction of insulin secretion by coffee in women. This reduction may be related to other components in coffee rather than caffeine.
The Effect of Rosiglitazone on Overweight Subjects With Type 1 Diabetes
Authors: Strowig Suzanne M. , Raskin Philip
Published: March 2007

OBJECTIVE—To evaluate the safety and effectiveness of rosiglitazone in the treatment of overweight subjects with type 1 diabetes.

RESEARCH DESIGN AND METHODS—A total of 50 adult type 1 diabetic subjects with a baseline BMI ≥27 kg/m2 were randomly assigned in a double-blind fashion to take insulin and placebo (n = 25) or insulin and rosiglitazone 4 mg twice daily (n = 25) for a period of 8 months. Insulin regimen and dosage were modified in all subjects to achieve near-normal glycemic control.

RESULTS—Both groups experienced a significant reduction in HbA1c (A1C) level (rosiglitazone: 7.9 ± 1.3 to 6.9 ± 0.7%, P < 0.0001; placebo: 7.7 ± 0.8 to 7.0 ± 0.9%, P = 0.002) and a significant increase in weight (rosiglitazone: 97.2 ± 11.8 to 100.6 ± 16.0 kg, P = 0.008; placebo: 96.4 ± 12.2 to 99.1 ± 15.0, P = 0.016). Baseline measures of BMI (P = 0.001), total daily insulin dose (P = 0.002), total cholesterol (P = 0.005), HDL cholesterol (P = 0.00l), and LDL cholesterol (P = 0.02) were predictors of improvement in A1C level only in the group treated with rosiglitazone. Total daily insulin dose increased in subjects taking placebo (74.0 ± 33.8 to 82.0 ± 48.9 units, P < 0.05 baseline vs. week 32), but it decreased slightly in subjects taking rosiglitazone (77.5 ± 28.6 to 75.3 ± 33.1 units). Both systolic blood pressure (137.4 ± 15.6 vs. 128.8 ± 14.8 mmHg, baseline vs. week 32, P < 0.02) and diastolic blood pressure (87.2 ± 9.4 vs. 79.4 ± 7.2 mmHg, P < 0.0001) improved in the group treated with rosiglitazone. The total incidence of hypoglycemia did not differ between groups.

CONCLUSIONS—Rosiglitazone in combination with insulin resulted in improved glycemic control and blood pressure without an increase in insulin requirements, compared with insulin- and placebo-treated subjects, whose improved glycemic control required an 11% increase in insulin dose. Weight gain and hypoglycemia were similar in both groups at the end of the study. The greatest effect of rosiglitazone occurred in subjects with more pronounced markers of insulin resistance.
Hospitalizations, Nursing Home Admissions, and Deaths Attributable to Diabetes
Authors: Russell Louise B. , Valiyeva Elmira , Roman Sheila H. , Pogach Leonard M. , Suh Dong-Churl , Safford Monika M.
Published: March 2007

OBJECTIVE—To estimate all-cause hospitalizations, nursing home admissions, and deaths attributable to diabetes using a new methodology based on longitudinal data for a representative sample of older U.S. adults.

RESEARCH DESIGN AND METHODS—A simulation model, based on data from the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Followup Study, was used to represent the natural history of diabetes and control for a variety of baseline risk factors. The model was applied to 6,265 NHANES III adults aged 45–74 years. The prevalence of risk factors in NHANES III, fielded in 1988–1994, better represents today’s adults.

RESULTS—For all NHANES III adults aged 45–74 years, a diagnosis of diabetes accounted for 8.6% of hospitalizations, 12.3% of nursing home admissions, and 10.3% of deaths in 1988–1994. For people with diabetes, diabetes alone was responsible for 43.4% of hospitalizations, 52.1% of nursing home admissions, and 47% of deaths. Adjusting for related cardiovascular conditions, which may provide more accurate estimates of attributable risks for people with diabetes, increased these estimates to 51.4, 57.1, and 56.8%, respectively.

CONCLUSIONS—Risks of institutionalization and death attributable to diabetes are large. Efforts to translate recent trials of primary prevention into practice and continued efforts to prevent complications of diabetes could have a substantial impact on hospitalizations, nursing home admissions, and deaths and their societal costs.
Psychosocial and Socioeconomic Risk Factors for Premature Death in Young People With Type 1 Diabetes
Authors: Laing Susan P. , Jones Michael E. , Swerdlow Anthony J. , Burden Andrew C. , Gatling Wendy
Published: March 2007

OBJECTIVE—Mortality from acute diabetes-related events is greatly raised in young adults with type 1 diabetes. Psychosocial and socioeconomic risk factors are examined for deaths from acute events separately from deaths due to other causes.

RESEARCH DESIGN AND METHODS—This study had a nested case-control design. The cases were patients from the Diabetes UK cohort who died before age 40 years. Deaths were categorized as acute events or chronic conditions related to diabetes. Where possible, two matched control subjects were selected for each case. Data relating to psychosocial and socioeconomic factors and variables related to diabetes complications were extracted from the case notes. Risks of death were estimated by calculation of odds ratios (ORs).

RESULTS—Case notes were obtained for 98 case and 137 control subjects. Fifty-one deaths were attributed to acute causes, 34 to chronic conditions related to diabetes, and the remaining 13 were unrelated to diabetes. Living alone (OR 4.4), past drug abuse (5.7), and previous psychiatric referral (4.6) were all significantly associated with death from acute events but not death from chronic conditions. There was no association between deaths from acute events and nephropathy, hypertension, neuropathy, or retinopathy, although all of these were associated with deaths from chronic conditions.

CONCLUSIONS—The results indicate that psychosocial factors are powerful risk factors for mortality from acute events in patients with type 1 diabetes, although not for mortality from chronic conditions. The data enable the identification of a high-risk group suitable for targeting with preventive measures to reduce acute event mortality.
Web-Based Care Management in Patients With Poorly Controlled Diabetes
Authors: McMahon Graham T. , Gomes Helen E. , Hickson Hohne Sara , Hu Tang Ming-Jye , Levine Betty A. , Conlin Paul R.
Published: March 2007

OBJECTIVE—To assess the effects of web-based care management on glucose and blood pressure control over 12 months in patients with poorly controlled diabetes.

RESEARCH DESIGN AND METHODS—For this study, 104 patients with diabetes and HbA1c (A1C) ≥9.0% who received their care at a Department of Veterans Affairs medical center were recruited. All participants completed a diabetes education class and were randomized to continue with their usual care (n = 52) or receive web-based care management (n = 52). The web-based group received a notebook computer, glucose and blood pressure monitoring devices, and access to a care management website. The website provided educational modules, accepted uploads from monitoring devices, and had an internal messaging system for patients to communicate with the care manager.

RESULTS—Participants receiving web-based care management had lower A1C over 12 months (P < 0.05) when compared with education and usual care. Persistent website users had greater improvement in A1C when compared with intermittent users (−1.9 vs. −1.2%; P = 0.051) or education and usual care (−1.4%; P < 0.05). A larger number of website data uploads was associated with a larger decline in A1C (highest tertile −2.1%, lowest tertile −1.0%; P < 0.02). Hypertensive participants in the web-based group had a greater reduction in systolic blood pressure (P < 0.01). HDL cholesterol rose and triglycerides fell in the web-based group (P < 0.05).

CONCLUSIONS—Web-based care management may be a useful adjunct in the care of patients with poorly controlled diabetes.
Impact of Overweight on Chronic Microvascular Complications in Type 1 Diabetic Patients
Authors: De Block Christophe E.M. , De Leeuw Ivo H. , Van Gaal Luc F.
Published: March 2007

OBJECTIVE—To investigate a possible association of BMI with retinopathy and neuropathy in type 1 diabetes. Retinopathy and neuropathy may not only be related to glycemic control and diabetes duration but also to blood pressure and BMI.

RESEARCH DESIGN AND METHODS—A total of 592 type 1 diabetic patients without nephropathy were studied (M/F: 324/268; age: 41 ± 12 years; duration: 19 ± 11 years; HbA1c [A1C]: 7.9 ± 1.1%). Patients were subdivided according to BMI: 168 men and 146 women with BMI <25 kg/m2, and 156 men and 122 women with BMI ≥25 kg/m2. Retinopathy was examined by fundoscopy and neuropathy by electromyography.

RESULTS—Hypertension (>130/85 mmHg) was present in 40%, retinopathy in 53%, and neuropathy in 43% of patients. Overweight subjects had more retinopathy (63 vs. 45%, P < 0.0001, odds ratio [OR] = 2.1) and neuropathy (49 vs. 38%, P = 0.008, OR = 1.6) than normal-weight patients. Patients with retinopathy were older (45 ± 12 vs. 37 ± 11 years, P < 0.0001) and had a longer diabetes duration (25 ± 10 vs. 12 ± 8 years, P < 0.0001), a higher A1C (8.0 ± 1.1 vs. 7.7 ± 1.1%, P = 0.001), and a higher BMI (25.8 ± 4.1 vs. 24.7 ± 4.2 kg/m2, P = 0.001) than individuals without retinopathy. The same results are found in neuropathy. Logistic regression analysis showed that diabetes duration (β = 0.15, P < 0.0001), blood pressure (β = 0.22, P = 0.0047), and A1C (β = 0.24, P = 0.01), but not BMI, lipid levels, sex, or age, were independent risk factors for retinopathy. Likewise, duration (β = 0.05, P < 0.0001), age (β = 0.04, P = 0.0001), A1C (β = 0.35, P < 0.0001), and sex (β = 0.74, P = 0.0001) but not BMI, lipid levels, or hypertension were independently associated with neuropathy. Men had more neuropathy than women (50 vs. 34%, P < 0.0001, OR = 1.9). Leptin and adiponectin levels did not differ between individuals with or without microvascular complications.

CONCLUSIONS—Retinopathy and neuropathy are more prevalent in overweight (BMI ≥25 kg/m2) type 1 diabetic subjects. However, logistic regression analysis showed that diabetes duration and A1C remain the main determinants for retinopathy and neuropathy.
No Effect of Statin Therapy on Silent Myocardial Ischemia in Patients With Type 2 Diabetes Without Manifest Cardiovascular Disease
Authors: Beishuizen Edith D. , Jukema J. Wouter , Tamsma Jouke T. , van de Ree Marcel A. , van der Vijver J. Carel M. , Putter Hein , Maan Arie C. , Meinders A. Edo , Huisman Menno V.
Published: March 2007

OBJECTIVE—Coronary artery disease is the most important cause of mortality in patients with type 2 diabetes. We aimed to determine the prevalence of silent myocardial ischemia (SMI) and the effect of statin therapy on SMI in type 2 diabetic patients without manifest cardiovascular disease.

RESEARCH DESIGN AND METHODS—A randomized, placebo-controlled, double-blind trial was performed in 250 patients with type 2 diabetes without manifest cardiovascular disease. Patients were given either 0.4 mg cerivastatin or placebo daily. In August 2001, when cerivastatin was withdrawn from the market, cerivastatin 0.4 mg was replaced by 20 mg simvastatin without deblinding the study. The primary end point was the change in ischemic episodes, duration, and burden as measured by 48-h ambulatory electrocardiography (AECG) over 2 years.

RESULTS—At baseline, 47 of 233 (20%) evaluable ambulatory electrocardiograms showed evidence of ischemia. After 2 years, there was a trend toward more ischemia in both treatment groups, without significant differences between the changes in ischemic parameters (episodes P = 0.498; duration P = 0.697; burden P = 0.798) in the two treatment groups. Cardiovascular events occurred in 12 patients in the placebo group and in two patients in the statin group (P = 0.006). There was no relationship between these cardiovascular events and the presence of SMI at baseline.

CONCLUSIONS—SMI occurred in 20% of type 2 diabetes patients without manifest cardiovascular disease. There was no effect from 2 years of statin therapy on SMI. In contrast, we observed a significantly lower cardiovascular event rate on statin therapy. AECG may not be a proper tool for risk stratification in patients with type 2 diabetes.
Subcutaneous Use of a Fast-Acting Insulin Analog
Authors: Della Manna Thais , Steinmetz Leandra , Campos Paula R. , Farhat Sylvia C.L. , Schvartsman Cláudio , Kuperman Hilton , Setian Nuvarte , Damiani Durval
Published: March 2007

OBJECTIVE—To look for technical simplification and economic efficiency in the treatment of pediatric diabetic ketoacidosis (DKA) with subcutaneous use of the fast-acting insulin analog (lispro) and compare its use with regular intravenous insulin treatment.

RESEARCH DESIGN AND METHODS—In this controlled clinical trial from June 2001 to June 2003, we randomized 60 episodes of DKA with a blood glucose level ≥16.6 mmol/l (300 mg/dl), venous pH <7.3 and/or bicarbonate <15 mmol/l, or ketonuria greater than ++. Of the 60 episodes, 30 were treated with subcutaneous lispro (0.15 units/kg) given every 2 h (lispro group) and the other 30 cases received continuous intravenous regular insulin (0.1 unit · kg−1 · h−1; CIRI group). Volume deficit was repaired with 10-ml/kg aliquots of 0.9% sodium chloride. Laboratory monitoring included hourly bedside capillary glucose, venous blood gas, β-hydroxybutyrate, and electrolytes. Plasma blood glucose levels were measured on admission, 2 h after admission, when capillary blood glucose reached ≤13.8 mmol/l (250 mg/dl), and 6, 12, and 24 h thereafter.

RESULTS—Capillary glucose levels decreased by 2.9 and 2.6 mmol · l−1 · h−1 in the lispro and CIRI groups, respectively, but blood glucose fluctuated at different time intervals. In the CIRI group, metabolic acidosis and ketosis resolved in the first 6-h period after capillary glucose reached 13.8 mmol/l, whereas in the lispro group, they resolved in the next 6-h interval; however, both groups met DKA recovery criteria without complications.

CONCLUSIONS—DKA treatment with a subcutaneous fast-acting insulin analog represents a cost-effective and technically simplified procedure that precludes intensive care unit admission.
Annual Incidence and Clinical Characteristics of Type 2 Diabetes in Children as Detected by Urine Glucose Screening in the Tokyo Metropolitan Area
Authors: Urakami Tatsuhiko , Kubota Shigeki , Nitadori Yoshikazu , Harada Kensuke , Owada Misao , Kitagawa Teruo
Published: March 2007

OBJECTIVE—This study investigates the annual incidence and clinical characteristics of type 2 diabetes among school-aged children as detected by urine glucose screening from 1974 to 2002 in the Tokyo metropolitan area.

RESEARCH DESIGN AND METHODS— In total, 8,812,356 school children were examined for glucosuria. Morning urine was used for the analysis. When the urine was positive for glucose, an oral glucose tolerance test was carried out to confirm diabetes.

RESULTS—In all, 232 students were identified to have type 2 diabetes. The overall annual incidence of type 2 diabetes was 2.63/100,000. The annual incidence after 1981 was significantly higher than that before 1980 (1.73 vs. 2.76/100,000, P < 0.0001). The annual incidence was significantly higher for junior high school students compared with primary school students (0.78 vs. 6.43/100,000, P < 0.0001). The overall male-to-female ratio of students with type 2 diabetes was 1.0:1.19 (P = 0.296), but it was 1.0:1.56 (P = 0.278) for primary school students. Overall, 83.4% of children with diabetes were obese (≥20% overweight). However, nonobese girls (<20% overweight) with diabetes accounted for 23.0% of the patients, whereas markedly obese boys (≥40% overweight) accounted for 61.5% of the patients. The frequency of a family history of type 2 diabetes in second- and first-degree relatives was 56.5%.

CONCLUSIONS—We confirmed that the incidence of young people with type 2 diabetes increased after 1981 in the Tokyo metropolitan area. The increase in the frequency of this disorder seemed to be strongly related to an increasing prevalence of obesity. Age and genetic susceptibility may be associated with the occurrence of type 2 diabetes.
Efficacy of Inhaled Insulin in Patients With Type 2 Diabetes not Controlled With Diet and Exercise
Authors: DeFronzo Ralph A. , Bergenstal Richard M. , Cefalu William T. , Pullman John , Lerman Sam , Bode Bruce W. , Phillips Lawrence S. ,   for the Exubera Phase III Study Group
Published: March 2007

OBJECTIVE—Effective type 2 diabetes management requires prompt intervention if glycemic control is not achieved by nonpharmacological means. This study investigates whether inhaled insulin (INH; Exubera) can achieve target glycemic control in patients failing on diet and exercise.

RESEARCH DESIGN AND METHODS—Patients with suboptimal control on diet and exercise (HbA1c [A1C] 8–11%) were randomized to 3 months’ treatment with either INH before meals (n = 76) or rosiglitazone 4 mg twice a day (n = 69), in conjunction with a diet and exercise regimen. The primary end point was percentage of patients achieving A1C <8.0%.

RESULTS—The INH and rosiglitazone groups had comparable baseline A1C values (9.5 vs. 9.4%, respectively). Significantly more patients achieved A1C <8.0% (83 vs. 58%, adjusted odds ratio 7.14 [95% CI 2.48–20.58], P = 0.0003), A1C <7.0% (44 vs. 18%, 4.43 [1.94–10.12]), and A1C ≤6.5% (28 vs. 7.5% 5.34 [1.83–15.57]) with INH. A1C decrease was greater with INH (−2.3% vs. −1.4%, adjusted treatment group difference: −0.89% [95% CI −1.23 to −0.55]) with final mean A1C values of 7.2 and 8.0% for INH and rosiglitazone, respectively. Hypoglycemia (episodes per subject-month) was higher with INH (0.7 vs. 0.05, risk ratio 14.72 [95% CI 7.51–28.83]), with no severe hypoglycemic episodes. Pulmonary function changes were small and comparable between groups.

CONCLUSIONS—INH could be an effective therapy for people with type 2 diabetes early in the course of their disease.
Ethnicity, Race, and Baseline Retinopathy Correlates in the Veterans Affairs Diabetes Trial
Authors: Emanuele Nicholas , Sacks Jerome , Klein Ronald , Reda Domenic , Anderson Robert , Duckworth William , Abraira Carlos ,   for the Veterans Affairs Diabetes Trial Group
Published: March 2007

OBJECTIVE—The Veterans Affairs Diabetes Trial (VADT) cohort is enriched with ∼20% Hispanics and 20% African Americans, affording a unique opportunity to study ethnic differences in retinopathy.

RESEARCH DESIGN AND METHODS—Cross-sectional analyses on the baseline seven-field stereo fundus photos of 1,283 patients are reported here. Diabetic retinopathy scores are grouped into four classes of increasing severity: none (10–14), minimal nonproliferative diabetic retinopathy (NPDR) (15–39), moderate to severe NPDR (40–59), and proliferative diabetic retinopathy (60+). These four groups have also been dichotomized to none or minimal (10–39) and moderate to severe diabetic retinopathy (40+).

RESULTS—The prevalence of diabetic retinopathy scores >40 was higher for Hispanics (36%) and African Americans (29%) than for non-Hispanic whites (22%). The difference between Hispanics and non-Hispanic whites was significant (P < 0.05). Similarly, the prevalence of diabetic retinopathy scores >40 was significantly higher in African Americans than in non-Hispanic whites (P < 0.05). These differences could not be accounted for by an imbalance in traditional risk factors such as age, duration of diagnosed diabetes, HbA1c (A1C), and blood pressure. Diabetic retinopathy severity scores were also significantly associated with increasing years of disease duration, A1C, systolic and diastolic blood pressure, the degree of microalbuminuria, fibrinogen, and the percentage of patients with amputations. There was no relationship between retinopathy severity and the percentage of people who had strokes or cardiac revascularization procedures. There was an inverse relationship between retinopathy severity and total cholesterol, triglycerides, and plasminogen activator inhibitor-1 as well as with smoking history. Diabetic retinopathy scores were not associated with age.

CONCLUSIONS—In addition to many well-known associations with retinopathy, a higher frequency of severe diabetic retinopathy was found in the Hispanic and African-American patients at entry into the VADT that is not accounted for by traditional risk factors for diabetic retinopathy, and these substantial ethnic differences remain to be explained.
Efficacy of Multilayered Hosiery in Reducing In-Shoe Plantar Foot Pressure in High-Risk Patients With Diabetes
Authors: Garrow Adam P. , van Schie Carine H.M. , Boulton Andrew J.M.
Published: March 2007

OBJECTIVE—High plantar pressure is an acknowledged risk factor in the development of plantar ulcers in the diabetic neuropathic foot. This study examines the ability of preventive foot care (PFC) socks to reduce plantar foot pressures in a sample of high-risk patients with diabetes.

RESEARCH DESIGN AND METHODS—Nineteen patients with established peripheral neuropathy attending a complications clinic of the Manchester Diabetes Centre were recruited to the study. Fifteen (78%) of the patients were male, 40–80 years of age, and ulcer-free at the time of recruitment. In-shoe plantar pressure measurements were recorded using the F-Scan and compared PFC socks with ordinary supermarket socks. The analysis measured differences in maximum foot contact area and plantar pressure for the whole foot, forefoot, and peak plantar pressure areas.

RESULTS—The results showed a significant increase in maximum foot contact area of 11 cm2 (95% CI 7–11) when subjects wore the PFC socks (P < 0.01). This was accompanied by 5.4 kPa (3.5–7.3) or 9% reduction in total foot pressure (P < 0.01). Similar results were observed at the forefoot, which showed a 14.2% increase in contact area and a 10.2% reduction in peak forefoot pressure.

CONCLUSIONS—These results suggest that the wearing of PFC socks increases the underfoot contact area and hence decreases plantar foot pressures. Further studies are required to determine whether the pressure and friction reductions achieved by this simple intervention would be effective in reducing the incidence of foot ulcers in high-risk patients.
The Impact of Psychiatric Comorbidities on Readmissions for Diabetes in Youth
Authors: Garrison Michelle M. , Katon Wayne J. , Richardson Laura P.
Published: March 2007

OBJECTIVE—Comorbid psychiatric disorders have been associated with poorer disease outcomes in diabetic youth. Less is known, however, about the relationship between psychiatric disorders and repeat hospitalizations for youth with diabetes.

RESEARCH DESIGN AND METHODS—We performed a retrospective cohort study using data from the Pediatric Health Information System, which included detailed discharge data from 37 noncompeting children’s hospitals in the U.S. Using logistic regression, we examined whether the presence of coded diagnoses for internalizing or externalizing disorders at an index hospitalization for diabetes was associated with increased risk for rehospitalization during follow-up (duration of follow-up ranged from 3 to 24 months). The analysis was stratified by age-groups, and we controlled for potential confounders including sex, age, race/ethnicity, type 1 versus type 2 diabetes, Medicaid status, intensive care unit utilization, length of stay during index admission, and duration of follow-up.

RESULTS—Among adolescents aged 13–18, internalizing disorders were associated with significantly increased odds of rehospitalization (odds ratio 1.79 [95% CI 1.27–2.52]); the point estimate for externalizing disorders was similar, but the finding was not statistically significant at the α = 0.05 level (1.74 [0.96–3.15]). No significant association between psychiatric diagnoses and odds of repeat hospitalization was observed in diabetic children aged 5–12 years.

CONCLUSIONS—Internalizing disorders are associated with increases in repeat hospitalizations for diabetes among adolescents. Future research is needed to explore the reasons for this finding, such as degree to which treatment nonadherence mediates this relationship and whether appropriate treatment of internalizing disorders results in improved diabetes outcomes and decreased readmissions.
Low Plasma Adiponectin Levels Are Associated With Increased Hepatic Lipase Activity In Vivo
Authors: Schneider Jochen G. , von Eynatten Maximilian , Schiekofer Stephan , Nawroth Peter P. , Dugi Klaus A.
Published: March 2007

OBJECTIVE—Hepatic lipase plays a key role in hydrolyzing triglycerides and phospholipids present in circulating plasma lipoproteins. Plasma hepatic lipase activity is known to be regulated by several hormonal and metabolic factors, but hepatic lipase responsiveness to insulin is still controversial. Hypoadiponectinemia is known to be associated with insulin resistance, diabetes, and obesity. These conditions are often characterized by high plasma triglyceride and low HDL cholesterol levels, and they have been shown to be associated with high plasma hepatic lipase activity. We therefore raised the question whether adiponectin may be associated with plasma hepatic lipase activity in vivo.

RESEARCH DESIGN AND METHODS—We measured plasma adiponectin and postheparin hepatic lipase activity in 206 nondiabetic men and in a second group of 110 patients with type 2 diabetes. The correlation of these parameters with markers of insulin resistance and systemic inflammation was investigated.

RESULTS—In nondiabetic patients, adiponectin levels were significantly inversely correlated with plasma hepatic lipase activity (r = −0.4, P < 0.01). These results were confirmed in the group of patients with type 2 diabetes (r = −0.32, P = 0.004). Multivariate analysis revealed that adiponectin was the strongest factor influencing hepatic lipase activity. The association was independent of age, sex, BMI, plasma triglycerides, insulin, HDL cholesterol, and high-sensitivity C-reactive protein and accounted for ∼10 and 12% of the variation in hepatic lipase activity in the two different patient cohorts, respectively.

CONCLUSIONS—These results demonstrate for the first time a significant inverse association between adiponectin and postheparin plasma hepatic lipase activity that is independent of other factors such as markers of insulin resistance or inflammation. Therefore, adiponectin, rather than insulin, may represent an important factor contributing to the regulation of hepatic lipase activity in both nondiabetic individuals and patients with type 2 diabetes. The effect of adiponectin on hepatic lipase activity may also help to explain the HDL cholesterol–elevating action of adiponectin.
Hepatitis C Is a Predictor of Poorer Renal Survival in Diabetic Patients
Authors: Crook Errol D. , Penumalee Sreelatha , Gavini Bharathi , Filippova Kseniya
Published: March 2007

OBJECTIVE—Hepatitis C virus (HCV) is highly prevalent in the U.S. and worsens renal survival in some kidney diseases. We examined the effects of HCV on renal survival in diabetic patients with renal disease.

RESEARCH DESIGN AND METHODS—HCV and diabetes status were noted in patients seen in our nephrology clinic in 2001 and 2002. Charts of diabetic patients were reviewed for demographics, blood pressure, renal function, medicines, the presence of HCV, and other factors at the initial visit and over follow-up. The effect of HCV on renal survival was determined by Cox proportional hazards, using end-stage renal disease (ESRD) as an end point.

RESULTS—Of 1,127 patients, prevalence rates for HCV were higher in African Americans than non–African Americans (8.09 vs. 3.93%, respectively, P = 0.06), with African-American men having the highest prevalence rates (12.7%). The charts of 312 diabetic patients were reviewed. Over 80% were African American, as were 23 of 24 patients with HCV. Compared with non-HCV patients, HCV patients were younger, had higher diastolic blood pressure, and had lower BMI. HCV patients had significantly worse cumulative renal survival by Kaplan-Meier. On Cox proportional hazards analysis, HCV was a significant predictor of reaching ESRD independent of initial renal function, proteinuria, blood pressure, sex, race, presence of diabetic nephropathy, age, or duration of diabetes (odds ratio 3.49, 95% CI 1.27–9.57, P = 0.015).

CONCLUSIONS—HCV is common in African Americans with diabetes and renal disease and is an independent risk factor for renal survival in this population. Prospective studies are necessary to confirm these observations.
Interpretation of Glycosuria in the Teenage Diabetic Patient
Authors: Moffitt P S
Published: March 2007

More than 700 insulin-dependent diabetic patients of both sexes and all ages have attended an education and stabilization course. Twelve adult females and four adult males were subsequently issued the means to monitor their blood glucose in their homes. Two of the adult females were pregnant, while the other 14 patients had one or more of the following: renal failure, an abnormal renal threshold, diabetic retinopathy, or continued and unexplained instability. A number of children were also issued Ames reflectometers. Eleven out of 13 male patients between the ages of 12 and 18 yr had no special difficulties except for a poor correlation between minor degrees of glycosuria and blood glucose estimations. One youth had a renal threshold of 17 mmol/L, while a recently diagnosed youth had a varying renal threshold. Eleven out of 17 teenage female diabetic patients had no correlation between urinary and blood glucose estimations with an apparant varying renal threshold being common. Four of these patients had a reflectometer on loan for 6–8 wk, but in three there was continued instability. Two others, who had continued use of home monitoring of blood glucose, had normoglycemia upon review. One of these patients had what appeared to be a varying renal threshold while unstable but a normal threshold with diabetic stability. Regardless of the cause of the disparity between blood and uninary glucose estimations, it appears that the unstable teenage female diabetic patient cannot rely upon urinalysis as a guide to insulin dosage.
Teaching Allied Health Professionals About Self-Management
Authors: Etzwiler Donnell D
Published: March 2007

Management of diabetes demands that informed patients cooperate with knowledgeable and concerned health professionals in a planned system of health care. It is imperative that each of the numerous health professionals caring for these patients has an understanding of his/her specific role and responsibilities as it relates to the entire health care team and to the individual patient. Acute, in-depth, and continuing phases of diabetes education are briefly described and the importance of altering patient behavior by contracting is documented.
Comparison of High-Dose and Low-Dose Insulin by Continuous Intravenous Infusion in the Treatment of Diabetic Ketoacidosis in Children
Authors: Burghen George A , Etteldorf James N , Fisher Joseph N , Kitabchi Abbas Q
Published: March 2007

We studied the efficacy of low-dose (0.1 U/kg/h) and high-dose (1.0 U/kg/h) insulin, given randomly to children with diabetic ketoacidosis (DKA) by continuous intravenous infusion without a loading dose. Plasma glucose reached 250 mg/dl in 3.4 ± 0.4 h with the high-dose insulin group compared with 5.4 ± 0.5 h with the low-dose insulin group (P < 0.01). During the first 12 h of therapy, plasma glucose fell below 100 mg/dl in 2 of 16 in the low-dose compared with 12 of 16 in the high-dose patients. The decrement of ketone bodies, cortisol, and glucagon was similar in both groups. The number of hours required for HCO3– ≥ 15 meq/l and arterial blood pH ≥ 7.30 were not significantly different in the two groups. Hypokalemia (K < 3.4 meq/L) occurred in 3 of 16 low-dose and 10 of 16 high-dose patients.

The data show that low-dose insulin, with a slower rate of glucose decrease, is as effective as a high dose for the treatment of DKA in children with less incidence of hypokalemia and decreased potential for hypoglycemia.
Pregnancy Complicating Ambulatory Patient Management of Diabetes
Authors: Schneider Jack M , Huddleston John F , Curet Luis B , Menzel Deborah L
Published: March 2007

Two groups of patients are summarized. The first group demonstrates contemporary perinatal outcome using a predominantly outpatient management plan. The second group demonstrates extension of the outpatient management using a reflectance meter for in-the-home blood glucose assessments. The financial savings of outpatient management is emphasized.
Deterioration of Diabetic Patients′ Knowledge and Management Skills as Determined During Outpatient Visits
Authors: Lawrence Patricia A , Cheely Jean
Published: March 2007

A checklist of 22 items that diabetic persons need to perform correctly in order to carry out adequate home management was analyzed for 30 patients in an outpatient clinic. Both a recording of correct performance (baseline assessment) and a reassessment 3–17 mo later were obtained for each item included in the study. An 8 ½% error rate occurred on reassessment. Approximately one-third of the patients had an error rate of 10% or more. No significant relationship was found between the percentage of error and age, interval between assessments, years of diabetes, or past performance on the checklist. Nor did a majority of the errors occur on items that showed an error immediately before the correct baseline assessment. This error rate is less than in reports not including a correct baseline performance. However, it is high enough to indicate that reassessment is needed more frequently than is generally done.
Considerations for the Programming of an Open-Loop Insulin Infusion Device from the Biostator Glucose Controller
Authors: Service F J , Rizza R A , Westland R E , Hall L D , Nelson R L , Haymond M W , Clemens A H , Gerich J E
Published: March 2007

To assess the feasibility of preprogramming an open-loop device with insulin flow rates generated by the Biostator Glucose Controller, comparisons were made in 10 juvenile-onset diabetic patients between meals of equal size and composition taken in the morning, at noon, and in the evening and a bedtime snack during a 24-h period of Biostator glucose control. Four additional diabetic patients had Biostator glucose control for 72 h. Similar amounts of insulin were infused for the meals taken at differing times of the day and, except for the morning meal, for the same meal on two successive days. The meal-related glycemic patterns expressed as mean indices of meal excursions (MIME) were similar for meals of identical size and composition during a single day and for the same meal taken on two consecutive days. Preliminary results using an open-loop device preprogrammed by the Biostator system, although encouraging, underscore the deficiency of the subcutaneous route viz. the delayed entry of insulin into the circulation in achieving normal glucose levels and patterns.
Gestational Diabetes: Infant and Maternal Complications of Pregnancy in Relation to Third-Trimester Glucose Tolerance in the Pima Indians
Authors: Pettitt David J , Knowler William C , Baird H Robert , Bennett Peter H
Published: March 2007

A modified oral glucose tolerance test was done during the third trimester in 811 pregnancies in Pima Indian women over a 13-yr period, and maternal and fetal complications were documented. Diabetes was known to be present in 51 pregnancies. Among those who were not previously known to have diabetes, rates of perinatal mortality, macrosomia, toxemia, and cesarean section varied directly with glucose concentration, but congenital malformation and prematurity rates did not. Rates of all of these complications were higher in known diabetic women than in the remainder of the population. In addition to glucose concentrations, maternal weight and age were predictive of macrosomia and toxemia. Third-trimester glucosuria was found to be of very limited value as a screening procedure for gestational diabetes. In 233 women followed for 4–8 yr, the third-trimester glucose concentration was highly predictive of the subsequent incidence of diabetes.
Effects of Identifying a High Risk Population
Authors: Gabbe Steven G
Published: March 2007

Gestational diabetic women who are at greater risk for perinatal loss include those patients with the history of a previous intrauterine death, an elevated fasting glucose level, pregnancy-induced hypertension, or prolonged gestation. These patients do require a program of antepartum fetal surveillance to prevent intrauterine deaths. Within the broad category of gestational diabetes, however, another group of patients may be defined who can be followed safely to term with no higher perinatal mortality than that observed in the general population. Such women have been designated Class A diabetic by White, indicating that they have normal fasting glucose levels, an abnormal oral glucose tolerance test, and require only minimal dietary regulation. Fasting glucose levels must be followed closely in Class A patients to detect those who develop overt diabetes.
Perception of Severity of Disease and Health Locus of Control in Compliant and Noncompliant Diabetic Patients
Authors: Alogna Maria
Published: March 2007

Compliant and noncompliant obese, non-insulin-dependent diabetic subjects were assessed using a variety of demographic variables, the health locus of control scale (HLC), and the perception of severity of disease index based on the health belief model. The compliant subjects were significantly older and viewed their illness as significantly more severe than the noncompliant patients. Additionally, they tended to exhibit more of an internal locus of control than the noncompliant patients.
Measurement and Modification of the Accuracy of Determinations of Urine Glucose Concentration
Authors: Epstein Leonard H , Chris Coburn P , Becker Dorothy , Drash Allan , Siminerio Linda
Published: March 2007

Studies were designed to assess the accuracy of urine glucose testing in a sample of juvenile diabetic subjects, and to determine the effects of a visual discrimination training procedure on the accuracy. In the first study, each of 81 juvenile-diabetic children was presented three prepared glucose solutions and asked to determine the glucose concentration using the 2-Drop Clinitest method. Results showed errors in 54.3% of the judgments, with greatest difficulty occurring with 1-g/dl concentrations. The majority of errors were false negatives. Study II involved similar testing accuracy on a sample of 10 nurses and 2 research technicians, before and after a visual discrimination training procedure. Results showed that the subjects were incorrect on 39% of the trials initially, with a reduction in the error rate to less than 19% after training.
Contraception for the Insulin-dependent Diabetic Woman: The View from One Clinic
Authors: Steel J M , Duncan L J P
Published: March 2007

Experience in a large diabetic clinic has confirmed the suspicion that insulin-dependent diabetic women are at considerably increased risk of thromboembolic disease if they take combined estrogen/progestogen oral contraceptive preparations. The most obvious alternative, an intrauterine device, is associated with an unexpectedly high failure rate, probably because of an unusual metabolic interaction with the diabetic endometrium. In a small group of diabetic women the progestogen-only pill was found to be a successful form of contraception not associated with any side effects except for menstrual irregularities. For most diabetic women the choice of contraceptive should therefore be between a progestogen-only pill and a mechanical method. Female sterilization and injectable progesterone each have their place in particular circumstances. Careful counseling of each patient is essential to ensure the best choice of contraceptive and correct application of the chosen method.
Effects of Oral Fructose in Normal, Diabetic, and Impaired Glucose Tolerance Subjects
Authors: Crapo Phyllis A , Kolterman Orville G , Olefsky Jerrold M
Published: March 2007

We studied the acute effects of oral ingestion of 50-g loads of dextrose, sucrose, and fructose on postprandial serum glucose, insulin, and plasma glucagon responses in 9 normal subjects, 10 subjects with impaired glucose tolerance, and 17 non-insulin-dependent diabetic subjects. The response to each carbohydrate was quantified when the respective carbohydrate was given alone in a drink or when given in combination with protein and fat in a test meal. The data demonstrate that (1) fructose ingestion resulted in significantly lower serum glucose and insulin responses than did sucrose or dextrose ingestion in all study groups, either when given alone or in the test meal; (2) although fructose ingestion always led to the least glycemic response compared with the other hexoses, the serum glucose response to fructose was increased the more glucose intolerant the subject; (3) urinary glucose excretion during the 3 h after carbohydrate ingestion was greatest after dextrose and least after fructose in all groups. In conclusion, fructose ingestion results in markedly lower serum glucose and insulin responses and less glycosuria than either dextrose or sucrose, both when given alone or as a constituent in a test meal. However, as glucose tolerance worsens, an increasingly greater glycemic response to fructose is seen.
Computer-planned Menus for Patients with Diabetes Mellitus
Authors: Madelyn L Wheeler , Lawrence A Wheeler
Published: March 2007

A computer program has been developed that has the capability to plan menus for diabetic patients. Program input includes the patient's diet prescription, usual daily meal pattern, and food preferences. The program uses a food selection algorithm that combines patient food preferences and randomization to produce menus that include foods the patient likes and that vary from day to day. The amount of each food item served at a meal is determined by an integer programming algorithm that satisfies the dietary prescription. Program output includes daily menus, weekly nutrient summaries, and a weekly shopping list. The menu includes for each food item: food name, amount in household units, numbers and types of exchanges, calories, and a space in which to write exchanges. The menu serves as a diet plan, exchange concept instructional model, and diabetic diary.