bluuebunny/crossref_metadata_2025 huggingface dataset:
An Automated Rotating Lysimeter System for Greenhouse Evapotranspiration Studies
Authors: Lazarovitch Naftali , Ben‐Gal Alon , Shani Uri
Published: May 2006

Lysimeters are important tools in soil–plant–atmosphere research because they allow direct measurements of evapotranspiration and facilitate studies of water, nutrient, and solute balances. Heterogeneity in the atmospheric conditions in greenhouses causes spatial variations in evapotranspiration. Accurate design and management of water balance research in greenhouses is difficult due to restraints of replication and placement needed to statistically minimize the influence of heterogeneity. Precision and control are necessary to maintain precise boundary conditions, a prerequisite for accurate investigations of selected variables. We present a rotating structure that significantly enhances uniformity in environmental conditions between individual free‐standing lysimeters placed on the structure. The system contains automatic irrigation (water and fertilizer) delivery and drainage collection devices. The system was tested in evaporation and plant growth experiments. A dual carousel setup was used to measure evaporation from containers placed on the soil surface of the lysimeters, as well as yield of lettuce (Lactuca sativa L.) plants growing in the lysimeters. Half of each carousel was covered with netting to reduce solar radiation by 50%. One carousel rotated throughout the experiment while the other one remained stationary. Variability in measured data was reduced as a result of rotation. The CV of measured evaporation from the rotating system (3.3%) was significantly lower than that of the stationary system (16.2%). Similarly, the CV of relative lettuce yields of the rotating system was 11.9% as compared with 20.9% for the stationary system. The proposed apparatus is very attractive as a research and teaching tool for studying plant physiological processes, flow and transport in soils, and plant response to management or environmental variables.
Characterization of the Specific Solid–Water Interfacial Area–Water Saturation Relationship and Its Import to Reactive Transport
Authors: Saripalli K. P. , Freedman V. L. , McGrail B. P. , Meyer P. D.
Published: May 2006

A modified rate equation for the dissolution of minerals in the unsaturated zone was proposed using a specific solid–water interfacial area (asw) varying as a function of water saturation (Sw). Vadose zone phenomena, such as infiltration, were discussed as example scenarios where such reformulation may be useful. A constitutive relationship for the asw–Sw was derived, and used to formulate an approximate model of the proposed rate equation. Implementation of this new model in the reactive transport code CRUNCH was used to evaluate the influence of a changing asw on reactive transport behavior of silica in the vadose zone. These simulations clearly demonstrate that a changing asw can have a significant impact on the silica distribution profiles in the vadose zone. This is to be expected because changes in asw are substantial in the dry Sw range, whereas they are only moderate in the relatively wet region. These findings have significant implications for contaminant transport in the vadose zone, especially in arid regions. Ignoring the effect of a changing asw is likely to result in an overestimation of the net contaminant fluxes in these cases, which leads to highly conservative risk assessments. In case of nutrient flux calculations coupled with dissolution phenomena, it may lead to an overestimation of nutrient availability. Additional theoretical and experimental verification of the proposed models would be valuable.
Numerical Analysis of Coupled Water, Vapor, and Heat Transport in the Vadose Zone
Authors: Saito Hirotaka , Šimůnek Jiri , Mohanty Binayak P.
Published: May 2006

Vapor movement is often an important part in the total water flux in the vadose zone of arid or semiarid regions because the soil moisture is relatively low. The two major objectives of this study were to develop a numerical model in the HYDRUS‐1D code that (i) solves the coupled equations governing liquid water, water vapor, and heat transport, together with the surface water and energy balance, and (ii) provides flexibility in accommodating various types of meteorological information to solve the surface energy balance. The code considers the movement of liquid water and water vapor in the subsurface to be driven by both pressure head and temperature gradients. The heat transport module considers movement of soil heat by conduction, convection of sensible heat by liquid water flow, transfer of latent heat by diffusion of water vapor, and transfer of sensible heat by diffusion of water vapor. The modifications allow a very flexible way of using various types of meteorological information at the soil–atmosphere interface for evaluating the surface water and energy balance. The coupled model was evaluated using field soil temperature and water content data collected at a field site. We demonstrate the use of standard daily meteorological variables in generating diurnal changes in these variables and their subsequent use for calculating continuous changes in water contents and temperatures in the soil profile. Simulated temperatures and water contents were in good agreement with measured values. Analyses of the distributions of the liquid and vapor fluxes vs. depth showed that soil water dynamics are strongly associated with the soil temperature regime.
A 26-Week, Randomized, Parallel, Treat-to-Target Trial Comparing Insulin Detemir With NPH Insulin as Add-On Therapy to Oral Glucose-Lowering Drugs in Insulin-Naïve People With Type 2 Diabetes
Authors: Hermansen Kjeld , Davies Melanie , Derezinski Taudeusz , Martinez Ravn Gabrielle , Clauson Per , Home Philip ,   on behalf of the Levemir Treat-to-Target Study Group
Published: May 2006

OBJECTIVE—To assess efficacy and tolerability of insulin detemir or NPH insulin added to oral therapy for type 2 diabetes in a treat-to-target titration protocol.

RESEARCH DESIGN AND METHODS—Individuals (n = 476) with HbA1c (A1C) 7.5–10.0% were randomized to addition of twice-daily insulin detemir or NPH insulin in a parallel-group, multicenter trial. Over 24 weeks, insulin doses were titrated toward prebreakfast and predinner plasma glucose targets of ≤6.0 mmol/l (≤108 mg/dl). Outcomes assessed included A1C, percentage achieving A1C ≤7.0%, risk of hypoglycemia, and body weight.

RESULTS—At 24 weeks, A1C had decreased by 1.8 and 1.9% (from 8.6 to 6.8 and from 8.5 to 6.6%) for detemir and NPH, respectively (NS). In both groups, 70% of participants achieved an A1C ≤7.0%, but the proportion achieving this without hypoglycemia was higher with insulin detemir than with NPH insulin (26 vs. 16%, P = 0.008). Compared with NPH insulin, the risk for all hypoglycemia with insulin detemir was reduced by 47% (P < 0.001) and nocturnal hypoglycemia by 55% (P < 0.001). Mean weight gain was 1.2 kg with insulin detemir and 2.8 kg with NPH insulin (P < 0.001), and the difference in baseline-adjusted final weight was −1.58 (P < 0.001).

CONCLUSIONS—Addition of basal insulin to oral drug therapy in people with suboptimal control of type 2 diabetes achieves guideline-recommended A1C values in most people with aggressive titration. Insulin detemir compared with NPH insulin achieves this with reduced hypoglycemia and less weight gain.
Hyperinsulinemia in Cord Blood in Mothers With Type 2 Diabetes and Gestational Diabetes Mellitus in New Zealand
Authors: Westgate Jenny A. , Lindsay Robert S. , Beattie Judith , Pattison Neil S. , Gamble Greg , Mildenhall Lindsay F.J. , Breier Bernhard H. , Johnstone Frank D.
Published: May 2006

OBJECTIVE—In genetically diabetes-prone populations, maternal diabetes during pregnancy increases the risk of their children developing diabetes and obesity (the vicious cycle of type 2 diabetes). Fetal hyperinsulinemia at birth acts as a marker of this risk. We therefore examined whether cord insulin and leptin concentrations are increased in offspring of Maori and Pacific Island mothers with type 2 and gestational diabetes mellitus (GDM) and varying degrees of glycemic control (HbA1c).

RESEARCH DESIGNS AND METHODS—Maori and Pacific Island mothers were prospectively recruited at Middlemore Hospital, South Auckland. Cord blood was taken from umbilical vein at birth from singleton babies born after 32 weeks of gestation to 138 mothers with GDM, 39 mothers with type 2 diabetes, and 95 control mothers.

RESULTS—Babies born to mothers with both type 2 diabetes and GDM had higher birth weight and skinfold thickness and markedly higher concentrations of insulin (median [interquartile range] type 2 diabetes 77 pmol/l [42–143], GDM 67 pmol/l [42–235], and control subjects 33 pmol/l [18–62]; P < 0.001) and leptin (type 2 diabetes 39 ng/ml [18–75], GDM 31 ng/ml [17–58], and control subjects 13 ng/ml [8–22]; P < 0.001) in cord blood. Cord insulin concentrations >120 pmol/l were found in 29% of offspring of mothers with GDM and 31% of mothers with type 2 diabetes. Many mothers with GDM had abnormalities of glucose tolerance postpartum (20% type 2 diabetes, 34% impaired glucose tolerance or impaired fasting glucose). Higher cord insulin (57 pmol/l [40–94]) and leptin (26 ng/ml [17–39]) concentrations were found even in offspring of GDM mothers with normal glucose tolerance postpartum.

CONCLUSIONS—Raised cord insulin and leptin concentrations are a common finding in offspring of mothers with type 2 diabetes and GDM in this population.
An Evaluation of Cost Sharing to Finance a Diet and Physical Activity Intervention to Prevent Diabetes
Authors: Ackermann Ronald T. , Marrero David G. , Hicks Katherine A. , Hoerger Thomas J. , Sorensen Stephen , Zhang Ping , Engelgau Michael M. , Ratner Robert E. , Herman William H.
Published: May 2006

OBJECTIVE—The Diabetes Prevention Program (DPP) lifestyle intervention is a cost-effective strategy to prevent type 2 diabetes, but it is unclear how this intervention could be financed. We explored whether this intervention could be offered in a way that allows return on investment for private health insurers while remaining attractive for consumers, employers, and Medicare.

RESEARCH DESIGN AND METHODS—We used the DPP and other published reports to build a Markov simulation model to estimate the lifetime progression of disease, costs, and quality of life for adults with impaired glucose tolerance. The model assumed a health-payer perspective and compared DPP lifestyle and placebo interventions. Primary outcomes included cumulative incidence of diabetes, direct medical costs, quality-adjusted life-years (QALYs), and cost per QALY gained.

RESULTS—Compared with placebo, providing the lifestyle intervention at age 50 years could prevent 37% of new cases of diabetes before age 65, at a cost of $1,288 per QALY gained. A private payer could reimburse $655 (24%) of the $2,715 in total discounted intervention costs during the first 3 intervention years and still recover all of these costs in the form of medical costs avoided. If Medicare paid up to $2,136 in intervention costs over the 15-year period before participants reached age 65, it could recover those costs in the form of future medical costs avoided beginning at age 65.

CONCLUSIONS—Cost-sharing strategies to offer the DPP lifestyle intervention for eligible people between ages 50 and 64 could provide financial return on investment for private payers and long-term benefits for Medicare.
Measurement of the High–Molecular Weight Form of Adiponectin in Plasma Is Useful for the Prediction of Insulin Resistance and Metabolic Syndrome
Authors: Hara Kazuo , Horikoshi Momoko , Yamauchi Toshimasa , Yago Hirokazu , Miyazaki Osamu , Ebinuma Hiroyuki , Imai Yasushi , Nagai Ryozo , Kadowaki Takashi
Published: May 2006

OBJECTIVE—The high–molecular weight (HMW) form of adiponectin, an adipocyte-derived insulin-sensitizing hormone, has been reported to be the most active form of this hormone. We investigated whether measurement of plasma HMW adiponectin levels, using our newly developed enzyme-linked immunosorbent assay system for selective measurement of human HMW adiponectin level, may be useful for the prediction of insulin resistance and metabolic syndrome.

RESEARCH DESIGN AND METHODS—A total of 298 patients admitted for diabetes treatment or coronary angiography served as study subjects. Receiver operator characteristic (ROC) curves for the HMW ratio (HMWR; ratio of plasma level of HMW adiponectin to that of total adiponectin) and plasma total adiponectin levels were plotted to predict the presence of insulin resistance and metabolic syndrome.

RESULTS—The area under the ROC curve (AUC) of the HMWR values to predict the presence of insulin resistance was significantly larger than that of plasma total adiponectin level in total subjects (0.713 [95% CI 0.620–0.805] vs. 0.615 [0.522–0.708], P = 0.0160). The AUC for the HMWR values to predict the presence of metabolic syndrome was significantly larger than that for plasma total adiponectin levels in men (0.806 [0.747–0.865] vs. 0.730 [0.660–0.800], P = 0.0025) and in women (0.743 [0.659–0.828] vs. 0.637 [0.532–0.742], P = 0.0458).

CONCLUSIONS—The HMWR value has better predictive power for the prediction of insulin resistance and metabolic syndrome than plasma total adiponectin level.
Impact of Office Systems and Improvement Strategies on Costs of Care for Adults With Diabetes
Authors: Gilmer Todd P. , O’Connor Patrick J. , Rush William A. , Crain A. Lauren , Whitebird Robin R. , Hanson Anne M. , Solberg Leif I.
Published: May 2006

OBJECTIVE—To assess the impact of organizational features and improvement strategies of primary care clinics on health care costs of adults with diabetes.

RESEARCH DESIGN AND METHODS—This study included a prospective cohort study of 1,628 adults with diabetes in a large, health care organization receiving care in 84 clinics within 18 medical groups. Data from surveys of patients, clinic medical directors and managers, and medical record reviews were merged with 3 years of medical claims. Costs were estimated using health plan data on resource use and common Medicare payment methodologies. Generalized linear regression models were used to analyze costs related to clinic characteristics, adjusting for individual patient comorbidity, demographic, and socioeconomic factors.

RESULTS—Clinics with regular clinician meetings to discuss patient care problems and clinics that used diabetes registries to prioritize patients based on cardiovascular risk were associated with lower 3-year costs: −$3,962 (P = 0.002) and −$2,916 (P = 0.019), respectively. The use of databases to monitor lab results was associated with higher costs ($2,439, P = 0.038). Quality improvement strategies focused on resource use related to diabetes care (−$2,883, P = 0.017) or heart disease care (−$3,228, P = 0.014) were associated with lowered costs, whereas quality improvement strategies that emphasized pharmacy use for patients with heart disease ($3,059, P = 0.029) or depression ($2,962, P = 0.038) were associated with increased costs.

CONCLUSIONS—Several organizational features of primary care offices were significant predictors of future health care costs for adults with diabetes. The mechanism by which such factors affect costs of care and the relationship of costs to clinical outcomes merits further evaluation.
Derivation and Validation of a Prediction Score for Major Coronary Heart Disease Events in a U.K. Type 2 Diabetic Population
Authors: Donnan Peter T. , Donnelly Louise , New John P. , Morris Andrew D.
Published: May 2006

OBJECTIVE—To derive and validate an absolute risk algorithm for major coronary heart disease (CHD) events in the U.K. population with type 2 diabetes.

RESEARCH DESIGN AND METHODS—A population cohort with type 2 diabetes was constructed in Tayside, Scotland, U.K., and longitudinally followed-up to June 2004. Participants were all people with type 2 diabetes registered with general practices and the Diabetes Audit and Research in Tayside, Scotland, database (97% sensitive) with no previous CHD event and with complete measurements (n = 4,569). The main outcome measure was risk of CHD defined as fatal or nonfatal myocardial infarction or CHD death, derived from the Weibull accelerated failure-time model. Validation of the algorithm was performed on an independent dataset from Salford, England, U.K.

RESULTS—There were a total of 243 subjects (5.3%) with a fatal or nonfatal myocardial infarction or CHD death over the follow-up period from 1 January 1995 to 30 June 2004 (maximum follow-up 9.5 years). The final Weibull model included the significant predictors of age at diagnosis, duration of diabetes, HbA1c, smoking (current, past, never), sex, systolic blood pressure, treated hypertension, total cholesterol, and height. Assessment of discrimination and calibration in the Salford validation dataset demonstrated a good fit (c = 0.71 [95% CI 0.63–0.79]).

CONCLUSIONS—This study provides the first validated, population-derived model for prediction of absolute risk of CHD in people with type 2 diabetes. It provides a useful additional decision aid for the clinician treating type 2 diabetes by indicating appropriate early action to decrease the risk of adverse outcomes.
Prediction of Diabetic Foot Ulcer Occurrence Using Commonly Available Clinical Information
Authors: Boyko Edward J. , Ahroni Jessie H. , Cohen Victoria , Nelson Karin M. , Heagerty Patrick J.
Published: May 2006

OBJECTIVE—The ability of readily available clinical information to predict the occurrence of diabetic foot ulcer has not been extensively studied. We conducted a prospective study of the individual and combined effects of commonly available clinical information in the prediction of diabetic foot ulcer occurrence.

RESEARCH DESIGN AND METHODS—We followed 1,285 diabetic veterans without foot ulcer for this outcome with annual clinical evaluations and quarterly mailed questionnaires to identify foot problems. At baseline we assessed age; race; weight; current smoking; diabetes duration and treatment; HbA1c (A1C); visual acuity; history of laser photocoagulation treatment, foot ulcer, and amputation; foot shape; claudication; foot insensitivity to the 10-g monofilament; foot callus; pedal edema; hallux limitus; tinea pedis; and onychomycosis. Cox proportional hazards modeling was used with backwards stepwise elimination to develop a prediction model for the first foot ulcer occurrence after the baseline examination.

RESULTS—At baseline, subjects were 62.4 years of age on average and 98% male. Mean follow-up duration was 3.38 years, during which time 216 foot ulcers occurred, for an incidence of 5.0/100 person-years. Significant predictors (P ≤ 0.05) of foot ulcer in the final model (hazard ratio, 95% CI) included A1C (1.10, 1.06–1.15), impaired vision (1.48, 1.00–2.18), prior foot ulcer (2.18, 1.61–2.95), prior amputation (2.57, 1.60–4.12), monofilament insensitivity (2.03, 1.50–2.76), tinea pedis (0.73, 0.54–0.98), and onychomycosis (1.58, 1.16–2.16). Area under the receiver operating characteristic curve was 0.81 at 1 year and 0.76 at 5 years.

CONCLUSIONS—Readily available clinical information has substantial predictive power for the development of diabetic foot ulcer and may help in accurately targeting persons at high risk of this outcome for preventive interventions.
Idiosyncratic Personal Explanations for Blood Glucose Events Are Associated With Poorer Self-Management and Glycemic Control in Adult Patients With Long-Standing Type 1 Diabetes
Authors: Wearden Alison J. , Hynd Kathryn , Smith Helen , Davies Rob , Tarrier Nicholas
Published: May 2006

OBJECTIVE—To examine whether spontaneous causal attributions for blood glucose events were associated with blood glucose control (HbA1c [A1C]), self-management, and adjustment to diabetes.

RESEARCH DESIGN AND METHODS—A total of 62 adults (31 female) with type 1 diabetes, recruited from a diabetes specialist clinic, with a mean age of 42.3 years and a mean illness duration of 19.6 years, were interviewed about the onset, history, course, and management of their diabetes. Spontaneous causal attributions for fluctuations in blood glucose level were extracted from the interviews and coded in accordance with the Leeds Attributional Coding System. Participants completed questionnaire measures of anxiety, depression, and appraisal of diabetes. Glycemic control (A1C) at the time of interview and 1 year later was extracted from notes.

RESULTS—Participants who made proportionally more personal, or idiosyncratic, explanations for blood glucose fluctuations or events (such as hypoglycemic episodes) had higher A1C levels at time 1 and 1 year later and were judged to manage their diabetes less well. Furthermore, the association between personal attributions and A1C was partly accounted for by self-management behavior. Participants who made personal and stable attributions appraised their diabetes more negatively.

CONCLUSIONS—Clinicians should be sensitive to patients’ causal explanations for blood glucose events. Helping patients consider alternative explanations may produce benefits in terms of better management and control of diabetes.
High-Risk Individuals’ Willingness to Pay for Diabetes Risk-Reduction Programs
Authors: Johnson F. Reed , Manjunath Ranjani , Mansfield Carol A. , Clayton Laurel J. , Hoerger Thomas J. , Zhang Ping
Published: May 2006

OBJECTIVE—The purpose of this study was to estimate how much at-risk individuals are willing to pay for type 2 diabetes primary prevention programs.

RESEARCH DESIGN AND METHODS—An Internet-based, choice-format conjoint survey was presented to individuals at elevated risk for type 2 diabetes. Hypothetical diabetes risk-reduction programs included seven features: diet, exercise, counseling, medication, weight loss goal, risk reduction, and program costs. The sample included 582 individuals aged ≥45 years, two-thirds of whom were obese. Conditional logit models were used to calculate participants’ willingness to pay for risk reduction programs. Each respondent’s self-assessed risk of developing diabetes was compared with an objective measure based on a diabetes screening tool.

RESULTS—Many respondents underestimated their personal risk of developing diabetes. Those with a low perceived risk were less likely to indicate that they would participate in a diabetes prevention program. Individuals had the strongest preference for programs with large weight loss goals, fewer restrictions on diet, and larger reductions in the risk of diabetes. Respondents were willing to pay ∼$1,500 over 3 years to participate in a lifestyle intervention program similar to the Diabetes Prevention Program. Individuals with a high perceived risk were willing to pay more than individuals with lower perceived risk.

CONCLUSIONS—Many individuals will be willing to participate in interventions to delay or prevent diabetes if the interventions are subsidized, but most will be unwilling to pay the full program cost. Our results also offer insights for designing risk-reduction programs that appeal to potential participants.
Dietary Fat Intake Predicts 1-Year Change in Body Fat in Adolescent Girls With Type 1 Diabetes
Authors: Särnblad Stefan , Ekelund Ulf , Åman Jan
Published: May 2006

OBJECTIVE—The purpose of this study was to determine whether objectively measured physical activity and dietary macronutrient intake differentially predict body fat in adolescent girls with type 1 diabetes and control girls.

RESEARCH DESIGN AND METHODS—This study comprised 23 girls (12–19 years) with type 1 diabetes and 19 age-matched healthy control girls. At baseline, physical activity and energy intake were assessed for 7 consecutive days by accelerometry and a structured food diary, respectively. Body composition was measured by dual-energy X-ray absorptiometry at baseline and after 1 year.

RESULTS—Fat intake was positively related to a 1-year change in percentage body fat (P = 0.006), after adjustment for total energy intake. No significant interaction was observed (case-control group × main exposure), indicating that the association between fat intake and gain in body fat was similar in both groups. Physical activity did not predict gain in body fat; however, total physical activity was positively associated with a gain in lean body mass (P < 0.01). Girls treated with six daily dosages of insulin increased their percentage of body fat significantly more than those treated with four daily injections (P < 0.05).

CONCLUSIONS—In this prospective case-control study, we found that fat intake predicted gain in percentage of body fat in both adolescent girls with type 1 diabetes and healthy control girls. The number of daily insulin injections seems to influence the accumulation of body fat in girls with type 1 diabetes.
Clinical Evaluation of Alternative-Site Glucose Measurements in Patients After Major Cardiac Surgery
Authors: Ellmerer Martin , Haluzik Martin , Blaha Jan , Kremen Jaromir , Svacina Stepan , Toller Wolfgang , Mader Julia , Schaupp Lukas , Plank Johannes , Pieber Thomas
Published: May 2006

OBJECTIVE—Tight glycemic control improves outcome in critically ill patients but requires frequent glucose measurements. Subcutaneous adipose tissue (SAT) has been characterized as promising for glucose monitoring in diabetes, but it remains unknown whether it can also be used as an alternative site in critically ill patients. The present study was performed to clinically evaluate the relation of glucose in SAT compared with arterial blood in patients after major cardiac surgery.

RESEARCH DESIGN AND METHODS—Forty critically ill patients were investigated at two clinical centers after major cardiac surgery. Arterial blood and SAT microdialysis samples were taken in hourly intervals for a period of up to 48 h. The glucose concentration in dialysate was calibrated using a two-step approach, first using the ionic reference technique to calculate the SAT glucose concentration (SATg) and second using a one-point calibration procedure to obtain a glucose profile comparable to SAT-derived blood glucose (BgSAT). Clinical validation of the data was performed by introducing data analysis based on an insulin titration algorithm.

RESULTS—Correlation between dialysate glucose and blood glucose (median 0.80 [interquartile range 0.68–0.88]) was significantly improved using the ionic reference calibration technique (SATg vs.blood glucose 0.90 [0.83–0.94]; P < 0.001). Clinical evaluation of the data indicated that 96.1% of glucose readings from SAT would allow acceptable treatment according to a well-established insulin titration protocol.

CONCLUSIONS—The results indicate good correlation between SATg and blood glucose in patients after major cardiac surgery. Clinical evaluation of the data suggests that with minor limitations, glucose from SAT can be used to establish tight glycemic control in this patient group.
Cardiovascular Death and the Metabolic Syndrome
Authors: Langenberg Claudia , Bergstrom Jaclyn , Scheidt-Nave Christa , Pfeilschifter Johannes , Barrett-Connor Elizabeth
Published: May 2006

OBJECTIVE— Levels of adiposity-signaling hormones and inflammatory markers are less favorable in individuals with the metabolic syndrome; their role in the association between the metabolic syndrome and cardiovascular mortality remains unclear.

RESEARCH DESIGN AND METHODS— We conducted a prospective study of 977 men and 1,141 women aged 40–94 years in 1984–1987, followed for mortality for a maximum of 20 years. Adiponectin, leptin, ghrelin, interleukin-6 (IL-6), C-reactive protein (CRP), and Adult Treatment Panel III–defined metabolic syndrome components were measured in fasting blood samples obtained in 1984–1987. Cox-proportional hazards models were used in survival analyses.

RESULTS— The age- and sex-adjusted hazard ratio (HR) (95% CI) for coronary heart disease (CHD) mortality associated with the metabolic syndrome was 1.65 (1.25–2.18) (P < 0.001); this association did not differ significantly by sex, age, or diabetic status (P > 0.2 for each interaction). The association between the metabolic syndrome and CHD mortality was not materially changed after adjustment for adiponectin, leptin, and ghrelin; it was attenuated by 25% after adjustment for IL-6 and 35% after adjustment for CRP. CHD mortality increased linearly with greater levels of IL-6 and CRP (Ptrend < 0.001 for each); the age- and sex-adjusted HRs comparing highest versus lowest quarter were 3.0 (1.87–4.89) for IL-6 and 2.1 (1.41–3.21) for CRP. IL-6, but not CRP, remained a significant predictor of CHD mortality in models including both inflammatory markers and the metabolic syndrome.

CONCLUSIONS— Adiposity-signaling hormones and inflammatory markers explain little to some of the association between the metabolic syndrome and CHD mortality. IL-6 levels predict CHD mortality independently of CRP.
Lipid Profile, Glucose Homeostasis, Blood Pressure, and Obesity-Anthropometric Markers in Macrosomic Offspring of Nondiabetic Mothers
Authors: Evagelidou Eleni N. , Kiortsis Dimitrios N. , Bairaktari Eleni T. , Giapros Vasileios I. , Cholevas Vasileios K. , Tzallas Christos S. , Andronikou Styliani K.
Published: May 2006

OBJECTIVE—The study was to determine whether being the macrosomic offspring of a mother without detected glucose intolerance during pregnancy has an impact on lipid profile, glucose homeostasis, and blood pressure during childhood.

RESEARCH DESIGN AND METHODS—Plasma total, HDL, and LDL cholesterol; triglycerides; apolipoprotein (Apo) A-1, -B, and -E; lipoprotein (a); fasting glucose and insulin; homeostasis model assessment of insulin resistance (HOMA-IR) index; blood pressure; BMI; and detailed anthropometry were evaluated in 85 children aged 3–10 years old, born appropriate for gestational age (AGA; n = 48) and large for gestational age (LGA; n = 37) of healthy mothers.

RESULTS—At the time of the assessment, body weight, height, skinfold thickness, BMI, waist circumference, and blood pressure did not differ between the LGA and AGA groups with the exception of head circumference (P < 0.01). There were no significant differences in plasma total or LDL cholesterol; triglycerides; Apo A-1, -B, or -E; lipoprotein (a); Apo B–to–Apo A-1 ratio; or glucose levels between the groups. The LGA group had significantly higher HDL cholesterol levels (P < 0.01), fasting insulin levels (P < 0.01), and HOMA-IR index (P < 0.01) but lower values of the glucose-to-insulin ratio (P < 0.01) as compared with the AGA group.

CONCLUSIONS—Children born LGA of mothers without confirmed impaired glucose tolerance during pregnancy show higher insulin concentrations than AGAs.
Risk Factors for Foot Infections in Individuals With Diabetes
Authors: Lavery Lawrence A. , Armstrong David G. , Wunderlich Robert P. , Mohler M. Jane , Wendel Christopher S. , Lipsky Benjamin A.
Published: May 2006

OBJECTIVE—To prospectively determine risk factors for foot infection in a cohort of people with diabetes.

RESEARCH DESIGN AND METHODS—We evaluated then followed 1,666 consecutive diabetic patients enrolled in a managed care–based outpatient clinic in a 2-year longitudinal outcomes study. At enrollment, patients underwent a standardized general medical examination and detailed foot assessment and were educated about proper foot care. They were then rescreened at scheduled intervals and also seen promptly if they developed any foot problem.

RESULTS—During the evaluation period, 151 (9.1%) patients developed 199 foot infections, all but one involving a wound or penetrating injury. Most patients had infections involving only the soft tissue, but 19.9% had bone culture–proven osteomyelitis. For those who developed a foot infection, compared with those who did not, the risk of hospitalization was 55.7 times greater (95% CI 30.3–102.2; P < 0.001) and the risk of amputation was 154.5 times greater (58.5–468.5; P < 0.001). Foot wounds preceded all but one infection. Significant (P < 0.05) independent risk factors for foot infection from a multivariate analysis included wounds that penetrated to bone (odds ratio 6.7), wounds with a duration >30 days (4.7), recurrent wounds (2.4), wounds with a traumatic etiology (2.4), and presence of peripheral vascular disease (1.9).

CONCLUSIONS—Foot infections occur relatively frequently in individuals with diabetes, almost always follow trauma, and dramatically increase the risk of hospitalization and amputation. Efforts to prevent infections should be targeted at people with traumatic foot wounds, especially those that are chronic, deep, recurrent, or associated with peripheral vascular disease.
Physician and Nurse Use of Psychosocial Strategies in Diabetes Care
Authors: Peyrot Mark , Rubin Richard R. , Siminerio Linda M. ,   on behalf of the International DAWN Advisory Panel
Published: May 2006

OBJECTIVE—To determine the use of psychosocial strategies by health care providers in treating patients with diabetes and the factors associated with use of these strategies.

RESEARCH DESIGN AND METHODS—Cross-sectional survey of national samples of generalist and diabetes specialist physicians (n = 2,705) and nurses (n = 1,122) from the multinational study of Diabetes Attitudes, Wishes and Needs. Respondents were from 13 countries in Asia, Australia, Europe, and North America. Two psychosocial strategies were examined: provider psychosocial care, which provides psychosocial support by diabetes care providers to their own patients, and psychosocial specialist care, which refers diabetic patients to psychosocial specialists.

RESULTS—Compared with physicians, nurses perceived significantly higher prevalence and severity of psychosocial problems and used psychosocial strategies significantly more frequently, even though they rated their own psychosocial skills lower. Among both physicians and nurses, diabetes specialists were significantly more likely than generalists to utilize psychosocial strategies. Physicians and nurses used psychosocial strategies significantly more when they believed that more patients have psychosocial problems and that problems interfere more with diabetes control. Referral to psychosocial specialists was significantly more likely when physicians and nurses perceived that professional psychological resources were more available. There were substantial country differences in all factors studied. Compared with other countries, U.S. providers provided more psychosocial care themselves but were less likely to refer to psychosocial specialists.

CONCLUSIONS—Psychosocial strategies are important parts of the diabetes care provider repertoire; understanding their determinants may facilitate efforts to increase their use.
Prevalence and Risk Factors for Urinary Incontinence in Women With Type 2 Diabetes and Impaired Fasting Glucose
Authors: Brown Jeanette S. , Vittinghoff Eric , Lin Feng , Nyberg Leroy M. , Kusek John W. , Kanaya Alka M.
Published: May 2006

OBJECTIVE—Diabetes is associated with increased risk of urinary incontinence. It is unknown whether women with pre-diabetes, or impaired fasting glucose (IFG), have increased prevalence of incontinence. We determined the prevalence of, and risk factors for, incontinence among U.S. women with diabetes and IFG.

RESEARCH DESIGN AND METHODS—The 2001–2002 National Health and Nutrition Examination Survey measured fasting plasma glucose and obtained information about diabetes and urinary incontinence among 1,461 nonpregnant adult women. Self-reported weekly or more frequent incontinence, both overall and by type (urge and stress), was our outcome.

RESULTS—Of the 1,461 women, 17% had diabetes and 11% met criteria for IFG. Prevalence of weekly incontinence was similar among women in these two groups (35.4 and 33.4%, respectively) and significantly higher than among women with normal fasting glucose (16.8%); both urge and stress incontinence were increased. In addition to well-recognized risk factors including age, weight, and oral estrogen use, two microvascular complications caused by diabetes, specifically macroalbuminuria and peripheral neuropathic pain, were associated with incontinence.

CONCLUSIONS—Physicians should be alert for incontinence, an often unrecognized and therefore undertreated disorder, among women with diabetes and IFG, in particular those with microvascular complications. The additional prospect of improvements in their incontinence may help motivate some high-risk women to undertake difficult lifestyle changes to reduce their more serious risk of diabetes and its sequelae.
Effect of Lowering LDL Cholesterol Substantially Below Currently Recommended Levels in Patients With Coronary Heart Disease and Diabetes
Authors: Shepherd James , Barter Philip , Carmena Rafael , Deedwania Prakash , Fruchart Jean-Charles , Haffner Steven , Hsia Judith , Breazna Andrei , LaRosa John , Grundy Scott , Waters David ,   for the Treating to New Targets Investigators
Published: May 2006

OBJECTIVE—The Treating to New Targets study showed that intensive lipid-lowering therapy with atorvastatin 80 mg/day provides significant clinical benefit beyond that afforded by atorvastatin 10 mg/day in patients with stable coronary heart disease (CHD). The objective of our study was to investigate whether similar benefits of high-dose intensive atorvastatin therapy can be achieved in patients with CHD and diabetes.

RESEARCH DESIGN AND METHODS—A total of 1,501 patients with diabetes and CHD, with LDL cholesterol levels of <130 mg/dl, were randomized to double-blind therapy with either atorvastatin 10 (n = 753) or 80 (n = 748) mg/day. Patients were followed for a median of 4.9 years. The primary end point was the time to first major cardiovascular event, defined as death from CHD, nonfatal non–procedure-related myocardial infarction, resuscitated cardiac arrest, or fatal or nonfatal stroke.

RESULTS—End-of-treatment mean LDL cholesterol levels were 98.6 mg/dl with atorvastatin 10 mg and 77.0 mg/dl with atorvastatin 80 mg. A primary event occurred in 135 patients (17.9%) receiving atorvastatin 10 mg, compared with 103 patients (13.8%) receiving atorvastatin 80 mg (hazard ratio 0.75 [95% CI 0.58–0.97], P = 0.026). Significant differences between the groups in favor of atorvastatin 80 mg were also observed for time to cerebrovascular event (0.69 [0.48–0.98], P = 0.037) and any cardiovascular event (0.85 [0.73–1.00], P = 0.044). There were no significant differences between the treatment groups in the rates of treatment-related adverse events and persistent elevations in liver enzymes.

CONCLUSIONS—Among patients with clinically evident CHD and diabetes, intensive therapy with atorvastatin 80 mg significantly reduced the rate of major cardiovascular events by 25% compared with atorvastatin 10 mg.
The 11482G>A Polymorphism in the Perilipin Gene Is Associated With Weight Gain With Rosiglitazone Treatment in Type 2 Diabetes
Authors: Kang Eun Seok , Cha Bong Soo , Kim Hyeong Jin , Kim Hae Jin , Kim So Hun , Hur Kyu Yeon , Lee Hyun Joo , Shim Wan Sub , Ahn Chul Woo , Lee Hyun Chul
Published: May 2006

OBJECTIVE—The aim of this study was to examine the effects of perilipin gene (PLIN) polymorphisms on weight gain with rosiglitazone treatment in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS—A total of 160 type 2 diabetic patients were treated with rosiglitazone (4 mg/day) for 12 weeks in addition to their previous medications, which were unchanged. Four single nucleotide polymorphisms (SNPs) at the PLIN locus were genotyped: PLIN 6209T>C, PLIN 11482G>A, PLIN 13041A>G, and PLIN 14995A>T.

RESULTS—Although fasting plasma glucose and HbA1c levels decreased; mean body weight increased significantly after rosiglitazone treatment. Among the four SNPs tested, only the PLIN 11482G>A polymorphism was associated with weight gain from rosiglitazone treatment. In addition, there was a significant difference in the increase in the body weight among the genotypes. Patients with the 11482A/A genotype showed less increase in body weight than those with other genotypes.

CONCLUSIONS—These data suggest that genetic variations in the perilipin gene can affect weight gain associated with rosiglitazone treatment in patients with type 2 diabetes.
Prevalence of Diabetes Complications in Adolescents With Type 2 Compared With Type 1 Diabetes
Authors: Eppens Maike C. , Craig Maria E. , Cusumano Janine , Hing Stephen , Chan Albert K.F. , Howard Neville J. , Silink Martin , Donaghue Kim C.
Published: May 2006

OBJECTIVE—To compare the prevalence of diabetes complications and their risk factors in youth with type 1 versus type 2 diabetes.

RESEARCH DESIGN AND METHODS—We performed a comparative clinic-based study of 1,433 patients with type 1 diabetes and 68 patients with type 2 diabetes aged <18 years from New South Wales, Australia. Retinopathy was assessed by seven-field stereoscopic retinal photography; albumin excretion rate from three consecutive, timed, overnight urine collections; peripheral neuropathy by thermal and vibration threshold; and autonomic neuropathy by pupillometry. HbA1c (A1C) and lipids were measured in all patients and C-peptide in patients with type 2 diabetes.

RESULTS—In patients with type 1 versus type 2 diabetes, median (interquartile range) age was 15.7 years (13.9–17.0) and 15.3 years (13.6–16.4), respectively (P = 0.2), whereas median diabetes duration was 6.8 years (4.7–9.6) and 1.3 years (0.6–3.1), respectively (P < 0.0001). Retinopathy was significantly more common in patients with type 1 diabetes (20 vs. 4%, P = 0.04), while microalbuminuria and hypertension were significantly less common (6 and 16% in type 1 diabetes vs. 28 and 36% in type 2 diabetes). Rates of peripheral and autonomic neuropathy were similar (27 and 61% in type 1 diabetes vs. 21 and 57% in type 2 diabetes). In multivariate analyses, microalbuminuria was significantly associated with older age (odds ratio 1.3 [95% CI 1.2–1.5], P < 0.001) and systolic hypertension (3.63 [2.0–6.3], P < 0.001) in type 1 diabetes, while only higher A1C (1.7 [1.3–2.9], P = 0.002) was significant in patients with type 2 diabetes.

CONCLUSIONS—Youth with type 2 diabetes have significantly higher rates of microalbuminuria and hypertension than their peers with type 1 diabetes, despite shorter diabetes duration and lower A1C. The results of this study support recommendations for early complications screening and aggressive targeting of glycemic control in patients with type 2 diabetes.
Health Care and Patient-Reported Outcomes
Authors: Rubin Richard R. , Peyrot Mark , Siminerio Linda M. ,   on behalf of the International DAWN Advisory Panel
Published: May 2006

OBJECTIVE—The purpose of this study was to assess the relationship of patients’ self-reported well-being, self-management, and diabetes control with factors related to the patient’s health care.

RESEARCH DESIGN AND METHODS—This was a cross-sectional survey of national samples of patients with diabetes (n = 5,104) from the multinational study of Diabetes Attitudes, Wishes and Needs (DAWN). Patients from 13 countries in Asia, Australia, Europe, and North America reported their level of well-being, self-management, and diabetes control. Hierarchical multiple regression analysis (blocks are countries, respondent characteristics, and health care features) was used to examine predictors of diabetes-related distress and general well-being, adherence to lifestyle and medical treatment recommendations, and perceived diabetes control and hyperglycemic symptoms.

RESULTS—Country, respondent demographic and disease characteristics, and health care features were all associated with patient-reported outcomes. Better patient-provider collaboration was associated with more favorable ratings on all outcomes, and better access to the provider and availability of team care were associated with some positive outcomes. Country differences were only partly accounted for by patient and health care factors. Relationships between health care factors and outcomes varied across countries.

CONCLUSIONS—Patients’ reports of well-being, self-management, and diabetes control were related to the countries in which they live, their demographic and disease characteristics, and features of their health care. Opportunities to enhance patient-provider collaboration, access to care, and availability of team care should be pursued.
Perilipin Gene Variation Determines Higher Susceptibility to Insulin Resistance in Asian Women When Consuming a High–Saturated Fat, Low-Carbohydrate Diet
Authors: Corella Dolores , Qi Lu , Tai E. Shyong , Deurenberg-Yap Mabel , Tan Chee Eng , Chew Suok Kai , Ordovas Jose M.
Published: May 2006

OBJECTIVE—To investigate the association between genetic variation in the adipocyte protein perilipin (PLIN) and insulin resistance in an Asian population as well as to examine their modulation by macronutrient intake.

RESEARCH DESIGN AND METHODS—A nationally representative sample (Chinese, Malays, and Indians) was selected in the Singapore National Health Survey following the World Health Organization–recommended model for field surveys of diabetes. A total of 1,909 men and 2,198 women (aged 18–69 years) were studied. Genetic (PLIN 11482G→A and 14995A→T), lifestyle, clinical, and biochemical data were obtained. Homeostasis model assessment of insulin resistance (HOMA-IR) was used to evaluate insulin resistance. Diet was measured by a validated food frequency questionnaire in one of every two subjects.

RESULTS—We did not find a significant between-genotype difference in insulin resistance measures. However, in women we found statistically significant gene-diet interactions (recessive model) between PLIN 11482G→A/14995A→T polymorphisms (in high linkage disequilibrium) and saturated fatty acids (SFAs; P = 0.003/0.005) and carbohydrate (P = 0.004/0.012) in determining HOMA-IR. These interactions were in opposite directions and were more significant for 11482G→A, considered the tag polymorphism. Thus, women in the highest SFA tertile (11.8–19%) had higher HOMA-IR (48% increase; P trend = 0.006) than women in the lowest (3.1–9.4%) only if they were homozygotes for the PLIN minor allele. Conversely, HOMA-IR decreased (−24%; P trend = 0.046) as carbohydrate intake increased. These effects were stronger when SFAs and carbohydrate were combined as an SFA-to-carbohydrate ratio. Moreover, this gene-diet interaction was homogeneously found across the three ethnic groups.

CONCLUSIONS—PLIN 11482G→A/14995A→T polymorphisms modulate the association between SFAs/carbohydrate in diet and insulin resistance in Asian women.