bluuebunny/crossref_metadata_2025 huggingface dataset:
Five-Week, Low–Glycemic Index Diet Decreases Total Fat Mass and Improves Plasma Lipid Profile in Moderately Overweight Nondiabetic Men
Authors: Bouché Clara , Rizkalla Salwa W. , Luo Jing , Vidal Hubert , Veronese Annie , Pacher Nathalie , Fouquet Caroline , Lang Vincent , Slama Gérard
Published: March 2007

OBJECTIVE—To evaluate whether a 5-week low–glycemic index (LGI) diet versus a high–glycemic index (HGI) diet can modify glucose and lipid metabolism as well as total fat mass in nondiabetic men.

RESEARCH DESIGN AND METHODS—In this study, 11 healthy men were randomly allocated to 5 weeks of an LGI or HGI diet separated by a 5-week washout interval in a crossover design.

RESULTS—The LGI diet resulted in lower postprandial plasma glucose and insulin profiles and areas under the curve (AUCs) than the HGI diet. A 5-week period of the LGI diet lowered plasma triacylglycerol excursion after lunch (AUC, P < 0.05 LGI vs. HGI). These modifications were associated with a decrease in the total fat mass by ∼700 g (P < 0.05) and a tendency to increase lean body mass (P < 0.07) without any change in body weight. This decrease in fat mass was accompanied by a decrease in leptin, lipoprotein lipase, and hormone-sensitive lipase RNAm quantities in the subcutaneous abdominal adipose tissue (P < 0.05).

CONCLUSIONS—We concluded that 5 weeks of an LGI diet ameliorates some plasma lipid parameters, decreases total fat mass, and tends to increase lean body mass without changing body weight. These changes were accompanied by a decrease in the expression of some genes implicated in lipid metabolism. Such a diet could be of benefit to healthy, slightly overweight subjects and might play a role in the prevention of metabolic diseases and their cardiovascular complications.
Inhibition of Dipeptidyl Peptidase IV Improves Metabolic Control Over a 4-Week Study Period in Type 2 Diabetes
Authors: Ahrén Bo , Simonsson Erik , Larsson Hillevi , Landin-Olsson Mona , Torgeirsson Hlin , Jansson Per-Anders , Sandqvist Madeléne , Båvenholm Peter , Efendic Suad , Eriksson Jan W. , Dickinson Sheila , Holmes David
Published: March 2007

OBJECTIVE—Glucagon-like peptide-1 (GLP-1) has been proposed as a new treatment modality for type 2 diabetes. To circumvent the drawback of the short half-life of GLP-1, inhibitors of the GLP-1–degrading enzyme dipeptidyl peptidase IV (DPP IV) have been examined. Such inhibitors improve glucose tolerance in insulin-resistant rats and mice. In this study, we examined the 4-week effect of 1-[[[2-[(5-cyanopyridin-2-yl)amino]ethyl]amino]acetyl]-2-cyano-(S)-pyrrolidine (NVP DPP728), a selective, orally active inhibitor of DPP IV, in subjects with diet-controlled type 2 diabetes in a placebo-controlled double-blind multicenter study.

RESEARCH DESIGN AND METHODS—A total of 93 patients (61 men and 32 women), aged 64 ± 9 years (means ± SD) and with BMI 27.3 ± 2.7 kg/m2, entered the study. Fasting blood glucose was 8.5 ± 1.5 mmol/l, and HbA1c was 7.4 ± 0.7%. Before and after treatment with NVP DPP728 at 100 mg × 3 (n = 31) or 150 mg × 5 (n = 32) or placebo (n = 30), subjects underwent a 24-h study with standardized meals (total 2,000 kcal).

RESULTS—Compared with placebo, NVP DPP728 at 100 mg t.i.d. reduced fasting glucose by 1.0 mmol/l (mean), prandial glucose excursions by 1.2 mmol/l, and mean 24-h glucose levels by 1.0 mmol/l (all P < 0.001). Similar reductions were seen in the 150-mg b.i.d. treatment group. Mean 24-h insulin was reduced by 26 pmol/l in both groups (P = 0.017 and P = 0.023). Although not an efficacy parameter foreseen in the study protocol, HbA1c was reduced to 6.9 ± 0.7% in the combined active treatment groups (P < 0.001). Laboratory safety and tolerability was good in all groups.

CONCLUSIONS—We conclude that inhibition of DPP IV is a feasible approach to the treatment of type 2 diabetes in the early stage of the disease.
UKPDS 59: Hyperglycemia and Other Potentially Modifiable Risk Factors for Peripheral Vascular Disease in Type 2 Diabetes
Authors: Adler Amanda I. , Stevens Richard J. , Neil Andrew , Stratton Irene M. , Boulton Andrew J. M. , Holman Rury R. ,   for the U.K. Prospective Diabetes Study Group
Published: March 2007

OBJECTIVE—To determine the role of hyperglycemia in prospective analyses of peripheral vascular disease (PVD) in type 2 diabetes, taking into account other potential risk factors.

RESEARCH DESIGN AND METHODS—Potential risk factors for the development of PVD were examined in 3,834 of 5,102 individuals enrolled in the U.K. Prospective Diabetes Study (UKPDS) without PVD at diagnosis of diabetes, followed for 6 years, and for whom relevant data were available. PVD was defined as two of the following: ankle-arm blood pressure index <0.8, absence of both dorsalis pedis and posterior tibial pulses to palpation in one or both legs, and intermittent claudication. Logistic regression was used to estimate the association between potential risk factors measured 3–4 months after diagnosis of diabetes and incident PVD. The prevalence of PVD at 3-year intervals to 18 years was determined.

RESULTS—Hyperglycemia, assessed as HbA1c, was associated with an increased risk for incident PVD, independent of other risk factors including age, increased systolic blood pressure, reduced HDL cholesterol, smoking, prior cardiovascular disease, peripheral sensory neuropathy, and retinopathy. Each 1% increase in HbA1c was associated with a 28% increased risk of PVD (95% CI 12–46), and each 10-mmHg increase in systolic blood pressure with a 25% increase in risk (95% CI 10–43).

CONCLUSIONS—Hyperglycemia, as well as smoking, dyslipidemia, and blood pressure are potentially modifiable risk factors for the development of PVD.
Delayed Gastric Emptying and Gastric Autoimmunity in Type 1 Diabetes
Authors: De Block Christophe E.M. , De Leeuw Ivo H. , Pelckmans Paul A. , Callens Dirk , Máday Emöke , Van Gaal Luc F.
Published: March 2007

OBJECTIVE—Delayed gastric emptying and/or gastrointestinal symptoms occur in 30–50% of diabetic patients. Known contributing factors are autonomic neuropathy and acute hyperglycemia, but the role of gastric autoimmunity has never been investigated, although 15–20% of type 1 diabetic patients exhibit parietal cell antibodies (PCAs). We studied gastric motility in diabetes in relation to PCA status, autonomic nerve function, HbA1c, thyroid-stimulating hormone (TSH), Helicobacter pylori (HP), acid production, and gastric histology.

RESEARCH DESIGN AND METHODS—Gastric emptying of solids and liquids (measured by 13C-octanoic acid and 13C-glycine breath tests, respectively) was tested in euglycemic conditions in 42 type 1 diabetic patients (male/female: 29/13; 15 PCA+; mean age 40 ± 15 years; mean HbA1c 7.8 ± 0.9%). Gastrointestinal symptoms, autonomic nerve function (Ewing tests), PCA status (indirect immunofluorescence), gastric histology, and acid secretion (pentagastrin) were assessed.

RESULTS—Solid gastric emptying was delayed in 40% and liquid emptying in 36% of patients. Gastric motility did not correlate with symptoms. PCA status, gastric morphology, and acid secretion were similar in those with and without gastroparesis. HbA1c level (β = 1.34, P = 0.011) was the only risk factor for delayed solid emptying in a logistic regression model testing HbA1c, autonomic nerve function, PCA, HP status, age, sex, diabetes duration, and TSH. Half-emptying time for liquids correlated with TSH level (r = 0.83, P < 0.0001) and autonomic neuropathy score (r = −0.79, P = 0.001).

CONCLUSIONS—We found that ∼50% of type 1 diabetic patients studied had delayed gastric emptying that did not correlate with symptoms. Gastric autoimmunity did not contribute to diabetic gastroparesis. Metabolic control was worse in patients with delayed solid emptying.
Neurotrophic Factor Receptors in Epiretinal Membranes After Human Diabetic Retinopathy
Authors: Harada Takayuki , Harada Chikako , Mitamura Yoshinori , Akazawa Chihiro , Ohtsuka Kenji , Ohno Shigeaki , Takeuchi Shinobu , Wada Keiji
Published: March 2007

OBJECTIVE—Formation of epiretinal membranes (ERMs) in the posterior fundus results in progressive deterioration of vision. ERMs have been associated with numerous clinical conditions, including proliferative diabetic retinopathy (PDR), but its pathogenic mechanisms are still unknown. This study was conducted to determine whether neurotrophic factor receptors (tyrosine kinase receptors trkA, trkB, and trkC; low-affinity neurotrophin [NT] receptor p75 [p75NTR]; glial cell line–derived neurotrophic factor receptor-α1 [GFRα1] and GFRα2; and Ret) are involved in the formation of ERMs after PDR.

RESEARCH DESIGN AND METHODS—ERM samples were obtained by vitrectomy from 19 subjects with PDR aged 57 ± 8 years with 17 ± 8 years of diabetes and 15 subjects with idiopathic ERM. They were processed for RT-PCR analysis. In addition, 11 ERM samples from PDR patients aged 47 ± 18 years with 13 ± 4 years of diabetes were processed for immunohistochemical analysis.

RESULTS—Expressions of trkA, trkB, trkC, p75NTR, and Ret mRNAs were similar in both groups. In contrast, GFRα2 expression levels were significantly higher (17 of 19 vs. 2 of 15 subjects in idiopathic ERM, P < 0.0001) in PDR subjects. Accordingly, immunohistochemical analysis revealed expression of GFRα2 protein in all of the 11 ERMs derived from PDR patients, and that region was double-labeled with glial cell-specific markers. On the other hand, GFRα1 expression was lower (8 of 19 vs. 12 of 15 subjects with idiopathic ERM, P = 0.0258) in PDR subjects.

CONCLUSIONS—These results suggest a possibility that glial cell line-derived neurotrophic factor receptor (GDNF) subtypes are differently involved in the formation of ERMs.
Coronary Artery Disease and Carotid Artery Intima-Media Thickness in Japanese Type 2 Diabetic Patients
Authors: Mitsuhashi Naomi , Onuma Tomio , Kubo Sayaka , Takayanagi Naoko , Honda Motoe , Kawamori Ryuzo
Published: March 2007

OBJECTIVE—To investigate the association between carotid atherosclerosis, measured as intima-media thickness (IMT), and cardiovascular morbidity in type 2 diabetic patients.

RESEARCH DESIGN AND METHODS—We investigated the relationship between IMT and coronary artery disease (CAD) in 40 type 2 diabetic patients and 40 control subjects. Diabetic patients with CAD determined by coronary angiography were consecutively recruited, whereas the control subjects were recruited from among diabetic outpatients without CAD at the same institution. IMT was measured in both carotid arteries using B-mode ultrasonography.

RESULTS—Carotid IMT was significantly greater in the diabetic patients than in the control subjects (1.27 ± 0.07 vs. 1.03 ± 0.04 mm, P < 0.05). IMT was associated with CAD by logistic regression analysis using all independent variables (P = 0.062). When the 40 patients with CAD were divided into a group of 20 patients with coronary artery bypass grafting (CABG) and another 20 patients without CABG, the IMT was significantly greater in the CABG group than in the non-CABG group (1.47 ± 0.11 vs. 1.07 ± 0.07 mm, P < 0.05).

CONCLUSIONS—These results indicate that the presence of carotid atherosclerosis implies a high probability of coronary involvement in Japanese nonobese subjects with type 2 diabetes.
Serum Insulin, Obesity, and the Incidence of Type 2 Diabetes in Black and White Adults
Authors: Carnethon Mercedes R. , Palaniappan Latha P. , Burchfiel Cecil M. , Brancati Frederick L. , Fortmann Stephen P.
Published: March 2007

OBJECTIVE—In this study, we tested the hypothesis that fasting serum insulin is higher in nonobese black adults than in white adults and that high fasting insulin predicts type 2 diabetes equally well in both groups.

RESEARCH DESIGN AND METHODS—At the baseline examination (1987–1989) of the Atherosclerosis Risk in Communities Study, fasting insulin and BMI were measured in 13,416 black and white men and women without diabetes. Participants were examined at years 3, 6, and 9 for incident diabetes based on fasting glucose and American Diabetes Association criteria.

RESULTS—Fasting insulin was 19.7 pmol/l higher among nonobese (BMI <30 kg/m2) black women compared with white women (race and obesity interaction term, P < 0.01). There were no differences among men. Among nonobese women, the relative risk for developing diabetes was similar between racial groups: 1.4 (95% CI 1.2–1.5) and 1.3 (1.2–1.4) per 60 pmol/l increase in insulin (P < 0.01) for black and white women, respectively (interaction term, P = 0.6). Findings were similar among men. Adjusting for established risk factors did not attenuate this association.

CONCLUSIONS—Nonobese black women have higher fasting insulin levels than nonobese white women, and fasting insulin is an equally strong predictor of diabetes in both groups. These results suggest one mechanism to explain the excess incidence of diabetes in nonobese black women but do not explain the excess among black men. Future research should evaluate additional factors: genetic, environmental, or the combination of both, which might explain higher fasting insulin among black women when compared with white women.
Digital Retinal Images and Teleophthalmology for Detecting and Grading Diabetic Retinopathy
Authors: Gómez-Ulla Francisco , Fernandez Maria I. , Gonzalez Francisco , Rey Pablo , Rodriguez Marta , Rodriguez-Cid Maria J. , Casanueva Felipe F. , Tome Maria A. , Garcia-Tobio Javier , Gude Francisco
Published: March 2007

OBJECTIVE—Detecting and grading of diabetic retinopathy (DR) by means of digital retinal images sent via the Internet.

RESEARCH DESIGN AND METHODS—Four nonstereoscopic digital retinal images (45° field each) of 126 eye fundus images from 70 diabetic patients were obtained with a nonmydriatic camera at two peripheral units. The images were sent via the Internet using a web-based system to a reference center, where they were diagnosed and graded by one ophthalmologist. These results were compared with those obtained by two other ophthalmologists, one at each peripheral unit, after direct examination of the patients. A modified severity scale of Airlie House was used for grading DR in all cases. Agreement between observers was assessed using unweighted κ for categorical data and the intraclass correlation coefficient (ICC) for continuous data.

RESULTS—Presence of DR was detected in 69 eyes (55%). All eyes with DR (69 of 69, 100%) were correctly identified (κ = 1) by inspecting the digital images. In 118 eyes (118 of 126, 94%), 57 with no DR and 61 with DR, there was an agreement between the gradation made after the direct examination and the gradation made after the inspection of the images (ICC = 0.92). In eight eyes with DR (8 of 126, 6%), there was disagreement in the grading made with both techniques.

CONCLUSIONS—Inspection of digital retinal images sent via the Internet allowed diagnosis and grading of DR. The presence or absence of DR was correctly assessed by inspection of the images in all instances. We also found agreement, in most cases, between retinopathy gradation made from the images and the gradation made by direct examination of the eyes. These findings suggest that this technique is suitable for screening procedures.
Assessment of Asymptomatic Coronary Artery Disease in Apparently Uncomplicated Type 2 Diabetic Patients
Authors: Gazzaruso Carmine , Garzaniti Adriana , Giordanetti Stefano , Falcone Colomba , De Amici Emanuela , Geroldi Diego , Fratino Pietro
Published: March 2007

OBJECTIVE—In patients with uncomplicated diabetes, there is low probability of finding significant coronary artery disease (CAD) by noninvasive tests. Therefore, screening for its presence is not justified, and it is important to find reliable predictors of silent CAD to identify patients with uncomplicated diabetes for further screening. The relationship between lipoprotein(a) [Lp(a)], apolipoprotein(a) [apo(a)] polymorphism, and silent CAD has never been studied. We investigated the association of Lp(a) and apo(a) polymorphism with angiographically documented asymptomatic CAD in type 2 diabetic patients without evident complications.

RESEARCH DESIGN AND METHODS—A total of 1,323 diabetic patients without any clinical and electrocardiographic evidence of CAD were evaluated. Of 121 patients with highly positive results of exercise electrocardiography (ECG) (n = 30) or positive results on exercise thallium scintigraphy (n = 91), 103 subjects showed angiographically documented CAD (CAD group). Of 1,106 patients with negative results on exercise ECG, 103 subjects without CAD (NO CAD group) were selected and matched by age, gender, and duration of diabetes to patients in the CAD group. In patients in the NO CAD group, results of exercise ECG, 48-h ambulatory ECG, and stress echocardiography were negative for CAD.

RESULTS—The CAD group had higher Lp(a) levels (21.7 ± 17.7 vs. 15.2 ± 19.0 mg/dl; P = 0.0093) than the NO CAD group, and a percentage of subjects had at least one small apo(a) isoform (68.9 vs. 29.1%; P = 0.0000) higher than the NO CAD group. Logistic regression analysis showed that apo(a) phenotypes (odds ratio [OR] 8.13, 95% CI 3.65–21.23), microalbuminuria (5.38, 2.44–11.88), smoking (2.72, 1.31–5.64), and Lp(a) levels (2.41, 1.15–5.03) were predictors of asymptomatic CAD.

CONCLUSIONS—Our investigation reports the first evidence of an independent association of Lp(a) and apo(a) polymorphism with asymptomatic CAD. This suggests that Lp(a) levels and apo(a) phenotypes could be used together with other risk factors as markers of asymptomatic CAD in patients with diabetes.
Population-Based Study of Diabetes and Risk Characteristics in Turkey
Authors: Satman Ilhan , Yilmaz Temel , Sengül Ahmet , Salman Serpil , Salman Fatih , Uygur Sevil , Bastar Irfan , Tütüncü Yildiz , Sargin Mehmet , Dinççag Nevin , Karsidag Kubilay , Kalaça Sibel , Özcan Cihangir , King Hilary ,   The TURDEP Group
Published: March 2007

OBJECTIVES—To investigate for the first time the prevalence of diabetes and impaired glucose tolerance (IGT) nationwide in Turkey; to assess regional variations and relationships between glucose intolerance and lifestyle and physical risk factors.

RESEARCH DESIGN AND METHODS—The Turkish Diabetes Epidemiology Study (TURDEP) is a cross-sectional, population-based survey that included 24,788 subjects (age ≥20 years, women 55%, response 85%). Glucose tolerance was classified according to World Health Organization recommendations on the basis of 2-h blood glucose values.

RESULTS—Crude prevalence of diabetes was 7.2% (previously undiagnosed, 2.3%) and of IGT, 6.7% (age-standardized to world and European populations, 7.9 and 7.0%). Both were more frequent in women than men (P < 0.0001) and in those living in urban rather than rural communities (P < 0.001). Prevalence rates of hypertension and obesity were 29 and 22%, respectively. Both were more common among women than men (P < 0.0001). Prevalence of diabetes and IGT increased with rising BMI, waist-to-hip ratio (WHR), and waist girth (P < 0.0001). Multiple logistic regression analysis revealed that age, BMI, WHR, familial diabetes, and hypertension were independently associated with diabetes, age, BMI, WHR, familial diabetes, and hypertension with IGT (except for familial diabetes in women with IGT). Education was related to diabetes in men but was protective for diabetes and IGT in women. Socioeconomic status appeared to decrease the risk of IGT in men while it increased the risk in women. Smoking had a protective effect for IGT in both sexes.

CONCLUSIONS—Diabetes and IGT are moderately common in Turkey by international standards. Associations with obesity and hypertension have been confirmed. Other lifestyle factors had a variable relationship with glucose tolerance.
Women With Impaired Glucose Tolerance During Pregnancy Have Significantly Poor Pregnancy Outcomes
Authors: Yang Xilin , Hsu-Hage Bridget , Zhang Hong , Zhang Cuiping , Zhang Yanni , Zhang Changjun
Published: March 2007

OBJECTIVE—This article tests the hypothesis that women with impaired glucose tolerance (IGT) have the same pregnancy outcomes as those of their counterparts with normal glucose tolerance.

RESEARCH DESIGN AND METHODS—From December 1998 to December 1999, 84 of 90 antenatal care base units (ACBUs) under the Tianjin Antenatal Care Network in China participated in the first screening program for gestational diabetes mellitus (GDM). A total of 9,471 pregnant women under the care of participating ACBUs were screened. Of the women screened, 154 were positive for IGT. Of the 154 women, 102 opted for conventional obstetric care. The comparison group was 302 women of normal glucose tolerance (NGT). The initial screening consisted of a 50-g 1-h glucose test, and was carried out at 26–30 gestational weeks. Women with a serum glucose ≥7.8 mmol/l were followed up with a 75-g 2-h oral glucose tolerance test. The World Health Organization’s diagnostic criteria for GDM were used.

RESULTS—Women with IGT were at increased risk for premature rupture of membranes (P-ROM) (odds ratio [OR] 10.07; 95% CI 2.90–34.93); preterm birth (6.42; 1.46–28.34); breech presentation (3.47; 1.11–10.84); and high birth weight (90th percentile or 4,000 g) (2.42; 1.07–5.46); adjusting for maternal age, pregravid BMI, hospital levels, and other confounding factors.

CONCLUSIONS—The presence of IGT in pregnancy is predictive of poor pregnancy outcomes.
Prevalence of Gestational Diabetes Mellitus Detected by the National Diabetes Data Group or the Carpenter and Coustan Plasma Glucose Thresholds
Authors: Ferrara Assiamira , Hedderson Monique M. , Quesenberry Charles P. , Selby Joseph V.
Published: March 2007

OBJECTIVE—In 2000, the American Diabetes Association proposed the adoption of the Carpenter and Coustan criteria for diagnosis of gestational diabetes mellitus (GDM). The Carpenter and Coustan cutoffs are lower than the previously recommended National Diabetes Data Group (NDDG) values and would result in higher prevalence of GDM. Our aim is to estimate the magnitude of change in prevalence of GDM using the Carpenter and Coustan thresholds as compared with the NDDG thresholds by age and ethnicity.

RESEARCH DESIGN AND METHODS—Cross-sectional study of 28,330 women aged 14–49 years who gave birth in 1996 and were members of the Northern California Kaiser Permanente Medical Care Program. Age, ethnicity, screening, and diagnostic test results were assessed from computerized hospitalization and laboratory systems.

RESULTS—A total of 26,481 (94%) women were screened using a 50-g, 1-h oral glucose tolerance test, and 4,190 women underwent a diagnostic 100-g, 3-h oral glucose tolerance test after an abnormal screening. Overall, the GDM prevalence among screened women was 3.2% (95% CI 3.0–3.4) by NDDG and 4.8% (95% CI 4.5–5.1) by Carpenter and Coustan criteria, and based on either threshold, it increased with age (P < 0.001). The age-adjusted GDM prevalence by NDDG and Carpenter and Coustan criteria, respectively, was 5.0 and 7.4% in Asians, 3.9 and 5.6% in Hispanics, 3.0 and 4.0% in African-Americans, and 2.4 and 3.8% in whites. Proportional increments were larger in women aged <25 years (70%) and in whites (58%).

CONCLUSIONS—The prevalence of GDM increased, on average, by 50% with use of the Carpenter and Coustan thresholds. Relative increments were greater in low-risk age and ethnic groups. This information would be useful for clinical settings in predicting cost of GDM based on demographic characteristics of the population.
Factors Associated With Academic Achievement in Children With Type 1 Diabetes
Authors: McCarthy Ann Marie , Lindgren Scott , Mengeling Michelle A. , Tsalikian Eva , Engvall Janet
Published: March 2007

OBJECTIVE—To examine academic achievement in children with diabetes and to identify predictors of achievement.

RESEARCH DESIGN AND METHODS—Participants were 244 children, ages 8–18 years, with type 1 diabetes. Measures included school-administered standardized achievement tests (Iowa Tests of Basic Skills and Iowa Tests of Educational Development [ITBS/ITED]), grade point averages (GPAs), school absences, behavioral assessment, age at disease onset, hospitalizations, and HbA1c. Statistical differences between subgroups of children were evaluated using t test and ANOVA, statistically controlling for socioeconomic status. Regression analyses were carried out to examine predictors of academic performance.

RESULTS—Reading scores and GPA were lower for children with poor metabolic control than for children with average control. Children with hospitalizations for hyperglycemia had lower overall achievement scores than children with better metabolic control and fewer hospitalizations for hyperglycemia. The small group of children with tight metabolic control and hypoglycemic hospitalizations scored particularly low on the ITBS/ITED. Other variables had less clear relationships with academic achievement. Neither early onset of diabetes nor frequent school absence was associated with lower scores on the ITBS/ITED. Sex comparisons found that boys performed better than girls only in math. Socioeconomic status and parent ratings of behavior problems were significantly correlated with academic achievement, but medical variables added only slightly to predictive precision.

CONCLUSIONS—For most children with diabetes, medical variables are not as strongly associated with academic achievement as are factors such as socioeconomic status and behavioral factors. Poor metabolic control and serious hypoglycemia, however, are a potential concern for a subset of these children.
Autoregulation of Glomerular Filtration Rate in Patients With Type 2 Diabetes During Isradipine Therapy
Authors: Christensen Per K. , Akram Kamran , Kønig Karen B. , Parving Hans-Henrik
Published: March 2007

OBJECTIVE—Calcium-channel blockade impairs renal autoregulation in animals. Impaired renal autoregulation leads to transmission of the systemic blood pressure (BP) into the glomerulus, resulting in capillary hypertension. Information on the impact of calcium antagonist treatment on renal autoregulation in humans is lacking. This study examines the effect of isradipine treatment on the autoregulation of the glomerular filtration rate (GFR).

RESEARCH DESIGN AND METHODS—We performed a randomized double-blind crossover study with 5 mg o.d. isradipine retard and matching placebo in 16 hypertensive patients with type 2 diabetes. Each treatment arm lasted 4 weeks. On the last day of each treatment period, GFR (single-shot 51Cr-EDTA plasma clearance technique for 4 h) was measured twice between 8:00 a.m. and 5:00 p.m., first without clonidine and then after intravenous injection of 75 μg clonidine. BP was measured every 10 min (Takeda TM2420; A&D, Tokyo).

RESULTS—Clonidine reduced mean arterial BP (MABP) by 15 ± 1 vs. 11 ± 1 mmHg (means ± SE) during placebo and isradipine treatment, respectively (P < 0.05). GFR was reduced from 102 ± 4 to 99 ± 4 ml · min−1 · 1.73 m−2 with placebo (P < 0.01) and from 106 ± 5 to 98 ± 5 ml · min−1 · 1.73 m−2 during treatment with isradipine (P < 0.01). Mean difference (95% CI) between changes in GFR with placebo and isradipine was −4.6 ml · min−1 · 1.73 m−2 (−10.0 to 0.6) (P = 0.08). Six patients had a reduction in GFR >13% (exceeding the normal limit of autoregulation) combined with a complete pressure-passive vasculature (defined as ΔMABP% ≤ ΔGFR%) during isradipine treatment versus none during the placebo treatment (P < 0.05).

CONCLUSIONS—Isradipine impairs GFR autoregulation in a sizeable proportion of hypertensive type 2 diabetic patients.
Promoter Polymorphisms −359T/C and −303A/G of the Catalytic Subunit p110β Gene of Human Phosphatidylinositol 3-Kinase Are Not Associated With Insulin Secretion or Insulin Sensitivity in Finnish Subjects
Authors: Kossila Maija , Pihlajamäki Jussi , Kärkkäinen Päivi , Miettinen Raija , Kekäläinen Päivi , Vauhkonen Ilkka , Ylä-Herttuala Seppo , Laakso Markku
Published: March 2007

OBJECTIVE—Phosphatidylinositol (PI) 3-kinase activity is required for insulin-stimulated translocation of GLUT4 transporters and glucose uptake and utilization. Therefore, genes encoding the subunits of PI 3-kinase are promising candidate genes for insulin resistance and type 2 diabetes. We recently cloned the catalytic subunit p110β gene of human PI 3-kinase and reported two nucleotide polymorphisms, −359T/C and −303A/G, in the promoter region of this gene. In this study, we determined the effects of these polymorphisms on insulin secretion and insulin sensitivity.

RESEARCH DESIGN AND METHODS—We studied two separate groups of Finnish nondiabetic subjects. Insulin secretion was evaluated by intravenous glucose tolerance test and insulin sensitivity by hyperinsulinemic-euglycemic clamp.

RESULTS—Our results showed that the −359T/C and −303A/G polymorphisms did not have a significant effect on fasting plasma insulin levels, insulin secretion, or insulin sensitivity.

CONCLUSIONS—It is unlikely that the promoter polymorphisms −359T/C and −303A/G of the catalytic subunit p110β gene of human PI 3-kinase have a major impact on insulin secretion, insulin sensitivity, or the risk of type 2 diabetes in Finnish subjects.
Excess Physical Limitations Among Adults With Diabetes in the U.S. Population, 1997–1999
Authors: Ryerson Blythe , Tierney Edward F. , Thompson Theodore J. , Engelgau Michael M. , Wang Jing , Gregg Edward W. , Geiss Linda S.
Published: March 2007

OBJECTIVE—To estimate the prevalence of physical limitations associated with diabetes among U.S. adults ≥18 years of age.

RESEARCH DESIGN AND METHODS—We conducted a cross-sectional analysis of the association between diabetes status and physical limitations using the 1997–1999 National Health Interview Survey (NHIS). Physical limitation was defined from self-reported degree of difficulty with nine tasks.

RESULTS—People with diabetes had a higher proportion of any physical limitation than did people without diabetes overall (66 vs. 29%, P < 0.001), for both men (59 vs. 24%, P < 0.001) and women (72 vs. 34%, P < 0.001). Compared with those without diabetes, a higher proportion of people with diabetes had some physical limitation among all age groups, and the difference declined (all P < 0.001) with increasing age (46 vs. 18% for 18–44 years, 63 vs. 35% for 45–64 years, 74 vs. 53% for 65–74 years, and 85 vs. 70% for those 75 years and older). After controlling for demographic characteristics and several other confounders, the odds ratio of physical limitation among adults with diabetes versus those without diabetes was 1.9 (95% CI: 1.8–2.1).

CONCLUSIONS—People with diabetes are much more likely to have a physical limitation than those without diabetes. Interventions are needed in this population to reduce progression from impairment to physical limitation and from physical limitation to disability, especially because the prevalence of diabetes is projected to increase dramatically in the next several decades.
Diabetic Muscle Infarction
Authors: Trujillo-Santos A. J.
Published: March 2007

OBJECTIVE—To systematically review all the reported cases of diabetic muscle infarction (DMI) and its pathogenesis, clinical features, prognostic implications, and management.

RESEARCH DESIGN AND METHODS—We searched databases (MEDLINE and EMBASE) from their inception to August 2001 and reviewed bibliographies in reports retrieved. Data were extracted in a standardized form.

RESULTS—A total of 47 references were retrieved; 115 patients and 166 episodes were included. DMI was more frequent in women (61.5%, mean age at presentation 42.6 years). Of the cases, 59% had type 1 diabetes; the mean duration of disease was 14.3 years, and multiple diabetic end-organ complications were noted. DMI affects the lower limbs with abrupt onset of pain and local swelling. Diagnosis is made by biopsy, but the characteristic features in magnetic resonance imaging are very typical. Treatment includes bed rest and administration of analgesics, but recurrence is common.

CONCLUSIONS—DMI is a very uncommon complication of long-standing diabetes; presentation is well characterized and management is simple.
Randomized Controlled Community-Based Nutrition and Exercise Intervention Improves Glycemia and Cardiovascular Risk Factors in Type 2 Diabetic Patients in Rural Costa Rica
Authors: Goldhaber-Fiebert Jeremy D. , Goldhaber-Fiebert Sara N. , Tristán Mario L. , Nathan David M.
Published: March 2007

OBJECTIVE—The prevalence of type 2 diabetes, especially in developing countries, has grown over the past decades. We performed a controlled clinical study to determine whether a community-based, group-centered public health intervention addressing nutrition and exercise can ameliorate glycemic control and associated cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica.

RESEARCH DESIGN AND METHODS—A total of 75 adults with type 2 diabetes, mean age 59 years, were randomly assigned to the intervention group or the control group. All participants received basic diabetes education. The subjects in the intervention group participated in 11 weekly nutrition classes (90 min each session). Subjects for whom exercise was deemed safe also participated in triweekly walking groups (60 min each session). Glycosylated hemoglobin, fasting plasma glucose, total cholesterol, triglycerides, HDL and LDL cholesterol, height, weight, BMI, and blood pressure were measured at baseline and the end of the study (after 12 weeks).

RESULTS—The intervention group lost 1.0 ± 2.2 kg compared with a weight gain in the control group of 0.4 ± 2.3 kg (P = 0.028). Fasting plasma glucose decreased 19 ± 55 mg/dl in the intervention group and increased 16 ± 78 mg/dl in the control group (P = 0.048). Glycosylated hemoglobin decreased 1.8 ± 2.3% in the intervention group and 0.4 ± 2.3% in the control group (P = 0.028).

CONCLUSIONS—Glycemic control of type 2 diabetic patients can be improved through community-based, group-centered public health interventions addressing nutrition and exercise. This pilot study provides an economically feasible model for programs that aim to improve the health status of people with type 2 diabetes.
Impact of Bedtime Snack Composition on Prevention of Nocturnal Hypoglycemia in Adults With Type 1 Diabetes Undergoing Intensive Insulin Management Using Lispro Insulin Before Meals
Authors: Kalergis Maria , Schiffrin Alicia , Gougeon Réjeanne , Jones Peter J.H. , Yale Jean-François
Published: March 2007

OBJECTIVE—To determine the impact of four bedtime (HS) snack compositions on nocturnal glycemic control, including frequency of hypoglycemia (<4 mmol/l) and morning hyperglycemia (>10 mmol/l), in adults with type 1 diabetes using lispro insulin before meals and NPH insulin at bedtime.

RESEARCH DESIGN AND METHODS—Substitutions of 15 g carbohydrate (one starch exchange) for an equivalent amount of uncooked cornstarch or pure protein were compared to a standard snack (control: two starch + one protein exchange) and to no snack (placebo) in 15 adults using a randomized, cross-over design. All snacks were equivalent in kcal, fat, and total available glucose. An intravenous facilitated hourly blood glucose sampling during the night (11:00 p.m. to 7:00 a.m.).

RESULTS—The glycemic level at bedtime (<7, 7–10, and >10 mmol/l) mediated the effects observed. A total of 14 hypoglycemic episodes, in 60% of patients, and 23 morning hyperglycemic episodes occurred over 50 nights. Most hypoglycemic episodes (10 of 14, 71%) occurred with no snack compared to any snack (P < 0.001) and at HS levels of <7 mmol/l (P = 0.05). The standard and protein snacks resulted in no nocturnal hypoglycemia at all HS glucose levels (P < 0.001). Only HS glucose >10 mmol/l was protective against hypoglycemia, even in the absence of a snack (P = 0.05); 46% of morning hyperglycemic episodes were associated (r = 0.37, P = 0.07) with this HS glucose level.

CONCLUSIONS—The need for and composition of an HS snack depends on the HS glucose such that no snack is necessary at levels >10 mmol/l. At levels between 7 and 10 mmol/l, any snack is advised, and at <7 mmol/l, a standard or protein snack is recommended.
Vitamin C Affects Thrombosis/ Fibrinolysis System and Reactive Hyperemia in Patients With Type 2 Diabetes and Coronary Artery Disease
Authors: Tousoulis Dimitris , Antoniades Charalambos , Tountas Charalambos , Bosinakou Erini , Kotsopoulou Maria , Toutouzas Pavlos , Stefanadis Christodoulos
Published: March 2007

OBJECTIVE—To examine the effect of vitamin C on forearm vasodilatory response to reactive hyperemia and on plasma level of plasminogen activator inhibitor 1 (PAI-1), von Willebrand factor (vWF), tissue plasminogen activator (tPA), antithrombin III (ATIII), proteins C and S, and factors V (fV) and VII (fVII) in patients with both type 2 diabetes and CAD.

RESEARCH DESIGN AND METHODS—A total of 39 patients with type 2 diabetes and CAD were divided into two groups and received vitamin C (2 g/day) or no antioxidant for 4 weeks. Forearm blood flow was determined using venous occlusion gauge-strain plethysmography at baseline and after treatment. Forearm vasodilatory response to reactive hyperemia (RH%) or nitrate (NTG%) was defined as the percent change of flow from baseline to the maximum flow during reactive hyperemia or after administration of nitrate, respectively. Biochemical markers were determined by enzyme-linked immunosorbent assay (ELISA) or other standard methods.

RESULTS—RH% was significantly increased after treatment with vitamin C (from 62.4 ± 7.2 to 83.1 ± 9.3%, P = 0.024) but remained unaffected in the control group. Vitamin C decreased plasma levels of fV (from 143 ± 5.4 to 123 ± 6.03%, P = 0.038), vWF (from 133.5 ± 14.5 to 109.5 ± 11.4%, P = 0.016), and tPA (from 12.3 ± 0.99 to 8.40 ± 0.60 ng/ml, P = 0.001), whereas these levels remained unaffected in the control group. The changes in RH%, vWF, and tPA were significantly greater (P = 0.028, 0.036, and 0.007, respectively) in the vitamin C-treated group than in the control group. Levels of ATIII, proteins S and C, fVII, and PAI-1 remained unchanged in all groups.

CONCLUSIONS—Short-term treatment with high doses of vitamin C improved RH% and decreased plasma levels of tPA and vWF in patients with type 2 diabetes and CAD.
The Prevalence and Management of Diabetes in Thai Adults
Authors: Aekplakorn Wichai , Stolk Ronald P. , Neal Bruce , Suriyawongpaisal Paibul , Chongsuvivatwong Virasakdi , Cheepudomwit Sayan , Woodward Mark ,   for the InterASIA Collaborative Group
Published: March 2007

OBJECTIVE—The aim of this study was to determine in Thai adults aged ≥35 years the prevalence and management of diabetes and the associations of diabetes with cardiovascular risk factors.

RESEARCH DESIGN AND METHODS—The International Collaborative Study of Cardiovascular Disease in Asia was a complex sample survey. Data from a structured questionnaire, brief physical examination, and blood sample were collected from 5,105 individuals aged ≥35 years (response rate 68%). Population estimates were calculated by applying sampling weights derived from the 2000 Thai census.

RESULTS—The estimated national prevalence of diabetes in Thai adults was 9.6% (2.4 million people), which included 4.8% previously diagnosed and 4.8% newly diagnosed. The prevalence of impaired fasting glucose was 5.4% (1.4 million people). Diagnosed diabetes, undiagnosed diabetes, and impaired fasting glucose were associated with greater age, BMI, waist-to-hip ratio, systolic blood pressure, total cholesterol, and serum creatinine levels. The majority of individuals with diagnosed diabetes had received dietary or other behavioral advice, and 82% were taking oral hypoglycemic therapy. Blood pressure-lowering therapy was provided to 67% of diagnosed diabetic patients with concomitant hypertension.

CONCLUSIONS—Diabetes is common in Thailand, but one-half of all cases are undiagnosed. Because diagnosed diabetes is likely to be treated with proven, low-cost, preventive therapies such as glucose lowering and blood pressure lowering, initiatives that increased diagnosis rates would be expected to produce substantial health benefits in Thailand.
Decisional Attributes of Patients With Diabetes
Authors: Montori Victor M. , Bryant Sandra C. , O’Connor Annette M. , Jorgensen Neal W. , Walsh Erin E. , Smith Steven A.
Published: March 2007

OBJECTIVE—The aim of this study was to determine personal characteristics and preferences that affect decision making (decisional attributes) in patients with diabetes. In particular, we were interested in relating these attributes to the choice of using aspirin to reduce cardiovascular risk.

RESEARCH DESIGN AND METHODS—We conducted a cross-sectional survey (70% response rate) of 206 diabetic patients (median age, 63 years; 42% women; 91% completed high school; median HbA1c, 8%) attending a tertiary care diabetes clinic. Patients answered a 42-question survey exploring decisional attributes. Medical records provided the source of clinical information. We evaluated sociodemographic, clinical, and decisional predictors of aspirin use. We also conducted a multivariable analysis with aspirin use as a dependent variable.

RESULTS—Sixty-seven percent of patients surveyed used aspirin. Patients using aspirin were at higher risk of cardiovascular disease (odds ratio 1.4, 95% CI 1.0–2.1), knew more about the benefits of aspirin (1.9, 1.4–2.6) and less about the risks of aspirin (1.4, 1.2–1.8), and were more certain about using aspirin (0.5, 0.3–0.8) than patients not using aspirin. Patients using aspirin placed a higher value on preventing cardiovascular events than on avoiding the side effects of aspirin. Patients perceived that their diabetes provider and the American Diabetes Association had greater influence on their decision to use aspirin than family members or other patients with diabetes.

CONCLUSIONS—The decisional attributes of patients with diabetes are associated with aspirin use. Decisional attributes may be the target of research and interventions to reduce underutilization to levels consistent with patient preferences.
Development of a Reliable and Valid Chinese Version of the Diabetes Empowerment Scale
Authors: Shiu Ann T.Y. , Wong Rebecca Y.M. , Thompson David R.
Published: March 2007

OBJECTIVE—To translate the Diabetes Empowerment Scale (DES) into Chinese and establish its psychometric properties among Hong Kong Chinese people.

RESEARCH DESIGN AND METHODS—A two-stage study design, incorporating qualitative and quantitative components, determined the cultural equivalency and content validity of the translated scale and established the psychometric properties of the Chinese DES (C-DES) in 207 patients.

RESULTS—Psychometric analysis supported the reliability and validity of the 20-item Chinese DES (C-DES-20) and five subscales: overcoming barriers (α = 0.89), determining suitable methods (α = 0.79), achieving goals (α = 0.78), obtaining support (α = 0.78), and coping (α = 0.76). The test-retest reliability of the intraclass correlations was satifactory when a subsample of 20 patients was tested after a 2-week interval. There was criterion validity between the global scale and metabolic control (HbA1c) of respondents with type 2 diabetes (P = 0.03).

CONCLUSIONS—The C-DES-20 is a reliable and valid outcome measure for patient education and psychosocial interventions among Hong Kong Chinese people with diabetes.
Changing Prevalence of Overweight Children and Adolescents at Onset of Insulin-Treated Diabetes
Authors: Libman Ingrid M. , Pietropaolo Massimo , Arslanian Silva A. , LaPorte Ronald E. , Becker Dorothy J.
Published: March 2007

OBJECTIVE—The aim of this study was to compare the prevalence of being overweight in black and white children and adolescents at onset of insulin-treated diabetes during two time periods: 1979–1989 (period I) and 1990–1998 (period II).

RESEARCH DESIGN AND METHODS—All black children <19 years of age diagnosed with diabetes and treated with insulin at onset admitted to the Children’s Hospital of Pittsburgh between January 1979 and December 1998 were matched with white children by sex, age at onset, and year of diagnosis. Data were obtained from a review of medical records. Overweight was defined as BMI ≥85th percentile for age and sex. Islet cell autoantibodies were measured.

RESULTS—The prevalence of being overweight increased from 12.6% (period I) to 36.8% (period II) (P = 0.0003); in whites from 2.9 to 16.6% (P = 0.04) and in blacks from 22 to 55% (P = 0.001); and in the age-group <11 years from 7.3 to 22.2% (P = 0.04) and age 11–18 years from 20 to 50% (P = 0.006). In children with at least one antibody, the prevalence of being overweight increased from 5.1 to 24.4% (P = 0.001). In the multivariate logistic regression, period of diagnosis (period II), race (black), age at onset (≥11 years old), and absence of autoimmunity were associated with being overweight.

CONCLUSIONS—At onset of the disease, the prevalence of being overweight has tripled from the 1980s to the 1990s, following the trend in the general population. Weight gain may be an accelerating factor for onset of insulin-treated diabetes and may have contributed to the increased incidence of diabetes in youth seen in some populations.
PC-1 Amino Acid Variant Q121 Is Associated With a Lower Glomerular Filtration Rate in Type 2 Diabetic Patients With Abnormal Albumin Excretion Rates
Authors: De Cosmo Salvatore , Trevisan Roberto , Dalla Vestra Michele , Vedovato Monica , Argiolas Alessandra , Solini Anna , Saller Alois , Damone Francesco , Tiengo Antonio , Trischitta Vincenzo , Fioretto Paola
Published: March 2007

OBJECTIVE—To study the relationships between the PC-1 K121Q variant and diabetic nephropathy (DN) in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS—A total of 125 patients with type 2 diabetes and abnormal albumin excretion rate (AER) (range 20–5,416 μg/min) were followed up for 4 years with repeated measurements of glomerular filtration rate (GFR). Genomic DNA was extracted from all patients, and the PC-1 K121Q polymorphism was determined by the PCR AvaII restriction enzyme. A subset of 64 patients underwent a percutaneous kidney biopsy at baseline, and glomerular structure was analyzed by electron microscopic morphometric analysis. At baseline, age (56 ± 8 vs. 59 ± 7 years), BMI (28.3 ± 4.3 vs. 28.6 ± 3.7 kg/m2), known duration of type 2 diabetes (11.1 ± 7 vs. 11.9 ± 8 years), and HbA1c (8.6 ± 1.8 vs. 8.4 ± 1.7%) were similar in K121K (KK, n = 87, 73 men/14 women) and XQ (35 K121Q + 3 Q121Q, n = 38, 27 men/11 women) patients. Baseline GFR was 96 ± 28 ml · min−1 · 1.73 m−2 and was related (P = 0.01–0.001) to age, known diabetes duration, and systolic blood pressure.

RESULTS—XQ patients had lower GFR (P < 0.05) than KK patients (88 ± 30 vs. 100 ± 26 ml · min−1 · 1.73 m−2); this difference persisted also after factoring in age and known diabetes duration. The rate of progression of DN was similar in KK and XQ patients: %ΔGFR was 4.1/year (median, range: 22.9–30.6) vs. 4.2/year (9.8–26.7). Morphometric parameters of diabetic glomerulopathy were similar in the two genotype groups.

CONCLUSIONS—Among patients with type 2 diabetes with abnormal AER, those carrying the Q PC-1 genotype have more severe DN but not a faster GFR decline than KK patients, thus suggesting faster DN development since diabetes diagnosis in XQ patients.