bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Active Family Nutritional Support in Navajos’ Type 2 Diabetes Metabolic Control
Authors: Epple Carolyn , Wright Anne L. , Joish Vijay N. , Bauer Mark
Published: March 2007

OBJECTIVE—We examined if active family nutritional support is associated with improved metabolic outcomes for Diné (Navajo) individuals living with type 2 diabetes.

RESEARCH DESIGN AND METHODS—The presence of family support, using variables identified in earlier ethnographic research, was assessed via surveys in a convenience sample of 163 diabetic individuals. Diabetes outcome measures (HbA1c, serum glucose, triglycerides, total cholesterol, creatinine, and systolic and diastolic blood pressure measures) were extracted from participants’ medical records. Bivariate analyses and multiple logistic regressions were conducted.

RESULTS—All measures of family support showed a relation with one or more indicators of metabolic control in bivariate analyses. In multivariate analyses, respondents were more likely to be in the best tertile for triglyceride (P < 0.05), cholesterol (P < 0.05), and HbA1c (P < 0.05) if another person cooked most of the meals. Respondents in families who bought/cooked “light” foods were more likely to be in the best tertile for triglyceride (P < 0.005) and cholesterol levels (P < 0.005), and those in families whose members ate “light” foods with them were more likely to be in the best tertile for triglycerides (P < 0.005). When all three support variables were entered into a multivariate model, only the variable “other family members cook the majority of the meals” was significantly associated with being in the lowest triglyceride (P = 0.05), HbA1c (P < 0.05), or cholesterol tertiles (P < 0.05). These relationships were most evident for women with diabetes.

CONCLUSIONS—Active family nutritional support, as measured by culturally relevant categories, is significantly associated with control of triglyceride, cholesterol, and HbA1c levels. The findings suggest that the family is a more useful unit of intervention for Diné individuals than for the individual alone when designing diabetes care strategies.
Nonremovable, Windowed, Fiberglass Cast Boot in the Treatment of Diabetic Plantar Ulcers
Authors: Ha Van Georges , Siney Hubert , Hartmann-Heurtier Agnes , Jacqueminet Sophie , Greau Françoise , Grimaldi André
Published: March 2007

OBJECTIVE—To compare the efficacy, safety, and compliance of a nonremovable fiberglass cast boot and off-loading shoes in the treatment of diabetic plantar ulcers.

RESEARCH DESIGN AND METHODS—Patients (n = 93) with noninfected, nonischemic plantar ulcers were included in this prospective nonrandomized study. Treatment used a nonremovable fiberglass cast boot for longer standing and deeper ulcers (n = 42) and a half shoe or heel-relief shoe for other ulcers (n = 51). We evaluated off-loading therapy, compliance, and complications in both groups.

RESULTS—The healing rate was significantly higher with the cast boot than with the off-loading shoe (81 vs. 70%, P = 0.017), with healing times of 68.6 ± 35.1 vs. 134.2 ± 133.0 days, respectively, and hazard ratio 1.68 (95% CI 1.04–2.70); complete compliance with treatment was 98 vs. 10% (P = 0.001), respectively. Secondary osteomyelitis developed in 3 patients in the cast boot group and 13 patients in the off-loading shoe group (P = 0.026).

CONCLUSIONS—A nonremovable fiberglass cast boot was effective in healing diabetic plantar ulcers and in decreasing the risk of secondary osteomyelitis. The cast boot forced compliance with off-loading, thus promoting healing.
Use of Thiazolidinediones and Risk of Heart Failure in People With Type 2 Diabetes
Authors: Delea Thomas E. , Edelsberg John S. , Hagiwara May , Oster Gerry , Phillips Lawrence S.
Published: March 2007

OBJECTIVE—To compare the incidence of heart failure in individuals with type 2 diabetes receiving thiazolidinediones (TZDs) versus other oral antihyperglycemic agents.

RESEARCH DESIGN AND METHODS—We conducted a retrospective cohort study using a health insurance claims database. The study sample included patients with type 2 diabetes who received an oral antihyperglycemic agent between January 1995 and March 2001. Those with any claims for TZDs were designated “exposed,” and each was compared with five randomly selected unexposed patients. Those with diagnoses of heart failure or who received digoxin or a diuretic in the year before their index date were excluded. The primary measure of interest was incidence of heart failure, which was defined as a hospitalization or outpatient visit with a diagnosis of heart failure.

RESULTS—TZD patients (n = 5,441) were younger than control subjects (n = 28,103) but more likely to have coronary artery disease or diabetes complications, receive ACE inhibitors, β-blockers, metformin, or insulin, and have undergone HbA1c tests or eye exams; they also had more comorbidities and higher costs (all P < 0.05). However, TZD use was predictive of heart failure even after controlling for these variables (hazard ratio = 1.7, P < 0.001). Adjusted incidence of heart failure at 40 months was 8.2% for TZD patients and 5.3% for control subjects.

CONCLUSIONS—The results of this observational study suggest that TZDs may increase the risk of heart failure. Physicians should use TZDs with caution in patients with heart failure, remain vigilant for manifestations of heart failure in those receiving these drugs (especially patients with cardiovasculopathy), and consider alternate therapies for patients who develop symptoms of heart failure, such as shortness of breath.
Validation of the Archimedes Diabetes Model
Authors: Eddy David M. , Schlessinger Leonard
Published: March 2007

OBJECTIVE—To validate the Archimedes model of diabetes and its complications for a variety of populations, organ systems, treatments, and outcomes.

RESEARCH DESIGN AND METHODS—We simulated a variety of randomized controlled trials by repeating in the model the steps taken for the real trials and comparing the results calculated by the model with the results of the trial. Eighteen trials were chosen by an independent advisory committee. Half the trials had been used to help build the model (“internal” or “dependent” validations); the other half had not. Those trials comprise “external” or “independent” validations.

RESULTS—A total of 74 validation exercises were conducted involving different treatments and outcomes in the 18 trials. For 71 of the 74 exercises there were no statistically significant differences between the results calculated by the model and the results observed in the trial. Considering only the trials that were never used to help build the model—the independent or external validations—the correlation was r = 0.99. Including all of the exercises, the correlation between the outcomes calculated by the model and the outcomes seen in the trials was r = 0.99. When the absolute differences in outcomes between the control and treatment groups were compared, the correlation coefficient was r = 0.97.

CONCLUSIONS—The Archimedes diabetes model is a realistic representation of the anatomy, pathophysiology, treatments, and outcomes pertinent to diabetes and its complications for applications that involve the populations, treatments, outcomes, and health care settings spanned by the trials.
Semiquantitative Analysis of the Histopathological Features of the Neuropathic Foot Ulcer
Authors: Piaggesi Alberto , Viacava Paolo , Rizzo Loredana , Naccarato Giuseppe , Baccetti Fabio , Romanelli Marco , Zampa Virna , Del Prato Stefano
Published: March 2007

OBJECTIVE—This study was designed to evaluate the histopathology of neuropathic ulcers and whether pressure relief could change such histological patterns.

RESEARCH DESIGN AND METHODS—We compared neuropathic plantar ulcers tissue excised from 10 diabetic patients (group A) with those taken from 10 patients with comparable lesions and glycemic control after 20 days in a total contact cast (group B). Tissue specimens were blindly examined by two independent pathologists for hyperkeratosis, fibrosis, cutaneous annexes, capillaries, inflammation, cellular debris, and granulating tissue. For each parameter, quantification was obtained according to an arbitrary score: 0, absent; 1, present in <33%; 2, present in 34–66%; and 3, present in >67% of the lesion.

RESULTS—Patients in group B showed a marked reduction in ulcer size after 20 days of casting (P < 0.01). The histopathological features of the two groups markedly differed. Group A patients showed a predominance of inflammatory elements as well as matrix alterations, vessel disruptions, inflammation, and debris. Group B ulcers showed a shift toward a reparative pattern with prevalence of neoformed capillaries and fibroblasts. Semiquantitative analysis confirmed the prevalence of hyperkeratosis, fibrosis, inflammation, and cellular debris in group A patients (P < 0.05), whereas cutaneous annexes, capillaries, and granulating tissue were more prevalent in group B lesions (P < 0.01).

CONCLUSIONS—These results indicate that pressure relief with a total contact cast is associated with changes in the histology of neuropathic foot ulcers, indicating reduction of inflammatory and reactive components and acceleration of reparative processes.
Effects of Pioglitazone Versus Diet and Exercise on Metabolic Health and Fat Distribution in Upper Body Obesity
Authors: Shadid Samyah , Jensen Michael D.
Published: March 2007

OBJECTIVE—Insulin resistance is associated with visceral adiposity, and interventions that reduce this depot, e.g., diet and exercise, improve insulin resistance. Thiazolidinediones (TZDs) also improve insulin action but paradoxically increase total fat mass, perhaps through remodeling (recruitment of smaller fat cells) and redistribution of adipose tissue. We assessed the effects of pioglitazone versus diet and exercise on fat distribution and the relationship between fat distribution and insulin sensitivity in upper body obesity.

RESEARCH DESIGN AND METHODS—Thirty-nine upper body obese, insulin-resistant, nondiabetic men and premenopausal women were randomly assigned to receive either 30 mg/day pioglitazone or a diet and exercise program for 20 weeks. Before and after the intervention, insulin sensitivity, body composition, body fat distribution (waist-to-hip ratio [WHR], computed tomography abdomen, and dual-energy X-ray absorptiometry), and abdominal and femoral fat cell size were assessed.

RESULTS—Diet and exercise resulted in an 11.8 ± 1.1 kg weight loss. Both diet and exercise and pioglitazone improved insulin sensitivity, but only the former was associated with loss of intra-abdominal fat. Pioglitazone increased total body fat, which preferentially accumulated in the lower body depot in both men and women. WHRs decreased in both groups. Abdominal fat cell size decreased (P = 0.06) after diet and exercise. No statistically significant changes in fat cell size were observed in pioglitazone-treated volunteers.

CONCLUSIONS—In nondiabetic upper body obese subjects, increasing insulin sensitivity via diet and exercise accompanies reductions in visceral fat. Pioglitazone treatment also improves insulin sensitivity and lowers WHR, but this is due to a selective increase in lower body fat. This confirms a site-specific responsiveness of adipose tissue to TZD and suggests that improvements in insulin sensitivity by pioglitazone are achieved independent of changes in intra-abdominal fat.
The Finnish Diabetes Prevention Study (DPS)
Authors: Lindström Jaana , Louheranta Anne , Mannelin Marjo , Rastas Merja , Salminen Virpi , Eriksson Johan , Uusitupa Matti , Tuomilehto Jaakko ,   for the Finnish Diabetes Prevention Study Group
Published: March 2007

OBJECTIVE—To describe the 1) lifestyle intervention used in the Finnish Diabetes Prevention Study, 2) short- and long-term changes in diet and exercise behavior, and 3) effect of the intervention on glucose and lipid metabolism.

RESEARCH DESIGN AND METHODS—There were 522 middle-aged, overweight subjects with impaired glucose tolerance who were randomized to either a usual care control group or an intensive lifestyle intervention group. The control group received general dietary and exercise advice at baseline and had an annual physician’s examination. The subjects in the intervention group received additional individualized dietary counseling from a nutritionist. They were also offered circuit-type resistance training sessions and advised to increase overall physical activity. The intervention was the most intensive during the first year, followed by a maintenance period. The intervention goals were to reduce body weight, reduce dietary and saturated fat, and increase physical activity and dietary fiber.

RESULTS—The intervention group showed significantly greater improvement in each intervention goal. After 1 and 3 years, weight reductions were 4.5 and 3.5 kg in the intervention group and 1.0 and 0.9 kg in the control group, respectively. Measures of glycemia and lipemia improved more in the intervention group.

CONCLUSIONS—The intensive lifestyle intervention produced long-term beneficial changes in diet, physical activity, and clinical and biochemical parameters and reduced diabetes risk. This type of intervention is a feasible option to prevent type 2 diabetes and should be implemented in the primary health care system.
Serum ACE Predicts Severe Hypoglycemia in Children and Adolescents With Type 1 Diabetes
Authors: Nordfeldt Sam , Samuelsson Ulf
Published: March 2007

OBJECTIVE—To investigate whether risk of severe hypoglycemia is related to serum (S) ACE level during intensive treatment in type 1 diabetic children.

RESEARCH DESIGN AND METHODS—A cohort of 86 intensively treated type 1 diabetic patients was studied during 1999–2000. In 1999, the age range was 7–19 years (median 12.8), diabetes duration was 1.2–14.7 years (5.3), insulin dose was 0.4–1.7 units · kg−1 · 24 h−1 (1.0), and the HbA1c year mean was 4.7–10.2% (6.8). HbA1c, insulin doses, and events of severe hypoglycemia (needing assistance from another person) were prospectively registered at regular visits, scheduled quarterly. S-ACE was determined once.

RESULTS—Severe hypoglycemia was correlated to S-ACE (r = 0.22, 95% CI 0.01–0.41, P = 0.0093). The square root of severe hypoglycemia was correlated to S-ACE (r = 0.27, 95% CI 0.06–0.45, P = 0.0093). Patients with S-ACE at the median level or above (n = 44) reported a mean of 3.0 yearly events of severe hypoglycemia compared with 0.5 events in patients with S-ACE lower than the median (n = 42) (P = 0.0079). Of the patients with an S-ACE at the median level or above, 27 (61%) reported severe hypoglycemia, compared with 17 (40%) patients with an S-ACE lower than the median (P = 0.0527). Insulin dose, HbA1c, age, onset age, duration, C-peptide, and sex did not differ between these two groups. S-ACE was negatively correlated with age (r = −0.27, 95% CI −0.46 to 0.07, P = 0.0265) but not with HbA1c, duration, or blood pressure.

CONCLUSIONS—The elevated rate of severe hypoglycemia among patients with higher S-ACE suggests, among other factors, that a genetic determinant for severe hypoglycemia exists. Further evaluation is needed before the clinical usefulness of this test can be elucidated.
Target-Seeking Behavior of Plasma Glucose With Exercise in Type 1 Diabetes
Authors: Biankin Sandra A. , Jenkins Arthur B. , Campbell Lesley V. , Choi Kin Lam , Forrest Quentin G. , Chisholm Donald J.
Published: March 2007

OBJECTIVE—To investigate the reproducibility of the plasma glucose (PG) response to exercise in subjects with type 1 diabetes on a nonintensive insulin regimen.

RESEARCH DESIGN AND METHODS—Subjects cycled for 45 min at 50% Vo2max on two occasions (studies 1 and 2) either 1 h after lunch and usual insulin (protocol A) or after overnight fasting without morning insulin (protocol B). Identical diet, activity, and insulin (twice daily neutral and intermediate) were maintained before and during each study day. A total of 13 type 1 diabetic subjects (6 men and 7 women, BMI 24.0 ± 0.9 kg/m2 [means ± SE], age 42.6 ± 2.7 years, diabetes duration 14.1 ± 2.8 years) completed protocol A, and 7 (3 men and 4 women, BMI 25.8 ± 1.3 kg/m2, age 39.7 ± 1.3 years, diabetes duration 14 ± 4.4 years) completed protocol B.

RESULTS—In protocol A (fed), the fall in PG during exercise was 4.5 ± 1.0 and 5.0 ± 0.8 mmol/l in studies 1 and 2, respectively, whereas in protocol B (fasted), it was 0.6 ± 0.8 and 3.4 ± 1.6 mmol/l. Regression analysis of the change in PG in protocol A in study 1 versus study 2 showed poor reproducibility (r2 = 0.12, P = 0.25) despite uniform conditions. In protocol B, the fall in PG was more reproducible (r2 = 0.81, P = 0.006). In fed subjects, there was better (P = 0.01) and clinically useful reproducibility of the PG at exercise completion (r2 = 0.77, P = 0.0001) compared with preexercise.

CONCLUSIONS—These results indicate poor reproducibility of the change in PG during exercise after feeding in type 1 diabetes on nonintensive insulin regimens but reasonable reproducibility when fasting. Exercise apparently decreases the glycemic variability after feeding, so that PG concentrations after exercise seek a reproducible “target.” Thus, the absolute PG level after a typical bout of exercise in the fed state should be a good guide to carbohydrate or insulin adjustment on subsequent occasions.
Epidemiology of Diabetes Among Arab Americans
Authors: Jaber Linda A. , Brown Morton B. , Hammad Adnan , Nowak Sandra N. , Zhu Qian , Ghafoor Anisa , Herman William H.
Published: March 2007

OBJECTIVE—To examine the prevalence of diabetes and glucose intolerance by age and sex in the Arab-American community of Dearborn, Michigan.

RESEARCH DESIGN AND METHODS—Participants were randomly selected adult Arab Americans, 20–75 years of age, from randomly selected households in Dearborn, Michigan. Demographic and anthropometric data were recorded. Glucose tolerance was assessed with 2-h 75-g oral glucose tolerance tests and classified according to 1997 American Diabetes Association and 1998 World Health Organization criteria.

RESULTS—A total of 626 eligible adults were selected, and 542 participated (87% response rate). Because prevalence increases with age and the overall response rate for women (328/352; 93%) was higher than that for men (214/274; 78%), prevalence rates were adjusted for age and sex. The overall prevalence of diabetes was 15.5% (95% CI 12.2–18.7%) in women and 20.1% (15.0–25.2%) in men (P = 0.13). The prevalence of previously diagnosed diabetes was similar to that of undiagnosed diabetes. Impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG) were present in 16.8% (12.8–20.8%) of women and 29.7% (23.4–35.9%) of men (P = 0.0007). The combined rates of glucose intolerance (diabetes, IGT, and IFG) were 32.3% (27.8–36.7%) for women and 49.8% (43.1–56.4%) for men (P < 0.0001). Among younger adults, the prevalence in men was higher than that in women. As expected, subjects with diabetes or IGT/IFG were older and had greater BMI and waist-to-hip ratios than subjects with normal glucose tolerance.

CONCLUSIONS—The prevalence of diabetes and glucose intolerance is extremely high among adult Arab Americans in Michigan and represents a major clinical and public health problem. Community-based intervention programs to prevent and treat diabetes are urgently needed.
Short-Term, Delayed, and Working Memory Are Impaired During Hypoglycemia in Individuals With Type 1 Diabetes
Authors: Sommerfield Andrew J. , Deary Ian J. , McAulay Vincent , Frier Brian M.
Published: March 2007

OBJECTIVE—To examine the effects of acute insulin-induced hypoglycemia on short-term, delayed, and working memory in individuals with type 1 diabetes.

RESEARCH DESIGN AND METHODS—A hyperinsulinemic glucose clamp was used to maintain arterialized blood glucose level at either 4.5 mmol/l (euglycemia) or 2.5 mmol/l (hypoglycemia) on two separate occasions in 16 adults with type 1 diabetes. The participants completed tests of immediate and delayed verbal memory, immediate and delayed visual memory, and working memory during each experimental condition. Two other mental tests, the Trail Making B Test and the Digit Symbol Test, were also administered.

RESULTS—Performance in tests of immediate verbal and immediate visual memory was significantly impaired during hypoglycemia. The effect of hypoglycemia on working memory and delayed memory was more profound. Performance in the nonmemory tests, the Trail Making B Test, and the Digit Symbol Test also deteriorated during hypoglycemia.

CONCLUSIONS—All of the memory systems examined in the present study were affected significantly by acute hypoglycemia, particularly working memory and delayed memory. Mild (self-treated) hypoglycemia is common in individuals with insulin-treated diabetes; therefore, these observed effects of hypoglycemia on memory are of potential clinical importance because they could interfere with many everyday activities.
Prevalence and Costs of Major Depression Among Elderly Claimants With Diabetes
Authors: Finkelstein Eric A. , Bray Jeremy W. , Chen Hong , Larson Mary Jo , Miller Kay , Tompkins Christopher , Keme Allen , Manderscheid Ronald
Published: March 2007

OBJECTIVE—To compare the odds of major depression among Medicare claimants with and without diabetes and to test whether annual medical payments are greater for those with both diabetes and major depression than for those with diabetes alone.

RESEARCH DESIGN AND METHODS—This retrospective analysis relies on claims data from the 1997 Medicare 5% Standard Analytic Files. Using these data, we statistically determined whether the odds of major depression are greater among elderly claimants with diabetes after controlling for age, race/ethnicity, and sex. We then used regression analysis on a sample of over 220,000 elderly claimants with diabetes to test whether payments for non-mental health-related services are greater for those with both diabetes and major depression (n = 4,203) than for those with diabetes alone.

RESULTS—Our findings indicate that the odds of major depression are significantly greater among elderly Medicare claimants with diabetes than among those without diabetes (OR 1.58 ± 0.05). We also found that elderly claimants with both diabetes and major depression seek treatment for more services and spend more time in inpatient facilities, and as a result incur higher medical costs than claimants with diabetes but without major depression. These results hold even after excluding services related to mental health treatment.

CONCLUSIONS—This analysis suggests that treatment for major depression among claimants with diabetes may reduce total medical costs if treatment results in a decrease in utilization for general medical services in the future.
The Influence of Shoe Design on Plantar Pressures in Neuropathic Feet
Authors: Praet Stephan F.E. , Louwerens Jan-Willem K.
Published: March 2007

OBJECTIVE—The aim of this study was to investigate the effect of shoe design on the plantar pressure dynamics of patients with diabetic neuropathy during walking.

RESEARCH DESIGN AND METHODS—Three shoe design categories were tested. Total contact area and biomechanical variables in multiple areas under the foot were measured.

RESULTS—Shoes with a rocker bottom principle reduced pressure 35–65% underneath the heel and the central metatarsal heads. Increased contact area did not result in significant pressure reductions underneath the forefoot. Pressure dynamics underneath the heel and medial forefoot (first metatarsal head and hallux) on average showed no significant differences among the different shoes with a cushioning insole.

CONCLUSIONS—The most effective way to offload the forefoot of patients with neuropathic feet is through the use of the rocker sole principle. In general, the effect of an insole depends on the design characteristics of a shoe. Predicting the effect of therapeutic footwear on an individual scale, however, remains difficult. Therefore, in-shoe pressure measurements seem to be necessary to evaluate a therapeutic shoe prescription in certain individual cases.
The K121Q Polymorphism of the PC-1 Gene Is Associated With Insulin Resistance but not With Dyslipidemia
Authors: Kubaszek Agata , Pihlajamäki Jussi , Karhapää Pauli , Vauhkonen Ilkka , Laakso Markku
Published: March 2007

OBJECTIVE—To investigate the relationship of the K121Q polymorphism of the plasma cell glycoprotein 1 (PC-1) gene with insulin resistance, insulin secretion, and lipids and lipoproteins.

RESEARCH DESIGN AND METHODS—Altogether, 110 normoglycemic subjects (group I) underwent a hyperinsulinemic-euglycemic clamp for evaluation of insulin sensitivity. The first-phase insulin secretion was determined by the intravenous glucose tolerance test (IVGTT) in a separate sample of 295 normoglycemic subjects (group II).

RESULTS—The 121Q allele (genotypes K121Q and Q121Q) compared with the K121K genotype was related to higher fasting insulin levels (group I: 69.6 ± 45.6 vs. 51.9 ± 28.4 pmol/l [mean ± SD], P = 0.050; group II: 66.6 ± 38.8 vs. 53.8 ± 26.6 pmol/l, P = 0.009). In group I, subjects carrying the 121Q allele compared with subjects with the K121K genotype had lower rates of whole-body glucose uptake (51.17 ± 12.07 vs. 60.12 ± 14.86 μmol · kg−1 · min−1, P = 0.012) and nonoxidative glucose disposal (33.71 ± 10.51 vs. 41.51 ± 13.36 μmol · kg−1 · min−1, P = 0.015) during the clamp. In group II, there was no significant difference between the 121Q allele carriers and subjects with the K121K genotype in total first-phase insulin secretion during the first 10 min of the IVGTT (2,973 ± 2,224 vs. 2,520 ± 1,492 pmol · l−1 · min−1, P = 0.415). No association of the K121Q polymorphism with serum lipids and lipoproteins was found.

CONCLUSIONS—In healthy normoglycemic Finnish subjects, the K121Q polymorphism of the PC-1 gene is associated with insulin resistance but not with impaired insulin secretion or dyslipidemia.
Trends in the Diabetes Quality Improvement Project Measures in Maine From 1994 to 1999
Authors: McClain Monica R. , Wennberg David E. , Sherwin Roger W. , Steinmann William C. , Rice Janet C.
Published: March 2007

OBJECTIVE—To examine changes in the management of patients with diabetes from 1994 to 1999 using the claims-based Diabetes Quality Improvement Project (DQIP) accountability measures.

RESEARCH DESIGN AND METHODS—Administrative claims from an employer-based health insurance cohort in Maine were used to describe the prevalence of claims-based DQIP accountability measures—HbA1c testing, dilated eye examination, lipid profile, and monitoring for diabetic nephropathy—from 1994 (n = 1,151) to 1999 (n = 2,221) in a 100% sample of adults (18–64 years of age) with diabetes. The Mantel-Haenszel χ2 test for trend was performed on each measure. Prevalence estimates were also stratified by three insurance products: health maintenance organization (HMO), point of service, and indemnity.

RESULTS—There was a positive trend for all outcome measures (P < 0.001). The baseline and final frequencies (percent increase) for lipid testing, HbA1c, dilated eye examination, and screening for diabetic nephropathy were as follows: 13–50% (257%), 37–69% (92%), 30–46% (53%), and 37–50% (36%), respectively. Individuals with diabetes and indemnity insurance were much less likely to receive these measures than individuals with other types of insurance, whereas people in HMOs were more likely to receive HbA1c testing and lipid profiles.

CONCLUSIONS—The proportion of patients with diabetes receiving DQIP accountability measures significantly increased from 1994 to 1999. There is large variation in prevalence among these measures and insurance products. It is urgent to identify effective mechanisms for delivering consistent preventive care that are congruent with defined standards of benefit.
Fatty Acid Composition of Serum Lipid Fractions in Type 2 Diabetic Patients With Microalbuminuria
Authors: Perassolo Magda S. , Almeida Jussara C. , Prá Ronivan L. , Mello Vanessa D. , Maia Ana L. , Moulin Cileide C. , Camargo Joíza L. , Zelmanovitz Themis , Azevedo Mirela J. , Gross Jorge L.
Published: March 2007

OBJECTIVE—To determine the fatty acid composition of serum phospholipid, triglyceride, and cholesterol ester fractions and to analyze the lipid profile of microalbuminuric type 2 diabetic patients.

RESEARCH DESIGN AND METHODS—A case-control study was conducted with 72 patients: 37 were normoalbuminuric (urinary albumin excretion rate [UAER] <20 μg/min), and 35 were microalbuminuric (UAER 20–200 μg/min). After 4 weeks of a standardized diet, the fatty acid composition of phospholipid, triglyceride, and cholesterol ester fractions was determined by gas chromatography. Total cholesterol and triglycerides were measured by enzymatic-colorimetric methods; cholesterol HDL by double precipitation with heparin, MnCl2, and dextran sulfate; and apolipoprotein B by immunoturbidimetry.

RESULTS—Microalbuminuric patients showed a lower proportion of polyunsaturated fatty acids (24.8 ± 11.0%), especially of the n-6 family (21.7 ± 10.5%), in triglyceride fraction than normoalbuminuric patients (34.1 ± 11.3%, P = 0.001 and 31.4 ± 11.5%, P < 0.001, respectively). Patients with microalbuminuria also presented higher levels of saturated fatty acids in triglyceride fraction (43.4 ± 18.0% vs. 34.7 ± 13.1%, P = 0.022). In the logistic regression analysis, only the proportion of polyunsaturated fatty acids in triglyceride fraction remained significantly associated with microalbuminuria (odds ratio [OR] 0.92, 95% CI 0.85–0.98, P = 0.019). Total cholesterol, HDL cholesterol, triglyceride, and apolipoprotein B levels were similar in normo- and microalbuminuric patients.

CONCLUSION—Microalbuminuria in type 2 diabetic patients is associated with low polyunsaturated fatty acid contents in serum triglyceride fraction. This association may represent a risk factor for cardiovascular disease and may contribute to the progression of renal disease.
Estimated Number of Adults With Prediabetes in the U.S. in 2000
Authors: Benjamin Stephanie M. , Valdez Rodolfo , Geiss Linda S. , Rolka Deborah B. , Narayan K.M. Venkat
Published: March 2007

OBJECTIVE—To estimate the percent and number of overweight adults in the U.S. with prediabetes who would be potential candidates for diabetes prevention as per the American Diabetes Association Position Statement (12).

RESEARCH DESIGN AND METHODS—We analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III; 1988–1994) and projected our estimates to the year 2000. We defined impaired glucose tolerance (IGT; 2-h glucose 140–199 mg/dl), impaired fasting glucose (IFG; fasting glucose 110–125 mg/dl), and prediabetes (IGT or IFG) per American Diabetes Association (ADA) criteria. The ADA recently recommended that all overweight people (BMI ≥25 kg/m2) who are ≥45 years of age with prediabetes could be potential candidates for diabetes prevention, as could prediabetic people aged >25 years with risk factors. In NHANES III, 2-h postload glucose concentrations were done only among subjects aged 40–74 years. Because we were interested in overweight people who had both the 2-h glucose and fasting glucose tests, we limited our estimates of IGT, IFG, and prediabetes to those aged 45–74 years.

RESULTS—Overall, 17.1% of overweight adults aged 45–74 years had IGT, 11.9% had IFG, 22.6% had prediabetes, and 5.6% had both IGT and IFG. Based on those data, we estimated that in the year 2000, 9.1 million overweight adults aged 45–74 had IGT, 5.8 million had IFG, 11.9 million had prediabetes, and 3.0 million had IGT and IFG.

CONCLUSIONS—Almost 12 million overweight individuals aged 45–74 years in the U.S. may benefit from diabetes prevention interventions. The number will be substantially higher if estimation is extended to individuals aged >75 and 25–44 years.
Community-Based Screening for Diabetes in Michigan
Authors: Tabaei Bahman P. , Burke Ray , Constance Ann , Hare Jean , May-Aldrich Glenda , Parker Sandra A. , Scott Ann , Stys Anne , Chickering Jean , Herman William H.
Published: March 2007

OBJECTIVE—To describe and evaluate a community-based diabetes screening program supported by the Michigan Department of Community Health.

RESEARCH DESIGN AND METHODS—Between 1 June 1999 and 31 December 1999, community screening for diabetes was conducted by voluntary organizations using a standard protocol, American Diabetes Association (ADA) questionnaires, and ADA capillary plasma glucose criteria.

RESULTS—A total of 3,506 individuals were screened, 14% of whom did not meet criteria for screening. Of the 3,031 individuals appropriately screened, 57% were classified as being at high risk based on the ADA questionnaire and 5% had positive screening tests based on ADA capillary plasma glucose criteria. Despite systematic follow-up, the screening program’s yield of individuals with undiagnosed diabetes was <1%.

CONCLUSIONS—Community screening for diabetes conducted according to ADA recommendations was extremely inefficient at identifying individuals with undiagnosed diabetes. The ADA diabetes screening questionnaire resulted in many false positive tests, and the ADA criteria for positive plasma glucose tests likely missed a substantial portion of individuals with undiagnosed diabetes. Relying on biochemical tests such as random plasma glucose, changing the criteria for a positive plasma glucose test, targeting racial and ethnic minority groups, and targeting medically underserved individuals might improve the yield of community-based diabetes screening.
Is the Current Definition for Diabetes Relevant to Mortality Risk From All Causes and Cardiovascular and Noncardiovascular Diseases?
Authors:   The DECODE Study Group,   on behalf of the European Diabetes Epidemiology Group
Published: March 2007

OBJECTIVE—To assess the relation between fasting plasma glucose (FPG) or 2-h plasma glucose (2hPG) and mortality from all causes, cardiovascular disease (CVD), and non-CVD and to determine whether the relationship is graded or threshold.

RESEARCH DESIGN AND METHODS—Diabetes Epidemiology: Collaborative Analysis Of Diagnostic Criteria in Europe (DECODE) is a collaborative prospective study of 22 cohorts in Europe with baseline glucose measurements for 29,714 subjects aged 30–89 years who were followed-up for 11 years (329,050 person-years). Hazard ratio (HR) for death was estimated using Cox regression analysis.

RESULTS—High glucose concentrations as well as very low glucose levels were associated with increased risk of death. Compared with an FPG of 4.50–6.09 mmol/l, the multivariate-adjusted HR (95% CI) for FPG <4.50 mmol/l was 1.2 (1.0–1.4) for all-cause, 1.3 (1.0–1.8) for CVD, and 1.1 (0.9–1.4) for non-CVD mortality; the corresponding HRs for diabetes (FPG ≥7.0 mmol/l) were 1.6 (1.4–1.8), 1.6 (1.3–1.9), and 1.6 (1.4–1.9), respectively. For a 2hPG of 3.01–4.50 mmol/l, as compared with a 2hPG of 4.51–5.50 mmol/l, the HRs were 1.1 (1.0–1.2), 1.1 (0.9–1.3), and 1.1 (1.0–1.3), respectively; the corresponding HRs for diabetes (2hPG ≥11.1 mmol/l) were 2.0 (1.7–2.3), 1.9 (1.5–2.4), and 2.1 (1.7–2.5), respectively. The HR for previously undetected diabetes defined by 2hPG was not significantly different from that for known diabetes, which was significantly higher than that for undetected diabetes based on FPG. Subjects with a 2hPG of 10.01–11.09 mmol/l had mortality risks similar to those diabetic subjects defined by an FPG ≥7.0 mmol/l.

CONCLUSIONS—The relation between mortality and glucose was J shaped rather than showing threshold effect at high glucose levels, except for CVD mortality and 2hPG, where the relation was graded and increasing.
Diabetes and Sleep Disturbances
Authors: Resnick Helaine E. , Redline Susan , Shahar Eyal , Gilpin Adele , Newman Anne , Walter Robert , Ewy Gordon A. , Howard Barbara V. , Punjabi Naresh M.
Published: March 2007

OBJECTIVE—To test the hypothesis that diabetes is independently associated with sleep-disordered breathing (SDB), and in particular that diabetes is associated with sleep abnormalities of a central, rather than obstructive, nature.

RESEARCH DESIGN AND METHODS—Using baseline data from the Sleep Heart Health Study (SHHS), we related diabetes to 1) the respiratory disturbance index (RDI; number of apneas plus hypopneas per h of sleep); 2) obstructive apnea index (OAI; ≥3 apneas/h of sleep associated with obstruction of the upper airway); 3) percent of sleep time < 90% O2 saturation; 4) central apnea index (CAI; ≥3 apneas [without respiratory effort]/h sleep); 5) occurrence of a periodic breathing (Cheyne Stokes) pattern; and 6) sleep stages. Initial analyses excluding persons with prevalent cardiovascular disease (CVD) were repeated including these participants.

RESULTS—Of the 5,874 participants included in this report, 692 (11.8%) reported diabetes or were taking oral hypoglycemic medications or insulin and 1,002 had prevalent CVD. Among the 4,872 persons without CVD, 470 (9.6%) had diabetes. Diabetic participants had worse CVD risk factor profiles than their nondiabetic counterparts, including higher BMI, waist and neck circumferences, triglycerides, higher prevalence of hypertension, and lower HDL cholesterol (P < 0.001, all). Descriptive analyses indicated differences between diabetic and nondiabetic participants in RDI, sleep stages, sleep time <90% O2 saturation, CAI, and periodic breathing (P < 0.05, all). However, multivariable regression analyses that adjusted for age, sex, BMI, race, and neck circumference eliminated these differences for all sleep measures except percent time in rapid eye movement (REM) sleep (19.0% among diabetic vs. 20.1% among nondiabetic subjects, P < 0.001) and prevalence of periodic breathing (odds ratio [OR] for diabetic subjects versus nondiabetic subjects 1.80, 95% CI 1.02–3.15). Additionally, adjusted analyses showed diabetes was associated with nonstatistically significant elevations in the odds of an increased central breathing index (OR 1.42, 95% CI 0.80–2.55). Addition to the analysis of the 1,002 persons with prevalent CVD (including 222 people with diabetes) did not materially change these results.

CONCLUSIONS—These data suggest that diabetes is associated with periodic breathing, a respiratory abnormality associated with abnormalities in the central control of ventilation. Some sleep disturbances may result from diabetes through the deleterious effects of diabetes on central control of respiration. The high prevalence of SDB in diabetes, although largely explained by obesity and other confounders, suggests the presence of a potentially treatable risk factor for CVD in the diabetic population.
The Diabetes Risk Score
Authors: Lindström Jaana , Tuomilehto Jaakko
Published: March 2007

OBJECTIVE—Interventions to prevent type 2 diabetes should be directed toward individuals at increased risk for the disease. To identify such individuals without laboratory tests, we developed the Diabetes Risk Score.

RESEARCH DESIGN AND METHODS—A random population sample of 35- to 64-year-old men and women with no antidiabetic drug treatment at baseline were followed for 10 years. New cases of drug-treated type 2 diabetes were ascertained from the National Drug Registry. Multivariate logistic regression model coefficients were used to assign each variable category a score. The Diabetes Risk Score was composed as the sum of these individual scores. The validity of the score was tested in an independent population survey performed in 1992 with prospective follow-up for 5 years.

RESULTS—Age, BMI, waist circumference, history of antihypertensive drug treatment and high blood glucose, physical activity, and daily consumption of fruits, berries, or vegetables were selected as categorical variables. Complete baseline risk data were found in 4,435 subjects with 182 incident cases of diabetes. The Diabetes Risk Score value varied from 0 to 20. To predict drug-treated diabetes, the score value ≥9 had sensitivity of 0.78 and 0.81, specificity of 0.77 and 0.76, and positive predictive value of 0.13 and 0.05 in the 1987 and 1992 cohorts, respectively.

CONCLUSIONS—The Diabetes Risk Score is a simple, fast, inexpensive, noninvasive, and reliable tool to identify individuals at high risk for type 2 diabetes.
Vardenafil, a New Phosphodiesterase Type 5 Inhibitor, in the Treatment of Erectile Dysfunction in Men With Diabetes
Authors: Goldstein Irwin , Young Jay M. , Fischer Jerome , Bangerter Keith , Segerson Thomas , Taylor Terry ,   The Vardenafil Diabetes Study Group
Published: March 2007

OBJECTIVE—This study evaluated the efficacy and safety of vardenafil treatment for erectile dysfunction (ED) in men with diabetes.

RESEARCH DESIGN AND METHODS—In this prospective multicenter double-blind placebo-controlled fixed-dose parallel-group phase III trial, 452 patients with diabetes (type 1 or type 2) and ED were randomized to take 10 or 20 mg vardenafil or placebo as needed for 12 weeks. Efficacy responses were assessed by International Index of Erectile Function domain scores, rates of vaginal penetration and successful intercourse, and a global assessment question (GAQ) about erection improvement during the previous 4 weeks.

RESULTS—After 12 weeks of treatment, a dose-dependent (P = 0.02) improvement in erections was noted for the GAQ, with 57 and 72% of men taking 10 mg or 20 mg vardenafil, respectively, reporting improved erections, in contrast to 13% after taking placebo (P < 0.0001). For the erectile function domain, dose-dependent (P = 0.03) final scores for the 10- and 20-mg dose were 17.1 and 19.0 compared with 12.6 for placebo (P < 0.0001). Both vardenafil doses significantly enhanced the rates of successful penetration (P < 0.0001) and successful intercourse (P < 0.0001) compared with placebo. Vardenafil treatment was effective in increasing intercourse success rates at all levels of baseline ED severity, at each level of plasma HbA1c, and for type 1 and 2 diabetes. Treatment-emergent adverse events were primarily mild to moderate headache (≤13%), flushing (≤10%), and rhinitis (≤10%).

CONCLUSIONS—Vardenafil statistically improved erectile function and was generally well tolerated in these diabetic patients with ED.
First-Trimester C-Reactive Protein and Subsequent Gestational Diabetes
Authors: Wolf Myles , Sandler Laura , Hsu Karen , Vossen-Smirnakis Karen , Ecker Jeffrey L. , Thadhani Ravi
Published: March 2007

OBJECTIVE—Systemic inflammation is associated with the development of type 2 diabetes. We tested the hypothesis that increased inflammation, measured early in pregnancy, is associated with the subsequent development of gestational diabetes mellitus (GDM), a precursor of type 2 diabetes.

RESEARCH DESIGN AND METHODS—We conducted a prospective nested case-control study in a pregnancy cohort. First-trimester C-reactive protein (CRP) levels were measured using a high-resolution assay in 43 women who subsequently developed GDM and in a random sample of 94 women who remained euglycemic throughout pregnancy. Median CRP levels were compared using Wilcoxon’s rank-sum test. Logistic regression was used to compute unadjusted and multivariable-adjusted odds ratios for developing GDM among CRP tertiles.

RESULTS—First-trimester CRP levels were significantly increased among women who subsequently developed GDM compared with control subjects (3.1 vs. 2.1 mg/l, P < 0.01). The risk of developing GDM among women in the highest CRP tertile compared with the lowest tertile was 3.2 (95% CI 1.2–8.8). After adjusting for age, race/ethnicity, smoking, parity, blood pressure, and gestational age at CRP sampling, the risk of developing GDM among women in the highest compared with the lowest tertile was 3.6 (95% CI 1.2–11.4). When BMI was included in the model, however, the association between increased CRP and GDM was attenuated (odds ratio for the highest compared with lowest tertile 1.5 [95% CI 0.4–5.5]).

CONCLUSIONS—In women who develop GDM, there is evidence of increased inflammation during the first trimester. This association is mediated in part by increased BMI. Larger studies are needed to verify these results.
Analysis of the Relationship Between the Pro12Ala Variant in the PPAR-γ2 Gene and the Response Rate to Therapy With Pioglitazone in Patients With Type 2 Diabetes
Authors: Blüher Matthias , Lübben Georg , Paschke Ralf
Published: March 2007

OBJECTIVE—To investigate the influence of peroxisome proliferator-activated receptor-γ (PPAR-γ) gene variants on the response rate to therapy with the thiazolidinedione (TZD) pioglitazone, because in vitro studies have suggested that genetic variants of the PPAR-γ gene may influence the drug efficacy of TZD.

RESEARCH DESIGN AND METHODS—A total of 131 patients were treated in an open-label, randomized, multicenter study with pioglitazone (45 mg o.d.) during a course of ≥26 weeks. Response to the pioglitazone therapy was defined by either a >20% decrease in fasting plasma glucose or a >15% decrease in HbA1c values after 26 weeks of pioglitazone treatment. We evaluated the association between the PPAR-γ genotype and the response rate to pioglitazone treatment.

RESULTS—The Pro12Ala and the Pro12Pro variants in the PPAR-γ gene are not associated with the response rate to pioglitazone treatment in patients with type 2 diabetes. However, we identified initial fasting plasma glucose level >11.0 mmol/l, HbA1c value >9.0%, BMI >32 kg/m2, and fasting C-peptide concentrations at baseline >2.5 pmol/l as predominant confounding factors for the responder frequency to pioglitazone treatment.

CONCLUSIONS—The Pro12Ala variant in the PPAR-γ gene does not affect the therapy efficacy of pioglitazone, suggesting that the drug-treatment response is independent from pharmacogenetic effects between PPAR-γ and its ligand pioglitazone. Whether the Ala12Ala genotype plays a role in the response rate to TZD therapy remains to be determined.
Effect of Glucagon-Like Peptide 1 (7-36 Amide) on Insulin-Mediated Glucose Uptake in Patients With Type 1 Diabetes
Authors: Meneilly Graydon S. , McIntosh Christopher H.S. , Pederson Raymond A. , Habener Joel F. , Ehlers Mario R.W. , Egan Josephine M. , Elahi Dariush
Published: March 2007

OBJECTIVE—To examine the insulinomimetic insulin-independent effects of glucagon-like peptide (GLP)-1 on glucose uptake in type 1 diabetic patients.

RESEARCH DESIGN AND METHODS—We used the hyperinsulinemic-euglycemic clamp (480 pmol · m−2 · min−1) in paired randomized studies of six women and five men with type 1 diabetes. In the course of one of the paired studies, the subjects also received GLP-1 at a dose of 1.5 pmol · kg−1 · min−1. The patients were 41 ± 3 years old with a BMI of 25 ± 1 kg/m2. The mean duration of diabetes was 23 ± 3 years.

RESULTS—Plasma glucose was allowed to fall from a fasting level of ∼11 mmol/l to 5.3 mmol/l in each study and thereafter was held stable at that level. Plasma insulin levels during both studies were ∼900 pmol/l. Plasma C-peptide levels did not change during the studies. In the GLP-1 study, plasma total GLP-1 levels were elevated from the fasting level of 31 ± 3 to 150 ± 17 pmol/l. Plasma glucagon levels fell from the fasting levels of ∼14 pmol/l to 9 pmol/l during both paired studies. Hepatic glucose production was suppressed during the glucose clamps in all studies. Glucose uptake was not different between the two studies (∼40 μmol · kg−1 · min−1).

CONCLUSIONS—GLP-1 does not augment insulin-mediated glucose uptake in lean type 1 diabetic patients.