bluuebunny/crossref_metadata_2025 huggingface dataset:
N-terminal Pro-B–Type Natriuretic Peptide (NT-proBNP) Concentrations in Hemodialysis Patients: Prognostic Value of Baseline and Follow-up Measurements
Authors: Gutiérrez Orlando M , Tamez Hector , Bhan Ishir , Zazra James , Tonelli Marcello , Wolf Myles , Januzzi James L , Chang Yuchiao , Thadhani Ravi
Published: June 2008

Background: Increased N-terminal pro-B–type natriuretic peptide (NT-proBNP) concentrations are associated with increased cardiovascular mortality in chronic hemodialysis patients. Previous studies focused on prevalent dialysis patients and examined single measurements of NT-proBNP in time.

Methods: We measured NT-proBNP concentrations in 2990 incident hemodialysis patients to examine the risk of 90-day and 1-year mortality associated with baseline NT-proBNP concentrations. In addition, we calculated the change in concentrations after 3 months in a subset of 585 patients to examine the association between longitudinal changes in NT-proBNP and subsequent mortality.

Results: Increasing quartiles of NT-proBNP were associated with a monotonic increase in 90-day [quartile 1, referent; from quartile 2 to quartile 4, hazard ratio (HR) 1.7–6.3, P < 0.001] and 1-year (quartile 1, referent; from quartile 2 to quartile 4, HR 1.7–4.9, P < 0.001) all-cause mortality. After multivariable adjustment, these associations remained robust. When examined using a multivariable fractional polynomial, increased NT-proBNP concentrations were associated with increased 90-day (HR per unit increase in log NT-proBNP 1.5, 95% CI 1.3–1.7) and 1-year (HR per unit increase in log NT-proBNP 1.4, 95% CI 1.3–1.5) all-cause mortality. In addition, patients with the greatest increase in NT-proBNP after 3 months of dialysis had a 2.4-fold higher risk of mortality than those with the greatest decrease in NT-proBNP.

Conclusions: NT-proBNP concentrations are independently associated with mortality in incident hemodialysis patients. Furthermore, the observation that longitudinal changes in NT-proBNP concentrations were associated with subsequent mortality suggests that monitoring serial NT-proBNP concentrations may represent a novel tool for assessing adequacy and guiding therapy in patients initiating hemodialysis.
Distribution of Adiponectin, Leptin, and Metabolic Correlates of Insulin Resistance: A Longitudinal Study in British Children; 1: Prepuberty (EarlyBird 15)
Authors: Murphy Michael J , Hosking Jo , Metcalf Brad S , Voss Linda D , Jeffery Alison N , Sattar Naveed , Williams Roger , Jeffery Jinny , Wilkin Terence J
Published: June 2008

Background: The emergence of type 2 diabetes in young populations has mirrored a rising prevalence of obesity and insulin resistance during childhood and adolescence. At the same time, the role of adipokines as links between obesity and insulin resistance is becoming more appreciated. We sought to establish age- and sex-specific distributions of metabolic correlates of insulin resistance in healthy prepubertal children.

Methods: We collected fasting blood samples from a contemporary cohort of 307 British children at ages 5, 6, 7, and 8 years and measured insulin, glucose, triglycerides, total and HDL cholesterol, urate, glycohemoglobin, sex hormone–binding globulin (SHBG), leptin, and adiponectin. We used homeostasis model assessment (HOMA 2) to estimate insulin sensitivity (HOMA-%S) and β-cell function (HOMA-%B). Anthropometric measures included body mass index.

Results: Body mass index increased from age 5 to 8 years (P < 0.001). HOMA-%B decreased (P < 0.001) and HOMA-%S increased (P < 0.05), but glucose also increased (P < 0.001) whereas glycohemoglobin decreased (P < 0.001). Consistent with the rise in insulin sensitivity, HDL cholesterol increased (P < 0.001) and triglycerides decreased (NS), whereas adiponectin decreased (P = 0.02). The patterns were similar in boys and girls, although girls were less insulin sensitive throughout. Accordingly, triglycerides tended to be higher in the girls, and HDL cholesterol and SHBG lower.

Conclusions: The metabolic disturbances associated with insulin resistance appear to be more advanced in girls. Markers of metabolic health improve in both sexes from 5 to 8 years, despite rising adiposity.
Changes in the expression of interleukin-1β and lipopolysaccharide-induced TNF factor in the oviduct of laying hens in response to artificial insemination
Authors: Das Shubash Chandra , Isobe Naoki , Yoshimura Yukinori
Published: June 2008

The aim of this study was to determine the physiological significance of interleukin-1β (IL1B) and lipopolysaccharide-induced TNF factor (LITAF) in the fate of sperm in the oviduct of laying hens after artificial insemination (AI). Laying hens were inseminated with fresh semen, PBS or seminal plasma and tissues from different oviductal segments were collected to observe the general histology, changes in the mRNA expression ofIL1BandLITAFand the localization of positive cells expressing immunoreactive IL1B (irIL1B). Semi-quantitative RT-PCR was used to observe the changes in mRNA expression of these molecules in the infundibulum, uterus, utero-vaginal junction (UVJ), and vagina after insemination. Intact sperm in the lumen and between the primary or secondary folds of the vagina were found until 6 h after insemination but were degraded at 12 h. The mRNA expression ofIL1BandLITAFwas significantly increased in the vagina until 6 h after AI but remained unchanged in the other oviductal segments. In the tissue of the vagina and UVJ, irIL1B was localized in the mucosal stroma. The number of irIL1B-positive cells was increased in the vagina but almost unchanged in UVJ after insemination with semen. Significant changes were not observed in the mRNA expression and irIL1B-positive cells in the vagina after PBS or seminal plasma insemination. The increase of IL1B and LITAF in the vagina may lead to sperm degradation and elimination by cilia of surface epithelium, whereas their lower levels in UVJ may permit sperm to survive in sperm storage tubules.
Diagnostic methods for confirming drug-allergy – the lymphocyte transformation test in dermatology
Authors: Makó Sarolta , Lepesi-Benkő Réka , Marschalkó Márta , Soós Gyöngyvér , Kárpáti Sarolta
Published: June 2008

A gyógyszermellékhatások felismerése és a tüneteket kiváltó gyógyszer oki szerepének bizonyítása komoly felkészültséget igényel. E közlemény célja a gyógyszerallergiás reakciók diagnosztikai lehetőségeinek rövid áttekintése és a lymphocytatranszformációs teszt gyógyszer-hiperszenzitivitási reakciókban való bizonyító szerepének bőrgyógyászati szempontok szerinti értékelése. A lymphocytatranszformációs teszt azon a megfigyelésen alapul, hogy a gyógyszerrel való első találkozáskor kialakult antigénspecifikus T-sejtek osztódni kezdenek az antigénnel való in vitro megismételt találkozás után. A szenzibilizációt az osztódó T-sejtekbe történő
3
H-timidin-beépülés mértéke jelzi. A hatóanyag-specifikus T-sejtek szinte mindig részt vesznek a gyógyszerallergiás reakciókban, ezért a vizsgálat előnye, hogy sok gyógyszernél és különböző immunreakciók eseteiben egyaránt jól alkalmazható. Hátránya a munkaigényesség, valamint az, hogy specificitásának és szenzitivitásának bizonyításához hiányoznak a széles körű, nagy beteganyagon elvégzett tanulmányok. Emiatt a teszt nem egyértelműen elfogadott a gyógyszerallergia igazolására. Hiányosságai ellenére azonban, jobb prediktív értékű egyéb vizsgálatok hiányában, a lymphocytatranszformációs tesztnek fontos szerepe van a gyógyszerallergiák diagnosztizálása terén.
Effect of atorvastatin treatment on the hemorheological and hemostaseological parameters in chronic cerebrovascular patients
Authors: Szapáry László , Horváth Beáta , Márton Zsolt , Fehér Gergely , Tóth Kálmán , Komoly Sámuel
Published: June 2008

Cerebrovascularis betegekben gyakoriak a haemorrheologiai és haemostaseologiai paraméterek kóros eltérései. A statinok az ischaemiás stroke prevenciójában hatékonyan alkalmazható szerek, kedvező hatásuk hátterében a lipidszint csökkentése mellett egyéb tényezők is igazolhatók.
Célok:
Tanulmányukban a szerzők áttekintik az atorvastatin stroke-prevencióval, haemorrheologiai és haemostaseologiai hatásaival kapcsolatos irodalmi adatokat, hivatkozva egy korábbi vizsgálatuk eredményeire, mely kis dózisú atorvastatinkezelés rövid távú haemorrheologiai, valamint endothel-diszfunkcióra és a thrombocytaaggregációra gyakorolt effektusait vizsgálta.
Módszerek:
27 krónikus, hyperlipidaemiás agyérbetegnél (átlagéletkor: 61 ± 8 év) meghatározták a szérumlipidszinteket, a haemorrheologiai paramétereket (haematocrit, plazmafibrinogén-koncentráció, plazma- és teljesvér-viszkozitás, vörösvértest-aggregáció és -deformabilitás), a thrombocytaaggregációt kiinduláskor, majd 1 és 3 hónappal napi 10 mg atorvastatinkezelést követően. Az endothel-diszfunkciót jelző von Willebrand-faktor aktivitását a kezelés előtt, majd 1 hónap múlva mérték meg.
Eredmények:
A plazmakoleszterin-szint átlagos csökkenése 1, illetve 3 hónap múlva egyaránt 28% volt (
p
< 0,001), az LDL-koleszterin-szint 40%-kal, illetve 38%-kal (
p
< 0,001) csökkent a kiindulási értékhez képest. Az atorvastatinkezelés a teljesvér-viszkozitást a 3. hónap végére, míg a vvt-deformabilitást már az első hónap végére szignifikánsan csökkentette (
p
< 0,05). A kollagén indukálta thrombocytaaggregáció a kiindulási értékhez képest szignifikánsan csökkent (
p
< 0,001) változatlan antiaggregációs kezelés mellett. Szintén szignifikánsan javult a von Willebrand-faktor-aktivitás már 1 hónapos kezelést követően (
p
< 0,05).
Következtetések:
Mind az irodalmi, mind a szerzők saját eredményei az atorvastatin komplex, kedvező hatására utalnak. A lipidcsökkentő effektus mellett a kis dózisban és rövid ideig alkalmazott atorvastatin javítja a haemorrheologiai paramétereket, a thrombocytaaggregációt és az endothel-diszfunkciót.
Discrepancies between clinical and pathological diagnoses, methods and pitfalls
Authors: Sebők János , Tarján Miklós
Published: June 2008

A szerzők követték a klinikai és kórbonctani diagnózisok összehasonlításának menetét. Saját anyaguk és irodalmi adatok alapján vizsgálták a halál alapjául szolgáló betegség megállapítását, valamint az összehasonlításukat zavaró, megnehezítő tényezőket és ezek kiküszöbölésének lehetőségeit. Javasolják, hogy a klinikai és kórbonctani diagnózisok összehasonlítására olyan módszert válasszanak, melyek az eltérések természetét és azok okainak elemzését is lehetővé teszik. Az összevetés csakis egységes elvek alapján feldolgozott, ellenőrzött anyag esetében reális, az eredményeket körültekintően kell interpretálni.
Intrachromosomal amplification of AML1 gene in childhood acute lymphoblastic leukemia
Authors: Haltrich Irén , Csóka Monika , Kovács Gábor , Fekete György
Published: June 2008

A rutinszerű molekuláris citogenetikai vizsgálatok bevezetése lehetővé tette, hogy a gyermekkori acut lymphoid leukaemiák bizonyos génszintű, eddig ismeretlen elváltozásait is feltárjuk. Különös jelentőségű a negatív prognosztikai értékű, ritkán előforduló citogenetikai kórképek felismerése, amikor azok közismerten jó kórjóslatú elváltozásokkal társulnak. A jelen tanulmányunkban egy gyermekkori B-sejtes ALL-re jellemző, új citogenetikai elváltozást, a 21-es kromoszóma intrakromoszomális amplifikációját ismertetjük, amely a többi kockázati tényezőtől függetlenül magas rizikócsoportú terápiát igényel, és amely egy jó prognosztikai értékű elváltozással, a rejtett 12;21-es kromoszóma-transzlokációval társult.
Similarities and differences in the social background of female medical, nursing and health visitor students
Authors: Feith Helga Judit , Soósné Kiss Zsuzsanna , Kovácsné Tóth Ágnes , Balázs Péter
Published: June 2008

Ismereteink szerint ez idáig nem történt olyan átfogó vizsgálat Magyarországon, amely egészségügyi felsőoktatásban tanuló hallgatók szociokulturális hátterét vizsgálta volna.
Célkitűzés:
Keresztmetszeti kutatásunk fő célkitűzése az volt, hogy megismerjük és elemezzük a leendő orvosnők, diplomás ápolónők és védőnők társadalmi hátterében megmutatkozó különbségeket.
Módszer:
Jelen kutatásunk orvostanhallgató-nők, valamint egészségügyi főiskolai karon tanuló hallgatónők között készült, a Semmelweis Egyetemen. Összesen 295 hallgatónőt vontunk be a kutatásba, értékelhető választ adott 68,08% (
n
= 201). Az eredményeket az SPSS programcsomag segítségével elemeztük, leíró statisztikai megközelítésben.
Eredmények:
A felmérésben részt vevő hallgatónők számos szociodemográfiai jellemzőjében meghatározó különbséget tapasztaltunk. Az orvostanhallgató-nők nagyobb hányada diplomás szülők gyermeke, ugyanakkor a főiskolai szintű képzésben részt vevő hallgatónők esetében ennek jóval kisebb az esélye. Nem találtunk ugyan statisztikailag alátámasztható különbséget a három hallgatói csoport családi állapotában, de megállapítható, hogy kevesebb diplomásápoló-hallgatónő volt férjezett, illetve élt élettársi kapcsolatban.
Következtetések:
A főiskolai hallgatónők, valamint az orvostanhallgatók szociokulturális hátterében megmutatkozó különbségek, az ebből következő társadalmi hátrányok nagyobb mértékben sújtják az ápoló- és védőnőhallgatókat, mint az orvostanhallgató-nőket.
The effect of acute exercise session on thyroid hormone economy in rats
Authors: Fortunato Rodrigo Soares , Ignácio Daniele Leão , Padron Álvaro Souto , Peçanha Ramon , Marassi Michelle Porto , Rosenthal Doris , Werneck-de-Castro João Pedro Saar , Carvalho Denise P
Published: June 2008

The hypothalamic–pituitary–thyroid axis is affected by acute exercise, but the mechanisms underlying thyroid function changes after exercise remain to be defined. The aim of this study was to elucidate the effects of a session of acute exercise on the treadmill at 75% of maximum oxygen consumption on thyroid function of rats. Male Wistar rats were divided into five groups: control (without exercise), and killed immediately after (0 min) or 30, 60, and 120 min after the end of the exercise session. A significant increase in serum tri-iodothyronine (T3) occurred immediately after the exercise, with a gradual decrease thereafter, so that 120 min after the end of the exercise, serum T3 was significantly lower than that in controls. Total thyroxine (T4) increased progressively reaching values significantly higher than that in the control group at 120 min. T3/T4 ratio was significantly decreased 60 and 120 min after the exercise, indicating impaired T4-to-T3 conversion. Liver type 1 deiodinase activity (D1) significantly decreased at 60 and 120 min, while pituitary D1 increased progressively from 30 to 120 min after the exercise, and thyroid D1 was increased only immediately after the end of the exercise. Brown adipose tissue (BAT) type 2 deiodinase activity (D2) was significantly lower at 30 min, but pituitary D2 remained unchanged. No change in serum thyrotropin was detected, while serum corticosterone was significantly higher 30 min after the exercise. Our results demonstrate that decreased liver D1 and BAT D2 might be involved in the decreased T4-to-T3 conversion detected after an exercise session on the treadmill.
Increased Second Trimester Maternal Glucose Levels Are Related to Extremely Large-for-Gestational-Age Infants in Women With Type 1 Diabetes
Authors: Kerssen Anneloes , de Valk Harold W. , Visser Gerard H.A.
Published: June 2008

OBJECTIVE—Large-for-gestational-age (LGA) infants (birth weight ≥90th centile) are a continuing problem in pregnancies of women with type 1 diabetes. We used the continuous glucose monitoring system (CGMS) to assess the relationship between 24-h diurnal glucose profiles in all three trimesters of pregnancy and infant birth weight.

RESEARCH DESIGN AND METHODS—Twenty-nine pregnant women with type 1 diabetes used the CGMS during each trimester of pregnancy. The glucose profiles of the women with a normal-weight infant or an LGA infant were compared.

RESULTS—Of the women with type 1 diabetes, 48% gave birth to an LGA infant. Fifty percent of these infants were already large for dates on ultrasound at <30 weeks of gestation (early LGA), and all these infants had a birth weight ≥97.7th centile. The diurnal glucose profiles show that the mothers of early LGA infants had elevated glucose levels for most of the day during the second trimester (P < 0.05). The median 24-h glucose level was significantly higher in women who gave birth to early LGA infants in all three trimesters of pregnancy (6.7, 8.3, and 6.5 mmol/l for the first, second, and third trimesters, respectively). Within the group of women with early LGA infants, the second trimester median glucose level was significantly higher than that in the first and third trimester (P < 0.05).

CONCLUSIONS—In women with type 1 diabetes, extreme growth of the fetus starts early in pregnancy and is likely caused by increased maternal glucose levels. Further investigation is needed to see whether early tight glycemic control will reduce the number of extreme LGA infants.
Randomized Efficacy Trial of Early Preconception Counseling for Diabetic Teens (READY-Girls)
Authors: Charron-Prochownik Denise , Ferons-Hannan Margaret , Sereika Susan , Becker Dorothy
Published: June 2008

OBJECTIVE—To develop and assess the feasibility of an early preconception counseling program for adolescents called READY-Girls (Reproductive-health Education and Awareness of Diabetes in Youth for Girls).

RESEARCH DESIGN AND METHODS—A total of 53 adolescent females with type 1 diabetes between 16 and 19.9 years of age were randomized into groups receiving a CD-ROM, a book, or standard care (control) and given one comprehensive session. Outcomes were assessed at baseline, immediately after, and at 3 months.

RESULTS—Teens who received the CD and those who received the book demonstrated significant (P ≤ 0.05) sustained improvement (over 3 months) in knowledge, perceived benefits of both receiving preconception counseling and using effective family planning, and perceived more support with reproductive health issues.

CONCLUSIONS—Clinical feasibility of the program was demonstrated. Both the CD and the book appeared to be efficacious formats for the short term. Future studies should examine repeated boosters of a CD and a book, which are not meant to replace but rather to reinforce and supplement health professional education.
Increased Shear Rate Resistance and Fastest Kinetics of Erythrocyte Aggregation in Diabetes Measured With Ultrasound
Authors: Cloutier Guy , Zimmer Audrey , Yu François T.H. , Chiasson Jean-Louis
Published: June 2008

OBJECTIVE—To measure with ultrasound the increased erythrocyte aggregation (EA) kinetics and adhesion energy between erythrocytes in patients with type 2 diabetes and poor metabolic control.

RESEARCH DESIGN AND METHODS—Blood samples were analyzed in a Couette rheometer at 32 MHz following shear rate reductions from 500 s−1 to residual shears of 0 (stasis), 1, 2, 10, 50, 100, and 200 s−1. The increase in EA was determined with the integrated backscatter coefficient as a function of time and shear rate.

RESULTS—The time required to form aggregates was shorter in diabetic patients at shear rates below 200 s−1 (P < 0.01). Erythrocytes formed larger aggregates in diabetic patients than in control subjects (P < 0.05 at 2 to 100 s−1).

CONCLUSIONS—Ultrasound can potentially noninvasively demonstrate, in vivo and in situ, the impact of local abnormal EA on arteriovenous flow disorders in diabetes.
Obesity and Undiagnosed Diabetes in the U.S.
Authors: Wee Christina C. , Hamel Mary Beth , Huang Annong , Davis Roger B. , Mittleman Murray A. , McCarthy Ellen P.
Published: June 2008

OBJECTIVE—To study whether obese individuals, who are at higher risk for diabetes and disparities in care than nonobese individuals, are more likely to have undiagnosed diabetes.

RESEARCH DESIGN AND METHODS—We performed an analysis of 5,514 adult participants in the 1999–2004 National Health and Nutrition Examination Survey. Particpants were interviewed about sociodemographic and medical data, including whether they had been diagnosed with diabetes, and were examined for height, weight, and fasting plasma glucose level ≥126 mg/dl or by previous physician diagnosis. After categorizing participants into normal weight, overweight, and obese according to BMI, the prevalance and diagnosis of diabetes across BMI categories was compared using χ2.

RESULTS—Of the 9.8% (weighted sample) of participants who had diabetes, based on fasting glucose levels and self-reported diagnosis, 28.1% were undiagnosed, translating to an estimated 5.2 million people in the U.S. population. The proportion undiagnosed was not significantly different among normal-weight (22.2%), overweight (32.5%), or obese adults (27.4%). Nevertheless, obese adults comprise more than half of the undiagnosed diabetes cases (2.7 million). Relative to normal-weight adults, the adjusted odds ratio (OR) for having undiagnosed diabetes was 1.50 (0.73–3.08) in overweight and 1.37 (0.72–2.63) in obese adults.

CONCLUSIONS—Despite a higher underlying risk of diabetes and widespread clinical recognition of this higher risk, obesity does not increase the likelihood that an individual's diabetes will be diagnosed.
The Prospective Contribution of Hostility Characteristics to High Fasting Glucose Levels
Authors: Shen Biing-Jiun , Countryman Amanda J. , Spiro Avron , Niaura Raymond
Published: June 2008

OBJECTIVE—To assess whether psychological constructs of hostility, anger, type A behavior pattern, and depressive symptom severity 1) were associated with concurrent and prospective fasting glucose levels and 2) whether this association was moderated by marital status.

RESEARCH DESIGN AND METHODS—Participants were 485 healthy men ([mean ± SD] age 59 ± 7 years) without a history of heart disease, diabetes, or taking related medications in the Veterans Affairs Normative Aging Study. Their fasting glucose levels between 1986 and 1995 were examined. Hierarchical linear regressions were conducted to investigate whether hostility, anger, type A behavior, and depressive symptoms were associated with concurrent fasting glucose levels as well as fasting glucose 9 years later, controlling for standard sociodemographic and biomedical covariates, including baseline fasting glucose, age, education, marital status, BMI, total cholesterol, and systolic blood pressure.

RESULTS—Although none of the psychological variables were associated with concurrent fasting glucose, Cook-Medley hostility (β = 0.105), anger (β = 0.091), and type A behavior (β = 0.152) each were associated with prospective fasting glucose 9 years later, controlling for standard covariates. Depressive symptom severity was not associated with either concurrent or follow-up glucose levels. Further analysis showed that marital status moderated the effects of these characteristics on follow-up fasting glucose such that hostility, anger, and type A behavior were significant only among those who were not married (β = 0.348, 0.444, 0.439, respectively; all P <0.001).

CONCLUSIONS—Hostility, anger, and type A behavior appear to be independent risk factors for impaired glucose metabolism among unmarried older men.
Dietary Patterns, Insulin Resistance, and Incidence of Type 2 Diabetes in the Whitehall II Study
Authors: McNaughton Sarah A. , Mishra Gita D. , Brunner Eric J.
Published: June 2008

OBJECTIVE—The aim of this study was to identify a dietary pattern associated with insulin resistance and investigate whether this pattern was prospectively associated with type 2 diabetes.

RESEARCH DESIGN AND METHODS—Analysis was based on 7,339 participants of the Whitehall II study. Dietary intake was measured using a 127-item food frequency questionnaire. We used the reduced rank regression method to determine dietary patterns using the homeostasis model assessment of insulin resistance as the intermediate or response variable. The association between the dietary pattern identified and incidence of type 2 diabetes was investigated using Cox proportional hazard regression models.

RESULTS—We identified a dietary pattern characterized by high consumption of low-calorie/diet soft drinks, onions, sugar-sweetened beverages, burgers and sausages, crisps and other snacks, and white bread and low consumption of medium-/high-fiber breakfast cereals, jam, French dressing/vinaigrette, and wholemeal bread. Higher dietary pattern scores were associated with increased risk of type 2 diabetes (hazard ratio for top quartile 2.95 [95% CI 2.19–3.97]; adjusted for age, sex, and energy misreporting). This relationship was attenuated after adjustment for ethnicity, employment grade, health behaviors (smoking, alcohol use, and physical activity) but remained significant after further adjustment for blood pressure and BMI (1.51 [1.10–2.09]).

CONCLUSIONS—A dietary pattern associated with insulin resistance predicts type 2 diabetes risk after adjustment for a range of confounders. This study adds to the evidence that dietary patterns are an important risk factor for type 2 diabetes.
Blood Glucose Awareness Training Delivered Over the Internet
Authors: Cox Daniel , Ritterband Lee , Magee Joshua , Clarke William , Gonder-Frederick Linda
Published: June 2008

OBJECTIVE—Blood glucose awareness training (BGAT), a psycho-educational intervention, trains individuals with type 1 diabetes to 1) detect/interpret internal cues to better detect extreme blood glucose levels, e.g., neurogenic and neuroglycopenic symptoms; and 2) interpret external cues to detect current and anticipate future extreme blood glucose levels, e.g., insulin timing/dose and recent self-monitoring of blood glucose results. Although outcome studies using BGAT are significant, limitations include the requirement of eight weekly meetings and limited professionals trained to deliver BGAT.

RESEARCH DESIGN AND METHODS—Due to the limitations mentioned above, BGAT was converted for web-based delivery. The internet allows BGAT delivery to be dynamic, engaging, convenient, and personalized. Efficacy was evaluated using a 2 (BGAThome, n = 20, vs. control, n = 20) × 2 (pre/post) design.

RESULTS—BGAThome was judged as useful and easy to use, was completed by 94% of the participants, and resulted in significant clinical improvements (P < 0.05).

CONCLUSIONS—The internet may be an efficient and effective means of delivering diabetes interventions like BGAT.
Mitigating Case Mix Factors by Choice of Glycemic Control Performance Measure Threshold
Authors: Bainbridge Kathleen E. , Cowie Catherine C. , Rust Keith F. , Fradkin Judith E.
Published: June 2008

OBJECTIVE—Performance measures are tools for assessing quality of care but may be influenced by patient factors. We investigated how currently endorsed performance measures for glycemic control in diabetes may be influenced by case mix composition. We assessed differences in A1C performance measure threshold attainment by case mix factors for A1C >9% and examined how lowering the threshold to A1C >8% or >7% changed these differences.

RESEARCH DESIGN AND METHODS—Using data from the 1999–2002 National Health and Nutrition Examination Survey for 843 adults self-reporting diabetes, we computed the mean difference in A1C threshold attainment of >9, >8, and >7% by various case mix factors. The mean difference is the average percentage point difference in threshold attainment for population groups compared with that for the overall population.

RESULTS—Diabetes medication was the only factor for which the difference in threshold attainment increased at lower thresholds, with mean differences of 5.7 percentage points at A1C >9% (reference), 10.1 percentage points at A1C >8% (P < 0.05), and 14.1 percentage points at A1C >7% (P < 0.001).

CONCLUSIONS—As 87% of U.S. adults have A1C <9%, a performance measure threshold of >9% will not drive major improvements in glycemic control. Lower thresholds do not exacerbate differences in threshold attainment for most factors. Reporting by diabetes medication use may compensate for heterogeneous case mix when a performance measure threshold of A1C >8% or lower is used.
Long-Term Follow-Up of Oral Glucose Tolerance Test–Derived Glucose Tolerance and Insulin Secretion and Insulin Sensitivity Indexes in Subjects With Glucokinase Mutations (MODY2)
Authors: Martin Delphine , Bellanné-Chantelot Christine , Deschamps Inge , Froguel Philippe , Robert Jean-Jacques , Velho Gilberto
Published: June 2008

OBJECTIVE—We investigated the natural history of glucokinase (GCK)-related maturity-onset diabetes of the young type 2 (MODY2), notably the factors associated with deterioration of hyperglycemia over time.

RESEARCH DESIGN AND METHODS—We report an 11-year follow-up of glucose tolerance and indexes of insulin secretion and insulin sensitivity derived from oral glucose tolerance tests in 33 MODY2 subjects.

RESULTS—The variation between tests of glucose tolerance (expressed as the area under the glucose curve) was 6.9 ± 3.2% (mean ± SEM), but individual results ranged from −20 to 61%. Deterioration of glucose tolerance between tests was associated with decreased insulin sensitivity, while insulin secretion remained stable.

CONCLUSIONS—Glucose tolerance can remain stable over many years in subjects with MODY2 due to the relative stability of the GCK-related β-cell defect. However, the development of insulin resistance may have an important role in the deterioration of the glucose tolerance and in the long-term evolution of the disorder.
Prognostic Value of the Insertion/Deletion Polymorphism of the ACE Gene in Type 2 Diabetic Subjects
Authors: Hadjadj Samy , Fumeron Frédéric , Roussel Ronan , Saulnier Pierre-Jean , Gallois Yves , Ankotche Amos , Travert Florence , Khalil Charbel Abi , Miot Aurélie , Alhenc-Gelas François , Lievre Michel , Marre Michel ,   on behalf of the DIABHYCAR, DIAB2NEPHROGENE, and SURDIAGENE study groups
Published: June 2008

OBJECTIVE—We tested whether determination of the ACE insertion/deletion polymorphism is useful for renal and cardiovascular prognoses of type 2 diabetic subjects.

RESEARCH DESIGN AND METHODS—The French participants (3,126 of 4,912) in the Non-Insulin-Dependent Diabetes, Hypertension, Microalbuminuria or Proteinuria, Cardiovascular Events, and Ramipril (DIABHYCAR) trial were studied for their prognosis over 4 years according to their ACE insertion/deletion polymorphism. We used two cohorts of French type 2 diabetic patients for replication: a 3-year follow-up study (n = 917; Survie, Diabete de type 2 et Genetique [SURDIAGENE] study) and a case-control study on diabetic nephropathy (n = 1,277; Diabete de type 2, Nephropathie et Genetique [DIAB2NEPHROGENE] study). We investigated the effect of the insertion/deletion polymorphism on the primary outcome in the DIABHYCAR trial (defined as the first of the following events to occur: cardiovascular death, nonfatal myocardial infarction, stroke, heart failure leading to hospital admission, or end-stage renal failure) and its components.

RESULTS—In DIABHYCAR, the primary outcome and most of its components were not affected by the ACE insertion/deletion genotype. Only renal outcome was favored by the I allele (P = 0.03). The risk of myocardial infarction was not affected by ACE genotype, but the probability of fatal outcome increased with the number of D alleles (P < 0.03). In SURDIAGENE, the association between the ACE I allele and renal outcome was not replicated. In DIAB2NEPHROGENE, no association was found with nephropathy.

CONCLUSIONS—We were not able to demonstrate the manifest usefulness of the ACE insertion/deletion polymorphism for the prognosis of type 2 diabetic subjects.
Global Coronary Heart Disease Risk Assessment of Individuals With the Metabolic Syndrome in the U.S.
Authors: Hoang Khiet C. , Ghandehari Heli , Lopez Victor A. , Barboza Michael G. , Wong Nathan D.
Published: June 2008

OBJECTIVE—Although metabolic syndrome is related to an increased risk of coronary heart disease (CHD) events, individuals with metabolic syndrome encompass a wide range of CHD risk levels. This study describes the distribution of 10-year CHD risk among U.S. adults with metabolic syndrome.

RESEARCH DESIGN AND METHODS—Metabolic syndrome was defined by the modified National Cholesterol Education Program (NCEP)/Third Adult Treatment Panel (ATP III) definition among 4,293 U.S. adults aged 20–79 years in the National Health and Nutrition Examination Survey 2003–2004. Low-, moderate-, moderately high–, and high-risk statuses were defined as <6, 6 to <10, 10–20, and >20% probability of CHD in 10 years (based on NCEP/ATP III Framingham risk score algorithms), respectively; those with diabetes or preexisting cardiovascular disease were assigned to high-risk status.

RESULTS—The weighted prevalence of metabolic syndrome by NCEP criteria in our study was 29.0% overall (30.0% in men and 27.9% in women, P = 0.28): 38.5% (30.7% men and 46.9% women) were classified as low risk, 8.5% (7.9% men and 9.1% women) were classified as moderate risk, 15.8% (23.4% men and 7.6% women) were classified as moderately high risk, and 37.3% (38.0% men and 36.5% women) were classified as high risk. The proportion at high risk increased with age but was similar among Hispanics, non-Hispanic whites, and non-Hispanic blacks.

CONCLUSIONS—Although many subjects with metabolic syndrome have a low calculated risk for CHD, about half have a moderately high or high risk, reinforcing the need for global risk assessment in individuals with metabolic syndrome to appropriately target intensity of treatment for underlying CHD risk factors.
Efficacy, Safety, and Tolerability of Pregabalin Treatment for Painful Diabetic Peripheral Neuropathy
Authors: Freeman Roy , Durso-DeCruz Edith , Emir Birol
Published: June 2008

OBJECTIVE—To evaluate the efficacy, safety, and tolerability of pregabalin across the effective dosing range, to determine differences in the efficacy of three times daily (TID) versus twice daily (BID) dosage schedules, and to use time-to-event analysis to determine the time to onset of a sustained therapeutic effect using data from seven trials of pregabalin in painful diabetic peripheral neuropathy (DPN).

RESEARCH DESIGN AND METHODS—Data were pooled across seven double-blind, randomized, placebo-controlled trials using pregabalin to treat painful DPN with dosages of 150, 300, and 600 mg/day administered TID or BID. Only one trial included all three of these dosages, and TID dosing was used in four. All studies shared fundamental selection criteria, and treatment durations ranged from 5 to 13 weeks.

RESULTS—Pooled analysis showed that pregabalin significantly reduced pain and pain-related sleep interference associated with DPN (150, 300, and 600 mg/day administered TID vs. placebo, all P ≤ 0.007). Only the 600 mg/day dosage showed efficacy when administered BID (P ≤ 0.001). Pain and sleep interference reductions associated with pregabalin appear to be positively correlated with dosage; the greatest effect was observed in patients treated with 600 mg/day. Kaplan-Meier analysis revealed that the median time to onset of a sustained (≥30% at end point) 1-point improvement was 4 days in patients treated with pregabalin at 600 mg/day, 5 days in patients treated with pregabalin at 300 mg/day, 13 days in patients treated with pregabalin at 150 mg/day, and 60 days in patients receiving placebo. The most common treatment-emergent adverse events were dizziness, somnolence, and peripheral edema.

CONCLUSIONS—Treatment with pregabalin across its effective dosing range is associated with significant, dose-related improvement in pain in patients with DPN.
Plasma Carotenoids and Onset of Dysglycemia in an Elderly Population
Authors: Akbaraly Tasnime N. , Fontbonne Annick , Favier Alain , Berr Claudine
Published: June 2008

OBJECTIVE—The hypothesis of carotenoid having a preventive role in diabetes is suggested by their antioxidant properties. In this report, we investigated the relationship between baseline total plasma carotenoid levels and 9-year onset of dysglycemia (impaired fasting glucose or type 2 diabetes) in a healthy elderly population.

RESEARCH DESIGN AND METHODS—The Epidemiology of Vascular Ageing Study is a 9-year longitudinal study including 1,389 volunteers aged 59–71 years. Fasting plasma glucose was measured at baseline and at 2, 4, and 9 years after inclusion. The relationship between plasma carotenoid at baseline and incidence of dysglycemia was determined by Cox proportional hazards regression analysis adjusting for potential confounders.

RESULTS—At 9 years, 127 incident cases of dysglycemia had occurred. Risk of dysglycemia was significantly lower in participants with plasma carotenoid in the highest quartile (Q4) compared with participants in the lowest quartile (Q1) (Q4 vs. Q1: relative risk 0.26 [95% CI 0.14–0.49], P < 10−4; Q3 vs. Q1: 0.55 [0.34–0.89], P = 0.01; and Q2 vs. Q1: 0.82 [0.51–1.31], P = 0.40). After controlling for sociodemographic variables, lifestyle habits, cardiovascular disease, blood pressure, BMI, and lipid profile, risk of dysglycemia remained significantly lower in participants in the highest quartile of total plasma carotenoid compared with participants in the lowest quartile (Q4 vs. Q1: 0.42 [0.22–0.82], P = 0.01; Q3 vs. Q1: 0.69 [0.41–1.15], P = 0.16; and Q2 vs. Q1: 0.80 [0.48–1.32], P = 0.38).

CONCLUSIONS—This study prospectively confirms that plasma carotenoid levels have an independent relationship to onset of dysglycemia.
Impact of Disease Management on Utilization and Adherence With Drugs and Tests
Authors: Thiebaud Patrick , Demand Michael , Wolf Scott A. , Alipuria Linda L. , Ye Qin , Gutierrez Peter R.
Published: June 2008

OBJECTIVE—The purpose of this study was to evaluate the effect of telephonic care management within a diabetes disease management program on adherence to treatment with hypoglycemic agents, ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), statins, and recommended laboratory tests in a Medicaid population.

RESEARCH DESIGN AND METHODS—A total of 2,598 patients with diabetes enrolled for at least 2 years in Florida: A Healthy State (FAHS), a large Medicaid disease management program, who received individualized telephonic care management were selected if they were eligible for at least 12 months before and 12 months after beginning care management. Patients were matched one-to-one on all baseline characteristics to 2,598 control patients. The impact of care management on utilization and adherence rates for diabetes-related medications and tests was analyzed with the difference-in-difference estimator.

RESULTS—Changes in utilization were evaluated separately for those who were characterized as adherent to treatment at baseline (“users”) and those who were not (“nonusers”). Both groups achieved significant improvement in adherence between baseline and follow-up. Nonusers increased their overall hypoglycemic use by 0.7 script (P < 0.001), by 0.7 script for ACEIs and statins (both P < 0.001), by 0.8 test for A1C (P < 0.001), and by 0.7 test for lipids (P < 0.001). Users increased hypoglycemic use by 1.5 scripts (P < 0.001) and insulin use by 0.9 script (P < 0.001).

CONCLUSIONS—The FAHS telephonic care management intervention effectively induced Medicaid patients with diabetes to begin treatment and improved adherence to oral hypoglycemic agents and recommended tests. It also substantially improved adherence among baseline insulin users.
Serum Bilirubin and Ferritin Levels Link Heme Oxygenase-1 Gene Promoter Polymorphism and Susceptibility to Coronary Artery Disease in Diabetic Patients
Authors: Chen Ying-Hwa , Chau Lee-Young , Chen Jaw-Wen , Lin Shing-Jong
Published: June 2008

OBJECTIVE—Heme oxygenase (HO) leads to the generation of free iron, carbon monoxide, and bilirubin. A length polymorphism of GT repeats in the promoter of human HO-1 gene has been shown to modulate gene transcription. The aim of this study was to assess the association of the length of (GT)n repeats in the HO-1 gene promoter with serum bilirubin, markers of iron status, and the development of coronary artery disease (CAD).

RESEARCH DESIGN AND METHODS—We screened the allelic frequencies of (GT)n repeats in the HO-1 gene promoter in 986 unrelated individuals who underwent coronary angiography. Serum bilirubin and markers of iron status were evaluated.

RESULTS—The distribution of numbers of (GT)n repeats was divided into two subclasses: class S included shorter (<27) repeats, and class L included longer (≥27) repeats. Among those with diabetes, subjects with the L/L genotype had significantly lower bilirubin levels than those with S/S and S/L genotypes (0.70 ± 0.22 vs. 0.81 ± 0.24 mg/dl, P = 0.001) and higher serum ferritin values (4.76 ± 0.72 vs. 4.28 ± 1.05 μg/l for log ferritin, P = 0.001). Compared with those carrying the S allele, diabetic subjects with the L/L genotype had an almost threefold increase in CAD risk after controlling for conventional risk factors (odds ratio 2.81, [95% CI 1.22–6.47], P = 0.015). With adjustment for both serum bilirubin and ferritin, the effect of HO-1 promoter polymorphism on susceptibility to CAD disappeared.

CONCLUSIONS—Length polymorphism in the HO-1 gene promoter is correlated with susceptibility to CAD in diabetic patients, and this effect might be conveyed through its influence on serum bilirubin and ferritin.
Adjust to Target in Type 2 Diabetes
Authors: Bergenstal Richard M. , Johnson Mary , Powers Margaret A. , Wynne Alan , Vlajnic Aleksandra , Hollander Priscilla , Rendell Marc
Published: June 2008

OBJECTIVE—Carbohydrate counting is an effective approach to mealtime insulin adjustment in type 1 diabetes but has not been rigorously assessed in type 2 diabetes. We sought to compare an insulin-to-carbohydrate ratio with a simple algorithm for adjusting the dose of prandial insulin glusiline.

RESEARCH AND DESIGN METHODS—This 24-week, multicenter, randomized, controlled study compared two algorithms for adjusting mealtime (glulisine) insulin along with a standard algorithm for adjusting background (glargine) insulin in 273 intent-to-treat patients with type 2 diabetes. Glulisine and glargine were adjusted weekly in both groups based on self-monitored blood glucose (SMBG) results from the previous week. The simple algorithm group was provided set doses of glulisine to take before each meal. The carbohydrate counting (carb count) group was provided an insulin-to-carbohydrate ratio to use for each meal and adjusted their glulisine dose based on the amount of carbohydrate consumed.

RESULTS—A1C levels at week 24 were 6.70% (simple algorithm) and 6.54% (carb count). The respective mean A1C changes from baseline to 24 weeks were −1.46 and −1.59% (P = 0.24). A1C <7.0% was achieved by 73.2% (simple algorithm) and 69.2% (carb count) (P = 0.70) of subjects; respective values for A1C <6.5% were 44.3 and 49.5% (P = 0.28). The total daily dose of insulin was lower, and there was a trend toward less weight gain in carb count group patients. Severe hypoglycemia rates were low and equal in the two groups.

CONCLUSIONS—Weekly basal-bolus insulin adjustments based on premeal and bedtime glucose patterns resulted in significant reductions in A1C. Having two effective approaches to delivering and adjusting rapid-acting mealtime insulin may increase physicians' and patients' willingness to advance therapy to a basal-bolus insulin regimen.
Long-Term Outcome and Disability of Diabetic Patients Hospitalized for Diabetic Foot Ulcers
Authors: Ghanassia Edouard , Villon Laetitia , Thuan dit Dieudonné Jean-François , Boegner Catherine , Avignon Antoine , Sultan Ariane
Published: June 2008

OBJECTIVE—The long-term outcome and functional status of subjects hospitalized for diabetic foot ulcers have been poorly studied and thus are the topics of this study.

RESEARCH DESIGN AND METHODS—Ninety-four consecutive diabetic subjects hospitalized for diabetic foot ulcers between January 1998 and December 2000 were prospectively followed for mean ± SD 79.5 ± 13.3 months. We calculated rates of primary healing, new ulcers, amputations, mortality, and disability and evaluated the global therapeutic success (GTS) of foot care management as defined by the association of primary healing without recurrence or disability at the end of follow-up.

RESULTS—Follow-up was successful in 89 of 94 subjects (63 men and 31 women; age 63.7 ± 10.8 years). Of these, 69 (77.5%) experienced primary healing without major amputation, 39 (43.8%) underwent amputation (24 minor and 15 major), and 46 died (51.7%), including 23 from cardiovascular events. Forty-two of 69 patients who experienced primary healing (60.9%) had ulcer recurrence. At the end of the follow-up period, 25 patients (28.1%) were dependent and 40 subjects (44.9%) had achieved GTS. Multivariate analysis showed the role of age as an independent predictor of GTS (P < 0.05) and of impaired renal function/albuminuria as independent predictors of healing failure, first amputation, and mortality (P < 0.01).

CONCLUSIONS—Despite a satisfactory initial healing rate, the global long-term outcome of patients hospitalized for diabetic foot ulcers was poor. Nephropathy appears to be an important predictor of long-term outcome. Further studies are needed to establish recognized criteria for therapeutic success going beyond just the evaluation of healing rate in the management of diabetic foot ulcers.
Association of Acculturation Levels and Prevalence of Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Kandula Namratha R. , Diez-Roux Ana V. , Chan Cheeling , Daviglus Martha L. , Jackson Sharon A. , Ni Hanyu , Schreiner Pamela J.
Published: June 2008

OBJECTIVE—The prevalence of type 2 diabetes among Hispanic and Asian Americans is increasing. These groups are largely comprised of immigrants who may be undergoing behavioral and lifestyle changes associated with development of diabetes. We studied the association between acculturation and diabetes in a population sample of 708 Mexican-origin Hispanics, 547 non–Mexican-origin Hispanics, and 737 Chinese participants in the Multi-Ethnic Study of Atherosclerosis (MESA).

RESEARCH DESIGN AND METHODS—Diabetes was defined as fasting glucose ≥126 mg/dl and/or use of antidiabetic medications. An acculturation score was calculated for all participants using nativity, years living in the U.S., and language spoken at home. The score ranged from 0 to 5 (0 = least acculturated and 5 = most acculturated). Relative risk regression was used to estimate the association between acculturation and diabetes.

RESULTS—For non–Mexican-origin Hispanics, the prevalence of diabetes was positively associated with acculturation score, after adjustment for sociodemographics. The prevalence of diabetes was significantly higher among the most acculturated versus the least acculturated non–Mexican-origin Hispanics (prevalence ratio 2.49 [95% CI 1.14−5.44]); the higher the acculturation score is, the higher the prevalence of diabetes (P for trend 0.059). This relationship between acculturation and diabetes was partly attenuated after adjustment for BMI or diet. Diabetes prevalence was not related to acculturation among Chinese or Mexican-origin Hispanics.

CONCLUSIONS—Among non–Mexican-origin Hispanics in MESA, greater acculturation is associated with higher diabetes prevalence. The relation is at least partly mediated by BMI and diet. Acculturation is a factor that should be considered when predictors of diabetes in racial/ethnic groups are examined.