bluuebunny/crossref_metadata_2025 huggingface dataset:
Abnormal Glucose Tolerance and Increased Risk for Cardiovascular Disease in Japanese-Americans With Normal Fasting Glucose
Authors: Liao David , Shofer Jane B. , Boyko Edward J. , McNeely Marguerite J. , Leonetti Donna L. , Kahn Steven E. , Fujimoto Wilfred Y.
Published: March 2007

OBJECTIVE— To compare the American Diabetes Association (ADA)fasting glucose and the World Health Organization (WHO) oral glucose tolerance test (OGTT) criteria for diagnosing diabetes and detecting people at increased risk for cardiovascular disease (CVD).

RESEARCH DESIGN AND METHODS— Study subjects were 596 Japanese-Americans. Fasting insulin, lipids, and C-peptide levels; systolic and diastolic blood pressures (BPs); BMI (kg/m2); and total and intra-abdominal body fat distribution by computed tomography (CT) were measured. Study subjects were categorized by ADA criteria as having normal fasting glucose (NFG), impaired fasting glucose (IFG), and diabetic fasting glucose and by WHO criteria for a 75-g OGTT as having normal glucose tolerance(NGT), impaired glucose tolerance (IGT), and diabetic glucose tolerance(DGT).

RESULTS— Of 503 patients with NFG, 176 had IGT and 20 had DGT. These patients had worse CVD risk factors than those with NGT. The mean values for NGT, IGT, and DGT, respectively, and analysis of covariance Pvalues, adjusted for age and sex, are as follows: intra-abdominal fat area by CT 69.7, 95.0, and 101.1 cm2 (P < 0.0001); total CT fat area 437.7, 523.3, and 489.8 cm2 (P < 0.0001); fasting triglycerides 1.40, 1.77, and 1.74 mmol/l (P = 0.002); fasting HDL cholesterol 1.56, 1.50, and 1.49 mmol/l (P = 0.02); C-peptide 0.80,0.90, 0.95 nmol/l (P = 0.002); systolic BP 124.9, 132.4, and 136.9 mmHg (P = 0.0035); diastolic BP 74.8, 77.7, and 78.2 mmHg (P= 0.01).

CONCLUSIONS— NFG patients who had IGT or DGT had more intra-abdominal fat and total adiposity; higher insulin, C-peptide, and triglyceride levels; lower HDL cholesterol levels; and higher BPs than those with NGT. Classification by fasting glucose misses many Japanese-Americans with abnormal glucose tolerance and less favorable cardiovascular risk profiles.
Diastolic Dysfunction in Normotensive Men with Well-Controlled Type 2 Diabetes
Authors: Poirier Paul , Bogaty Peter , Garneau Caroline , Marois Louise , Dumesnil Jean-G.
Published: March 2007

OBJECTIVE— Because a pseudonormal pattern of ventricular filling has never been considered in studies that reported a prevalence of left ventricular diastolic dysfunction (LVDD) between 20 and 40%, our aim was to more completely evaluate the prevalence of LVDD in subjects with diabetes.

RESEARCH DESIGN AND METHODS— We studied 46 men with type 2 diabetes who were aged 38-67 years; without evidence of diabetic complications, hypertension, coronary artery disease, congestive heart failure, or thyroid or overt renal disease; and with a maximal treadmill exercise test showing no ischemia. LVDD was evaluated by Doppler echocardiography, which included the use of the Valsalva maneuver and pulmonary venous recordings to unmask a pseudonormal pattern of left ventricular filling.

RESULTS— LVDD was found in 28 subjects (60%), of whom 13 (28%)had a pseudonormal pattern of ventricular filling and 15 (32%) had impaired relaxation. Systolic function was normal in all subjects, and there was no correlation between LVDD and indexes of metabolic control.

CONCLUSIONS— LVDD is much more common than previously reported in subjects with well-controlled type 2 diabetes who are free of clinically detectable heart disease. The high prevalence of this phenomenon in this high-risk population suggests that screening for LVDD in type 2 diabetes should include procedures such as the Valsalva maneuver and pulmonary venous recordings to unmask a pseudonormal pattern of ventricular filling.
All-Cause Mortality in the Canterbury (New Zealand) Insulin-Treated Diabetic Registry Population
Authors: Brown Laurie J. , Scott Russell S. , Moir Cameron L.
Published: March 2007

OBJECTIVE— To establish all-cause death rates and life expectancies of and risk factors for mortality in insulin-treated diabetic individuals living in Canterbury, New Zealand.

RESEARCH DESIGN AND METHODS— Insulin-treated diabetic subjects(n = 1,008) on the Canterbury Diabetes Registry were tracked over 9 years, and their vital status was determined. Death rates were standardized using direct and indirect methods. Cox proportional hazard regression was used to model the effects of demographic and clinical covariates on survival time.

RESULTS— At study entry, age ranged from 2.9 to 92.7 years,with mean 48.7 ± 20.4 years; age at diagnosis was 0.2-88.9 years, mean 34.5 ± 20.0 years; and duration of diabetes was 0.1-58.5 years, mean 14.0 ± 10.6 years. There were 303 deaths in 7,372 person-years of follow-up with a standardized mortality ratio (SMR) of 2.6 (95% CI 2.4-3.0). Relative mortality was greatest for those aged 30-39 years (SMR 9.2[4.8-16.2]). The death rate for the diabetic cohort standardized against the Segi world standard population was 16.2 per 1,000. Attained age, sex, and clinical subtype were significant predictors of mortality. The SMR for subjects with type 1 diabetes and age at onset <30 years was 3.7 (CI 2.7-5.0), 2.2 (1.8-2.6) for those with onset ≥30 years, and 3.1 (2.5-3.7)for subjects suspected of having latent autoimmune diabetes in adulthood or insulin-treated type 2 diabetes. Life expectancy was reduced for both sexes at all ages.

CONCLUSIONS— Mortality rates for insulin-treated diabetic individuals remain high, resulting in shortened life spans relative to the general population. Marked differences in mortality exist between clinical groups of subjects. Further research is needed to improve diabetes classification and to clarify differences in health outcomes.
Pregnancy Outcome in Type 1 Diabetic Women With Microalbuminuria
Authors: Ekbom Pia , Damm Peter , Feldt-Rasmussen Bo , Feldt-Rasmussen Ulla , Mølvig Jens , Mathiesen Elisabeth R.
Published: March 2007

OBJECTIVE—To determine the influence of microalbuminuria on pregnancy outcome in women with type 1 diabetes.

RESEARCH DESIGN AND METHODS—This prospective cohort study took place at the Obstetric Clinic at National University Hospital, Copenhagen, from January 1996 to February 2000. All Caucasian women with type 1 diabetes, unselected from the eastern part of Denmark, with a living fetus before 17 weeks of gestation on admission were asked to participate. For women with more than one delivery in the study period, only the first pregnancy was included. Of the remaining 246 women, 240 (98%) entered the study. They were categorized according to their urinary albumin excretion (normal urinary albumin excretion, <30 mg/24 h; microalbuminuria, 30–300 mg/24 h; or diabetic nephropathy, >300 mg/24 h) before pregnancy or in the first trimester.

RESULTS—A total of 203 women (85%) had normal urinary albumin excretion, 26 (11%) had microalbuminuria, and 11 (5%) had diabetic nephropathy. Mean HbA1c at 2–6 weeks was 7.5% (SD 1.1), 8.1 (0.9), and 8.8 (1.3) (P < 0.001), respectively. Of all deliveries in women with normal urinary albumin excretion, microalbuminuria, and diabetic nephropathy, 35, 62, and 91% (P < 0.001), respectively, were preterm, and 2, 4, and 45% (P < 0.001), respectively, were small-for-gestational-age infants. Preeclampsia developed in 6, 42, and 64% of the women (P < 0.001), respectively. Category of urinary albumin excretion (P < 0.01) and HbA1c at 2–6 weeks (P < 0.05) were independently associated with preterm delivery.

CONCLUSIONS—The prevalence of preterm delivery is considerably increased in women with microalbuminuria, mainly caused by preeclampsia. Classification according to urinary albumin excretion and metabolic control around the time of conception are superior to the White classification in predicting preterm delivery in women with type 1 diabetes.
Physical Activity, Physical Fitness, and Insulin and Glucose Concentrations in an Isolated Native Canadian Population Experiencing Rapid Lifestyle Change
Authors: Kriska Andrea M. , Hanley Anthony J.G. , Harris Stewart B. , Zinman Bernard
Published: March 2007

OBJECTIVE—Little is known about the relation of physical activity and physical fitness to insulin resistance and glucose intolerance in isolated subarctic Native Canadian populations. The purpose of this effort was to examine the relation between activity and fitness and obesity and glucose concentrations in such a unique population.

RESEARCH DESIGN AND METHODS—This study describes 530 men and women from the community of Sandy Lake, Ontario, located in the boreal forest region of central Canada. Fasting blood glucose and insulin concentrations were determined after an overnight fast. Past year physical activity levels were assessed using a modified version of an interviewer-administered questionnaire. Maximal oxygen uptake, a measure of cardiovascular fitness, was estimated using a submaximal step test.

RESULTS—Total (leisure and occupational) physical activity and physical fitness were significantly associated with fasting insulin concentrations after adjusting for age, BMI or percent body fat, waist circumference, and fasting glucose concentration in men but not in women. The relations between physical activity, fitness, and fasting glucose concentrations were not as strong or as consistent as they were when fasting insulin concentration was the dependent variable.

CONCLUSIONS—In this isolated Native Canadian community, both physical activity and fitness were independently associated with fasting insulin concentrations, suggesting a beneficial role of physical activity/fitness on insulin sensitivity that is separate from any influence of activity on body composition. The fact that this relation was found in men but not in women is most likely explained by issues related to the measurement of activity and fitness in this study and the fact that the women in this population appear to be less active than the men.
Short-Term Moderate Weight Loss and Resistance Training Do Not Affect Insulin-Stimulated Glucose Disposal in Postmenopausal Women
Authors: Joseph Lyndon J.O. , Trappe Todd A. , Farrell Peter A. , Campbell Wayne W. , Yarasheski Kevin E. , Lambert Charles P. , Evans William J.
Published: March 2007

OBJECTIVES—Moderate weight loss and exercise have been proposed as important tools in the treatment and prevention of type 2 diabetes. Therefore, we tested the hypothesis that short-term (4 weeks) moderate energy restriction (−750 kcal/day) would result in a significant increase in insulin-stimulated glucose disposal (40 mU · m−2 · min−1 hyperinsulinemic-euglycemic clamp) in moderately overweight postmenopausal women and that when combined with resistance training (RT) an even greater effect would be seen.

RESEARCH DESIGN AND METHODS—Older women were randomly assigned to energy restriction (WLoss group; n = 9) or energy restriction plus RT (RT + WLoss group; n = 10).

RESULTS—For the WLoss versus the RT + WLoss groups, changes in body weight (−3.0 ± 0.2 kg vs. −3.2 ± 0.3 kg), fat mass (FM) (−3.0 ± 0.3 kg vs. −3.2 ± 0.3 kg), and percent body fat (BF) (−2.1 ± 0.4 vs. −2.4 ± 0.3%) were not different between groups. Muscle mass (group-by-time interaction, P = 0.04) was preserved in RT + WLoss (0.40 ± 0.40 kg) and reduced in WLoss (−0.64 ± 0.18 kg). There were no changes in fat-free mass (FFM) and waist-to-hip ratio in either group. Whole body glucose disposal (WLoss 6.14 ± 0.57 vs. 6.03 ± 0.53, RT + WLoss 5.85 ± 0.60 vs. 6.09 ± 0.56 mg/kg of FFM/min) did not change in either group.

CONCLUSIONS—The results of this study demonstrate that short-term energy restriction resulting in moderate decreases in body weight (4.0 ± 0.3%) and FM (8.2 ± 0.7%) did not improve insulin-stimulated glucose disposal. The addition of RT to the hypoenergetic diet preserved muscle mass but provided no synergistic effect on insulin action. These results suggest that a greater change in body weight or FM may be necessary to observe a significant improvement in insulin action.
The Impact of Blood Glucose Self-Monitoring on Metabolic Control and Quality of Life in Type 2 Diabetic Patients
Authors: Franciosi Monica , Pellegrini Fabio , De Berardis Giorgia , Belfiglio Maurizio , Cavaliere Donatella , Di Nardo Barbara , Greenfield Sheldon , Kaplan Sherrie H. , Sacco Michele , Tognoni Gianni , Valentini Miriam , Nicolucci Antonio ,   for the QuED Study Group
Published: March 2007

OBJECTIVE—The role of self-monitoring of blood glucose (SMBG) in type 2 diabetes is still a matter of debate. In the framework of a nationwide outcomes research program, we investigated the frequency of SMBG and its association with metabolic control and quality of life (QoL).

RESEARCH DESIGN AND METHODS—The study involved 3,567 patients with type 2 diabetes who were recruited by 101 outpatient diabetes clinics and 103 general practitioners. Patients completed a questionnaire investigating SMBG practice and QoL (diabetes-related stress, diabetes health distress, diabetes-related worries, and Centers for Epidemiologic Studies-Depression scale).

RESULTS—Data on SMBG were available for 2,855 subjects (80% of the entire study population). Overall, 471 patients (17%) stated that they tested their blood glucose levels at home ≥1 time per day, 899 patients (31%) tested their blood glucose levels ≥1 time per week, and 414 patients (14%) tested their blood glucose levels <1 time per week, whereas 1,071 patients (38%) stated that they never practiced SMBG. A higher frequency of SMBG was associated with better metabolic control among subjects who were able to adjust insulin doses, whereas no relationship was found in all other patients, irrespective of the kind of treatment. Multivariate analyses showed that an SMBG frequency ≥1 time per day was significantly related to higher levels of distress, worries, and depressive symptoms in non–insulin-treated patients.

CONCLUSIONS—Our findings suggest that SMBG can have an important role in improving metabolic control if it is an integral part of a wider educational strategy devoted to the promotion of patient autonomy. In patients not treated with insulin, self-monitoring is associated with higher HbA1c levels and psychological burden. Our data do not support the extension of SMBG to this group.
From Policemen to Policies: What Is the Future for 2-h Glucose?
Authors: Eschwège Eveline , Charles Marie Aline , Simon Dominique , Thibult Nadine , Balkau Beverley
Published: March 2007

OBJECTIVE—To describe the characteristics and vital prognosis of men with diabetes diagnosed by one fasting plasma glucose (FPG) concentration ≥7.0 mmol/l, with diabetes diagnosed by one isolated postchallenge hyperglycemia (IPH) (FPG <7.0 mmol/l and a 2-h plasma glucose concentration ≥11.1 mmol/l), or with impaired glucose tolerance (IGT).

RESEARCH DESIGN AND METHODS—This study involved a cohort of 6,881 Caucasian nondiabetic men from the Paris Prospective Study, aged 44–55 years, who were followed for cause of death for 20 years.

RESULTS—Diabetes was diagnosed in 4.3% of the men (1.0% diabetes diagnosed by IPH), and IGT was diagnosed in 9% of the men. At baseline, the men with diabetes diagnosed by IPH had a lower cardiovascular risk profile than those with diabetes diagnosed by FPG, as did the men with IGT and a normal fasting glucose level (<6.1 mmol/l, IGT and normal fasting glucose), compared with men with impaired fasting glucose (6.1–6.9 mmol/l, IGT and impaired fasting glucose [IFG]). At 20 years of follow-up, all-cause and cancer death rates were higher in men with diabetes diagnosed by IPH than in men with diabetes diagnosed by FPG (55 vs. 44%, P < 0.1 and 31 vs. 17%, P < 0.01, respectively) but were not significantly different for coronary causes (6 vs. 11%). Men with IGT and normal fasting glucose also had significantly higher cancer death rates than men with IGT and IFG.

CONCLUSIONS—The most likely explanation for the high cancer and low coronary death rates is that men with diabetes diagnosed by IPH consumed alcohol; the men in this study drank 49 g of pure alcohol on average per day, equivalent to 0.6 l of wine. If these results are confirmed by other prospective studies, screening subjects for isolated postchallenge hyperglycemia may not be worthwhile.
Plasma Glucose Levels Throughout the Day and HbA1c Interrelationships in Type 2 Diabetes
Authors: Bonora Enzo , Calcaterra Francesco , Lombardi Simonetta , Bonfante Nicoletta , Formentini Gianni , Bonadonna Riccardo C. , Muggeo Michele
Published: March 2007

OBJECTIVE—To evaluate the extent of plasma glucose excursions with meals, the relations between plasma glucose levels at different times of the day, and the relations between the latter and HbA1c in non–insulin-treated type 2 diabetic subjects.

RESEARCH DESIGN AND METHODS—Daily glucose profiles were assessed in non–insulin-treated type 2 diabetic patients. Outpatients at the diabetes clinic (n = 371; one daily plasma glucose profile) and at home (n = 30; five daily blood glucose profiles over 1 month) as well as inpatients (n = 455; profile of plasma glucose on the day of admission) were examined. Subjects had plasma/blood glucose assessment before and 2–3 h after breakfast, lunch, and dinner. HbA1c was also measured.

RESULTS—After the meals many subjects had glucose levels >8.9 mmol/l (160 mg/dl) and/or glucose excursions >2.2 mmol/l (40 mg/dl). This was also often found when HbA1c was satisfactory (<7%). The coefficients of simple correlation among plasma/blood glucose at different times of the day ranged from 0.52 to 0.88. Correlations between HbA1c and plasma/blood glucose at different times of the day ranged from 0.44 to 0.67. The strongest correlation was between HbA1c and mean daily glucose (r = 0.57–0.69). Multiple regression analyses showed that premeal but not postmeal plasma/blood glucose levels were independent predictors of HbA1c.

CONCLUSIONS—These results suggest that 1) the majority of non–insulin-treated type 2 diabetic patients have exaggerated plasma/blood glucose excursions with meals, and many of them have higher-than-recommended glucose concentrations 2 h after the meals; 2) plasma/blood glucose levels throughout the day are not as strongly interrelated as one might believe; and 3) HbA1c is more related to preprandial than postprandial plasma/blood glucose levels. These findings have potential implications for treatment and monitoring of metabolic control in type 2 diabetes.
Smoking and Mortality Among Women With Type 2 Diabetes
Authors: Al-Delaimy Wael K. , Willett Walter C. , Manson JoAnn E. , Speizer Frank E. , Hu Frank B.
Published: March 2007

OBJECTIVE—To assess the relationship between cigarette smoking and mortality among women with type 2 diabetes in the Nurses’ Health Study cohort.

RESEARCH DESIGN AND METHODS—The Nurses’ Health Study, a prospective cohort of U.S. female registered nurses, included 7,401 women with type 2 diabetes diagnosed at baseline or during follow-up from 1976 to 1996. Total and cause-specific mortality of these diabetic women were the outcomes of interest.

RESULTS—We documented 724 deaths during 20 years of follow-up (67,420 person-years) among women with type 2 diabetes. In multivariate analyses, adjusting for age, history of high blood pressure and high cholesterol, and other cardiovascular risk factors, compared with never smokers, the RRs of mortality were 1.31 (95% CI 1.11–1.55) for past smokers, 1.43 (0.96–2.14) for current smokers of 1–14 cigarettes/day, 1.64 (1.24–2.17) for current smokers of 15–34 cigarettes/day, and 2.19 (1.32–3.65) for current smokers of ≥35 cigarettes/day (P for trend = 0.0002). Women with type 2 diabetes who had stopped smoking for ≥10 years had a mortality RR of 1.11 (0.92–1.35) compared with diabetic women who were never smokers.

CONCLUSIONS—Cigarette smoking is associated in a dose-response manner with an increased mortality among women with type 2 diabetes. Furthermore, quitting smoking appears to decrease this excess risk substantially. Diabetes patients should be strongly advised against smoking.
Was the Historic Contribution of Spain to the Mexican Gene Pool Partially Responsible for the Higher Prevalence of Type 2 Diabetes in Mexican-Origin Populations?
Authors: Lorenzo Carlos , Serrano-Rios Manel , Martinez-Larrad Maria T. , Gabriel Rafael , Williams Ken , Gonzalez-Villalpando Clicerio , Stern Michel P. , Hazuda Helen P. , Haffner Steven M.
Published: March 2007

OBJECTIVE—Mexican-American populations in San Antonio, Texas (SA-MA) and Mexico have a higher prevalence of type 2 diabetes than non-Hispanic whites in San Antonio (SA-NHW). However, the higher prevalence of type 2 diabetes in Mexican-origin populations might be related, in part, not to Native American genetic admixture but to Spanish genetic admixture.

RESEARCH DESIGN AND METHODS—Four population-based epidemiological surveys conducted with Mexican-origin and European-origin samples provided data relevant to this question. In all four surveys, type 2 diabetes was defined as fasting plasma glucose ≥7.0 mmol/l or 2-h glucose ≥11.1 mmol/l or use of antidiabetic agents.

RESULTS—A comparison of the two Mexican-origin populations showed that the age- and sex-adjusted prevalence of type 2 diabetes was lower in Mexico than in SA-MA (15.1 vs. 17.9%, P = 0.032). Between the two European-origin populations, the prevalence of type 2 diabetes was lower in SA-NHW than in Spain (6.2 vs. 9.1%, P < 0.0001), but differences were attenuated by adjustment for BMI or after stratification by education. In logistic regression analyses, type 2 diabetes was associated with Mexican ethnic origin after adjusting for age, education, BMI, and waist-to-hip ratio.

CONCLUSIONS—The prevalence of type 2 diabetes in Spain was intermediate between that in Mexican-origin populations and SA-NHW. Although the higher degree of Native American admixture is a major contributor to the higher rates of type 2 diabetes, we cannot completely rule out a partial contribution of Spanish admixture to diabetes susceptibility among Mexican- origin populations.
Increased Arterial Wall Stiffness Limits Flow Volume in the Lower Extremities in Type 2 Diabetic Patients
Authors: Suzuki Eiji , Kashiwagi Atsunori , Nishio Yoshihiko , Egawa Katsuya , Shimizu Shinya , Maegawa Hiroshi , Haneda Masakazu , Yasuda Hitoshi , Morikawa Shigehiro , Inubushi Toshiro , Kikkawa Ryuichi
Published: March 2007

OBJECTIVE—To document an association between arterial wall stiffness and reduced flow volume in the lower-extremity arteries of diabetic patients.

RESEARCH DESIGN AND METHODS—We recruited 60 consecutive type 2 diabetic patients who had no history or symptoms of peripheral arterial disease (PAD) in the lower extremities and normal ankle/brachial systolic blood pressure index at the time of the study (non-PAD group) and 20 age-matched nondiabetic subjects (control group). We used an automatic device to measure pulse wave velocity (PWV) in the lower extremities as an index of arterial wall stiffness. At the popliteal artery, we evaluated flow volume and the resistive index as an index of arterial resistance to blood flow using gated two-dimensional cine-mode phase-contrast magnetic resonance imaging.

RESULTS—Consistent with previous reports, we confirmed that the non-PAD group had an abnormally higher PWV compared with that of the control group (P < 0.001). To further demonstrate decreased flow volume and abnormal flow pattern at the popliteal artery in patients with a higher degree of arterial wall stiffness, we assigned the 60 non-PAD patients to tertiles based on their levels of PWV. In the highest group, magnetic resonance angiograms of the calf and foot arteries showed decreased intravascular signal intensity, indicating the decreased arterial inflow in those arteries. The highest group was also characterized by the lowest late diastolic and total flow volumes as well as the highest resistive index among the groups. From stepwise multiple regression analysis, PWV and autonomic function were identified as independent determinants for late diastolic flow volume (r2 = 0.300; P < 0.001).

CONCLUSIONS—Arterial wall stiffness was associated with reduced arterial flow volume in the lower extremities of diabetic patients.
Aspirin Use Among Adults With Diabetes
Authors: Rolka Deborah B. , Fagot-Campagna Anne , Narayan K.M. Venkat
Published: March 2007

OBJECTIVE— Since 1997, the American Diabetes Association has recommended that aspirin therapy be considered for adults with diabetes who have cardiovascular disease (CVD) or CVD risk factors. We examined the prevalence of regular aspirin use among adults in the U.S. with diagnosed diabetes.

RESEARCH DESIGN AND METHODS— The Third National Health and Nutrition Examination Survey (1988-1994) used a probability sample of the U.S. population and included an interview, physical examination, and laboratory studies. Among the survey participants were 1,503 adults (age ≥21 years)with self-reported diabetes. We defined regular aspirin use as reported having taken aspirin ≥15 times in the previous month. CVD conditions were self-reported heart attack and stroke and symptoms of angina and claudication. CVD risk factors included smoking, hypertension, obesity, albuminuria, lipid abnormalities, and family history of heart attack.

RESULTS— An estimated 27% of adults with diabetes had CVD, and an additional 71% had one or more CVD risk factors. Aspirin was used regularly by 37% of those with CVD and by 13% of those with risk factors only. Adjusted odds of regular aspirin use were significantly greater for individuals with CVD than for those with one CVD risk factor (odds ratio [OR] = 4.3); for non-Hispanic whites than for blacks, Mexican-Americans, and others (OR = 2.5);and for individuals age 40-59 years than for those <40 years (OR =33.3).

CONCLUSIONS— Nearly every adult in the U.S. with diabetes has at least one risk factor for CVD and thus may be considered a potential candidate for aspirin therapy. During 1988-1994, only 20% (95% CI 16-23) took aspirin regularly. Major efforts are needed to increase aspirin use.
The Potentially Poor Response to Outpatient Diabetes Care in Urban African-Americans
Authors: Cook Curtiss B. , Lyles Robert H. , El-Kebbi Imad , Ziemer David C. , Gallina Daniel L. , Dunbar Virginia G. , Phillips Lawrence S.
Published: March 2007

OBJECTIVE— HbAlc levels can be reduced in populations of diabetic patients, but some individuals may exhibit little improvement. To search for reasons underlying differences in HbAlcoutcome, we analyzed patients managed in an outpatient diabetes clinic.

RESEARCH DESIGN AND METHODS— African-Americans with type 2 diabetes were categorized as responders, intermediate responders or poor responders according to their HbAlc level after 1 year of care. Logistical regression was used to determine baseline characteristics that distinguished poor responders from responders. Therapeutic strategies were examined for each of the response categories.

RESULTS— The 447 patients had a mean age and disease duration of 58 and 5 years, respectively, and BMI of 32 kg/m2. Overall, the mean HbAlc level fell from 9.6 to 8.1% after 12 months. Mean HbAlc levels improved from 8.8 to 6.2% in responders, and from 9.5 to 7.9% in intermediate responders. In poor responders, the average HbAlc level was 10.8% on presentation and 10.9% at 1 year. The odds of being a poor responder were significantly increased with longer disease duration, higher initial HbAlc level, and greater BMI. Although doses of oral agents and insulin were significantly higher among poor responders at most visits, the acceleration of insulin therapy did not occur until late in the follow-up period.

CONCLUSIONS— Clinical diabetes programs need to devise methods to identify patients who are at risk for persistent hyperglycemia. Whereas patient characteristics explain some heterogeneity of HbAlc outcome(and may aid in earlier identification of patients who potentially may not respond to conventional treatment), insufficient intensification of therapy may also be a component underlying the failure to achieve glycemic goals.
Comparison of Single-Mother and Two-Parent Families on Metabolic Control of Children With Diabetes
Authors: Thompson Sanna J. , Auslander Wendy F. , White Neil H.
Published: March 2007

OBJECTIVE— To understand the impact of family structure on the metabolic control of children with diabetes, we posed two research questions: 1) what are the differences in sociodemographic, family, and community factors between single-mother and two-parent families of diabetic children? and 2) to what extent do these psychosocial factors predict metabolic control among diabetic children from single-mother and two-parent families?

RESEARCH DESIGN AND METHODS— This cross-sectional study included 155 diabetic children and their mothers or other female caregivers. The children were recruited if they had been diagnosed with diabetes for at least 1 year, had no other comorbid chronic illnesses, and were younger than 18 years of age. Interviews and self-report questionnaires were used to assess individual, family, and community variables.

RESULTS— The findings indicate that diabetic children from single-mother families have poorer metabolic control than do children from two-parent families. Regression models of children's metabolic control from single-mother families indicate that age and missed clinic appointments predicted HbAlc levels; however, among two-parent families,children's ethnicity and adherence to their medication regimen significantly predicted metabolic control.

CONCLUSIONS— This study suggests that children from single-mother families are at risk of poorer metabolic control and that these families have more challenges to face when raising a child with a chronic illness. Implications point to a need for developing strategies sensitive to the challenges of single mothers.
Limited Value of the Homeostasis Model Assessment to Predict Insulin Resistance in Older Men With Impaired Glucose Tolerance
Authors: Ferrara Cynthia M. , Goldberg Andrew P.
Published: March 2007

OBJECTIVE— Insulin resistance (IR) in older individuals is associated with risk factors for coronary artery disease. The glucose clamp measures IR directly, but the homeostasis model assessment (HOMA) of IR,referred to here as HOMA-IR, is based on fasting glucose and insulin and is less invasive and labor intensive. This method requires validation in the elderly.

RESEARCH DESIGN AND METHODS— We assessed the validity of HOMA-IR as an index of IR by comparing it to glucose infusion rates (GIRs)measured by a glucose clamp (600 pmol · m-2 ·min-1) in 45 obese men (61 ± 8 years of age, mean ±SD) with normal glucose tolerance (NGT) (n = 21) or impaired glucose tolerance (IGT) (n = 24). We also evaluated relationships between body composition, exercise capacity, and IR.

RESULTS— Subjects with NGT had lower BMI (28 ± 3 vs. 31± 3 kg/m2), waist circumference (97 ± 9 vs. 105± 9 cm), waist-to-hip ratio (WHR) (0.93 ± 0.06 vs. 0.97 ±0.05), and percent body fat (25 ± 6 vs. 30 ± 6) than subjects with IGT. Subjects with NGT also had lower areas above basal during the 2-h oral glucose tolerance test for glucose (274 ± 95 vs. 419 ± 124 mmol · min/l) and insulin (38,142 ± 18,206 vs. 58,383 ±34,408 pmol · min/l) and lower HOMA-IR values (2.2 ± 0.8 vs. 4.2± 2.6) than subjects with IGT. GIR (μmol · kg-1FFM · min-1) was higher in subjects with NGT than in subjects with IGT (53 ± 11 vs. 43 ± 14). HOMA-IR correlated with GIR in subjects with NGT (r = -0.59), but not in subjects with IGT(r = -0.13). GIR correlated with Vo2max in subjects with NGT (r = 0.58) and IGT (r = 0.42), but with WHR only in subjects with NGT (r = -0.53). HOMA-IR correlated with Vo2max (r = -0.57) and waist circumference (r =0.54) in subjects with NGT, but with percent body fat in subjects with IGT(r = 0.54).

CONCLUSIONS— These findings indicate that HOMA-IR should not be used as an index of IR in older individuals who may be at risk for IGT, and suggest that lifestyle changes that increase Vo2max and decrease body fat may reduce IR in older people.
African-American Women Have Higher Initial HbAlc Levels in Diabetic Pregnancy
Authors: Holcomb William L. , Mostello Dorothea J. , Leguizamon Gustavo F.
Published: March 2007

OBJECTIVE— African-American women with diabetes are at greater risk for poor glycemic control outside of pregnancy. We evaluated the effect of race on glycemic control in a racially mixed population of women with diabetes entering prenatal care.

RESEARCH DESIGN AND METHODS— HbAlc levels along with demographic data were collected at the first prenatal visit from a group of 234 women with preexisting diabetes. We applied logistic multivariate analysis to identify factors associated with HbAlc levels above the median for the group.

RESULTS— The median HbAlc level for the group was 8%. HbAlc levels were 8.7 ± 2.0% in African-Americans and 7.7 ± 1.5% in Caucasians (P < 0.001). African-American racial designation was significantly and independently associated with high HbAlc when controlled for maternal age, parity, White classification, diabetes type, education, marital status, obesity, insurance type, and first trimester entry into care. The effect of race was confined to the nonobese patients, for whom the adjusted odds ratio for African-American race as a predictor of high HbAlc was 8.15 with a 95% CI of 2.41-27.58 (P = 0.001).

CONCLUSIONS— We found a clear racial disparity in glycemic control among women entering prenatal care with preexisting diabetes. This study demonstrates that there generally is need for better glycemic control among reproductive-age women with diabetes, but especially among those who are African-American.
Macrophage Activation in Type 1 Diabetic Patients With Catheter Obstruction During Peritoneal Insulin Delivery With an Implantable Pump
Authors: Kessler Laurence , Tritschler Sylviane , Bohbot Alain , Sigrist Severine , Karsten Veronique , Boivin Sophie , Dufour Patrick , Belcourt Alain , Pinget Michel
Published: March 2007

OBJECTIVE— The purpose of this study was to evaluate the activation of macrophages in type 1 diabetic patients during peritoneal insulin delivery with an implantable pump against two types of insulin: that which was collected from the pump reservoir and that which came straight from the bottle (i.e., vial insulin). Macrophage activation was studied in patients with and without catheter obstruction and compared with activation in healthy subjects.

RESEARCH DESIGN AND METHODS— Human insulin (21PH, 400 U/ml;Hoescht) was collected from the pump reservoir (Minimed) of diabetic patients with (n = 3) or without (n = 7) catheter obstruction, as assessed by histological examination of the catheter tip. Monocytes were obtained from venous blood samples from both kinds of diabetic patients and from healthy subjects (n = 5) and were differentiated into monocyte-derived macrophages in culture. Their chemotaxis and tumor necrosis factor-α (TNF-α) release were studied with respect to both types of insulin, as previously stated. Formyl-methionyl-leucyl-phenylalanine (fMLP)and lipopolysaccharide (LPS) were used as controls.

RESULTS— Neither insulin recovered from the pump reservoir nor vial insulin proved chemotactic to macrophages from either healthy subjects or those diabetic patients with and without catheter obstruction. The migration toward fMLP of macrophages from patients presenting a catheter obstruction was significantly higher than that observed with macrophages from either diabetic patients without obstruction or healthy subjects; the chemotactic index (mean± SD) was 3.81 ± 0.36 vs. 2.30 ± 0.89 and 2.60 ±0.80, respectively (P < 0.05). LPS significantly stimulated the TNF-α secretion of macrophages from diabetic subjects with a catheter obstruction, whereas both native and reservoir-recovered insulin had no effect on this release (144.83 ± 67.25 vs. 5.15 ± 2.93 and 5.27± 2.43 pg/ml, P < 0.001).

CONCLUSIONS— The human insulin used in implantable pumps,regardless of how long it had remained in the pump reservoir, did not induce macrophage activation in diabetic patients treated through intraperitoneal insulin delivery. In some of these diabetic patients, catheter obstruction could be explained by their high capacity of macrophage chemotaxis.
Plasma Levels of Cellular Fibronectin in Diabetes
Authors: Kanters Suzan D.J.M. , Banga Jan-Dirk , Algra Ale , Frijns Rini C.J.M. , Beutler Jaap J. , Fijnheer Rob
Published: March 2007

OBJECTIVE— Cellular fibronectin is an endothelium-derived protein involved in subendothelial matrix assembly. Elevated plasma levels of cellular fibronectin therefore reflect loss of endothelial cell polarization or injury to blood vessels. Consequently, elevated plasma levels of circulating cellular fibronectin have been described in clinical syndromes with vascular damage, although not in diabetes or atherosclerosis.

RESEARCH DESIGN AND METHODS— We determined fibronectin levels in 52 patients with type 1 diabetes, 50 patients with type 2 diabetes, 54 patients with a history of ischemic stroke, 23 patients with renal artery stenosis, and 64 healthy subjects.

RESULTS— Circulating cellular fibronectin was significantly elevated in patients with diabetes (4.3 ± 2.8 μg/ml) compared with patients with ischemic stroke (2.0 ± 0.9 μg/ml), patients with renovascular hypertension (1.7 ± 1.1 μg/ml), and healthy subjects(1.4 ± 0.6 μg/ml). Patients with diabetes and at least one cardiovascular risk factor had an almost 2.5-fold increase in cellular fibronectin compared with diabetic subjects without such a risk factor. In multivariate regression analysis, higher triglycerides, current or past cigarette smoking, and higher urinary albumin excretion were independently associated with an increase in circulating cellular fibronectin in diabetes.

CONCLUSIONS— These results suggest that circulating cellular fibronectin may be a marker protein for endothelial cell activation,especially in diabetes. Prospective studies are needed to explore this possibility.
Plasma Levels of Tumor Necrosis Factor-α, Angiotensin II, Growth Hormone, and IGF-I Are Not Elevated in Insulin-Resistant Obese Individuals With Impaired Glucose Tolerance
Authors: Blüher Matthias , Kratzsch Juergen , Paschke Ralf
Published: March 2007

OBJECTIVE— To investigate the relationship between insulin resistance and plasma concentrations of free fatty acids (FFAs), leptin, and potential agonists of the insulin receptor substrate (IRS) system, including tumor necrosis factor-α (TNF-α), IGF-I, growth hormone (GH), and angiotensin II in individuals with impaired glucose tolerance (IGT).

RESEARCH DESIGN AND METHODS— Because glucose toxicity per se leads to insulin resistance, the determination of the primary metabolic alterations leading to insulin resistance is best accomplished in individuals who are at an increased risk to develop type 2 diabetes. Therefore, 48 subjects with IGT and insulin resistance (IR), characterized by hyperinsulinemic-euglycemic clamps, were compared with 52 healthy insulin-sensitive (IS) control subjects with respect to the relationship between the plasma levels of TNF-α, IGF-I, GH, angiotensin II, FFA,leptin, and insulin resistance.

RESULTS— Between the IR and the IS groups, there were no significant differences in the plasma concentrations of TNF-α, GH,angiotensin II, IGF-I, and leptin. However, plasma FFA levels were significantly elevated in the IR group compared with the IS group after matching for BMI.

CONCLUSIONS— The plasma concentrations of FFA, but not TNF-α, IGF-I, GH, and angiotensin II, are elevated in patients at an early stage of insulin resistance, suggesting that FFAs, but not the other modulators of the IRS system, may be a primary metabolic abnormality leading to insulin resistance.
Increased Prevalence of Significant Coronary Artery Calcification in Patients With Diabetes
Authors: Schurgin Sunita , Rich Stuart , Mazzone Theodore
Published: March 2007

OBJECTIVE— Coronary artery disease is the major cause of morbidity and mortality in patients with diabetes. Detection of coronary artery disease before the first myocardial infarction and before anginal symptoms will allow for strategies designed to reduce the cardiovascular event rate in this group of patients. Electron beam—computed tomography (EBCT)is a noninvasive technology for evaluating the extent of coronary artery atherosclerosis that relies on the detection of coronary artery calcium (CAC). We used EBCT to detect significant coronary artery atherosclerosis in diabetic patients without symptoms of heart disease.

RESEARCH DESIGN AND METHODS— We used EBCT to evaluate calcium in the coronary arteries of 139 consecutive diabetic patients scanned over a 20-month period. The CAC scores in this group were compared with a randomly selected nondiabetic control group and a control group that was selected to match a number of established cardiovascular risk factors.

RESULTS— Patients with diabetes had a significant increase in the prevalence of CAC scores ≥400 (25.9%) compared with the randomly selected (7.2%) and matched (14.4%) nondiabetic control groups. Scores in this range have been reported to be highly predictive for abnormal stress myocardial perfusion tomography and subsequent coronary events.

CONCLUSIONS— Our results, therefore, indicate a substantial prevalence of significant coronary artery disease in an asymptomatic diabetic patient population compared with non-diabetic control subjects. They also suggest that EBCT may be a useful approach for selecting a group of diabetic subjects who would benefit most from additional evaluation for subclinical coronary artery disease.
Subclinical States of Glucose Intolerance and Risk of Death in the U.S.
Authors: Saydah Sharon H. , Loria Catherine M. , Eberhardt Mark S. , Brancati Frederick L.
Published: March 2007

OBJECTIVE—Although clinically evident type 2 diabetes is a well-established cause of mortality, less is known about subclinical states of glucose intolerance.

RESEARCH DESIGN AND METHODS—Data from the Second National Health and Nutrition Examination Survey Mortality Study, a prospective study of adults, were analyzed. This analysis focused on a nationally representative sample of 3,174 adults aged 30–75 years who underwent an oral glucose tolerance test at baseline (1976–1980) and who were followed up for death through 1992.

RESULTS—Using 1985 World Health Organization criteria, adults were classified as having previously diagnosed diabetes (n = 248), undiagnosed diabetes (n = 183), impaired glucose tolerance (IGT) (n = 480), or normal glucose tolerance (n = 2,263). For these groups, cumulative all-cause mortality through age 70 was 41, 34, 27, and 20%, respectively (P < 0.001). Compared with those with normal glucose tolerance, the multivariate adjusted RR of all-cause mortality was greatest for adults with diagnosed diabetes (RR 2.11, 95% CI 1.56–2.84), followed by those with undiagnosed diabetes (1.77, 1.13–2.75) and those with IGT (1.42, 1.08–1.87; P < 0.001). A similar pattern of risk was observed for cardiovascular disease mortality.

CONCLUSIONS—In the U.S., there was a gradient of mortality associated with abnormal glucose tolerance ranging from a 40% greater risk in adults with IGT to a 110% greater risk in adults with clinically evident diabetes. These associations were independent of established cardiovascular disease risk factors.
Blood Pressure Does Not Rise Before the Onset of Microalbuminuria in Children Followed From Diagnosis of Type 1 Diabetes
Authors: Schultz Carl J. , Neil H. Andrew W. , Dalton R. Neil , Bahu Teresa Konopelska , Dunger David B. ,   on behalf of the Oxford Regional Prospective Study Group
Published: March 2007

OBJECTIVE—To examine whether a rise in blood pressure could be detected before the onset of microalbuminuria (MA) in a cohort of children followed from diagnosis of type 1 diabetes.

RESEARCH DESIGN AND METHODS—The Oxford Regional Prospective Study is an incident cohort study of children with type 1 diabetes aged (mean ± SD) 9.8 ± 3.7 years at diagnosis. Subjects were assessed annually from diagnosis, with measurement of HbA1c, arterial blood pressure (random zero), and three urine samples for estimation of the albumin/creatinine ratio. During follow-up, 63 of 494 children developed MA at one or more annual assessments and were designated as cases for a nested case-control study. Each case was matched for sex and age at diagnosis with two normoalbuminuric control subjects. Blood pressure (BP) data were compared at corresponding years of diabetes duration.

RESULTS—Cases with MA were similar to normoalbuminuric control subjects with respect to age and BMI, but they had higher mean HbA1c levels (mean difference 1.1%, P < 0.001). In the years before the onset of MA, the diastolic BP standard deviation score (SDS) was significantly higher than zero in cases (mean 0.49, P < 0.001) and in control subjects (0.50, P < 0.001). No difference could be detected between cases and control subjects before the onset of MA in either systolic or diastolic BP (mean difference systolic −1.2 mmHg [95% CI −4.7 to 2.7], mean difference diastolic 0.1 mmHg [−2.4 to 2.6]). However, within the cases, the onset of MA was associated with elevations in systolic and diastolic BP SDSs (F = 16.1, P < 0.001; and F = 18.0, P < 0.001). BMI, but not HbA1c, was associated with systolic and diastolic BP SDSs in the subjects with MA (F = 0.6, P = 0.4; and F = 12.3, P = 0.001). However, the association of BP with MA remained significant for systolic BP (P = 0.001) and for diastolic BP (P < 0.001) after adjusting for BMI.

CONCLUSIONS—A rise in systemic BP cannot be detected before the first appearance of MA in children with type 1 diabetes. BP rises concurrently with the onset of MA and is also closely related to BMI.
Recent Advances in Our Understanding of Insulin Action and Insulin Resistance
Authors: Le Roith Derek , Zick Yehiel
Published: March 2007

Insulin signaling at the target tissue results in a large array of biological outcomes. These events are essential for normal growth and development and for normal homeostasis of glucose, fat, and protein metabolism. Elucidating the intracellular events after activation of the IR has been the primary focus of a large number of investigators for decades, and for excellent reasons. Understanding the signaling pathways involved in insulin action could lead to a better understanding of the pathophysiology of insulin resistance associated with obesity and type 2 diabetes, and identifying key molecules and processes could lead to newer and more effective therapeutic agents for treating these common disorders.

This review summarizes our previous understanding of how insulin acts and outlines some recent developments in our understanding of insulin action and insulin resistance at the cellular level, beginning with a discussion on the discovery of evolutionarily conserved molecules of the insulin signaling pathways. This article will also provide a summary of a few in vitro and cellular models of insulin resistance and a description of some new paradigms in the cellular mechanisms of insulin action.

This review will not attempt to be all-inclusive; for a more comprehensive understanding, readers are referred to more complete reviews on insulin action (1–5).