bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Glycemic Control of Type II Diabetes Suffice to Control Diabetic Dyslipidemia?: A Community Perspective
Authors: Stern Michael P , Mitchell Braxton D , Haffner Steven M , Hazuda Helen P
Published: March 2007

Objective

–To assess the extent to which glycemic control by itself results in satisfactory control of diabetic dyslipidemia.

Research Design and Methods

A population-based case series consisting of 386 Mexican Americans and 94 non-Hispanic whites with non-insulin-dependent (type II) diabetes was studied. All subjects answered questions about their medical history and care received and underwent a standardized oral glucose tolerance test and measurements of fasting serum lipid and lipoprotein concentrations. Three definitions of dyslipidemia were used: total cholesterol >6.20 mM (240 mg/dl), triglyceride >2.82 mM (250 mg/dl), and high-density lipoprotein cholesterol <0.90 mM (35 mg/dl).

Resulrs

Despite having removed subjects receiving lipid-lowering drugs, diabetic subjects who had been previously diagnosed and were under medical care exhibited a lower prevalence of hypertriglyceridemia than those who were newly diagnosed at the time of their survey visit, suggesting that conventional management was associated with a reduced frequency of this dyslipidemia. Among previously diagnosed cases, the prevalence of dyslipidemia rose with worsening glycemic control but there was little association with type of therapy (diet only, oral agents, or insulin) or frequency of physician visits. In general, the prevalence of dyslipidemia in diabetic subjects remained higher than in nondiabetic subjects, despite hypoglycemic therapy.

Conclusions

The results suggest that glycemic control by itself does not suffice to control diabetic dyslipidemia and that significant numbers of diabetic subjects will need direct lipid management. Clinical trials are urgently needed to define the optimum management strategy for diabetic dyslipidemia.
Morning or Bedtime NPH Insulin Combined With Sulfonylurea in Treatment of NIDDM
Authors: Groop Leif C , Widén Elisabeth , Ekstrand Agneta , Saloranta Carola , Franssila-Kallunki Anja , Schalin-Jäntti Camilla , Eriksson Johan G
Published: March 2007

Objective

To compare the effect of morning and bedtime NPH insulin combined with daytime sulfonylurea on glycemic control in non-insulin-dependent diabetes mellitus (NIDDM) patients no longer responding to treatment with sulfonylureas alone.

Research Design and Methods

Twenty-four NIDDM patients who fulfilled these criteria were randomized to treatment with Protaphan human insulin in the morning or at bedtime (22 ± 1 IU) plus 3.5 mg glibenclamide twice a day.

Results

Morning and bedtime NPH insulin resulted in equal reduction of HbA1 (from 13.5 ± 0.3 to 9.4 ± 0.1 and 9.6 ± 0.2%, respectively) and mean self-monitored blood glucose (9.2 ± 0.5 vs. 10.1 ± 0.4 mM). Bedtime insulin resulted in lower morning blood glucose (7.8 ± 0.5 vs. 9.1 ± 0.4 mM; P < 0.01), whereas morning insulin resulted in lower evening blood glucose (10.1 ± 0.6 vs 12.1 ± 0.6 mM, P < 0.01).

Conclusions

Morning and bedtime NPH insulin combined with glibenclamide are equipotent in the treatment of NIDDM patients with secondary failure to sulfonylurea. However, this treatment regimen normalizes blood glucose only in a small group of patients. Therefore, more intensified insulin therapy seems to be required to achieve this goal.
Stress Buffering and Glycemic Control: The Role of Coping Styles
Authors: Peyrot Mark F , McMurry James F
Published: March 2007

Objective

To test the hypotheses that chronic psychosocial stress is associated with worse glycemic control and that coping moderates (buffers) this effect.

Research Design and Methods

Subjects consisted of 105 insulin-treated adults from the Diabetes Division of Henry Ford Hospital who filled out questionnaires on stress and coping and received an HbA1 test at a clinic appointment. Six coping styles were examined, including both emotion- and problem-focused styles. Two standardized stress inventories were administered. Ineffective coping was defined as scoring below the median for stress-dampening coping styles and above the median for stress-exacerbating styles.

Results

Stress was significantly (P < 0.05) correlated with higher HbA1 in all but one ineffective coping subgroup. Conversely, none of 12 correlations between stress and glycemic control was significant in the effective coping subgroups.

Conclusions

Chronic psychosocial stress is associated with worse glycemic control among those who do not cope effectively with stress. Effective coping can protect individuals from the deleterious effects of stress.
Controversial Beliefs About Diabetes and its Care
Authors: Anderson Robert M , Donnelly Michael B , Davis Wayne K
Published: March 2007

Objective

The purpose of this study was to identify specific beliefs that differentiate health-care professionals whose attitudes toward diabetes agreed most strongly with a group of national diabetes experts from those whose attitudes disagreed most strongly.

Research Design and Methods

The sample for this study included 271 physicians, 834 nurses, and 546 dietitians who completed a Diabetes Attitudes Survey. The sample included specialists in diabetes care and nonspecialists. Controversial beliefs about diabetes and its care were determined by comparing the beliefs of the 10% of the sample whose attitudes were most concordant (with the national panel) with the beliefs of the 10% of the sample whose attitudes were the most discordant. Ten beliefs met the criteria for being defined as controversial.

Results

The most controversial beliefs concerned whether the patient or the physician should be the primary decision maker in diabetes care, the meaning of patient noncompliance, and the seriousness of non-insulin-dependent diabetes mellitus. The 10% of the sample with the most discordant attitudes contained a disproportionately large number of physicians, nonspecialists in diabetes, and health-care professionals who had been in practice longer than the other members of the sample.

Conclusions

This study identifies some important differences in beliefs between younger health-care professionals who specialize in diabetes and older nonspecialists. Such beliefs should be addressed in continuing education programs with the aim being to foster the widespread adoption of a contemporary approach to diabetes care.
Temporal Variation in Incidence of IDDM in Canterbury, New Zealand
Authors: Scott Russell S , Brown Laurie J , Darlow Brain A , Forbes Louisa V , Moore M Peter
Published: March 2007

Objective

To establish the statistical significance of observed variations over the last decade in the incidence of insulin-dependent diabetes mellitus (IDDM) in the 0- to 19-yr-old age-group and to determine whether incidence has increased in Canterbury, New Zealand.

Research Design and Methods

The Canterbury, New Zealand, Diabetes Registry has recorded all incidence cases of diabetes mellitus prospectively since 1982. All IDDM subjects aged 0–19 yr at diagnosis and using insulin are included in the study. Ascertainment is believed to be 100%. Prevalence was recorded at 1 January 1982 and 1 January 1990. Annual incidence for 1982–1990 was determined using age and sex cross-sectional census population denominators. The statistical significance of temporal, age, sex, and seasonal variations in incidence rates was ascertained by Poisson regression models (GLIM statistical software).

Results

Prevalence on 1 January 1990 was 115/100,000. Incidence rates during the 9 yr were periodic, with two major peaks—one in the early 1980s, the other in 1989 continuing into 1990. The temporal variation (P < 0.02) was not age or sex specific. Incidence rates for boys were three- to fourfold higher during peak versus trough years, with a peak level of 20.7/100,000 in 1990. For girls, there was less variation, with a peak rate of 21.6/100,000 in 1990. There has been no significant increase in IDDM incidence over time. The mean rate of incidence across all age-groups for 1982–1990 was 12.7/100,000 person-yr. A significant seasonal association to the onset of IDDM was found only in boys, with incidence rates being significantly higher in winter than in summer (P < 0.01).

Conclusions

IDDM in Canterbury, New Zealand, presents in cycles of incidence peaks and troughs, each spanning 2–3 yr.
Prevalence of Cardiovascular Autonomic Dysfunction Assessed by Spectral Analysis and Standard Tests of Heart-Rate Variation in Newly Diagnosed IDDM Patients
Authors: Ziegler Dan , Dannehl Karsten , Mühlen Hansjürg , Spüler Manfred , Gries F Arnold
Published: March 2007

Objective

To determine the prevalence of cardiovascular autonomic nerve dysfunction in patients with newly diagnosed insulin-dependent diabetes mellitus (IDDM) compared with healthy nondiabetic subjects.

Research Design and Methods

A battery of cardiovascular reflex tests was performed in 130 newly diagnosed IDDM patients aged 12–40 yr at mean blood glucose levels of 7.2 mM after insulin had been administered for 3–39 days. Age-dependent lower limits of normal of these tests were defined at the 2.3 percentile in 120 nondiabetic subjects. Tests of heart-rate variation (HRV) included the coefficient of variation (C.V.) and the low-frequency (LF), midfrequency (MF), and high-frequency (HF) bands of spectral analysis at rest, HRV during deep breathing (C.V., expiratory-inspiratory ratio, and mean circular resultant), Valsalva ratio, and maximum/minimum 30:15 ratio. In addition, spectral analysis on standing, the change in systolic blood pressure to standing, and diastolic blood pressure response to sustained handgrip were determined in 50 patients.

Results

A significantly higher percentage of abnormal test responses in the diabetic group compared with the control group was noted for power spectrum in the LF band (7.3 vs. 0.8%, P < 0.05) and MF band (10.6 vs. 0%, P < 0.001) at rest and HF band on standing (10.0 vs. 0.9%, P < 0.05), maximum/minimum 30:15 ratio (25.4 vs. 5.0%, P < 0.001), and Valsalva ratio (17.5 vs. 4.2%, P < 0.001). There were no significant differences between both groups in regard to the remaining parameters. Ten (7.7%) diabetic patients but none of the nondiabetic subjects had cardiovascular autonomic neuropathy defined by the strict criterion of abnormal results in more than three of six tests (P < 0.001). In addition, 12 (9.2%) patients but only 2 (1.7%) control subjects had abnormal results in two of six tests (P < 0.01).

Conclusions

Cardiovascular autonomic nerve dysfunction is relatively common in newly diagnosed IDDM patients after correction of the initial metabolic imbalance. A combination of tests based on spectral and conventional analysis of HRV appears suitable for detection of early abnormalities in autonomic function in diabetes.
Use of Blood Glucose Data by Families of Children and Adolescents with IDDM
Authors: Wysocki Tim , Hough Brenda S , Ward Kory M , Allen Anthony A , Murgai Neena
Published: March 2007

OBJECTIVE

Prospective evaluation of the use of blood glucose test results for treatment actions by families of youth with IDDM.

RESEARCH DESIGN AND METHODS

Forty-seven patients with IDDM used reflectance meters with memory for SMBG for 28 days. Parents kept weekly diaries of six types of uses of SMBG data. We collected SMBG data from the reflectance meters, HbA1 and serum fructosamine assays, and measures of behavioral factors that could affect use of SMBG data.

RESULTS

Families recorded a mean of 4.85 data-based actions during the 28-day study, and 74% of the families reported at least one such action. Fifty percent of recorded actions consisted of management of hypoglycemia and, among the remainder, only 18% were anticipatory, proactive actions. Partial correlation analysis showed that families with more frequent use of SMBG data had less parent-child conflict about diabetes, more diabetes knowledge, and better overall treatment adherence. Use of SMBG data was unrelated to objective indices of the need for treatment adjustments or to diabetic control.

CONCLUSIONS

Most families made active use of their SMBG data, but few of these actions were proactive. Behavioral factors were stronger predictors of family use of SMBG data than were objective indices of the need for treatment adjustments. The results illustrate the need for further research on use of SMBG data and methods to enhance its impact on diabetic control.
Comparison of Two Commonly Used Standard IVGTTs
Authors: Colman Peter G , Stewart Vicky , Kean Jan , Koschmann Marion , Alford Frank , Ward Glen , Deam David , Harrison Leonard C
Published: March 2007

OBJECTIVE

To compare the magnitude and reproducibility of the FPIR measured during two different IVGTT protocols in nondiabetic subjects.

RESEARCH DESIGN AND METHODS

Nine control subjects each had two pairs of IVGTTs with either a 4-min infusion of 0.5 g/kg glucose or a 1-min infusion of 0.3 g/kg glucose. Blood glucose and serum insulin were measured before and 1, 2, 3, 5, and 10 min after completion of the glucose infusion. The FPIR was measured with either 1 + 3−, 2 + 3 + 5−, or 1 + 3 + 5-min serum insulins, areas under the insulin curve (0–5 or 0–10 min), or the ratio of serum insulin to blood glucose area.

RESULTS

The FPIR was higher in eight of nine subjects with the short-infusion test, but the within-subject variation of the two methods was identical. Reproducibility was not significantly improved with an integrated insulin area or insulin-to-glucose ratio measurement.

CONCLUSIONS

Reproducibility of the FPIR measured during IVGTT is not significantly affected by the duration of the glucose infusion. However, the magnitude of the difference in FPIR observed between the two protocols highlights the need for standardization of the methodology if the IVGTT is to be used in studies of the preclinical stage of IDDM.
Assessment of Glucose Tolerance Test Criteria for Diagnosis of Diabetes in Chinese Subjects
Authors: Cockram Clive S , Lau Joseph T F , Chan Albert Y W , Woo Jean , Swaminathan Ramasamyiyer
Published: March 2007

OBJECTIVE

To examine and compare WHO diagnostic criteria for diabetes mellitus.

RESEARCH DESIGN AND METHOD

The relationship between FPG and 2-h glucose are examined in 680 OGTTs with a quadratic regression model and ROC analysis. Simultaneous measurements of HbA1 and fructosamine are also compared with multiple linear regression.

RESULTS

Two hundred eighteen subjects (32%) had 2-h glucose ≥ 11.1 mM, of which only 86 had FPG ≥ 7.8 mM. Only 2 subjects had FPG > 7.8 mM and 2-h glucose < 7.8 mM. Of subjects with 2-h glucose < 7.8 mM (n = 332), only 9 had FPG > 6.0 mM. From the quadratic model, the predicted FPG corresponding to 2-h glucose = 11.1 mM was 5.7 mM, whereas the predicted 2-h glucose corresponding to FPG = 7.8 mM was 15.2 mM. ROC analysis showed that, with 2-h glucose ≥ 11.1 mM as indicating diabetes, an FPG of 5.6 mM gave an intersect for sensitivity and specificity of 87%. HbA1 and fructosamine correlated more closely with 2-h glucose and area under the OGTT curve than with FPG.

CONCLUSIONS

Given that a 2-h glucose cutoff of 11.1 mM can be justified from other studies, our results suggest that the FPG cutoff of 7.8 mM when used for screening purposes should be reduced. At a suggested value of 7.0 mM, specificity remains 98.5%, whereas sensitivity increases to 57%.
Cell-Cell Interactions in Diabetic Angiopathy
Authors: Dodge Andrea B , D'Amore Patricia A
Published: March 2007

Normally, both ECs and mural cells, pericytes in the microvasculature and SMCs in large vessels of the mature vasculature, are under stringent growth control and remain quiescent. Regulation of vascular growth is a complex process that is likely to take place at multiple levels. Evidence indicates that intercellular communication, which may take several forms, including diffusible factors, gap junctions, and CAMs underlies the maintenance of normal vessels. A disruption or imbalance in any of these factors may be responsible for the vascular remodeling associated with macro/microangiopathy.
Impaired Glucose Tolerance and its Relationship to ECG-Indicated Coronary Heart Disease and Risk Factors Among Chinese: Da Qing IGT and diabetes study
Authors: Pan Xiao-Ren , Hu Ying-Hua , Li Gung-Wie , Liu Ping-Am , Bennett Peter H , Howard Barbara V
Published: March 2007

Objective— To determine the prevalence of IGT and diabetes and identify the occurrence of CVD and its risk factors.

Research Design and Methods— This study was a population-based, cross-sectional study of 110,660 residents, 25–74 yr of age of DaQing, Hei Long Jiang Province, China.

Results— Using 1985 WHO criteria, 577 (5.5/1000) subjects with IGT and 630 (6.0/1000) with newly diagnosed diabetes were identified. In addition, 190 (1.7/1000) with previously known diabetes were identified. Hypertension, obesity, and abnormal albumin excretion were twice as frequent in those with IGT as in 279 men and 240 women of similar age and sex distribution who had normal OGTTs. Plasma cholesterol and TGs were higher, and HDL cholesterol was lower in subjects with IGT than in nondiabetic subjects. Those with IGT had a prevalence of electrocardiographically recognized CHD 9.5-fold greater than the normoglycemic subjects. Subjects with IGT had higher plasma insulin concentrations, but the 1-h insulin-glucose ratio after the 75-g glucose load was lower. In a forward stepwise multiple logistic regression analysis, IGT itself remained an independent factor associated with CHD after adjustment for age, sex, cigarette smoking, plasma cholesterol, BP, and obesity.

Conclusions— Therefore, in China, IGT may occur with almost as high a frequency as diabetes and is accompanied by an increased frequency of CVD and its risk factors. Estimates from this study indicate that >12.0% of all ECG-indicated CHD in the Da Qing population occurs in individuals with IGT and NIDDM. The IGT subjects identified in this survey form the cohort for a long-term follow-up and intervention study.
Behavioral Treatment of Obesity: Its application to type II diabetes
Authors: Wing Rena R
Published: March 2007

This review describes the improvements made in the behavioral treatment of obesity from the 1970s to the present, and then provides a comparable overview of progress that has been made in the behavioral treatment of obese patients with type II diabetes by Wing et al. (13–19) at the University of Pittsburgh. Evidence is presented to show that structured exercise, VLCDs, and intensification of treatment programs may be useful in improving the long-term outcome of behavioral weight-loss interventions.
Prevalence of Diagnosed Diabetes Among American Indians and Alaska Natives, 1987: Estimates from a national outpatient data base
Authors: Valway Sarah , Freeman William , Kaufman Stephen , Welty Thomas , Helgerson Steven D , Gohdes Dorothy
Published: March 2007

Objective— To estimate the prevalence of diagnosed diabetes among American Indians and Alaska Natives served by the IHS.

Research Design and Methods— This was a cross-sectional study of the 1987 IHS national outpatient data base.

Results— Prevalence rates of diagnosed diabetes determined from the IHS outpatient data base were consistent with recent studies of diabetes in different IHS areas. IHS-wide, age-adjusted prevalence was 69/100,000, or 2.8 times the U.S. rate. There was considerable variation in prevalence rates of diabetes throughout the country, with rates ranging from 15.3/100,000 in Alaska to 119.2/100,000 in southern Arizona.

Conclusions— This study documented the high prevalence of diabetes among American Indians and Alaska Natives and the wide variation in rates between different tribal groups. This study also demonstrated the feasibility of using an outpatient data base to estimate rates of disease that have uniform methods of diagnosis and result in frequent clinic visits.
Diabetes Mortality Among New Mexico's American Indian, Hispanic, and Non-Hispanic White Populations, 1958–1987
Authors: Carter Janette S , Wiggins Charles L , Becker Thomas M , Key Charles R , Samet Jonathan M
Published: March 2007

OBJECTIVE— To determine the diabetes-related mortality rates among New Mexico's American Indians, Hispanics, and non-Hispanic whites over a 30-yr period.

RESEARCH DESIGN AND METHODS— Death certificates were used to identify diabetes as an underlying cause of death by ethnic group in New Mexico during each 5-yr period from 1958 through 1987. The age-adjusted rates were calculated by ethnic group and sex, and temporal trends were examined. Comparison was made to U.S. white age-adjusted rates during the same time period.

RESULTS— Age-adjusted diabetes mortality rates for American Indians and Hispanics increased throughout the 30-yr period, and far exceeded rates for New Mexico non-Hispanic whites and U.S. whites by the 1983–1987 time period. The rates increased most dramatically among the state's American Indians, increasing 550% among women and 249% among men. Hispanic women and men experienced increases of 112 and 140%, respectively.

CONCLUSIONS–New Mexico's American Indian and Hispanic populations have higher diabetes mortality rates than non-Hispanic whites, and American Indian mortality rates have risen dramatically over the 30-yr period included in our study. Although the high prevalence of diabetes in American Indians and Hispanics is a major contributor to these rates, other factors may also influence the reported mortality rates.
Lipid Tolerance Testing in Pregnancy
Authors: Cowett Richard M , Carr Stephen R , Ogburn Paul L
Published: March 2007

Objective— Macrosomia in the infant of the well-controlled diabetic mother suggests that a substrate other than glucose may influence fetal growth. We hypothesized that GDM alters lipid homeostasis during pregnancy. Our objective was to determine if an LTT could assist in identification of lipid abnormalities in the GDM individual.

Research Designs and Methods— The LTT consisted of bolus infusion of 1.0 mg/kg 10% Intralipid (Cutter Vitrum, Berkeley, CA) followed by measurements of plasma glucose, insulin, glycerol, total triglycerides, and triglyceride fatty acids (18:1 and 18:2), total FFAs, and total phospholipids for 30 min before and 90 min after the bolus. The study groups were composed of 8 nonpregnant, nondiabetic subjects, 8 pregnant, nondiabetic subjects, 8 GDM patients receiving insulin, and 8 GDM patients who were diet controlled.

Results— Plasma glucose and plasma insulin concentrations did not change significantly after the bolus. No significant difference was noted in the K2 for glycerol of the nonpregnant, nondiabetic group compared with the pregnant groups. The K2 for total triglycerides, plasma triglyceride 18:1, and plasma triglyceride 18:2 indicated increased rates of disappearance of these substrates for the nonpregnant nondiabetic group compared with all pregnant groups. No significant differences were observed among the pregnant groups for any of these parameters.

Conclusions— Pregnancy may be associated with a decreased rate of triglyceride lipolysis compared with nonpregnancy. No differences in lipid metabolism were noted among normal pregnant and relatively well-controlled GDM patients.
Mortality of Mexican Americans With NIDDM: Retinopathy and other predictors in Starr County, Texas
Authors: Hanis Craig L , Chu Hsuan-Ho , Lawson Kim , Hewett-Emmett David , Barton Sara A , Schull William J , Garcia Charles A
Published: March 2007

Objective— To determine the rate and risk factors of mortality in a cohort of Mexican Americans with NIDDM.

Research Design and Methods— A cohort of 353 Mexican Americans with NIDDM were identified between 1981 and 1986. All individuals underwent extensive evaluations that included physical, historical, ophthalmological, and laboratory assessments. This cohort was followed prospectively for a mean of 8 yr. Follow-up included mortality surveillance, death certificate extraction, and a combination of annual and intermediate examinations.

Results— The cohort experienced 67 mortality events. One-third of all deaths were premature <65 yr of age) and most often were attributed to diseases of the heart (60.0%). In no case was diabetes listed as the cause of death, although it was listed as a contributing cause in 25.5% of cases. Men had a higher mortality rate than women. In both sexes, baseline retinopathy was identified as an important predictor of subsequent mortality. Mortality was significantly elevated in those with nonproliferative retinopathy and even further elevated in those with proliferative disease (relative risks of ≥ 4 for proliferative disease).

Conclusions— Mexican Americans with NIDDM are experiencing premature and excessive mortality compared with the general population. The results clearly link microvascular complications with macrovascular disease, but this link is not explained by a more untoward profile of traditional cardiovascular risk factors. Retinopathy appears to serve as an important monitor of the progression of diabetes and when identified would warrant aggressive action to inhibit or slow the processes leading to subsequent mortality.
Glucose Intolerance in Colombia: A population-based survey in an urban community
Authors: Aschner Pablo , King Hilary , Torrado Mercedes Triana De , Rodriguez Bianca Marina
Published: March 2007

Objective— To determine the prevalence of diabetes and its relationship to age and obesity in an urban community in Colombia.

Research Design and Methods— A cluster sample of 670 adults ≥ 30 yr of age was selected from the city of Santafè de Bogotá. Classification of diabetes and IGT was according to WHO criteria.

Results— Response to the survey, conducted in 1988–1989, was 71% for men and 84% for women. Prevalence of diabetes was 7% in both sexes. Prevalence of IGT was 5% in men and 7% in women. Age-standardized prevalence of diabetes in the 30- to 64-yr age range was comparable with that reported in urban Brazilians and rural Hispanics in the U.S.. Prevalence was higher than in the white population of the U.S. but lower than in several urban U.S. Hispanic communities. Some 40% of men and 30% of women with diabetes were unaware of their condition before the survey, but all those <50 yr of age were diagnosed previously. Glucose intolerance was associated with high BMI in men and with advancing age in both sexes.

Conclusions— Glucose intolerance is common in this community and will likely increase in frequency in Colombians with further urbanization and population aging.
Predictors of Microalbuminuria in Individuals with IDDM: Pittsburgh Epidemiology of Diabetes Complications Study
Authors: Coonrod Beth Ann , Ellis Demetrius , Becker Dorothy J , Bunker Clareann H , Kelsey Sheryl F , Lloyd Cathy E , Drash Allan L , Kuller Lewis H , Orchard Trevor J
Published: March 2007

OBJECTIVE

To examine the relationships between microalbuminuria and the development of overt diabetic nephrology, elevated blood pressure, and a more atherogenic lipid profile; and to identify risk factors for the development of microalbuminuria in individuals with IDDM. Microalbuminuria has been associated with the subsequent development of overt diabetic nephropathy in individuals with IDDM. It is associated with elevated blood pressure and a more atherogenic lipid profile, but the temporal relationship between the development of microalbuminuria and the changes in these factors is unclear.

RESEARCH DESIGN AND METHODS

Baseline characteristics were examined in 256 individuals with IDDM who had normal albumin excretion (urinary AER ≤20 μg/min in ≥2 timed urine collections) and were re-examined 2 yr later.

RESULTS

At follow-up, 24 had developed microalbuminuria (AER 20–200 (Ag/min in ≥2 timed urine collections) and 1 had developed overt nephropathy (AER ≥200 μg/min). Overall, the significant independent predictors of microalbuminuria were HbA1 (P < 0.001), low-density lipoprotein (P < 0.01), duration of IDDM (P < 0.05), and systolic blood pressure (P = 0.05). Sex-specific analyses showed HbA1 age, and baseline AER were particularly important for men; whereas, for women, the main predictors were duration of IDDM and triglycerides. Duration-specific analyses showed that HbA1 was an important predictor both for individuals with < and >20-yr duration. Low-density lipoprotein cholesterol was more important for subjects with shorter durations; whereas triglycerides were important for those with longer durations.

CONCLUSIONS

These results suggest that glycemic control, age or duration of IDDM, disturbed lipids, and possibly elevated blood pressure all may contribute to the development of microalbuminuria; and, further, that the adverse cardiovascular risk profile seen in individuals with overt nephropathy may begin to develop even before the detection of microalbuminuria.
The Role of Diet Behaviors in Achieving Improved Glycemic Control in Intensively Treated Patients in the Diabetes Control and Complications Trial
Authors: Delahanty Linda M , Halford Beverly N
Published: March 2007

OBJECTIVE

To determine whether specific diet-related behaviors practiced by IDDM patients in the intensive treatment group of the Diabetes Control and Complications Trial were associated with lower HbAlc values.

RESEARCH DESIGN AND METHODS

A questionnaire addressing various aspects of their dietary behavior during the previous year in the DCCT was completed by 623 DCCT intensive treatment group subjects. The association between selfreported diet behaviors and the subject's mean HbA1c during the previous year was evaluated using a linear rank test for trend. The goal of intensive treatment was to achieve blood glucose and HbA1c levels as close to the nondiabetic range as possible without hypoglycemia.

RESULTS

Adherence to the prescribed meal plan and adjusting food and/or insulin in response to hyperglycemia were significantly associated with lower HbA1c levels. Over-treating hypoglycemia and consuming extra snacks beyond the meal plan were associated with higher HbA1c levels. Adjusting insulin dose for meal size and content and consistent consumption of an evening snack were associated, albeit to a lesser degree, with lower HbA1c.

CONCLUSIONS

The average HbA1c among intensively managed patients who reported that they followed specific diet-related behaviors was 0.25 to 1.0 lower than among subjects who did not follow these behaviors. Health-care providers may wish to use these results to focus clinical care for intensively treated IDDM patients by emphasizing counseling on meal plans, prompt response to high blood glucose levels, appropriate treatment of hypoglycemia, and consistent snacking behaviors.
Blood Pressure, Insulin, and C-Peplide Levels in San Luis Valley, Colorado
Authors: Every Nathan R , Boyko Edward J , Keane Ellen M , Marshall Julie A , Rewers Marian , Hamman Richard F
Published: March 2007

OBJECTIVE

To explore the associations between blood pressure and both fasting insulin and C-pep tide levels.

RESEARCH DESIGN AND METHODS

A cross-sectional analysis was conducted of 895 normoglycemic members of a bi-ethnic community in Colorado who were selected from a control group recruited for a geographically based study of diabetes mellitus prevalence and risk factors. All subjects included in this study had normal glucose tolerance as judged by a 75-g oral glucose tolerance test interpreted using World Health Organization criteria. None of the subjects were taking antihypertensive medication. Multiple linear regression analysis was used to examine relationships between fasting insulin and C-peptide levels and blood pressure.

RESULTS

Among all subjects, diastolic blood pressure was found to significantly increase with increasing levels of both hormones (insulin coefficient = 0.197, P = 0.013; C-peptide coefficient = 0.0436, P = 0.004), whereas systolic blood pressure was significantly related to fasting C-peptide level (coefficient = 0.0295, P = 0.050). These relationships were similar in magnitude for both Hispanic and non-Hispanic white subjects, but were diminished among women and subjects with a higher body mass index.

CONCLUSIONS

Higher fasting insulin and C-peptide levels are associated with higher blood pressure, but these relationships are modified by sex and degree of obesity.
Reproductive History, Glucose Tolerance, and NIDDM in Hispanic and Non-Hispanic White Women: The San Luis Valley Diabetes Study
Authors: Alderman Beth W , Marshall Julie A , Boyko Edward J , Markham Kathleen A , Baxter Judith , Hamman Richard F
Published: March 2007

OBJECTIVE

To ascertain whether childbearing would decrease oral glucosestimulated insulin and C-peptide levels and increase the risk of NIDDM and impaired glucose tolerance in a population of Hispanic and non-Hispanic white women residing in the San Luis Valley of Colorado. Several investigators have related childbearing to subsequent abnormal glucose tolerance.

RESEARCH DESIGN AND METHODS

In a population-based case-control epidemiological study, diabetic patients 20–74 yr of age (n = 196) and randomly sampled control women subjects (n = 735) underwent a glucose tolerance test, a physical examination, and an in-person standardized interview. The relations between the live-birth number and fasting and oral glucose stimulated glucose, insulin and C-peptide concentrations, and NIDDM and impaired glucose tolerance were estimated using linear or logistic regression to adjust for extraneous variables.

RESULTS

In women selected as control subjects, the live-birth number was related to a significant decrease in the sum of 1- and 2-h C-peptide concentrations (coefficient = −0.077, P <0.001) and the logarithm of the sum of 1- and 2-h insulin concentrations (coefficient = −0.014, P = 0.02). After adjustment for subscapular skin-fold thickness, the relative odds of NIDDM for the live-birth number, which was small and of borderline significance, diminished (odds ratio = 1.04 for one birth, P = 0.18). Findings were similar for impaired glucose tolerance.

CONCLUSIONS

Childbearing was related to lower C-peptide and insulin levels in Hispanic and non-Hispanic women of the San Luis Valley. It had little apparent effect on later risk of NIDDM or impaired glucose tolerance.
Unplanned Pregnancies in Young Women With Diabetes: An analysis of psychosocial factors
Authors: James Paula J St , Younger M Donna , Hamilton Brenda D , Waisbren Susan E
Published: March 2007

OBJECTIVE

To assess psychosocial factors related to preventing birth defects in children bom to diabetic women. Diabetic women are at high risk for bearing children with congenital anomalies associated with teratogenic effects early in pregnancy. This study focuses on factors related to the family planning behavior of diabetic women.

RESEARCH DESIGN AND METHODS

Sixty-six diabetic women were included in a 5-yr, prospective, longitudinal study along with 69 phenylketonuric women, who also face a high risk of bearing children with birth defects, and 68 healthy women. Annual interviews and questionnaires were administered. Women who did not want a pregnancy completed measures related to contraceptive behavior and quality of life. Areas assessed were knowledge, personality, attitudes, and social support.

RESULTS

Diabetic women were more likely to be sexually active than women with phenylketonuria. Use and type of birth control were comparable among the groups except that diabetic women used condoms more often. For diabetic women, social support and positive attitudes towards birth control were associated with consistent birth control use. Of the diabetic women, 23 became pregnant, and only 6 (26%) were planned pregnancies.

CONCLUSIONS

Birth control use by diabetic women needs to be addressed by health professionals. Attitudes about birth control of the women and those close to them appear to be important factors in consistent birth control use. Suggestions are made for addressing these factors.
An Epidemic of Childhood Diabetes in the United States?: Evidence from Allegheny County, Pennsylvania
Authors: Dokheel Tomadher M ,   The Pittsburgh Diabetes Epidemiology Research Group
Published: March 2007

OBJECTIVE

To evaluate IDDM trends in Allegheny County, Pennsylvania, from 1965 to 1989.

RESEARCH DESIGN AND METHODS

A population-based registry established in 1976—the Allegheny County Registry—was used for this study through a retrospective chart review of all cases diagnosed in the county from 1965. Through this registry, cases of IDDM patients <20 yr of age were identified. In addition, pediatricians in the county were contacted about IDDM cases they diagnosed between 1965 and 1989 in individuals <20 yr of age.

RESULTS

For the first time a major increase in IDDM was seen (1985–1989). This increase in IDDM was heterogenous with the rise for males being double that for females. The increase for non-white males was considerably greater than that seen for white males, and an exceptionally large increase in the youngest age-group (0–4 yr of age) was observed.

CONCLUSIONS

Ecological analyses indicated an association between chicken pox infection and IDDM, and this suggested that at least part of the rise may be of an infectious origin.
Long-Term Effects of Protein-Restricted Diet on Albuminuria and Renal Function in IDDM Patients Without Clinical Nephropathy and Hypertension
Authors: Dullaart Robin P F , Beusekamp Berta J , Meijer Sytze , Doormaal Jasper J Van , Sluiter William J
Published: March 2007

OBJECTIVE

To determine the long-term effects of an LPD on albuminuria and renal hemodynamics in IDDM patients without nephropathy.

RESEARCH DESIGN AND METHODS

We selected 31 patients with overnight albuminuria between 10 and 200 g/min and without hypertension from a referral-based diabetic clinic. One participant dropped out. A 2-yr randomized prospective study was conducted on 14 patients assigned to an LPD (0.6 g · kg−1 · day−1) and 16 patients assigned to continue their UPD. Protein intake was assessed by using urinary urea excretion. Albuminuria (three overnight collections) was measured at baseline and on seven occasions thereafter. GFR and ERPF were measured annually using [125I]iothalamate and [131I]hippuran, respectively.

RESULTS

In the LPD group, protein intake decreased from 1.05 ± 0.32 to 0.79 ± 0.16 g · kg−1 [ day−1 (P < 0.005), but only seven participants consumed < 0.8 g [ kg−1 [ day−1. Protein intake was unaltered in the UPD group (P < 0.001 vs. LPD). Baseline albuminuria and renal hemodynamics were not different in the groups. In the LPD group albuminuria decreased from 36 (95% CI, 16–83) to 30 μg/min (95' CI, 14–67) (P < 0.05). After adjustment for MAP and diabetes duration, the decrease in albuminuria in the LPD group was 26% (95% CI, 13–36) (P < 0.001), which was significantly different from the 5% (95% CI, −10–22) change in the UPD group (P < 0.005 vs. LPD). Multiple regression analysis showed the actual decrease in protein intake lessened (P < 0.005), whereas prevailing MAP accelerated albuminuria (P < 0.001). Low-protein intake independently reduced ERPF (P = 0.009) and GFR (indirectly via ERPF, P < 0.001) after 1 yr. Only minor changes in renal hemodynamics occurred in the second yr.

CONCLUSIONS

This study suggests that long-term dietary protein restriction beneficially reduces albuminuria and renal hemodynamics in IDDM patients with mildly elevated albuminuria. Systemic BP counteracts these effects even in the absence of hypertension. Suboptimal compliance limits diet efficacy.
Influencing the Attitudes of Medical Students Toward Diabetes: Results of a controlled study
Authors: Anderson Robert M , Donnelly Michael B , Gorenflo Daniel W , Funnell Martha M , Sheets Kent J
Published: March 2007

OBJECTIVE

To determine the effect of two educational interventions on the diabetes-related attitudes of medical students.

RESEARCH DESIGN AND METHODS

We studied 67 junior and senior medical students who were participating in the University of Michigan Medical School's Family Practice elective clerkship. Students were assigned to one of two interventions. The first was a 1-wk living-with-diabetes behavioral simulation that involved injections, blood glucose monitoring, diet, exercise, and record keeping. The second intervention involved reading an autobiography about living with diabetes and viewing a videotape about the psychosocial impact of diabetes.

RESULTS

No differential impact was found between the two interventions. However, both interventions were followed by a modest positive change in the attitudes of the medical students (which were very positive to begin with) toward the importance of patient autonomy and the value of the team approach to diabetes care. The attitude gains persisted at follow-up for patient autonomy but returned to baseline for team care.

CONCLUSIONS

This study suggests that these two educational interventions resulted in modest increases in the already positive attitudes of medical students toward the importance of patient autonomy and team care in diabetes. However, because the study did not include a group that received no treatment, we cannot be certain on this point. The attitude gain related to team care did not persist at follow-up. These findings are consistent with classical attitude research, which suggests that attitudes are sensitive to influences such as these interventions, but that attitude changes may not persist when those influences are changed or withdrawn. We were not able to find a differential impact between the two interventions and suspect that the general nature of the DAS used as the dependent measure may not have been sensitive enough to capture such a differential impact.
Prevalence of Diabetes and Impaired Glucose Tolerance in Funagata Area, Japan
Authors: Sekikawa Akira , Tominaga Makoto , Takahashi Kenji , Eguchi Hideyuki , Igarashi Masahiko , Ohnuma Hiroshi , Sugiyama Kazuhiko , Manaka Hideo , Sasaki Hideo , Fukuyama Haru , Miyazawa Kouzui
Published: March 2007

OBJECTIVE

To determine the prevalence of diabetes mellitus and IGT in the Funagata area of Japan.

RESEARCH DESIGN AND METHODS

The total eligible subjects was 1163, all were > or ≥45 yr of age, and 52 were known diabetic patients. Data collected included body height, weight, and answers to medical questionnaires. A 75-g OGTT was done in the morning. WHO criteria were used to classify the current diabetes status of study participants.

RESULTS

Of the 1111 scheduled for the OGTT, 868 took the test; the participation rate was 77.8%. The prevalence of diabetes was 10.5 and 12.9%, and the prevalence of IGT was 14.7 and 18.0% for men and women, respectively. The prevalence of undiagnosed diabetes (4.9%) was almost equal to that of previously diagnosed diabetes (4.5%).

CONCLUSIONS

The prevalence of diabetes in the Funagata area was two to four times higher than that of previous reports in Japan, in which many investigators used a urinary glucose test as a preliminary test. This difference is attributed to the method of determining the prevalence of diabetes.
Effects of Gemfibrozil on Low-Density Lipoprotein Particle Size, Density Distribution, and Composition in Patients With Type II Diabetes
Authors: Lahdenperä Sanni , Tilly-Kiesi Marju , Vuorinen-Markkola Helena , Kuusi Timo , Taskinen Marja-Riitta
Published: March 2007

OBJECTIVE

To study the effects of gemfibrozil treatment on LDL particle size, density distribution, and composition in NIDDM patients.

RESEARCH DESIGN AND METHODS

We performed LDL analyses on 16 NIDDM patients with stable glycemic control. They were randomly allocated to receive either gemfibrozil (n = 8) or a placebo (n = 8) for 3 mo in a double-blind study. The LDL particle size distribution and the particle diameter of the major LDL peak were measured with nondenaturing polyacrylamide gradient gel electrophoresis. The density distribution and composition of LDL were determined with the density gradient ultracentrifugation method.

RESULTS

In the gemfibrozil group the mean serum TG concentration decreased by 38%, HDL cholesterol concentration increased by 10%, and LDL cholesterol concentration by 17% (P < 0.05). During gemfibrozil therapy the mean particle diameter of the major LDL peak increased from 244 to 251 Å (P < 0.05), whereas in the placebo group the mean LDL particle diameter remained unchanged. We found an inverse correlation between the changes of serum TG and the particle diameters of the major LDL peak (r = 0.85, P < 0.01). Gemfibrozil produced a shift in the LDL density distribution toward lower density. The mean peak density decreased from 1.0371 to 1.0345 g/ml because of a significant rise in the light LDL concentration from 141.0 to 183.2 mg/dl (P < 0.05), whereas the concentration of dense LDL had a tendency to decrease. In the placebo group the LDL density distribution did not change. Gemfibrozil increased the CE-to-TG ratio in LDL core lipids by 27% (P < 0.05); otherwise, the LDL composition was only slightly affected.

CONCLUSIONS

The results indicate gemfibrozil-induced changes in LDL properties in NIDDM patients are similar to those previously reported in nondiabetic individuals and are related to changes in serum TG level.
Microalbuminuria in NIDDM
Authors: Bashyam Mani M , O'Sullivan Neil J , Baker Habib H , Duggan Patrick F , Mitchell Teresa H
Published: March 2007

OBJECTIVE

To determine an effective screening procedure for microalbuminuria.

RESEARCH DESIGN AND METHODS

The prevalence of microalbuminuria in NIDDM patients whose urine was negative on routine Albustix testing was studied. Microalbuminuria was measured in overnight urine samples from 128 NIDDM patients on at least two of three occasions over a 6-mo period. Patients were tested with Micro-Bumintest or Micral-Test.

RESULTS

Ten of 128 patients had albumin concentrations ≥ or = 20 mg/L on two or more occasions, 14 patients had A-C ratios ≥ or = 3 mg/M on two or more occasions, and 9 patients had both.

CONCLUSIONS

Neither Micro-Bumintest nor Micral-Test is a useful or feasible screening procedure for microalbuminuria.
Racial Differences in the Relationship Between Blood Pressure and Risk of Retinopathy Among Individuals With NIDDM
Authors: Harris Emily L , Feldman Susan , Robinson C Rahj , Sherman Steven , Georgopoulos Angeljki
Published: March 2007

OBJECTIVE

To assess whether the prevalence of retinopathy differs between blacks and whites with diabetes and to examine differences between blacks and whites in the relationship between risk factors for and prevalence of retinopathy. Population data suggest diabetic retinopathy is either more prevalent or more severe in blacks than in whites.

RESEARCH DESIGN AND METHODS

We analyzed data from a screening study for retinopathy among patients with diabetes, conducted in Maryland from 1986–1990.

RESULTS

After adjusting for age, duration of diabetes, type of treatment for diabetes, and presence or absence of high blood pressure, black men with NIDDM were ∼23% more likely to have retinopathy than other race-sex groups (not statistically significant). We also found a different relationship between systolic blood pressure and retinopathy prevalence in blacks than in whites among individuals with NIDDM. Among blacks, the risk increased as systolic blood pressure increased, even within the normal range, and reached statistical significance at > 150 mmHg. Among whites, the risk was increased only among those with high systolic blood pressure (>140 mmHg) and did not reach statistical significance.

CONCLUSIONS

Our data are consistent with the hypothesis that differences exist between blacks and whites in risk of diabetic retinopathy, and that the effect of blood pressure on risk of retinopathy differs between blacks and whites.