bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-Management Education for Adults With Type 2 Diabetes
Authors: Norris Susan L. , Lau Joseph , Smith S. Jay , Schmid Christopher H. , Engelgau Michael M.
Published: March 2007

OBJECTIVE—To evaluate the efficacy of self-management education on GHb in adults with type 2 diabetes.

RESEARCH DESIGN AND METHODS—We searched for English language trials in Medline (1980–1999), Cinahl (1982–1999), and the Educational Resources Information Center database (ERIC) (1980–1999), and we manually searched review articles, journals with highest topic relevance, and reference lists of included articles. Studies were included if they were randomized controlled trials that were published in the English language, tested the effect of self-management education on adults with type 2 diabetes, and reported extractable data on the effect of treatment on GHb. A total of 31 studies of 463 initially identified articles met selection criteria. We computed net change in GHb, stratified by follow-up interval, tested for trial heterogeneity, and calculated pooled effects sizes using random effects models. We examined the effect of baseline GHb, follow-up interval, and intervention characteristics on GHb.

RESULTS—On average, the intervention decreased GHb by 0.76% (95% CI 0.34–1.18) more than the control group at immediate follow-up; by 0.26% (0.21% increase - 0.73% decrease) at 1–3 months of follow-up; and by 0.26% (0.05–0.48) at ≥4 months of follow-up. GHb decreased more with additional contact time between participant and educator; a decrease of 1% was noted for every additional 23.6 h (13.3–105.4) of contact.

CONCLUSIONS—Self-management education improves GHb levels at immediate follow-up, and increased contact time increases the effect. The benefit declines 1–3 months after the intervention ceases, however, suggesting that learned behaviors change over time. Further research is needed to develop interventions effective in maintaining long-term glycemic control.
Reproducibility of Glucose Measurements Using the Glucose Sensor
Authors: Metzger Muriel , Leibowitz Gil , Wainstein Julio , Glaser Benjamin , Raz Itamar
Published: March 2007

OBJECTIVE—Recent studies have confirmed that improved glycemic control decreases the risk of diabetic complications in type 1 and type 2 diabetic patients. The Minimed glucose sensor allows continuous 72-h glucose monitoring and represents a potentially important tool to improve diabetes management. Its use is currently limited to the health care team. Our aim was to evaluate the reproducibility of data provided by the device by comparing data provided by two sensors worn simultaneously by the same subject.

RESEARCH DESIGN AND METHODS—A total of 11 subjects (6 type 1 and 3 type 2 diabetic patients and 2 healthy subjects) agreed to wear two sensors and perform at least four daily finger-stick glucose determinations during 72 h. The simultaneous glucose values provided by the sensors were compared. To determine the clinical implications of the glucose data, each day was divided into eight periods, and for each period the glucose range was rated as satisfactory, too high, or too low by a blinded clinician experienced in interpreting glucose sensor data in the clinical setting. The evaluation of glycemic levels based on the recordings of the two sensors were compared for each paired time interval.

RESULTS—We discarded 18% of the sensor data for technical reasons. Examined as a group, the remaining 3,370 paired data points in all 11 patients were highly correlated (r = 0.84). However, when individual pairs were evaluated, large differences in the glucose values were apparent, with differences of >10% in 70% of the measurements and >50% in 7% of the measurements. Moreover, clinical evaluation of the glucose range provided simultaneously by two sensors was concordant for only 65% of the evaluation periods.

CONCLUSION—In a real-life setting, the accuracy of data provided by the Minimed glucose sensor may be less than expected. To avoid therapeutic errors, sensor findings should be confirmed by independent means before clinical decisions are made.
Insulin Sensitivity and β-Cell Function in Women With Polycystic Ovary Syndrome
Authors: Vrbíková Jana , Bendlová Bela , Hill Martin , Vanková Markéta , Vondra Karel , Stárka Luboslav
Published: March 2007

OBJECTIVE—To evaluate insulin sensitivity (IS) and β-cell function (βF) in lean and obese women with polycystic ovary syndrome (PCOS), either separately or by using a disposition index (DI).

RESEARCH DESIGN AND METHODS—A total of 64 women with PCOS and 20 healthy women were examined by anthropometry, oral glucose tolerance tests (OGTTs), and insulin tolerance tests. Statistical analysis used one-way ANOVA, Kruskal-Wallis, and Mann-Whitney U tests, as appropriate.

RESULTS—A significantly higher waist-to-hip ratio (P < 0.0001) was found in both lean and obese women with PCOS. Higher basal blood glucose (P < 0.004) and blood glucose values at 3 h of OGTT (P < 0.008) were found in lean and obese PCOS subjects in comparison with control subjects. Insulin resistance by homeostasis model assessment (P < 0.007) was significantly higher in obese PCOS than in control or lean PCOS subjects. Early-phase insulin secretion (insulinogenic index [ΔI/ΔG30–0, where I is insulin and G is glucose]; P < 0.0007) was significantly higher in both lean and obese PCOS subjects than in healthy women. All tested combinations of parameters of IS and βF (DIs) followed a physiological hyperbolic relationship. Significantly lower values of the fasting state–derived DIs were found (all P < 0.05) in obese PCOS subjects. Significantly higher values of all of these indexes derived from nonfasting values were found in lean PCOS as compared with control and obese PCOS subjects (all P < 10–3).

CONCLUSIONS—Increased βF was found even in lean individuals with PCOS. Insulin hypersecretion is thus probably connected to the pathogenesis of PCOS.
Effects of Diets Enriched in Saturated (Palmitic), Monounsaturated (Oleic), or trans (Elaidic) Fatty Acids on Insulin Sensitivity and Substrate Oxidation in Healthy Adults
Authors: Lovejoy Jennifer C. , Smith Steven R. , Champagne Catherine M. , Most Marlene M. , Lefevre Michael , DeLany James P. , Denkins Yvonne M. , Rood Jennifer C. , Veldhuis Johannes , Bray George A.
Published: March 2007

OBJECTIVE—Diets high in total and saturated fat are associated with insulin resistance. This study examined the effects of feeding monounsaturated, saturated, and trans fatty acids on insulin action in healthy adults.

RESEARCH DESIGN AND METHODS—A randomized, double-blind, crossover study was conducted comparing three controlled 4-week diets (57% carbohydrate, 28% fat, and 15% protein) enriched with different fatty acids in 25 healthy men and women. The monounsaturated fat diet (M) had 9% of energy as C18:1cis (oleic acid). The saturated fat diet (S) had 9% of energy as palmitic acid, and the trans fatty acid diet (T) had 9% as C18:1trans. Body weight was kept constant throughout the study. After each diet period, insulin pulsatile secretion, insulin sensitivity index (SI) by the minimal model method, serum lipids, and fat oxidation by indirect calorimetry were measured.

RESULTS—Mean SI for the M, S, and T diets was 3.44 ± 0.26, 3.20 ± 0.26, and 3.40 ± 0.26 × 10−4 min−1 · μU−1 · ml−1, respectively (NS). SI decreased by 24% on the S versus M diet in overweight subjects but was unchanged in lean subjects (NS). Insulin secretion was unaffected by diet, whereas total and HDL cholesterol increased significantly on the S diet. Subjects oxidized the least fat on the M diet (26.0 ± 1.5 g/day) and the most fat on the T diet (31.4 ± 1.5 g/day) (P = 0.02).

CONCLUSIONS—Dietary fatty acid composition significantly influenced fat oxidation but did not impact insulin sensitivity or secretion in lean individuals. Overweight individuals were more susceptible to developing insulin resistance on high-saturated fat diets.
The Economic Cost of Diabetes in Canada, 1998
Authors: Dawson Keith G. , Gomes Daniel , Gerstein Hertzel , Blanchard James F. , Kahler Kristijan H.
Published: March 2007

OBJECTIVE—In Canada, diabetes poses a significant health problem, and current estimates of its economic burden have not incorporated the total cost of the disease. The objective of this study was to quantify the direct medical- and mortality-related productivity cost of diabetes in Canada for 1998.

RESEARCH DESIGN AND METHODS—Direct medical costs included hospital services, physician services, and medicines consumed by people with diabetes. These costs were based on a top-down costing methodology that allocated 1998 total medical expenditures to diabetes. The prevalence of diagnosed and undiagnosed diabetes and the relative risk of complications in people with diabetes were used to estimate the proportion of medical services that were consumed by people with diabetes. Mortality-related productivity losses were calculated using the human capital approach.

RESULTS—After varying the assumptions in a sensitivity analysis, the total economic burden (in U.S. dollars) of diabetes and its chronic complications in Canada for 1998 was likely to be between $4.76 and $5.23 billion. In those people just with diagnosed diabetes, the direct medical costs associated with diabetes care, before considering any complications, were $573 million. Of the costs associated with the complications of diabetes, cardiovascular disease was by far the greatest, at $637 million.

CONCLUSIONS—Cardiovascular disease was the major contributor to the direct costs of diabetes. The preventive management of diabetes should receive priority attention, and the prevention of cardiovascular disease in the patient with diabetes should become an imperative.
Distribution of HbA1c Levels For Children and Young Adults in the U.S.
Authors: Saaddine Jinan B. , Fagot-Campagna Anne , Rolka Deborah , Narayan K.M. Venkat , Geiss Linda , Eberhardt Mark , Flegal Katherine M.
Published: March 2007

OBJECTIVE—To describe the distribution of HbA1c levels among children and young adults in the U.S. and to evaluate the effects of age, sex, race/ethnicity, socioeconomic status, parental history of diabetes, overweight, and serum glucose on HbA1c levels.

RESEARCH DESIGN AND METHODS—We analyzed HbA1c data from the Third National Health and Nutrition Examination Survey, 1988–1994, for 7,968 participants aged 5–24 years who had not been treated for diabetes. After adjusting for the complex sample design, we compared the distributions of HbA1c in subgroups and developed multiple linear regression models to examine factors associated with HbA1c.

RESULTS—Mean HbA1c level was 4.99% (SD 0.50%) and varied from 4.93% (95% CI ±0.04) in non-Hispanic whites to 5.05% (±0.02) in Mexican-Americans to 5.17% (±0.02) in non-Hispanic blacks. There were very small differences among subgroups. Within each age- group, among men and women, among overweight and nonoverweight subjects, and at any level of education, mean HbA1c levels were higher in non-Hispanic blacks than in non-Hispanic whites. After adjusting for confounders, HbA1c levels for non-Hispanic blacks (5.15%, 95% CI ±0.04) and Mexican-Americans (5.01%, ±0.04) were higher than those for non-Hispanic whites (4.93%, ±0.04).

CONCLUSIONS—These data provide national reference levels for HbA1c distributions among Americans aged 5–24 years and show statistically significant racial/ethnic differences in HbA1c levels that are not completely explained by demographic and health-related variables.
Prevalence of Insulin Resistance Syndrome in Southwestern France and Its Relationship With Inflammatory and Hemostatic Markers
Authors: Marques-Vidal Pedro , Mazoyer Elizabeth , Bongard Vanina , Gourdy Pierre , Ruidavets Jean-Bernard , Drouet Ludovic , Ferrières Jean
Published: March 2007

OBJECTIVE—To assess the prevalence and relationships of insulin resistance syndrome (IRS) with inflammatory and hemostatic markers in a representative sample of the population of Southwestern France aged 35–64 years.

RESEARCH DESIGN AND METHODS—In this cross-sectional study, data were collected from 597 men and 556 women and were assessed regarding BMI, blood pressure, total and HDL cholesterol levels, triglyceride level, glucose level, plasma insulin level, white blood cell count, fibrinogen level, factor VII level, von Willebrand factor, C-reactive protein level, soluble intercellular adhesion molecule, soluble vascular cell adhesion molecule-1, and soluble CD14. Insulin resistance was defined by homeostasis model assessment ≥3.8.

RESULTS—Prevalence of IRS was higher in men than in women (23 vs. 12%, respectively; P < 0.001) and increased with age in both sexes (9, 24, and 34% for age groups 35–44, 45–54, and 55–64 years, respectively, for men and 4, 10, and 21% for women). After adjusting for age, alcohol consumption, tobacco smoking, and also for menopause in women, subjects (men and women) with IRS had significantly higher white blood cell count, factor VII levels, coagulating factor VII levels, and C-reactive protein levels than the other subjects. In men, further increases in soluble intercellular adhesion molecule and soluble vascular cell adhesion molecule-1 were noted, whereas in women, the differences were borderline significant. Conversely, no differences were found in fibrinogen, von Willebrand factor, and soluble CD14 in both sexes.

CONCLUSIONS—IRS is relatively common in residents of Southwestern France and is related to a deleterious increase in hemostatic and inflammatory parameters.
The Prevalence of Diabetes in the Kingdom of Tonga
Authors: Colagiuri Stephen , Colagiuri Ruth , Na’ati Siva , Muimuiheata Soana , Hussain Zafirul , Palu Taniela
Published: March 2007

OBJECTIVE—To determine the prevalence of diabetes, impaired glucose metabolism, and related risk factors in Tonga.

RESEARCH DESIGN AND METHODS—A randomly selected representative national sample of 1,024 people aged >15 years was surveyed. Each participant had fasting blood glucose and HbA1c measured. Subjects with a fasting blood glucose >5.0 mmol/l (90 mg/dl) and <11.1 mmol/l (200 mg/dl) or a fasting blood glucose ≤5.0 mmol/l and an HbA1c >6.0% and every fifth subject with a fasting blood glucose ≤5.0 mmol/l and a normal HbA1c had a 75-g oral glucose tolerance test (OGTT). A total of 472 individuals had an OGTT based on these criteria. Subjects with a fasting blood glucose ≥11.1 mmol/l and an elevated HbA1c were diagnosed as having diabetes.

RESULTS—The mean age was 41.3 years, and the mean BMI was 32.3 kg/m2. The age-standardized prevalence of diabetes was 15.1% (CI 12.5–17.6), 12.2% (8.7–15.8) in men and 17.6% (14.0–21.1) in women (NS), of which only 2.1% was previously diagnosed. A total of 75% of people with newly diagnosed diabetes had a fasting plasma glucose ≥7.0 mmol/l (126 mg/dl). The prevalence of impaired glucose tolerance was 9.4% (7.3–11.5) and of impaired fasting glycemia 1.6% (0.7–2.6). Undiagnosed diabetes was significantly associated with increasing age, obesity, hypertension, and a family history of diabetes.

CONCLUSIONS—The current prevalence of diabetes in Tonga is 15.1%, of which 80% is undiagnosed. A similar survey in 1973 reported a 7.5% diabetes prevalence, indicating a doubling of diabetes over the past 25 years. In addition, lesser degrees of glucose intolerance are common, and much of the community is overweight
Role of Hyperglycemia in Nitrotyrosine Postprandial Generation
Authors: Ceriello Antonio , Quagliaro Lisa , Catone Barbara , Pascon Roberta , Piazzola Marta , Bais Bruno , Marra Giampiero , Tonutti Laura , Taboga Claudio , Motz Enrico
Published: March 2007

OBJECTIVE—Recently, much attention has been paid to the possibility that postprandial hyperglycemia may be a cardiovascular risk factor in diabetes. Oxidative stress has been involved in the pathogenesis of diabetic complications, and increased plasma levels of nitrotyrosine, a product of peroxynitrite action, have been found in the plasma of diabetic subjects. The aim of the present study was to evaluate whether postprandial hyperglycemia is accompanied by nitrotyrosine generation and, if so, to explore a possible direct role of hyperglycemia in such a phenomenon.

RESEARCH DESIGN AND METHODS—A total of 23 type 2 diabetic patients and 15 matched normal healthy subjects were recruited for this study. Two different tests were performed in diabetic patients: a standard meal preceded by regular insulin (0.15 units/kg body wt) or insulin aspart (0.15 units/kg body wt) to achieve different levels of postprandial hyperglycemia. The meal test was also performed in healthy control subjects. At 0 min and 1, 2, 4, and 6 h after each meal, blood glucose, triglyceride, and nitrotyrosine levels were measured.

RESULTS—Fasting nitrotyrosine was significantly increased in diabetic patients and was further increased during both meal tests in diabetic subjects but not normal subjects. As compared with regular insulin, aspart administration significantly reduced the area under the curve of both glycemia (P < 0.04) and nitrotyrosine (P < 0.03), whereas that of triglycerides was not significantly affected by the treatment.

CONCLUSIONS—This study shows a direct correlation between postprandial hyperglycemia and the production of nitrotyrosine, a marker of oxidative stress, in patients with type 2 diabetes.
Walking Strategy in Diabetic Patients With Peripheral Neuropathy
Authors: Giacomozzi Claudia , Caselli Antonella , Macellari Velio , Giurato Laura , Lardieri Lina , Uccioli Luigi
Published: March 2007

OBJECTIVE—Diabetic neuropathic patients show a peculiar loading pattern of the foot, which led us to hypothesize that a substantial modification exists in their deambulatory strategy. The aim of the present study was to support this hypothesis by quantifying the changes of the loading patterns and by monitoring the excursion of center of pressure (COP) during gait.

RESEARCH DESIGN AND METHODS—A total of 21 healthy volunteers (C) and 61 diabetic patients were evaluated: 27 diabetic subjects without neuropathy (D), 19 with neuropathy (DN), and 15 with previous neuropathic ulcer (DPU). A piezo-dynamometric platform was used to record the foot-to-floor interaction by measuring loading time and the instantaneous COP position during the stance phase of gait.

RESULTS—Loading time was significantly longer in neuropathic patients than in control subjects (DPU: 816.8 ± 150 ms; DN: 828.6 ± 152 ms; D: 766.5 ± 89.9 ms; C: 723.7 ± 65.7 ms; P < 0.05). COP excursion along the medio-lateral axis of the foot clearly decreased from C to DPU groups (C: 6.41 ± 0.1 cm; D: 4.88 ± 0.2 cm; DN: 4.57 ± 0.1 cm; DPU: 3.36 ± 0.1 cm; P < 0.05) as well as COP excursion along the longitudinal axis for the DPU group only (C: 26.6 ± 1 cm; D: 26.9 ± 1 cm; DN: 27.2 ± 1 cm; DPU: 24.2 ± 1 cm; P < 0.05). COP integrals were significantly reduced for all pathological classes (DPU: 14.2 ± 8 cm2; DN: 25.8 ± 6 cm2; D: 27.7 ± 3 cm2; C: 38.6 ± 6 cm2; P < 0.05).

CONCLUSIONS—The accurate quantification of loading patterns and of COP excursions and integrals highlights changes of foot-to-floor interaction in diabetic neuropathic patients. The decreased medio-lateral and longitudinal COP excursions and corresponding changes of loading times and patterns support our hypothesis that a change in the walking strategy of diabetic patients with peripheral neuropathy does occur.
Treatment With Dietary trans10cis12 Conjugated Linoleic Acid Causes Isomer-Specific Insulin Resistance in Obese Men With the Metabolic Syndrome
Authors: Risérus Ulf , Arner Peter , Brismar Kerstin , Vessby Bengt
Published: March 2007

OBJECTIVE—Conjugated linoleic acid (CLA) is a group of dietary fatty acids with antiobesity and antidiabetic effects in some animals. The trans10cis12 (t10c12) CLA isomer seems to cause these effects, including improved insulin sensitivity. Whether such isomer-specific effects occur in humans is unknown. The aim of this study was to investigate whether t10c12 CLA or a commercial CLA mixture could improve insulin sensitivity, lipid metabolism, or body composition in obese men with signs of the metabolic syndrome.

RESEARCH DESIGN AND METHODS—In a randomized, double-blind controlled trial, abdominally obese men (n = 60) were treated with 3.4 g/day CLA (isomer mixture), purified t10c12 CLA, or placebo. Euglycemic-hyperinsulinemic clamp, serum hormones, lipids, and anthropometry were assessed before and after 12 weeks of treatment.

RESULTS—Baseline metabolic status was similar between groups. Unexpectedly, t10c12 CLA increased insulin resistance (19%; P < 0.01) and glycemia (4%; P < 0.001) and reduced HDL cholesterol (−4%; P < 0.01) compared with placebo, whereas body fat, sagittal abdominal diameter, and weight decreased versus baseline, but the difference was not significantly different from placebo. The CLA mixture did not change glucose metabolism, body composition, or weight compared with placebo but lowered HDL cholesterol (−2%; P < 0.05).

CONCLUSIONS—These results reveal important isomer-specific metabolic actions of CLA in abdominally obese humans. A CLA-induced insulin resistance has previously been described only in lipodystrophic mice. Considering the use of CLA-supplements among obese individuals, it is important to clarify the clinical consequences of these results, but they also provide physiological insights into the role of specific dietary fatty acids as modulators of insulin resistance in humans.
Combination Therapy With Nateglinide and a Thiazolidinedione Improves Glycemic Control in Type 2 Diabetes
Authors: Rosenstock Julio , Shen Sharen G. , Gatlin Marjorie R. , Foley James E.
Published: March 2007

OBJECTIVE—To compare the effects of monotherapy using nateglinide and the thiazolidinedione troglitazone with initial combination of the two agents on glycated hemoglobin (HbA1c) in patients with type 2 diabetes inadequately controlled by diet alone.

RESEARCH DESIGN AND METHODS—This study consisted of a 28-week, double-blind, randomized, multicenter study that included a 4-week, single-blind, placebo, run-in period and a 24-week (shortened to 16 weeks), double-blind, active treatment period.

RESULTS—At the 16-week end point, nateglinide 120 mg, troglitazone 600 mg, and the combination of the agents achieved statistically significant decreases in HbA1c in comparison with placebo and a baseline HbA1c of 8.1–8.4% (P < 0.001). The reductions in HbA1c were similar in the nateglinide (0.6%) and troglitazone (0.8%) monotherapy groups. The reduction in HbA1c (1.7%) was greatest in the combination group; 79% of patients in the combination group achieved HbA1c levels of <7%. The combination group had a higher number of adverse events, primarily due to an increased incidence of mild hypoglycemia in this treatment group.

CONCLUSIONS—Nateglinide and troglitazone are equally effective in decreasing HbA1c levels. However, these reductions from baseline HbA1c values of >8% are not adequate to achieve HbA1c levels of <7%. In contrast, the combination of nateglinide and of a thiazolidinedione shows an additive effect that is highly effective in reducing HbA1c levels to the target of <7% in 66% of patients, from a baseline HbA1c that is just above 8%.
All-Cause and Cardiovascular Mortality Among Diabetic Participants in the San Antonio Heart Study
Authors: Hunt Kelly J. , Williams Ken , Resendez Roy G. , Hazuda Helen P. , Haffner Steve M. , Stern Michael P.
Published: March 2007

OBJECTIVE—The observation that Hispanics have lower all-cause and cardiovascular mortality, despite increased diabetes and obesity, lower socioeconomic status (SES), and barriers to health care, has been termed the “Hispanic Paradox.” We examined the relationship between ethnicity and all-cause and cardiovascular mortality in Mexican Americans (MAs) and non-Hispanic whites (NHWs) with diabetes.

RESEARCH DESIGN AND METHODS—In the San Antonio Heart Study, a prospective cohort, we compared the mortality in 554 U.S.-born MAs, 95 Mexico-born MAs, and 178 NHW participants with diabetes aged 25–72 years. Over an average of 10.4 years, 188 deaths occurred: 115 from cardiovascular disease (CVD) [death certificate ICD-9 codes 401–414 or 420–447 (excluding 427.5)]. Because of potential differences between migrants and nonmigrants, hazard ratios (HRs) were calculated comparing U.S.-born MAs and Mexico-born MAs with NHWs.

RESULTS—The age- and sex-adjusted HR for all-cause mortality comparing U.S.-born MAs with NHWs was 1.66 (95% CI 1.15–2.40), while comparing Mexico-born MAs with NHWs was 1.14 (95% CI 0.63–2.06). Cardiovascular mortality HRs were 1.66 (95% CI 1.04–2.65) and 0.89 (95% CI 0.40–2.01), respectively. After adjusting for possible confounders, such as fasting glucose and diabetes duration, the hazard of all-cause and cardiovascular mortality (although not statistically significant) appeared higher in U.S.-born MAs than in the other two groups.

CONCLUSIONS—We found it important to differentiate MAs by birthplace. Among diabetic participants, contrary to the prediction of the “Hispanic Paradox,” compared with NHWs, U.S.-born MAs were at greater risk of all-cause and cardiovascular mortality, while Mexico-born MAs appeared to be at similar risk.
Depression and Anxiety Among Partners of European-American and Latino Patients With Type 2 Diabetes
Authors: Fisher Lawrence , Chesla Catherine A. , Skaff Marilyn M. , Mullan Joseph T. , Kanter Richard A.
Published: March 2007

OBJECTIVE—To assess the levels of and the independent contributors to depressive affect and anxiety among partners of patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS—The partners of 75 Latino and 113 European-American patients with type 2 diabetes were assessed for level of depressive affect and anxiety and for three groups of potential stressors: demographics (age, gender, and education), patient disease status (time since diagnosis, HbA1c, comorbidities, and BMI), and family stress (disease impact, spouse conflict, and family closeness). Dependent variables were partner depressive affect (Center for Epidemiological Studies-Depression scale) and anxiety (Symptom Checklist [SCL-90] anxiety). Predictors of partner depressive affect and anxiety and partner-patient concordance rates were computed.

RESULTS—Levels of depressive affect and anxiety and rates of likely depression (21.4%) were as high for partners as they were for patients. No differences were found on depressive affect or anxiety by ethnicity, but female partners scored higher than male partners on both measures. Partner-patient concordance rates were low. The family level variables accounted for the most variance in both depressive affect and anxiety, with demographics and disease status variables contributing modest or nonsignificant independent variance.

CONCLUSIONS—Partners of patients with type 2 diabetes experience levels of psychological distress as high or even higher than patients, especially if the partner is female. Low levels of concordance suggest that partners can be distressed even if patients are not. Many life stresses contribute to psychological distress among partners, not just disease-related indicators. The findings suggest the utility of evaluating both partners and patients using a life-centered rather than a disease-focused perspective.
Classification of Type 1 Diabetic Females With Bulimia Nervosa Into Subgroups According to Purging Behavior
Authors: Takii Masato , Uchigata Yasuko , Nozaki Takehiro , Nishikata Hiroaki , Kawai Keisuke , Komaki Gen , Iwamoto Yasuhiko , Kubok Chiharu
Published: March 2007

OBJECTIVE—To classify type 1 diabetic females with bulimia nervosa (BN) by type of inappropriate compensatory behavior in order to prevent weight gain (ICB) and to investigate the group differences.

RESEACH DESIGN AND METHODS—Type 1 diabetic females with BN, diagnosed by structured diagnostic interview based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) criteria, were classified by type of ICB as follows: 1) only severe insulin omission as an ICB (BN-I) (n = 22), 2) both severe insulin omission and self-induced vomiting and/or laxative abuse (BN-IP) (n = 22), or 3) no insulin omission but another ICB (BN-NI) (n = 11). The clinical characteristics of these three groups and a binge-eating disorder (BED) group (n = 24) were compared.

RESULTS—The BN-IP and BN-I groups had the highest HbA1c levels. The BN-IP group had the highest rates of diabetic neuropathy, retinopathy, and nephropathy. The BN-NI group had the second highest rates of neuropathy and retinopathy. The BN-IP group had the highest frequencies of diabetes- and ketoacidosis-related hospital admissions, and the BN-I group had the second highest frequencies. The BN-NI group showed the highest scores on psychological tests related to depression, anxiety, eating disorder psychopathology, and perfectionism. The BN-NI group had the highest rate of history of visits to a psychiatrist, and the BN-IP group had the second highest history.

CONCLUSIONS—Type 1 diabetic females with BN seem not to be homogenous and can be classified into three distinctive subgroups by type of ICB. Individuals with BN-IP had the most severe problems with both medical and psychological/behavioral aspects. Individuals with BN-NI manifested the highest psychological distress. The BN-I group had comparatively mild distress despite having the poorest metabolic control. Each BN group manifested more severe pathology than the BED group.
A Randomized Trial of an Intervention to Improve Self-Care Behaviors of African-American Women With Type 2 Diabetes
Authors: Keyserling Thomas C. , Samuel-Hodge Carmen D. , Ammerman Alice S. , Ainsworth Barbara E. , Henríquez-Roldán Carlos F. , Elasy Tom A. , Skelly Anne H. , Johnston Larry F. , Bangdiwala Shrikant I.
Published: March 2007

OBJECTIVE—To determine whether a culturally appropriate clinic- and community-based intervention for African-American women with type 2 diabetes will increase moderate-intensity physical activity (PA).

RESEARCH DESIGN AND METHODS—In this randomized controlled trial conducted at seven practices in central North Carolina, 200 African-American women, ≥40 years of age with type 2 diabetes, were randomized to one of three treatment conditions: clinic and community (group A), clinic only (group B), or minimal intervention (group C). The clinic-based intervention (groups A and B) consisted of four monthly visits with a nutritionist who provided counseling to enhance PA and dietary intake that was tailored to baseline practices and attitudes; the community-based intervention (group A) consisted of three group sessions and 12 monthly phone calls from a peer counselor and was designed to provide social support and reinforce behavior change goals; and the minimal intervention (group C) consisted of educational pamphlets mailed to participants. The primary study outcome was the comparison of PA levels between groups assessed at 6 and 12 months by accelerometer, which was worn while awake for 7 days.

RESULTS—Totals of 175 (88%) and 167 (84%) participants completed PA assessment at 6 and 12 months, respectively. For comparison of PA, the P value for overall group effect was 0.014. Comparing group A with C, the difference in the average adjusted mean for PA was 44.1 kcal/day (95% CI 13.1–75.1, P = 0.0055). Comparing group B with C, the difference in the average adjusted mean was 33.1 kcal/day (95% CI 3.3–62.8, P = 0.029). The intervention was acceptable to participants: 88% were very satisfied with clinic-based counseling to enhance PA, and 86% indicated that the peer counselor’s role in the program was important.

CONCLUSIONS—The intervention was associated with a modest enhancement of PA and was acceptable to participants.
Glimepiride Improves Both First and Second Phases of Insulin Secretion in Type 2 Diabetes
Authors: Korytkowski Mary , Thomas Abraham , Reid Lynn , Tedesco Mary Beth , Gooding William E. , Gerich John
Published: March 2007

OBJECTIVE—The purpose of this study was to assess the effect of glimepiride on insulin sensitivity and secretion in subjects with type 2 diabetes.

RESEARCH DESIGN AND METHODS—After a 2-week washout from prior sulfonylurea therapy, 11 obese subjects with type 2 diabetes underwent euglycemic and hyperglycemic clamp studies before and during glimepiride therapy.

RESULTS—Glimepiride resulted in a 2.4-mmol/l decrease in fasting plasma glucose (P = 0.04) that was correlated with reductions in postabsorptive endogenous glucose production (EGP) (16.4 ± 0.6 vs. 13.5 ± 0.5 μmol · kg−1 · min−1, P = 0.01) (r = 0.21, P = 0.01). Postabsorptive EGP on glimepiride was similar to that of control subjects (12.8 ± 0.9 μmol · kg−1 · min−1, NS). Fasting plasma insulin (66 ± 18 vs. 84 ± 48 pmol/l, P = 0.05), and first-phase (19 ± 8 vs. 32 ± 11 pmol/l, P = 0.04) and second-phase incremental insulin responses to glucose (48 ± 23 vs. 72 ± 32 pmol/l, P = 0.02) improved with glimepiride therapy. Insulin sensitivity did not change with treatment (4.6 ± 0.7 vs. 4.3 ± 0.7 μmol · kg−1 · min−1 · pmol−1) and remained below that of control subjects (8.1 ± 1.8 μmol · kg−1 · min−1 · pmol−1, P = 0.04).

CONCLUSIONS—The current study demonstrates that glimepiride improves both first and second phases of insulin secretion, but not insulin sensitivity, in individuals with type 2 diabetes.
Impact of Pramlintide on Glucose Fluctuations and Postprandial Glucose, Glucagon, and Triglyceride Excursions Among Patients With Type 1 Diabetes Intensively Treated With Insulin Pumps
Authors: Levetan Claresa , Want Laura L. , Weyer Christian , Strobel Susan A. , Crean John , Wang Yan , Maggs David G. , Kolterman Orville G. , Chandran Manju , Mudaliar Sunder R. , Henry Robert R.
Published: March 2007

OBJECTIVE—To assess the effects of adjunctive treatment with pramlintide, an analog of the β-cell hormone amylin, on 24-h glucose fluctuations and postprandial glucose, glucagon, and triglyceride excursions in patients with type 1 diabetes intensively treated with continuous subcutaneous insulin infusion (CSII).

RESEARCH DESIGN AND METHODS—In this study, 18 patients (16 of whom could be evaluated) with type 1 diabetes (age 44 ± 11 years, HbA1c 8.2 ± 1.3% [mean ± SD]) were given mealtime injections of 30 μg pramlintide t.i.d. for 4 weeks in addition to their preexisting CSII regimen (16 lispro, 2 regular insulin). Mealtime insulin boluses were reduced by a minimum of 10% during the first 3 days, and re-adjusted thereafter based on clinical judgment. At weeks 0 (baseline), 4 (on treatment), and 6 (2 weeks off treatment), 24-h interstitial glucose concentrations were measured using a continuous glucose monitoring system (CGMS), and postprandial plasma glucose, glucagon, and triglyceride concentrations were measured in response to a standardized test meal.

RESULTS—At baseline, patients had excessive 24-h glucose fluctuations, with 59% of the CGMS measurements >140 mg/dl, 13% <80 mg/dl, and only 28% in the euglycemic range (80–140 mg/dl). After 4 weeks on pramlintide, measurements in the hyperglycemic range declined to 48% and measurements within the euglycemic range increased to 37%. This shift from the hyperglycemic to the euglycemic range occurred with a concomitant 17% reduction in mealtime insulin dosages and without relevant increases in measurements below the euglycemic range (15%) or any severe hypoglycemic events. After 4 weeks on pramlintide, postprandial glucose, glucagon, and triglyceride excursions were reduced by ∼86, ∼87, and ∼72%, respectively (incremental areas under the curve, all P < 0.05 vs. baseline). At week 6 (off treatment), the 24-h glucose profile and postprandial glucose, glucagon, and triglyceride excursions approached pretreatment values.

CONCLUSIONS—In this study, the addition of pramlintide to insulin therapy reduced excessive 24-h glucose fluctuations as well as postprandial glucose, glucagon, and triglyceride excursions in patients with type 1 diabetes intensively treated with insulin pumps.
Independent Factors Associated With Major Depressive Disorder in a National Sample of Individuals With Diabetes
Authors: Egede Leonard E. , Zheng Deyi
Published: March 2007

OBJECTIVE—To determine whether perceived poor physical health, duration of diabetes, and smoking are associated with major depressive disorder in a national sample of individuals with diabetes.

RESEARCH DESIGN AND METHODS—Data on 1,810 individuals with diabetes from the 1999 National Health Interview Survey (NHIS) were analyzed. The Composite International Diagnostic Interview (CIDI) Short-Form (CIDI-SF) developed by the World Health Organization was used to identify individuals with major depressive disorder. Multiple logistic regression was used to determine whether perceived poor physical health, duration of diabetes, and smoking were associated with major depressive disorder. The model controlled for age, sex, race/ethnicity, education, income, employment, marital status, and health status. Other control variables included BMI, smoking, duration of diabetes, presence or absence of major complications, and type of treatment for diabetes. SUDAAN software was used for statistical analyses to account for the complex sampling design of NHIS.

RESULTS—Independent factors associated with major depressive disorder were age <64 years, female sex, at least high school education, income <124% of federal poverty level, perceived worsening of health status, and smoking.

CONCLUSIONS—In addition to other psychosocial factors such as younger age, female sex, lower income, at least high school education, and smoking, perceptions about the effect of diabetes on overall health seems to play an important role in the etiology of depression.
Relation of Birth Weight to Fasting Insulin, Insulin Resistance, and Body Size in Adolescence
Authors: Murtaugh Maureen A. , Jacobs David R. , Moran Antoinette , Steinberger Julia , Sinaiko Alan R.
Published: March 2007

OBJECTIVE—A relationship between birth weight and the insulin resistance syndrome has been reported in adults but has not been defined in adolescents.

RESEARCH DESIGN AND METHODS—Data were analyzed in 296 children (132 girls and 164 boys) mean age 15.0 ± 1.2 years who had euglycemic insulin clamp studies (intravenous administration of 1 mU · kg–1 · min–1 of insulin balanced by a variable infusion of 20% glucose to maintain blood glucose at 100 mg/dl). Insulin sensitivity (MLBM) was determined by glucose uptake per kg lean body mass (LBM), and parents reported birth weight.

RESULTS—Birth weight ranged from 1,021 to 4,848 g (mean ± SD 3,433 ± 551), with 4.0% <2,500 g. Fat mass and BMI had U-shaped relations with birth weight after adjustment for race, age, sex, and blood pressure. Lean mass index (lean mass/height squared) was stable across birth weight quartiles. Fasting insulin decreased nonsignificantly across birth weight quartiles but became significant after adjustment for adolescent weight (P = 0.008). Although MLBM was highest in the highest birth weight quartile, the pattern was not significant. Triglycerides tended to increase with birth weight, whereas LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) tended to decrease. Blood pressure was unrelated to birth weight.

CONCLUSIONS—In this cohort, fat mass was greater in adolescents with low and high birth weight; fasting insulin was lower with higher birth weight after adjustment for adolescent weight. Insulin sensitivity increased nonsignificantly with birth weight.
Is HbA1c Affected by Glycemic Instability?
Authors: Derr Rachel , Garrett Elizabeth , Stacy Gerald A. , Saudek Christopher D.
Published: March 2007

OBJECTIVE—HbA1c is a standard clinical assessment of glycemia and the basis of most data relating glycemic control to complications. It remains unclear, however, whether HbA1c is affected by glycemic variation and mean glycemia.

RESEARCH DESIGN AND METHODS—To test this question, we analyzed the statistical relationship between HbA1c levels and glycemic variability as measured by self-monitoring of blood glucose (SMBG). The records of 256 subjects were studied. SMBG data for the preceding 3 months were downloaded, and HbA1c was measured by ion-exchange high-performance liquid chromatography. Simple- and random-effects linear regression models were used to assess the independent contributions of mean blood glucose (BG) and SD of BG to HbA1c, after adjusting for the mean BG.

RESULTS—Mean ± SD for HbA1c was 7.66 ± 1.11% and for BG was 8.5 ± 1.9 mmol/l (153.3 ± 34.9 mg/dl); SD of BG for individual subjects was 3.5 mmol/l (63.3 mg/dl), varying from 0.4 mmol/l (8.1 mg/dl; very stable glycemia) to 8.4 mmol/l (152.5 mg/dl; very unstable glycemia). A close correlation between mean BG and HbA1c was demonstrated (r = 0.62). Also, within-subject SD of BG correlated with HbA1c (r = 0.375), indicating that people with poorer glycemic control had higher BG variance. After adjusting for mean BG in a linear regression model, however, the effect of the within-subject SD of BG on the HbA1c was insignificant. Several further analyses confirmed the strength of the observation.

CONCLUSIONS—HbA1c reflects mean glycemia and is not meaningfully affected by glycemic instability after adjusting for mean BG.
Elevated C-Reactive Protein Is a Risk Factor for the Development of Type 2 Diabetes in Japanese Americans
Authors: Nakanishi Shuhei , Yamane Kiminori , Kamei Nozomu , Okubo Masamichi , Kohno Nobuoki
Published: March 2007

OBJECTIVE—Increasing evidence from a cohort of Caucasians recently suggests that an elevated level of C-reactive protein (CRP) is associated with an increased risk of developing type 2 diabetes. However, Japanese subjects are skewed to lower CRP concentrations than westerners. Therefore, the effect of CRP on the development of type 2 diabetes among Japanese is unclear.

RESEARCH DESIGN AND METHODS—We examined 396 male and 551 female nondiabetic Japanese Americans who underwent a 75-g oral glucose tolerance test (GTT) and were then followed for an average of 6.5 years. We investigated whether elevated serum CRP level is a risk factor in the development of type 2 diabetes among these subjects.

RESULTS—Subjects with a high CRP level showed a significantly higher incidence of type 2 diabetes compared with subjects with a low level among both men (P = 0.028) and women (P = 0.004) in a log-rank test. In a Cox proportional hazards model dividing quartiles of CRP, the hazard ratios for diabetes development in the highest versus lowest quartile of CRP levels were 2.84 (95% CI 1.09–7.39) among men and 3.11 (1.25–7.75) among women after adjustment for age, smoking, family history of diabetes, classification of a 75-g GTT, hormone replacement therapy (among women), BMI, and homeostasis model assessment.

CONCLUSIONS—Among Japanese Americans, CRP may be a risk factor for development of type 2 diabetes independent of either obesity or insulin resistance. Our results suggest that inflammation may be closely related to the mechanism of type 2 diabetes among Japanese Americans.
Diabetes and Idiopathic Cardiomyopathy
Authors: Bertoni Alain G. , Tsai Arthur , Kasper Edward K. , Brancati Frederick L.
Published: March 2007

OBJECTIVE—Controversy exists regarding the relation between diabetes and nonischemic idiopathic cardiomyopathy (ICM), and only limited data on the incidence of ICM in adults with diabetes are available. Therefore, we used the 1995 Nationwide Inpatient Sample (NIS) to determine discharge rates and test the hypothesis that diabetes is independently associated with ICM.

RESEARCH DESIGN AND METHODS—The 1995 NIS includes demographic and diagnostic data on all discharges from >900 representative hospitals in 19 states. ICD-9 codes were used to identify ICM, defined as discharges with a diagnosis of primary cardiomyopathy but without established risk factors for cardiomyopathy. Control subjects were selected by stratified random sampling by age to yield 10 per ICM case. The analyzed covariates included age, race, median income, diabetes, and hypertension. Multivariate logistic regression was used to conduct case-control analyses.

RESULTS—Using sampling weights, we estimated that in 1995, the rate of hospital discharge for ICM among individuals diagnosed with diabetes was 7.6 per 1,000. The prevalence of diabetes was substantially higher in the 44,837 ICM vs. 450,254 control subjects (26.6 vs. 17.2%), corresponding to a relative odds (RO) of 1.75 (95% CI 1.71–1.79). After adjusting for age, sex, race, hypertension, and median income using multiple logistic regression, diabetes remained significantly associated with ICM (RO 1.58, 95% CI 1.55–1.62).

CONCLUSIONS—We concluded that diabetes is independently associated with ICM in the general U.S. population.
Depression Predicts Increased Incidence of Adverse Health Outcomes in Older Mexican Americans With Type 2 Diabetes
Authors: Black Sandra A. , Markides Kyriakos S. , Ray Laura A.
Published: March 2007

OBJECTIVE—To examine the separate and combined effects of depression and diabetes on the incidence of adverse health outcomes among older Mexican Americans.

RESEARCH DESIGN AND METHODS—Longitudinal data from the Hispanic Established Population for the Epidemiologic Study of the Elderly (EPESE) survey were used to examine the main effects and interaction effects of diabetes and depressive symptoms (measured with the Center for Epidemiologic Study of Depression) or clinical diagnostic criteria (measured with the Composite International Diagnostic Interview Depression Module) on the development of macrovascular complications (including cardiovascular disease, stroke, and kidney disease), microvascular complications (including nephropathy, neuropathy, retinopathy, and amputations), functional disability, and mortality over 7 years in a sample of 2,830 Mexican Americans aged ≥65 years.

RESULTS—The interaction of diabetes and depression was found to be synergistic, predicting greater mortality, greater incidence of both macro- and microvascular complications, and greater incidence of disability in activities of daily living, even when controlling for sociodemographic characteristics such as sex, age, education, acculturation, and marital status. Importantly, this interaction was found to predict not only greater incidence but also earlier incidence of adverse events in older adults.

CONCLUSIONS—Whether a marker for underlying disease severity, an indicator of diminished self-care motivation, or the result of physiologic changes, the interaction of depression and diabetes has a synergistic effect on the health of older Mexican Americans, increasing the risk for poor outcomes. This is of particular clinical importance because although depression is often underrecognized in older adults, effective treatment is available and can result in improved medical outcomes.