bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treat-to-Target Insulin Titration Algorithms When Initiating Long or Intermediate Acting Insulin in Type 2 Diabetes
Authors: Strange Poul 
Published: January 2014

Background: Until recently, titration of insulin in type 2 diabetes clinical trials was typically left up to the investigator's discretion with a simple statement of the target ranges for glucose. In type 2 diabetes trials the average glycemic control achieved was usually less than desirable. Since then a number of trials have been conducted and reported utilizing various algorithms under various conditions. The objective of this article is to provide a review of the evidence to date. Methods: In addition to studies already identified through work in the area, the literature was searched using PubMed with the search words “insulin and titration” and subsequently “insulin and algorithm” from which studies starting insulin therapy using insulin titration algorithms in type 2 diabetes were selected. Results: The different algorithms and achieved results for glycemic control and hypoglycemia, as well as factors appearing to impact the results, are reviewed. Conclusion: The recent introduction of rigorously implemented insulin titration algorithms when adding on basal insulin to oral drugs in inadequately treated type 2 diabetes patients has led to better average glycemic control with little risk of severe hypoglycemia, as long as the morning fasting plasma glucose target is not lower than 100 mg/dl. Insulin titration algorithms have undergone and continue evolution in the direction of increased patient control.
Safety of the Ullorex® Oral Intragastric Balloon for the Treatment of Obesity
Authors: Martin Corby K. , Bellanger Drake E. , Rau Kristina K. , Coulon Sandra , Greenway Frank L. 
Published: January 2014

Background: Intragastric balloons have been used for weight loss with varying success. Widespread use of intragastric balloons has been limited because balloons must be placed in, and removed from, the stomach endoscopically. Development of a balloon that does not require endoscopy suggests that obesity treatment with intragastric balloons is feasible. The purpose of this study was to test the Ullorex® oral intragastric balloon (OIB) in a sample of human participants. Methods: The Ullorex OIB is a large capsule that is injected with citric acid and swallowed. After 4 minutes, the balloon inflates to 300 cm3. Stomach acid degrades a plug on the balloon over 25–30 days, when the balloon deflates and passes in feces. The Ullorex OIB was tested in 12 humans (two participants received placebo capsules). Body weight was monitored before and after balloon placement, and test meals quantified food intake among 6 of the 12 participants, all of whom received one balloon. Results: A single significant adverse event occurred. The one participant randomized to receive three balloons developed nausea and vomiting, requiring intravenous fluids, which was likely influenced by noncompliance (eating solid foods after balloon placement). Participants who received balloons had a significant mean weight loss over 2 weeks, amounting to 1.5 kg (p < 0.05). A marginally significant food intake reduction from baseline to week 1 was found (149 kcal, 24.4%) ( p = 0.055). Conclusions: The Ullorex OIB was successfully utilized in this study, with one serious adverse event that was likely influenced by noncompliance. Body weight and food intake data suggest that the Ullorex OIB be tested further as a possible treatment for obesity.
Hypoglycemia Detection and Prediction Using Continuous Glucose Monitoring—A Study on Hypoglycemic Clamp Data
Authors: Palerm Cesar C. , Bequette B. Wayne 
Published: January 2014

Motivation: The fear of hypoglycemia remains an important limiting factor in the ability of an individual with type 1 diabetes to tightly regulate glycemia. Continuous glucose monitors provide important feedback to improve glycemic control, but there remains a need for these devices to better alarm of possible impending hypoglycemia, particularly overnight or other periods when the individual is engaged in activities that take their focus away from glucose monitoring. Methods: We have previously proposed an algorithm, based on the use of real-time glucose sensor signals and optimal estimation theory (Kalman filtering), to predict hypoglycemia; the algorithm was validated in simulation-based studies. In this article we further refine and validate the prediction algorithm based on the analysis of clinical hypoglycemic clamp data from 13 subjects. The sensitivity and specificity of the predictions are calculated with respect to reference blood glucose values obtained at the same sampling rate of the sensor. Results: For a 30-minute prediction horizon and alarm threshold of 70 mg/dl, the sensitivity and specificity were 90 and 79%, respectively, indicating that a 21% false alarm rate must be tolerated to predict 90% of the hypoglycemic events 30 minutes ahead of time. Shorter prediction horizons yield a significant improvement in sensitivity and specificity. Discussion: Sensitivity and specificity data as a function of prediction horizon and alarm threshold enable an individual to adjust the alarm to best meet their needs. Such decisions can be made depending on the subject's risk for hypoglycemia, for example.
Use of Fourier Models for Analysis and Interpretation of Continuous Glucose Monitoring Glucose Profiles
Authors: Miller Michael , Strange Poul 
Published: January 2014

Background: The introduction of continuous glucose monitoring (CGM) devices has dramatically increased the amount of information available about each patient. While CGM has become a useful diagnostic tool for the individual patient, interpretive issues including noise reduction remain and further analytical work is needed to fully utilize the data richness. Method: We applied discrete Fourier transform methodology to CGM data to obtain an overall statistical model providing the dimension reduction necessary for insightful analyses of the whole function and explored some properties and possible applications of this technology. Results: The following example applications are shown. Discrete Fourier transform allows reduction of noise using an objective statistical criterion and may, as a first step, possibly enhance the value of various measures of variability through this noise reduction. Average functions of groups in a prospective randomized clinical are demonstrated and the aggregate function is readily visualized. Second and third harmonic amplitudes at baseline correlate with hemoglobin A1c after a 6-month treatment period. The time points of most rapid glucose decreases are identified easily with the functional through the second derivative, and its correlation with subsequent reported symptomatic hypoglycemia is shown. Conclusions: Discrete Fourier transform offers an attractive analytical methodology for CGM data given the achievable dimension reduction without loss of essential information as well as its ability to eliminate noise.
Overnight versus 24 Hours of Continuous Subcutaneous Insulin Infusion as Supplement to Oral Antidiabetic Drugs in Type 2 Diabetes
Authors: Parkner Tina , Laursen Torben , Chen Jian-Wen , Møller Marianne K. , Thomsen Henrik F. , Jørgensen Christina , Smedegaard Jørgen S. , Lauritzen Torsten , Christiansen Jens S. 
Published: January 2014

Background: Basal continuous subcutaneous insulin infusion (CSII) therapy at a fixed rate may effectively improve glycemic control in patients with type 2 diabetes when oral antidiabetic treatment fails. Regimens of simple constant subcutaneous delivery of insulin may provide theoretical advantages in type 2 diabetes. Methods: Ten subjects with type 2 diabetes who obtained insufficient glycemic control on oral antidiabetic drugs were included. Following an initial control day, two periods of 3 days with CSII of a rapid-acting insulin analogue, 1.5 IU/h (dose obtained from a preceding study), for 8 hours overnight and for 24 hours, respectively, were carried out in random order. Profiles of serum insulin aspart, serum endogenous insulin, and plasma glucose were recorded. Results: Compared to the control day, an 8-hour overnight insulin infusion during a 3-day period improved fasting plasma glucose (FPG) (mean differences ± SEM; Δ59.0 ± 10.1 mg/dl; p < 0.01) and 2-hour postprandial plasma glucose (PPPG) (Δ57.8 ± 10.6 mg/dl; p < 0.01) after breakfast. Compared to an 8-hour overnight infusion, a 24-hour infusion further improved all three PPPG values after breakfast, lunch, and dinner (Δ28.8 ± 8.1 mg/dl, Δ30.6 ± 8.1 mg/dl, and Δ35.1 ± 7.9 mg/dl; p < 0.01). During insulin infusion, only one hypoglycemic episode with PG <55.8 mg/dl and mild symptoms was recorded. Conclusion: Continuous subcutaneous insulin infusion with a rapid-acting insulin analogue at a fixed rate of 1.5 IU/h, either overnight or for 24 hours, improved glycemic control without safety concerns in patients with type 2 diabetes who had secondary failure to oral antidiabetic drugs. The effect on FPG was similar for both treatments, whereas the effect on PPPG was superior when insulin was infused during the entire 24 hours.
Impact of Different Fat Depots on Insulin Sensitivity: Predominant Role of Liver Fat
Authors: Kirchhoff Kerstin , Kantartzis Konstantinos , Machann Jürgen , Schick Fritz , Thamer Claus , Machicao Fausto , Fritsche Andreas , Häring Hans-Ulrich , Stefan Norbert 
Published: January 2014

Background: Overall obesity and, as it is increasingly appreciated, body fat distribution and ectopic fat deposition in liver and skeletal muscle, determine insulin resistance in humans. However, little is known about the independence of these relationships. Therefore, we determined the impact of different fat depots as well as fat accumulation in ectopic tissues such as liver and skeletal muscle in the prediction of insulin resistance in healthy humans. Methods: Visceral and subcutaneous abdominal fat were determined by magnetic resonance (MR) tomography and liver fat and intramyocellular fat in the tibialis anterior muscle by 1H-MR spectroscopy in 220 subjects. Insulin sensitivity was estimated from the oral glucose tolerance test (OGTT) and measured by a euglycemic hyperinsulinemic clamp in a subgroup ( n = 157). Results: Insulin sensitivity estimated from the OGTT correlated negatively with total body fat ( r = −0.27, p < 0.0001), subcutaneous abdominal fat ( r = −0.35, p < 0.0001), and visceral fat ( r = −0.43, p < 0.0001). Furthermore, insulin sensitivity correlated negatively with liver fat ( r = −0.53, p < 0.0001) and intramyocellular fat ( r = −0.26, p < 0.0001). In multivariate regression models, high liver and visceral fat emerged as the strongest predictors of low insulin sensitivity. Conclusion: Among various fat compartments, high liver fat and high visceral fat are the strongest determinants of insulin sensitivity in humans.
Vagus Nerve Stimulation and Emotional Responses to Food among Depressed Patients
Authors: Bodenlos Jamie S. , Kose Samet , Borckardt Jeffrey J. , Nahas Ziad , Shaw Darlene , O'Neil Patrick M. , Pagoto Sherry L. , George Mark S. 
Published: January 2014

Background: Approved for treatment of treatment-resistant depression and for epilepsy, vagus nerve stimulation (VNS) therapy involves stimulation of the vagus nerve, affecting both mood and appetite regulating systems. VNS is associated with changes in food intake and weight loss in animals. Studies of its impact on food intake and weight with humans are limited. It is not known whether or how VNS influences emotional response to food, but vagus afferents project to regions in the insula involving satiety and taste. Method: Thirty-three participants were recruited for three groups: depressed patients undergoing VNS therapy, depressed patients not undergoing VNS therapy, and healthy controls. All participants viewed images of foods twice in random order. When applicable, VNS devices were turned on for one viewing and off for the other. Participants were instructed to rate immediately after the viewings how each picture made them feel on a visual analog on three dimensions (unhappy to happy, calm to aroused, and small/submissive to big/domineering). Results: Controlling for time since last meal, a significant main effect was found for arousal ratings in response to sweet food images. Post-hoc analyses indicated that the VNS group demonstrated significant changes in arousal ratings between paired food image viewings compared to controls. Sixty-four percent of VNS participants demonstrated increases and 36% demonstrated decreases in arousal. Higher body mass indexes and greater levels of self-reported sweet cravings were associated with increased arousal during VNS activation. Conclusions: This study was the first to examine the effects of acute left cervical VNS on emotional ratings of food in adults with major depression. Results suggest that VNS device activation may be associated with acute alteration in arousal response to sweet foods among depressed patients. Future research is needed to replicate these findings and to assess how activation of the vagus nerve affects eating and weight.
A Review of Web-Assisted Interventions for Diabetes Management: Maximizing the Potential for Improving Health Outcomes
Authors: Brown Linda Lockett , Lustria Mia Liza A. , Rankins Jenice 
Published: January 2014

Current endeavors in diabetes care focus on helping patients and providers deal successfully with the complexities of the disease by improving the system of care, expanding the reach of interventions, and empowering patients to engage in self-care behaviors. Internet technologies that combine the broad reach of mass media with the interactive capabilities of interpersonal media provide a wide range of advantages over standard modes of delivery. The technical affordances of Web delivery enable individualization or tailoring, appropriately timed reinforcement of educational messages, social support, improved feedback, and increased engagement. In turn, these have been significantly correlated with improved health outcomes. This article is a narrative review of Web-based interventions for managing type 2 diabetes published from 2000 to 2007 that utilize Web sites, Web portals, electronic medical records, videoconference, interactive voice response, and short messaging systems. The most effective systems link medical management and self-management. Patient satisfaction is highest when the Web-based system gives them the ability to track blood glucose, receive electronic reminders, schedule physician visits, email their health care team, and interact with other diabetic patients. However, comprehensive medical and self-management programs have not been implemented widely outside of systems funded by government agencies. The cost of developing and maintaining comprehensive systems continues to be a challenge and is seldom measured in efficacy studies. Lack of reimbursement for Web-based treatments is also a major barrier to implementation. These barriers must be overcome for widespread adoption and realization of subsequent cost savings.
In Pursuit of Change: Youth Response to Intensive Goal Setting Embedded in a Serious Video Game
Authors: Thompson Debbe , Baranowski Tom , Buday Richard , Baranowski Janice , Juliano Melissa , Frazior McKee , Wilsdon Jon , Jago Russell 
Published: January 2014

Background: Type 2 diabetes has increased in prevalence among youth, paralleling the increase in pediatric obesity. Helping youth achieve energy balance by changing diet and physical activity behaviors should decrease the risk for type 2 diabetes and obesity. Goal setting and goal review are critical components of behavior change. Theory-informed video games that emphasize development and refinement of goal setting and goal review skills provide a method for achieving energy balance in an informative, entertaining format. This article reports alpha-testing results of early versions of theory-informed goal setting and reviews components of two diabetes and obesity prevention video games for preadolescents. Method: Two episodes each of two video games were alpha tested with 9- to 11-year-old youth from multiple ethnic groups. Alpha testing included observed game play followed by a scripted interview. The staff was trained in observation and interview techniques prior to data collection. Results: Although some difficulties were encountered, alpha testers generally understood goal setting and review components and comprehended they were setting personal goals. Although goal setting and review involved multiple steps, youth were generally able to complete them quickly, with minimal difficulty. Few technical issues arose; however, several usability and comprehension problems were identified. Conclusion: Theory-informed video games may be an effective medium for promoting youth diabetes and obesity prevention. Alpha testing helps identify problems likely to have a negative effect on functionality, usability, and comprehension during development, thereby providing an opportunity to correct these issues prior to final production.
Comparisons of Body Volumes and Dimensions Using Three-Dimensional Photonic Scanning in Adult Hispanic-Americans and Caucasian-Americans
Authors: Olivares Josefina , Wang Jack , Yu Wen , Pereg Vicente , Weil Richard , Kovacs Betty , Gallagher Dympna , Pi-Sunyer F. Xavier 
Published: January 2014

Background: We studied whether significant differences exist between Hispanic-Americans (H-A) and Caucasian-Americans (C-A) in body dimensions using a newly validated three-dimensional photonic scanner (3DPS). Methods: We compared two cohorts of 34 adult U.S.-based H-A (19 females) and 40 adult C-A (25 females) of similar age and body mass index (BMI, kg/m2). We measured total body volume (TBV), trunk volume (TV), and other body dimensions, including waist and hip circumferences, estimated percentage body fat (%fat), calculated TV/TBV, and waist-to-hip ratio. Results: For female cohorts, there were no significant differences in age, weight, height, and 3DPS-measured variables between the two ethnic cohorts. For male cohorts, C-A had greater height ( p = 0.014), but there were no significant differences in absolute or proportional volumes or dimensions between the two cohorts. Conclusions: Results demonstrate that, in these H-A and C-A cohorts of similar age and BMI, total and regional body volumes and dimensions, as well as their proportions, approximate each other very closely in both sexes; these variables also show similar relationships with %fat in each sex. This is in contradistinction to previous study reports using other measurement techniques.
Harnessing Information Technologies to Improve the Delivery of Diabetes Care to Veterans: The Future is Today
Authors: Aron David C. , Pogach Leonard M. 
Published: January 2014

Background: Although momentum is now building nationally for improved informatics, progress has been incremental in most cases. One notable exception is the Veterans Health Administration, which utilizes one of the most widely used electronic medical record systems in the world. Objectives: The articles in this symposium demonstrate the implementation of technology to move beyond the electronic medical record at the time of the medical encounter to improve timeliness and outcomes of care delivery for veterans with diabetes. Results: We report on the use of electronic registries and nurse practitioner-based programs across multiple sites to improve glycemic control; the implementation of a digital retinal imaging system in primary care clinics; the use of health information technology to improve patient self-care; and the development of a research database to move beyond performance measurement to evaluate longitudinal outcomes. Conclusions: While these articles demonstrate the ability of a single national system of care to harness the power of technology to novel strategies for the delivery of care and its evaluation, the technology is scalable from small group practices to regional health care systems.
Building a Diabetes Registry from the Veterans Health Administration's Computerized Patient Record System
Authors: Kern Elizabeth F. O. , Beischel Scott , Stalnaker Randal , Aron David C. , Kirsh Susan R. , Watts Sharon A. 
Published: January 2014

Background: Little information is available describing how to implement a disease registry from an electronic patient record system. The aim of this report is to describe the technology, methods, and utility of a diabetes registry populated by the Veterans Health Information Systems Architecture (VistA), which underlies the computerized patient record system of the Veterans Health Administration (VHA) in Veteran Affairs Integrated Service Network 10 (VISN 10). Methods: VISN 10 data from VistA were mapped to a relational SQL-based data system using KB_SQL software. Operational definitions for diabetes, active clinical management, and responsible providers were used to create views of patient-level data in the diabetes registry. Query Analyzer was used to access the data views directly. Semicustomizable reports were created by linking the diabetes registry to a Web page using Microsoft asp.net2. A retrospective observational study design was used to analyze trends in the process of care and outcomes. Results: Since October 2001, 81,227 patients with diabetes have enrolled in VISN 10: approximately 42,000 are currently under active management by VISN 10 providers. By tracking primary care visits, we assigned 91% to a clinic group responsible for diabetes care. In the Cleveland Veterans Affairs Medical Center (VAMC), the frequency of mean annual hemoglobin A1c levels ≥9% has declined significantly over 5 years. Almost 4000 patients have been seen in diabetes intervention programs in the Cleveland VAMC over the past 4 years. Conclusions: A diabetes registry can be populated from the database underlying the VHA electronic patient record database system and linked to Web-based and ad hoc queries useful for quality improvement.