bluuebunny/crossref_metadata_2025_split huggingface dataset:
Plantar Fascia Thickness is Longitudinally Associated with Retinopathy and Renal Dysfunction: A Prospective Study from Adolescence to Adulthood
Authors: Benitez-Aguirre Paul Z. , Craig Maria E. , Jenkins Alicia J. , Gallego Patricia H. , Cusumano Janine , Duffin Anthony C. , Hing Stephen , Donaghue Kim C. 
Published: January 2014

Aim: The aim was to study the longitudinal relationship between plantar fascia thickness (PFT) as a measure of tissue glycation and microvascular (MV) complications in young persons with type 1 diabetes (T1DM). Methods: We conducted a prospective longitudinal cohort study of 152 (69 male) adolescents with T1DM who underwent repeated MV complications assessments and ultrasound measurements of PFT from baseline (1997–2002) until 2008. Retinopathy was assessed by 7-field stereoscopic fundal photography and nephropathy by albumin excretion rate (AER) from three timed overnight urine specimens. Longitudinal analysis was performed using generalized estimating equations (GEE). Results: Median (interquartile range) age at baseline was 15.1 (13.4–16.8) years, and median follow-up was 8.3 (7.0–9.5) years, with 4 (3–6) visits per patient. Glycemic control improved from baseline to final visit [glycated hemoglobin (HbA1c) 8.5% to 8.0%, respectively; p = .004]. Prevalence of retinopathy increased from 20% to 51% ( p < .001) and early elevation of AER (>7.5 μg/min) increased from 26% to 29% ( p = .2). A greater increase in PFT (mm/year) was associated with retinopathy at the final assessment (ΔPFT 1st vs. 2nd-4th quartiles, χ2 = 9.87, p = .02). In multivariate GEE, greater PFT was longitudinally associated with retinopathy [odds ratio (OR) 4.6, 95% confidence interval (CI) 2.0–10.3] and early renal dysfunction (OR 3.2, CI 1.3–8.0) after adjusting for gender, blood pressure standard deviation scores, HbA1c, and total cholesterol. Conclusions: In young people with T1DM, PFT was longitudinally associated with retinopathy and early renal dysfunction, highlighting the importance of early glyccmic control and supporting the role of metabolic memory in MV complications. Measurement of PFT by ultrasound offers a noninvasive estimate of glyccmic burden and tissue glycation.
Interindividual and Intraindividual Variations in Postprandial Glycemia Peak Time Complicate Precise Recommendations for Self-Monitoring of Glucose in Persons with Type 1 Diabetes Mellitus
Authors: Johansen Mette Dencker , Gjerløv Irene , Christiansen Jens Sandahl , Hejlesen Ole K. 
Published: January 2014

Background: In glycemic control, postprandial glycemia may be important to monitor and optimize as it reveals glycemic control quality and postprandial hyperglycemia partly predicts late diabetic complications. Self-monitoring of blood glucose (SMBG) may be an appropriate technology to use, but recommendations on measurement time are crucial. Method: We retrospectively analyzed interindividual and intraindividual variations in postprandial glycemic peak time. Continuous glucose monitoring (CGM) and carbohydrate intake were collected in 22 patients with type 1 diabetes mellitus. Meals were identified from carbohydrate intake data. For each meal, peak time was identified as time from meal to CGM zenith within 40–150 min after meal start. Interindividual (one-way Anova) and intraindividual (intraclass correlation coefficient) variation was calculated. Results: Nineteen patients were included with sufficient meal data quality. Mean peak time was 87 ± 29 min. Mean peak time differed significantly between patients ( p = 0.02). Intraclass correlation coefficient was 0.29. Conclusions: Significant interindividual and intraindividual variations exist in postprandial glycemia peak time, thus hindering simple and general advice regarding postprandial SMBG for detection of maximum values.
Comparison of Known Food Weights with Image-Based Portion-Size Automated Estimation and Adolescents' Self-Reported Portion Size
Authors: Lee Christina D. , Chae Junghoon , Schap TusaRebecca E. , Kerr Deborah A. , Delp Edward J. , Ebert David S. , Boushey Carol J. 
Published: January 2014

Background: Diet is a critical element of diabetes self-management. An emerging area of research is the use of images for dietary records using mobile telephones with embedded cameras. These tools are being designed to reduce user burden and to improve accuracy of portion-size estimation through automation. The objectives of this study were to (1) assess the error of automatically determined portion weights compared to known portion weights of foods and (2) to compare the error between automation and human. Methods: Adolescents ( n = 15) captured images of their eating occasions over a 24 h period. All foods and beverages served were weighed. Adolescents self-reported portion sizes for one meal. Image analysis was used to estimate portion weights. Data analysis compared known weights, automated weights, and self-reported portions. Results: For the 19 foods, the mean ratio of automated weight estimate to known weight ranged from 0.89 to 4.61, and 9 foods were within 0.80 to 1.20. The largest error was for lettuce and the most accurate was strawberry jam. The children were fairly accurate with portion estimates for two foods (sausage links, toast) using one type of estimation aid and two foods (sausage links, scrambled eggs) using another aid. The automated method was fairly accurate for two foods (sausage links, jam); however, the 95% confidence intervals for the automated estimates were consistently narrower than human estimates. Conclusions: The ability of humans to estimate portion sizes of foods remains a problem and a perceived burden. Errors in automated portion-size estimation can be systematically addressed while minimizing the burden on people. Future applications that take over the burden of these processes may translate to better diabetes self-management.
Upregulation of Proinflammatory Cytokine Production in Response to Bacterial Pathogen-Associated Molecular Patterns in Dogs with Diabetes Mellitus Undergoing Insulin Therapy
Authors: DeClue Amy E. , Nickell Jordan , Chang Chee-Hoon , Honaker Allison 
Published: January 2014

Background: Metabolic alterations associated with diabetes mellitus alter innate immunity. Dogs often develop infectious or inflammatory complications related to diabetes mellitus, yet little is known about the effects of diabetes mellitus on the immune system in this species. Methods: Prospective evaluation in dogs with poorly regulated spontaneous type 1 diabetes mellitus (T1DM). In vitro leukocyte cytokine response to lipopolysaccharide (LPS), lipoteichoic acid (LTA), and peptidoglycan (PG) was compared between dogs with T1DM and healthy dogs. Additionally, the effect of acute in vitro glucose exposure on leukocyte tumor necrosis factor (TNF) production from healthy dogs was measured. Results: Leukocytes from dogs with T1DM had significantly greater TNF production after LTA and PG stimulation compared with leukocytes from healthy dogs. Leukocyte interleukin (IL)-6 production was greater after stimulation with LPS, LTA, PG, and phosphate-buffered saline in the T1DM group. No such difference was noted when evaluating IL-10 production between groups regardless of stimulant. Dogs with T1DM had significantly greater IL-6 to IL-10 production ratios than healthy dogs. Acute exposure to dextrose did not augment cytokine production from healthy canine leukocytes. Conclusions: Dogs with T1DM have altered innate immunity characterized by upregulation of proinflammatory cytokine production without a concurrent change in anti-inflammatory cytokine production. This may be one explanation for the common infectious and inflammatory complications associated with T1DM in dogs.
Association between Sitagliptin Adherence and Self-Monitoring of Blood Glucose
Authors: Nigam Somesh , Virdi Naunihal S. , Daskiran Mehmet , Kozma Chris M. , Paris Andrew , Dickson William M. 
Published: January 2014

Background: We evaluated the association between self-monitoring of blood glucose (SMBG) use and sitagliptin or sitagliptin/ metformin (SSMT) adherence. SSMT was chosen as these medications have little risk of hypoglycemia and are believed to not require SMBG data for titration. Methods: This was an observational study using data extracted from a large United States insurance claims database (i3 InVision™ Data Mart, Ingenix, Inc.). Data were extracted on noninsulin-using patients initiating SSMT for each 12-month period pre- and post-SSMT initiation. Logistic regression was used to assess the relationship between SMBG use and the likelihood of being medication adherent (defined as a medication possession ratio of ≥75%) while controlling for covariates. Results: This analysis included 7,306 patients (57.6% male; mean age 54.2 years). Mean pre-SSMT hemoglobin A1c (HbA1c) was 8.0%. In the post-SSMT initiation period, 58% of patients were adherent with SSMT. Older age, male gender, prior use of oral diabetes medication, and lower HbA1c were associated with improved SSMT adherence. SMBG use was associated with improved adherence [odds ratio (OR) ranged from 1.198 to 1.338; p < .05] compared with patients with no SMBG use pre- or post-SSMT initiation. For patients who began SMBG after starting SSMT, greater SMBG use was associated with better adherence (OR 1.449 for higher vs 1.246 for lower strip use; p < .05). Conclusions: This study demonstrated that SMBG is associated with improved SSMT adherence. This relationship is strengthened with greater SMBG use.
Retinal Vascular Geometry in Asian Persons with Diabetes and Retinopathy
Authors: Cheung Carol Yim-Lui , Lamoureux Ecosse , Ikram M. Kamran , Sasongko M. Bayu , Ding Jie , Zheng Yingfeng , Mitchell Paul , Wang Jie Jin , Wong Tien Yin 
Published: January 2014

Purpose: Our purpose was to examine the relationship of retinal vascular parameters with diabetes and retinopathy in an older Asian population. Methods: Retinal photographs from participants of a population-based survey of Asian Malay persons aged 40–80 years were analyzed. Specific retinal vascular parameters (tortuosity, branching angle, fractal dimension, and caliber) were measured using a semiautomated computer-based program. Diabetes was defined as random plasma glucose = 11.1 mmol/liter, the use of diabetes medication, or physician-diagnosed diabetes. Retinopathy signs were graded from photographs using the modified Airlie House classification system. Results: A total of 2735 persons were included in the study. Persons with diabetes ( n = 594) were more likely to have straighter (less tortuous) arterioles and wider arteriolar and venular caliber than those without diabetes ( n = 2141). Among subjects with diabetes, those with retinopathy had wider venular caliber than those without retinopathy (211.3 versus 204.9 μm, p = .001). Among nondiabetic subjects, however, those with retinopathy had more tortuous venules than those without retinopathy [5.19(x104) versus 4.27(x104), p < .001]. Conclusions: Retinal vascular parameters varied by diabetes and retinopathy status in this older Asian cohort. Our findings suggest that subtle alterations in retinal vascular architecture are influenced by diabetes.
Screening for Diabetic Cardiac Autonomic Neuropathy Using a New Handheld Device
Authors: Gulichsen Elisabeth , Fleischer Jesper , Ejskjaer Niels , Eldrup Ebbe , Tarnow Lise 
Published: January 2014

Background: Cardiac autonomic neuropathy (CAN) is a serious complication of longstanding diabetes and is associated with an increased morbidity and reduced quality of life in patients with diabetes. The present study evaluated the prevalence of CAN diagnosed by reduced heart rate variability (HRV) using a newly developed device in a large, unselected, hospital-based population of patients with diabetes. Methods: The study examined 323 patients consisting of 206 type 1 diabetes (T1DM) patients and 117 type 2 diabetes (T2DM) patients. The new handheld prototype Vagus™ was used to screen for CAN. Three different standardized cardiac reflex tests were performed to calculate HRV: 30:15 ratio, E:I ratio, and the Valsalva maneuver. An abnormal HRV in one test is indicative of early CAN, and if two or more tests show abnormal HRV, the diagnosis of CAN is established. Results: In total, 86% of examined patients completed all three tests. Each test was completed by more than 90% of the patients. The prevalence of established CAN was 23%, whereas 33% of the patients had early signs of CAN. The prevalence was higher in T2DM patients (27.8%) than in T1DM patients (20.6 %), p = .02. Patients with CAN were older and had a longer duration of diabetes, higher systolic blood pressure, more nephropathy and retinopathy, and a higher vibration threshold. Conclusions: Cardiac autonomic neuropathy is frequent in both T2DM and T1DM patients, especially in those with other late diabetes complications. Screening for CAN with the new device is feasible.
Risk Factors for Inpatient Hypoglycemia during Subcutaneous Insulin Therapy in Non-Critically Ill Patients with Type 2 Diabetes
Authors: Farrokhi Farnoosh , Klindukhova Olena , Chandra Prakash , Peng Limin , Smiley Dawn , Newton Christopher , Pasquel Francisco , Fereira Maria E. , Umpierrez Guillermo 
Published: January 2014

Objective: We aimed to determine risk factors associated with hypoglycemia during subcutaneous insulin therapy in non-critically ill patients with type 2 diabetes. Methods: We conducted an analysis of three randomized control trials using basal/bolus regimen and regular sliding scale insulin (SSI) in patients with diabetes admitted to medical and surgical settings. Results: We analyzed medical records of 261 general medicine and 211 noncardiac surgery patients treated with basal/ bolus regimen with glargine/glulisine ( n = 169), detemir/aspart ( n = 67), neutral protamine Hagedorn/regular ( n = 63), or with SSI ( n = 173). The overall frequency of mild and severe hypoglycemia (<70 and <40 mg/dl) was 19% and 2%, respectively. During treatment, medical patients experienced a higher number of hypoglycemia than surgical patients (23% versus 13%; p = .005), but the rate of severe hypoglycemia was similar between groups (1.9% versus 1.9%; p = not significant). Increasing age, impaired kidney function (glomerular filtration rate < 60 ml/min), total daily insulin dose, and type of insulin regimen (basal/bolus versus SSI) during hospitalization were important contributors for hypoglycemia in both medical and surgical patients. Among these variables, increasing age and type of insulin regimen (basal/bolus versus SSI) were found to be independent predictors of hypoglycemic events. Conclusions: Mild hypoglycemic events are common during subcutaneous insulin therapy in medical and surgical patients with type 2 diabetes. Increasing age, impaired renal function, daily insulin dose, and insulin regimen (basal/bolus versus SSI) are important predictors of hypoglycemia during insulin therapy in patients with type 2 diabetes mellitus.
System Accuracy Evaluation of 43 Blood Glucose Monitoring Systems for Self-Monitoring of Blood Glucose according to DIN EN ISO 15197
Authors: Freckmann Guido , Schmid Christina , Baumstark Annette , Pleus Stefan , Link Manuela , Haug Cornelia 
Published: January 2014

Background: The accuracy of systems for self-monitoring of blood glucose is important, as reliable measurement results are a prerequisite for therapeutic decisions. Methods: This system accuracy evaluation study was performed according to DIN EN ISO 15197:2003 for 43 Conformité Européenne (CE)-labeled blood glucose (BG) monitoring systems. Measurement results of each system were compared with results of the designated comparison method (manufacturer's measurement procedure): glucose oxidase method (YSI 2300 glucose analyzer) or hexokinase method (Hitachi 917/ cobas 501). Results: Complete assessment according to the International Organization for Standardization (ISO) standard was performed for 34 out of 43 systems, and 27 (79.4%) meet the requirements of the standard, i.e., ≥95% of their results showed at least the minimum acceptable accuracy. For 9 of the 43 systems, complete accuracy assessment was not performed due to an oxygen sensitivity (manufacturer's labeling). The bias (according to Bland and Altman) of all 43 evaluated systems ranged from −14.1% to +12.4%. Conclusions: From the 34 systems completely assessed, 7 systems did not fulfill the minimal accuracy requirements of the ISO standard. The CE mark apparently does not guarantee that all BG systems provide accuracy according to the standard. Because inaccurate systems bear the risk of false therapeutic decisions, regular and standardized evaluation of BG meters and test strips should be requested in order to ensure adherence to quality standards.
Lot-to-Lot Variability of Test Strips and Accuracy Assessment of Systems for Self-Monitoring of Blood Glucose according to ISO 15197
Authors: Baumstark Annette , Pleus Stefan , Schmid Christina , Link Manuela , Haug Cornelia , Freckmann Guido 
Published: January 2014

Background: Accurate and reliable blood glucose (BG) measurements require that different test strip lots of the same BG monitoring system provide comparable measurement results. Only a small number of studies addressing this question have been published. Methods: In this study, four test strip lots for each of five different BG systems [Accu-Chek® Aviva (system A), FreeStyle Lite® (system B), GlucoCheck XL (system C), Pura™/mylife™ Pura (system D), and OneTouch® Verio ™ Pro (system E)] were evaluated with procedures according to DIN EN ISO 15197:2003. The BG system measurement results were compared with the manufacturer's measurement procedure (glucose oxidase or hexokinase method). Relative bias according to Bland and Altman and system accuracy according to ISO 15197 were analyzed. A BG system consists of the BG meter itself and the test strips. Results: The maximum lot-to-lot difference between any two of the four evaluated test strip lots per BG system was 1.0% for system E, 2.1% for system A, 3.1% for system C, 6.9% for system B, and 13.0% for system D. Only two systems (systems A and B) fulfill the criteria of DIN EN ISO 15197:2003 with each test strip lot. Conclusions: Considerable lot-to-lot variability between test strip lots of the same BG system was found. These variations add to other sources of inaccuracy with the specific BG system. Manufacturers should regularly and effectively check the accuracy of their BG meters and test strips even between different test strip lots to minimize risk of false treatment decisions.
Outcomes of Community-Dwelling Adults without Diabetes Mellitus Who Require Ambulance Services for Hypoglycemia
Authors: Parsaik Ajay K. , Carter Rickey E. , Myers Lucas A. , Dong Ming , Basu Ananda , Kudva Yogish C. 
Published: January 2014

Objective: We evaluate the prevalence, etiology, and outcomes of hypoglycemia requiring emergency medical services (EMS) in patients without diabetes mellitus (non-DM). Methods: We reviewed medical records of all ambulance calls for non-DM with blood glucose <70 mg/dl in Olmsted County, Minnesota, between January 1, 2003, and December 31, 2009. Results: A total of 131 patients (age 51 ± 19 years; 54 % females) made 142 EMS calls, while 10 patients made repeated calls. Causes of hypoglycemia were critical illness (42; 32%), alcohol and polysubstance use (36; 27.5 %), insulinoma/ bariatric surgery (10; 8%), restricted oral intake (7; 5%), and multiple factors (3; 27.5 %). Patients with alcohol and polysubstance abuse were younger ( p = .002). A total of 54 patients had additional hypoglycemia predisposing comorbidities/factors [adrenal insufficiency (2), end-stage renal disease (11) and chronic liver disease (7), beta blockers use (34), and pentamidine use (1)]. Repeated calls and emergency room transportation were similar, but hospitalization varied across the etiologies, with the lowest proportion in the multiple-factor-related hypoglycemia group ( p = .01). Duration of follow-up was 1.28 (interquartile range 0.13–2.70) years. A total of 38 patients died, and age-adjusted mortality varied across different etiologies ( p < .001), with highest among critically ill. Cancer caused the highest number of deaths (7/38; 18%), while 1 death was due to hypoglycemia. Conclusions: There were multiple etiologies for hypoglycemic episodes in community-dwelling non-DM that required EMS. Critical illness, multifactorial causes, and alcohol/polysubstance abuse were common causes. Hospitalization and mortality were higher with critical illnesses.
Robust Fault Detection System for Insulin Pump Therapy Using Continuous Glucose Monitoring
Authors: Herrero Pau , Calm Remei , Vehí Josep , Armengol Joaquim , Georgiou Pantelis , Oliver Nick , Tomazou Christofer 
Published: January 2014

Background: The popularity of continuous subcutaneous insulin infusion (CSII), or insulin pump therapy, as a way to deliver insulin more physiologically and achieve better glycemic control in diabetes patients has increased. Despite the substantiated therapeutic advantages of using CSII, its use has also been associated with an increased risk of technical malfunctioning of the device, which leads to an increased risk of acute metabolic complications, such as diabetic ketoacidosis. Current insulin pumps already incorporate systems to detect some types of faults, such as obstructions in the infusion set, but are not able to detect other types of fault such as the disconnection or leakage of the infusion set. Methods: In this article, we propose utilizing a validated robust model-based fault detection technique, based on interval analysis, for detecting disconnections of the insulin infusion set. For this purpose, a previously validated metabolic model of glucose regulation in type 1 diabetes mellitus (T1DM) and a continuous glucose monitoring device were used. As a first step to assess the performance of the presented fault detection system, a Food and Drug Administration-accepted T1DM simulator was employed. Results: Of the 100 in silico tests (10 scenarios on 10 subjects), only two false negatives and one false positive occurred. All faults were detected before plasma glucose concentration reached 300 mg/dl, with a mean plasma glucose detection value of 163 mg/dl and a mean detection time of 200 min. Conclusions: Interval model-based fault detection has been proven ( in silico) to be an effective tool for detecting disconnection faults in sensor-augmented CSII systems. Proper quantification of the uncertainty associated with the employed model has been observed to be crucial for the good performance of the proposed approach.
The Impact of Mobile Monitoring Technologies on Glycosylated Hemoglobin in Diabetes: A Systematic Review
Authors: Baron Justine , McBain Hayley , Newman Stanton 
Published: January 2014

Background: A new development in the field of telehealth is the use of mobile health technologies (mhealth) to help patients record and track medical information. Mhealth appears particularly advantageous for conditions that require intense and ongoing monitoring, such as diabetes, and where people are of working age and not disabled. This review aims to evaluate the evidence for the effectiveness of mhealth interventions in diabetes management on glycosylated hemoglobin. Method: A comprehensive search strategy was developed and applied to eight electronic databases to identify studies that investigated the clinical effectiveness of mobile-based applications that allowed patients to record and send their blood glucose readings to a central server. The eligibility of 8543 papers was assessed against the selection criteria, and 24 papers were reviewed. All studies reviewed were assessed for quality using a standardized quality assessment tool. Results: Results for patients with type 1 and type 2 diabetes were examined separately. Study variability and poor reporting made comparison difficult, and most studies had important methodological weaknesses. Evidence on the effectiveness of mhealth interventions for diabetes was inconsistent for both types of diabetes and remains weak.