bluuebunny/crossref_metadata_2025_split huggingface dataset:
Blunted Counterregulatory Hormone Responses to Hypoglycemia in Young Children and Adolescents With Well-Controlled Type 1 Diabetes
Authors:   Diabetes Research in Children Network (DirecNet) Study Group
Published: August 2009

OBJECTIVE
Hypoglycemia in young children with type 1 diabetes is an acute complication of intensive insulin therapy and is commonly observed in the absence of signs or symptoms. The effect of intensive treatment and patient age on sympathoadrenal responses has not been established in youth with type 1 diabetes because of difficulties in testing procedures.

RESEARCH DESIGN AND METHODS
We developed a standardized inpatient continuous subcutaneous insulin infusion protocol to produce a progressive fall in plasma glucose concentrations in insulin pump–treated patients. Plasma glucose and counterregulatory hormone concentrations were measured in 14 young children (3 to &lt;8 years, A1C 7.7 ± 0.6%) vs. 14 adolescents (12 to &lt;18 years, A1C 7.6 ± 0.8%).

RESULTS
Plasma glucose decreased to similar nadir concentrations in the two groups. Four young children and four adolescents never had an epinephrine response. In the four young children and five adolescents who had a modest epinephrine response, this only occurred when plasma glucose fell to &lt;60 mg/dl. In evaluating symptom scores, 29% of parents of young children felt that their child looked hypoglycemic, even at the lowest plasma glucose concentrations. Adolescents were better able to detect symptoms of hypoglycemia. In comparison with our data, epinephrine response to hypoglycemia in 14 nondiabetic adolescents studied at the Children's Hospital of Pittsburgh was higher.

CONCLUSIONS
These data suggest that even young children and adolescents with type 1 diabetes are prone to develop hypoglycemia-associated autonomic failure regardless of duration. Whether these abnormalities can be reversed using continuous glucose monitoring and closed-loop insulin delivery systems awaits further study.
Determinants of Quality in Diabetes Care Process
Authors: Gnavi Roberto , Picariello Roberta , la Karaghiosoff Ludmi , Costa Giuseppe , Giorda Carlo 
Published: August 2009

OBJECTIVE
To investigate the role of clinical and socioeconomic variables as determinants of adherence to recommended diabetes care guidelines and assess differences in the process of care between diabetologists and general practitioners.

RESEARCH DESIGN AND METHODS
We identified diabetic residents in Torino, Italy, as of 31 July 2003, using multiple independent data sources. We collected data on several laboratory tests and specialist medical examinations registered during the subsequent 12 months and performed regression analyses to identify associations with quality-of-care indicators based on existing guidelines.

RESULTS
After 1 year, only 35.8% of patients had undergone a comprehensive assessment. In the multivariate models, factors independently and significantly associated with lower quality of care were age ≥75 years (prevalence rate ratio [PRR] 0.66 [95% CI 0.61–0.70]) and established cardiovascular disease (0.89 [0.86–0.93]). Disease severity (PRR for insulin-treated patients 1.45 [1.38–1.53]) and diabetologist consultation (PRR 3.34 [3.17–3.53]) were positively associated with high quality of care. No clear association emerged between sex and socioeconomic status. These differences were strongly reduced in patients receiving diabetologist care compared with patients receiving general practitioner care only.

CONCLUSIONS
Despite widespread availability of guidelines and simple screening procedures, a nonnegligible portion of the diabetic population, namely elderly individuals and patients with less severe forms of the disease, are not properly cared for. As practitioners in diabetes centers are more likely to adhere to guidelines than general practitioners, quality in the diabetes care process can be improved by increasing the intensity of disease management programs, with greater participation by general practitioners.
Diabetic Retinopathy Is Associated With Elevated Serum Asymmetric and Symmetric Dimethylarginines
Authors: Abhary Sotoodeh , Kasmeridis Nicholas , Burdon Kathryn P. , Kuot Abraham , Whiting Malcolm J. , Yew Wai Ping , Petrovsky Nikolai , Craig Jamie E. 
Published: August 2009

OBJECTIVE
Asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), and l-arginine directly influence nitric oxide production. Our objective was to test whether serum ADMA, SDMA, or l-arginine levels correlate with diabetic retinopathy subtype or severity.

RESEARCH DESIGN AND METHODS
A total of 162 subjects with type 1 diabetes and 343 with type 2 diabetes, of whom 329 subjects had no diabetic retinopathy, 27 had nonproliferative diabetic retinopathy (NPDR), 101 had proliferative diabetic retinopathy (PDR), and 107 had clinically significant macular edema (CSME), were recruited. Blinding diabetic retinopathy was defined as severe NPDR, PDR, or CSME. Serum ADMA, SDMA, and l-arginine concentrations were determined by mass spectroscopy.

RESULTS
In multivariate analysis, blinding diabetic retinopathy, PDR, and nephropathy were associated with significantly increased serum levels of ADMA (P &lt; 0.001), SDMA (P &lt; 0.001), and l-arginine (P = 0.001). Elevated ADMA (P &lt; 0.001) and SDMA (P &lt; 0.001) were also significantly associated with CSME.

CONCLUSIONS
Severe forms of diabetic retinopathy are associated with elevated serum ADMA, SDMA, and l-arginine. Further investigation is required to determine whether these findings are of clinical relevance.
Association Between Neighborhood-Level Deprivation and Disability in a Community Sample of People With Diabetes
Authors: Schmitz Norbert , Nitka Danit , Gariepy Genevieve , Malla Ashok , Wang JianLi , Boyer Richard , Messier Lyne , Strychar Irene , Lesage Alain 
Published: August 2009

OBJECTIVE
The objective of the present study was to analyze the association between neighborhood deprivation and self-reported disability in a community sample of people with type 2 diabetes.

RESEARCH DESIGN AND METHODS
Random digit dialing was used to select a sample of adults with self-reported diabetes aged 18–80 years in Quebec, Canada. Health status was assessed by the World Health Organization Disability Assessment Schedule II. Material and social deprivation was measured using the Pampalon index, which is based on the Canadian Census. Potential risk factors for disability included sociodemographic characteristics, socioeconomic status, social support, lifestyle-related factors (smoking, physical activity, and BMI), health care–related problems, duration of diabetes, insulin use, and diabetes-specific complications.

RESULTS
There was a strong association between disability and material and social deprivation in our sample (n = 1,439): participants living in advantaged neighborhoods had lower levels of disability than participants living in disadvantaged neighborhoods. The means ± SD disability scores for men were 7.8 ± 11.8, 12.0 ± 11.8, and 18.1 ± 19.4 for low, medium, and high deprivation areas, respectively (P &lt; 0.001). The disability scores for women were 13.4 ± 12.4, 14.8 ± 15.9, and 18.9 ± 16.2 for low, medium, and high deprivation areas, respectively (P &lt; 0.01). Neighborhood deprivation was associated with disability even after controlling for education, household income, sociodemographic characteristics, race, lifestyle-related behaviors, social support, diabetes-related variables, and health care access problems.

CONCLUSIONS
The inclusion of neighborhood characteristics might be an important step in the identification and interpretation of risk factors for disability in diabetes.
Sustained Benefit of Continuous Glucose Monitoring on A1C, Glucose Profiles, and Hypoglycemia in Adults With Type 1 Diabetes
Authors:   The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group
Published: August 2009

OBJECTIVE
To evaluate long-term effects of continuous glucose monitoring (CGM) in intensively treated adults with type 1 diabetes.

RESEARCH DESIGN AND METHODS
We studied 83 of 86 individuals ≥25 years of age with type 1 diabetes who used CGM as part of a 6-month randomized clinical trial in a subsequent 6-month extension study.

RESULTS
After 12 months, median CGM use was 6.8 days per week. Mean change in A1C level from baseline to 12 months was −0.4 ± 0.6% (P &lt; 0.001) in subjects with baseline A1C ≥7.0%. A1C remained stable at 6.4% in those with baseline A1C &lt;7.0%. The incidence rate of severe hypoglycemia was 21.8 and 7.1 events per 100 person-years in the first and last 6 months, respectively. Time per day with glucose levels in the range of 71–180 mg/dl increased significantly (P = 0.02) from baseline to 12 months.

CONCLUSIONS
In intensively treated adults with type 1 diabetes, CGM use and benefit can be sustained for 12 months.
Factors Predictive of Use and of Benefit From Continuous Glucose Monitoring in Type 1 Diabetes
Authors:   Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group
Published: August 2009

OBJECTIVE
To evaluate factors associated with successful use of continuous glucose monitoring (CGM) among participants with intensively treated type 1 diabetes in the Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Randomized Clinical Trial.

RESEARCH DESIGN AND METHODS
The 232 participants randomly assigned to the CGM group (165 with baseline A1C ≥7.0% and 67 with A1C &lt;7.0%) were asked to use CGM on a daily basis. The associations of baseline factors and early CGM use with CGM use ≥6 days/week in the 6th month and with change in A1C from baseline to 6 months were evaluated in regression models.

RESULTS
The only baseline factors found to be associated with greater CGM use in month 6 were age ≥25 years (P &lt; 0.001) and more frequent self-reported prestudy blood glucose meter measurements per day (P &lt; 0.001). CGM use and the percentage of CGM glucose values between 71 and 180 mg/dl during the 1st month were predictive of CGM use in month 6 (P &lt; 0.001 and P = 0.002, respectively). More frequent CGM use was associated with a greater reduction in A1C from baseline to 6 months (P &lt; 0.001), a finding present in all age-groups.

CONCLUSIONS
After 6 months, near-daily CGM use is more frequent in intensively treated adults with type 1 diabetes than in children and adolescents, although in all age-groups near-daily CGM use is associated with a similar reduction in A1C. Frequency of blood glucose meter monitoring and initial CGM use may help predict the likelihood of long-term CGM benefit in intensively treated patients with type 1 diabetes of all ages.
Association of Type 1 Diabetes With Month of Birth Among U.S. Youth
Authors: Kahn Henry S. , Morgan Timothy M. , Case L. Douglas , Dabelea Dana , Mayer-Davis Elizabeth J. , Lawrence Jean M. , Marcovina Santica M. , Imperatore Giuseppina ,   for the SEARCH for Diabetes in Youth Study Group
Published: August 2009

OBJECTIVE
Seasonal environment at birth may influence diabetes incidence in later life. We sought evidence for this effect in a large sample of diabetic youth residing in the U.S.

RESEARCH DESIGN AND METHODS
We compared the distribution of birth months within the SEARCH for Diabetes in Youth Study (SEARCH study) with the monthly distributions in U.S. births tabulated by race for years 1982–2005. SEARCH study participants (9,737 youth with type 1 diabetes and 1,749 with type 2 diabetes) were identified by six collaborating U.S. centers.

RESULTS
Among type 1 diabetic youth, the percentage of observed to expected births differed across the months (P = 0.0092; decreased in October–February and increased in March–July). Their smoothed birth-month estimates demonstrated a deficit in November–February births and an excess in April–July births (smoothed May versus January relative risk [RR] = 1.06 [95% CI 1.02–1.11]). Stratifications by sex or by three racial groups showed similar patterns relating type 1 diabetes to month of birth. Stratification by geographic regions showed a peak-to-nadir RR of 1.10 [1.04–1.16] in study regions from the northern latitudes (Colorado, western Washington State, and southern Ohio) but no birth-month effect (P &gt; 0.9) in study regions from more southern locations. Among type 2 diabetic youth, associations with birth month were inconclusive.

CONCLUSIONS
Spring births were associated with increased likelihood of type 1 diabetes but possibly not in all U.S. regions. Causal mechanisms may involve factors dependent on geographic latitude such as solar irradiance, but it is unknown whether they influence prenatal or early postnatal development.
Eating Fish and Risk of Type 2 Diabetes
Authors: van Woudenbergh Geertruida J. , van Ballegooijen Adriana J. , Kuijsten Anneleen , Sijbrands Eric J.G. , van Rooij Frank J.A. , Geleijnse Johanna M. , Hofman Albert , Witteman Jacqueline C.M. , Feskens Edith J.M. 
Published: August 2009

OBJECTIVE
To investigate the relation between total fish, type of fish (lean and fatty), and eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake and risk of type 2 diabetes in a population-based cohort.

RESEARCH DESIGN AND METHODS
The analysis included 4,472 Dutch participants aged ≥55 years without diabetes at baseline. Dietary intake was assessed with a semiquantitative food frequency questionnaire. Hazard ratios (relative risk [RR]) with 95% CIs were used to examine risk associations adjusted for age, sex, lifestyle, and nutritional factors.

RESULTS
After 15 years of follow-up, 463 participants developed type 2 diabetes. Median fish intake, mainly lean fish (81%), was 10 g/day. Total fish intake was associated positively with risk of type 2 diabetes; the RR was 1.32 (95% CI 1.02–1.70) in the highest total fish group (≥28 g/day) compared with that for non–fish eaters (Ptrend = 0.04). Correspondingly, lean fish intake tended to be associated positively with type 2 diabetes (RR highest group ]≥23 g/day] 1.30 [95% CI 1.01–1.68]; Ptrend = 0.06), but fatty fish was not. No association was observed between EPA and DHA intake and type 2 diabetes (RR highest group [≥149.4 mg/day] 1.22 [0.97–1.53]). With additional adjustment for intake of selenium, cholesterol, and vitamin D, this RR decreased to 1.05 (0.80–1.38; Ptrend = 0.77).

CONCLUSIONS
The findings do not support a beneficial effect of total fish, type of fish, or EPA and DHA intake on the risk of type 2 diabetes. Alternatively, other dietary components, such as selenium, and unmeasured contaminants present in fish might explain our results.
Vitamin D Levels in Subjects With and Without Type 1 Diabetes Residing in a Solar Rich Environment
Authors: Bierschenk Lindsey , Alexander John , Wasserfall Clive , Haller Michael , Schatz Desmond , Atkinson Mark 
Published: August 2009

OBJECTIVE
Previous studies, largely in northern Europe, have suggested an association between type 1 diabetes and reduced serum 25-hydroxy(OH) vitamin D levels, a concept we tested in individuals residing in a solar-rich region (Florida).

RESEARCH DESIGN AND METHODS
Serum samples from 415 individuals residing in Florida were cross-sectionally analyzed: 153 control subjects, 46 new-onset type 1 diabetic patients, 110 established type 1 diabetic patients (samples ≥5 months from diagnosis), and 106 first-degree relatives of the diabetic patients.

RESULTS
In this study, 25-OH vitamin D levels (median, range, interquartile range [IQR]) were similar among control subjects (20.1, below detection [bd]–163.5, 13.0–37.4 ng/ml), new-onset type 1 diabetic patients (21.2, bd–48.6, 12.2–30.2 ng/ml), established type 1 diabetic patients (23.2, bd–263.8, 13.8–33.9 ng/ml), and first-degree relatives (22.2, bd–59.9, 12.7–33.1 ng/ml) (P = 0.87). Mean 25-OH vitamin D levels were less than the optimal World Health Organization level of 30 ng/ml in all study groups.

CONCLUSIONS
Reduced serum 25-OH vitamin D levels were not specifically associated with type 1 diabetes. The uniform suboptimal 225-OH vitamin D levels, despite residence in a zone with abundant sunshine, support additional dietary vitamin D fortification practices.
Ten-year prevalence of fungal peritonitis in the city of Nis, South Serbia
Authors: Tasic S. , Miladinovic-Tasic N. , Djordjevic J. , Pesic S. , Avramovic M. 
Published: August 2009

Abstract
Fungal peritonitis is a rare but serious complication in patients with chronic renal failure on continuous ambulatory peritoneal dialysis (CAPD). The purpose of this study was to report the prevalence of fungal peritonitis in patients on CAPD in the Clinical Center-Nis (South Serbia) in the period from 1997 until the end of 2007. Fungal species were isolated in 66 cases (4.5%) of 1471 peritoneal fluid (PF) samples that we examined. During the study period, 22 (1.5%) cases of fungal peritonitis were registered. In 19 cases, Candida isolates were identified, Candida albicans (C. albicans) being the most common species (n=15). Two cases of fungal peritonitis caused by Aspergillus fumigatus and 1 possible case caused by Cladosporium cladosporioides (Cl. cladosporioides) were also detected.
Visual Rehabilitation by Scleral Fixation of Posterior Chamber Intraocular Lenses in Omani Children With Aphakia
Authors: Ganesh Anuradha , Al-Zuhaibi Sana , Mitra Sandip , Saad Sabt Buthaina I. , Ganguly Shyam S. , Bialasiewicz Alexander A. 
Published: August 2009

Background and Objective:
To report indications and outcomes of scleral-fixated posterior chamber intraocular lenses (PC IOLs) in Omani children with aphakia.

Patients and Methods:
Patients with aphakia who were younger than 16 years, unsuitable for spectacle or contact lens correction, and without capsular support underwent an anterior vitrectomy and 10-0 polypropylene inside-out scleral fixation of a PC IOL.

Results:
Scleral-fixated PC IOLs were implanted in 28 eyes of 24 patients. Group A comprised 10 (36%) eyes with congenital cataract and 3 (11%) eyes with ectopia lentis and group B comprised 15 (53%) eyes with traumatic cataract. The mean age at implantation was higher in group A (10.5 years) than in group B (7.3 years). Visual acuity improved in 17 of 28 (61%) eyes and remained at the preoperative levels in 11 of 28 (39%) eyes. Mean postoperative refraction was within ± 2.0 diopters of the predicted refraction in 19 of 28 (68%) eyes. Complications included temporary intraocular pressure increase, vitreous hemorrhage, and iris capture with lens malposition.

Conclusion:
Scleral-fixated PC IOLs are beneficial for children with aphakia without posterior capsular support who are lacking other means for visual rehabilitation. Patients with traumatic cataract and lens dislocation are more likely to experience an improvement in visual acuity postoperatively than patients with congenital cataract. However, this procedure is technically more difficult than routine PC IOL implantation and potentially carries greater risks.

[Ophthalmic Surg Lasers Imaging 2009;40:354–360.]
Effects of Ranibizumab on Exudative Disciform Scars
Authors: Ahmad Fatima K. , Morley Michael G. , Berry Anna , Wiegand Torsten W. , Heier Jeffrey S. , Morley Eleanor F. , Sanguansak Thuss , Topping Trexler M. , Frederick Albert R. , Sang Delia N. , Hughes Mark S. , Cleary Tina S. 
Published: August 2009

Background and Objective:
To evaluate the effect of intravitreal ranibizumab in patients with leaking disciform scars.

Patients and Methods:
In this retrospective case series, 31 eyes received one or two ranibizumab injections for treatment of choroidal neovascularization. Visual acuity, central retinal thickness, and macular volume were measured prior to injection and at 1-month follow-up.

Results:

After one injection (n = 31), mean optical coherence tomography (OCT) central foveal thickness decreased from 317 to 242 µm (
P
= .00016). Mean OCT macular volume decreased from 7.89 to 6.80 mm
3
(
P
= .00019). After two injections (n = 12), mean OCT central foveal thickness decreased from 310 to 248 µm following the second injection (
P
= .04). Mean OCT macular volume decreased from 7.80 to 6.43 mm
3
at 1-month follow-up after a second injection (
P
= .006). There was no significant change in visual acuity after injections.

Conclusion:
In the short-term, ranibizumab decreases the leakage associated with choroidal neovascularization in chronic macular degeneration.

[Ophthalmic Surg Lasers Imaging 2009;40:366–372.]
Enhancing Nonmydriatic Color Photographs of the Retina With Monochromatic Views and a Stereo Pair to Detect Diabetic Retinopathy
Authors: Salti Haytham I. , Nasrallah Mona , Haddad Sandra , Khairallah Walid , Salti I. S. 
Published: August 2009

Background and Objective:
Nonmydriatic digital color imaging is rapidly gaining an important role in screening for diabetic retinopathy. However, it has yet to equal a dilated fundus examination or seven Early Treatment Diabetic Retinopathy Study field 35-mm photography. The authors therefore attempted to enhance efficacy and validity by adding two low-cost steps to the nonmydriatic digital image evaluation.

Patients and Methods:
The fundi of 145 consecutive patients with diabetes mellitus were evaluated for diabetic retinopathy using two different nonmydriatic reading techniques: creating a red-free view (using digital filters) and looking at a stereo pair of each field taken. These methods were each compared to a mydriatic fundus examination.

Results:

Although the first technique yielded views with sensitivities and specificities similar to what exists in the literature using this same technique, enhancing these photographs (second technique) yielded a statistically significant increase in sensitivity and specificity (
P
< .005).

Conclusion:
The authors recommend using both low-cost steps when screening for diabetic retinopathy through nonmydriatic digital color imaging.

[Ophthalmic Surg Lasers Imaging 2009;40:373–378.]
Spectral Domain Optical Coherence Tomography in Type 2 Idiopathic Perifoveal Telangiectasia
Authors: Krivosic Valérie , Tadayoni Ramin , Massin Pascale , Erginay Ali , Gaudric Alain 
Published: August 2009

Background and Objective:
To compare images acquired by Stratus time domain optical coherence tomography (OCT) (Carl Zeiss Meditec, Dublin, CA) and Cirrus spectral domain OCT (Carl Zeiss Meditec) in cases of bilateral type 2 idiopathic perifoveal telangiectasia.

Patients and Methods:
Twenty-three eyes of 12 patients with type 2 idiopathic perifoveal telangiectasia were examined on the same day with both OCT systems.

Results:
Foveal cystoid spaces were detected in more eyes by Cirrus than Stratus OCT (19 of 23 vs 13 of 23). Disruptions of the inner segment/outer segment photoreceptor line were detected with both systems but were only quantified on Cirrus images. Thinning of central foveal thickness was established by both, but only Cirrus OCT measured outer retinal thinning on the temporal compared to the nasal side of the fovea.

Conclusions:
Spectral domain OCT could become a new noninvasive tool for facilitating early diagnosis of type 2 idiopathic perifoveal telangiectasia and for following its evolution and the effects of any treatments.

[Ophthalmic Surg Lasers Imaging 2009;40:379–384.]