bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Predictive of Severe Hypoglycemia in Type 1 Diabetes
Authors:   Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group
Published: January 2011

OBJECTIVE
Identify factors predictive of severe hypoglycemia (SH) and assess the clinical utility of continuous glucose monitoring (CGM) to warn of impending SH.

RESEARCH DESIGN AND METHODS
In a multicenter randomized clinical trial, 436 children and adults with type 1 diabetes were randomized to a treatment group that used CGM (N = 224), or a control group that used standard home blood glucose monitoring (N = 212) and completed 12 months of follow-up. After 6 months, the original control group initiated CGM while the treatment group continued use of CGM for 6 months. Baseline risk factors for SH were evaluated over 12 months of follow-up using proportional hazards regression. CGM-derived indices of hypoglycemia were used to predict episodes of SH over a 24-h time horizon.

RESULTS
The SH rate was 17.9 per 100 person-years, and a higher rate was associated with the occurrence of SH in the prior 6 months and female sex. SH frequency increased eightfold when 30% of CGM values were ≤70 mg/dL on the prior day (4.5 vs. 0.5%; P &lt; 0.001), but the positive predictive value (PPV) was low (&lt;5%). Results were similar for hypoglycemic area under the curve and the low blood glucose index calculated by CGM.

CONCLUSIONS
SH in the 6 months prior to the study was the strongest predictor of SH during the study. CGM-measured hypoglycemia over a 24-h span is highly associated with SH the following day (P &lt; 0.001), but the PPV is low.
Glycemic Control and Health Disparities in Older Ethnically Diverse Underserved Adults With Diabetes
Authors: Weinstock Ruth S. , Teresi Jeanne A. , Goland Robin , Izquierdo Roberto , Palmas Walter , Eimicke Joseph P. , Ebner Susana , Shea Steven ,   The IDEATel Consortium
Published: January 2011

OBJECTIVE
The Informatics for Diabetes Education and Telemedicine (IDEATel) project randomized ethnically diverse underserved older adults with diabetes to a telemedicine intervention or usual care. Intervention participants had lower A1C levels over 5 years. New analyses were performed to help better understand this difference.

RESEARCH DESIGN AND METHODS
IDEATel randomized Medicare beneficiaries with diabetes (n = 1,665) to receive home video visits with a diabetes educator and upload glucose levels every 4–6 weeks or usual care (2000–2007). Annual measurements included BMI, A1C (primary outcome), and completion of questionnaires. Mixed-model analyses were performed using random effects to adjust for clustering within primary care physicians.

RESULTS
At baseline, A1C levels (mean ± SD) were 7.02 ± 1.25% in non-Hispanic whites (n = 821), 7.58 ± 1.78% in non-Hispanic blacks (n = 248), and 7.79 ± 1.68% in Hispanics (n = 585). Over time, lower A1C levels were associated with more glucose uploads (P = 0.02) and female sex (P = 0.002). Blacks, Hispanics, and insulin-users had higher A1C levels than non-Hispanic whites (P &lt; 0.0001). BMI was not associated with A1C levels. Blacks and Hispanics had significantly fewer uploads than non-Hispanic whites over time. Hispanics had the highest baseline A1C levels and showed the greatest improvement in the intervention, but, unlike non-Hispanic whites, Hispanics did not achieve A1C levels &lt;7.0% at 5 years.

CONCLUSIONS
Racial/ethnic disparities were observed in this cohort of underserved older adults with diabetes. The IDEATel telemedicine intervention was associated with improvement in glycemic control, particularly in Hispanics, who had the highest baseline A1C levels, suggesting that telemedicine has the potential to help reduce disparities in diabetes management.
No Loss of Chance of Diabetic Retinopathy Screening by Endocrinologists With a Digital Fundus Camera
Authors: Germain Natacha , Galusca Bodgan , Deb-Joardar Nilanjana , Millot Luc , Manoli Pierre , Thuret Gilles , Gain Philippe , Estour Bruno 
Published: January 2011

OBJECTIVE
To compare the efficacy of the diabetic retinopathy (DR) screening with digital camera by endocrinologists with that by specialist and resident ophthalmologists in terms of sensitivity, specificity, and level of “loss of chance.”

RESEARCH DESIGN AND METHODS
In a cross-sectional study, 500 adult diabetic patients (1,000 eyes) underwent three-field retinal photography with a digital fundus camera following pupillary dilatation. Five endocrinologists and two ophthalmology residents underwent 40 h of training on screening and grading of DR and detection of associated retinal findings. A κ test compared the accuracy of endocrinologist and ophthalmology resident screening with that performed by experienced ophthalmologists. Screening efficiency of endocrinologists was evaluated in terms of “loss of chance,” i.e., missed diagnoses that required ophthalmologist referrals.

RESULTS
The mean weighted κ of DR screening performed by endocronologists was similar to that of ophthalmology residents (0.65 vs. 0.73). Out of 456 DR eyes, both endocrinologists and ophthalmology residents misdiagnosed only stage 1 DR (36 and 14, respectively), which did not require ophthalmologist referral. There were no significant differences between endocrinologists and ophthalmology residents in terms of diabetic maculopathy and incidental findings except for papillary cupping and choroidal lesions, which were not the main purpose of the study or of the training.

CONCLUSIONS
The endocrinologist with specific training for DR detection using a three-field digital fundus camera with pupillary dilatation can perform a reliable DR screening without any loss of chance for the patients when compared with identical evaluation performed by experienced ophthalmologists.
Heart Rate Recovery After Exercise Is a Predictor of Silent Myocardial Ischemia in Patients With Type 2 Diabetes
Authors: Yamada Tomohide , Yoshitama Takashi , Makino Kunihiko , Lee Tetsuo , Saeki Fumihiko 
Published: January 2011

OBJECTIVE
Slow heart rate recovery (HRR) predicts all-cause mortality. This study investigated the relationship between silent myocardial ischemia (SMI) and HRR in type 2 diabetes.

RESEARCH DESIGN AND METHODS
The study enrolled 87 consecutive patients with type 2 diabetes and no chest symptoms. They underwent treadmill exercise testing and single-photon emission computed tomography imaging with thallium scintigraphy. Patients with abnormal myocardial perfusion images also underwent coronary angiography.

RESULTS
SMI was diagnosed in 41 patients (47%). The SMI group showed slower HRR than the non–SMI group (18 ± 6 vs. 30 ± 12 bpm; P &lt; 0.0001). HRR was significantly associated with SMI (odds ratio 0.83 [95% CI 0.75–0.92]; P = 0.0006), even after adjustment for maximal exercise workload, resting heart rate, maximum heart rate, rate pressure product, HbA1c, use of sulfonamides, and a history of cardiovascular disease.

CONCLUSIONS
HRR can predict SMI in patients with type 2 diabetes.
Proximal Neuropathic Lesions in Distal Symmetric Diabetic Polyneuropathy
Authors: Pham Mirko , Oikonomou Dimitrios , Bäumer Philipp , Bierhaus Angelika , Heiland Sabine , Humpert Per M. , Nawroth Peter P. , Bendszus Martin 
Published: January 2011

OBJECTIVE
This study investigated high-resolution magnetic resonance neurography (MRN) in distal symmetric diabetic polyneuropathy (dPNP).

RESEARCH DESIGN AND METHODS
MRN comprised high-resolution transaxial imaging of peripheral nerves of the lower limbs in 20 patients with type 2 diabetes (10 with dPNP, type 2/dPNP[+], and 10 without dPNP, type 2/dPNP[−]), seven patients with type 1 diabetes (two with dPNP, type 1/dPNP[+], five without dPNP, type 1/dPNP[−]), and 10 nondiabetic control subjects. Intraneural T2 lesions, as the main diagnostic criterion of MRN, were detected visually by two independent observers and quantitatively by analysis of T2 contrast ratios.

RESULTS
Multifocal fascicular, symmetric intraneural T2 lesions occurred in the proximal trunks of sciatic nerves in four patients (three with type 2/dPNP[+] and one with type 1/dPNP[+]) but not in control subjects (type 2/dPNP[−], type 1/dPNP[−], nondiabetic control subjects), which was confirmed by quantitative analysis. Clinical severity was higher in patients with T2 lesions (neuropathy deficit score: 10 vs. 7.8; P = 0.05).

CONCLUSIONS
For the first time, proximal neuropathic lesions of dPNP are reported in vivo. This supports that accumulation of proximal, multifocal fascicular injury may be important in disease progression.
Islet Autoantibody Seroconversion in the DPT-1 Study
Authors: Vehik Kendra , Haller Michael J. , Beam Craig A. , Schatz Desmond A. , Wherrett Diane K. , Sosenko Jay M. , Krischer Jeffrey P. ,   DPT-1 Study Group
Published: January 2011

OBJECTIVE
Although type 1 diabetes autoimmunity frequently begins in childhood, little is known about the relationship between age and autoimmunity development. Our aim was to determine the timing of seroconversion to diabetes-associated autoantibody (DAA) positivity and risk in first- and second-degree relatives of patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS
Study subjects were identified through the Diabetes Prevention Trial-Type 1 (DPT-1). Children 3–18 years of age (n = 42,447) were screened for DAAs; 1,454 were ICA positive (≥10 JDF units), 1,758 were GAD65 positive, and 899 were ICA512 positive at the time of initial screening. Subjects who were initially antibody negative (n = 39,212) were recalled for rescreening, and 11,813 returned for rescreening.

RESULTS
DAA seroconversion occurred in 469 (4%) children; 258 seroconverted to ICA, 234 to GAD65, and 99 to ICA512. The median time to seroconversion was 2 years. The 2-year risk for DAAs was highest in early childhood. For each 1-year increase in age in this cohort, the risk of any autoantibody seroconversion (HR 0.95, 95% CI 0.92–0.97) decreased by 5%, and for any two autoantibodies risk decreased by 13% (0.87, 0.82–0.93).

CONCLUSIONS
Risk of autoantibody seroconversion among children followed in DPT-1 is age dependent. Younger children have the highest risk for DAAs, with the majority of children seroconverting by 13 years of age (75%). This suggests that annual screenings should be started in early childhood and continued through early adolescence to identify the majority of subjects at risk for type 1 diabetes and eligible for prevention trials.
Maternal Glucose Concentration During Pregnancy Predicts Fat and Lean Mass of Prepubertal Offspring
Authors: Chandler-Laney Paula C. , Bush Nikki C. , Rouse Dwight J. , Mancuso Melissa S. , Gower Barbara A. 
Published: January 2011

OBJECTIVE
Intrauterine exposure to high maternal glucose is associated with excess weight gain during childhood, but it is not clear whether the excess weight represents increased fat or lean mass. The purpose of this study was to examine the relationship between maternal glucose concentrations during pregnancy and offspring body composition. A secondary goal was to examine whether the association between maternal glucose and children’s body fat was independent of energy intake, energy expenditure, or physical activity.

RESEARCH DESIGN AND METHODS
Children aged 5–10 years and their biological mothers (n = 27) were recruited. Maternal glucose concentration 1 h after a 50-g oral glucose load, used to screen for gestational diabetes mellitus at 24–28 weeks gestation, was retrieved from medical records. Children underwent dual-energy X-ray absorptiometry to measure body composition, indirect calorimetry to measure resting energy expenditure (REE), accelerometry to measure physical activity, and three 24-h diet recalls to measure energy intake.

RESULTS
Maternal glucose concentration during pregnancy was positively associated with children’s lean mass (P &lt; 0.05) and adiposity (fat mass adjusted for lean mass; P &lt; 0.05). The association between maternal glucose and children’s adiposity was independent of children’s REE, percent of time spent physically active, and energy intake (P &lt; 0.001).

CONCLUSIONS
Intrauterine exposure to relatively high maternal glucose is associated with greater lean mass and adiposity among prepubertal offspring. Further research is needed to examine the mechanisms by which maternal glucose concentrations during pregnancy influence children’s body composition.
Endotoxemia Is Associated With an Increased Risk of Incident Diabetes
Authors: Pussinen Pirkko J. , Havulinna Aki S. , Lehto Markku , Sundvall Jouko , Salomaa Veikko 
Published: January 2011

OBJECTIVE
Diabetes is accompanied with a chronic low-grade inflammation, which may in part be mediated by endotoxins derived from Gram-negative bacteria.

RESEARCH DESIGN AND METHODS
We investigated in a population-based cohort whether endotoxemia is associated with clinically incident diabetes. The serum endotoxin activity was measured by limulus assay from the FINRISK97 cohort comprising 7,169 subjects aged 25–74 years and followed up for 10 years.

RESULTS
Both the subjects with prevalent diabetes (n = 537) and those with incident diabetes (n = 462) had higher endotoxin activity than the nondiabetic individuals (P &lt; 0.001). The endotoxin activity was significantly associated with increased risk for incident diabetes with a hazard ratio 1.004 (95% CI 1.001–1.007; P = 0.019) per unit increase resulting in a 52% increased risk (P = 0.013) in the highest quartile compared with the lowest one. The association was independent of diabetes risk factors: serum lipids, γ-glutamyl transferase, C-reactive protein, BMI, and blood glucose. Furthermore, the association of endotoxemia with an increased risk of incident diabetes was independent of the metabolic syndrome as defined either by the National Cholesterol Educational Program-Adult Treatment Panel III or the International Diabetes Federation. Endotoxin activity was linearly related (P &lt; 0.001) to the number of components of the metabolic syndrome.

CONCLUSIONS
Both prevalent and incident diabetes were associated with endotoxemia, which may link metabolic disorders to inflammation. The results suggest that microbes play a role in the pathogenesis of diabetes.
Fasting Plasma Glucose and Hemoglobin A1c in Identifying and Predicting Diabetes
Authors: Wang Wenyu , Lee Elisa T. , Howard Barbara V. , Fabsitz Richard R. , Devereux Richard B. , Welty Thomas K. 
Published: January 2011

OBJECTIVE
To compare fasting plasma glucose (FPG) and HbA1c in identifying and predicting type 2 diabetes in a population with high rates of diabetes.

RESEARCH DESIGN AND METHODS
Diabetes was defined as an FPG level ≥126 mg/dL or an HbA1c level ≥6.5%. Data collected from the baseline and second exams (1989–1995) of the Strong Heart Study were used.

RESULTS
For cases of diabetes identified by FPG ≥126 mg/dL, using HbA1c ≥6.5% at the initial and 4-year follow-up diabetes screenings (or in identifying incident cases in 4 years) among undiagnosed participants left 46% and 59% of cases of diabetes undetected, respectively, whereas for cases identified by HbA1c ≥6.5%, using FPG ≥126 mg/dL left 11% and 59% unidentified, respectively. Age, waist circumference, urinary albumin-to-creatinine ratio, and baseline FPG and HbA1c levels were common significant risk factors for incident diabetes defined by either FPG or HbA1c; triglyceride levels were significant for diabetes defined by HbA1c alone, and blood pressure and sibling history of diabetes were significant for diabetes defined by FPG alone. Using both the baseline FPG and HbA1c in diabetes prediction identified more people at risk than using either measure alone.

CONCLUSIONS
Among undiagnosed participants, using HbA1c alone in initial diabetes screening identifies fewer cases of diabetes than FPG, and using either FPG or HbA1c alone cannot effectively identify diabetes in a 4-year periodic successive diabetes screening or incident cases of diabetes in 4 years. Using both criteria may identify more people at risk. The proposed models using the commonly available clinical measures can be applied to assessing the risk of incident diabetes using either criterion.
Quality of Diabetes Care Predicts the Development of Cardiovascular Events: Results of the AMD-QUASAR Study
Authors: Rossi Maria C.E. , Lucisano Giuseppe , Comaschi Marco , Coscelli Carlo , Cucinotta Domenico , Di Blasi Patrizia , Bader Giovanni , Pellegrini Fabio , Valentini Umberto , Vespasiani Giacomo , Nicolucci Antonio ,   on behalf of the AMD-QUASAR Study Group
Published: January 2011

OBJECTIVE
The QUASAR (Quality Assessment Score and Cardiovascular Outcomes in Italian Diabetes Patients) study aimed to assess whether a quality-of-care summary score predicted the development of cardiovascular (CV) events in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS
In 67 diabetes clinics, data on randomly selected patients were extracted from electronic medical records. The score was calculated using process and outcome indicators based on monitoring, targets, and treatment of A1C, blood pressure, LDL cholesterol, and microalbuminuria. The score ranged from 0 to 40.

RESULTS
Overall, 5,181 patients were analyzed; 477 (9.2%) patients developed a CV event after a median follow-up of 28 months. The incidence rate (per 1,000 person-years) of CV events was 62.4 in patients with a score of &lt;15, 41.0 in those with a score between 20 and 25 and 36.7 in those with a score of &gt;25.
Multilevel analysis, adjusted for clustering and case-mix, showed that the risk to develop a new CV event was 84% higher in patients with a score of &lt;15 (incidence rate ratio [IRR] = 1.84; 95% confidence interval [CI] 1.29–2.62) and 17% higher in those with a score between 15 and 25 (IRR = 1.17; 95% CI 0.93–1.49) compared with those with a score of &gt;25.
Mean quality score varied across centers from 16.5 ± 7.5 to 29.1 ± 6.3. When the score was tested as the dependent variable, it emerged that 18% of the variance in the score could be attributed to setting characteristics.

CONCLUSIONS
Our study documented a close relationship between quality of diabetes care and long-term outcomes. A simple score can be used to monitor quality of care and compare the performance of different centers/physicians.
The Prevalence and Predictors of an Abnormal Ankle-Brachial Index in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial
Authors: Singh Premranjan P. , Abbott J. Dawn , Lombardero Manuel S. , Sutton-Tyrrell Kim , Woodhead Gail , Venkitachalam Lakshmi , Tsapatsaris Nicholas P. , Piemonte Thomas C. , Lago Rodrigo M. , Rutter Martin K. , Nesto Richard W. ,   BARI,   2D Study Group
Published: January 2011

OBJECTIVE
To examine ankle-brachial index (ABI) abnormalities in patients with type 2 diabetes and coronary artery disease (CAD).

RESEARCH DESIGN AND METHODS
An ABI was obtained in 2,240 patients in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial. ABIs were classified as: normal, 0.91–1.3; low, ≤0.9; high, &gt;1.3; or noncompressible artery (NC). Baseline characteristics were examined according to ABI and by multivariate analysis.

RESULTS
ABI was normal in 66%, low in 19%, and high in 8% of patients, and 6% of patients had NC. Of the low ABI patients, 68% were asymptomatic. Using normal ABI as referent, low ABI was independently associated with smoking, female sex, black race, hypertension, age, C-reactive protein, diabetes duration, and lower BMI. High ABI was associated with male sex, nonblack race, and higher BMI; and NC artery was associated with diabetes duration, higher BMI, and hypertension.

CONCLUSIONS
ABI abnormalities are common and often asymptomatic in patients with type 2 diabetes and CAD.
Use of Continuous Glucose Monitoring in Subjects With Type 1 Diabetes on Multiple Daily Injections Versus Continuous Subcutaneous Insulin Infusion Therapy
Authors: Garg Satish K. , Voelmle Mary K. , Beatson Christie R. , Miller Hayley A. , Crew Lauren B. , Freson Brandon J. , Hazenfield Rachel M. 
Published: January 2011

OBJECTIVE
To compare use of continuous glucose monitoring in subjects with type 1 diabetes on multiple daily injection (MDI) therapy versus continuous subcutaneous insulin infusion (CSII) therapy for 6 months.

RESEARCH DESIGN AND METHODS
Sixty type 1 diabetic adults with similar baseline characteristics, using either MDI (n = 30) or CSII (n = 30) therapy, were enrolled in this 6-month prospective study. Subjects were instructed to wear the DexCom SevenPLUS continuous glucose monitor at all times throughout the study. All subjects were initially blinded from the continuous glucose monitoring (CGM) glucose data. After 4 weeks of blinded CGM use, the CGM was unblinded, making glucose data available to the patient. The CGM remained in the unblinded state for the remainder of the study (20 weeks). Clinic visits occurred every 4 weeks, at which time A1C values were collected and CGM data were downloaded.

RESULTS
Mean baseline (± SD) A1C was 7.61 (± 0.76) and 7.63 (± 0.68) for CSII and MDI, respectively (P &gt; 0.05). Without any significant therapy change, A1C decrease at 12 weeks was similar in both groups (P = 0.03). When compared with the blinded phase, unblinded use of CGM was associated with similar but significant reductions in glycemic control and variability parameters. In addition, both therapy groups had similar changes in mean glucose and glucose variability indexes at 3 and 6 months (ITT analysis, P &gt; 0.05). Predefined per protocol analysis (sensor use at least 6 days/week) showed greater improvement in time spent in target range glycemia, 3.9–10.0 mmol/L (70–180 mg/dL), in the CSII group.

CONCLUSIONS
We conclude that CGM provides similar benefits in glucose control for patients using MDI or CSII therapy.
Age-Related Blood Antioxidant Capacity in Men and Women
Authors: Hübner-Woźniak Elżbieta , Okecka-Szymańska Joanna , Stupnicki Romuald , Malara Marzena , Kozdroń Ewa 
Published: January 2011

Age-Related Blood Antioxidant Capacity in Men and WomenThe aim of the study was to assess the blood antioxidant capacity in men and women in relation to age. The subjects were 19 men (YM) and 19 women (YW) aged 25-32 years, and 11 men (OM) and 11 women (OW) aged 63-71 years, all sedentary. The following factors were determined: the activity of erythrocyte superoxide dismutase (SOD), glutathione reductase (GR), glutathione peroxidase (GPX), catalase (CAT), total antioxidant status (TAS), as well as plasma retinol, α-tocopherol, uric acid and total protein concentrations. The sum of standardized activities of antioxidant enzymes was calculated to compare age-related changes in the total capacity of the erythrocyte antioxidant defense. No significant age-related changes in SOD activity were observed; mean CAT activity was higher in older women and men than in younger subjects. Mean activity of GPX was higher and that of GR lower in older subjects compared to the younger ones. The calculated total erythrocyte antioxidant enzyme capacity in younger and older subjects rendered similar values. No significant differences in plasma retinol and α-tocopherol concentrations in relation to sex or age were noted. The plasma total protein level was significantly lower in younger women and men compared to their older mates. It was concluded that the total erythrocyte enzymatic antioxidant capacity did not change with age. The results obtained clearly show that multiple factors may contribute to the ageing process.