bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Bedtime Snack Composition on Prevention of Nocturnal Hypoglycemia in Adults With Type 1 Diabetes Undergoing Intensive Insulin Management Using Lispro Insulin Before Meals
Authors: Kalergis Maria , Schiffrin Alicia , Gougeon Réjeanne , Jones Peter J.H. , Yale Jean-François 
Published: March 2007

OBJECTIVE—To determine the impact of four bedtime (HS) snack compositions on nocturnal glycemic control, including frequency of hypoglycemia (&lt;4 mmol/l) and morning hyperglycemia (&gt;10 mmol/l), in adults with type 1 diabetes using lispro insulin before meals and NPH insulin at bedtime.
RESEARCH DESIGN AND METHODS—Substitutions of 15 g carbohydrate (one starch exchange) for an equivalent amount of uncooked cornstarch or pure protein were compared to a standard snack (control: two starch + one protein exchange) and to no snack (placebo) in 15 adults using a randomized, cross-over design. All snacks were equivalent in kcal, fat, and total available glucose. An intravenous facilitated hourly blood glucose sampling during the night (11:00 p.m. to 7:00 a.m.).
RESULTS—The glycemic level at bedtime (&lt;7, 7–10, and &gt;10 mmol/l) mediated the effects observed. A total of 14 hypoglycemic episodes, in 60% of patients, and 23 morning hyperglycemic episodes occurred over 50 nights. Most hypoglycemic episodes (10 of 14, 71%) occurred with no snack compared to any snack (P &lt; 0.001) and at HS levels of &lt;7 mmol/l (P = 0.05). The standard and protein snacks resulted in no nocturnal hypoglycemia at all HS glucose levels (P &lt; 0.001). Only HS glucose &gt;10 mmol/l was protective against hypoglycemia, even in the absence of a snack (P = 0.05); 46% of morning hyperglycemic episodes were associated (r = 0.37, P = 0.07) with this HS glucose level.
CONCLUSIONS—The need for and composition of an HS snack depends on the HS glucose such that no snack is necessary at levels &gt;10 mmol/l. At levels between 7 and 10 mmol/l, any snack is advised, and at &lt;7 mmol/l, a standard or protein snack is recommended.
Vitamin C Affects Thrombosis/ Fibrinolysis System and Reactive Hyperemia in Patients With Type 2 Diabetes and Coronary Artery Disease
Authors: Tousoulis Dimitris , Antoniades Charalambos , Tountas Charalambos , Bosinakou Erini , Kotsopoulou Maria , Toutouzas Pavlos , Stefanadis Christodoulos 
Published: March 2007

OBJECTIVE—To examine the effect of vitamin C on forearm vasodilatory response to reactive hyperemia and on plasma level of plasminogen activator inhibitor 1 (PAI-1), von Willebrand factor (vWF), tissue plasminogen activator (tPA), antithrombin III (ATIII), proteins C and S, and factors V (fV) and VII (fVII) in patients with both type 2 diabetes and CAD.
RESEARCH DESIGN AND METHODS—A total of 39 patients with type 2 diabetes and CAD were divided into two groups and received vitamin C (2 g/day) or no antioxidant for 4 weeks. Forearm blood flow was determined using venous occlusion gauge-strain plethysmography at baseline and after treatment. Forearm vasodilatory response to reactive hyperemia (RH%) or nitrate (NTG%) was defined as the percent change of flow from baseline to the maximum flow during reactive hyperemia or after administration of nitrate, respectively. Biochemical markers were determined by enzyme-linked immunosorbent assay (ELISA) or other standard methods.
RESULTS—RH% was significantly increased after treatment with vitamin C (from 62.4 ± 7.2 to 83.1 ± 9.3%, P = 0.024) but remained unaffected in the control group. Vitamin C decreased plasma levels of fV (from 143 ± 5.4 to 123 ± 6.03%, P = 0.038), vWF (from 133.5 ± 14.5 to 109.5 ± 11.4%, P = 0.016), and tPA (from 12.3 ± 0.99 to 8.40 ± 0.60 ng/ml, P = 0.001), whereas these levels remained unaffected in the control group. The changes in RH%, vWF, and tPA were significantly greater (P = 0.028, 0.036, and 0.007, respectively) in the vitamin C-treated group than in the control group. Levels of ATIII, proteins S and C, fVII, and PAI-1 remained unchanged in all groups.
CONCLUSIONS—Short-term treatment with high doses of vitamin C improved RH% and decreased plasma levels of tPA and vWF in patients with type 2 diabetes and CAD.
The Prevalence and Management of Diabetes in Thai Adults
Authors: Aekplakorn Wichai , Stolk Ronald P. , Neal Bruce , Suriyawongpaisal Paibul , Chongsuvivatwong Virasakdi , Cheepudomwit Sayan , Woodward Mark ,   for the InterASIA Collaborative Group
Published: March 2007

OBJECTIVE—The aim of this study was to determine in Thai adults aged ≥35 years the prevalence and management of diabetes and the associations of diabetes with cardiovascular risk factors.
RESEARCH DESIGN AND METHODS—The International Collaborative Study of Cardiovascular Disease in Asia was a complex sample survey. Data from a structured questionnaire, brief physical examination, and blood sample were collected from 5,105 individuals aged ≥35 years (response rate 68%). Population estimates were calculated by applying sampling weights derived from the 2000 Thai census.
RESULTS—The estimated national prevalence of diabetes in Thai adults was 9.6% (2.4 million people), which included 4.8% previously diagnosed and 4.8% newly diagnosed. The prevalence of impaired fasting glucose was 5.4% (1.4 million people). Diagnosed diabetes, undiagnosed diabetes, and impaired fasting glucose were associated with greater age, BMI, waist-to-hip ratio, systolic blood pressure, total cholesterol, and serum creatinine levels. The majority of individuals with diagnosed diabetes had received dietary or other behavioral advice, and 82% were taking oral hypoglycemic therapy. Blood pressure-lowering therapy was provided to 67% of diagnosed diabetic patients with concomitant hypertension.
CONCLUSIONS—Diabetes is common in Thailand, but one-half of all cases are undiagnosed. Because diagnosed diabetes is likely to be treated with proven, low-cost, preventive therapies such as glucose lowering and blood pressure lowering, initiatives that increased diagnosis rates would be expected to produce substantial health benefits in Thailand.
Decisional Attributes of Patients With Diabetes
Authors: Montori Victor M. , Bryant Sandra C. , O’Connor Annette M. , Jorgensen Neal W. , Walsh Erin E. , Smith Steven A. 
Published: March 2007

OBJECTIVE—The aim of this study was to determine personal characteristics and preferences that affect decision making (decisional attributes) in patients with diabetes. In particular, we were interested in relating these attributes to the choice of using aspirin to reduce cardiovascular risk.
RESEARCH DESIGN AND METHODS—We conducted a cross-sectional survey (70% response rate) of 206 diabetic patients (median age, 63 years; 42% women; 91% completed high school; median HbA1c, 8%) attending a tertiary care diabetes clinic. Patients answered a 42-question survey exploring decisional attributes. Medical records provided the source of clinical information. We evaluated sociodemographic, clinical, and decisional predictors of aspirin use. We also conducted a multivariable analysis with aspirin use as a dependent variable.
RESULTS—Sixty-seven percent of patients surveyed used aspirin. Patients using aspirin were at higher risk of cardiovascular disease (odds ratio 1.4, 95% CI 1.0–2.1), knew more about the benefits of aspirin (1.9, 1.4–2.6) and less about the risks of aspirin (1.4, 1.2–1.8), and were more certain about using aspirin (0.5, 0.3–0.8) than patients not using aspirin. Patients using aspirin placed a higher value on preventing cardiovascular events than on avoiding the side effects of aspirin. Patients perceived that their diabetes provider and the American Diabetes Association had greater influence on their decision to use aspirin than family members or other patients with diabetes.
CONCLUSIONS—The decisional attributes of patients with diabetes are associated with aspirin use. Decisional attributes may be the target of research and interventions to reduce underutilization to levels consistent with patient preferences.
Development of a Reliable and Valid Chinese Version of the Diabetes Empowerment Scale
Authors: Shiu Ann T.Y. , Wong Rebecca Y.M. , Thompson David R. 
Published: March 2007

OBJECTIVE—To translate the Diabetes Empowerment Scale (DES) into Chinese and establish its psychometric properties among Hong Kong Chinese people.
RESEARCH DESIGN AND METHODS—A two-stage study design, incorporating qualitative and quantitative components, determined the cultural equivalency and content validity of the translated scale and established the psychometric properties of the Chinese DES (C-DES) in 207 patients.
RESULTS—Psychometric analysis supported the reliability and validity of the 20-item Chinese DES (C-DES-20) and five subscales: overcoming barriers (α = 0.89), determining suitable methods (α = 0.79), achieving goals (α = 0.78), obtaining support (α = 0.78), and coping (α = 0.76). The test-retest reliability of the intraclass correlations was satifactory when a subsample of 20 patients was tested after a 2-week interval. There was criterion validity between the global scale and metabolic control (HbA1c) of respondents with type 2 diabetes (P = 0.03).
CONCLUSIONS—The C-DES-20 is a reliable and valid outcome measure for patient education and psychosocial interventions among Hong Kong Chinese people with diabetes.
Changing Prevalence of Overweight Children and Adolescents at Onset of Insulin-Treated Diabetes
Authors: Libman Ingrid M. , Pietropaolo Massimo , Arslanian Silva A. , LaPorte Ronald E. , Becker Dorothy J. 
Published: March 2007

OBJECTIVE—The aim of this study was to compare the prevalence of being overweight in black and white children and adolescents at onset of insulin-treated diabetes during two time periods: 1979–1989 (period I) and 1990–1998 (period II).
RESEARCH DESIGN AND METHODS—All black children &lt;19 years of age diagnosed with diabetes and treated with insulin at onset admitted to the Children’s Hospital of Pittsburgh between January 1979 and December 1998 were matched with white children by sex, age at onset, and year of diagnosis. Data were obtained from a review of medical records. Overweight was defined as BMI ≥85th percentile for age and sex. Islet cell autoantibodies were measured.
RESULTS—The prevalence of being overweight increased from 12.6% (period I) to 36.8% (period II) (P = 0.0003); in whites from 2.9 to 16.6% (P = 0.04) and in blacks from 22 to 55% (P = 0.001); and in the age-group &lt;11 years from 7.3 to 22.2% (P = 0.04) and age 11–18 years from 20 to 50% (P = 0.006). In children with at least one antibody, the prevalence of being overweight increased from 5.1 to 24.4% (P = 0.001). In the multivariate logistic regression, period of diagnosis (period II), race (black), age at onset (≥11 years old), and absence of autoimmunity were associated with being overweight.
CONCLUSIONS—At onset of the disease, the prevalence of being overweight has tripled from the 1980s to the 1990s, following the trend in the general population. Weight gain may be an accelerating factor for onset of insulin-treated diabetes and may have contributed to the increased incidence of diabetes in youth seen in some populations.
PC-1 Amino Acid Variant Q121 Is Associated With a Lower Glomerular Filtration Rate in Type 2 Diabetic Patients With Abnormal Albumin Excretion Rates
Authors: De Cosmo Salvatore , Trevisan Roberto , Dalla Vestra Michele , Vedovato Monica , Argiolas Alessandra , Solini Anna , Saller Alois , Damone Francesco , Tiengo Antonio , Trischitta Vincenzo , Fioretto Paola 
Published: March 2007

OBJECTIVE—To study the relationships between the PC-1 K121Q variant and diabetic nephropathy (DN) in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—A total of 125 patients with type 2 diabetes and abnormal albumin excretion rate (AER) (range 20–5,416 μg/min) were followed up for 4 years with repeated measurements of glomerular filtration rate (GFR). Genomic DNA was extracted from all patients, and the PC-1 K121Q polymorphism was determined by the PCR AvaII restriction enzyme. A subset of 64 patients underwent a percutaneous kidney biopsy at baseline, and glomerular structure was analyzed by electron microscopic morphometric analysis. At baseline, age (56 ± 8 vs. 59 ± 7 years), BMI (28.3 ± 4.3 vs. 28.6 ± 3.7 kg/m2), known duration of type 2 diabetes (11.1 ± 7 vs. 11.9 ± 8 years), and HbA1c (8.6 ± 1.8 vs. 8.4 ± 1.7%) were similar in K121K (KK, n = 87, 73 men/14 women) and XQ (35 K121Q + 3 Q121Q, n = 38, 27 men/11 women) patients. Baseline GFR was 96 ± 28 ml · min−1 · 1.73 m−2 and was related (P = 0.01–0.001) to age, known diabetes duration, and systolic blood pressure.
RESULTS—XQ patients had lower GFR (P &lt; 0.05) than KK patients (88 ± 30 vs. 100 ± 26 ml · min−1 · 1.73 m−2); this difference persisted also after factoring in age and known diabetes duration. The rate of progression of DN was similar in KK and XQ patients: %ΔGFR was 4.1/year (median, range: 22.9–30.6) vs. 4.2/year (9.8–26.7). Morphometric parameters of diabetic glomerulopathy were similar in the two genotype groups.
CONCLUSIONS—Among patients with type 2 diabetes with abnormal AER, those carrying the Q PC-1 genotype have more severe DN but not a faster GFR decline than KK patients, thus suggesting faster DN development since diabetes diagnosis in XQ patients.
Applying Diabetes-Related Prevention Quality Indicators to a National Cohort of Veterans With Diabetes
Authors: Helmer Drew A. , Tseng Chin-Lin , Brimacombe Michael , Rajan Mangala , Stiptzarov Nikolay , Pogach Leonard 
Published: March 2007

OBJECTIVE—The Prevention Quality Indicators (PQIs) are measures of hospitalizations that reflect quality of ambulatory care. We applied the PQIs of metabolic decompensation to Veterans Health Administration (VHA) utilizers with diabetes. We identified patient-level characteristics associated with hospitalization for metabolic decompensation, developed a risk-adjustment model for the measures, and compared regional network performance using these PQIs.
RESEARCH DESIGN AND METHODS—This was a retrospective cohort study of 406,575 veterans with diabetes who used the VHA between 1997 and 1999. The outcomes were the PQIs of uncontrolled diabetes, short-term complications, or a combined measure. Patient-level variables were identified from administrative databases. Variation in performance of the networks was compared between full risk adjustment and age and sex adjustment only.
RESULTS—In fiscal year 1999, there were 1,719 VHA discharges (4.2 per 1,000 cohort members) for uncontrolled and short-term complications of diabetes. A logistic regression model including age, sex, marital status, Charlson Comorbidity Index, mental health condition, insulin use, and oral antiglycemic medication use was developed for risk adjustment of the combined PQI. Full risk adjustment changed performance ranks of the networks using the combined PQI outcome relative to age and sex adjustment only. Ten networks remained in the same quartile of performance, five moved one quartile, and seven moved two or more quartiles.
CONCLUSIONS—The PQIs of uncontrolled and short-term complications of diabetes are uncommon outcomes among veterans with diabetes and should be used only as a combined outcome. More complete risk adjustment should be used when comparing systems of care using the combined measure.
The Singapore Impaired Glucose Tolerance Follow-Up Study
Authors: Wong Moh-Sim , Gu Ken , Heng Derrick , Chew Suok-Kai , Chew Loy-Soong , Tai E. Shyong 
Published: March 2007

OBJECTIVE—To 1) document the change in glucose tolerance for subjects with normal glucose tolerance (NGT) and impaired glucose tolerance (IGT) over time, 2) identify baseline factors associated with worsening of glucose tolerance, and 3) determine whether cardiovascular disease (CVD) risk factors associated with IGT improved in tandem with glucose tolerance.
RESEARCH DESIGN—Subjects with IGT and NGT (matched for age, sex, and ethnic group) were identified from a cross-sectional survey conducted in 1992. Subjects with IGT (297) and NGT (298) (65.0%) were reexamined in 2000. Glucose tolerance (assessed by 75-g oral glucose tolerance test), anthropometric data, serum lipids, blood pressure, and insulin resistance were determined at baseline and at the follow-up examination.
RESULTS—For NGT subjects, 14.0% progressed to IGT and 4.3% to diabetes over 8 years. For IGT subjects, 41.4% reverted to NGT, 23.0% remained impaired glucose tolerant, and 35.1% developed diabetes. Obesity, hypertriglyceridemia, higher blood pressure, increased insulin resistance, and lower HDL cholesterol at baseline were associated with worsening of glucose tolerance in both IGT and NGT subjects. Those with IGT who reverted to NGT remained more obese and had higher blood pressure than those with NGT in both 1992 and 2000. However, serum triglyceride, HDL cholesterol, and insulin resistance values in 2000 became indistinguishable from those of subjects who maintained NGT throughout the study period.
CONCLUSIONS—Some, but not all, CVD risk factors associated with IGT and with the risk of future diabetes normalize when glucose tolerance normalizes. Continued surveillance and treatment in subjects with IGT, even after they revert to NGT, may be important in the prevention of CVD.
Integrating Medical Management With Diabetes Self-Management Training
Authors: Polonsky William H. , Earles Jay , Smith Susan , Pease Donna J. , Macmillan Mary , Christensen Reed , Taylor Thomas , Dickert Judy , Jackson Richard A. 
Published: March 2007

OBJECTIVE—This study evaluated the Diabetes Outpatient Intensive Treatment (DOIT) program, a multiday group education and skills training experience combined with daily medical management, followed by case management over 6 months. Using a randomized control design, the study explored how DOIT affected glycemic control and self-care behaviors over a short term. The impact of two additional factors on clinical outcomes were also examined (frequency of case management contacts and whether or not insulin was started during the program).
RESEARCH DESIGN AND METHODS—Patients with type 1 and type 2 diabetes in poor glycemic control (A1c &gt;8.5%) were randomly assigned to DOIT or a second condition, entitled EDUPOST, which was standard diabetes care with the addition of quarterly educational mailings. A total of 167 patients (78 EDUPOST, 89 DOIT) completed all baseline measures, including A1c and a questionnaire assessing diabetes-related self-care behaviors. At 6 months, 117 patients (52 EDUPOST, 65 DOIT) returned to complete a follow-up A1c and the identical self-care questionnaire.
RESULTS—At follow-up, DOIT evidenced a significantly greater drop in A1c than EDUPOST. DOIT patients also reported significantly more frequent blood glucose monitoring and greater attention to carbohydrate and fat contents (ACFC) of food compared with EDUPOST patients. An increase in ACFC over the 6-month period was associated with improved glycemic control among DOIT patients. Also, the frequency of nurse case manager follow-up contacts was positively linked to better A1c outcomes. The addition of insulin did not appear to be a significant contributor to glycemic change.
CONCLUSIONS—DOIT appears to be effective in promoting better diabetes care and positively influencing glycemia and diabetes-related self-care behaviors. However, it demands significant time, commitment, and careful coordination with many health care professionals. The role of the nurse case manager in providing ongoing follow-up contact seems important.
Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes
Authors: Khan Alam , Safdar Mahpara , Ali Khan Mohammad Muzaffar , Khattak Khan Nawaz , Anderson Richard A. 
Published: March 2007

OBJECTIVE—The objective of this study was to determine whether cinnamon improves blood glucose, triglyceride, total cholesterol, HDL cholesterol, and LDL cholesterol levels in people with type 2 diabetes.
RESEARCH DESIGN AND METHODS—A total of 60 people with type 2 diabetes, 30 men and 30 women aged 52.2 ± 6.32 years, were divided randomly into six groups. Groups 1, 2, and 3 consumed 1, 3, or 6 g of cinnamon daily, respectively, and groups 4, 5, and 6 were given placebo capsules corresponding to the number of capsules consumed for the three levels of cinnamon. The cinnamon was consumed for 40 days followed by a 20-day washout period.
RESULTS—After 40 days, all three levels of cinnamon reduced the mean fasting serum glucose (18–29%), triglyceride (23–30%), LDL cholesterol (7–27%), and total cholesterol (12–26%) levels; no significant changes were noted in the placebo groups. Changes in HDL cholesterol were not significant.
CONCLUSIONS—The results of this study demonstrate that intake of 1, 3, or 6 g of cinnamon per day reduces serum glucose, triglyceride, LDL cholesterol, and total cholesterol in people with type 2 diabetes and suggest that the inclusion of cinnamon in the diet of people with type 2 diabetes will reduce risk factors associated with diabetes and cardiovascular diseases.
Plasma Adiponectin Is an Independent Predictor of Type 2 Diabetes in Asian Indians
Authors: Snehalatha Chamukuttan , Mukesh Bheekamchand , Simon Mary , Viswanathan Vijay , Haffner Steven M. , Ramachandran Ambady 
Published: March 2007

OBJECTIVE—Adiponectin, secreted by fat cells, has regulatory functions on energy metabolism. Its low levels are predictive of future development of diabetes. Because no studies on the regulatory role of adiponectin in glucose homeostasis in Asian Indians exist, this analysis was performed to determine the prospective association of adiponectin and diabetes in subjects with impaired glucose tolerance (IGT).
RESEARCH DESIGN AND METHODS—Baseline values of plasma adiponectin, results of anthropometry, fasting and 2-h plasma glucose levels, HbA1c, results of lipid profile, and insulin resistance were analyzed in 91 subjects with IGT (53 men and 38 women) in a primary prevention study. Reassessment of glucose tolerance was performed during 1-year review. The predictive nature of adiponectin for development of diabetes was assessed using univariate and multiple logistic regression analyses. A control group comprising healthy, normoglycemic individuals was used for comparison.
RESULTS—At follow-up, diabetes had developed in 25 of the 91 study subjects. The mean baseline adiponectin level was lower in the diabetic subjects than in the nondiabetic subjects (11.3 ± 5.5 vs. 16.7 ± 7.6 μg/ml, P = 0.0017). Low adiponectin level was a strong predictor of future development of diabetes, and HbA1c also showed a positive predictive association. Women had higher adiponectin levels (16.4 ± 6.1 μg/ml) than men (13.9 ± 7.6 μg/ml) (P = 0.035).
CONCLUSIONS—In Asian Indians, low plasma adiponectin level was predictive of future development of diabetes.