bluuebunny/crossref_metadata_2025_split huggingface dataset:
Monitoring of Psychological Well-Being in Outpatients With Diabetes
Authors: Pouwer François , Snoek Frank J. , van der Ploeg Henk M. , Adèr Herman J. , Heine Robert J. 
Published: March 2007

OBJECTIVE—To investigate whether monitoring and discussing psychological well-being in outpatients with diabetes improves mood, glycemic control, and the patient’s evaluation of the quality of diabetes care.
RESEARCH DESIGN AND METHODS—This study was a randomized controlled trial of 461 outpatients with diabetes who were randomly assigned to standard care or to the monitoring condition. In the latter group, the diabetes nurse specialist assessed and discussed psychological well-being with the patient (with an interval of 6 months) in addition to standard care. The computerized Well-being Questionnaire was used for this purpose. Primary outcomes were mood, HbA1c, and the patient’s evaluation of the quality of diabetes care at 1-year follow-up. The number of referrals to the psychologist was analyzed as a secondary outcome. Intention-to-treat analysis was used.
RESULTS—The monitoring group reported better mood compared with the standard care group, as indicated by significantly lower negative well-being and significantly higher levels of energy, higher general well-being, better mental health, and a more positive evaluation of the quality of the emotional support received from the diabetes nurse. The two groups did not differ for HbA1c or in their overall evaluation of the quality of diabetes care. In the monitoring condition, significantly more subjects were referred to the psychologist.
CONCLUSIONS—Monitoring and discussing psychological well-being as part of routine diabetes outpatient care had favorable effects on the mood of patients but did not affect their HbA1c. Our results support the recommendation to monitor psychological well-being in patients with diabetes.
Relation Between Soluble Adhesion Molecules and Insulin Sensitivity in Type 2 Diabetic Individuals
Authors: Targher Giovanni , Bonadonna Riccardo C. , Alberiche Maria , Zenere Marina B. , Muggeo Michele , Bonora Enzo 
Published: March 2007

OBJECTIVE—The purpose of this study was to explore the relation between insulin resistance and plasma levels of soluble adhesion molecules and to examine the effects of acute hyperinsulinemia on these molecules in type 2 diabetic individuals.
RESEARCH DESIGN AND METHODS—Intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1, and E- and P-selectin plasma concentrations were measured in 36 nonobese type 2 diabetic patients without cardiovascular disease and in 7 healthy subjects. Insulin sensitivity was assessed by a 4-h euglycemic (∼5 mmol/l)-hyperinsulinemic (∼300 pmol/l) clamp performed in combination with [3H]3-d-glucose infusion.
RESULTS—Diabetic subjects were insulin resistant but did not show plasma concentrations of adhesion molecules that were significantly higher than control subjects. In diabetic subjects, plasma ICAM-1 and E-selectin were negatively correlated with total glucose disposal during the insulin clamp (r = −0.432, P &lt; 0.01; and r = −0.375, P &lt; 0.05, respectively), whereas plasma VCAM-1 and P-selectin were not. Plasma ICAM-1 as well as E- and P-selectin were positively correlated with BMI, total body fat (TBF), and waist girth (P &lt; 0.05–0.001). In multiple regression analyses, the relation of plasma ICAM-1 and E-selectin with insulin sensitivity was lost after adjustment for potential confounders, including HbA1c, blood pressure, and/or LDL cholesterol. In these analyses, BMI was the only independent predictor of plasma ICAM-1 (R2 = 0.244, P &lt; 0.002), whereas TBF was the only independent predictor of plasma E-selectin (R2 = 0.202, P = 0.01). The 4-h insulin infusion during the glucose clamp did not significantly change plasma levels of adhesion molecules.
CONCLUSIONS—Overall adiposity, rather than insulin resistance, may be a determinant of plasma levels of ICAM-1 and E-selectin in type 2 diabetic individuals. In these patients, acute hyperinsulinemia does not exert any significant effect on plasma adhesion molecules. These findings support the possibility that adipose tissue releases one or more factors that may adversely affect endothelial function on one hand and insulin sensitivity on the other.
Effects of Low Birth Weight on Insulin Resistance Syndrome in Caucasian and African-American Children
Authors: Li Chaoyang , Johnson Maria S. , Goran Michael I. 
Published: March 2007

OBJECTIVE—To examine the effects of low birth weight (LBW) on the components of insulin resistance syndrome (IRS) in Caucasian and African-American children aged 4–14 years (n = 560 observations among 139 subjects).
RESEARCH DESIGN AND METHODS—A linear random-effects modeling analysis with repeated measures (average four annual visits per child) was conducted to examine the associations between LBW and the components of IRS and their developmental trends over age. Fasting glucose, insulin, and lipids were assessed after an overnight fast; insulin action and secretion were determined by the tolbutamide-modified frequently sampled intravenous glucose tolerance test; and body composition was assessed by dual energy X-ray absorptiometry and computed tomography.
RESULTS—LBW was significantly associated with increased fasting insulin concentration and visceral fat mass, decreased acute insulin response, β-cell function, and HDL cholesterol among African-American children. Among children with LBW, there were significant differences in fasting insulin, insulin sensitivity, acute insulin response, and HDL cholesterol between Caucasians and African-Americans. LBW was significantly associated with faster decrease in acute insulin response and increase in triglycerides with regard to age. The hyperbolic function between insulin sensitivity and β-cell function was retarded among children with LBW (P = 0.04). In addition, there was a significant interaction between LBW and ethnicity in relation to fasting insulin (P &lt; 0.05) and visceral fat (P = 0.05).
CONCLUSIONS—LBW may predict the risk of the IRS and its progression over age in childhood, and this effect may be more pronounced among African-American children.
Differing Associations of Lipid and Lipoprotein Disturbances With the Macrovascular and Microvascular Complications of Type 1 Diabetes
Authors: Chaturvedi Nish , Fuller John H. , Taskinen Marja-Riitta ,   On behalf of the EURODIAB PCS Group
Published: March 2007

OBJECTIVE—Cardiovascular disease (CVD) is increased in patients with type 1 diabetes, but lipid and lipoprotein patterns remain favorable. In contrast, nephropathy is associated with an adverse distribution. We compared the associations and predictive power of lipid and lipoprotein disturbances with these complications.
RESEARCH DESIGN AND METHODS—A nested case-control study from the EURODIAB cohort of 140 case subjects with evidence of at least one complication and 84 control subjects with no complications were analyzed. Conventional and unconventional lipid and lipoprotein fractions, including apolipoprotein (apo)-A1, lipoprotein (Lp)-A1, LpA1/A2, apoB, and LDL particle size were measured centrally.
RESULTS—CVD was only associated with increased LDL cholesterol (3.6 vs. 3.0 mmol/l, P = 0.02). In contrast, albuminuria was associated with elevated cholesterol, triglyceride, LDL, and apoB and with diminished LDL particle size. No disturbances in HDL and related lipoproteins were noted. In normoalbuminuric patients, CVD was not associated with any significant changes in lipids. CVD in macroalbuminuric patients was associated with increased triglyceride level (2.37 vs. 1.07 mmol/l, P = 0.001; P = 0.02 for CVD/albuminuria interaction) and LDL cholesterol (5.4 vs. 3.3 mmol/l, P = 0.005; P = 0.004 for interaction). Independent associations were observed for total cholesterol and for LDL particle size and albuminuria.
CONCLUSIONS—Abnormalities in lipid and lipoprotein disturbances are more closely related to albuminuria than to CVD in patients with type 1 diabetes. Measurement of conventional parameters provide sufficient risk information. ApoB and LDL particle size offer limited extra information. HDL metabolism remains undisturbed in the presence of complications. These changes reflect associations with glycemic control, which is the key to understanding lipid and lipoprotein disturbances.
Use of Insulin Pumps in Pregnancies Complicated by Type 2 Diabetes and Gestational Diabetes in a Multiethnic Community
Authors: Simmons David , Thompson Colin F. , Conroy Caroline , Scott David J. 
Published: March 2007

OBJECTIVE—To describe the use of insulin pump therapy in women with gestational diabetes mellitus (GDM) or type 2 diabetes in pregnancy and persistent hyperglycemia despite multiple injections of subcutaneous insulin.
RESEARCH DESIGN AND METHODS—As part of a service audit, deliveries to women with diabetes at a single South Auckland hospital were reviewed from 1991 through 1994. Glycemic control was estimated by the mean of self-recorded and laboratory postprandial glucose concentrations. In a nested case-control study, pregnancies complicated by GDM/type 2 diabetes with use of an insulin pump were compared with those without insulin pump therapy and peak insulin requirements of 100–199 units/ day, matched for ethnicity and type of diabetes.
RESULTS—A total of 30 of 251 Polynesian, European, and South Asian women with singleton pregnancies complicated by insulin-requiring GDM/type 2 diabetes used an insulin pump. An additional two women with high insulin requirements discontinued pump therapy. None of the women with GDM/type 2 diabetes experienced severe hypoglycemia, whereas 79% of the women had improved glycemic control within 1–4 weeks. Mothers using a pump had greater insulin requirements (median maximum 246 vs. 130 units per day) and greater weight gain (10.6 vs. 5.0 kg). Their babies were more likely to be admitted to the Special Care Baby Unit but were neither significantly heavier nor experienced greater hypoglycemia than control subjects.
CONCLUSIONS—Insulin pump therapy seems to be safe and effective for maintaining glycemic control in pregnancies complicated by GDM/type 2 diabetes and requiring large doses of insulin.
Two-Field Photography Can Identify Patients With Vision-Threatening Diabetic Retinopathy
Authors: Stellingwerf Catharina , Hardus Peter L.L.J. , Hooymans Johanna M.M. 
Published: March 2007

OBJECTIVE—To compare the effectiveness of two 45° photographic fields per eye in the screening for diabetic retinopathy with the routine ophthalmologist’s examination and to study the effectiveness of visual acuity measurement in the detection of diabetic macular edema.
RESEARCH DESIGN AND METHODS—Type 1 and 2 diabetic patients without a known history of more than minimal retinopathy (n = 469) had a routine examination by an ophthalmologist, including visual acuity measurement, indirect retinoscopy, and biomicroscopy. At the same time, two-field nonstereoscopic retinal photographs were made of both eyes and assessed in a masked fashion by a retinal specialist. The results were compared.
RESULTS—The prevalence was 4.3% for vision-threatening retinopathy and 24% for any retinopathy. The sensitivity of two-field photography in identifying diabetic patients with sight-threatening retinopathy was 95% (specificity 99%) and sensitivity for detecting any retinopathy was 83% (specificity 88%). The percentage of referrals to an ophthalmologist was 6.2%. All patients with macular edema detected by biomicroscopy were classified as having vision-threatening retinopathy on the photographs.
CONCLUSIONS—Two-field retinal photography is a promising alternative to the routine ophthalmologist’s examination in the screening for diabetic retinopathy. Visual acuity measurement is not a sensitive tool for the detection of macular edema. Screening for diabetic retinopathy using two-field retinal photography is feasible in a primary care setting and can substantially lower the number of ophthalmic referrals.
Vascular Compliance Is Reduced in the Early Stages of Type 1 Diabetes
Authors: Romney Jacques S. , Lewanczuk Richard Z. 
Published: March 2007

OBJECTIVE—To determine whether arterial compliance of patients with type 1 diabetes is reduced before the development of clinically apparent diabetes complications.
RESEARCH DESIGN AND METHODS—Pulse-wave analysis was used to compare vascular compliance between patients with type 1 diabetes and nondiabetic control subjects. Analysis of covariance was used to determine differences between the two groups with adjustment for age if needed.
RESULTS—A total of 59 patients with type 1 diabetes were studied; age ranged from 17–61 years. Of the 59 patients, 32 had no evidence of diabetes complications and 27 had microvascular complications. The control group consisted of 57 healthy subjects ranging in age from 23–79 years. In the control group, large artery compliance (C1) and small artery compliance (C2) were inversely proportional to age (r = −0.55 for C1 and −0.50 for C2; P &lt; 0.01). When the control subjects were compared with type 1 diabetic patients without microvascular complications, C1 was 1.51 ± 0.04 (SEM) for the control group and 1.33 ± 0.06 (SE) ml/mmHg for the diabetic group, whereas C2 was 0.080 ± 0.005 (SE) and 0.065 ± 0.005 (SE) ml/mmHg for the control and diabetic subjects, respectively, when adjusted for age (P = 0.03 for both C1 and C2).
CONCLUSIONS—Vascular compliance of both the large and small arteries is reduced in type 1 diabetic patients before any clinical complications from the diabetes are evident. This study serves to emphasize that vascular changes occur at an early point in the disease and may increase risk of cardiovascular events in patients with diabetes. Larger prospective studies are required to confirm this finding and to investigate the efficacy of medical intervention.
Productivity Losses Associated With Diabetes in the U.S.
Authors: Ng Ying Chu , Jacobs Philip , Johnson J.A. 
Published: March 2007

OBJECTIVE— The objective of this study was to estimate the cost of productivity losses in the U.S. attributable to diabetes, with regard to specific demographic and disease-related characteristics in the U.S.
RESEARCH DESIGN AND METHODS— We used the 1989 National Health Interview Survey, a random survey of individuals in the U.S. that included a diabetes supplement. Data on individuals were obtained for labor force participation, hours of work, demographic and occupational characteristics,self-reported health status, and several variables that indicated the presence, duration, and severity (complications) of diabetes. Using multivariate regression analyses, we estimated the association of independent variables (e.g., demographics, health, and diabetes status) with labor force participation, hours of work lost, and the economic value of lost work attributable to diabetes and its complications and duration.
RESULTS— In general, the presence of diabetes and complications were found to be related to workforce participation variables. The magnitude of the lost-productivity costs depended on personal characteristics and on the presence and status of diabetes. In general, the loss of yearly earnings amounted to about a one-third reduction in earnings and ranged from $3,700 to $8,700 per annum.
CONCLUSIONS— Diabetes has a considerable net effect on earnings, and the complications and duration of diabetes have compound effects. Our findings have implications for the cost-effectiveness of diabetes control; the presence of complicating factors is the single most important predictive factor in lost productivity costs attributable to diabetes, and thus the avoidance or retardation of complications will have an impact on indirect health-related costs.
Graftskin, a Human Skin Equivalent, Is Effective in the Management of Noninfected Neuropathic Diabetic Foot Ulcers
Authors: Veves Aristidis , Falanga Vincent , Armstrong David G. , Sabolinski Michael L. ,   the Apligraf Diabetic Foot Ulcer Study
Published: March 2007

OBJECTIVE— We assessed in a randomized prospective trial the effectiveness of Graftskin, a living skin equivalent, in treating noninfected nonischemic chronic plantar diabetic foot ulcers.
RESEARCH DESIGN AND METHODS— In 24 centers in the U.S., 208 patients were randomly assigned to ulcer treatment either with Graftskin (112 patients) or saline-moistened gauze (96 patients, control group). Standard state-of-the-art adjunctive therapy, which included extensive surgical debridement and adequate foot off-loading, was provided in both groups. Graftskin was applied at the beginning of the study and weekly thereafter for a maximum of 4 weeks (maximum of five applications) or earlier if complete healing occurred. The major outcome of complete wound healing was assessed by intention to treat at the 12-week follow-up visit.
RESULTS— At the 12-week follow-up visit, 63 (56%)Graftskin-treated patients achieved complete wound healing compared with 36(38%) in the control group (P = 0.0042). The Kaplan-Meier median time to complete closure was 65 days for Graftskin, significantly lower than the 90 days observed in the control group (P = 0.0026). The odds ratio for complete healing for a Graftskin-treated ulcer compared with a control-treated ulcer was 2.14 (95% CI 1.23-3.74). The rate of adverse reactions was similar between the two groups with the exception of osteomyelitis and lower-limb amputations, both of which were less frequent in the Graftskin group.
CONCLUSIONS— Application of Graftskin for a maximum of 4 weeks results in a higher healing rate when compared with state-of-the-art currently available treatment and is not associated with any significant side effects. Graftskin may be a very useful adjunct for the management of diabetic foot ulcers that are resistant to the currently available standard of care.
Homeostasis Model Assessment Is a Reliable Indicator of Insulin Resistance During Follow-up of Patients With Type 2 Diabetes
Authors: Katsuki Akira , Sumida Yasuhiro , Gabazza Esteban C. , Murashima Shuichi , Furuta Masahiko , Araki-Sasaki Rika , Hori Yasuko , Yano Yutaka , Adachi Yukihiko 
Published: March 2007

OBJECTIVE— To investigate the usefulness of the homeostasis model assessment as an index of insulin resistance (HOMA-IR) for evaluating the clinical course of patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS— The usefulness of HOMA-IR and its relationship with insulin resistance assessed by the hyperinsulinemic-euglycemic clamp study (clamp IR) were evaluated in 55 Japanese patients with type 2 diabetes before and after treatment. The patients were subjected to diet (∼1,440-1,720 kcal/day) and exercise therapy (walking 10,000 steps daily) for 6 weeks during their hospitalization.
RESULTS— Univariate regression analysis disclosed a significant correlation between log-transformed HOMA-IR and log-transformed clamp IR before (r = -0.613, P &lt; 0.0001) and after(r = -0.734, P &lt; 0.0001) treatment. Neither the slopes(-0.71 ± 0.12 vs. -0.79 ± 0.09, F = 0.25, P =0.61) nor the intercepts (y-intercept = 1.67 vs. 1.70, x-intercept = 2.36 vs. 2.15, F = 0.02, P = 0.88) of the regression lines between HOMA-IR and clamp IR were significantly different before and after treatment. There was a significant correlation between the decrease in log-transformed HOMA-IR and the increase in clamp IR during treatment (r = -0.617, P &lt; 0.0001).
CONCLUSIONS— HOMA-IR may constitute a useful method not only for diagnosing insulin resistance, but also for follow-up during the treatment of patients with type 2 diabetes.
Corneal Advanced Glycation End Products Increase in Patients With Proliferative Diabetic Retinopathy
Authors: Sato Eiichi , Mori Fumihiko , Igarashi Sho , Abiko Tohru , Takeda Masumi , Ishiko Satoshi , Yoshida Akitoshi 
Published: March 2007

OBJECTIVE—To evaluate corneal advanced glycation end product (AGE) fluorescence in patients with diabetes and in healthy control subjects.
RESEARCH DESIGN AND METHODS—Corneal autofluorescence was measured in 26 eyes of 26 patients with type 2 diabetes (mean age 57.0 years; mean disease duration 12.2 years; mean HbA1c 7.1%) and 13 eyes of 13 healthy age-matched control subjects (mean age 57.9 years). The patients with type 2 diabetes were divided into the following groups: patients without diabetic retinopathy (DR), patients without proliferative diabetic retinopathy (PDR), and patients with PDR. Corneal autofluorescence was measured by fluorophotometry with the wavelength that is characteristic of AGE fluorescence (excitation and emission 360–370 nm and 430–450 nm, respectively). We defined peak corneal autofluorescence levels as corneal AGE fluorescence values. We compared the corneal AGE fluorescence values in the four groups.
RESULTS—In the PDR group (11.9 ± 3.9 arbitrary units [mean ± SD]), the corneal AGE fluorescence values were significantly higher compared with the control subjects (6.9 ± 1.3 arbitrary units), the patients without DR (7.4 ± 2.1 arbitrary units), and the patients without PDR (6.9 ± 2.2 arbitrary units) (P &lt; 0.05).
CONCLUSIONS—We found that corneal AGEs may increase in patients with diabetes and PDR compared with control subjects, patients without DR, and patients without PDR. In the patients with PDR, increased corneal AGEs may play a role in diabetic keratopathy.
Elevated Serum IP-10 Levels Observed in Type 1 Diabetes
Authors: Shimada Akira , Morimoto Jiro , Kodama Keiichi , Suzuki Ryuji , Oikawa Yoichi , Funae Osamu , Kasuga Akira , Saruta Takao , Narumi Shosaku 
Published: March 2007

OBJECTIVE—Although most patients with type 1 diabetes are considered to have T-cell–mediated autoimmune disease, a method of measuring of pancreatic β-cell–specific T-cell function in cases of type 1 diabetes has yet to be established. Here, we focused on interferon-inducible protein-10 (IP-10), a chemokine that promotes the migration of activated T-helper 1 (Th1) cells and measured serum IP-10 levels in patients with human type 1 diabetes, which is regarded as a Th1-mediated disease.RESEARCH DESIGN AND METHODS—Serum samples were obtained from diabetic patients, and the levels of autoantibodies (GAD and insulinoma-associated protein-2 [IA-2]) and IP-10 were measured. Diabetic patients positive for either or both of the autoantibodies were classified as Ab+ type 1, and those negative for both were classified as Ab− type 1. To evaluate islet antigen–specific responses, peripheral blood from patients stimulated with or without GAD was used, and intracellular cytokine staining for flowcytometry was performed.RESULTS—The Ab+ and Ab− type 1 groups both showed a significantly higher serum IP-10 level than the healthy subjects (P &lt; 0.001 and P &lt; 0.05, respectively), and the IP-10 level in the recent-onset Ab+ subgroup was significantly higher than that in the established (longstanding) Ab+ subgroup (P &lt; 0.002). Furthermore, there was a significant positive correlation between the serum IP-10 level and the number of GAD-reactive γ-interferon–producing CD4+ cells in the Ab+ type 1 group (P &lt; 0.007).CONCLUSIONS—Our findings demonstrate that measurement of serum IP-10 concentrations is useful in patients with type 1 diabetes.