bluuebunny/crossref_metadata_2025_split huggingface dataset:
Same Eyes, Different Doctors: Differences in Primary Care Physician Referrals for Diabetic Retinopathy Screening
Authors: Lazaridis Emmanuel N , Qiu Chunfu , Kraft Stephanie K , Marrero David G 
Published: March 2007

OBJECTIVE
To analyze eye care specialist referral patterns for the diabetic patients of primary care physicians.

RESEARCH DESIGN AND METHODS
In 1993, we conducted a census of primary care physicians to evaluate practice patterns relating to diabetes care in the state of Indiana. Using a logistic regression model and data from this census, we compared 1) physicians' odds of referring type II diabetic patients to an optometrist, as opposed to an ophthalmologist, with those of type I diabetic patients and 2) the referral odds ratios of type II to type I diabetic patients between metropolitan and nonmetropolitan counties.

RESULTS
Overall, 10% of the physicians in our study most often refer some patients to an optometrist. Physicians are more likely to refer their type II diabetic patients to an optometrist, as opposed to an ophthalmologist, than they are to refer type I diabetic patients, both before and after adjustment for covariates. Physicians who practice in metropolitan counties are 1.55 times more likely to refer their type II diabetic patients than their type I diabetic patients to an optometrist. In nonmetropolitan counties, physicians are 2.5 times more likely to refer their type II diabetic patients to an optometrist. The difference between metropolitan and nonmetropolitan physicians is significant (P = 0.027).

CONCLUSIONS
Some physicians mostly refer their diabetic patients to optometrists, instead of ophthalmologists, for eye examinations intended to discover early signs of diabetic eye disease. Type II diabetic patients are more likely to be referred to an optometrist, instead of an ophthalmologist, than are type I diabetic patients. In nonmetropolitan areas, the difference in referral patterns becomes even more marked.
Diabetes Nutrition and Complications Trial (DNCT): Food Intake and Targets of Diabetes Treatment in a Sample of Spanish People With Diabetes
Authors:   The Diabetes and Nutrition Study Group of the Spanish Diabetes Association (GSEDNu)
Published: March 2007

OBJECTIVE
To know the nutritional pattern of people with diabetes in Spain and that pattern's relationship with targets of metabolic control.

RESEARCH DESIGN AND METHODS
The Diabetes Nutrition and Complications Trial (DNCT) is a prospective multicenter study designed to determine the nutritional behavior of diabetic patients in Spain using 7-day food diaries. A total of 337 diabetic patients, 144 (70 men and 74 women) with type I and 193 (81 men and 112 women) with type II diabetes, satisfactorily completed the 7-day food diaries from May 1993 to December 1994.

RESULTS
The median energy intake of the Spanish diabetic subjects was between 1,453 and 2,217 kcal/day (6.1–9.3 MJ/day), distributed as follows: 38–40% from carbohydrate, 19–23% from protein, and 36–41.5% from fat (11.1–13.9% saturated fatty acids, 4.6–5.8% polyunsaturated fatty acids, and 19.7–21.9% monounsaturated fatty acids). Of the subjects, 69% had a cholesterol level &lt;5.6 mmol, 97% had an HDL cholesterol level &gt;0.9 mmol, and 85% had a triglyceride level &lt;1.7 mmol, while &lt;36% had an HbA1c value &gt;8%.

CONCLUSIONS
People with diabetes in Spain have near-optimal serum lipid levels and maintain reasonably good blood glucose control and BMI, suggesting that diabetes management that includes the usual Spanish diet, which is low in carbohydrates and high in fat, especially monounsaturated fat, might be adequate.
The Relationship of Concentrations of Insulin and Proinsulin-Like Molecules With Coronary Heart Disease Prevalence and Incidence: A study of two ethnic groups
Authors: Yudkin John S , Denver A Elizabeth , Mohamed-Ali Vidya , Ramaiya Kaushik L , Nagi Dinesh K , Goubet Stephanie , McLarty Donald G , Swai Andrew 
Published: March 2007

OBJECTIVE
To define the potential role of proinsulin-like molecules as risk factors for cardiovascular disease.

RESEARCH DESIGN AND METHODS
Fasting concentrations of proinsulin, des-31,32-proinsulin, and insulin, and of insulin 2 h after a 75-g glucose load, were measured in 1,034 nondiabetic europid subjects and 257 south Asian subjects and related to prevalent coronary heart disease (Minnesota-coded electrocardiographic criteria or ischemic chest pain). In 137 south Asian subjects, the fasting concentrations were related to incident coronary heart disease over a 6.5-year follow-up.

RESULTS
The standardized odds ratios for prevalent coronary heart disease were as follows: fasting insulin, 1.29 (1.11–1.49), P = 0.0006; 2-h insulin, 1.25 (1.08–1.45), P = 0.003; proinsulin, 1.23 (0.99–1.53), P = 0.058; and des-31,32-proinsulin, 1.32 (1.03–1.69), P = 0.026. The odds ratios were similar in the two ethnic groups. These relationships became insignificant when controlling for age, sex, and BMI. The standardized odds ratios for incident coronary heart disease were as follows: fasting insulin, 0.99 (0.63–1.55), P = 0.97; proinsulin, 1.13 (0.72–1.78), P = 0.59; and des-31,32-proinsulin, 1.00 (0.61–1.63), P = 1.00.

CONCLUSIONS
We have found similar relationships between concentrations of proinsulin-like molecules and prevalent coronary heart disease, as are observed for insulin in these nondiabetic subjects, although these molecules comprise only ∼ 10% of all insulin-like molecules. It appears biologically implausible that these relationships represent cause and effect.
Elevated Glycosylated Albumin in NIDDM Is a Function of Recent Everyday Environmental Stress
Authors: Aikens James E , Mayes Rhonda 
Published: March 2007

OBJECTIVE
To evaluate the association of recent daily environmental stress (daily hassles) with glycemia in NIDDM.

RESEARCH DESIGN AND METHODS
Fifty-five NIDDM patients reported the number and intensity of daily hassles occurring during the past week and concurrently underwent glycemic assessment.

RESULTS
Hassles were generally unassociated with demographic variables, illness duration, treatment regimen, and the presence of complications. Multiple regression analysis indicated that hassles (in both frequency and intensity) were positively associated with recent glycemia (glycosylated albumin [GA]), even after statistically controlling for long-term glycemia (glycosylated hemoglobin [HbA1c]). The subtypes of hassles having the most potent relationships with GA were work and family/friend-related stressors.

CONCLUSIONS
The frequency and perceived impact of everyday minor stress have proximal positive associations with glycemia that do not necessarily reflect chronic hyperglycemia. Stress arising from work and family/friend sources may be particularly relevant.
A Neural Network Model for Predicting Pancreas Transplant Graft Outcome
Authors: Dorsey Susan G , Waltz Carolyn F , Brosch Laura , Connerney Ingrid , Schweitzer Eugene J , Bartlett Stephen T 
Published: March 2007

OBJECTIVE
To compare the results of a neural network versus a logistic regression model for predicting early (0–3 months) pancreas transplant graft survival or loss.

RESEARCH DESIGN AND METHODS
This study was a cross-sectional, secondary analysis of demographic and clinical data from 117 simultaneous pancreas-kidney (SPK), 35 pancreas-after-kidney (PAK), and 8 pancreas-transplant-alone (PTA) patients (n = 160). The majority of patients were men (57%) and were white (90.1%), with a mean age of 39 ± 8.09 years. Of the patients, 23 (14.4%) experienced early graft loss, which included any loss owing to technical or immunological causes, and death with a functional graft. Data were analyzed with a logistic regression model for multivariate analysis and a backpropagation neural network (BPNN) model.

RESULTS
A total of 12 predictor variables were chosen from literature and transplant surgeon recommendations. A logistic model with all predictor variables included correctly classified 93.53% of cases. Model sensitivity was 35.71%; specificity was 100% (pseudo-R2 0.24). Of the predictors, history of alcohol abuse (odds ratio [OR] 32.39; 95% CI 1.67–626.89), having a PAK or PTA (OR 13.6; 95% CI 2.20–84.01), and use of a nonlocal organ procurement center (OPO) (OR 4.51; 95% CI 0.78–25.96) were most closely associated with early graft loss. The BPNN model with the same 12 predictor variables correctly predicted 92.50% of cases (R2 0.71). Model sensitivity was 68%; specificity was 96%. Of the predictors, the three variables most closely associated with graft outcome in this model were recipient/donor weight difference &gt;50 lb, having a PAK or PTA, and use of a nonlocal OPO.

CONCLUSIONS
First, the BPNN model correctly predicted 92.5% of graft outcomes versus the logistic model (93.53%). Second, the BPNN model rendered more accurate predictions (&gt;0.70 = loss; &lt;0.30 = survival) versus the logistic model (&gt;0.50 = loss; &lt;0.50 = survival). Third, the BPNN model was more sensitive (68%) than the logistic model (35.71%) to graft failures and demonstrated an almost threefold increase in explained variance (R2 = 0.71 vs. 0.24). These results suggest that the BPNN model is a more powerful tool for predicting early pancreas graft loss than traditional multivariate statistical models.
Immune Response to Glycated and Oxidized LDL in IDDM Patients With and Without Renal Disease
Authors: Korpinen Eija , Groop Per-Henrik , Åkerblom Hans K , Vaarala Outi 
Published: March 2007

OBJECTIVE
To study autoantibodies to oxidized and glycated LDL in IDDM patients with and without diabetic nephropathy and in nephropathy-related macroangiopathy

RESEARCH DESIGN AND METHODS
The study included 101 IDDM patients with a long duration of diabetes and 54 healthy subjects. Patients were divided into two groups according to their median urinary albumin excretion rate (AER); the normoalbuminuric group had AER &lt;20 μg/min and the albuminuric group &gt;200 μg/min. The groups were matched for age and BMI, and the two diabetic groups were matched for duration of diabetes and glycemic control. Antibodies against oxidized LDL (using malondialdehyde-modified LDL as the antigen) and against glycated LDL were measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS
The mean antibody levels against glycated LDL were higher in IDDM patients (0.305 ± 0.399) than in healthy subjects (0.166 ± 0.22 optical density [OD]; P = 0.019), but levels did not differ significantly between normoalbuminuric and albuminuric IDDM patients (0.258 ± 0.354 vs. 0.388 ± 0.459, respectively). Among the three groups, antibody levels to oxidized LDL did not differ. IDDM patients showed an inverse correlation between antibodies to oxidized LDL and HbA1 (r = −0.211, P = 0.04). The antibody levels to glycated and oxidized LDL did not differ among albuminuric IDDM patients with or without clinical macroangiopathy.

CONCLUSIONS
Antibodies to glycated and oxidized LDL do not seem to associate with diabetic nephropathy or nephropathy-related macroangiopathy.
Insulin Antibody Response to a Short Course of Human Insulin Therapy in Women With Gestational Diabetes
Authors: Balsells Montserrat , Corcoy Rosa , Mauricio Dídac , Morales Josefa , García-Patterson Apolonia , Carreras Gemma , Puig-Domingo Manuel , de Leiva Alberto 
Published: March 2007

OBJECTIVE
To assess the insulin antibody (IA) response to human insulin (HI) therapy in women with gestational diabetes.

RESEARCH DESIGN AND METHODS
IAs were measured by a competitive radiobinding assay in 50 women with gestational diabetes before and during treatment with HI and after delivery. At delivery, 15 maternal-cord blood sample pairs were analyzed for IA. As a reference, we searched for IA in 25 new-onset type I diabetic patients, before and at 3, 6, and 12 months after insulin therapy.

RESULTS
Insulin autoantibodies (IAAs) were detected in 1 of 50 women with gestational diabetes and 4 of 16 type I diabetic patients (P &lt; 0.05). At the end of pregnancy after 9.3 ± 6.8 weeks on insulin therapy, 22 of 50 (44%) women with gestational diabetes became IA+ and 4 additional women were found to be positive 2 months postpartum. After 3 months on insulin, type I diabetic patients showed a higher rate of IA positivity (92%, P &lt; 0.001). IA titers at the end of pregnancy were associated with the cumulative insulin dose (r = 0.29, P &lt; 0.05). Postpartum, IA disappeared slowly in most IA+ women, but two women still showed IA 2 years after delivery Titers in cord blood were strongly related to those in maternal blood (r = 0.74, P &lt; 0.01). The rate of adverse fetal outcome did not differ in IA− and IA+ mothers (27 vs. 40%, NS).

CONCLUSIONS
HI is immunogenic, and a short course of HI therapy induces IA in ∼ 50% of women with gestational diabetes and 92% of type I diabetic patients. In women with gestational diabetes, insulin dose is slightly associated with IA titers. These IAs apparently cross the placenta. Fetal outcome does not differ according to the maternal IA status, and IAs disappear gradually after delivery but may remain positive for 2 years after delivery.
Glibenclamide, but Not Acarbose, Increases Leptin Concentrations Parallel to Changes in Insulin in Subjects With NIDDM
Authors: Haffner Steven M , Hanefeld Markolf , Fischer Sabine , Fuçker Katja , Leonhardt Wolfgang 
Published: March 2007

OBJECTIVE
To hypothesize if glibenclamide, which increases insulin levels, also increases leptin concentrations.

RESEARCH DESIGN AND METHODS
Leptin is a hormone that regulates weight in mice. In obese humans, leptin concentrations are increased, suggesting resistance to the effects of this hormone. Although short-term infusion of insulin during the hyperinsulinemiceuglycemic clamp does not increase leptin concentration, the effect of oral antidiabetic agents on leptin concentration is unknown. Differing effects can be expected, since glibenclamide acts via stimulation of insulin secretion, whereas acarbose inhibits alpha-glucosidases of the small intestine and has no direct effect on insulin levels. We examined the effect of acarbose (n = 4), glibenclamide (n = 6), and placebo (n = 6) on insulin and leptin levels during 24-h periods before and after 16 weeks of therapy.

RESULTS
We observed a significant diurnal variation in leptin concentrations. This was inversely related to insulin levels during the 24-h follow-up with usual diet. Neither the placebo nor acarbose altered leptin concentrations. However, glibenclamide increased leptin concentrations parallel to insulin levels. There were only minor changes in body weight during the l6-week follow-up: decrease in the placebo group (change −0.5 kg/m2, P = 0.07) and acarbose (change −0.7 kg/m2, P = 0.046) and increase in the glibenclamide group (change 0.8 kg/m2, P = 0.27). However, individual subjects who gained weight had increases in their leptin concentrations. The diurnal variation in leptin concentrations was preserved after glibenclamide.

CONCLUSIONS
Glibenclamide increases circadian leptin and insulin concentrations, whereas acarbose does not. This observation may help to explain weight gain in subjects treated with glibenclamide and stable weight in those treated with acarbose in the long run.
Optimal Time of Administration of Insulin Lispro. Importance of meal composition
Authors: Strachan Mark W J , Frier Brian M 
Published: March 2007

OBJECTIVE
To compare the glucodynamics of pre- and postprandial administration of insulin lispro using test meals of differing composition.

RESEARCH DESIGN AND METHODS
Twenty subjects with IDDM were studied on four separate occasions. Ten subjects ingested high-carbohydrate and high-fat breakfasts with a large liquid component, and 10 subjects ingested high-carbohydrate and high-fat breakfasts in a more solid form. With each meal, insulin lispro was injected 10 min preprandial on one occasion and 20 min postprandial on another. The magnitude and temporal pattern of postprandial glucose excursions were observed.

RESULTS
With all meal types studied, postprandial blood glucose excursions were significantly smaller when insulin lispro was administered preprandially (P &lt; 0.05). With both high-carbohydrate meals and the liquid high-fat meal, preprandial administration of lispro was associated with modest postprandial increments of blood glucose. With the solid high-fat meal, preprandial lispro produced a cumulative decline in postprandial blood glucose, whereas blood glucose rose when lispro was administered postprandially.

CONCLUSIONS
For meals with a high carbohydrate content, the optimal time of administration of lispro is preprandial. However, for meals with a high solid fat content, postprandial administration of lispro may be preferable.
The Effect of the Insulin Analog Lispro on Nighttime Blood Glucose Control in Type 1 Diabetic Patients
Authors: Ahmed Abu Baker E , Home Philip D 
Published: March 2007

OBJECTIVE
Unmodified regular insulin has a long absorption tail, unlike the fast-acting insulin analog lispro, and may contribute to hypoglycemia in the early part of the night. A randomized crossover double-blind study was performed to compare blood glucose concentrations in the early part of the night in type 1 diabetic patients receiving lispro or unmodified regular human insulin, in random order, on 2 separate study days.

RESEARCH DESIGN AND METHODS
We studied 23 C-peptide-negative patients; 12 were using a premeal plus basal insulin regimen, and 11 were using twice-daily insulin injections. Patients were admitted to the investigation unit at 5:00 P.M. and received a single dose of lispro or unmodified regular human insulin before the evening meal. In both groups, the NPH insulin dose remained unchanged. Identical meals and snacks were eaten at the same time during both study days.

RESULTS
Average postprandial (6:00−10:00 P.M.) blood glucose concentrations were significantly lower after lispro therapy compared with human insulin (7.1 ± 0.4 [SE] vs. 8.5 ± 0.4 mmol/l, P = 0.0002). Nighttime (midnight to 4:00 A.M.) blood glucose concentrations were significantly higher after lispro compared with human insulin (10.3 ± 0.4 vs. 9.1 ± 0.4 mmol/l, P = 0.02). This difference was greatest in patients on the premeal plus basal insulin regimen (11.6 ± 0.5 vs. 8.7 ± 0.4 mmol/l, P &lt; 0.001). The incidence of nocturnal hypoglycemia (midnight to 4:00 A.M., blood glucose &lt; 3.5 mmol/l) was less with lispro compared with unmodified insulin (1 vs. 6 patients, P = 0.04). Nighttime (midnight to 4:00 A.M.) 3-hydroxybutyrate (102 ± 13 vs. 51 ± 7 mumol/l, P = 0.000) and glycerol (52 ± 3 vs. 42 ± 2 mumol/l, P &lt; 0.01) were significantly higher after lispro therapy compared with human insulin in patients on the premeal plus bolus insulin regimen.

CONCLUSIONS
Lispro can improve postprandial blood glucose control and reduce the incidence of nocturnal hypoglycemia at the expense of nocturnal hyperglycemia and hyperketonemia in patients using a premeal plus basal insulin regimen.
Serum Ferritin as a Component of the Insulin Resistance Syndrome
Authors: Fernández-Real José-Manuel , Ricart-Engel Wifredo , Arroyo Enric , Balançá Rafael , Casamitjana-Abella Roser , Cabrero Dolores , Fernández-Castañer Miquel , Soler Joan 
Published: March 2007

OBJECTIVE
In epidemiological studies, serum ferritin was the second-strongest determinant of blood glucose (after BMI) in regression models and the third-strongest determinant of serum insulin (after BMI and age). Its concentration also correlated positively with plasma triglycerides and apolipoprotein B concentrations, and negatively with HDL2 cholesterol. We hypothesized that serum ferritin could be a marker of insulin resistance.

RESEARCH DESIGN AND METHODS
Oral glucose tolerance and insulin sensitivity (SI, minimal model method) were prospectively evaluated in 36 healthy subjects. The relationship between serum ferritin and metabolic control (as measured by HbA1c levels) was also studied in 76 consecutive NIDDM patients.

RESULTS
In healthy subjects, log-transformed serum ferritin (LOGFER) correlated with basal serum glucose (r = 0.44, P = 0.007), but not with BMI, age, systolic or diastolic blood pressure, total cholesterol, VLDL cholesterol, HDL cholesterol, total triglycerides, VLDL triglycerides, serum insulin, or HbA1c (all P = NS). Identical results were obtained when the two lowest quartiles of serum ferritin were evaluated separately. However, in the two highest quartiles, LOGFER correlated with BMI (0.50, P = 0.02), diastolic blood pressure (r = 0.8, P &lt; 0.0001), serum LDL cholesterol (r = 0.57, P = 0.01), VLDL cholesterol (r = 0.48, P = 0.03), total cholesterol and HDL2 and HDL3 subtractions of HDL cholesterol (r = −0.68, −0.76, −0.55, P = 0.001. &lt; 0.0001, and 0.01, respectively), total triglycerides (r = 0.60, P = 0.006), HDL2/HDL3 quotient (P = −0.71, P = 0.001), VLDL triglycerides (r = 0.65, P = 0.004), and serum uric acid (r = 0.51, P = 0.03), but not with systolic blood pressure (r = 0.38, P = 0.15). After adjusting for BMI, only the correlations between LOGFER and diastolic blood pressure (r = 0.7, P = 0.002) and HDL2/HDL3 quotient (r = −0.63, P = 0.01) remained significant. Strong correlations between LOGFER and glucose area under the curve during oral glucose tolerance test (Pearson's r = 0.73, P = 0.001) and S1 (r = −0.68, P = 0.001), which remained significant after controlling for BMI, were observed. LOGFER (β = −0.44, P = 0.01) and BMI (β = −0.52, P = 0.004) constituted independent predictors of insulin sensitivity in a multivariate analysis (R2 = 0.68). In 76 consecutive NIDDM outpatients, serum glucose (P &lt; 0.00001) and LOGFER (P = 0.03) independently predicted the value of HbA1c (R2 = 0.40) in a multiple linear regression analysis.

CONCLUSIONS
The correlations among serum ferritin and diastolic blood pressure, HDL quotient, glucose area under the curve, and S1 suggest that serum ferritin could be a marker of the insulin resistance syndrome. Serum ferritin may also be an independent determinant of poor metabolic control in the diabetic patient.
Physical Activity, Dyspnea, and Chest Pain Before ana After Coronary Artery Bypass Grafting in Relation to a History of Diabetes
Authors: Herlitz Johan , Haglid Maria , Hartford Marianne , Karlson Björn W , Karlsson Thomas , Lindelöw Björn , Caidahl Kenneth 
Published: March 2007

OBJECTIVE
To describe the limitation of physical activity and symptoms of chest pain and dyspnea before and after coronary artery bypass grafting (CABG) in relation to a history of diabetes.

RESEARCH DESIGN AND METHODS
All patients in western Sweden in whom CABG was performed between 1988 and 1991 were asked to complete a questionnaire before 3 months and 2 years after the operation. The questionnaire evaluated limitation of physical activity and symptoms of chest pain and dyspnea.

RESULTS
In all, 2,121 patients participated in the evaluation, of whom 13% had a history of diabetes. The overall 2-year mortality was 14% among patients with a history of diabetes and 6% among patients without such a history (P &lt; 0.001). The proportion of patients with a limitation of physical activity caused by chest pain decreased from 76% before CABG to 19% 2 years after in diabetic patients (P &lt; 0.001) and from 79 to 17% in nondiabetic patients (P &lt; 0.001). The proportion of diabetic patients without dyspnea increased from 13% before to 31% 2 years after CABG (P &lt; 0.001). The corresponding figures for nondiabetic patients were 12 and 43% (P &lt; 0.001). Symptoms of angina pectoris were reported in 94% of diabetic patients before CABG versus 35% after 2 years (P &lt; 0.001). Corresponding figures for nondiabetic patients were 93 and 29% (P &lt; 0.001). Aggregate data confirmed differences between diabetic and nondiabetic patients, with more symptoms in the diabetic patients, particularly with regard to dyspnea.

CONCLUSIONS
Mortality during 2 years of follow up was more than twice as high in diabetic than in nondiabetic patients. Limitation of physical activity, dyspnea, and angina pectoris improved markedly and similarly in diabetic and nondiabetic patients after CABG. Whereas limitation of physical activity and dyspnea was more frequent in diabetic than in nondiabetic patients, the occurrence of angina pectoris was more similar in the two groups.