bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low Levels of Leisure-Time Physical Activity and Cardiorespiratory Fitness Predict Development of the Metabolic Syndrome
Authors: Laaksonen David E. , Lakka Hanna-Maaria , Salonen Jukka T. , Niskanen Leo K. , Rauramaa Rainer , Lakka Timo A. 
Published: March 2007

OBJECTIVE—Little is known about the association of leisure-time physical activity (LTPA) and cardiorespiratory fitness with development of the metabolic syndrome, which predisposes diseases such as diabetes and atherosclerosis. We studied the associations of LTPA and cardiorespiratory fitness with development of the metabolic syndrome (World Health Organization [WHO] and the National Cholesterol Education Program [NCEP] definitions).
RESEARCH DESIGN AND METHODS—LTPA over the previous 12 months, Vo2max (ml · kg−1 · min−1), and cardiovascular and metabolic risk factors were assessed in a population-based cohort of 612 middle-aged men without the metabolic syndrome.
RESULTS—At the 4-year follow-up, 107 men had metabolic syndrome (WHO definition). Men engaging in &gt;3 h/week of moderate or vigorous LTPA were half as likely as sedentary men to have the metabolic syndrome after adjustment for major confounders (age, BMI, smoking, alcohol, and socioeconomic status) or potentially mediating factors (insulin, glucose, lipids, and blood pressure), especially in high-risk men. Vigorous LTPA had an even stronger inverse association, particularly in unfit men. Men in the upper third of Vo2max were 75% less likely than unfit men to develop the metabolic syndrome, even after adjustment for major confounders. Adjustment for possible mediating factors attenuated the association. Associations of LTPA and Vo2max with development of the metabolic syndrome, as defined by the NCEP, were qualitatively similar.
CONCLUSIONS—In particular, high-risk men engaging in currently recommended levels of physical activity were less likely to develop the metabolic syndrome than sedentary men. Cardiorespiratory fitness was also strongly protective, although possibly not independent of mediating factors.
A Randomized Trial of Sibutramine in the Management of Obese Type 2 Diabetic Patients Treated With Metformin
Authors: McNulty Steven J. , Ur Ehud , Williams Gareth ,   For the Multicenter Sibutramine Study Group
Published: March 2007

OBJECTIVE—To evaluate the effects of sibutramine (15 and 20 mg/day) on weight, metabolic control, and blood pressure in metformin-treated obese subjects with type 2 diabetes.
RESEARCH DESIGN AND METHODS—A 12-month randomized prospective placebo-controlled double-blind study was performed. It included 21 primary and secondary care centers in England, Canada, France, and Belgium. A total of 195 subjects (44% male) with type 2 diabetes and a BMI &gt;27 kg/m2 were studied. Changes were assessed in weight, blood pressure and resting heart rate, HbA1c, fasting glucose, and lipids.
RESULTS—Sibutramine induced significant weight loss (P &lt; 0.001) with both 15 mg/day (5.5 ± 0.6 kg at 12 months) and 20 mg/day (8.0 ± 0.9 kg), whereas placebo did not (0.2 ± 0.5 kg). Weight loss ≥10% was achieved by 14 and 27% of subjects receiving 15 and 20 mg, respectively, but by none given placebo. Glycemic control improved in parallel with weight loss, and subjects who lost ≥10% weight showed significant decreases in both HbA1c (1.2 ± 0.4%, P &lt; 0.0001) and fasting plasma glucose (1.8 mmol/l, P &lt; 0.001). HDL cholesterol increased slightly with the higher dose, whereas plasma triglycerides fell with both doses, especially in subjects with weight loss of ≥10% (a 29% decrease, P &lt; 0.01). Treatment was generally well tolerated. Sibutramine treatment raised sitting diastolic blood pressure by ≥5 mmHg in a higher proportion of patients than did placebo (43% with 15 mg/day vs. 25% with placebo, P &lt; 0.05), but this effect was less evident in subjects who had a weight loss of ≥10% weight. Pulse rate increased significantly more with sibutramine, being ≥10 bpm higher in 42% of treated patients versus 17% with placebo (P &lt; 0.01).
CONCLUSIONS—Sibutramine can be an effective adjunct to metformin treatment in selected obese type 2 diabetic subjects and improves metabolic control in individuals who lose weight.
Rosiglitazone Improves Insulin Sensitivity and Lowers Blood Pressure in Hypertensive Patients
Authors: Raji Annaswamy , Seely Ellen W. , Bekins Shannon A. , Williams Gordon H. , Simonson Donald C. 
Published: March 2007

OBJECTIVE—To examine the effect of rosiglitazone on insulin resistance and blood pressure in patients with essential hypertension, classified based on abnormalities of their renin-angiotensin system.
RESEARCH DESIGN AND METHODS—A total of 24 hypertensive nondiabetic patients (age 58 ± 6 years, BMI 30 ± 5 kg/m2) were studied before and after rosiglitazone treatment. After 2 weeks off antihypertensive medication, subjects received a euglycemic-hyperinsulinemic clamp (40 mU · m−2 · min−1) with 6,6-[2H2]glucose infusion, ambulatory blood pressure monitoring, and blood tests for cardiovascular risk factors. Subjects were then placed on rosiglitazone (4 mg orally b.i.d.) and their usual antihypertensive medications (but not ACE inhibitors) for 16 weeks, and baseline tests were repeated.
RESULTS—There was no change in fasting plasma glucose (83 ± 2 vs. 82 ± 2 mg/dl, P = 0.60), but fasting insulin decreased (16.1 ± 1.4 vs. 12.5 ± 0.9 μU/ml, P &lt; 0.01). Total glucose disposal during the clamp increased (5.0 ± 0.4 vs. 5.9 ± 0.5 mg · kg−1 · min−1, P &lt; 0.001), with no change in suppression of hepatic glucose output. There were significant decreases in mean 24-h systolic (138 ± 2 vs. 134 ± 2 mmHg, P &lt; 0.02) and diastolic (85 ± 2 vs. 80 ± 2 mmHg, P &lt; 0.0001) blood pressure, and the decline in systolic blood pressure was correlated with the improvement in insulin sensitivity (r = 0.59, P &lt; 0.005). Triglycerides (135 ± 16 vs. 89 ± 8 mg/dl, P &lt; 0.01), LDL cholesterol (129 ± 6 vs. 122 ± 8 mg/dl, P = 0.18), and HDL cholesterol (51 ± 3 vs. 46 ± 3 mg/dl, P &lt; 0.02) all decreased, with no change in the LDL-to-HDL ratio. Plasminogen activator inhibitor-1 and C-reactive protein also declined significantly.
CONCLUSIONS—Rosiglitazone treatment of nondiabetic hypertensive patients improves insulin sensitivity, reduces systolic and diastolic blood pressure, and induces favorable changes in markers of cardiovascular risk. Insulin sensitizers may provide cardiovascular benefits when used in the treatment of patients with hypertension.
Determinants of Fetal Growth at Different Periods of Pregnancies Complicated by Gestational Diabetes Mellitus or Impaired Glucose Tolerance
Authors: Schaefer-Graf Ute M. , Kjos Siri L. , Kilavuz Ömer , Plagemann Andreas , Brauer Martin , Dudenhausen Joachim W. , Vetter Klaus 
Published: March 2007

OBJECTIVE—To determine maternal parameters with the strongest influence on fetal growth in different periods of pregnancies complicated by an abnormal glucose tolerance test (GTT).
RESEARCH DESIGN AND METHODS—Retrospective study of 368 women with gestational diabetes mellitus (GDM; ≥2 abnormal GTT values, n = 280) and impaired glucose tolerance (IGT; one abnormal value, n = 88) with 869 ultrasound examinations at entry to and during diabetic care. Both groups were managed comparably. Abdominal circumference (AC) ≥90th percentile defined fetal macrosomia. Maternal historical and clinical parameters, and diagnostic and glycemic values of glucose profiles divided into five categories of 4 weeks of gestational age (GA; &lt;24 weeks, 24 weeks/0 days to 27 weeks/6 days, 28/0–31/6, 32/0–35/6, and 36/0–40/0 [referred to as &lt;24 GA, 24 GA, 28 GA, 32 GA, and 36 GA categories, respectively]) were tested by univariate and multiple logistic regression analysis for their ability to predict an AC ≥90th percentile at each GA group and large-for-gestational-age (LGA) newborn. Data obtained at entry were also analyzed separately irrespective of the GA.
RESULTS—Maternal weight, glycemia after therapy, rates of fetal macrosomia, and LGA were not significantly different between GDM and IGT; thus, both groups were analyzed together. LGA in a previous pregnancy, (odds ratio [OR] 3.6; 95% CI 1.8–7.3) and prepregnancy obesity (BMI ≥30 kg/m2; 2.1; 1.2–3.7) independently predicted AC ≥90th percentile at entry. When data for each GA category were analyzed, no predictors were found for &lt;24 GA. Independent predictors for each subsequent GA category were as follows: at 24 GA, LGA history (OR 9.8); at 28 GA, LGA history (OR 4.2), and obesity (OR 3.3); at 32 GA, fasting glucose of 32 GA (OR 1.6 per 5-mg/dl increase); at 36 GA, fasting glucose of 32 GA (OR 1.6); and for LGA at birth, LGA history (OR 2.7), and obesity (OR 2.4).
CONCLUSIONS—In the late second and early third trimester, maternal BMI and LGA in a previous pregnancy appear to have the strongest influence on fetal growth, while later in the third trimester coincident with the period of maximum growth described in diabetic pregnancies, maternal glycemia predominates.
Costs Associated With the Primary Prevention of Type 2 Diabetes Mellitus in the Diabetes Prevention Program
Authors:   The Diabetes Prevention Program Research Group
Published: March 2007

OBJECTIVE—To describe the costs of the Diabetes Prevention Program (DPP) interventions to prevent or delay type 2 diabetes.RESEARCH DESIGN AND METHODS—We describe the direct medical costs, direct nonmedical costs, and indirect costs of the placebo, metformin, and intensive lifestyle interventions over the 3-year study period of the DPP. Resource use and cost are summarized from the perspective of a large health system and society. Research costs are excluded.RESULTS—The direct medical cost of laboratory tests to identify one subject with impaired glucose tolerance (IGT) was $139. Over 3 years, the direct medical costs of the interventions were $79 per participant in the placebo group, $2,542 in the metformin group, and $2,780 in the lifestyle group. The direct medical costs of care outside the DPP were $272 less per participant in the metformin group and $432 less in the lifestyle group compared with the placebo group. Direct nonmedical costs were $9 less per participant in the metformin group and $1,445 greater in the lifestyle group compared with the placebo group. Indirect costs were $230 greater per participant in the metformin group and $174 less in the lifestyle group compared with the placebo group. From the perspective of a health system, the cost of the metformin intervention relative to the placebo intervention was $2,191 per participant and the cost of the lifestyle intervention was $2,269 per participant over 3 years. From the perspective of society, the cost of the metformin intervention relative to the placebo intervention was $2,412 per participant and the cost of the lifestyle intervention was $3,540 per participant over 3 years.CONCLUSIONS—The metformin and lifestyle interventions are associated with modest incremental costs compared with the placebo intervention. The evaluation of costs relative to health benefits will determine the value of these interventions to health systems and society.
Alcohol Consumption and Risk for Development of Impaired Fasting Glucose or Type 2 Diabetes in Middle-Aged Japanese Men
Authors: Nakanishi Noriyuki , Suzuki Kenji , Tatara Kozo 
Published: March 2007

OBJECTIVE—To investigate the association between alcohol consumption and risk for development of diabetes.
RESEARCH DESIGN AND METHODS—We examined 2,953 Japanese male office workers aged 35–59 years who did not have impaired fasting glucose (IFG) (a fasting plasma glucose concentration of 6.1–6.9 mmol/l), type 2 diabetes (a fasting plasma glucose concentration of ≥7.0 mmol/l or receipt of hypoglycemic medication), medication for hypertension, or a history of cardiovascular disease. Fasting plasma glucose concentrations were measured at periodic annual health examinations from May 1994 through May 2001.
RESULTS—There was a U-shaped association between alcohol consumption and the incidence of IFG or type 2 diabetes during 7 years of follow-up, with the lowest incidence at alcohol intake of 23.0–45.9 g ethanol/day. After controlling for age, family history of diabetes, BMI, cigarette smoking, and physical activity, the relative risk for development of IFG or type 2 diabetes compared with alcohol consumption of 23.0–45.9 g ethanol/day was 1.51 (95% CI, 1.07–2.13), 1.31 (95% CI, 0.93–1.84), 1.18 (95% CI, 0.87–1.61), and 1.43 (95% CI, 1.01–2.02) with alcohol consumption of 0, 0.1–22.9, 46.0–68.9, and ≥69.0 g ethanol/day, respectively (P for quadratic trend = 0.016). Analyses by presence or absence of a risk factor revealed that a U-shaped association was more evident in older men, men without a family history of diabetes, and nonsmokers.
CONCLUSIONS—These results indicate that moderate alcohol consumption among apparently healthy Japanese men is associated with reduced risk for development of IFG or type 2 diabetes.
Age- and Sex-Specific Prevalences of Diabetes and Impaired Glucose Regulation in 13 European Cohorts
Authors:   The DECODE Study Group
Published: March 2007

OBJECTIVE—To report the age- and sex-specific prevalences of diabetes and impaired glucose regulation (IGR) according to the revised 1999 World Health Organization criteria for diabetes in Europe.
RESEARCH DESIGN AND METHODS—A total of 13 studies from nine European countries with 7,680 men and 9,251 women aged 30–89 years were included in the data analysis.
RESULTS—In most of the study populations, the age-specific prevalences of diabetes were &lt;10% in subjects younger than 60 years and between 10 and 20% at 60–79 years of age. Mean 2-h plasma glucose (2hPG) concentration increased linearly with age, but fasting plasma glucose (FPG) concentration did not. The increase in the prevalence of undiagnosed diabetes and IGR in the elderly was mainly a result of the large increase in 2hPG rather than FPG. Diabetes and impaired fasting glycemia defined by isolated fasting hyperglycemia was more common in men than in women 30–69 years of age, whereas the prevalence of isolated postload hyperglycemia, particularly impaired glucose tolerance, was higher in women than in men, especially in the elderly (individuals &gt;70 years of age). More than half of the diabetes was undiagnosed in subjects younger than 50 years of age.
CONCLUSIONS—Most European populations have a moderate to low prevalence of diabetes and IGR. Diabetes and IGR will be underestimated in Europe, particularly in women and in elderly men, if diagnoses are based on fasting glucose determination alone.
Incidence of Retinopathy and Nephropathy in Youth-Onset Compared With Adult-Onset Type 2 Diabetes
Authors: Krakoff Jonathan , Lindsay Robert S. , Looker Helen C. , Nelson Robert G. , Hanson Robert L. , Knowler William C. 
Published: March 2007

OBJECTIVE—To examine the risk of retinopathy and nephropathy in participants in whom type 2 diabetes was diagnosed in youth (before 20 years of age) compared with those in whom type 2 diabetes was diagnosed at older ages.
RESEARCH DESIGN AND METHODS—Subjects in whom youth-onset or adult-onset diabetes was diagnosed in the longitudinal study of health in the Pima Indians of Arizona were followed for microvascular complications. Diabetes was diagnosed in 178 subjects before 20 years of age (youth), in 1,359 subjects at 20–39 years of age (younger adults), and in 971 subjects at 40–59 years of age (older adults). Incidence rates of diabetic retinopathy diagnosed by direct ophthalmoscopy through dilated pupils and nephropathy (protein-to-creatinine ratio ≥0.5 g/g) were calculated by age at diagnosis.
RESULTS—Over 25 years, nephropathy developed in 35 of the participants with youth-onset type 2 diabetes; this incidence rate was not significantly different from that in patients with adult-onset diabetes (P = 0.77). Incidence rates of retinopathy, however, were significantly lower for the youth-onset group (P = 0.007). Adjusted for sex, glycemia, and blood pressure, risk of retinopathy was lower in patients with youth-onset diabetes than in those with adult-onset diabetes (hazard rate ratio [HRR] 0.42, 95% CI 0.24–0.74, P = 0.003), but risk of nephropathy was not different (HRR 1.2, 95% CI 0.77–1.3, P = 0.38).
CONCLUSIONS—In Pima Indians, the risk of nephropathy as a function of duration of diabetes is similar in all age groups. By contrast, the risk of retinopathy is lower in patients with youth-onset type 2 diabetes.
Autoimmune Gastropathy in Type 1 Diabetic Patients With Parietal Cell Antibodies
Authors: De Block Christophe E.M. , De Leeuw Ivo H. , Bogers Johannes J.P.M. , Pelckmans Paul A. , Ieven Margareta M. , Van Marck Eric A.E. , Van Acker Kristien L. , Van Gaal Luc F. 
Published: March 2007

OBJECTIVE—Approximately 15–20% of type 1 diabetic patients exhibit parietal cell antibodies (PCAs) targeting gastric H+/K+ATPase. We examined whether iron deficiency anemia, pernicious anemia, and autoimmune gastritis, which may predispose to gastric tumors, were more frequent in PCA+ than in PCA- patients.
RESEARCH DESIGN AND METHODS—Gastric biopsies from 88 consecutively recruited type 1 diabetic patients (51 men and 37 women, 47 PCA+ and 41 PCA-, aged 42 ± 13 years) were evaluated using the updated Sydney system. Immunostaining was done for parietal cells, B- and T-cells, enterochromaffin-like (ECL) cells, and Helicobacter pylori (HP). PCAs were assayed by indirect immunofluorescence, H+/K+ATPase antibodies by enzyme immunoassay, and HP by serology, urea breath test, and histology. Pentagastrin tests were performed in 42 subjects.
RESULTS—Autoimmune gastritis (AG) was present in 57% of PCA+ and 10% of PCA- cases (OR 12.5, P &lt; 0.0001). PCA positivity (β = 1.44; P = 0.04) and hypergastrinemia (β = 0.01; P = 0.026), but not HP, age, diabetes duration, sex, and HLA-DQ type were risk factors for AG. Iron deficiency anemia (OR 3.9, P = 0.015), pernicious anemia (OR = 4.6, P = 0.022), and hypochlorhydria (OR = 20.0, P = 0.0002) were more frequent in AG+ individuals. HP infection was present in 47 patients but did not influence corpus histology or gastrinemia. (Pre)malignant lesions were found in 26% of PCA+ subjects: ECL cell hyperplasia in 7 AG+ patients, comprising 1 with a gastric carcinoid tumor, and corpus intestinal metaplasia in 11 AG+ patients, including 1 with linitis plastica.
CONCLUSIONS—PCA+ type 1 diabetic patients should be screened for autoimmune gastritis, iron deficiency, and pernicious anemia. Particularly hypergastrinemic PCA+ patients with autoimmune gastritis are at increased risk for (pre)malignant gastric lesions.
Secondary Prevention of Cardiovascular Events With Long-Term Pravastatin in Patients With Diabetes or Impaired Fasting Glucose
Authors: Keech Anthony , Colquhoun David , Best James , Kirby Adrienne , Simes R. John , Hunt David , Hague Wendy , Beller Elaine , Arulchelvam Manjula , Baker Jennifer , Tonkin Andrew ,   for the LIPID Study Group
Published: March 2007

OBJECTIVE—Diabetes, a major health problem worldwide, increases the risk of cardiovascular disease and its associated mortality. Evidence of the overall benefits of lipid modification in this area is needed.
RESEARCH DESIGN AND METHODS—The Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) trial showed that cholesterol-lowering treatment with pravastatin reduced mortality and coronary heart disease (CHD) events in 9,014 patients aged 31–75 years with CHD and total cholesterol 4.0–7.0 mmol/l. We measured the effects of pravastatin therapy, 40 mg/day over 6.0 years, on the risk of CHD death or nonfatal myocardial infarction and other cardiovascular outcomes in 1,077 LIPID patients with diabetes and 940 patients with impaired fasting glucose (IFG).
RESULTS—In patients allocated to placebo, the risk of a major CHD event was 61% higher in patients with diabetes and 23% higher in the IFG group than in patients with normal fasting glucose, and the risk of any cardiovascular event was 37% higher in the diabetic group and 19% higher in the IFG group. Pravastatin therapy reduced the risk of a major CHD event overall from 15.9 to 12.3% (relative risk reduction [RRR] 24%, P &lt; 0.001) and from 23.4 to 19.6% in the diabetic group (19%, P = 0.11); in the diabetic group, the reduction was not significantly different from the reductions in the other groups. Pravastatin reduced the risk of any cardiovascular event from 52.7 to 45.2% (21%, P &lt; 0.008) in patients with diabetes and from 45.7 to 37.1% (26%, P = 0.003) in the IFG group. Pravastatin reduced the risk of stroke from 9.9 to 6.3% in the diabetic group (RRR 39%, CI 7–61%, P = 0.02) and from 5.4 to 3.4% in the IFG group (RRR 42%, CI −9 to 69%, P = 0.09). Pravastatin did not reduce the incidence of diabetes. Over 6 years, pravastatin therapy prevented one major CHD event (CHD death or nonfatal myocardial infarction) in 23 patients with IFG and 18 patients with diabetes. A meta-analysis of other major trials confirmed the high absolute risks of diabetes and IFG and the absolute benefits of statin therapy in these patients.
CONCLUSIONS—Cholesterol-lowering treatment with pravastatin therapy prevents cardiovascular events, including stroke, in patients with diabetes or IFG and established CHD.
Relation of Left Ventricular Hypertrophy to Inflammation and Albuminuria in Adults With Type 2 Diabetes
Authors: Palmieri Vittorio , Tracy Russell P. , Roman Mary J. , Liu Jennifer E. , Best Lyle G. , Bella Jonathan N. , Robbins David C. , Howard Barbara V. , Devereux Richard B. 
Published: March 2007

OBJECTIVE—To evaluate in adults with type 2 diabetes the extent to which the relation of left ventricular hypertrophy (LVH) to markers of systemic inflammation (fibrinogen and high-sensitivity C-reactive protein [hsCRP]) are affected by microangiopathy.
RESEARCH DESIGN AND METHODS—We selected adults with type 2 diabetes using American Diabetes Association criteria from a population-based cohort, excluding those with medical history or electrocardiographic evidence of coronary heart disease or dialysis-dependent renal failure. LVH was assessed by echocardiogram.
RESULTS—Of the 1,299 eligible participants, 384 (29.6%) had LVH, which was associated with higher BMI, hsCRP, fibrinogen, and albuminuria in univariate analyses. After controlling for significant confounders, fibrinogen and albuminuria were higher in the presence of LVH (both P &lt; 0.01), whereas hsCRP was not (P = 0.2), mostly because of the confounding effect of BMI. Adjustment for albuminuria abolished the relation of LVH to higher fibrinogen (P = 0.2). However, fibrinogen was significantly higher in participants with LVH among those without pathologic levels of albuminuria (&lt;30 mg/g creatinuria), but not independent of BMI. Although hsCRP and fibrinogen were moderately correlated, fibrinogen, but not CRP, showed a significant relation with albuminuria.
CONCLUSIONS—In adults with type 2 diabetes, echocardiographic LVH is associated with susceptibility to atherothrombosis and increased albuminuria, which is a marker of microangiopathy and endothelial dysfunction that appears in turn to be a relevant pathogenetic link between LVH and inflammation. However, in the absence of significant microalbuminuria, elevated BMI is a relevant pathogenetic factor in the relation of LVH to increased levels of markers of inflammation, potentially preceding development of significant albuminuria. In the presence of microangiopathy, we found that the atherothrombotic risk profile associated with LVH was independent of BMI and possibly reflected the association of LVH with a higher degree of endothelial dysfunction.