bluuebunny/crossref_metadata_2025_split huggingface dataset:
Presence of Anti-Pituitary Antibodies and GAD Antibodies in NIDDM and IDDM
Authors: Kobayashi Takeo , Yabe Shigeki , Kikuchi Takashi , Kanda Tsugiyasu , Kobayashi Isao 
Published: March 2007

OBJECTIVE
To evaluate the clinical significance of the presence of anti-pituitary antibodies (APAs) in patients with NIDDM or IDDM and to examine the relationship of APAs to GAD antibodies (GADAs).

RESEARCH DESIGN AND METHODS
Serum samples were obtained from patients with NIDDM and IDDM. APAs, determined by Western blot analysis, and GADAs, determined by radioimmunoassay, were detected in the patients' sera and control sera. Urinary levels of C-peptide (U-CPR) were measured.

RESULTS
The prevalence of APAs was significantly higher in patients with NIDDM (24.2%) or IDDM (56.8%) than in healthy control subjects (6%). In patients with NIDDM, the levels of U-CPR were significantly lower, and the prevalence of insulin deficiency was higher in APA+ patients than in APA− patients.

CONCLUSIONS
This is the first study to demonstrate that the prevalence of APAs is increased in patients with NIDDM and IDDM. The presence of APAs may be related to reduced secretion of insulin in NIDDM patients.
Contraindications to Metformin Therapy in Patients With NIDDM
Authors: Sulkin Thomas V , Bosman Deborah , Krentz Andrew J 
Published: March 2007

OBJECTIVE
Treatment with metformin is occasionally associated with the development of severe lactic acidosis. However, this is usually observed in patients with major contraindications to the drug. In this study, we aimed to determine the prevalence of conditions currently regarded as either contraindications or cautions to the use of metformin in patients with NIDDM.

RESEARCH DESIGN AND METHODS
The case notes of metformin-treated NIDDM patients (mean age 62 years) attending a United Kingdom university hospital diabetes clinic over a 3-month period were reviewed according to criteria reflecting a pragmatic view of current prescribing recommendations.

RESULTS
Of 89 consecutive patients whose notes could be evaluated in detail, only 41 (46%) had no contraindications or cautions to metformin whatsoever. Concomitant chronic disorders associated with a potentially increased risk of hyperlactatemia were renal impairment (n = 2; plasma creatinine concentrations 1.7 and 2.3 mg/dl, respectively), cardiac failure (n = 2), and chronic liver disease (n = 2). Other potentially relevant disorders included ischemic heart disease (n = 20), clinical proteinuria (n = 14), peripheral vascular disease (n = 22), and pulmonary disease (n = 7). Multiple conditions (i.e., two, three, or four) were present in eight, five, and one patient(s), respectively.

CONCLUSIONS
More than half the patients in our series had concomitant conditions or complications conventionally regarded as cautions or contraindications to metformin; ∼ 10% had a multiplicity of such conditions. Regular surveillance is necessary to detect the development of complications such as renal impairment. Vigilance is also required in view of the increased risk of major intercurrent illnesses, which may independently disturb lactate metabolism in patients with NIDDM. Metformin should be withdrawn promptly under such circumstances.
Glipizide-GITS Does Not Increase the Hypoglycemic Effect of Mild Exercise During Fasting in NIDDM
Authors: Riddle Matthew C , McDaniel Patricia A , Tive Leslie A 
Published: March 2007

OBJECTIVE
This study compared the effect of mild exercise while fasting on plasma glucose concentrations in subjects with NIDDM treated with extended-release glipizide and subjects not taking an oral hypoglycemic agent.

RESEARCH DESIGN AND METHODS
Twenty-five moderately obese subjects with NIDDM were randomized to treatment with extended-release glipizide or placebo. After 9 weeks of treatment, they fasted overnight, took their study drug, omitted breakfast, and exercised on a treadmill for 90 min. Glucose, insulin, and C-peptide concentrations were measured before, during, and after exercise.

RESULTS
On the fasting-exercise day, fasting glucose concentrations were lower (153 vs. 241 mg/dl, P &lt; 0.01) and insulin and C-peptide concentrations higher in the extended-release glipizide group. The decrement of glucose from the fasting baseline was modest and equivalent in the two groups: 17 vs. 21 mg/dl at the end of exercise and 28 vs. 27 mg/dl after 2 h of recovery. No subject had hypoglycemic symptoms.

CONCLUSIONS
Chronic use of extended-release glipizide does not enhance the hypoglycemic effect of fasting plus mild exercise for people with NIDDM. Routine lifestyle treatments for NIDDM may be continued during ongoing use of this agent.
Epalrestat, an Aldose Reductase Inhibitor, Improves an Impaired Generation of Oxygen-Derived Free Radicals by Neutrophils From Poorly Controlled NIDDM Patients
Authors: Sato Noriyuki , Kashima Koji , Uehara Yutaka , Ohtani Kenichi , Shimizu Hiroyuki , Mori Masatomo 
Published: March 2007

OBJECTIVE
To study the in vivo effect of epalrestat (Epa), an aldose reductase inhibitor, on the generation of oxygen-derived free radicals by neutrophils from poorly controlled NIDDM patients (HbA1c &gt; 10%).

RESEARCH DESIGN AND METHODS
A total of 31 diabetic patients were randomly divided into two groups: an Epa(+) group of 16 patients treated with 150 mg/day epalrestat and an Epa(−) group of 15 patients treated without epalrestat. A control group of 20 age- and sex-matched normal healthy subjects also participated. HbA1c, postprandial plasma glucose (PPG), and neutrophil bactericidal function were measured before and at the end of the drug treatment period (4 weeks). Neutrophil bactericidal function was measured as chemilu-minescence amplified by a Cypridina luciferin analog (CLA), which is dependent on O2− generation, and by luminol (L), which is highly dependent on OCl− generation, in response to formyl-methonyl-leucyl-phenylalanine (fMLP).

RESULTS
At the start of the experiment, both CLA-dependent chemiluminescence (CLA-DCL) and L-dependent chemiluminescence (L-DCL) were clearly decreased in diabetic subjects (64 and 54%, respectively; P &lt; 0.05) compared with control subjects (2,182 ± 144 and 3,221 ± 173 kc · min−1 · 10−6 cells, respectively). At the end of the experiment, CLA-DCL and L-DCL in the Epa(+) group were significantly improved by 44 and 46%, respectively; however, these values were still lower than the corresponding results in the control group. HbA1c and PPG in both the Epa(+) and Epa (−) groups were significantly higher than in the control group, and treatment had no effect on either HbA1c or PPG.

CONCLUSIONS
These data suggest that epalrestat may be a useful drug to prevent infection by improving the impaired O2− and OCl− generation by neutrophils from poorly controlled NIDDM patients.
Risk Factors for Diabetic Peripheral Sensory Neuropathy: Results of the Seattle Prospective Diabetic Foot Study
Authors: Adler Amanda I , Boyko Edward J , Ahroni Jessie H , Stensel Victoria , Forsberg Ruby C , Smith Douglas G 
Published: March 2007

OBJECTIVE
To identify risk factors for diabetic lower-extremity peripheral sensory neuropathy prospectively in a cohort of U.S. veterans with diabetes.

RESEARCH DESIGN AND METHODS
General medicine clinic outpatients with diabetes were followed prospectively for the development of insensitivity to the 5.07 monofilament on the foot.

RESULTS
Of 775 subjects, 388 (50%) had neuropathy at baseline. Of the 387 subjects without neuropathy at baseline, 288 were followed up, and of these, 58 (20%) developed neuropathy. Multivariate logistic regression modeling of prevalent neuropathy controlling for sex and race revealed independent and significant associations with age, duration of diabetes, glycohemoglobin level, height, history of lower-extremity ulceration, callus, and edema; an independent and inverse correlation was noted with ankle-arm index. Risk factors for incident neuropathy in multivariate logistic regression included age, baseline glycohemoglobin level, height, history of ulcer, and CAGE screening instrument alcohol score; current smoking and albumin level were inversely associated with risk.

CONCLUSIONS
Poorer glycemic control increases the risk of neuropathy and is amenable to intervention. Height and age directly increase risk of neuropathy and may help identify patients at risk. A proportion of neuropathy in diabetic veterans is probably due to or worsened by alcohol ingestion. Neuropathy was less common in current smokers than subjects not currently smoking.
IDDM and Milk Consumption: A case-control study in São Paulo, Brazil
Authors: Gimeno Suely Godoy Agostinho , Souza José Maria Pacheco De 
Published: March 2007

OBJECTIVE
To test the hypothesis that breast-feeding is a protective factor against IDDM and that early exposure to cow's milk is a risk factor for the disease.

RESEARCH DESIGN AND METHODS
A case-control study was conducted in São Paulo, Brazil. A total of 346 diabetic children, aged &lt; 18 years, were identified in two institutions in the city of São Paulo. Duration of exclusive breast-feeding and age of introduction to cow's milk products in infant diet were compared with 346 sex-, age-, and neighborhood-matched control children. All comparisons between diabetic and control children were done using paired tests.

RESULTS
Statistically significant differences were found for the duration of exclusive breast-feeding (P = 0.007) and for the age of introduction to cow's milk products (P = 0.047). Control children had a longer time of exclusive breast-feeding and had received cow's milk later in their diet than the case children.

CONCLUSIONS
The results suggest that a shorter duration of exclusive breast-feeding is a risk factor for IDDM (odds ratio [OR] 2.13; 95% CI 1.8–3.55) and that the introduction to cow's milk products before age 8 days is a risk factor for the disease (OR 2.29;95% CI 1.37–3.83).
NIDDM and Blood Pressure as Risk Factors for Poor Cognitive Performance: The Framingham Study
Authors: Elias Penelope K , Elias Merrill F , D'Agostino Ralph B , Cupples L Adrienne , Wilson Peter W , Silbershatz Halit , Wolf Philip A 
Published: March 2007

OBJECTIVE
To determine if NIDDM and blood pressure are risk factors for poor cognitive performance and if history and duration of NIDDM and blood pressure interact such that the risk of poor performance is greater for subjects with both NIDDM and hypertension.

RESEARCH DESIGN AND METHODS
We used a large prospective cohort sample with 187 NIDDM subjects and 1,624 nondiabetic subjects who were followed for 28–30 years. Cognitive function was assessed using eight tests of learning, memory, visual organization, verbal fluency attention, concept formation, and abstract reasoning. A composite score was also calculated. Odds ratios were used to estimate the relative risk of performing below the lower 25th percentile of z scores on these tests.

RESULTS
NIDDM and blood pressure interacted such that diagnosis and duration of NIDDM were associated with greater risk of poor performance on tests of visual memory and on the composite score for hypertensive subjects. Duration of NIDDM was associated with increased risk for poor performance on tests of verbal memory and concept formation. Insulin-treated NIDDM subjects were at higher risk for poor cognitive performance than those NIDDM subjects treated with oral agents or diet. Blood pressure level was associated independently with a measure of verbal fluency.

CONCLUSIONS
History and duration of NIDDM and high blood pressure are significant risk factors for poor cognitive performance. Hypertensive people with NIDDM are at greatest risk for poor performance on tests measuring visual organization and memory.
Serum Immunoreactive Leptin Concentrations in a Canadian Aboriginal Population With High Rates of NIDDM
Authors: Hanley Anthony J G , Harris Stewart B , Gao X Joe , Kwan Jeremy , Zinman Bernard 
Published: March 2007

OBJECTIVE
To better understand the relationship between leptin and the anthropometric and physiological variables associated with diabetes, we measured this protein in an isolated Canadian aboriginal population with very high rates of NIDDM.

RESEARCH DESIGN AND METHODS
There were 728 individuals aged 10–79 years who participated in a population-based survey to determine the prevalence of NIDDM and its associated risk factors. Fasting blood samples for glucose, insulin, triglyceride, and leptin were collected; a 75-g oral glucose tolerance test was administered and a second blood sample drawn after 120 min. Height, weight, and waist and hip circumference were determined, and percent body fat was estimated using biological impedance analysis. Fitness level was assessed in a subsample of individuals using a validated submaximal step test. The relationship between serum leptin and the other variables was assessed using Spearman's correlation coefficients and multiple linear regression.

RESULTS
Serum leptin concentration was strongly correlated with adiposity, and levels were substantially higher in female subjects in all age-groups. For male subjects, percent body fat, fasting insulin level, and waist circumference were significant independent predictors of log serum leptin concentration in a multiple linear regression model (R2 ; 0.582). For female subjects, these variables plus glucose tolerance status were included in the final model (R2 ; 0.633). Fitness level, when included with the main effects of the above models, was a significant predictor for male subjectsonly.

CONCLUSIONS
In an isolated aboriginal community with high rates of diabetes, we found significant independent relationships between leptin and percent body fat and between leptin and fasting insulin. As documented in other populations, the higher leptin concentration among female subjects may reflect differential leptin production from different adipose tissue beds, or leptin resistance. Independent relationships also existed among leptin and glucose tolerance status in female subjects and fitness level in male subjects.
Glycosylated Hemoglobin Level and Carotid Intimal-Medial Thickening in Nondiabetic Individuals: The Atherosclerosis Risk in Communities Study
Authors: Vitelli Lori L , Shahar Eyal , Heiss Gerardo , McGovern Paul G , Brancati Frederick L , Eckfeldt John H , Folsom Aaron R ,   Atherosclerosis risk in Communities (ARIC) Study Investigators
Published: March 2007

OBJECTIVE
People with diabetes are at increased risk for cardiovascular events. However, questions remain about what role, if any, homeostatic glucose control plays in the development of cardiovascular disease among nondiabetic individuals. We investigated the relationship between HbA1c level and carotid intimal-medial thickening in normoglycemic individuals.

RESEARCH DESIGN AND METHODS
We conducted a case-control study among 208 normoglycemic individuals (fasting glucose ≤ 6.4 mmol/l and no history of diabetes) who had carotid initial-medial thickening (case subjects) and 208 normoglycemic control subjects individually matched for age, sex, race, field center, and date of exam. Subjects were free-living men and women, aged 45–64 years at baseline, who participated in the Atherosclerosis Risk in Communities (ARIC) Study.

RESULTS
HbA1c levels, expressed as percent of total hemoglobin, ranged from 4 to 7% and correlated only modestly with single measurements of fasting glucose (r = 0.16) and fasting insulin (r = 0.14). The mean level of HbA1c was 5.18% among case subjects and 5.07% among control subjects (P = 0.004, paired t test). As compared with the first quartile of HbA1c the matched relative odds of being a case were 1.15, 1.33, and 2.30 for the second, third, and fourth quartiles, respectively (P = 0.005 for linear trend). After multivariate adjustment for age, fasting glucose, fasting insulin, BMI, smoking status, hypertension, LDL cholesterol, HDL cholesterol, fibrinogen, and education level, the respective relative odds estimates were 0.98, 1.07, and 1.8 (P = 0.16 for linear trend). When modeled linearly as a continuous variable and after adjustment for the above-mentioned covariates, a 1% point increment in HbA1c level was associated with 1.77 greater odds of being a case (95% CI, 0.9–3.5).

CONCLUSIONS
These data provide some support to the hypothesis that in the absence of diabetes, homeostatic glycemic control is a risk factor for atherosclerosis.
Longitudinal Study of Carbohydrate Metabolism in Healthy Obese Pregnant Women
Authors: Sivan Eyal , Chen Xinhua , Homko Carol J , Reece E Albert , Boden Guenther 
Published: March 2007

OBJECTIVE
To longitudinally characterize changes in insulin sensitivity in obese women during and after pregnancy.

RESEARCH DESIGN AND METHODS
Six glucose-tolerant obese women underwent a 4-h euglycemic-hyperinsulinemic (500–600 pmol/l) clamping during the second (22.5 ± 2 weeks [mean ± SD]) and third trimester (36.8 ± 0.9) of pregnancy and again 15.6 ± 1.4 weeks after delivery. Rates of total body glucose turnover (with [6.6−2H2]glucose) and oxidation (with indirect calorimetry) were measured.

RESULTS
There were no significant changes with respect to the action of insulin on rates of glucose disappearance (GRd), carbohydrate oxidation, or endogenous glucose production (EGP), comparing the second trimester of pregnancy with the nonpregnant (postpartum) state. The third trimester, however, was characterized 1) by reductions in insulin-stimulated GRd (−28%, P &lt; 0.05, compared with the second trimester and −40%, P &lt; 0.05, compared with postpartum); 2) by even larger reductions in insulin-stimulated carbohydrate oxidation (−46%, P &lt; 0.05, compared with the second trimester and −54%, P &lt; 0.02, compared with postpartum); and 3) by reduction of insulin suppression of EGP (−39% compared with −79% at the second trimester and −77% postpartum, P &lt; 0.01).

CONCLUSIONS
Glucose-tolerant obese women developed peripheral was well as hepatic insulin resistance during the third trimester of pregnancy. These alterationswere reversed after delivery and appeared to be adaptive mechanisms to copewith the increased demand for glucose of the growing fetus.
Improved Glycemic Control in Intensively Treated Type 1 Diabetic Patients Using Blood Glucose Meters With Storage Capability and Computer-Assisted Analyses
Authors: Strowig Suzanne M , Raskin Philip 
Published: March 2007

OBJECTIVE
To determine the effect on glycemic control in intensively treated type 1 diabetic patients using a blood glucose meter with storage capability and computer-assisted analyses.

RESEARCH DESIGN AND METHODS
Glycemic control was assessed in 22 intensively treated adults with type 1 diabetes for 12 months while using a meter without memory, followed by 12 months while using a meter with memory. Log books were used to assist patients in managing aspects of the diabetes treatment plan during the first 12-month period, and computer-assisted analyses were used when the meter with memory was used. GHb levels were measured monthly throughout the 24 months of observation.

RESULTS
The mean GHb level averaged across all patients during the period of memory meter use (6.4%) was significantly lower than that during the period of meter use without memory (6.9%) (P = 0.0004). The change in GHb levels from each period-specific baseline level occurred at significantly different slopes (P = 0.046) when adjusted for baseline GHb level. In addition, the downward trend in GHb level was greater in those patients who increased the frequency of testing the most (r = −0.54, P = 0.01).

CONCLUSIONS
Use of a meter with memory in conjunction with computer-generated analyses of stored blood glucose test results can lead to improved glycemic control when used by a group of intensively treated adult diabetic patients. Improvement in glycemic control was related to frequency of blood glucose testing.
Hepatocyte Growth Factor in Vitreous Fluid of Patients With Proliferative Diabetic Retinopathy and Other Retinal Disorders
Authors: Katsura Yoshiya , Okano Tadashi , Noritake Masayuki , Kosano Hiroshi , Nishigori Hideo , Kado Seijiro , Matsuoka Takeshi 
Published: March 2007

OBJECTIVE
To determine whether hepatocyte growth factor (HGF) is elevated in the vitreous fluid of patients with proliferative diabetic retinopathy (PDR).

RESEARCH DESIGN AND METHODS
Vitreous fluid samples were obtained at the time of vitreoretinal surgery from 73 eyes of PDR patients and from 17 eyes of nondiabetic patients (control subjects) who had macular hole, rhegmatogenous retinal detachment, or epiretinal membrane (9, 4, and 4 eyes, respectively) but no associated proliferative vitreoretinopathy. Stages of PDR were classified as active or quiescent. Concentrations of HGF and vascular endothelial growth factor (VEGF) in vitreous fluid were determined by enzyme-linked immunosorbent assay (ELISA).

RESULTS
Intravitreous concentrations of HGF (median [range]) were significantly higher in diabetic patients with PDR (6.00 ng/ml [0.75−22.2]) than in control patients (2.86 ng/ml [0.75−5.80]). Intravitreous concentrations of VEGF were also higher in diabetic patients with PDR (1.62 ng/ml [0.15−7.9]) than in control patients (0.16 ng/ml [0.16−0.29]). Both VEGF and HGF concentrations were significantly higher in patients with active retinopathy than in those with quiescent retinopathy. However, vitreous concentrations of HGF were unrelated to those of VEGF

CONCLUSIONS
We found that levels of HGF in vitreous fluid of PDR patients are significantly higher than in nondiabetic patients and that the levels of HGF are elevated in the active PDR stage. This suggests that HGF stimulates or perpetuates neovascularization in PDR.
Offering a Randomized Mai of Intensive Therapy for IDDM to Adolescents: Reasons for refusal, patient characteristics, and recruiter effects
Authors: Tercyak Kenneth P , Johnson Suzanne Bennett , Kirkpatrick Kimberly A , Silverstein Janet H 
Published: March 2007

OBJECTIVE
To identify reasons adolescents refuse to participate in a randomized trial of intensive therapy (IT) for IDDM, to describe the patient characteristics of those who consent and those who refuse to participate, and to examine recruiter effects on trial participation rates.

RESEARCH DESIGN AND METHODS
A total of 99 adolescents, age 11–18 years, were provided with the results of the Diabetes Control and Complications Trial and approached for possible study participation by two nurse recruiters. Adolescents refusing the trial were administered a semi-structured interview to describe reasons for study refusal; responses were recorded and later coded into categories. Patient characteristics of consenters and refusers were collected and compared. The differential enrollment rates of the two nurse recruiters were also compared.

RESULTS
A total of 56 patients (∼57%) agreed to participate; 43 refused. The four most common reasons for study refusal were 1) increased clinic visits (42%), 2) increased insulin injections (30%), 3) increased frequency of self-monitoring of blood glucose (SMBG) (28%), and 4) transportation difficulties (19%). Concerns about randomization to an unwanted treatment condition and fears of hypoglycemia or weight gain were rarely cited. Consenters and refusers did not differ in demographic characteristics, disease status, or family composition. Large differences were found between the two nurse recruiters: one experienced a 60% refusal rate, while the other experienced a 27% refusal rate.

CONCLUSIONS
Issues of convenience (increased clinic visits, transportation difficulties) and concerns about the demands of IT (increased injections and SMBG) were the predominant reasons for trial refusal. Patient characteristics did not differentiate consenters from refusers. However, recruiters differed greatly in study refusal rates, suggesting that provider behavior may be an important but understudied aspect of adolescent acceptance of randomized trials in general and IT in particular.