bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insulin Resistance–Related Factors, but not Glycemia, Predict Coronary Artery Disease in Type 1 Diabetes
Authors: Orchard Trevor J. , Olson Jon C. , Erbey John R. , Williams Katherine , Forrest Kimberly Y.-Z. , Smithline Kinder Leslie , Ellis Demetrius , Becker Dorothy J. 
Published: March 2007

OBJECTIVE—To determine the independent risk factors for coronary artery disease (CAD) in type 1 diabetes by type of CAD at first presentation.
RESEARCH DESIGN AND METHODS—This is a historical prospective cohort study of 603 patients with type 1 diabetes diagnosed before 18 years of age between 1950 and 1980. The mean age and duration of diabetes at baseline were 28 (range 8–47) and 19 years (7–37), respectively, and patients were followed for 10 years. Patients with prevalent CAD were excluded from the study. Electrocardiogram (ECG) ischemia was defined by Minnesota Code (MC) 1.3, 4.1–3, 5.1–3, or 7.1; angina was determined by Pittsburgh Epidemiology of Diabetes Complications (EDC) study physician diagnosis; and hard CAD was determined by angiographic stenosis ≥50%, revascularization procedure, Q waves (MC 1.1–1.2), nonfatal myocardial infarction (MI), or CAD death.
RESULTS—A total of 108 incident CAD events occurred during the 10-year follow-up: 17 cases of ECG ischemia, 49 cases of angina, and 42 cases of hard CAD (5 CAD deaths, 25 nonfatal MI or major Q waves, and 12 revascularization or ≥50% stenosis). Blood pressure, lipid levels, inflammatory markers, renal disease, and peripheral vascular disease showed a positive gradient across the groups of no CAD, angina, and hard CAD (P &lt; 0.01, trend analysis, all variables), although estimated glucose disposal rate (eGDR) and physical activity showed inverse associations (P &lt; 0.01, trend analysis, both variables). In addition, depressive symptomatology predicted angina (P = 0.016), whereas HbA1 showed no association with subsequent CAD.
CONCLUSIONS—These data suggest that although the standard CAD risk factors are still operative in type 1 diabetes, greater glycemia does not seem to predict future CAD events. In addition, depressive symptomatology predicts angina and insulin resistance (eGDR) predicts hard CAD end points.
Polypharmacy and Medication Adherence in Patients With Type 2 Diabetes
Authors: Grant Richard W. , Devita Nicole G. , Singer Daniel E. , Meigs James B. 
Published: March 2007

OBJECTIVE—To determine medication adherence and predictors of suboptimal adherence in a community cohort of patients with diabetes and to test the hypothesis that adherence decreases with increased number of medicines prescribed.
RESEARCH DESIGN AND METHODS—A total of 128 randomly selected patients with type 2 diabetes from a single community health center responded to a pharmacist-administered questionnaire regarding medication use. Survey data were linked to clinical data available from the electronic medical record. We assessed self-reported adherence rates for each diabetes-related medicine, barriers and attitudes regarding medication use, and HbA1c, total cholesterol, and blood pressure levels.
RESULTS—Patients were taking a mean of 4.1 (±1.9) diabetes-related medicines. The average 7-day adherence was 6.7 ± 1.1 days. Total number of medicines prescribed was not correlated with medication adherence. Adherence was significantly lower for medicines not felt to be improving current or future health (6.1 vs. 6.9 days out of 7, P &lt; 0.001). Among patients on three or more medicines, 71% (15 of 21 patients) with suboptimal adherence were perfectly adherent with all but one medicine. Side effects were the most commonly reported problem with medication use. Of 29 medicines causing side effects that interfered with adherence, 24 (83%) did so for &gt;1 month, and only 7 (24%) were reported to the patient’s primary care physician.
CONCLUSIONS—In this sample, patients reported very high medication adherence rates regardless of number of medicines prescribed. Among patients on multiple medicines, most patients with suboptimal adherence were perfectly adherent to all but one medicine. Unreported side effects and a lack of confidence in immediate or future benefits were significant predictors of suboptimal adherence. Physicians should not feel deterred from prescribing multiple agents in order to achieve adequate control of hyperglycemia, hypertension, and hyperlipidemia.
Visceral Adipose Tissue Cutoffs Associated With Metabolic Risk Factors for Coronary Heart Disease in Women
Authors: Nicklas Barbara J. , Penninx Brenda W.J.H. , Ryan Alice S. , Berman Dora M. , Lynch Nicole A. , Dennis Karen E. 
Published: March 2007

OBJECTIVE—This study determined whether there is a critical level of visceral adipose tissue (VAT) associated with elevated coronary heart disease (CHD) risk factors in a cohort of women &gt;45 years of age.
RESEARCH DESIGN AND METHODS—Measurements of body composition (dual-energy X-ray absorptiometry), body fat distribution (computed tomography), fasting and 2-h postprandial (75-g) glucose concentrations, and fasting lipoprotein lipid and insulin concentrations were performed in 233 perimenopausal (9%) and postmenopausal women (age 59 ± 6 years, 79% Caucasian, 16% on hormone replacement therapy).
RESULTS—Women in the lowest VAT quintile (≤105 cm2) had higher concentrations of HDL and HDL2 cholesterol, lower LDL/HDL cholesterol ratios and triglyceride concentrations, and lower fasting glucose and insulin concentrations than women in the remaining four quintiles (P values &lt;0.05–0.001). Women in the second lowest VAT quintile (106–139 cm2) had higher HDL and HDL2 cholesterol and lower LDL/HDL ratios than women with a VAT ≥163 cm2 (P &lt; 0.05). Logistic regression analyses showed that women with a VAT of 106–162 cm2 are 2.5 times more likely to have a low HDL cholesterol (P &lt; 0.05), while women with a VAT ≥163 cm2 are 5.5 times more likely to have a low HDL cholesterol (P &lt; 0.01) and ∼4.0 times more likely to have a high LDL/HDL ratio (P &lt; 0.05) compared with women with a VAT ≤105 cm2. Women with a VAT ≥163 cm2 are at a higher risk of having impaired glucose tolerance (P &lt; 0.01).
CONCLUSIONS—A VAT ≥106 cm2 is associated with an elevated risk, and a VAT ≥163 cm2 with an even greater risk, for these metabolic CHD risk factors compared with women with a VAT ≤105 cm2. These values may prove useful for defining “visceral obesity” and for identifying women most likely to benefit from preventative interventions.
Multiple Hospitalizations for Patients With Diabetes
Authors: Jiang H. Joanna , Stryer Daniel , Friedman Bernard , Andrews Roxanne 
Published: March 2007

OBJECTIVE—To describe the extent to which hospitalizations for patients with diabetes reflect multiple stays by the same individuals and to examine how multiple hospitalizations vary by patient demographic and socioeconomic characteristics.
RESEARCH DESIGN AND METHODS—Using the Healthcare Cost and Utilization Project complete discharge data for five states (California, Missouri, New York, Tennessee, and Virginia) in 1999, we identified 648,748 nonneonatal, nonmaternal patients who had one or more hospitalizations listing diabetes. Multiple hospitalizations were measured as percent of patients with multiple stays, percent of total stays represented by multiple stays, and average number of stays per patient. Total hospital costs were also examined. Stratified analysis and regression were performed to assess differences by age, sex, race/ethnicity, payer, location, and income.
RESULTS—Among patients with diabetes who had been hospitalized, 30% had two or more stays accounting for &gt;50% of total hospitalizations and hospital costs. Controlled for patient age, sex, and clinical characteristics, the likelihood of having multiple hospitalizations was higher for Hispanics and non-Hispanic blacks compared with non-Hispanic whites, as well as for patients covered by Medicare or Medicaid and those living in low-income areas. The prevalence of diabetes complications and multiple conditions differed by age, race/ethnicity, and payer among patients with multiple stays.
CONCLUSIONS—Multiple hospitalizations are common among patients with diabetes but vary by age, race/ethnicity, payer, and income, with those populations traditionally considered to be more vulnerable experiencing higher likelihoods of multiple stays. Significant opportunities exist to reduce the proportion of multiple hospitalizations for patients with diabetes. Clinical and policy interventions to improve the quality of care and outcomes for these patients should be designed accordingly and have the potential to pay major dividends.
Low IGF-I and Elevated Testosterone During Puberty in Subjects With Type 1 Diabetes Developing Microalbuminuria in Comparison to Normoalbuminuric Control Subjects
Authors: Amin Rakesh , Schultz Carl , Ong Ken , Frystyk Jan , Dalton R. Neil , Perry Les , Ørskov Hans , Dunger David B. 
Published: March 2007

OBJECTIVE—To describe longitudinal variations in pubertal hormonal variables in subjects with and without microalbuminuria (MA).
RESEARCH DESIGN AND METHODS—Blood samples collected annually from subjects recruited at diagnosis of type 1 diabetes and followed prospectively through puberty (median follow-up 9.3 years, range 4.7–12.8) were analyzed for total and free IGF-I, IGF binding protein-1, testosterone, sex hormone-binding globulin, and HbA1c. A total of 55 subjects who developed MA (MA+ group) were compared with 55 age-, sex-, and duration-matched control subjects who did not develop MA (MA− group).
RESULTS—For female subjects, total IGF-I (MA+ 1.2 mU/l vs. MA− 1.4 mU/l, P = 0.03) and free IGF-I levels (MA+ 1,767 ng/l vs. MA− 2010 ng/l, P = 0.002) were lower, whereas the free androgen index (MA+ 2.4 vs. MA− 2.0, P = 0.03) was higher in those with MA. These changes were less pronounced in male subjects. For both sexes, in a Cox model after adjusting for puberty, the presence of MA was associated with lower free IGF-I levels, higher testosterone standard deviation score (SDS), and poor glycemic control. We found that 22 of 55 case subjects (40%) developed persistent MA, whereas 33 (60%) had transient MA. In the persistent MA group compared with the transient and control groups, total IGF-I levels were lower (1.1 vs. 1.3 vs. 1.4 mU/l, P = 0.002) as were free IGF-I levels (1,370.9 vs. 1,907.3 vs. 1,886.7 ng/l, P &lt; 0.001), whereas HbA1c levels were higher (11.8 vs. 10.3 vs. 9.9%, P &lt; 0.001).
CONCLUSIONS—Poor glycemic control and differences in IGF-I levels and androgens, particularly in female subjects, accompany development of MA at puberty. These differences may in part account for the sexual dimorphism in MA risk during puberty and could relate to disease progression.
Modem Transmission of Glucose Values Reduces the Costs and Need for Clinic Visits
Authors: Chase H. Peter , Pearson Jerusha A. , Wightman Clare , Roberts Mary D. , Oderberg Adam D. , Garg Satish K. 
Published: March 2007

OBJECTIVE—To determine whether modem technology allows for effective management of type 1 diabetes when used in lieu of a clinic visit.
RESEARCH DESIGN AND METHODS—A total of 70 adolescent patients with diabetes were prospectively randomized to either a control group or a modem group. Control group patients continued the standard of care of quarterly clinic visits, and modem group patients were instructed to transmit blood glucose data every 2 weeks for 6 months instead of a usual quarterly clinic visit. Health care providers analyzed the data received by modem and contacted patients to discuss diabetes treatment changes. GHbA1c levels were determined at 0 and 6 months, and the number of high and low blood glucose levels and adverse events were tracked. Clinic visit costs, patient expenses, and health care provider times were tracked for cost analysis for both groups.
RESULTS—A total of 63 patients (33 control, 30 modem) completed the 6-month study. The GHbA1c values significantly decreased in both groups, with no statistically significant difference between groups (P = 0.96). The occurrence of mild-to-moderate hypoglycemic events were similar in the two groups, and there were no severe hypoglycemic events. The average cost of care for a clinic visit was $305.00, whereas the cost for 6 months of modem transmission was $163.00.
CONCLUSIONS—This study shows that electronic transmission of blood glucose levels and other diabetes data every 2 weeks—in lieu of a clinic visit—results in a similar level of glucose control and incidence of acute diabetes complications when compared with current standard care.
Effects of an Automated Electronic Reminder in Changing the Antiplatelet Drug–Prescribing Behavior Among Italian General Practitioners in Diabetic Patients
Authors: Filippi Alessandro , Sabatini Andrea , Badioli Letizia , Samani Fabio , Mazzaglia Giampiero , Catapano Alberico , Cricelli Claudio 
Published: March 2007

OBJECTIVE—To evaluate whether an electronic reminder integrated into a routine computer system increases the use of antiplatelet drugs for diabetic patients among Italian general practitioners (GPs).
RESEARCH DESIGN AND METHODS—A randomized controlled trial was carried out among 300 GPs and their patients selected from the Health Search Database. Among these, 150 GPs (intervention group) received instructions to activate an electronic reminder plus a letter summarizing the beneficial effects of antiplatelet drugs in diabetic patients with at least one additional cardiovascular risk factor (“high risk”), whereas the other 150 GPs (control group) received only the letter. The electronic reminder, integrated into a standard software system for the management of the daily clinical practice, was displayed when every participating GP opened the medical record of diabetic patients aged ≥30 years. Only high-risk diabetic patients were included in the analysis. Patients were considered under antiplatelet treatment if they received two or more prescriptions at baseline and during the follow-up.
RESULTS—We selected 15,343 high-risk diabetic patients, 7,313 belonging to GPs of the control group and 8,030 belonging to GPs of the intervention group. Overall, 1,672 patients (22.9%) of the control group and 1,886 (23.5%) patients of the intervention group received antiplatelet drugs at baseline (P = N.S.). At the end of the follow-up, the number of treated patients was significantly increased in the intervention group (odds ratio 1.99, 95% CI 1.79–2.22) versus the control group. The effect of the electronic reminder was more relevant among those patients with one or more cardiovascular risk factors but without previous cardiovascular diseases (CVDs), compared with those with CVDs.
CONCLUSIONS—These findings provide evidence for the effect of an electronic reminder in affecting the prescriptive behavior of GPs.
Evaluation of Urinary 8-Hydroxydeoxy-Guanosine as a Novel Biomarker of Macrovascular Complications in Type 2 Diabetes
Authors: Nishikawa Takeshi , Sasahara Takayuki , Kiritoshi Shinsuke , Sonoda Kazuhiro , Senokuchi Takahumi , Matsuo Tomoko , Kukidome Daisuke , Wake Nakayasu , Matsumura Takeshi , Miyamura Nobuhiro , Sakakida Michiharu , Kishikawa Hideki , Araki Eiichi 
Published: March 2007

OBJECTIVE—To evaluate urinary 8-hydroxydeoxyguanosine (8-OHdG) as a marker for the progression of diabetic macroangiopathic complications.
RESEARCH DESIGN AND METHODS—The content of urinary 8-OHdG, common carotid intima-media thickness (IMT), the coronary heart disease (CHD) risk score, the severity of diabetic retinopathy, and urinary albumin excretion were examined in 96 patients with type 2 diabetes, including 32 patients who had been nominated for the Kumamoto Study [Shichiri M, et al. Diabetes Care 23 (Suppl 2):B21–B29, 2000]. In addition, the patients from the Kumamoto Study were further evaluated regarding the effect of intensive insulin therapy on urinary 8-OHdG excretion.
RESULTS—The urinary 8-OHdG:creatinine ratio (U8-OHdG) was 2.5-fold higher in patients with increased HbA1c than in those with normal HbA1c (P &lt; 0.05). In addition, U8-OHdG was 2.3-fold higher in patients with increased IMT (P &lt; 0.005). A similar result was observed between U8-OHdG and CHD risk score (P &lt; 0.01). U8-OHdG was significantly higher in patients with simple retinopathy (P &lt; 0.05) and those with advanced retinopathy (P &lt; 0.01) than in patients without retinopathy. Similarly, U8-OHdG was significantly higher in patients with albuminuria (P &lt; 0.01). Furthermore, in the Kumamoto Study, U8-OHdG was significantly lower in the multiple insulin injection therapy group compared with the conventional insulin injection therapy group (P &lt; 0.01).
CONCLUSIONS—Hyperglycemia independently increases 8-OHdG in patients with type 2 diabetes. 8-OHdG is a useful biomarker of not only microvascular but also macrovascular complications in patients with type 2 diabetes.
Diabetes and Coronary Artery Bypass Surgery
Authors: McAlister Finlay A. , Man Jeremy , Bistritz Lana , Amad Hani , Tandon Puneeta 
Published: March 2007

OBJECTIVE—To determine the adequacy of perioperative glycemic control in diabetic patients undergoing coronary artery bypass grafting (CABG) and to explore the association between glycemic control and in-hospital morbidity/mortality.
RESEARCH DESIGN AND METHODS—Retrospective cohort study of consecutive patients with diabetes undergoing CABG between April 2000 and March 2001 who survived at least 24 h postoperatively.
RESULTS—Of the 291 patients in this study, 95% had type 2 diabetes and 40% had retinopathy, nephropathy, or neuropathy at baseline. During hospitalization (median 7 days), 78 (27%) of these patients suffered a nonfatal stroke or myocardial infarction, septic complication, or died (“adverse outcomes”). Glycemic control was suboptimal (average glucose on first postoperative day was 11.4 [11.2–11.6] mmol/l) and was significantly associated with adverse outcomes post-CABG (P = 0.03). Patients whose average glucose level was in the highest quartile on postoperative day 1 had higher risk of adverse outcomes after the first postoperative day than those with glucose in the lowest quartile (odds ratio 2.5 [1.1–5.3]). Even after adjustment for other clinical and operative factors, average blood glucose level on the first postoperative day remained significantly associated with subsequent adverse outcomes: for each 1-mmol/l increase above 6.1 mmol/l, risk increased by 17%.
CONCLUSIONS—Perioperative glycemic control in our cohort of diabetic patients undergoing CABG in a tertiary care facility was suboptimal. We believe closure of this care gap is imperative, because hyperglycemia in the first postoperative day was associated with subsequent adverse outcomes in our study patients.
C-Reactive Protein and Glycemic Control in Adults With Diabetes
Authors: King Dana E. , Mainous Arch G. , Buchanan Thomas A. , Pearson William S. 
Published: March 2007

OBJECTIVE—Recent evidence suggests that poor glycemic control is significantly associated with the development of macrovascular complications of diabetes. Studies have indicated that C-reactive protein (CRP) is an important risk factor for cardiovascular disease. The purpose of this study was to determine the relation between CRP and HbA1c in a large national sample of individuals with diabetes.
RESEARCH DESIGN AND METHODS—A nationally representative sample of noninstitutionalized U.S. adults aged 17 years and over with nongestational diabetes was derived from the National Health and Nutrition Examination Survey III (1988–1994) (n = 1,018). Respondents with diabetes were stratified by HbA1c level. The main outcome measure was elevated (&gt;0.30 mg/dl) CRP.
RESULTS—In unadjusted analyses, respondents with diabetes who had elevated HbA1c levels (≥9.0%) had a significantly higher percent of elevated CRP than people with low (&lt;7%) HbA1c levels (P &lt; 0.001). In adjusted regression analysis, after controlling for age, race, sex, smoking, length of time with diabetes, insulin, and BMI, HbA1c was significantly associated with an increased likelihood of elevated CRP for HbA1c &gt;9.0% (OR 2.15, 95% CI 1.07–4.32) and for HbA1c &gt;11.0% (4.40, 1.87–10.38). Higher HbA1c also predicted elevated CRP in the regression model when HbA1c was analyzed as a continuous variable (1.20, 1.07–1.34).
CONCLUSIONS—In this study, the likelihood of elevated CRP concentrations increased with increasing HbA1c levels. These findings suggest an association between glycemic control and systemic inflammation in people with established diabetes.
Antihyperglycemic Effect of Oolong Tea in Type 2 Diabetes
Authors: Hosoda Kazuaki , Wang Ming-Fu , Liao Mei-Ling , Chuang Chin-Kuang , Iha Miyuki , Clevidence Beverly , Yamamoto Shigeru 
Published: March 2007

OBJECTIVE—To determine the efficacy of oolong tea for lowering plasma glucose in type 2 diabetic patients in Miaoli, Taiwan.
RESEARCH DESIGN AND METHODS—A total of 20 free-living subjects who had type 2 diabetes and took hyperglycemic drugs as prescribed were enrolled in the present study. Subjects consumed oolong tea (1,500 ml) or water for 30 days each in a randomized crossover design. Tea was not consumed for 14 days prior to treatments.
RESULTS—Relative to initial concentrations, oolong tea markedly lowered concentrations of plasma glucose (from 229 ± 53.9 to 162.2 ± 29.7 mg/dl, P &lt; 0.001) and fructosamine (from 409.9 ± 96.1 to 323.3 ± 56.4 μmol/l, P &lt; 0.01), whereas the water control group had not changed (208.7 ± 61.0 vs. 232.3 ± 63.1 mg/dl for glucose and from 368.4 ± 85.0 to 340.0 ± 76.1 μmol/l for fructosamine).
CONCLUSIONS—Oolong tea may be an effective adjunct to oral hypoglycemic agents in the treatment of type 2 diabetes.
Type 2 Diabetes and Subsequent Incidence of Breast Cancer in the Nurses’ Health Study
Authors: Michels Karin B. , Solomon Caren G. , Hu Frank B. , Rosner Bernard A. , Hankinson Susan E. , Colditz Graham A. , Manson JoAnn E. 
Published: March 2007

OBJECTIVE—Hyperinsulinemia may promote mammary carcinogenesis. Insulin resistance has been linked to an increased risk of breast cancer and is also characteristic of type 2 diabetes. We prospectively evaluated the association between type 2 diabetes and invasive breast cancer incidence in the Nurses’ Health Study.
RESEARCH DESIGN AND METHODS—A total of 116,488 female nurses who were 30–55 years old and free of cancer in 1976 were followed through 1996 for the occurrence of type 2 diabetes and through 1998 for incident invasive breast cancer, verified by medical records and pathology reports.
RESULTS—During 2.3 million person-years of follow-up, we identified 6,220 women with type 2 diabetes and 5,189 incident cases of invasive breast cancer. Women with type 2 diabetes had a modestly elevated incidence of breast cancer (hazard ratio [HR] = 1.17; 95% CI 1.01–1.35) compared with women without diabetes, independent of age, obesity, family history of breast cancer, history of benign breast disease, reproductive factors, physical activity, and alcohol consumption. This association was apparent among postmenopausal women (1.16; 0.98–1.62) but not premenopausal women (0.83; 0.48–1.42). The association was predominant among women with estrogen receptor-positive breast cancer (1.22; 1.01–1.47).
CONCLUSIONS—Women with type 2 diabetes may have a slightly increased risk of breast cancer.