bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alcohol With a Meal Has No Adverse Effects on Postprandial Glucose Homeostasis in Diabetic Patients
Authors: Koivisto Veikko A , Tulokas Sirkku , Toivonen Markku , Haapa Eliina , Pelkonen Risto 
Published: March 2007

OBJECTIVE
To examine the effect of moderate alcohol intake with a meal on gluco e homeostasis in diabetic patients.

RESEARCH DESIGN AND METHODS
Alcohol (1 g/kg, an aperitif before, wine during, and a drink after a meal) or an equal amount of mineral water was given during a dinner. Blood glucose and insulin concentrations were measured before, uring, and after the meal until the next morning. This study was conducted at the Helsinki University Hospital Metabolic Ward and the Finnish Diabetes Association Education Center. The participants in the study included 10 type I diabetic patients treated with insulin and 16 type II diabetic patients treated with diet alone or with diet and oral drugs. In each subject, we examined hypoglycemic episodes or differences in blood glucose or serum insulin concentrations between alcohol and the control study.

RESULTS
In type I diabetic patients, blood glucose and insulin concentrations were virtually identical in both studies. In type II diabetic patients, alcohol slightly enhanced the meal-induced insulin secretion resulting in lower blood glucose concentrations next morning. No hypoglycemic glucose concentrations were observed in either group after alcohol ingestion.

CONCLUSIONS
Moderate alcohol intake with a meal does not lead to hypo- or hyperglycemia in diabetic patients.
Factors That Influence Outcome in Diabetic Subjects With Myocardial Infarction
Authors: Fava Stephen , Azzopardi Joseph , Muscat Hugo Agius , Fenech Frederick F 
Published: March 2007

OBJECTIVE
To compare the outcome of acute myocardial infarction in NIDDM patients and nondiabetic control subjects. The relation of glycemic control, duration of diabetes, and major diabetic complications to the outcome of acute myocardial infarction in diabetic subjects was investigated.

RESEARCH DESIGN AND METHODS
This was a prospective, hospitalbased, case-control study.

RESULTS
One hundred and ninety-six NIDDM patients and 196 nondiabetic control subjects with acute myocardial infarction were entered into the study: 23.5% of diabetic subjects and 34.2% of control subjects received thrombolytic therapy (P &lt; 0.05). Diabetic subjects showed signs of reperfusion less often than control subjects (P &lt; 0.05). Mortality was higher in the diabetic group (17.3 vs. 10.2%, P &lt; 0.05). Pump failure (38.3 vs. 16.8%, P &lt; 0.01) and cardiogenic shock (9.7 vs. 3.6%, P &lt; 0.05) also occurred more frequently in diabetic subjects. Loss of heart rate variability was correlated with both pump failure and mortality; proliferative retinopathy was correlated with pump failure. Glycemic control and other diabetic complications did not correlate with outcome.

CONCLUSIONS
Our findings confirm the higher mortality and incidence of pump failure in acute myocardial infarction with co-morbid diabetes. They suggest that the less frequent use of thrombolytic therapy, lower reperfusion rates, and more advanced coronary artery disease might be contributory. The presence of autonomic neuropathy and microvascular disease probably also contribute to poor outcome; other major diabetic complications and diabetic control did not influence outcome.
Diabetes, Other Risk Factors, and 12-Yr Cardiovascular Mortality for Men Screened in the Multiple Risk Factor Intervention Trial
Authors: Stamler Jeremiah , Vaccaro Olga , Neaton James D , Wentworth Deborah ,   The Multiple Risk Factor Intervention Trial Research Group
Published: March 2007

OBJECTIVE
To assess predictors of CVD mortality among men with and without diabetes and to assess the independent effect of diabetes on the risk of CVD death.

RESEARCH DESIGN AND METHODS
Participants in this cohort study were screened from 1973 to 1975; vital status has been ascertained over an average of 12 yr of follow-up (range 11–13 yr). Participants were 347,978 men aged 35–57 yr, screened in 20 centers for MRFIT. The outcome measure was CVD mortality.

RESULTS
Among 5163 men who reported taking medication for diabetes, 1092 deaths (603 CVD deaths) occurred in an average of 12 yr of follow-up. Among 342,815 men not taking medication for diabetes, 20,867 deaths were identified, 8965 ascribed to CVD. Absolute risk of CVD death was much higher for diabetic than nondiabetic men of every age stratum, ethnic background, and risk factor level—overall three times higher, with adjustment for age, race, income, serum cholesterol level, sBP, and reported number of cigarettes/day (P &lt; 0.0001). For men both with and without diabetes, serum cholesterol level, sBP, and cigarette smoking were significant predictors of CVD mortality. For diabetic men with higher values for each risk factor and their combinations, absolute risk of CVD death increased more steeply than for nondiabetic men, so that absolute excess risk for diabetic men was progressively greater than for nondiabetic men with higher risk factor levels.

CONCLUSIONS
These findings emphasize the importance of rigorous sustained intervention in people with diabetes to control blood pressure, lower serum cholesterol, and abolish cigarette smoking, and the importance of considering nutritional-hygienic approaches on a mass scale to prevent diabetes.
The Prevalence and Identification of Risk Factors for NIDDM in Urban Africans in Cape Town, South Africa
Authors: Levitt Naomi S , Katzenellenbogen Judith M , Bradshaw Deborah , Hoffman Margaret N , Bonnici Francois 
Published: March 2007

OBJECTIVE
To determine the prevalence of NIDDM and associated risk factors in urban Africans in Cape Town, South Africa.

RESEARCH DESIGN AND METHODS
With a three-stage, proportional, stratified, random cluster method, we sampled 1000 Africans, &gt; 30 yr of age, living in African residential areas in Cape Town. We assessed glucose tolerance with a 75-g oral glucose tolerance test, according to World Health Organization criteria, and obtained anthropometric and demographic data.

RESULTS
The response rate was 79%. The prevalence of NIDDM was 8.0% (confidence interval 5.8–10.3%), age-adjusted to world population figures and that of impaired glucose tolerance, 7.0% (confidence interval 4.9–9.1%). Multivariate analysis indicated that increased age (odds ratio 4.18), upper-segment fat distribution (odds ratio 2.94), proportion of life spent in an urban area (odds ratio 2.32), and obesity (odds ratio 2.31) were significant independent risk factors for NIDDM. In contrast, sex, family history, alcohol intake, and physical activity were not independent risk factors. Only increased age (odds ratio 4.06) was a significant risk factor for impaired glucose tolerance.

CONCLUSIONS
The prevalence of NIDDM in urban Africans in Cape Town, South Africa, is moderately high, and considerably higher than previous reports from Africa. The association of NIDDM with urbanization has important implications in view of the large-scale urbanization occurring in southern Africa.
Comparison of Morning or Bedtime Insulin With and Without Glyburide in Secondary Sulfonylurea Failure
Authors: Soneru Ileana L , Agrawal Lily , Murphy John C , Lawrence A M , Abraira Carlos 
Published: March 2007

OBJECTIVES— New treatment options are needed for glycemic control in NIDDM. We evaluated the effects of bedtime or morning insulin treatment, combined with daytime glyburide or given alone.
RESEARCH DESIGN AND METHODS— Twenty-nine male patients with NIDDM, mean age 63 ± 1.7 yr, body weight 124 ± 2.98% of DBW, received a maximum glyburide dose (20 mg/day) for a minimum of 6 wk, to confirm sulfonylurea failure. Human lente insulin was added for 12 wk either AM (n = 14) or HS (n = 15) and adjusted to obtain fasting euglycemia (FPG; combination treatment phase). Glyburide was then stopped, and insulin was continued for 6 wk, aiming for normal FPG (insulin phase).
RESULTS— After combination treatment phase, FPG decreased (P &lt; 0.02) from 12.43 ± 0.68 to 5.73 ± 0.65 mM (AM) and from 12.68 ± 0.76 to 5.51 ± 0.48 mM (HS) (AM vs. HS, NS). Postbreakfast, presupper, and 0200 AM plasma glucose levels fell equally (P &lt; 0.02) except for 1-h postprandial (AM 12.46 ± 0.51 mM, HS 10.88 ± 0.62 mM, AM vs. HS, P &lt; 0.1). Mean HBA1c fell similarly in both AM and HS groups. At 2 wk of the insulin phase, FPG was higher in AM than HS, 9.8 ± 0.76 vs. 7.56 ± 0.7 mM (P &lt; 0.1). At the end of insulin phase, plasma glucose levels were similar to the end of combination treatment phase, but the insulin dose had to be raised in AM by 39% (P &lt; 0.02) and HS by 30% (P &lt; 0.05). After the combination treatment phase, fasting C-peptide was significantly suppressed in HS group only, from 1.22 ± 0.12 to 0.82 ± 0.09 nM (P &lt; 0.02). At the end of insulin phase, fasting C-peptide was further suppressed in both groups, but 2-h postprandial C-peptide levels decreased significantly in AM group only, from 1.85 ± 0.23 to 1.42 ± 0.13 nM (P &lt; 0.02). Triglycerides and total and HDL cholesterol did not change significantly after either combination treatment phase or insulin phase. Mean weight gain was 6.5 lb during combination treatment phase (NS from baseline), without further change during insulin phase. Hypoglycemic reactions, all mild, were recorded at a rate of 1.35/patient in the AM group and 0.4/patient in the HS group (P &lt; 0.025).
CONCLUSIONS— Normal fasting glycemia and near-normal postprandial glucose profile could be obtained with combination therapy in NIDDM. Results were similar if insulin, alone or in combination with glyburide, was given before breakfast or at bedtime, but hypoglycemic reactions were more common with conventional morning insulin injections.
Relaxation Training for NIDDM: Predicting who may benefit
Authors: Lane James D , McCaskill Cynthia C , Ross Suzanne L , Feinglos Mark N , Surwit Richard S 
Published: March 2007

OBJECTIVE
To examine the benefits of relaxation training for patients with NIDDM and to investigate individual differences that could predict a positive response to relaxation training.

RESEARCH DESIGN AND METHODS
Thirty-eight subjects with NIDDM were treated with intensive conventional diabetes therapy after an initial metabolic evaluation and psychological and pharmacological testing. Half were assigned to also receive biofeedback-assisted relaxation training. Treatment effects on GHb levels and glucose tolerance were evaluated after 8 wk.

RESULTS
Subjects demonstrated significant improvements in GHb level, but not in glucose tolerance, after 8 wk of intensive conventional treatment. These improvements persisted throughout the follow-up period. However, the group provided with relaxation training did not experience greater improvements on either measure than the group given conventional diabetes treatment only. Within the group that received relaxation training, correlations occurred between the improvements in glucose tolerance after treatment and individual differences in trait anxiety and in the effect of alprazolam on glucose tolerance. Differences in the effects of EPI on glucose tolerance and personality measures of neuroticism and perceived locus of control also appeared to be related to improvements in glucose tolerance after training.

CONCLUSIONS
Relaxation training did not confer added benefit over and above that provided by conventional diabetes treatment for patients with NIDDM. Additional research is needed to determine whether the administration of relaxation training to selected patients, especially those who are most responsive to stress, would provide benefits for glucose control that are not achieved by conventional treatment.
Cost-Effective Screening for Diabetic Retinopathy Using a Nonmydriatic Retinal Camera in a Prepaid Health-Care Setting
Authors: Peters Anne L , Davidson Mayer B , Ziel Frederick H 
Published: March 2007

OBJECTIVE
To assess the efficacy of using a nonmydriatic Polaroid retinal camera as a method for screening diabetic patients for treatable diabetic retinopathy.

RESEARCH DESIGN AND METHODS
All 522 diabetic patients followed in a health maintenance organization-affiliated diabetes program had retinal photos taken. Compliance with the routine referral to one of two retinal specialists (the examiners) was 74%. The results from the examiners were compared with the results of the reader of the retinal photos.

RESULTS
Sensitivity was 100% and specificity was 82% for the diagnosis of serious diabetic retinopathy (preproliferative or proliferative retinopathy or macular edema) by the examiners compared with the diagnosis of any diabetic retinopathy by the reader. No patient had serious diabetic retinopathy inside or outside the photographic field that was missed because all patients with serious diabetic retinopathy showed some diabetic retinopathy within the photographic field. The reader tended to underrate the severity of the diabetic retinopathy, but when the reader diagnosed serious diabetic retinopathy, it was always present on exam.

CONCLUSIONS
The nonmydriatic retinal camera is easy to use, inexpensive, and can be used as part of a general diabetes exam, independent of a physician, in patients who should, but may not, be referred to an ophthalmologist. Any patient with abnormal findings on photos should be referred to an ophthalmologist, and any patient with findings of serious diabetic retinopathy on the photos should be referred immediately for possible laser therapy.
Caloric Restriction Per Se Is a Significant Factor in Improvements in Glycemic Control and Insulin Sensitivity During Weight Loss in Obese NIDDM Patients
Authors: Wing Rena R , Blair Elaine H , Bononi Patricia , Marcus Marsha D , Watanabe Richard , Bergman Richard N 
Published: March 2007

OBJECTIVE
To examine the effects of caloric restriction, independent of differences in weight loss, on improvements in glycemic control, fasting insulin, and insulin sensitivity.

RESEARCH DESIGN AND METHODS
We randomized 93 obese type II diabetic patients to two different degrees of calorie restriction (1,674 or 4,185 kJ/day; 400 or 1,000 kcal/day) and compared the changes in fasting glucose, fasting insulin, and insulin sensitivity that resulted from a comparable reduction in body weight (11% of initial body weight). Insulin sensitivity was assessed using the minimal model analysis of frequently sampled intravenous glucose tolerance tests.

RESULTS
Despite equal weight losses, subjects in the 1,674 kJ/day (400 kcal) condition had lower fasting glucose levels (7.61 vs. 10.13 mM, P = 0.03) and greater insulin sensitivity (1.79 vs. 1.13, P = 0.04) after weight loss than did subjects in the 4,185 kJ/day (1,000 calorie) condition. Subjects were restudied 15 weeks later when both groups were consuming a 4,185 kJ/day (1,000 kcal/day) diet. Subjects who increased from 1,674 to 4,185 kJ (400 to 1,000 calories) had worse fasting glycemic control in spite of continued weight loss, whereas subjects who remained on 4,185 kJ (1,000 calories) throughout had further improvements in both blood glucose and insulin sensitivity with increased weight loss.

CONCLUSIONS
Both degree of calorie restriction and magnitude of weight loss have independent effects on improvements in glycemic control and insulin sensitivity.
Insulin Omission in Women With IDDM
Authors: Polonsky William H , Anderson Barbara J , Lohrer Patricia A , Aponte Jennifer E , Jacobson Alan M , Cole Charlotte F 
Published: March 2007

OBJECTIVE
To describe the extent of intentional insulin omission in an outpatient population of women with insulin-dependent diabetes mellitus (IDDM) and examine its relationship to disordered eating, attitudes toward diabetes, other psychosocial factors, long-term complications, and glycemic control.

RESEARCH DESIGN AND METHODS
Before their routinely scheduled clinic appointments, female IDDM patients who were 13–60 years of age completed a self-report survey (final n = 341). The survey included standardized questionnaires assessing disordered eating attitudes and behaviors, psychological functioning (general distress, diabetes-specific distress, and hypoglycemic fear), attitudes toward diabetes, and self-care behaviors. All subjects were assessed for glycosylated hemoglobin within 30 days of survey completion. Long-term complications were determined through chart review.

RESULTS
Approximately 31% of the subject sample, representing women of all ages, reported intentional insulin omission, but only 8.8% reported frequent omission. Compared with non-omitters, omitters reported more disordered eating, greater psychological distress (general and diabetes-specific), more hypoglycemic fear, poorer regimen adherence, and greater fears concerning improved diabetes management (which may lead to weight gain). Omitters evidenced poorer glycemic control, more diabetes-related hospitalizations, and higher rates of retinopathy and neuropathy. Multivariate examination revealed only two variables that independently predicted omission: diabetes-specific distress and fear of improved glycemic control (“because I will gain weight”). Of the omitters, approximately half reported omitting insulin for weight-management purposes (weight-related omitters). These subjects evidenced significantly greater psychological distress, poorer regimen adherence (including more frequent omission), poorer glycemic control, and higher rates of complications than did non-weight-related omitters as well as non-omitters. Non-weight-related omitters tended to fall between weight-related omitters and non-omitters on most measures of psychological functioning, adherence, and glycemic control.

CONCLUSIONS
These findings suggest that insulin omission is common, that it is not limited to younger women, and that the medical consequences of omission, especially frequent omission, may be severe. Although a strong association between omission and disordered eating was observed, these data suggest that this link may be complicated by important diabetes-specific factors. Patients preoccupied with eating and weight concerns may also become emotionally overwhelmed by diabetes and/or fearful of normoglycemia (and the associated weight-related consequences), thus reinforcing the desire to omit insulin and maintain elevated blood glucose levels.
Shanghai, China, Has the Lowest Confirmed Incidence of Childhood Diabetes in the World
Authors: Fu Hua , Shen Shui-Xian , Chen Zhao-Wen , Wang Jia-Jun , Ye Ting-Ting , LaPorte Ronald E , Tajima Naoko 
Published: March 2007

OBJECTIVE
To determine the incidence of insulin-dependent diabetes mellitus in 0- to 14-year-old children in Shanghai, China, from 1980 to 1991.

RESEARCH DESIGN AND METHODS
Data were collected from hospitals with pediatric departments. The secondary source of validation was primary and middle schools.

RESULTS
The average crude annual incidence rate was 0.61/100,000 (95% confidence interval, 0.48–0.77). The ascertainment-corrected incidence rates were 0.72/100,000 (0.57–0.91).

CONCLUSIONS
The incidence of childhood diabetes in Shanghai, China, was one of the lowest, if not the lowest, in the world.
Common Carotid Arterial Wall Thickness in NIDDM Subjects
Authors: Pujia Arturo , Gnasso Agostino , Irace Concetta , Colonna Alfredo , Mattioli Pier Luigi 
Published: March 2007

OBJECTIVE
To verify whether carotid arterial intimal plus media thickness (IMT) is greater in non-insulin-dependent diabetes mellitus (NIDDM) subjects, known to be at high risk for atherosclerosis. Evidence is growing that IMT is increased in subjects with coronary heart disease (CHD) risk factors like hypercholesterolemia and cigarette smoking.

RESEARCH DESIGN AND METHODS
Fifty-four NIDDM subjects and 54 sex- and age-matched control subjects underwent CHD risk factors assessment and echo-Doppler examination of carotid arteries. IMT was measured by computer technique in the common carotid artery (CCA). Presence of plaques and/or stenosis (carotid atherosclerosis [CA]) was also evaluated by a single-blinded reader.

RESULTS
NIDDM subjects had larger IMT, higher levels of triglycerides, and lower concentrations of high-density lipoprotein (HDL) cholesterol compared with control subjects. IMT was positively correlated to age and systolic blood pressure and inversely to HDL cholesterol in both groups. The prevalence of CA was 46% in NIDDM subjects and 18% in control subjects. In multiple regression analysis, IMT was the only variable significantly associated to CA.

CONCLUSIONS
IMT of CCA is enlarged in NIDDM subjects compared with control subjects. Its association with carotid plaques and/or stenosis might be of importance to detect early atherosclerotic lesions in the carotid arteries.
Effect of Added Fat on the Plasma Glucose and Insulin Response to Ingested Potato Given in Various Combinations as Two Meals in Normal Individuals
Authors: Ercan Nacide , Gannon Mary C , Nuttall Frank Q 
Published: March 2007

OBJECTIVE
In normal subjects, ingestion of fat with potato in a morning meal resulted in a decrease in the glucose response. Therefore, we wished to determine whether a fat-induced decrease in blood glucose also would be observed after a second identical meal. In addition, we were interested in determining if fat ingestion with a morning meal would have an effect on the blood glucose and insulin responses to a second meal not containing fat.

RESEARCH DESIGN AND METHODS
Nine healthy male subjects ingested two meals consisting of an amount of potato containing 50 g carbohydrate, either alone or with 50 g fat as butter. The meals were served in four combinations as follows: 1) potato for the first meal, potato for the second meal; 2) potato for the first meal, potato with fat for the second meal; 3) potato with fat for the first meal, potato for the second meal; and 4) potato with fat for the first meal, potato with fat for the second meal. Meals were ingested at 8:00 A.M. and noon. Plasma glucose and C-peptide, serum insulin, triglyceride, and free fatty acid (FFA) concentrations were determined over an 8-h period. The integrated area responses to the meals were quantified over the subsequent 4-h period using the fasting value or the noon value as baseline for the first and second meals, respectively.

RESULTS
When the first meal contained potato only, the glucose area response to the second meal was significantly less when the second meal contained fat. However, fat ingestion had no effect on the glucose area response to the second meal when fat was present in the first meal. The insulin area responses to the first and second meals were similar after ingestion of potato or potato with fat. However, the insulin response to the second meal always was less that to the first meal. The C-peptide area responses after ingestion of the second meal also were all higher than those after the first meal. The triglyceride area responses were slightly negative after ingestion of potato alone in the first meal. When fat was ingested, they were positive. When the first meal contained fat but the second meal did not, there was a rise in triglyceride concentration after the second meal as well as after the first meal. That is, a rise occurred without ingestion of fat with the second meal. If fat was present in the second meal the rise was even greater. The FFA area responses were similar to the triglyceride area responses.

CONCLUSIONS
When fat was ingested with carbohydrate in either the first or second meal, the glucose area response was decreased. However, when both meals contained fat, a decrease in the glucose area response did not occur with the second meal. The glucose area responses all were greater after the second meal compared with those after the first meal, i.e., the opposite of a Staub-Traugott effect was observed. The insulin area responses to the first and second meals were similar whether fat was ingested or not.