bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of Progression to Type 2 Diabetes Based on Relationship Between Postload Plasma Glucose and Fasting Plasma Glucose
Authors: Abdul-Ghani Muhammad A. , Williams Ken , DeFronzo Ralph , Stern Michael 
Published: June 2006

OBJECTIVE—We sought to assess the risk of progression to type 2 diabetes in normal glucose tolerance (NGT) subjects based on the relationship between the plasma glucose concentration during oral glucose tolerance tests (OGTTs) and the fasting plasma glucose (FPG) concentration.
RESEARCH DESIGN AND METHODS—Subjects with NGT (n = 1,282) from the San Antonio Heart Study received an OGTT with measurement of the plasma glucose concentration at 0, 30, 60, and 120 min at baseline and after 7–8 years of follow-up. Subjects were divided into four groups based on the relationship between the plasma glucose concentration during the OGTT and the FPG concentration on the same day as the OGTT. Insulin resistance was calculated by the homeostasis model assessment of insulin resistance (HOMA-IR) and Matsuda index. Early-phase insulin secretion was calculated as the ratio between the incremental plasma insulin and glucose concentrations during the first 30 min of the OGTT (ΔI0–30/ΔG0–30). Total insulin secretion was calculated as the ratio between the incremental areas under the insulin and glucose curves during the OGTT [ΔG(AUC)/ΔI(AUC)].
RESULTS—In 23 subjects (group I), the plasma glucose concentration during the OGTT returned to levels below the FPG concentration at 30 min; in 111 subjects (group II) and in 313 subjects (group III), the plasma glucose concentration during the OGTT returned to levels below the FPG concentration at 60 and 120 min, respectively. In the remaining 835 subjects (group IV), the plasma glucose concentration during the OGTT never fell below the FPG concentration. Insulin resistance, measured by HOMA-IR and the Matsuda index, increased progressively from group I through group IV, while insulin secretion measured by ΔI0–30/ΔG0–30 and ΔG(AUC)/ΔI(AUC) decreased progressively from group I through group IV. The incidence of type 2 diabetes was 0% in group I and progressively increased to 0.9% in group II, 3.2% in group III, and 6.4% in group IV.
CONCLUSIONS—Subjects whose postload plasma glucose concentration returned to baseline (i.e., FPG level) more quickly had greater insulin sensitivity, a higher insulinogenic index, and a lower risk of developing type 2 diabetes after 8 years of follow-up compared with subjects whose postload glucose concentration returned to baseline more slowly.
Is Nonalbuminuric Renal Insufficiency in Type 2 Diabetes Related to an Increase in Intrarenal Vascular Disease?
Authors: MacIsaac Richard J. , Panagiotopoulos Sianna , McNeil Karen J. , Smith Trudy J. , Tsalamandris Con , Hao Huming , Matthews P. Geoffrey , Thomas Merlin C. , Power David A. , Jerums George 
Published: June 2006

OBJECTIVE—To investigate the role of intrarenal vascular disease in the pathogenesis of nonalbuminuric renal insufficiency in type 2 diabetes.
RESEARCH DESIGN AND METHODS—We studied 325 unselected clinic patients who had sufficient clinical and biochemical information to calculate an estimated glomerular filtration rate (eGFR) using the Modified Diet in Renal Disease six-variable formula, at least two estimations of urinary albumin excretion rates (AER), and a renal duplex scan to estimate the resistance index of the interlobar renal arteries. The resistance index, measured as part of a complications surveillance program, was compared in patients with an eGFR &lt; or ≥60 ml/min per 1.73 m2 who were further stratified into normo- (AER &lt;20), micro- (20–200), or macroalbuminuria (&gt; 200 μg/min) categories.
RESULTS—Patients with an eGFR &lt;60 ml/min per 1.73 m2 had a higher resistance index of the renal interlobar arteries compared with patients with an eGFR ≥60 ml/min per 1.73 m2. However, the resistance index was elevated to a similar extent in patients with an eGFR &lt;60 ml/min per 1.73 m2 regardless of albuminuric status (normo- 0.74 ± 0.01, micro- 0.73 ± 0.01, and macroalbuminuria resistance index 0.75 ± 0.11). Multiple regression analysis revealed that increased age (P &lt; 0.0001), elevated BMI (P = 0.0001), decreased eGFR (P &lt; 0.01), and decreased diastolic blood pressure (P &lt; 0.01), but not an increased AER, were independently associated with an elevated resistance index in patients with impaired renal function.
CONCLUSIONS—Subjects with type 2 diabetes and reduced glomerular filtration rate had similar degrees of intrarenal vascular disease, as measured by the intrarenal arterial resistance index, regardless of their AER status. The pathological mechanisms that determine the relationship between impaired renal function and AER status in subjects with type 2 diabetes remain to be elucidated.
Impact of Glycemic Control on Survival of Diabetic Patients on Chronic Regular Hemodialysis
Authors: Oomichi Takeshi , Emoto Masanori , Tabata Tsutomu , Morioka Tomoaki , Tsujimoto Yoshihiro , Tahara Hideki , Shoji Tetsuo , Nishizawa Yoshiki 
Published: June 2006

OBJECTIVE—To investigate the impact of glycemic control during regular hemodialysis on the survival of diabetic patients with chronic kidney disease (CKD) in a longitudinal observational study.
RESEARCH DESIGN AND METHODS—A total of 114 diabetic CKD patients on hemodialysis at Inoue Hospital (Suita, Japan) were surveyed from May 1995 to December 2002 (survey period 45.5 ± 29.3 [means ± SD] months). All subjects were categorized into three groups by mean HbA1c (A1C) level during the 3-month period on hemodialysis preceding entry, as follows: good (A1C &lt;6.5%, 5.7 ± 0.4%, n = 34), fair (6.5 ≤ A1C &lt; 8.0%, 7.2 ± 0.4%, n = 39), and poor (A1C ≥8.0%, 9.2 ± 0.9%, n = 41) A1C groups.
RESULTS—There were no significant differences in age at entry, initiation of hemodialysis, duration of hemodialysis, blood pressure, cardiothoracic ratio, serum creatinine level, or hemoglobin level among the three groups. The cumulative survival of the poor A1C group during the survey was significantly lower than that of the fair and good A1C groups as determined by Kaplan-Meier estimation (P = 0.041, log-rank test). In a multivariate Cox proportional hazard model, both poor A1C group (hazard ratio 2.889, P = 0.010) and mean A1C (1.260 per 1.0%, P = 0.003) were significant predictors of survival.
CONCLUSIONS—In diabetic CKD patients on regular hemodialysis, poor glycemic control is an independent predictor of prognosis. This finding indicates the importance of careful management of glycemic control even after initiation of hemodialysis.
Hypoadiponectinemia and Proinflammatory State: Two Sides of the Same Coin?
Authors: Herder Christian , Hauner Hans , Haastert Burkhard , Röhrig Karin , Koenig Wolfgang , Kolb Hubert , Müller-Scholze Sylvia , Thorand Barbara , Holle Rolf , Rathmann Wolfgang 
Published: June 2006

OBJECTIVE—Previous studies have yielded conflicting results on the association of adiponectin levels and inflammation. Low systemic concentrations of adiponectin, as well as elevated levels of immune mediators, represent risk factors for the development of type 2 diabetes and coronary artery disease. The major aim of this cross-sectional study was to investigate the interdependence of hypoadiponectinemia and low-grade systemic inflammation.
RESEARCH DESIGN AND METHODS—The study sample consisted of 606 participants aged 55–74 years (244 with normal glucose tolerance, 242 with impaired glucose tolerance, and 120 with newly diagnosed type 2 diabetes) of the population-based KORA S4 (Cooperative Health Research in the Region of Augsburg Survey 4; 1999–2001). Systemic concentrations of adiponectin and a wide range of anthropometric, metabolic, and inflammatory variables were available for analyses. The association of adiponectin with 15 immunological markers, including leukocyte count, acute-phase proteins, cytokines, cytokine receptors, and chemokines, was assessed using univariable and multivariable models.
RESULTS—No evidence for a significant correlation between adiponectin and all immunological parameters except eotaxin could be found after multivariable adjustments, whereas multiple strong correlations with obesity and metabolic factors were present.
CONCLUSIONS—From these data, we conclude that hypoadiponectinemia and a proinflammatory state are largely independent from each other.
A Systematic Review of Interventions to Improve Diabetes Care in Socially Disadvantaged Populations
Authors: Glazier Richard H. , Bajcar Jana , Kennie Natalie R. , Willson Kristie 
Published: June 2006

OBJECTIVE—To identify and synthesize evidence about the effectiveness of patient, provider, and health system interventions to improve diabetes care among socially disadvantaged populations.
RESEARCH DESIGN AND METHODS—Studies that were included targeted interventions toward socially disadvantaged adults with type 1 or type 2 diabetes; were conducted in industrialized countries; were measured outcomes of self-management, provider management, or clinical outcomes; and were randomized controlled trials, controlled trials, or before-and-after studies with a contemporaneous control group. Seven databases were searched for articles published in any language between January 1986 and December 2004. Twenty-six intervention features were identified and analyzed in terms of their association with successful or unsuccessful interventions.
RESULTS—Eleven of 17 studies that met inclusion criteria had positive results. Features that appeared to have the most consistent positive effects included cultural tailoring of the intervention, community educators or lay people leading the intervention, one-on-one interventions with individualized assessment and reassessment, incorporating treatment algorithms, focusing on behavior-related tasks, providing feedback, and high-intensity interventions (&gt;10 contact times) delivered over a long duration (≥6 months). Interventions that were consistently associated with the largest negative outcomes included those that used mainly didactic teaching or that focused only on diabetes knowledge.
CONCLUSIONS—This systematic review provides evidence for the effectiveness of interventions to improve diabetes care among socially disadvantaged populations and identifies key intervention features that may predict success. These types of interventions would require additional resources for needs assessment, leader training, community and family outreach, and follow-up.
Hypoadiponectinemia Is Associated With Progression Toward Type 2 Diabetes and Genetic Variation in the ADIPOQ Gene Promoter
Authors: Schwarz Peter E.H. , Towers Gordon W. , Fischer Sabine , Govindarajalu Suresh , Schulze Jan , Bornstein Stephan R. , Hanefeld Markolf , Vasseur Francis 
Published: June 2006

OBJECTIVE—Adiponectin encoded by the ADIPOQ gene modulates insulin sensitivity and glucose homeostasis. The aim of the current study was to investigate whether ADIPOQ gene variants in the promoter region predict adiponectin levels and type 2 diabetes progression.
RESEARCH DESIGN AND METHODS—A total of 550 subjects with increased risk of type 2 diabetes were investigated; they underwent a 75-g oral glucose tolerance test, repeated after 3 years. Adiponectin levels were analyzed, and two ADIPOQ promoter variant single nucleotide polymorphisms, −11391G&gt;A and −11377C&gt;G, were genotyped.
RESULTS—Tertiles of the adjusted adiponectin levels were associated with single nucleotide polymorphism −11391G&gt;A and −11377C&gt;G haplotypes (P &lt; 0.0001). Carriers of the intermediate/high-level haplotype combination showed a bisected diabetes risk at the 3-year follow-up and were characterized by a “regression” of glucose tolerance. Evolution of disease status correlates with preexisting low adiponectin levels at inclusion rather than with variation in adiponectin levels.
CONCLUSIONS—We present data that gene variants in the ADIPOQ promoter region are associated with variations in adiponectin levels and thus with future type 2 diabetes and disease progression.
The Prevalence, Severity, and Impact of Painful Diabetic Peripheral Neuropathy in Type 2 Diabetes
Authors: Davies Mark , Brophy Sinead , Williams Rhys , Taylor Ann 
Published: June 2006

OBJECTIVE—To determine the prevalence of painful diabetic peripheral neuropathy (PDPN) in a population-based sample and to estimate its severity and impact.
RESEARCH DESIGN AND METHODS—A cross-sectional descriptive study consisting of two phases: phase 1, a postal survey to patients with type 2 diabetes (an initial screening questionnaire including one question about pain); phase 2, neurological history and examination using the Toronto Clinical Scoring System. Subjects with PDPN or mixed (PDPN and nonneuropathic) pain completed the Neuropathic Pain Scale and Neuroqol to assess severity and nature of the pain and impact on quality of life. Those without PDPN completed the Neuroqol only.
RESULTS—In phase 1, there was a 92.7% response (n = 326), with 208 (63.8%) subjects reporting pain. In phase 2, 269 (82.5%) subjects attended and 51 (19.0%) were found to have PDPN: 99 (36.8%) nonneuropathic pain, 20 (7.4%) mixed pain, and 99 (36.8%) no pain (PDPN prevalence 26.4%). Of those with PDPN, 80% stated that their pain was moderate or severe. Those affected had poorer quality of life than those with no pain (difference in mean scores 3.6 [95% CI 2.5–4.6%]) compared with those with nonneuropathic pain (1.7 [0.4–2.9%]). Both pain and neuropathy score were independently associated with quality of life, and subjects with PDPN had significantly higher neuropathy scores.
CONCLUSIONS—Our study showed a prevalence of PDPN of 26.4%. Having PDPN has a significant negative effect on quality of life, and increasing neuropathy is associated with an increasing risk of developing PDPN.
Continuous Glucose Monitoring–Guided Insulin Adjustment in Children and Adolescents on Near-Physiological Insulin Regimens
Authors: Yates Kylie , Hasnat Milton Abul , Dear Keith , Ambler Geoffrey 
Published: June 2006

OBJECTIVE—This randomized controlled trial assesses the effect on glycemic control of continuous glucose monitoring system (CGMS)-guided insulin therapy adjustment in young people with type 1 diabetes on intensive diabetes treatment regimens with continuous subcutaneous insulin infusion (CSII) or glargine.
RESEARCH DESIGN AND METHODS—Pediatric subjects were recruited if they had an HbA1c (A1C) &lt;10% and had been on CSII or glargine for at least 3 months. Thirty-six subjects were randomized to insulin adjustment on the basis of 72 h of CGMS every 3 weeks or intermittent self-monitoring of blood glucose (SMBG) for 3 months. A1C and fructosamine were measured at baseline and 6 and 12 weeks. Follow-up A1C was measured at 6 months. Mean baseline A1C was 8.2% (n = 19) in the CGMS group and 7.9% (n = 17) in the control group.
RESULTS—There was a significant improvement in A1C from baseline values in both groups, but there was no difference in the degree of improvement in A1C at 12 weeks between the CGMS (−0.4% [95% CI −0.7 to −0.1]) and the control group (−0.4% [−0.8 to 0.2]). In the CGMS group, improved A1C was at the cost of increased duration of hypoglycemia.
CONCLUSIONS—CGMS is no more useful than intermittent fingerstick SMBG and frequent review in improving diabetes control in reasonably well-controlled patients on near-physiological insulin regimens when used in an outpatient clinic setting.
Long-Term Clinical Effects of Epalrestat, an Aldose Reductase Inhibitor, on Diabetic Peripheral Neuropathy
Authors: Hotta Nigishi , Akanuma Yasuo , Kawamori Ryuzo , Matsuoka Kempei , Oka Yoshitomo , Shichiri Motoaki , Toyota Takayoshi , Nakashima Mitsuyoshi , Yoshimura Isao , Sakamoto Nobuo , Shigeta Yukio ,   the ADCT Study Group
Published: June 2006

OBJECTIVE—We sought to evaluate the long-term efficacy and safety of epalrestat, an aldose reductase inhibitor, on diabetic peripheral neuropathy.
RESEARCH DESIGN AND METHODS—Subjects with diabetic neuropathy, median motor nerve conduction velocity (MNCV) ≥40 m/s, and HbA1c ≤9% were enrolled in this open-label, multicenter study and randomized to 150 mg/day epalrestat or a control group. After excluding the withdrawals, 289 (epalrestat group) and 305 (control group) patients were included in the analyses. The primary end point was change from baseline in median MNCV at 3 years. Secondary end points included assessment of other somatic nerve function parameters (minimum F-wave latency [MFWL] of the median motor nerve and vibration perception threshold [VPT]), cardiovascular autonomic nerve function, and subjective symptoms.
RESULTS—Over the 3-year period, epalrestat prevented the deterioration of median MNCV, MFWL, and VPT seen in the control group. The between-group difference in change from baseline in median MNCV was 1.6 m/s (P &lt; 0.001). Although a benefit with epalrestat was observed in cardiovascular autonomic nerve function variables, this did not reach statistical significance compared with the control group. Numbness of limbs, sensory abnormality, and cramping improved significantly with epalrestat versus the control group. The effects of epalrestat on median MNCV were most evident in subjects with better glycemic control and with no or mild microangiopathies.
CONCLUSIONS—Long-term treatment with epalrestat is well tolerated and can effectively delay the progression of diabetic neuropathy and ameliorate the associated symptoms of the disease, particularly in subjects with good glycemic control and limited microangiopathy.
Effect of Peroxisome Proliferator–Activated Receptor γ Agonist Treatment on Subclinical Atherosclerosis in Patients With Insulin-Requiring Type 2 Diabetes
Authors: Hodis Howard N. , Mack Wendy J. , Zheng Ling , Li Yanjie , Torres Mina , Sevilla Diego , Stewart Yolanda , Hollen Barbara , Garcia Karla , Alaupovic Petar , Buchanan Thomas A. 
Published: June 2006

OBJECTIVE—To determine the effect of thiazolidinedione treatment on subclinical atherosclerosis progression in insulin-requiring patients with clinical characteristics suggesting type 2 diabetes.
RESEARCH DESIGN AND METHODS—Eligible participants (n = 299) were randomized within strata of baseline common carotid artery (CCA) intima-media thickness (IMT) (&lt;0.8 mm, ≥0.8 mm) to 400 mg troglitazone daily or placebo for 2 years. A general linear mixed-effects model was used to compare the rate of change in CCA-IMT between treatment groups.
RESULTS—Overall, average rates of CCA-IMT change were not significantly different between troglitazone- and placebo-treated subjects (0.0030 ± 0.021 vs. 0.0066 ± 0.021 mm/year; P = 0.17). In the stratum of subjects with CCA-IMT ≥0.8 mm, troglitazone significantly reduced the progression of CCA-IMT relative to placebo (0.0013 ± 0.022 vs. 0.0084 ± 0.023 mm/year; P = 0.03). Fasting glucose, insulin, and HbA1c were significantly lower in troglitazone- versus placebo-treated subjects (P &lt; 0.01). Whereas blood pressure significantly differed between treatment groups in the ≥0.8-mm stratum, there was no difference between treatment groups in the &lt;0.8-mm stratum.
CONCLUSIONS—Insulin sensitization and reduction in blood pressure may be contributory mechanisms by which troglitazone reduced subclinical atherosclerosis progression in this cohort of well-controlled insulin-dependent patients with clinical characteristics suggesting type 2 diabetes.
Combined Treatment With Exercise Training and Acarbose Improves Metabolic Control and Cardiovascular Risk Factor Profile in Subjects With Mild Type 2 Diabetes
Authors: Wagner Henrik , Degerblad Marie , Thorell Anders , Nygren Jonas , Ståhle Agneta , Kuhl Jeanette , Brismar Torkel B. , Öhrvik John , Efendic Suad , Båvenholm Peter N. 
Published: June 2006

OBJECTIVE—The effect of exercise training and acarbose on glycemic control, insulin sensitivity, and phenotype was investigated in mild type 2 diabetes.
RESEARCH DESIGN AND METHODS—Sixty-two men and women with type 2 diabetes were randomized to 12 weeks of structured exercise training with or without acarbose treatment or to acarbose alone. Glycemic control was determined by HbA1c (A1C), insulin sensitivity (M value) by euglycemic-hyperinsulinemic clamp, and regional fat distribution by computerized tomography and dual X-ray absorptiometry. Physical fitness was determined as maximal oxygen uptake (Vo2max). All investigations were performed before and after the intervention.
RESULTS—Forty-eight subjects completed the study. Exercise improved M value by 92% (P = 0.017) and decreased total and truncal fat (P = 0.002, 0.001) and systolic blood pressure (P = 0.01) but had no significant effect on Vo2max or A1C level. The combination of exercise and acarbose significantly decreased fasting plasma glucose, A1C, lipids, and diastolic blood pressure and increased Vo2max, whereas effects on M value and body composition were comparable with that of exercise alone. Acarbose alone had no significant effect on either M value or A1C but decreased systolic (P = 0.001) and diastolic blood pressure (P = 0.001) and fasting proinsulin level (P = 0.009). Multiple regression analysis showed that addition of acarbose to exercise improved glycemic control.
CONCLUSIONS—In subjects with mild type 2 diabetes, exercise training improved insulin sensitivity but had no effect on glycemic control. The addition of acarbose to exercise, however, was associated with significant improvement of glycemic control and possibly cardiovascular risk factors.
Use of HbA1c in Predicting Progression to Diabetes in French Men and Women
Authors: Droumaguet Celine , Balkau Beverley , Simon Dominique , Caces Emile , Tichet Jean , Charles Marie Aline , Eschwege Eveline ,   the DESIR Study Group
Published: June 2006

OBJECTIVE—Early identification of subjects at high risk for diabetes is essential, and random HbA1c (A1C) may be more practical than fasting plasma glucose (FPG). The predictive value of A1C, in comparison to FPG, is evaluated for 6-year incident diabetes.
RESEARCH DESIGN AND METHODS—From the French cohort study Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR), 1,383 men and 1,437 women, aged 30–65 years, were volunteers for a routine health check-up. Incident diabetes was defined by FPG ≥7.0 mmol/l or treatment by antidiabetic drugs. Multivariate logistic regression models were used to predict diabetes at 6 years. Receiver operating characteristic curves compared the predictive values of A1C and FPG.
RESULTS—At 6 years, 30 women (2.1%) and 60 men (4.3%) had developed diabetes. Diabetes risk increased exponentially with A1C in both sexes (P &lt; 0.001). After stratifying on FPG, A1C predicted diabetes only in subjects with impaired fasting glucose (IFG) (FPG ≥6.10 mmol/l): the odds ratio (95% CI) for a 1% increase in A1C was 7.20 (3.00–17.00). In these subjects, an A1C of 5.9% gave an optimal sensitivity of 64% and specificity of 77% to predict diabetes.
CONCLUSIONS—A1C predicted diabetes, even though the diagnosis of diabetes was based on FPG, but it was less sensitive and specific than FPG. It could be used as a test if fasting blood sampling was not available or in association with FPG. In subjects with IFG, A1C is better than glucose to evaluate diabetes risk, and it could be used to select subjects for intensive early intervention.