bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diabetes and Accident Insurance: A 3-year follow-up of 7,599 insured diabetic individuals
Authors: Mathiesen Bent , Borch-Johnsen Knut 
Published: March 2007

OBJECTIVE
Individuals with diabetes pay increased premiums and experience limited coverage when taking out accident insurance, despite the lack of scientific support for this practice. The aim of the present study was to analyze whether diabetic individuals have an increased risk of accident or an increased risk of permanent disability after an accident, compared with two nondiabetic groups.

RESEARCH DESIGN AND METHODS
All diabetic members of the Danish Diabetes Association were given free accident insurance for a 3-year period. Based on informed consent, they were also asked to participate in a follow-up study, comparing accident rates in diabetic individuals with a nondiabetic group. A total of 7,599 diabetic members accepted. The control groups were 1) individuals with a leisure-time insurance in the same company (individual issue) and 2) members of full-time group-based insurance (bank employees) in the same company.

RESULTS
The risk of accidents was 0.7 per 1,000 person-years in the diabetic group, compared with 4.5 per 1,000 person-years in the first and 5.5 per 1,000 person-years in the second nondiabetic control group (P &lt; 0.001). The degree of permanent injury did not differ between the diabetic and the nondiabetic group.

CONCLUSIONS
The risk of accidents and permanent disability is not increased in diabetic individuals. Thus, diabetic individuals should be offered accident insurance at a standard premium without limited coverage.
Results of a Placebo-Controlled Study of the Metabolic Effects of the Addition of Metformin to Sulfonylurea-Treated Patients: Evidence for a central role of adipose tissue
Authors: Abbasi Fahim , Kamath Vinaya , Rizvi Ali A , Carantoni Marcello , Chen Y D I , Reaven Gerald M 
Published: March 2007

OBJECTIVE
To define the metabolic effects of metformin in the treatment of NIDDM and to evaluate potential mechanisms for its ability to improve glycemic control.

RESEARCH DESIGN AND METHODS
Sulfonylurea-treated patients, with inadequate glycemic control, were treated with metformin in either a placebo-controlled or open fashion. Measurements were made of 1) fasting and postprandial plasma glucose, insulin, and free fatty acid (FFA) concentrations; 2) glucose appearance and disappearance rates measured overnight with 3-[3H]glucose; and 3) plasma FFA concentrations during a 45-min infusion period at relatively low (∼ 60 pmol/l) insulin concentrations.

RESULTS
Mean ± SE hourly plasma glucose, insulin, and FFA concentrations were similar before and after treatment in the placebo group. In contrast, mean hourly plasma glucose concentrations were significantly lower (P &lt; 0.005) after metformin treatment in both the placebo-controlled and open-label groups (−3.9 ± 1.0 and −4.4 ± 0.8 mmol/l, respectively). Similarly, day-long hourly FFA levels were lower (P &lt; 0.005) following metformin in the placebo-controlled and open-label groups (−87 ± 35 and −136 ± 31 μmol/l, respectively). Plasma insulin concentrations did not change with treatment in any group. Overnight glucose turnover studies indicated that neither the rate of glucose appearance (hepatic glucose production) or glucose disappearance changed significantly with treatment in the placebo or metformin groups. Because plasma glucose concentration was much lower after metformin treatment, overnight glucose metabolic clearance rate was significantly (P &lt; 0.001) lower in this group. Finally, plasma FFA concentrations in response to a low-dosage insulin infusion (5 mU · m−2 · min−1) were significantly lower after metformin as compared with the placebo-treated group (P &lt; 0.001).

CONCLUSIONS
Metformin treatment was associated with significantly lower day-long plasma glucose and FFA concentrations. Although overnight hepatic glucose production was unchanged following treatment with metformin, the overnight glucose metabolic clearance rate significantly increased. Given these findings, it is suggested that at least part of the antihyperglycemic effect of metformin is due to an increase in glucose uptake, secondary to a decrease in release of FFA from adipose tissue, and lower circulating FFA concentrations.
Ambulatory Medical Care for Non-Hispanic Whites, African-Americans, and Mexican-Americans With NIDDM in the U.S
Authors: Cowie Catherine C , Harris Maureen I 
Published: March 2007

OBJECTIVE
To assess whether medical care for diabetes is different among non-Hispanic whites, African-Americans, and Mexican-Americans with NIDDM.

RESEARCH DESIGN AND METHODS
A questionnaire was administered to a representative U.S. sample of 2,170 noninstitutionalized adults with NIDDM. Information was obtained on physician visits, hyperglycemic therapy, monitoring of glycemic control, screening for and monitoring of complications, and diabetes education.

RESULTS
About 90% of subjects had a regular diabetes physician, and the physician visit rate was similar by race (median of four visits per year). African-Americans were more likely to be treated with insulin (51.9%) than non-Hispanic whites (35.9%, P &lt; 0.0001) and Mexican-Americans (46.2%). Among insulin-treated subjects, African-Americans were less likely to use multiple daily insulin injections (35.1 vs. 53.8% of non-Hispanic whites [P &lt; 0.0001] and 50.5% of Mexican-Americans [P = 0.027]) and were less likely to self-monitor their blood glucose at least once per day (14.0 vs. 29.8% of non-Hispanic whites [P &lt; 0.0001] and 29.0% of Mexican-Americans). The rates of visits to specialists for diabetes complications, physician testing of blood glucose, and screening for hypertension, retinopathy, and foot problems were not substantially different among the three race/ethnic groups. A higher proportion of African-Americans (43.3%) than non-Hispanic whites (31.5%, P &lt; 0.0001) and Mexican-Americans (25.6%, P = 0.001) had received patient education; however, the median number of hours of instruction was lower for African-Americans.

CONCLUSIONS
The frequency of diabetes care is similar among non-Hispanic whites, African-Americans, and Mexican-Americans. The major differences relate to methods of glycemic control and patient education.
Phobic Symptoms, Particularly the Fear of Blood and Injury, Are Associated With Poor Glycemic Control in Type I Diabetic Adults
Authors: Berlin Ivan , Bisserbe Jean Claude , Eiber Renate , Balssa Nicolas , Sachon Claude , Bosquet Frédéric , Grimaldi André 
Published: March 2007

OBJECTIVE
To investigate the presence of psychiatric disorders and symptoms in type I diabetic patients and to identify those that may influence metabolic control as assessed by GHb levels.

RESEARCH DESIGN AND METHODS
This was a cross-sectional study. One hundred and two consecutive patients with type I diabetes who were regular outpatient visitors of a diabetology department were evaluated. The psychiatric assessments included self-rating questionnaires (General Health Questionnaire and Fear Questionnaire) and observer-rating questionnaires (Montgomery-Asberg Depression Rating Scale [MADRS] and Mini International Interview). Diabetic characteristics were assessed by a structured interview. The observer was blind to the diabetic characteristics of the patients.

RESULTS
Type I diabetic patients with GHb levels ≥ 8% had higher psychological distress, scored significantly higher for symptoms of agoraphobia and for fear of blood and injury, had substantially higher levels of anxiety-depression, and performed significantly fewer blood glucose measurements per day. They did not differ in MADRS score from patients with GHb levels &lt; 8%. Multivariate analysis showed that GHb was positively associated with the total score of phobic symptoms and the level of anxiety-depression and inversely associated with the number of daily blood glucose measurements. These factors explained 41% of the variance of GHb. The inverse relationship between GHb and the number of blood glucose measurements per day was mainly influenced by the fear of blood and injury. Patients with high scores for the fear of blood and injury performed fewer blood glucose measurements and had poorer glycemic control; conversely, subjects without fear of blood and injury performed more daily blood glucose measurements and had better glycemic control.

CONCLUSIONS
Phobic symptoms are frequent in patients with type I diabetes. The intensity of phobic symptoms and anxiety-depression negatively influences metabolic control. Increased fear of blood and injury may lead some patients to perform few home blood glucose measurements and may result in poorer glycemic control. This suggests that, by decreasing the fear of blood, injury, and injection, metabolic control may be improved.
A Cross-Sectional Study Comparing Two Quantitative Sensory Testing Devices in Individuals With Diabetes
Authors: Maser Raelene E , Laudadio Charles , Lenhard M James , DeCherney G Stephen 
Published: March 2007

OBJECTIVE
This study was designed to compare circumference discrimination thresholds, as assessed by the Tacticon (Tacticon, Inc., Westtown, PA), a new quantitative sensory testing (QST) device, with vibratory thresholds, an assessment modality of large sensory nerve fibers, in individuals with diabetes.

RESEARCH DESIGN AND METHODS
In this study, 150 individuals with diabetes were evaluated. Vibratory thresholds and circumference discrimination thresholds, evaluated with the Tacticon, were determined using a two-alternative forced-choice procedure.

RESULTS
Vibratory thresholds increased with decreasing ability to discriminate differences in circumference (P &lt; 0.001) for those below and above 50 years of age. Agreement between the two QST devices was assessed via the kappa-statistic in both age-groups (i.e., ≤ 50 years old [kappa = 0.67], &gt; 50 years old [κ = 0.55]). In multiple logistic regression, where circumference discrimination thresholds were the dependent variable, age, duration of diabetes, and height were found to be independently associated for those &gt; 50 years old.

CONCLUSIONS
The Tacticon offers a simple method of assessing the complex function of area discrimination. Our results suggest that the Tacticon can detect neuropathy in the primary care setting. Its cost, portability, and ease of use provide some advantages over existing QST equipment.
Impaired Glucose Tolerance is Normalized by Treatment With the Thiazolidinedione Troglitazone
Authors: Antonucci Tammy , Whitcomb Randall , McLain Richard , Lockwood Dean 
Published: March 2007

OBJECTIVE
The primary purpose of this study was to assess the effects of 12 weeks of treatment with either troglitazone, an investigational thiazolidinedione that acts as an insulin-action enhancer, or placebo in patients with impaired glucose tolerance (IGT).

RESEARCH DESIGN AND METHODS
A total of 51 subjects with IGT between 24 and 77 years of age were enrolled in this multicenter, double-blind, placebo-controlled, parallel group study (troglitazone, 25 patients; placebo, 26 patients). Patients were randomly assigned to receive either 400 mg troglitazone (every morning [QAM]) or placebo (QAM). The main outcome measure was the oral glucose tolerance test (OGTT) assessing glucose, insulin, and C-peptide levels in the fasting state and every 30 min up to 2 h after ingesting the glucose load. Fasting serum levels of HbA1c, fructosamine, lipids, and blood pressure were also measured.

RESULTS
A total of 46 patients completed the study. The glucose, insulin, and C-peptide responses after a glucose load were significantly reduced at 6 and 12 weeks in the troglitazone treatment group. After 6 weeks of treatment, 75% (n = 18) of those taking troglitazone had improved to normal glucose tolerance, whereas only 38% (n = 9) of those of placebo showed improvement (P = 0.008). After 12 weeks of treatment, 80% (n = 16) of the troglitazone treatment group had normalized their glucose tolerance, while only 48% (n = 10) of those on placebo had converted to normal (P = 0.016). Fasting triglyceride levels in the troglitazone treatment group had decreased by 40 mg/dl (0.45 mmol/l) (P = 0.0016). Other lipid measurements, blood pressure, glycosylated hemoglobin, and fructosamine were normal at baseline for both treatment groups and remained normal throughout the study.

CONCLUSIONS
The glycemic response after a glucose load is statistically and clinically significantly improved for patients with IGT treated with troglitazone.
Effect of Intensive Treatment of Diabetes on the Risk of Death or Renal Failure in NIDDM and IDDM
Authors: Hellman Richard , Regan Julie , Rosen Howard 
Published: March 2007

OBJECTIVE
To examine the effectiveness and safety of long-term intensive therapy in NIDDM and IDDM.

RESEARCH DESIGN AND METHODS
In a private practice setting with a multi-disciplinary team, we compared the rates of total mortality, cardiac-specific mortality, and severe renal failure over 14 years in a cohort of 780 eligible patients, 209 patients with a longer duration of intensive therapy (median duration &gt; 11 years, group I) and 571 patients with shorter duration of intensive therapy (median duration &lt; 1 year, group II). A comorbidity index was used to assess the degree of prognostic risk at baseline. A comprehensive diabetes program was the therapeutic intervention. The endocrinologists and diabetes care team provided primary care, aggressive cardiovascular screening, and risk reduction. Intensive insulin therapy was used in 95.7% of group I IDDM and 66.0% of group I NIDDM patients.

RESULTS
The overall median HbA1c for group I was 7.3%. Compared with group II, the overall reduction in cumulative total mortality in group I was 22%. In the cohort with less severe initial comorbidity, the reduction in total mortality was 45%. We found similar reductions in renal failure rates in IDDM and in cardiac mortality in NIDDM patients on intensive insulin therapy.

CONCLUSIONS
This comprehensive diabetes program is associated with lowered mortality and morbidity in both IDDM and NIDDM. Intensive insulin therapy in long-term patients with NIDDM does not increase cardiac mortality. Intensive therapy is safe and effective in NIDDM within the context of a comprehensive program.
NIDDM Patients' Fears and Hopes About Insulin Therapy: The basis of patient reluctance
Authors: Hunt Linda M , Valenzuela Miguel A , Pugh Jacqueline A 
Published: March 2007

OBJECTIVE
This study examines NIDDM patients' attitudes toward insulin injections, the basis of these attitudes, and how they may affect patients' willingness to take insulin.

RESEARCH DESIGN AND METHODS
Forty-four low-income Mexican American NIDDM patients were interviewed using open-ended in-depth interviewing techniques. Transcripts were analyzed using techniques of content analysis. Data classification was cross-checked in analysis conferences and through a second researcher coding 50% of the cases, comparing the results, then resolving any discrepancies.

RESULTS
Patients' positive attitudes toward insulin focus on its efficacy and efficiency, the avoidance of complications, and feeling better and more energetic. Negative attitudes were much more frequently discussed and include “technical concerns”: anxiety about the pain, proper techniques, and general hassles of taking injections; about hypoglycemic symptoms; and about insulin causing serious health problems; and “experimental concerns”: sensing that the disease has progressed into a serious phase, that past treatment efforts have failed, and that the patient has not taken proper care. Attitudes were based on personal experience, observation, what others say, and interactions with health care professionals.

CONCLUSIONS
Results from the few published reports on NIDDM patients' attitudes about insulin from various cultural settings were consistent with our findings, indicating that these themes may be generally applicable to a wider population. It is recommended that health care providers take care to avoid unwitting promotion of negative attitudes toward insulin and actively elicit and respond to patient attitudes to reduce reluctance to take the medication.
High Variability of Glycated Hemoglobin Concentrations in Patients With IDDM Followed Over 9 years: What is the best index of long-term glycemic control?
Authors: Singh Baldev M , McNamara Catherine , Wise Peter H 
Published: March 2007

OBJECTIVE
To determine variability of long-term glycemic control in patients with IDDM.

RESEARCH DESIGN AND METHODS
A retrospective analysis of HbA1 among 122 IDDM patients followed over 9 years.

RESULTS
Annual group mean HbA1 ranged from 8.4 to 9.3% with large standard deviations (1.7–2.0%), indicating marked variability among individuals. Fluctuations of more than ± 1% HbA1 occurred in 50% of the patients year to year, and over 9 years the minimum-maximum range was &gt; 3 and &gt; 5% HbA1 in 55 and 11% of patients, respectively. In any one year, 22–43% of patients had HbA1 &lt; 8%, but over 9 years only 3.3% were consistently &lt; 8%. Groups divided according to baseline HbA1 of &lt; 8, 8–10, and &gt; 10% were significantly separated over 9 years by frequency distribution analysis of individual mean HbA1 but were indistinguishable when analyzed by individual HbA1 interquartile range (measure of variability).

CONCLUSIONS
High variability of long-term glycemic control is a marked feature of IDDM, the extent of which may be relevant to microvascular risk.
Prevalence of NIDDM Among Populations of the African Diaspora
Authors: Cooper Richard S , Rotimi Charles N , Kaufman Jay S , Owoaje Eme E , Fraser Henry , Forrester Terrence , Wilks Rainford , Riste Lisa K , Cruickshank J Kennedy 
Published: March 2007

OBJECTIVE
Rates of non-insulin-dependent diabetes mellitus have risen sharply in recent years among blacks in the U.S. and the U.K. Increases in risk have likewise been observed in the island nations of the Caribbean and in urban West Africa. To date, however, no systematic comparison of the geographic variation of NIDDM among black populations has been undertaken.

RESEARCH DESIGN AND METHODS
In the course of an international collaborative study on cardiovascular disease, we used a standardized protocol to determine the rates of NIDDM and associated risk factors in populations of the African diaspora. Representative samples were drawn from sites in Nigeria, St. Lucia, Barbados, Jamaica, the United States, and the United Kingdom. A total of 4,823 individuals aged 25–74 years were recruited, all sites combined.

RESULTS
In sharp contrast to a prevalence of 2% in Nigeria, age-adjusted prevalences of self-reported NIDDM were 9% in the Caribbean and 11% in the U.S. and the U.K. Mean BMI ranged from 22 kg/m2 among men in West Africa to 31 kg/m2 in women in the U.S. Disease prevalence across sites was essentially collinear with obesity, pointing to site differences in the balance between energy intake and expenditure as the primary determinant of differential NIDDM risk among these populations.

CONCLUSIONS
In ethnic groups sharing a common genetic ancestry, these comparative data demonstrate the determining influence of changes in living conditions on the population risk of NIDDM.
Mobilization of Visceral Adipose Tissue Related to the Improvement in Insulin Sensitivity in Response to Physical Training in NIDDM: Effects of branched-chain amino acid supplements
Authors: Mourier Agnès , Gautier Jean-François , Kerviler Eric De , Bigard André Xavier , Villette Jean-Marie , Garnier Jean-Pierre , Duvallet Alain , Guezennec Charles Yannick , Cathelineau Gérard 
Published: March 2007

OBJECTIVE
To evaluate the effects of an intense physical training program on abdominal fat distribution, glycemic control, and insulin sensitivity in patients with NIDDM and to determine whether branched-chain amino acid (BCAA) supplements influence these effects.

RESEARCH DESIGN AND METHODS
Twenty-four patients (ages 45 ± 2 [mean ± SE] years, BMI 30.2 ± 0.9 kg/m2, HbA1c 7.9 ± 0.3%) were randomly assigned to four groups: training plus BCAA supplement (n = 6), training plus placebo (n = 6), sedentary plus BCAA supplement (n = 6), and sedentary plus placebo (n = 6). Physical training consisted of a supervised 45-min cycling exercise at 75% of their oxygen uptake peak (VO2 peak) two times per week and an intermittent exercise one time per week for 2 months.

RESULTS
Patients who exercised increased their VO2 peak by 41% and their insulin sensitivity by 46%. Physical training significantly decreased abdominal fat evaluated by magnetic resonance imaging (umbilicus), with a greater loss of visceral adipose tissue (VAT) (48%) in comparison with the loss of subcutaneous adipose tissue (18%), but did not significantly affect body weight. The change in visceral abdominal fat was associated with the improvement in insulin sensitivity (r = 0.84, P = 0.001). BCAA supplementation had no effect on abdominal fat and glucose metabolism.

CONCLUSIONS
Physical training resulted in an improvement in insulin sensitivity with concomitant loss of VAT and should be included in the treatment program for patients with NIDDM.
Prevalence and Determinants of Solid and Liquid Gastric Emptying in Unstable Type I Diabetes: Relationship to postprandial blood glucose concentrations
Authors: Lyrenås Ebbe B , Olsson Eva H K , Arvidsson Ulla C , Örn Thomas J , Spjuth Jan H 
Published: March 2007

OBJECTIVE
To compare postprandial blood glucose levels with gastric emptying (GE) time after intake of a solid and a nutrient liquid meal in patients with unstable, type I diabetes.

RESEARCH DESIGN AND METHODS
The subjects studied were 15 patients with long-standing type I diabetes who during the last year repeatedly reported unexplained episodes of instability in their blood glucose regulation, including postprandial hypoglycemia. All patients were on a meal-administered, fast-acting insulin regimen. As control group, 19 healthy subjects were studied. GE was measured at two separate occasions, using a gamma camera after intake of either a solid or a nutrient liquid, isotope-labeled meal. Measurement of GE was done directly after meal completion and at 30-min intervals for 2 h. Insulin was taken 30 min before intake of the meal. Blood glucose was measured 30 min before the meal, after meal completion and at 30, 60, 90, and 120 min after start of the meal. All patients were evaluated for evidence of autonomic neuropathy and were asked for signs of gastrointestinal motor dysfunction.

RESULTS
Seven (44%) of the patients had significantly delayed emptying of the solid meal (three men, four women) (P &lt; 0.01), of whom one woman also had delayed emptying of the liquid meal compared with the healthy control subjects. Changes in blood glucose concentration were correlated to GE time with, in the group with delayed GE, a significant fall after the solid meal compared with the liquid meal (P &lt; 0.05). The lag phase was prolonged in the women compared with the men, reaching significance in the patient group (P &lt; 0.01). The women, patients as well as control subjects, had throughout the study a prolonged emptying time compared with the men after both the solid and the liquid meal. No correlation between GE and blood glucose concentration could be found.

CONCLUSIONS
Delayed GE of a solid meal is commonly found in patients with type I diabetes and may be one cause of unstable blood glucose regulation. Women, patients as well as control subjects, seem to have a more prolonged GE than men. Awareness of gastric function in patients with type I diabetes is essential, especially in patients treated with meal-administered, fast-acting insulin.