bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health-Insurance Coverage for Adults With Diabetes in the U. S. Population
Authors: Harris Maureen I , Cowie Catherine C , Eastman Richard 
Published: March 2007

OBJECTIVE
To compare the extent and types of health insurance coverage for adults with diabetes to coverage for those without diabetes in the U. S. population.

RESEARCH DESIGN AND METHODS
Nationally representative samples of 2,405 adults with diabetes and 20,131 adults who were not known to have diabetes in the U. S. completed a questionnaire on current health insurance, including coverage through Medicare, private insurance, the military, and Medicaid and other public programs.

RESULTS
Among all adults with diabetes, 92.0% have some form of health insurance, including 86.5% of those 18–64 years of age and 98.8% of those ≥65 years of age. Approximately 41% are covered by more than one health insurance mechanism, but almost 600,000 people with diabetes do not have any form of health-care coverage. Little difference was found by type of diabetes in the proportion who have health insurance. Only small differences exist between people with diabetes and those without diabetes in the percentages covered and the types of health-care coverage. Government-funded programs are responsible for health-care coverage of 57.4% of adults with diabetes, including 26.4% of those 18–64 years of age and 96.0% of those &gt;65 years of age. Private health insurance is held by 69.3% of diabetic people. Lack of private insurance appears to be attributable primarily to lower income.

CONCLUSIONS
Almost all patients with diabetes who are ≥65 years of age have health-care coverage, but 13.5% of those 18–64 years of age have no health insurance. Few differences exist in coverage between individuals with and without diabetes. However, the absence of insurance should have a substantially greater impact on the ability of patients with diabetes to obtain services necessary for care of their disease, compared with those without diabetes. Government-funded insurance mechanisms cover a large proportion of diabetic patients, which indicates a significant societal burden associated with diabetes. Any changes in government reimbursement and coverage policies could have a major impact on health care for patients with diabetes.
Food-Containing Hypocaloric Diets Are As Effective As Liquid-Supplement Diets for Obese Individuals With NIDDM
Authors: Anderson James W , Brinkman-Kaplan Valerie , Hamilton Carlene C , Logan Jo Ellen B , Collins Robert W , Gustafson Nancy J 
Published: March 2007

OBJECTIVE
This study was designed to determine if food-containing hypocaloric diets are as effective as liquid-supplement diets in promoting weight loss for obese individuals with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS
Forty NIDDM subjects with body mass indexes (BMIs) of 30–40 kg/m2 were randomized to one of two 800-kcal diets for 12 weeks. Group A received liquid supplement only, and group B received supplement plus an evening meal. Both groups received an intensive behavioral education program.

RESULTS
Weight loss and improvements in glycemic, blood lipid, and blood pressure parameters were similar for the two groups. Weight loss averaged 15.7 kg for the entire group. The need for insulin, anti-diabetes, and anti-hypertensive medication decreased significantly. No serious side effects were observed.

CONCLUSIONS
Both food-containing and supplement diets providing 800 kcal a day effectively promote weight loss for obese individuals with NIDDM.
A Retrospective Study of Glucose Metabolism in Mothers of Large Babies
Authors: Kurishita Masahiro , Nakashima Koji , Kozu Hiromu 
Published: March 2007

OBJECTIVE
To evaluate retrospectively the glucose metabolism of women who gave birth to large babies.

RESEARCH DESIGN AND METHODS
Within the first 3 days of postpartum, HbA1c of the dense erythrocytes and glycated albumin were measured. The sample group was comprised of 59 women who gave birth to heavy-for-dates infants. Fifty-five women who had average-sized infants formed the control group. Both groups had normal results on screening for gestational diabetes mellitus (GDM) by 28 weeks of gestation. The dense erythrocyte fractionation was obtained by capillary centrifugation for measurement of stable HbA1c.

RESULTS
Mothers of heavy-for-dates infants had a significantly higher level of HbA1c of the dense erythrocytes (mean ± SD; 5.86 ± 0.68 vs. 5.50 ± 0.70%, P = 0.015) and a higher maternal body mass index (BMI) (mean ± SD; 26.5 ±2.9 vs. 24.1 ±2.3 kg/m2, P &lt; 0.00001) than control mothers. Differences in the occurrence of high levels of HbA1c of the dense erythrocytes and maternal BMI were statistically significant (P &lt; 0.01, P &lt; 0.05) between the two groups, but no difference was noted in glycated albumin. There was no statistical correlation between high levels of HbA1c of the dense erythrocytes and maternal obesity.

CONCLUSIONS
High HbA1c levels of the dense erythrocytes and maternal obesity are independent factors that affect fetal oversize. Heavy-for-dates infants may be a consequence of maternal hyperglycemia in late pregnancy. This maternal hyperglycemia was not detected by the routine screening test for GDM.
CD5+ B-Cells at the Onset of Type I Diabetes and in the Prediabetic Period
Authors: Smerdon Rebecca A , Peakman Mark , Hussain Munther J , Sue Wong F , Watkins Peter J , Leslie R David G , Vergani Diego 
Published: March 2007

OBJECTIVE
B-cells expressing CD5 are associated with the production of autoantibodies and are present at increased levels in several autoimmune diseases. The aim of this study was to investigate the relationship of these cells to the development of type I diabetes and the presence of organ and non-organ-specific autoantibodies.

RESEARCH DESIGN AND METHODS
We measured percentage levels of CD5+ B-cells in patients with recent-onset (n = 34) and long-standing (n = 21) type I diabetes and in a cohort of 18 identical twins of patients with type I diabetes studied prospectively, 8 of whom became diabetic (prediabetic twins) during the study; the rest remained nondiabetic after at least 7 years and are now unlikely to develop the disease. Forty-seven healthy individuals were studied as control subjects.

RESULTS
Percentage levels of total B-cells (CD20+) and the proportion expressing CD5 were increased in patients with recent-onset (P &lt; 0.001 for both) but not long-standing type I diabetes compared with control subjects. Percentage levels of CD20+ B-cells were increased in prediabetic twins throughout the prediabetic period (P &lt; 0.05), and there was an increased proportion of CD5-expressing B-cells that failed to reach statistical significance (P = 0.08). Percentage levels of CD20+ B-cells and the proportion expressing CD5 were normal throughout the study in twins remaining nondiabetic. No relationship between percentage levels of CD5+ B-cells and islet cell antibody, thyroid autoantibodies, or non-organ-specific autoantibodies was found.

CONCLUSIONS
These results show an increase in B-cell percentage levels at the diagnosis of type I diabetes, which is because of an expansion of the CD5+ subset. These changes are also evident in twins throughout the prediabetic period, which suggests that they are related to the processes that lead to diabetes.
Long-Term Improvement of Glycemic Control by Insulin Treatment in NIDDM Patients With Secondary Failure
Authors: Lindström Torbjörn , Eriksson Per , Olsson Anders G , Arnqvist Hans J 
Published: March 2007

OBJECTIVE
To evaluate the long-term efficacy of insulin treatment of patients with non-insulin-dependent diabetes mellitus (NIDDM) and secondary failure to oral hypoglycemic agents.

RESEARCH DESIGN AND METHODS
Twenty one NIDDM patients with secondary failure were studied while they were still on oral agents. Then they were switched to insulin treatment, and after a median of 27 months, a long-term evaluation was conducted.

RESULTS
At the long-term evaluation, metabolic control was still markedly improved by insulin treatment, with reduction of HbA1c from 8.8 ± 0.2 (mean ± SE) to 6.9 ± 0.3% (P &lt; 0.0001), lowering of very-low-density lipoprotein (VLDL) cholesterol concentration from 0.97 ± 0.3 to 0.69 ± 0.1 mM (P &lt; 0.03), and lowering of total triglycerides from 2.8 ± 0.6 to 1.8 ± 0.3 mM (P &lt; 0.005), mainly due to reduction of VLDL triglycerides. Body weight increased during the first year, but not thereafter (71.3 ± 2.5 kg during oral treatment, 78.9 ± 2.9 and 79.8 ± 3.2 kg after 12 and 36 months of insulin treatment, respectively). Blood pressure did not change. Fasting and postprandial insulin concentrations increased, and C-peptide concentrations were lowered.

CONCLUSIONS
Improvements of glycemic control and lipoprotein concentrations in patients with NIDDM and secondary failure persist also after insulin treatment for 2–3 years in spite of weight gain and hyperinsulinemia.
Biochemical and Molecular Studies of Mitochondrial Function in Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, and Deafness
Authors: Jackson Margaret J , Bindoff Laurence A , Weber Katharina , Wilson Jonathan N , Ince Paul , Alberti K George M M , Turnbull Douglass M 
Published: March 2007

OBJECTIVE
To determine if diabetes insipidus, diabetes mellitus, optic atrophy, and deafness (DIDMOAD) combined with a cerebellar syndrome is associated with a systemic disorder of respiratory chain function as found in similar genetic syndromes.

CASE
A muscle biopsy was taken from a patient with DIDMOAD, and a mitochondrial fraction was prepared. Respiratory chain function was assessed by analysis of intermediary metabolites, histochemical analysis of muscle biopsy, measurement of the activity of individual respiratory chain complexes, oxidative flux through the respiratory chain, and cytochrome concentration and compared with a population with normal respiratory chain function. Mitochondrial DNA from skeletal muscle, brain, and pancreas was examined for major rearrangements and specific point mutations. Brain tissue was examined neuropathologically for abnormalities, particularly those previously described in association with DIDMOAD.

RESULTS
No abnormality was found in mitochondrial oxidation, individual complex activity, or cytochrome concentration. Histochemical analysis and electron microscopy showed no abnormality known to be associated with mitochondrial dysfunction. A single-base substitution at position 12308 of the mitochondrial genome was found, but no major rearrangement of mitochondrial DNA was demonstrated. Neuropathological examination revealed severe demyelination and gliosis in the optic nerves and loss of Purkinje cells associated with gliosis in the white matter in the cerebellum.

CONCLUSIONS
We have found no evidence that DIDMOAD is associated with a systemic abnormality of respiratory chain function. The mitochondrial DNA single-base substitution noted is likely to be a polymorphism rather than a pathogenic point mutation. We have confirmed that DIDMOAD may be associated with a neurodegenerative disorder, but the cause of this remains undetermined.
HLA-DQB1 Codon 57 and IDDM in Chinese Living in Taiwan
Authors: Chuang Lee-Ming , Jou Tzuu-Shuh , Hu Chung-Yi , Wu Huey-Peir , Tsai Wen-Yu , Lee Jing-Sheng , Hsieh Rhong-Phong , Chen Kuang-Ho , Tai Tong-Yuan , Lin Boniface J 
Published: March 2007

OBJECTIVE
To study the human leukocyte antigen (HLA)-DQB1 genetic background in the Chinese population in Taiwan and its association with the low incidence of insulin-dependent diabetes mellitus (IDDM) in this population.

RESEARCH DESIGN AND METHODS
Forty-eight IDDM patients and 59 nondiabetic unrelated control subjects were recruited from the population in Taiwan. HLA-DQB1 exon 2 was enzymatically amplified by polymerase chain reaction. HLA-DQBl alleles were diagnosed by dot blotting and hybridization with 16 sequence-specific oligonucleotide probes.

RESULTS
DQB1*0201 and DQB1*0302 alleles were more frequent and DQB1*0301 and DQB1*0601 were less frequent in Chinese with IDDM than in control subjects. Genotypes for homozygous non-aspartic acid residue (NA/NA) at position 57 were positively associated with IDDM at a relative risk of 4.34 (P &lt; 0.001), and those for homozygous aspartic acid (A/A) were negatively associatedwith IDDM at a relative risk of 0.14 (P &lt; 0.001). Among the NA/A heterozygotes, only DQB1*0201/ DQB1*0303 was significantly increased in IDDM subjects.

CONCLUSIONS
The amino acid residue at position 57 of HLA-DQ β3-chain is significantly associated with the development or prevention of IDDM in Chinese subjects living in Taiwan. Other genetic and environmental factors may also play important roles in pathogenesis of IDDM.
Use of Focus Groups to Explore Nutrition Practices and Health Beliefs of Urban Caribbean Latinos With Diabetes
Authors: Quatromoni Paula A , Milbauer Marian , Posner Barbara M , Carballeira Nicolas Parkhurst , Brunt Melanie , Chipkin Stuart R 
Published: March 2007

OBJECTIVE
Although Caribbean Latinos are two to three times more likely than non-Hispanic whites to develop diabetes, cultural influences on nutrition and health are poorly understood. To provide insight into important features of diabetes prevention and management, we conducted focus groups to explore nutrition practices and health beliefs.

RESEARCH DESIGN AND METHODS
Thirty low-income urban Caribbean Latinos with non-insulin-dependent diabetes mellitus (NIDDM) and four familymembers participated in four focus group interviews that were conducted in Boston and Cambridge, Massachusetts. Interviews were conducted in Spanish, were tape recorded, and were led and analyzed by Latino professionals from a community-based health organization.

RESULTS
Consistent themes described by participants were feelings of social isolation, little understanding of long-term consequences of diabetes, fatalism regarding the course of the disease, multiple barriers todiet and exercise interventions, skepticism regarding the value of preventive health behaviors, prevalent use of traditional nonmedicai remedies, and a clear need for culturally sensitive health-care providers and services.

CONCLUSIONS
The information from focus groups provides useful information for planning innovative intervention programs for chronic disease risk reduction that emphasize practical skills development, family/peer networks, empowerment techniques, and bilingual providers. We conclude that the focus group technique can be used effectively with low-income, urban minority populations to provide information on lifestyle behaviors and beliefs regarding chronic diseases that impact on health and nutritional status.
Premixed Insulin Preparations in Pen Syringes Maintain Glycemie Control and Are Preferred by Patients
Authors: Dunbar Jennifer M , Madden Patricia M , Gleeson Deirdre T , Fiad Tarek M , McKenna T Joseph 
Published: March 2007

OBJECTIVE
To examine the impact on glycemie control of substituting a range of premixed insulins for the standard treatment with patient-mixed insulin combinations. In addition, a pen-type syringe was substituted for the conventional insulin syringe, and the patients' preference wasascertained at the end of the study.

RESEARCH DESIGN AND METHODS
Before the study, all patients had maintained a constant insulin dosage for 2 months. For the first month of the study, all patients were encouraged to make any adjustment in insulin dosage required to optimize control. Twenty-seven patients participated in the study. At the end of the first month, patients were randomized either to change to premixed insulins or to continue with self-mixed insulins for 2 months. At the end of the 2-month period, participants changed to the alternative regime for a further 2 months. Glycemie control was measured by assessment of glycosylated hemoglobin levels at the start of the study and aftereach 2-month period of the study. In addition, during the 1-month run-in period and during both 2-month study periods, a seven-point blood glucose profile was obtained extending from before breakfast to just before retiring for sleep.

RESULTS
Glycosylated hemoglobin levels were unchanged throughout the duration of the study. Similarly, there were no systematic changes inindividual seven-point blood glucose profiles. The frequency of hypoglycemie reactions was similar on patient-mixed and premixed insulin programs. However, 83% of patients expressed a preference for premixed insulins. A similar percentage regarded pen-type insulin syringes to be preferable to the conventional syringe.

CONCLUSIONS
Glycemie control was similar on patient-mixed and premixed insulins, and patients had a marked preference for premixed insulins delivered in a pen-type syringe over conventional insulin therapy. Premixed insulin delivered by a pen-type syringe promises to ease the burden of daily injections for many diabetic patients.
Assessment of Diabetes Care by Medical Record Review: The Indian Health Service Model
Authors: Mayfield Jennifer A , Rith-Najarean Stephen J , Acton Kelly J , Schraer Cynthia D , Stahn Ruggles M , Johnson Mildred H , Gohdes Dorothy 
Published: March 2007

OBJECTIVE
To evaluate the adherence to minimum standards for diabetes care in multiple primary-care facilities using a uniform system of medical record review.

RESEARCH DESIGN AND METHODS
In 1986, the Indian Health Service (IHS) developed diabetes care standards and an assessment process to evaluate adherence to those standards using medical record review. We review our assessment method and results for 1992. Charts were selected in a systematic random fashion from 138 participating facilities. Trained professional stai reviewed patient charts, using a uniform set of definitions. A weighted rate of adherence was constructed for each item.

RESULTS
Medical record reviews were conducted on 6,959 charts selected from 40,118 diabetic patients. High rates of adherence (&gt;70%) were noted for blood pressureand weight measurements at each visit, blood sugar determinations at each visit, annual laboratory screening tests, electrocardiogram at baseline, and adult immunizations. Lower rates of adherence (≤50%) were noted for annual eye, foot, and dental examinations.

CONCLUSIONS
IHS rates of adherence are similar to rates obtained from medical record reviews and computerized billing data, but are less than rates obtained by provider self-report. Medical record review, using uniform definitions and inexpensive software for data entry and reports, can easily be implemented in multiple primary-care settings. Uniformity of data definition and collection facilitates the aggregation of the data and comparison over time and among facilities. This medical record review system, although labor intensive, can be easily adopted in a variety of primary-care settings for quality improvement activities, program planning, and evaluation.
Differential Regulation of Counterregulatory Hormone Secretion and Symptoms During Hypoglycemia in IDDM: Effect of glycemic control
Authors: Kinsley Brendan T , Widom Barbara , Simonson Donald C 
Published: March 2007

OBJECTIVE
To determine 1) if there was a differential effect of glycemic control on individual counterregulatory hormone responses to hypoglycemia in patients with insulin-dependent diabetes mellitus (IDDM), 2) whether these modifications affect hypoglycemic symptom perception, and 3) if there was a level of glycemic control below which counterregulatory and symptomatic responses to hypoglycemia become consistently altered.

RESEARCH DESIGN AND METHODS
We performed hypoglycemic clamp studies on 38 patients with IDDM and 38 healthy control subjects. Glucose was lowered from 5.0 to 2.2 mmol/1 over 3 h in decrements of 0.6 mmol/1 each 30 min. Epinephrine, cortisol, growth hormone (GH), glucagon, and symptom score were measured at each glucose plateau.

RESULTS
In IDDM patients, HbA1 levels were positively correlated with incremental epinephrine (r = 0.58, P &lt; 0.001) and cortisol (r = 0.52, P &lt; 0.01) responses, but inversely correlated with GH responses (r = –0.31, P &lt; 0.05). The increase in symptom score correlated with the epinephrine response in the IDDM patients (r = 0.57, P &lt; 0.001), but not in the healthy control subjects (r = –0.02, NS). In IDDM patients with HbA1 ≤7.8% (n = 7), the epinephrine, cortisol, and symptomatic responses to hypoglycemia were blunted, but GH secretion was preserved.

CONCLUSIONS
These data suggest that 1) there is differential regulation of counterregulatory hormone secretion that is dependent on the level of glycemic control, 2) epinephrine is an important determinant of symptom perception in IDDM patients, but not in healthy control subjects, and 3) multiple defects in counterregulatory hormone secretion and symptom perception are consistently observed in patients with HbA1 levels ≤7.8%.
Promotion and Acceleration of Diabetic Ulcer Healing by Arginine-Glycine-Aspartic Acid (RGD) Peptide Matrix
Authors: Steed David L , Ricotta John J , Prendergast J Joseph , Kaplan Robert J , Webster Marshall W , McGill Janet B , Schwartz Sherwyn L ,   The Rgd Study Group
Published: March 2007

OBJECTIVE
To determine the effectiveness and safety of arginine-glycine-aspartic acid (RGD) peptide matrix in the treatment of diabetic foot ulcers.

RESEARCH DESIGN AND METHODS
This randomized placebo-controlled investigator- and patient-blinded prospective multicenter investigation was conducted at three institutional and three private U.S. clinics providing ambulatory care. Sixty-five diabetic patients with chronic full-thickness neurotrophic foot ulcers were enrolled. Six discontinued the study because of adverse events. RGD peptide matrix (Argidene Gel; formerly Telio-Derm Gel) was applied topically twice weekly for up to 10 weeks in patients who otherwise received standard care. Control group patients received topical saline as a placebo plus standard care. The primary method of assessment was the incidence and rate of ulcer closure. All patients enrolled were included in the data analysis.

RESULTS
The percentage of patients whose ulcers healed completely in the RGD peptide matrix group (35%; 14 of 40 patients) was over fourfold greater (P = 0.02) than that in the placebo group (8%; 2 of 25 patients). By the study end point (either day of healing or week 10), 30 of 40 (75%) RGD peptide matrix patients had achieved &gt;50% ulcer closure compared with 12 of 25 (48%) placebo patients (P = 0.03). RGD peptide matrix also significantly (P = 0.03) increased the rate of ulcer closure over the 10 weeks of the study.

CONCLUSIONS
RGD peptide matrix treatment promoted and accelerated the healing of chronic diabetic foot ulcers to a significant degree.
Incidence of Diabetes Among Dependents of the U.S. Military Forces Admitted to U.S. Army Treatment Facilities, 1971-1991
Authors: Tiwary Chandra M , Michalek Joel E 
Published: March 2007

OBJECTIVE
To determine the national incidence of diabetes in children by studying a group representing all parts of the country: the dependent children of U.S. military personnel.

RESEARCH DESIGN AND METHODS
Dates of admission, diagnosis of diabetes, age, and gender were collected for all 522,326 children, age 21 or younger, of active duty military personnel admitted to U.S. Army treatment facilities during fiscal years 1971-1991. Incidence rates were expressed as cases per 100,000 person-years.

RESULTS
A total of 2,308 cases of diabetes were diagnosed in 14.3 million person-years of follow-up over the 21 years. The overall incidence rate of diabetes in this population is 16.2 (95% confidence interval 15.5–16.9). For 1987–1991, the age-specific rates were 8.1 (0–4 years), 15.9 (5–9 years), 25.6 (10–14 years), 23.9 (15–19 years), and 23.4 (20–21 years).

CONCLUSIONS
The rates may be biased because of exclusion of people with diabetes from entering military service, and are limited by lack of age adjustment. The racial admixture of our study population does not match the U.S. population as a whole.