bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimation of the Glomerular Filtration Rate in NIDDM Patients From Plasma Creatinine Concentration After Cimetidine Administration
Authors: Kemperman Frits AW , Silberbusch Joseph , Slaats Eduard H , Prins Ariël M , Weber Joop A , Krediet Raymond T , Arisz Lambertus 
Published: March 2007

OBJECTIVE
Glomerular filtration rate (GFR) can be estimated in patients with renal disease from plasma creatinine concentration, age, sex, and body weight according to the formula of Cockcroft and Gault. The hypothesis that this method can be improved when tubular secretion of creatinine is inhibited by cimetidine was studied in NIDDM patients.

RESEARCH DESIGN AND METHODS
In 30 outpatients with NIDDM and normo-(n = 10), micro- (n = 9), or macroalbuminuria (n = 11), GFR was measured as the urinary clearance during continuous infusion of 125I-labeled iothalamate. Plasma creatinine concentration was analyzed with an enzymatic assay before and after 800 mg t.i.d. oral cimetidine was given during a 24-h period.

RESULTS
Plasma creatinine rose in all patients after cimetidine administration and, as a consequence, the clearance calculated with the Cockcroft-Gault formula fell. The ratio of this formula and GFR decreased from 1.16 ± 0.20 to 0.97 ± 0.16 (means ± SD). This ratio tended to be smaller in the normo- (0.93) than in the micro- (0.98) and macroalbuminuric (1.00) groups. Also, 20 patients with a BMI &lt; 30 kg/m2 had a smaller ratio than those with a BMI &gt; 30 kg/m2 (0.92 vs. 1.07; P &lt; 0.05). Bland and Altman analysis showed a difference of the Cockcroft-Gault formula and GFR of 12.0 ± 17.4 ml · min−1 · (1.73 m2)−1, which decreased to −3.8 ± 14.8 ml · min−1 · (1.73 m2)−1. The same analysis of 24-h creatinine clearance with urine collection and GFR showed larger standard deviations.

CONCLUSIONS
GFR can be estimated in an acceptable way from plasma creatinine concentration after cimetidine administration in outpatients with NIDDM. Despite a nonsignificant underestimation in normoalbuminuric and overestimation in overweighted patients, this method is superior to 24-h creatinine clearance with outpatient urine collection.
Hospitalization and Mortality of Diabetes in Older Adults: A 3-year prospective study
Authors: Rosenthal Mark J , Fajardo Mercedes , Gilmore Stephanie , Morley John E , Naliboff Bruce D 
Published: March 2007

OBJECTIVE
In light of increased fatality from acute events and the increased frequency of chronic complications, life expectancy might well be shortened in older patients with diabetes. The current studies investigated factors affecting the likelihood of dying or being hospitalized in older patients with diabetes.

RESEARCH DESIGN AND METHODS
A total of 135 older patients with diabetes were followed for 3 years after predictive factors were evaluated and compared with a cohort of patients without diabetes.

RESULTS
Mortality was only 3,250 per 100,000 patient-years, similar to that for patients without diabetes, but the frequency of hospitalizations was more than twice as high in patients with diabetes. Five factors predicted hospitalization and death. Of these, the geriatric depression score was the best predictor of these poor outcomes.

CONCLUSIONS
Older patients with diabetes were hospitalized more often than those without diabetes, but mortality was similar. Dysphoria is a major predictor of poor outcomes in older patients with diabetes.
Unrecognized Diabetes Among Hospitalized Patients
Authors: Levetan Claresa S , Passaro Maureen , Jablonski Kathleen , Kass Mary , Ratner Robert E 
Published: March 2007

OBJECTIVE
To evaluate the hospital care rendered to hyperglycemic individuals who did not have a diagnosis of diabetes before admission.

RESEARCH DESIGN AND METHODS
A total of 1,034 consecutively hospitalized adult patients at a 750-bed inner-city teaching hospital were evaluated. Patients with one or more plasma glucose values &gt;200 mg/dl were identified by the laboratory data system on a daily basis. Patients without a diagnosis of diabetes at the time of admission were evaluated to determine if and how physicians addressed the hyperglycemia, whether a new diagnosis of diabetes was made during admission, and whether follow-up was planned to address the hyperglycemia.

RESULTS
After excluding patients who were admitted for a primary diagnosis of diabetes, 37.5% of all hyperglycemic medical patients and 33% of hyperglycemic surgical patients were without a diagnosis of diabetes at the time of admission. These patients had a mean peak glucose of 299 mg/dl, and 66% had two or more elevated values during their hospitalization. Fifty-four percent received insulin therapy, and 59% received bedside glucose monitoring, yet 66% of daily patient progress notes failed to comment on the presence of hyperglycemia or diabetes. Diabetes was documented in only three patients (7.3%) as a possible diagnosis in the daily progress notes.

CONCLUSIONS
Despite marked hyperglycemia, most medical records made no reference to the possibility of unrecognized diabetes. Given the average delay of a decade between the onset and diagnosis of type 2 diabetes, further evaluation of hyperglycemic hospitalized patients may present an important opportunity for earlier detection and the initiation of therapy.
Insulin Secretion in Normal Glucose-Tolerant Relatives of Type 2 Diabetic Subjects: Assessments using hyperglycemic glucose clamps and oral glucose tolerance tests
Authors: van Haeften Timon W , Dubbeldam Suzanne , Zonderland Maria L , Erkelens D Willem 
Published: March 2007

OBJECTIVE
To assess insulin secretion in normal glucose-tolerant Caucasian first-degree relatives of type 2 diabetes subjects and in matched normal glucose-tolerant control subjects and to compare insulin secretion as assessed using a hyperglycemic glucose clamp with insulin secretion as assessed using an oral glucose tolerance test (OGTT).

RESEARCH DESIGN AND METHODS
Twenty-one first-degree relatives of type 2 diabetic subjects and 21 control subjects without a family history of type 2 diabetes, who were matched for sex, age, BM1, waist-to-hip ratio, and aerobic capacity, underwent a hyperglycemic glucose clamp (10 mmol/1, 180 min). An OGTT (75 g glucose in 300 ml water) was also performed.

RESULTS
First-phase insulin release (plasma insulin, 0–10 min) was not different (multiple analysis of variance [MANOVA]: F = 2.63, P = 0.11). Second-phase insulin release was lower (MANOVA: F = 4.18, P = 0.047). Separate analyses of variance showed decreased plasma insulin levels from 120 min onward (all P &lt; 0.05), decreasing to geometric mean (95% CI) levels of 330 (270–402) and 462 (366–582) pmol/1 at 180 min in relatives and control subjects, respectively. The insulin sensitivity index (ISI) as assessed using a hyperglycemic clamp was not different between the two groups. Mean ± SE ISI during the 3rd hour was 27.5 ± 2.2 and 30.5 ± 3.0 μg · kg−1 · min−1 · pmol−1 · l−1 in relatives and control subjects, respectively (P &gt; 0.20). At 90 min after the OGTT, log plasma insulin levels correlated significantly with secondphase insulin release as assessed using the hyperglycemic glucose clamp.

CONCLUSIONS
Normal glucose-tolerant first-degree relatives of type 2 diabetic subjects have a decreased second-phase insulin release, compared with matched control subjects. After an OGTT, 90-min values of log plasma insulin and 90-min values of the ratio of log plasma insulin to blood glucose may be good indicators of insulin secretory properties in normal glucose-tolerant family members of type 2 diabetic subjects.
Effects of Glycemic Control on Protective Responses Against Hypoglycemia in Type 2 Diabetes
Authors: Korzon-Burakowska Anna , Hopkins David , Matyka Krystyna , Lomas Jill , Pernet Andrew , Macdonald IAN , Amiel Stephanie 
Published: March 2007

OBJECTIVE
To determine the effects of glycemic control on the counterregulatory responses to hypoglycemia in type 2 diabetes.

RESEARCH DESIGN AND METHODS
Seven poorly controlled type 2 diabetes patients (mean HbA1c, 11.3 ± 1.1%) were studied by stepped hyperinsulinemic hypoglycemic clamp (nadir, 2.4 mmol/1) before and after improving glycemic control with insulin treatment. Counterregulatory hormones, symptoms, and four-choice reaction time were measured at each glucose plateau.

RESULTS
In patients with poorly controlled type 2 diabetes, counterregulatory hormone responses began at higher plasma glucose levels than did those in healthy subjects (epinephrine, 4.4 ± 0.2 vs. 3.7 ± 0.2 mmol/1, P = 0.011). After significant improvement in glycemic control (mean HbA1c, 8.1 ± 0.9%, P &lt; 0.001) was achieved without severe hypoglycemia, hormonal responses started at much lower plasma glucose levels (e.g., epinephrine, 3.5 ± 0.3 mmol/1, P = 0.005) and were significantly reduced in magnitude (e.g., area under epinephrine response curve, 306 ± 93 vs. 690 ± 107 nmol · min−1 · l−1, P = 0.012). This was accompanied by a change in the plasma glucose threshold at which hypoglycemic symptoms first developed from 3.6 ± 0.2 to 3.0 ± 0.2 mmol/1 (P = 0.019). In contrast, the plasma glucose threshold at which four-choice reaction time deteriorated did not change significantly (3.1 ±0.1 vs. 2.9 ± 0.1 mmol/1, P = 0.125).

CONCLUSIONS
Counterregulatory responses begin at normoglycemia in poorly controlled type 2 diabetes. Improving glycemic control with insulin therapy normalizes hormonal responses but lowers the plasma glucose levels at which hypoglycemic symptoms develop to levels associated with impairment of four-choice reaction time, a marker of cognitive function. This process potentially increases the risk of severe hypoglycemia, but to a lesser extent than occurs in type 1 disease.
Economic Consequences of Diabetes Mellitus in the U.S. in 1997
Authors:   American Diabetes Association
Published: March 2007

OBJECTIVE
Diabetes is a significant public health problem resulting in substantial morbidity and mortality. The objectives of this study were 1) to determine the direct medical and indirect costs attributable to diabetes and 2) to calculate total and per capita expenditures of people with and without diabetes.

RESEARCH DESIGN AND METHODS
Direct medical and indirect expenditures attributable to diabetes in 1997 were estimated at $98 billion. Medical expenditures for the treatment of diabetes were estimated for all individuals in the U.S. in 1997 by age-group, sex, race, type of condition, and site of service. Productivity costs due to disability and premature mortality were also estimated for selected patient cohorts. Etiological fractions based on national health care survey data and published literature were used to estimate the proportion of health service utilization and mortality associated with diabetes-related chronic complications and general medical conditions.

RESULTS
Direct medical expenditures attributable to diabetes in 1997 totaled $44.1 billion and comprised $7.7 billion for diabetes and acute glycemic care, $11.8 billion due to the excess prevalence of related chronic complications, and $24.6 billion due to the excess prevalence of general medical conditions. The majority of attributable expenditures were for inpatient care (62%), followed by outpatient services (25%) and nursing home care (13%). Two-thirds of all medical costs for diabetes were borne by elderly people. Attributable indirect costs totaled $54.1 billion and comprised $17.0 billion resulting from premature mortality and $37.1 billion from disability. Total medical expenditures incurred by people with diabetes totaled $77.7 billion or $10,071 per capita, compared with $2,669 for people without diabetes.

CONCLUSIONS
The economic burden of diabetes mellitus in the U.S. is enormous. Medical innovations that can delay the onset and slow the progression of diabetes have tremendous potential to mitigate the associated clinical and cost repercussions.
High Blood Glucose Concentration Is a Risk Factor for Mortality in Middle-Aged Nondiabetic Men: 20-year follow-up in the Whitehall Study, the Paris Prospective Study, and the Helsinki Policemen Study
Authors: Balkau Beverley , Shipley Martin , Jarrett R John , Pyörälä Kalevi , Pyörälä Marja , Forhan Anne , Eschwège Eveline 
Published: March 2007

OBJECTIVE
To assess the association between high but nondiabetic blood glucose levels and the risk of death from all causes, coronary heart disease (CHD), cardiovascular disease, and neoplasms.

RESEARCH DESIGN AND METHODS
We studied the 20-year mortality of non-diabetic, working men, age 44–55 years, in three European cohorts known as the Whitehall Study (n = 10,025), the Paris Prospective Study (n = 6,629), and the Helsinki Policeman Study (n = 631). These men were identified by their 2-h glucose levels following an oral glucose tolerance test and by the absence of a prior diagnosis of diabetes. As the protocol for the oral glucose tolerance test and methods for measuring glucose differed between studies, mortality was analyzed according to the percentiles of the 2-h and fasting glucose distributions, using the Cox's proportional hazards model.

RESULTS
Men in the upper 20% of the 2-h glucose distributions and those in the upper 2.5% for fasting glucose had a significantly higher risk of all-cause mortality in comparison with men in the lower 80% of these distributions, with age-adjusted hazard ratios of 1.6 (95% CI 1.4–1.9) and 2.0 (1.6–2.6) for the upper 2.5%. For death from cardiovascular and CHD, men in the upper 2.5% of the 2-h and fasting glucose distributions were at higher risk, with age-adjusted hazard ratios for CHD of 1.8 (1.4–2.4) and 2.7 (1.7–4.4), respectively.

CONCLUSIONS
If early intervention aimed at lowering blood glucose concentrations can be shown to reduce mortality, it may be justified to lower the levels of both 2-h and fasting glucose, which define diabetes.
Longitudinal Changes in Pancreatic β-Cell Function and Metabolic Clearance Rate of Insulin in Pregnant Women With Normal and Abnormal Glucose Tolerance
Authors: Catalano Patrick M , Drago Noreen M , Amini Saeid B 
Published: March 2007

OBJECTIVE
To evaluate basal pancreatic β-cell secretion and suppression during infused insulin and the metabolic clearance rate of insulin in women with normal and abnormal glucose tolerance prior to conception and during pregnancy.

RESEARCH DESIGN AND METHODS
Seven women with normal glucose tolerance and nine women with abnormal glucose tolerance during gestation were evaluated prior to conception, in early (12–14 weeks) and late (34–36 weeks) gestation. Basal insulin and C-peptide were measured after an 11-h fast and during the last 40 min of a 2-h hyperinsulinemic-euglycemic clamp at 40 mU·m−2·m−1. Suppression of basal C-peptide was calculated as the steady-state C-peptide/basal C-peptide. The metabolic clearance rate of insulin was calculated by dividing the insulin infusion rate by the steady-state insulin concentration, which was corrected for residual β-cell secretion.

RESULTS
No significant differences were noted in the following parameters between women with normal and abnormal glucose tolerance with advancing gestation: increase in basal insulin (P = 0.20) and C-peptide (P = 0.12), ability of infused insulin to decrease basal C-peptide concentration (P = 0.22), and metabolic clearance rate of insulin (P = 0.76). There was a significant 65% increase in both basal insulin (P = 0.0005) and C-peptide (P = 0.0002) concentrations in all subjects with advancing gestation. There was a significant (P = 0.0001) decrease in the ability of the infused insulin to decrease basal C-peptide concentration. C-peptide as a percentage of the basal was 64% before conception, 74% in early pregnancy, and 108% in late pregnancy. The metabolic clearance rate of insulin significantly (P = 0.0005) increased with advancing gestation: pregravid 442 ml·m−2 · min−1, early pregnancy 514 ml·m−2· min−1, and 526 ml·m−2 · min−1 in late pregnancy.

CONCLUSIONS
Pregnancy is accompanied by progressive alterations in insulin kinetics, which are partly responsible for the hyperinsulinemia of this condition. These alterations are more likely a homeostatic response to the increased physiological insulin resistance of pregnancy.
Normalization of Plasma Lipid Peroxides, Monocyte Adhesion, and Tumor Necrosis Factor-α Production in NIDDM Patients After Gliclazide Treatment
Authors: Desfaits Anne-Cécile , Serri Omar , Renier Geneviève 
Published: March 2007

OBJECTIVE
To evaluate the effect of gliclazide administration to NIDDM patients on 1) monocyte adhesion to cultured endothelial cells, 2) plasma cytokine and lipid peroxide levels, and 3) monocyte cytokine production.

RESEARCH DESIGN AND METHODS
Poorly controlled glyburide-treated diabetic patients (n = 8) and healthy control subjects (n = 8) were recruited. At the beginning of the study, glyburide was replaced by an equivalent hypoglycemic dose of gliclazide. Serum and monocytes were isolated from blood obtained from control and diabetic subjects before and after 3 months of treatment with gliclazide.

RESULTS
Plasma lipid peroxide levels and monocyte adhesion to endothelial cells are enhanced in NIDDM patients, and gliclazide administration totally reverses these abnormalities. Before gliclazide treatment, serum levels of cytokines did not differ in the control and the diabetic groups, with the exception of an enhancement of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL)-6 in NIDDM subjects. Basal and lipopolysaccharide (LPS)-stimulated monocyte production of interleukin-1β, IL-6, and IL-8 did not differ between the two groups. Furthermore, basal monocyte production of TNF-α was similar in the control and the diabetic groups, whereas a marked increase in the LPS-stimulated monocyte production of TNF-α was observed in the NIDDM group. Gliclazide treatment lowered LPS-stimulated TNF-α production by diabetic monocytes to levels similar to those observed in control subjects.

CONCLUSIONS
Gliclazide administration to NIDDM patients inhibits the increased adhesiveness of diabetic monocytes to endothelial cells and reduces the production of TNF-α by these cells. These results suggest that treatment of NIDDM subjects with gliclazide may be beneficial in the prevention of atherosclerosis associated with NIDDM.
Diabetes in Urban African-Americans. VI. Utility of Fasting or Random Glucose in Identifying Poor Glycemic Control
Authors: El-Kebbi Imad M , Ziemer David C , Gallina Daniel L , Phillips Lawrence S 
Published: March 2007

OBJECTIVE
African-Americans have an increased prevalence of both diabetes and diabetes complications, creating an imperative for improved metabolic control. Because American Diabetes Association guidelines recommend that action be taken when HbA1c is &gt;8.0', but access to rapid-turnaround HbA1c assays remains limited, we tested the utility of fasting and random plasma glucose cutoffs as indicators of HbA1c &gt;8.0%.

RESEARCH DESIGN AND METHODS
Using receiver operating characteristics (ROC) analysis, we evaluated the sensitivity, specificity, and predictive value of fasting and random plasma glucose measurements in identifying an HbA1c &gt;8.0% (fasting n = 974, random n = 552). The population studied was predominantly African-American, middle-aged, and noninsulin-dependent.

RESULTS
Fasting plasma glucose was a significant indicator of HbA1c &gt;8.0%, both in the whole group and in subgroups for diet, sulfonylureas, and insulin; the corresponding areas under the ROC curve were 0.87, 0.90, 0.87, and 0.84, respectively (all P &lt; 0.0001). A fasting plasma glucose cutoff of &gt;9.2 mmol/1 (165 mg/dl) provided a sensitivity of 80% and a specificity of 83% for the whole group and a 77% positive predictive value. Random plasma glucose was also a good indicator of HbA1c &gt;8.0%, both in the whole group and in subgroups for diet, sulfonylureas, and insulin; the corresponding areas under the ROC curve were 0.85, 0.91, 0.85, and 0.77, respectively (all P &lt; 0.0001). A cutoff &gt;9.8 mmol/1 (177 mg/dl) provided a sensitivity of 78% and a specificity of 77% for the whole group and a 78% positive predictive value. Overall, a plasma glucose &gt;11.1 mmol/1 (200 mg/dl) identified an HbA1c &gt;8.0% with a predictive value of ∼90% if done while fasting and a predictive value of ∼80–85% if random. The utility of both fasting and random plasma glucose cutoffs was subsequently confirmed in a prospective study of another 2,309 and 1,396 patients, respectively.

CONCLUSIONS
Although glucose levels cannot replace HbA1c determinations, measurement of fasting or random plasma glucose may be used during a clinic visit to identify poorly controlled type 2 patients with reasonable certainty and allow timely patient education and therapeutic intervention.
Prevalence of Glucose Intolerance Among Native Hawaiians in Two Rural Communities
Authors: Grandinetti Andrew , Chang Healani K , Mau Marjorie K , Curb J David , Kinney Everett K , Sagum Rebecca , Arakaki Richard F 
Published: March 2007

OBJECTIVE
To estimate prevalence of type 2 diabetes and impaired glucose tolerance (IGT) among a population of native Hawaiians in two rural communities.

RESEARCH DESIGN AND METHODS
Prevalence of glucose intolerance was assessed in two rural communities by history (confirmed by record review) or with a 75-g oral glucose tolerance test according to World Health Organization criteria. Anthropometric and demographic data were also obtained. A short survey was used to estimate the prevalence of known diabetes among nonparticipants. Prevalence rates were adjusted using the standard world population of Segi.

RESULTS
A total of 574 native Hawaiians age ≥30 years participated. The crude prevalence of IGT and type 2 diabetes were 15.5 and 20.4%, respectively. Only IGT prevalence was significantly higher (P = 0.03) among women (18.7%) than among men (10.9%). Prevalence of glucose intolerance was significantly associated with BM1, waist circumference, and waistto-hip ratio (WHR). After adjusting for age and BMI, waist circumference and WHR were significantly and independently associated with type 2 diabetes prevalence only among women. Prevalence of type 2 diabetes was not significantly associated with the percentage of Hawaiian ancestry after adjusting for age.

CONCLUSIONS
This study observed a high prevalence of glucose intolerance associated with being overweight among native Hawaiians. Age-adjusted type 2 diabetes prevalence was four times higher than among the U.S. National Health and Nutrition Examination Survey (NHANES) II population. Prevalence was high despite high rates of admixture with other ethnic groups of Hawaii, suggesting that these other Asian and Pacific Island populations share similar susceptibility to type 2 diabetes risk.