bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Insulin Resistance and Nephropathy on Homocysteine in Type 2 Diabetes
Authors: Emoto Masanori , Kanda Hiroyuki , Shoji Tetsuo , Kawagishi Takahiko , Komatsu Miyoko , Mori Katsuhito , Tahara Hideki , Ishimura Eiji , Inaba Masaaki , Okuno Yasuhisa , Nishizawa Yoshiki 
Published: March 2007

OBJECTIVE—To assess the impacts of insulin resistance and renal function on plasma total homocysteine (tHcy) levels in patients with type 2 diabetes with a wide range of nephropathy.
RESEARCH DESIGN AND METHODS—Plasma tHcy levels were measured using the enzyme immunoassay method in 75 patients with type 2 diabetes and compared with those in 54 healthy control subjects. Insulin sensitivity indexes were assessed in patients with type 2 diabetes by hyperinsulinemic-euglycemic clamp using artificial pancreas.
RESULTS—Plasma tHcy levels and their log-transformed values (log tHcy) were significantly higher in all patients with diabetes than in control subjects (tHcy, 12.0 ± 0.7 [SE] vs. 8.7 ± 0.3 μmol/l, P &lt; 0.0001; log tHcy, 1.040 ± 0.021 vs. 0.920 ± 0.016 μmol/l, P &lt; 0.0001). Plasma tHcy levels in patients with diabetes were significantly increased according to degree of nephropathy (P &lt; 0.0001). On simple regression analyses, log tHcy correlated with insulin sensitivity indexes (r = –0.319, P = 0.005) as well as creatinine clearance (r = 0.634, P &lt; 0.0001) in all patients with diabetes. Multiple regression analyses showed that insulin sensitivity indexes (β = –0.245) as well as creatinine clearance were independent contributors to log tHcy in all patients with diabetes (R2 = 0.750, P &lt; 0.0001). For the 59 patients with diabetes with creatinine clearance &gt;60 ml/min, insulin sensitivity indexes were also shown to be a significant contributor to log tHcy (β = –0.438, R2 = 0.561, P &lt; 0.001).
CONCLUSION—Insulin resistance and renal function are independent determinants of tHcy levels in patients with type 2 diabetes.
A Model-Based Method for Assessing Insulin Sensitivity From the Oral Glucose Tolerance Test
Authors: Mari Andrea , Pacini Giovanni , Murphy Elaine , Ludvik Bernhard , Nolan John J. 
Published: March 2007

OBJECTIVE—Available insulin sensitivity (IS) methods based on the oral glucose tolerance test (OGTT) are empirical. We used a glucose-insulin model to derive an OGTT-based IS (oral glucose insulin sensitivity [OGIS]) index, which predicts glucose clearance in a glucose clamp. We validated OGIS against clamp data.
RESEARCH DESIGN AND METHODS—OGIS requires glucose and insulin concentrations from a 75-g OGTT at 0, 2, and 3 h (3-h OGTT) or at 0, 1.5, and 2 h (2-h OGTT). The formula includes six constants optimized to match the clamp results. For this purpose, 15 lean nondiabetic subjects (BMI &lt; 25 kg/m2), 38 obese nondiabetic subjects (BMI &gt; 25 kg/m2), and 38 subjects with type 2 diabetes randomly underwent an OGTT and a 120 mU · min−1 · m−2 insulin infusion euglycemic clamp. Glucose clearance (ClCLAMP), calculated as the ratio of glucose infusion to concentration during the last hour of the clamp, was compared with OGIS. OGIS was also tested on an independent group of 13 subjects with impaired glucose tolerance (IGT).
RESULTS—OGIS and ClCLAMP were correlated in the whole group (R = 0.77, P &lt; 0.0001), in the subgroups (lean: R = 0.59; obese: R = 0.73; type 2 diabetes: R = 0.49; P &lt; 0.02), and in the independent IGT group (R = 0.65, P &lt; 0.02). Reproducibility of OGIS and ClCLAMP were similar (coefficients of variation: OGIS 7.1%, ClCLAMP 6.4%). OGIS was as effective as ClCLAMP in discriminating between groups (for OGIS, lean vs. obese: 440 ± 16 vs. 362 ± 11 ml · min−1 · m−2, P &lt; 0.001; lean vs. type 2 diabetes: 440 ± 16 vs. 239 ± 7, P &lt; 0.0001; obese vs. type 2 diabetes: 362 ± 11 vs. 239 ± 7, P &lt; 0.0001; results were similar for ClCLAMP). The relationships between IS and BMI, fasting plasma insulin, and insulin secretion (calculated from the OGTT insulin concentration) were examined. OGIS yielded results similar to ClCLAMP and fully consistent with established physiological principles. The performance of the index for the 3-h and 2-h OGTT was similar.
CONCLUSIONS—OGIS is an index of IS in good agreement with the clamp. Because of its simplicity (only three blood samples required), this method has potential use for clinical investigation including large-scale epidemiological studies.
Baseline Characteristics of the Diabetic Participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)
Authors: Barzilay Joshua I. , Jones Cheryl L. , Davis Barry R. , Basile Jan N. , Goff David C. , Ciocon Jerry O. , Sweeney Mary Ellen , Randall Otelio S. ,   for the ALLHAT Collaborative Research Group
Published: March 2007

OBJECTIVE—Hypertension (HTN) is a major risk factor for cardiovascular disease (CVD) in the setting of diabetes. There is no consensus on how best to treat hypertension among those with diabetes. Here we describe the characteristics of a cohort of hypertensive adults with diabetes who are part of a large prospective blood pressure study. This study will help clarify the treatment of HTN in the setting of diabetes.
RESEARCH DESIGN AND METHODS—The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is a double-blind randomized trial of 42,448 high-risk hypertensive participants, ages ≥55 years, designed to determine whether the incidence of fatal and nonfatal coronary heart disease (CHD) and combined cardiovascular events (fatal and nonfatal CHD, revascularization surgery, angina pectoris, congestive heart failure, and stroke) differs between diuretic (chlorthalidone) treatment and three alternative antihypertensive therapies: a calcium channel blocker (amlodipine), an ACE inhibitor (lisinopril), and an alpha-adrenergic blocker (doxazosin). The planned follow-up is an average of 6 years, to be completed March 2002.
RESULTS—There are 15,297 diabetic individuals in the ALLHAT study (36.0% of the entire cohort). Of these individuals, 50.2% are male, 39.4% are African-American, and 17.7% are Hispanic. Demographic and laboratory characteristics of the cohort are similar to those of other studies of the U.S. elderly population with HTN. The sample size has 42 and 93% confidence, respectively, for detecting a 16% difference between the diuretic and each of the nondiuretic treatments for the two study outcomes.
CONCLUSIONS—The diabetic cohort in ALLHAT will be able to provide valuable information about the treatment of hypertension in older diabetic patients at risk for incident CVD.
Chronic Care Clinics for Diabetes in Primary Care
Authors: Wagner Edward H. , Grothaus Louis C. , Sandhu Nirmala , Galvin Mary Sue , McGregor Mary , Artz Karen , Coleman Eric A. 
Published: March 2007

OBJECTIVE—To evaluate the impact of primary care group visits (chronic care clinics) on the process and outcome of care for diabetic patients.
RESEARCH DESIGN AND METHODS—We evaluated the intervention in primary care practices randomized to intervention and control groups in a large-staff model health maintenance organization (HMO). Patients included diabetic patients ≥30 years of age in each participating primary care practice, selected at random from an automated diabetes registry. Primary care practices were randomized within clinics to either a chronic care clinic (intervention) group or a usual care (control) group. The intervention group conducted periodic one-half day chronic care clinics for groups of ∼8 diabetic patients in their respective doctor’s practice. Chronic care clinics consisted of standardized assessments; visits with the primary care physician, nurse, and clinical pharmacist; and a group education/peer support meeting. We collected self-report questionnaires from patients and data from administrative systems. The questionnaires were mailed, and telephoned interviews were conducted for nonrespondents, at baseline and at 12 and 24 months; we queried the process of care received, the satisfaction with care, and the health status of each patient. Serum cholesterol and HbA1c levels and health care use and cost data was collected from HMO administrative systems.
RESULTS—In an intention-to-treat analysis at 24 months, the intervention group had received significantly more recommended preventive procedures and helpful patient education. Of five primary health status indicators examined, two (SF-36 general health and bed disability days) were significantly better in the intervention group. Compared with control patients, intervention patients had slightly more primary care visits, but significantly fewer specialty and emergency room visits. Among intervention participants, we found consistently positive associations between the number of chronic care clinics attended and a number of outcomes, including patient satisfaction and HbA1c levels.
CONCLUSIONS—Periodic primary care sessions organized to meet the complex needs of diabetic patients improved the process of diabetes care and were associated with better outcomes.
Additive Glucose-Lowering Effects of Glucagon-Like Peptide-1 and Metformin in Type 2 Diabetes
Authors: Zander Mette , Taskiran Mustafa , Toft-Nielsen Mai-Britt , Madsbad Sten , Holst Jens Juul 
Published: March 2007

OBJECTIVE—The incretin hormone glucagon-like peptide-1 (GLP-1) reduces plasma glucose in type 2 diabetic patients by stimulating insulin secretion and inhibiting glucagon secretion. The biguanide metformin is believed to lower plasma glucose without affecting insulin secretion. We conducted this study to investigate the effect of a combination therapy with GLP-1 and metformin, which could theoretically be additive, in type 2 diabetic patients.
RESEARCH DESIGN AND METHODS—In a semiblinded randomized crossover study, seven patients received treatment with metformin (1,500 mg daily orally) alternating with GLP-1 (continuous subcutaneous infusion of 2.4 pmol · kg–1 · min–1) alternating with a combination of metformin and GLP-1 for 48 h. Under fixed energy intake, we examined the effects on plasma glucose, insulin, C-peptide, glucagon, and appetite.
RESULTS—Fasting plasma glucose (day 2) decreased from 13.9 ± 1 (no treatment) to 11.2 ± 0.4 (metformin) and 11.5 ± 0.5 (GLP-1) and further decreased to 9.4 ± 0.7 (combination therapy) (P = 0.0005, no difference between monotherapy with GLP-1 and metformin). The 24-h mean plasma glucose (day 2) decreased from 11.8 ± 0.5 (metformin) and 11.7 ± 0.8 (GLP-1) to 9.8 ± 0.5 (combination) (P = 0.02, no difference between GLP-1 and metformin). Insulin levels were similar between the three regimens, but glucagon levels were significantly reduced with GLP-1 compared with metformin (P = 0.0003). Combination therapy had no additional effect on appetite scores.
CONCLUSIONS—Monotherapy with GLP-1 and metformin have equal effects on plasma glucose and additive effects upon combination.
Higher Intakes of Fish Protein Are Related to a Lower Risk of Microalbuminuria in Young Swedish Type 1 Diabetic Patients
Authors: Möllsten Anna V. , Dahlquist Gisela G. , Stattin Eva-Lena , Rudberg Susanne 
Published: March 2007

OBJECTIVE—To examine the influence of dietary intake from various protein and fat sources on the occurrence of microalbuminuria in type 1 diabetic patients.
RESEARCH DESIGN AND METHODS—In this nested case control study, 1,150 patients with diabetes duration &gt;5 years reported dietary habits for the previous 12 months and submitted urinary samples for the analysis of albumin excretion rate (AER). A total of 75 cases of albuminuria (overnight AER ≥15 μg/min) were identified and compared with 225 duration-matched control subjects.
RESULTS—Neither mean protein, fat intake, average fish protein intake (control subjects 4.56 ± 3.83 g/day and cases 3.82 ± 2.87 g/day; P = 0.12), nor intake of meat and vegetable protein differed between the cases of albuminuria and the control subjects. High consumers of fish protein (greater than the 75th percentile) (12 cases and 63 control subjects, mean intake 9.35 g fish protein/day, i.e., ∼53 g fish/day) had lower odds ratios (ORs) for microalbuminuria than individuals consuming less fish protein (mean 2.72 g/day) (crude OR 0.49 and 95% CI 0.25–0.97). When adjusted for known confounding factors, such as HbA1c, mean arterial pressure, diabetes duration, age, sex, smoking, BMI, country region, and total energy, individuals with a high intake of fish protein and fish fat showed a reduction in the risk for microalbuminuria (OR 0.22 and 0.31, respectively; 95% CI 0.09–0.56 and 0.13–0.76, respectively). When fish protein and fat were adjusted for each other, a high intake of fish protein but not of fish fat was still significantly associated with a decrease in the risk for microalbuminuria.
CONCLUSIONS—Total protein and fat intake were not associated with the presence of microalbuminuria, but a diet including a high amount of fish protein seemed to lessen the risk.
Personal Models of Diabetes in Relation to Self-Care, Well-Being, and Glycemic Control
Authors: Skinner T. Chas , Hampson Sarah E. 
Published: March 2007

OBJECTIVE—Personal models of diabetes have been shown to be proximal determinants of self-care behavior in adults with diabetes, both cross-sectionally and prospectively. This study set out to test the predictive utility of this approach in adolescents with diabetes.
RESEARCH DESIGN AND METHODS—Participants were recruited from four regional hospitals in southern England (n = 54). They completed questionnaires assessing diabetes self-care, well-being, and personal models of diabetes (perceived impact, perceived seriousness, and short- and long-term treatment effectiveness) at baseline and 1-year follow-up. GHb assays performed as part of the patients’ usual diabetes care were used to assess glycemic control.
RESULTS—After controlling for baseline anxiety, change in perceived impact of diabetes prospectively predicted adolescents’ anxiety (β = −0.21; t = −2.65; P &lt; 0.01). After controlling for baseline dietary self-care, change in perceived effectiveness of the diabetes treatment regimen to control diabetes predicted dietary self-care (β = −0.39; t = −3.28; P &lt; 0.0005). Poorer dietary self-care and being female were predictive of poorer glycemic control (r2 = 0.29; F = 2.74; P &lt; 0.005).
CONCLUSIONS—This study provides further support for the role of personal models of illness in determining responses to illness. As adolescents take responsibility for the management of their diabetes, parents, clinicians, educators, and interventionists should consider these adolescents’ beliefs about their diabetes and its treatment as key factors influencing self-care, emotional well-being, and glycemic control.
Impact of Diabetic Nephropathy on Pharmacodynamic and Pharmacokinetic Properties of Insulin in Type 1 Diabetic Patients
Authors: Rave Klaus , Heise Tim , Pfützner Andreas , Heinemann Lutz , Sawicki Peter T. 
Published: March 2007

OBJECTIVE—To quantify pharmacokinetic and pharmacodynamic properties of regular insulin and insulin lispro in type 1 diabetic patients with and without overt diabetic nephropathy.
RESEARCH DESIGN AND METHODS—In this double-blind, two-way cross-over, euglycemic (5 mmol/l) glucose clamp study, we investigated the metabolic response to subcutaneous injections of regular insulin and insulin lispro (0.2 U/kg) in 12 type 1 diabetic patients with overt diabetic nephropathy (proteinuria &gt;500 mg/24 h and/or serum creatinine &gt;1.5 mg/dl; NP group) and in a control group of 12 type 1 diabetic patients with normal renal function (DC group).
RESULTS—Peak plasma free insulin levels with insulin lispro (359 [NP] vs. 254 pmol/l [DC]) were higher and time to maximal insulin concentrations (85 [NP] vs. 99 min [DC]) shorter than with regular insulin (213 [NP] vs. 144 pmol/l [DC]; 118 [NP] vs. 153 min [DC]) in both patient groups. Overall insulin levels for regular insulin and for insulin lispro were higher in patients with overt diabetic nephropathy compared with control patients. Time to maximal metabolic effect was shorter with insulin lispro than with regular insulin in both patient groups (102 vs. 191 min [NP]; 105 vs. 172 min [DC]). The overall metabolic effect of regular insulin but not of insulin lispro was lower in patients with diabetic nephropathy than in diabetic control patients (967 vs. 1,510 mg/kg, respectively).
CONCLUSIONS—Although insulin levels are higher in patients with overt diabetic nephropathy, the metabolic response to regular insulin is reduced. Insulin lispro maintains its characteristic pharmacokinetic and pharmacodynamic properties in patients with overt diabetic nephropathy.
Reduction of ACE Activity Is Insufficient to Decrease Microalbuminuria in Normotensive Patients With Type 1 Diabetes
Authors: Bojestig Mats , Karlberg Bengt E. , Lindström Torbjörn , Nystrom Fredrik H. 
Published: March 2007

OBJECTIVE—To study whether administration of 1.25 and 5.0 mg ramipril daily, compared with placebo treatment, reduces the urinary albumin excretion rate (UAER) in normotensive patients with type 1 diabetes.
RESEARCH DESIGN AND METHODS—Ramipril was administered double blind at two different doses (1.25 [n = 19] and 5.0 mg [n = 18]), and compared with placebo (n = 18) after a single-blind placebo period of 1–4 weeks. The patients (total, n = 55; women, n = 14) were followed for 2 years. To document an effect on the renin-angiotensin system, ACE activity and plasma-renin activity (PRA) were measured. In addition, 24-h ambulatory blood pressure (BP) was recorded at baseline and repeated after 1 and 2 years using a Spacelab 90207 ambulatory BP recording device (Spacelab, Redmont, CA).
RESULTS—Both doses of ramipril were sufficient to reduce ACE activity and to increase PRA significantly as compared with placebo (P &lt; 0.05 for both). On the other hand, neither ambulatory nor clinic BP was affected by either dose of ramipril compared with the placebo group. There was no progression of UAER in the placebo group during the 2 years of the study. Analysis of covariance showed no differences in UAER between the three treatment groups at year 1 (P = 0.94) or year 2 (P = 0.97), after adjusting for baseline. Furthermore, there were no statistically significant changes from baseline UAER within any of the three treatment groups.
CONCLUSIONS—Treatment with ramipril did not affect microalbuminuria or clinic or ambulatory BP in this study. On the basis of the present study, we question the clinical use of ACE inhibitors in stably normotensive patients with type 1 diabetes and microalbuminuria in whom a concomitant reduction in BP is not demonstrated.
Contribution of Abdominal Adiposity to Age-Related Differences in Insulin Sensitivity and Plasma Lipids in Healthy Nonobese Women
Authors: DeNino Walter F. , Tchernof Andre , Dionne Isabelle J. , Toth Michael J. , Ades Philip A. , Sites Cynthia K. , Poehlman Eric T. 
Published: March 2007

OBJECTIVE—We examined the hypothesis that an age-related increase in the compartments of visceral fat would account, in part, for the deleterious changes in insulin sensitivity and blood lipid profile in nonobese women.
RESEARCH DESIGN AND METHODS—We directly assessed visceral and subcutaneous abdominal adipose tissue areas (computed tomography), glucose disposal (hyperinsulinemic-euglycemic clamp), body composition (dual energy X-ray absorptiometry), blood-lipid profile, and aerobic fitness (Vo2max) in 178 nonobese women categorized into four age groups: group 1, 28 ± 4 years, n = 88; group 2, 46 ± 2 years, n = 38; group 3, 53 ± 2 years, n = 31; and group 4, 67 ± 6 years, n = 21.
RESULTS—Visceral abdominal adipose tissue area increased with age (2.36 cm2 per year, P &lt; 0.0001). We noted an age-related increase in total cholesterol (P &lt; 0.0003), triglycerides (P &lt; 0.0009), LDL cholesterol (P &lt; 0.027), and the ratio of total cholesterol to HDL cholesterol (P &lt; 0.042). However, age-related changes in insulin sensitivity exhibited a different age-related pattern. That is, insulin sensitivity, expressed on an absolute basis or indexed per kilogram of fat-free mass, was lowest in group 4 but was not significantly different among groups 1, 2, and 3. After statistical control for visceral fat, lower insulin sensitivity persisted in group 4, although differences were diminished relative to other groups. However, the effect of visceral fat on age-related changes in the blood-lipid profile was stronger. That is, differences in visceral and deep subcutaneous adipose tissue area abolished age-related differences in total cholesterol, triglycerides, and LDL cholesterol. No independent effects of Vo2max or leisure-time physical activity on age-related changes in insulin sensitivity or on the blood–lipid profile were noted.
CONCLUSIONS—We conclude that 1) visceral fat shows an increase with advancing age, whereas a decrease in insulin sensitivity was noted only in older women; 2) age-related differences in visceral fat explain only a modest part of the decline in insulin sensitivity in nonobese women; and 3) unfavorable changes in plasma lipids were strongly associated with the age-related increase in visceral abdominal adipose tissue.
Establishing Surveillance for Diabetes in American Indian Youth
Authors: Harwell Todd S. , McDowall Janet M. , Moore Kelly , Fagot-Campagna Anne , Helgerson Steven D. , Gohdes Dorothy 
Published: March 2007

OBJECTIVE—To determine prevalence estimates in order to monitor diabetes, particularly type 2 diabetes, in American Indian youth.RESEARCH DESIGN AND METHODS—To explore the feasibility of developing a case definition using information from primary care records, all youth aged &lt;20 years with an outpatient visit or hospitalization for diabetes were identified from the Billings Area Indian Health Service database in Montana and Wyoming from 1997 to 1999, and the medical records were reviewed. Classification for probable type 1 diabetes was based on age ≤5 years, weight per age ≤15th percentile at diagnosis, or positive results of islet cell antibody test. Classification for probable type 2 diabetes was based on weight per age ≥85th percentile or presence of acanthosis nigricans at diagnosis, elevated C-peptide or insulin, family history for type 2 diabetes, or use of oral hypoglycemic agents with or without insulin or absence of current treatment 1 year after diagnosis.RESULTS—A total of 52 case subjects with diabetes were identified, 3 of whom had diabetes secondary to other conditions. Of the remaining 49 case subjects, 25 (51%) were categorized as having probable type 2 diabetes, 14 (29%) as having probable type 1 diabetes, and 10 (20%) could not be categorized because of missing or negative information. Prevalence estimates for diabetes of all types, type 1 diabetes, and type 2 diabetes were 2.3, 0.6, and 1.1, respectively, per 1,000 youth aged &lt;20 years.CONCLUSIONS—Our definitions may be useful for surveillance in primary care settings until further studies develop feasible case definitions for monitoring trends in diabetes among youth.