bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Hyperinsulinemia Preserve Bone?
Authors: Barrett-Connor Elizabeth , Kritz-Silverstein Donna 
Published: March 2007

OBJECTIVE
Obesity and NIDDM are each associated with increased bone mineral density (BMD). We therefore hypothesize that hyperinsulinemia is an osteogenic factor.

RESEARCH DESIGN AND METHODS
Subjects consisted of 411 men and 559 women aged 50–89 years who were participants in the Rancho Bernardo Heart and Chronic Disease Study and were not diabetic by history or oral glucose tolerance test. Fasting and 2-h postchallenge insulin were measured by radioimmunoassay. Bone mineral density was measured at the midshaft radius with single photon absorptiometry and at the lumbar spine and hip with dual energy X-ray absorptiometry.

RESULTS
Multiple regression analyses indicated that among men, a significant insulin-BMD association at the hip was no longer apparent after adjusting for covariates. Among women, fasting insulin was significantly and positively associated with bone density of the radius and spine (P &lt; 0.05), independent of age, BMI, waist-hip ratio, postmenopausal estrogen use, age at menopause, thiazide use, family history of diabetes, current cigarette smoking, and exercise. Each 10 μU/ml increase in fasting insulin was associated with an increase of 0.33 and 0.57 g/cm2 of the radius and spine, respectively.

CONCLUSIONS
Hyperinsulinemia may be responsible for part of the observed association of both diabetes and obesity with BMD in women.
Androgen Activity as a Risk Factor for Impaired Glucose Tolerance in Postmenopausal Women
Authors: Larsson Hillevi , Ahrén Bo 
Published: March 2007

OBJECTIVE
Low sex hormone–binding globulin (SHBG) has been proposed as a risk factor for NIDDM development in women. Our aim was to study the relationship between SHBG and androgen activity and glucose tolerance, as well as insulin sensitivity, in women with impaired glucose tolerance (IGT).

RESEARCH DESIGN AND METHODS
We studied 22 women with IGT and 46 women with normal glucose tolerance (NGT) aged 57–59 years. Free testosterone (androgen activity) was determined as the testosterone-to-SHBG ratio. A World Health Organization 75-g oral glucose tolerance test (OGTT) was performed, and insulin sensitivity was measured with a euglycemic-hyperinsulinemic clamp.

RESULTS
Fasting glucose (P = 0.021), 2-h blood glucose after the OGTT (P &lt; 0.001), and fasting insulin (P = 0.009) were higher in the IGT group, while insulin sensitivity did not differ significantly between the two groups (P = 0.065). We found that SHBG levels were lower in the IGT group (P = 0.004), while the testosterone-to-SHBG ratio was higher in the IGT than in the NGT group (P = 0.004). Insulin sensitivity correlated negatively with testosterone-to-SHBG ratio in both groups. The correlation was higher in the IGT (r = −0.67, P = 0.001) than in the NGT group (r = −0.29, P = 0.047). In contrast, the 2-h blood glucose correlated with testosterone-to-SHBG ratio in the IGT (r = 0.66, P = 0.001) but not the NGT group (r = −0.04, NS).

CONCLUSIONS
Postmenopausal women with IGT have higher androgen activity than women with NGT, and the androgen activity correlates with the degree of glucose intolerance in IGT. Furthermore, in women with IGT, who have a high risk of NIDDM development, androgen activity seems to have an enhanced negative influence on insulin sensitivity. Therefore, androgen activity appears to be a risk factor for IGT.
Is ACE Gene Polymorphism a Useful Marker for Diabetic Albuminuria in Japanese NIDDM Patients?
Authors: Nakajima Shinichi , Baba Tsuneharu , Yajima Yoshitada 
Published: March 2007

OBJECTIVE
We studied the relationship between an insertion/deletion (I/D) polymorphism in the ACE gene and albuminuria/proteinuria in Japanese NIDDM patients.

RESEARCH DESIGN AND METHODS
A total of 142 Japanese NIDDM patients (89 men, 53 women) with a known diabetes duration of 14 ± 5 (mean ± SD) years and an age of 56 ± 6 years were divided into three groups according to the stage of nephropathy: 41 patients with normoalbuminuria, 47 patients with microalbuminuria, and 54 with overt proteinuria. The three groups were similar in age, diabetes duration, and recent HbA1c level.

RESULTS
The distribution of DD, ID, and II genotypes of the ACE gene did not differ among the three groups (10, 46, and 44% in the normoalbuminuric patients; 13, 53, and 34% in the microalbuminuric patients; and 15, 46, and 39% in the proteinuric patients, respectively). Meanwhile, the frequency of the D allele in the proteinuric male patients was slightly higher than in the normoalbuminuric male patients (45 vs. 27%, X 2 = 3.9, P &lt; 0.05), while the D allele frequency was nonsignificantly lower in the proteinuric female patients than in the normoalbuminuric female patients.

CONCLUSION
These results did not support the hypothesis that the genotype of the ACE gene would be a clinically useful genetic marker for predicting the development of nephropathy in Japanese NIDDM patients. However, the role of D allele of ACE gene in the progression of nephropathy in male patients remains to be seen.
Injection Site Effects on the Pharmacokinetics and Glucodynamics of Insulin Lispro and Regular Insulin
Authors: Braak Edith W Ter , Woodworth James R , Bianchi Rutgert , Cerimele Benito , Erkelens D Willem , Thijssen Jos H H , Kurtz Darcie 
Published: March 2007

OBJECTIVE
The pharmacokinetics and glucodynamics of a new insulin analog, insulin lispro, and regular human insulin were compared and contrasted after subcutaneous administrations in femoral, deltoid, and abdominal injection sites.

RESEARCH DESIGN AND METHODS
Single 0.2 U/kg doses of insulin lispro and regular insulin were administered to 12 healthy subjects in a six-way randomized crossover fashion. Each dose was given after an overnight fast in one of three injection sites: abdominal, deltoid, or femoral. Study drugs were given during a manual euglycemic glucose clamp. Blood samples were collected over the 12-h clamp for measurement of insulin-reactive components, with pharmacokinetic and glucodynamic measurements derived from these serum insulin and clamp measurements.

RESULTS
Glucodynamic comparisons between insulin lispro and regular insulin showed a greater maximum infusion rate (Rmax) at an earlier time (TRmax), regardless of injection site. The total glucose infused (Gtot) showed nearly identical values between sites for insulin lispro. Regular insulin showed greater Gtot values from deltoid and femoral injections. When comparisons were made between drugs, regular insulin produced significantly greater Gtot, primarily driven by the increased Gtot from deltoid and femoral injections. Greater maximum serum insulin concentrations (Cmax) were experienced with insulin lispro at earlier times (tmax), regardless of the injection site (P &lt; 0.001). Abdominal administrations produced the greatest Cmax values at the earliest tmax for both regular insulin and insulin lispro. Deltoid and femoral injections had lower Cmax values for both compounds. Shifts also occurred with tmax, although these shifts were much greater with regular insulin than with insulin lispro. Equivalent area under the curve (AUC) values were found when compared between compounds.

CONCLUSIONS
Slower absorption from deltoid and femoral administrations resulted in an increased duration of action for both regular insulin and insulin lispro when compared to abdominal administration. However, notable increases in the onset of action were only apparent with regular insulin. The consistency with insulin lispro response from abdominal and extremity injection sites allows more potential sites for subcutaneous injection with an assured rapid response.
Five-Year Prospective Study of Glomerular Filtration Rate and Albumin Excretion Rate in Normofiltering and Hyperfiltering Normoalbuminuric NIDDM Patients
Authors: Silveiro Sandra Pinho , Friedman Rogerio , De Azevedo Mirela Jobim , Canani Luis Henrique , Gross Jorge Luiz 
Published: March 2007

OBJECTIVE
To evaluate the evolution of glomerular filtration rate (GFR) and albumin excretion rate (AER) of normofiltering (NF) and hyperfiltering (HF) normoalbuminuric NIDDM patients.

RESEARCH DESIGN AND METHODS
A longitudinal study of 32 normoalbuminuric (AER &lt; 20 μg/min) NIDDM patients and 20 age-, sex-, and BMI-matched normal individuals was done. Subjects had their GFR (51Cr-labeled EDTA single-injection method) measured at entry and after 40 and 60 months. At entry, 13 NIDDM patients had GFR values above the upper limit of the normal range in our laboratory (&gt; 137 ml · min−1 x 1.73 m−2) and were considered as HF. In NIDDM patients, the 24-h AER (radioimmunoassay), HbA1c, urinary urea, and mean arterial blood pressure (MBP) were analyzed at entry and after 40 and 60 months.

RESULTS
There was a significant decline of GFR in NIDDM patients and normal subjects at 60 months. The decline was significantly greater in HF patients (−0.61 ml · min−1.month−1; P = 0.001) than in NF (−0, 18) and control subjects (−0, 14); the rate of change in NF and control subjects was the same (P &gt; 0.05). In stepwise multiple regression analysis, with GFR decline as the dependent variable and GFR and AER at baseline, age and change in MBP, change in urinary urea, change in HbA1c, and change in therapy as independent variables, only baseline GFR (R2 = 0.19, P = 0.002) and age (R2 = 0.31, P = 0.048) were significantly related to the outcome. At 60 months, AER raised &gt; 20 μg/min in three HF and in four NF patients. In logistic regression analysis, only higher initial AER (although still in the normal range; P = 0.037) and an increase in urinary urea (P = 0.021) were significantly related to the later development of microalbuminuria.

CONCLUSIONS
The GFR of normoalbuminuric NIDDM patients declines significantly over 60 months. This decline is associated to baseline GFR and age. HF NIDDM patients show a faster decline in GFR than NF patients, whose GFR falls at a rate that is compatible with the age-related change observed in normal control subjects. The development of microalbuminuria is related to higher baseline AER and to increases in urinary urea and is similar in NF (4 of 19) and HF (3 of 13) NIDDM patients (P &gt; 0.05).
Psychiatric Disorder and Metabolic Control Among Youths With IDDM: A longitudinal study
Authors: Kovacs Maria , Mukerji Protap , Iyengar Satish , Drash Allan 
Published: March 2007

OBJECTIVE
To investigate the longitudinal relationship between psychiatric diagnostic variables and metabolic control among youths with IDDM.

RESEARCH DESIGN AND METHODS
A group of 88 youths, 8 to 13 years old at onset of 1DDM, were evaluated repeatedly during a 9-year follow-up period, on average, using a standardized psychiatric protocol. Levels of HbA1 were also assessed repeatedly. Psychiatric diagnoses were derived independently of HbA1 values.

RESULTS
In univariate longitudinal analyses, the psychiatric diagnosis of noncompliance with medical treatment was significantly related to HbA1 level. There was a trend of an association between any major psychiatric disorder, as well as nondepressive disorder, and HbA1 Interaction terms between IDDM duration (or age) and psychiatric variables were also significantly related to metabolic control. According to the final multivariate model of repeatedly assessed HbA1, noncompliance with medical treatment (irrespective of IDDM duration) and the interaction between nondepressive psychiatric disorder and IDDM duration contributed to worse metabolic control.

CONCLUSIONS
We found some support for the hypothesis that psychiatric morbidity negatively affects blood glucose regulation and that its consequences are more marked the longer young patients have had IDDM. We did not confirm the hypothesis that depressive illness has particularly deleterious consequences on metabolic control. Noncompliance with medical treatment and having had nondepressive psychiatric illness in interaction with IDDM duration account for a statistically significant but clinically modest amount of variability in HbA1 over time. The weak relationship among these variables may explain the inconsistent findings in the literature regarding psychiatric morbidity and metabolic control.
Routine Perioperative Dipyridamole 2O1TI Imaging in Diabetic Patients Undergoing Vascular Surgery: Is it necessary?
Authors: Zarich Stuart W , Cohen Mylan C , Lane Stephen E , Mittleman Murray A , Nesto Richard W , Hill Thomas , Campbell David , Lewis Stanley M 
Published: March 2007

OBJECTIVE
To assess the utility of dipyridamole thallium testing in symptomatic and asymptomatic patients with diabetes undergoing vascular surgery.

RESEARCH DESIGN AND METHODS
Dipyridamole 201Tl myocardial scmtigraphy was performed preoperatively in 93 consecutive patients with diabetes undergoing peripheral vascular procedures. The utility of clinical and thallium variables in predicting cardiovascular complications was assessed.

RESULTS
Two groups of patients were identified: group A (36 patients) without clinical evidence of cardiac disease and group B (57 patients) with clinical evidence of cardiac disease. Dipyridamole thallium scans were abnormal in 21 of 36 (58%) of group A patients compared with 53 of 57 (93%) of group B patients (P &lt; 0.0001). Compared with group B patients with perfusion defects, group A patients with perfusion abnormalities tended to have fewer defects per scan (2.7 ± 1.5 vs. 3.6 ± 1.9, P = 0.05). No perioperative cardiac complications occurred in group A patients while perioperative cardiac complications occurred in 9 of 57 (16%, 95% CI 7-28%) group B patients (P = 0.01). For the entire study population, the complication rate was 10%.

CONCLUSIONS
Diabetic individuals without clinical markers for coronary artery disease appear to be at low risk for adverse postoperative cardiac events after vascular surgery. Preoperative myocardial perfusion imaging may add little to cardiovascular risk assessment in this subgroup of patients with diabetes.
Determinants of Progression of Microalbuminuria in Adolescents With IDDM
Authors: Rudberg Susanne , Dahlquist Glsela 
Published: March 2007

OBJECTIVE
To evaluate the significance of microalbuminuria in adolescents with IDDM and to study the relative importance of blood pressure (BP), metabolic control, and albumin excretion rate (AER) on progression of microalbuminuria.

RESEARCH DESIGN AND METHODS
A cohort of 155/156 children and adolescents followed from onset up to 18.3 years of IDDM participated. In a previous follow-up in July 1991 (up to 15 years of duration), 17 patients had developed persistent microalbuminuria (≥20 μg/min). In these adolescents, we analyzed whether microalbuminuria had progressed (in mean ≥5% per year), had remained unchanged, or had normalized (&lt;20 μg/min) after another 3 years. The predictive values of mean HbA1c, diastolic blood pressure (dBP), systolic blood pressure (sBP), overnight AER, sex, age, and duration of diabetes for the progression of microalbuminuria were determined using multiple regression modeling.

RESULTS
Seven of 17 patients with microalbuminuria in July 1991 had normalized, 6 of 17 patients had progressed, and 4 of 17 patients had remained unchanged after 3 years. Progressors had higher mean HbA1c during the first 5 years of IDDM and higher mean sBP in 1991 than nonprogressors. Patients with normalized microalbuminuria all had AER &lt;30 μg/min in 1991, were younger at onset of microalbuminuria, had lower mean HbA1c, and had lower dBP before normalized AER than nonregressors at the same duration of microalbuminuria. In multivariate analysis, independent significant predictors for progression were first 5-year mean HbAlc, mean AER, and mean sBP in 1991 (R2 = 0.76, P = 0.001).

CONCLUSIONS
Progression of microalbuminuria in adolescents with IDDM is predicted by early sustained hyperglycemia, later elevated sBP, and increased AER per se. Microalbuminuria is frequently normalized in adolescents, and this is associated with better prevailing metabolic control, younger age, and lower dBP.
Socioeconomic Status and Clustering of Cardiovascular Disease Risk Factors in Diabetic Patients
Authors: Connolly V M , Kesson C M 
Published: March 2007

OBJECTIVE
Correction of cardiovascular risk factors is an essential component of good diabetes care. Our goal was to examine the relationship of socioeconomic status in five risk factors: obesity, hypertension, high cholesterol, smoking, and high HbA1c.

RESEARCH DESIGN AND METHODS
We conducted a cross-sectional prevalence study of all patients with diabetes (n = 1,553) attending a clinic in Glasgow, U.K. Area-based codes were used to measure socioeconomic status; these ranged from 1, the most affluent, to 7, the most deprived.

RESULTS
Comparing patients with NIDDM from the seven categories of socioeconomic status, we found that those from deprived categories experienced a higher prevalence of obesity. In the most affluent groups, 30% had a BMI &gt; 30 kg/m2 compared with 47% in the most deprived categories (P &lt; 0.002). With regard to smoking, 13% in the most affluent category smoked compared with 33% in the most deprived (P &lt; 0.001). In patients with IDDM from affluent categories, 13% smoked compared with 34% from deprived categories (P &lt; 0.001). The proportion of patients with no cardiac risk factors fell by 30.6% from deprived category 1 to 7 (P &lt; 0.001), and the proportion of patients with three or more risk factors rose from 8.6% in category 1 to 20.2% in category 7.

CONCLUSIONS
Diabetic patients from areas of low socioeconomic status are at increased risk of cardiovascular disease. To counter this, specific health education programs should be evolved and resources should be directed toward these areas.
Increased Tissue Factor Pathway Inhibitor Activity in IDDM Patients With Nephropathy
Authors: Yokoyama Hiroki , Myrup Bjarne , Rossing Peter , østergaard Per B 
Published: March 2007

OBJECTIVE
Tissue factor pathway inhibitor (TFPI) is bound to vascular endothelium (presumably to heparan sulfate) and circulates in complex with plasma lipoproteins. It directly binds and inhibits factor Xa. The purpose of the study is to investigate whether plasma TFPI activity is altered in IDDM and nephropathy and to evaluate the possible determinants of the alteration.

RESEARCH DESIGN AND METHODS
We assessed plasma concentration of TFPI (total, truncated, and domain 3 TFPI) and plasma activity of factor Xa inhibition in nondiabetic control subjects (n = 22) and in IDDM patients with normoalbuminuria (urinary albumin excretion rate [UAE] &lt; 30 mg/24h, n = 17), incipient nephropathy (UAE 30-300 mg/24 h, n = 17), clinical nephropathy (UAE &gt; 300 mg/24h, n = 25).

RESULTS
Total, truncated, and domain 3 TFPI concentrations were increased in IDDm patients compared with those in control subjects and were more pronounced in IDDM patients with nephropathy. Plasma activity of factor Xa inhibition measured by HEPTEST (Haemachem, St. Louis, MO) assay was increased in IDDM patients, especially in those with nephropathy. TFPI-dependent factor Xa inhibition, obtained as the difference in clotting time with and without adding activity-neutralizing anti-TFPI antibody to samples, was increased in IDDm patients with nephropathy. This was, however, not sufficient to inhibit the biological activity of factor Xa as demonstrated by increased levels of prothrombin fragment 1 + 2. LDL cholesterol and HbA1c were independently correlated to plasma TFPI.

CONCLUSIONS
Inhibition of factor Xa activity is increased in IDDM patients with nephropathy, mainly because of increased plasma TFPI activity. The increased plasma TFPI activity in these patients may be associated with and regulated by LDL in plasma and metabolic control. The anticoagulant activity of TFPI may attenuate the hypercoagulable state in diabetes but does not seem to be able to normalize hemostasis.
Does a High-Carbohydrate Diet Have Different Effects in NIDDM Patients Treated With Diet Alone or Hypoglycemic Drugs?
Authors: Parillo M , Giacco R , Ciardullo A V , Rivellese A A , Riccardi G 
Published: March 2007

OBJECTIVE
To compare the effects of a nigh-carbohydrate diet on blood glucose and plasma lipids in NIDDM patients with either mild or severe glucose intolerance.

RESEARCH DESIGN AND METHODS
A crossover design with a 15-day intervention diet was used. Eighteen patients were separated into two groups on the basis of hypoglycemic treatment (diet, n = 9, or diet plus glibenclamide, n = 9) and were assigned to a 15-day treatment with a high-carbohydrate/low-fiber diet containing 60% energy from carbohydrate and 20% from fat or a low-carbohydrate/low-fiber diet with 40% energy from carbohydrate and 40% from fat and then crossed over to the other diet for 15 more days.

RESULTS
The high-carbohydrate diet produced a significant increase in postprandial blood glucose in patients on glibenclamide (13.6 ± 1.4 vs. 11.0 ± 1.8 mmol/l, P &lt; 0.002, while no difference was recorded in the group on diet alone (9.7 ± vs. 8.9 ± 0.6 mmol/l). Postprandial insulin levels were significantly higher after the high-carbohydrate diet in the group on diet along (248 ± 32 vs. 192 ± 28 pmol/l, P &lt; 0.01), while no significant differences were observed in the other group (226 ± 19 vs. 202 ± 24 pmol/l) The high-carbohydrate diet also induced a significant increase in fasting plasma triglyceride concentrations in both groups (1.36 ± 0.2 vs. 1.12 ± 0.2 mmol/l, P &lt; 0.05 and 1.4 ± 0.3 vs. 1.1 ± 0.1 mmol/l, P &lt; 0.05). No differences were observed in fasting plasma cholesterol and HDL.

CONCLUSIONS
The effects of the high-carbohydrate diet on blood glucose control in NIDDM patients differ according to severity of glucose intolerance.
Rapid HbA1c Testing in a Community Setting
Authors: Carter Janette S , Houston Caron A , Gilliland Susan S , Perez Georgia E , Owen Charles L , Pathak Dorothy R , Little Randie R 
Published: March 2007

OBJECTIVE
To determine whether the DCA 2000 analyzer provides valid and reliable HbA1c results when used under field conditions and operated by nonmedical personnel. This study was part of a community diabetes education program, the Native American Diabetes Project, in which HbA1c was measured as an indicator of average glycemic control.

RESEARCH DESIGN AND METHODS
Two study samples were taken, the first in the spring of 1994 and the second in the spring of 1995. Seven community members in 1994 and six new community members in 1995 were trained over 2 days, using standard protocol, to operate the DCA 2000 HbA1c analyzer and to collect two capillary blood samples from participants in the Native American Diabetes Project. Duplicate DCA 2000 HbA1c measurements performed by the community workers were compared with measurements from a high-performance liquid chromatography (HPLC) system. Validity and reliability measures were calculated.

RESULTS
Of the participants, 43 were studied in 1994 and 14 in 1995. Comparison of the mean DCA 2000 results with those of HPLC showed high validity, with the absolute relative difference between the mean DCA 2000 and the external reference of HPLC (│ mean DCA 2000-HPLC │ /HPLC) as 4.0 and 2.0% for 1994 and 1995, respectively. The Pearson correlation coefficients (r) between these two measures were 0.968 and 0.996 for 1994 and 1995, respectively. While the 1994 data appeared to have less validity for values &gt; 10%, they included only one value with a 60-min warm-up of the DCA analyzer. The 1995 data, all collected after a 60-min warm-up, had good correlation throughout the range of values. The within-run reliability was excellent, with an intraclass correlation coefficient of reliability of 0.959 and 0.975 for paired samples, for 1994 and 1995 respectively. The mean coefficient of variation for these paired measures was 3.0% in 1994 and 2.8% in 1995. Both validity and reliability were improved by changing the warm-up period of the DCA 2000 analyzer from 5 to 60 min. All correlation coefficients were statistically significant (P &lt; 0.0001).

CONCLUSIONS
The DCA 2000 gave valid and reliable HbA1c results when operated in a community setting by nonmedical personnel. Extending the warm-up period of the device to 60 min slightly improved the validity and reliability of the test.