bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Indian or Anglo Dietary Preference on the Incidence of Diabetes in Pima Indians
Authors: Williams Desmond E. , Knowler William C. , Smith Cynthia J. , Hanson Robert L. , Roumain Janine , Saremi Aramesh , Kriska Andrea M. , Bennett Peter H. , Nelson Robert G. 
Published: March 2007

OBJECTIVE—In short-term studies, adoption of a traditional diet is associated with reduction in metabolic abnormalities often found in populations experiencing rapid lifestyle changes. We examined the long-term effects of a self-assessed traditional or nontraditional dietary pattern on the development of type 2 diabetes in 165 nondiabetic Pima Indians.
RESEARCH DESIGN AND METHODS—Dietary intake was assessed in 1988 by a quantitative food frequency method, and subjects were asked to classify their diet as “Indian,” “Anglo,” or “mixed.” The Indian diet reflects a preference for Sonoran-style and traditional desert foods. The Anglo diet reflects a preference for non-Sonoran–style foods typical of the remaining regions of the U.S.
RESULTS—In women, the intake of complex carbohydrates, dietary fiber, insoluble fiber, vegetable proteins, and the proportion of total calories from complex carbohydrate and vegetable proteins were significantly higher (P &lt; 0.05) in the Indian than in the Anglo diet. The mixed diet was intermediate in of all these constituents. In men, the intake for these nutrients was also higher in the Indian than in the Anglo group, but not significantly. Diabetes developed in 36 subjects (8 men and 28 women) during 6.2 years of follow-up (range 0.9–10.9). The crude incidence rates of diabetes were 23, 35, and 63 cases per 1,000 person-years in the Indian, mixed, and Anglo groups, respectively. After adjustment for age, sex, BMI, and total energy intake in a proportional hazards model, the risk of developing diabetes in the Anglo-diet group was 2.5 times as high (95% CI 0.9–7.2) and the rate in the mixed-diet group was 1.3 times as high (0.6–3.3) as in the Indian-diet group.
CONCLUSIONS—This study suggests that the adoption of an Anglo diet may increase the risk of developing diabetes in Pima Indians, but it does not provide unequivocal evidence for or against this hypothesis.
Mortality Trends in Type 1 Diabetes
Authors: Nishimura Rimei , LaPorte Ronald E. , Dorman Janice S. , Tajima Naoko , Becker Dorothy , Orchard Trevor J. 
Published: March 2007

OBJECTIVES—To investigate long-term mortality and its temporal trends as of 1 January 1999 among the 1,075 patients with type 1 diabetes (onset age &lt;18 years, diagnosed between 1965 and 1979) who comprise the Allegheny County population-based registry.
RESEARCH DESIGN AND METHODS—Overall, sex- and race-specific mortality rates per person-year of follow-up were determined. Standardized mortality ratios were also calculated. Survival analyses and Cox proportional hazard model were also used. Temporal trends were examined by dividing the cohort into three groups by year of diagnosis (1965–1969, 1970–1974, and 1975–1979).
RESULTS—Living status of 972 cases was ascertained as of January 1, 1999 (ascertainment rate 90.4%). The mean duration of diabetes was 25.2 ± 5.8 (SD) years. Overall, 170 deaths were observed. The crude mortality rate was 627 per 100,000 person-years (95% CI 532–728) and standardized mortality ratio was 519 (440–602). Life-analyses by the Kaplan-Meier method indicated cumulative survival rates of 98.0% at 10 years, 92.1% at 20 years, and 79.6% at 30 years duration of diabetes. There was a significant improvement in the survival rate between the cohort diagnosed during 1965–1969 and that diagnosed during 1975–1979 by the log-rank test (P = 0.03). Mortality was higher in African-Americans than in Caucasians, but there were no differences seen by sex. The improvement in recent years was seen in both ethnic groups and sexes.
CONCLUSIONS—An improvement in long-term survival was observed in the more recently diagnosed cohort. This improvement is consistent with the introduction of HbA1 testing, home blood glucose monitoring, and improved blood pressure therapy in the 1980s.
Unchanged Incidence of Lower-Limb Amputations in a German City, 1990–1998
Authors: Trautner Christoph , Haastert Burkhard , Spraul Maximilian , Giani Guido , Berger Michael 
Published: March 2007

OBJECTIVE—A reduction of diabetes-related amputations by at least one-half within 5 years was declared a primary objective for Europe (St. Vincent Declaration, 1989). We collected data about incidence rates of amputations in one German city (Leverkusen, with a population of ∼160,000 inhabitants) between 1990 and 1998 to ascertain a potential change in rates of incidence.
RESEARCH DESIGN AND METHODS—From all three hospitals in Leverkusen, we obtained complete lists of lower-limb amputations. From each patient record, diabetic status was determined. Only the first observed amputation was counted for the analysis. We estimated incidence rates of amputations in the entire population, the diabetic population, and the nondiabetic population. To test for time trend, we fitted Poisson regression models, adjusting for age and sex.
RESULTS—During the defined period (the years 1990, 1991, and 1994–1998), 339 patients (all residents of Leverkusen) without previous amputations had nontraumatic lower-limb amputations. Of all subjects, 46% were female. Moreover, 76% of the subjects were known to have diabetes. Mean age was 71.3 years. Incidence rates in the diabetic population (standardized to the estimated German diabetic population, per 100,000 person-years) were as follows: 1990, 549; 1991, 356; 1994, 544; 1995, 386; 1996, 426; 1997, 433; and 1998, 463. The Poisson models showed no significant change of incident amputations over time in the diabetic population or in the nondiabetic population.
CONCLUSIONS—Beyond random variation, no change of incidence rates could be observed over the past 9 years. More specific interventions are needed to achieve a substantial reduction of diabetes-related amputations.
Geographic Variation of Lower-Extremity Major Amputation in Individuals With and Without Diabetes in the Medicare Population
Authors: Wrobel James S. , Mayfield Jennifer A. , Reiber Gayle E. 
Published: March 2007

OBJECTIVE—To describe geographic variation in rates of lower-limb major amputation in Medicare patients with and without diabetes.
RESEARCH DESIGN AND METHODS—This cross-sectional population-based study used national fee-for-service Medicare claims from 1996 through 1997. The unit of analysis was 306 hospital referral regions (HRRs) representing health care markets for their respective tertiary medical centers. Numerators were calculated using nontraumatic major amputations and the diabetes code (250.x) for individuals with diabetes. Denominators for individuals with diabetes were created by multiplying the regional prevalence of diabetes (as determined using a 5% sample of Medicare Part B data identifying at least two visits with a diabetes code for 1995–1996) by the regional Medicare population. Denominators for individuals without diabetes were the remaining Medicare beneficiaries. Rates of major amputations were adjusted for age, sex, and race.
RESULTS—Rates of major amputations per year were 3.83 per 1,000 (95% CI 3.60–4.06) individuals with diabetes compared with 0.38 per 1,000 (95% CI 0.35–0.41) individuals without diabetes. Marked geographic variation was observed for individuals with and without diabetes; however, patterns were distinct between the two populations. Rates were high in the Southern and Atlantic states for individuals without diabetes. In contrast, rates for individuals with diabetes were widely varied. Variation across HRRs for individuals with diabetes was 8.6-fold compared with 6.7-fold in individuals without diabetes for major amputations.
CONCLUSIONS—Diabetes-related amputation rates exhibit high regional variation, even after age, sex, and race adjustment. Future work should be directed to exploring sources of this variation.
Idiopathic Type 1 Diabetes in Dallas, Texas
Authors: Piñero-Piloña Antonio , Litonjua Patrick , Aviles-Santa Larissa , Raskin Philip 
Published: March 2007

OBJECTIVE—To describe the clinical course of individuals with idiopathic type 1 diabetes after a mean of 5 years from diagnosis and to compare glycemic control between those treated with diet and/or oral agents and those treated with insulin at follow-up.
RESEARCH DESIGN AND METHODS—Medical records of patients with new-onset diabetes, who presented with unprovoked diabetic ketoacidosis, were reviewed. A total of 54 of these individuals were traceable and had relevant data collected within the past 2 years. All patients had nonsusceptibility HLA haplotypes and no serological evidence of autoimmune type 1 diabetes. Most of these patients were male (41 men and 13 women), were non-Caucasian, were obese at the time of diagnosis (BMI 31.6 ± 6.3 kg/m2), reported weight loss (12.8 ± 9.8 kg), had a family history of type 2 diabetes, and had acanthosis nigricans. At follow-up, 33 patients were still taking insulin and 21 were on diet and/or oral-agent therapy.
RESULTS—Both treatment groups were similar in clinical presentation and demographics at diagnosis. After 4.8 ± 1.6 years of follow-up, the 33 patients that were receiving insulin had a lower HbA1c than the 21 patients who were using therapies other than insulin (7.8 ± 2.4 vs. 11.1 ± 3.5%, P = 0.009; 95% CI 1.0–6.5%). There was a high correlation between change in weight and change in HbA1c at follow-up (r = 0.45, P &lt; 0.001, n = 54). There were no differences in the rate of diabetes complications or in the episodes of recurrent diabetic ketoacidosis.
CONCLUSIONS—Idiopathic type 1 diabetes occurs more frequently in male African-American patients but also occurs in other ethnic groups. Patients with idiopathic type 1 diabetes who continued to use insulin had better glycemic control than patients using therapies other than insulin. Regained weight is a good clinical marker for improvement in glycemic control. Individuals with this type of diabetes should not be switched to therapies other than insulin.
Polychlorinated Biphenyl Serum Levels in Pregnant Subjects With Diabetes
Authors: Longnecker Matthew P. , Klebanoff Mark A. , Brock John W. , Zhou Haibo 
Published: March 2007

OBJECTIVE—Polychlorinated biphenyls (PCBs) are persistent pollutants that are ubiquitous in the food chain; detectable amounts are in the blood of nearly everyone. Their effect on humans at background levels of exposure is an area of active investigation. Increased blood levels of dioxin (2,3,7,8-tetrachlorodibenzo-p-dioxin), a PCB-like compound, have recently been reported among subjects with diabetes, suggesting that PCB levels could be similarly elevated. To test this hypothesis, we examined a group of pregnant women whose serum PCB levels had been measured and whose diabetes status had been previously recorded.
RESEARCH DESIGN AND METHODS—Using stored serum from a large birth cohort study, we conducted a cross-sectional study of 2,245 pregnant women, of whom 44 had diabetes (primarily type 1) and 2,201 were control subjects.
RESULTS—The adjusted mean serum level of PCBs among the subjects with diabetes was 30% higher than in the control subjects (P = 0.0002), and the relationship of PCB level to adjusted odds of diabetes was linear.
CONCLUSIONS—The possibility exists that PCBs and diabetes are causality related; alternatively, the pharmacokinetics of PCBs could be altered among patients with diabetes. At any event, if the association is replicated in other studies, increased serum levels of PCBs in subjects with diabetes or their offspring may put them at increased risk of PCB-induced changes in thyroid metabolism or neurodevelopment.
Importance of Early Insulin Secretion
Authors: Hollander Priscilla A. , Schwartz Sherwyn L. , Gatlin Marjorie R. , Haas Stephen J. , Zheng Hongjie , Foley James E. , Dunning Beth E. 
Published: March 2007

OBJECTIVE—This study compared the effects of nateglinide, glyburide, and placebo on postmeal glucose excursions and insulin secretion in previously diet-treated patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—This randomized, double-blind, placebo-controlled multicenter study was conducted in 152 patients who received either nateglinide (120 mg before three meals daily, n = 51), glyburide (5 mg q.d. titrated to 10 mg q.d. after 2 weeks, n = 50), or placebo (n = 51) for 8 weeks. Glucose, insulin, and C-peptide profiles during liquid meal challenges were measured at weeks 0 and 8. At weeks −1 and 7, 19-point daytime glucose and insulin profiles, comprising three solid meals, were measured.
RESULTS—During the liquid-meal challenge, nateglinide reduced the incremental glucose area under the curve (AUC) more effectively than glyburide (Δ = −4.94 vs. −2.71 mmol · h/l, P &lt; 0.05), whereas glyburide reduced fasting plasma glucose more effectively than nateglinide (Δ = −2.9 vs. −1.0 mmol/l, respectively, P &lt; 0.001). In contrast, C-peptide induced by glyburide was greater than that induced by nateglinide (Δ = +1.83 vs. +0.95 nmol · h/l, P &lt; 0.01), and only glyburide increased fasting insulin levels. During the solid meal challenges, nateglinide and glyburide elicited similar overall glucose control (Δ 12-h incremental AUC = −13.2 vs. −15.3 mmol · h/l), but the insulin AUC induced by nateglinide was significantly less than that induced by glyburide (Δ 12-h AUC = +866 vs. +1,702 pmol · h/l, P = 0.01).
CONCLUSIONS—This study demonstrated that nateglinide selectively enhanced early insulin release and provided better mealtime glucose control with less total insulin exposure than glyburide.
Role of Hemochromatosis C282Y and H63D Mutations in HFE Gene in Development of Type 2 Diabetes and Diabetic Nephropathy
Authors: Moczulski Dariusz K. , Grzeszczak Wladyslaw , Gawlik Barbara 
Published: March 2007

OBJECTIVE—In patients with clinical hemochromatosis, the frequency of diabetes ranges from 20 to 50%, and the heterozygosity for the C282Y mutation in the HFE gene might be associated with an increased risk for diabetes. There are also some reports that suggest that iron overload might cause diabetic nephropathy.
RESEARCH DESIGN AND METHODS—We performed an association study to assess the role of the C282Y and H63D mutations in the HFE gene as a risk factor for type 2 diabetes and diabetic nephropathy. Altogether, 563 patients with type 2 diabetes were included in the study. In the analyzed group, 108 patients had overt proteinuria, 154 had microalbuminuria, and 301 had normoalbuminuria. Among the patients with normoalbuminuria, only those with known diabetes duration ≥10 years were considered normoalbuminuric (n = 162). A total of 196 unrelated healthy subjects were used as a control group. All subjects were genotyped for C282Y and H63D using the polymerase chain reaction–based protocol.
RESULTS—There was an increased frequency of 282Y allele carriers among patients with type 2 diabetes versus healthy control subjects (OR 5.3, 95% CI 1.6–17.3). We observed an increased frequency of the 63D allele carriers among patients with diabetic nephropathy (1.8, 1.2–2.8).
CONCLUSIONS—In conclusion, our study is the first to indicate that being a carrier of the H63D hemochromatosis mutation is a risk factor for nephropathy in type 2 diabetic patients. We also confirmed previous observations that the frequency of the 282Y mutation was higher in patients with type 2 diabetes than it was in the general population of healthy subjects.
Use of an Automated Device for Alternative Site Blood Glucose Monitoring
Authors: Fineberg S. Edwin , Bergenstal Richard M. , Bernstein Robert M. , Laffel Lori M. , Schwartz Sherwyn L. 
Published: March 2007

OBJECTIVE—To evaluate the accuracy, comfort, and ease of use of a new automated device for blood glucose monitoring using the arm as an alternative sampling site.
RESEARCH DESIGN AND METHODS—These studies use an automated hand-held device that applies a small vacuum, lances the skin, transfers blood onto an electrochemical test strip, and measures glucose. Patients who had type 1 or type 2 diabetes and had received no prior training using this device were recruited from five diabetes clinics. Testing was performed by the patients using this device and by trained healthcare professionals. Blood glucose was measured by 354 patients: from the arm using the device, from the finger using a laboratory reference instrument, and from the finger using the device via the secondary test port. Each patient completed a questionnaire rating the level of pain and ease of use of the device.
RESULTS—Blood glucose results in samples obtained from the arm with the automated device agreed well with finger-stick plasma glucose results using a reference instrument (regression slope 0.98, intercept 0.01 mmol/l [0.1 mg/dl], r = 0.96). Error grid analysis showed that 100% of the measurements fell within zones A and B. In the survey, 60% of the patients reported that arm testing with the automated device was “painless;” another 31% of the patients stated that it was “much less painful,” and 6% of patients considered using the device “less painful” than finger-stick testing. In a survey containing 15 questions for rating the ease of use with a scale of 1 to 6, the overall mean rating was 5.5.
CONCLUSIONS—The automated device is easy to use and provides accurate glucose results; 97% of the patients found it less painful than finger-stick testing.
Body Fatness and Fat Distribution as Predictors of Metabolic Abnormalities and Early Carotid Atherosclerosis
Authors: Takami Rieko , Takeda Noriyuki , Hayashi Makoto , Sasaki Akihiko , Kawachi Shinichi , Yoshino Koji , Takami Kazuhisa , Nakashima Kazuya , Akai Akifumi , Yamakita Noriyoshi , Yasuda Keigo 
Published: March 2007

OBJECTIVE—To test the hypothesis that intra-abdominal fat plays a primary role over general adiposity for metabolic abnormalities and atherosclerosis.
RESEARCH DESIGN AND METHODS—We cross-sectionally studied 849 Japanese men aged 50.3 ± 8.5 years (range 20–78) with BMI 23.5 ± 2.9 kg/m2. Intimal-medial thickness (IMT) of the carotid artery was measured by ultrasound. General adiposity was assessed by BMI. Waist circumference and waist-to-hip ratio (WHR) were used as a surrogate measure for abdominal fat. Abdominal subcutaneous fat area (ASF) and intra-abdominal fat area (IAF) were measured by computed tomography. Correlations between these measures and carotid IMT were analyzed. The interaction of generalized adiposity (BMI) and IAF in relation to metabolic variables, such as glucose tolerance, insulin resistance, and serum lipids, was also evaluated.
RESULTS—BMI, waist circumference, WHR, ASF, and IAF were all correlated with carotid IMT. Adjustment for BMI eliminated the associations between IMT and waist circumference, ASF, and IAF. In contrast, WHR retained a significant correlation with IMT. BMI and IAF were associated with insulin resistance, glucose tolerance, HDL cholesterol, and blood pressure independently of each other. IAF was an independent correlate for serum triglyceride, but BMI was not.
CONCLUSIONS—The primary importance of IAF over general adiposity for carotid atherosclerosis was not confirmed. Caution is recommended when using WHR as a measure of abdominal fat. The roles of IAF for metabolic abnormalities may be more limited than conventionally thought. BMI and WHR are simple and better clinical predictors for carotid atherosclerosis versus IAF.
Predictors of Delayed Gastric Emptying in Diabetes
Authors: Jones Karen L. , Russo Antonietta , Stevens Julie E. , Wishart Judith M. , Berry Melanie K. , Horowitz Michael 
Published: March 2007

OBJECTIVE—To define the predictors of the rate of gastric emptying in patients with diabetes.
RESEARCH DESIGN AND METHODS—A total of 101 outpatients with diabetes (79 type 1 and 22 type 2) underwent measurements of gastric emptying of a solid/liquid meal (scintigraphy), upper gastrointestinal symptoms (questionnaire), glycemic control (blood glucose concentrations during gastric emptying measurement), and autonomic nerve function (cardiovascular reflexes).
RESULTS—The gastric emptying of solid and/or liquid was delayed in 66 (65%) patients. Solid (retention at 100 min 64 ± 3.2 vs. 50.2 ± 3.6%, P &lt; 0.005) and liquid (retention at 100 min 22.7 ± 1.7 vs. 16.0 ± 1.8%, P &lt; 0.001) gastric emptying was slower in women than in men. Of all upper gastrointestinal symptoms (including nausea and vomiting), only abdominal bloating/fullness was associated with slower gastric emptying (P &lt; 0.005). A multiple regression analysis demonstrated that both abdominal bloating/fullness and female sex were predictors of slower gastric emptying of both solids and liquids.
CONCLUSIONS—We conclude that the presence of abdominal bloating/fullness but not any other upper gastrointestinal symptom is associated with diabetic gastroparesis and that gastric emptying is slower in diabetic women than in diabetic men.
Is Diabetes Treated as an Acute or Chronic Illness in Community Family Practice?
Authors: Yawn Barbara , Zyzanski Stephen J. , Goodwin Meredith A. , Gotler Robin S. , Stange Kurt C. 
Published: March 2007

OBJECTIVE—Poor quality of diabetes care has been ascribed to the acute care focus of primary care practice. A better understanding of how time is spent during outpatient visits for diabetes compared with visits for acute conditions and other chronic diseases may facilitate the design of programs to enhance diabetes care.RESEARCH DESIGN AND METHODS—Research nurses directly observed consecutive outpatient visits during two separate days in 138 community family physician offices. Time use was categorized into 20 different behaviors using the Davis Observation Code (DOC). Time use was compared for visits for diabetes, other chronic conditions, and acute illnesses during 1,867 visits by patients ≥40 years of age.RESULTS—Of 20 DOC behavioral categories, 10 exhibited differences among the three groups. Discriminant analysis identified two distinct factors that distinguished visits for chronic disease from visits for acute illness and visits for diabetes from those for other chronic diseases. Compared with visits for other chronic diseases, visits for diabetes devoted a greater proportion of time to nutrition counseling, health education, and feedback on results and less time to chatting. Compared with visits for acute illness, visits for diabetes were longer and involved a higher proportion of dietary advice, negotiation, and assessment of compliance.CONCLUSIONS—Visits for diabetes are distinct from visits for other chronic diseases and acute illnesses in ways that may facilitate patient self-management. Novel quality-improvement interventions could support and expand existing differences between family physicians’ current approaches to care of diabetes and other chronic and acute illnesses.