bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hemostasis Variables in Type I Diabetic Patients Without Demonstrable Vascular Complications
Authors: Khawand Charbel El , Jamart Jacques , Donckier Julian , Chatelain Bernard , Lavenne Edith , Moriau Maurice , Buysschaert Martin 
Published: March 2007

OBJECTIVE
To determine hemostasis variables in type I diabetic patients without clinically demonstrable micro- and macroangiopathy and to relate them to glycemic control.

RESEARCH DESIGN AND METHODS
Fifty patients and 50 comparable control subjects were enrolled in this study. The patients were subdivided in two groups, according to their level of HbA1c (group 1, n = 30, HbA1c ≤ 8% group 2, n = 20, HbA1c &gt; 8%). We determined the platelet count, the platelet aggregation in the spontaneous state and in the presence of ADP or collagen, β-thromboglobulin, platelet factor 4, fibrinogen, von Willebrand factor (factors VIII:C, VIIIR:Ag, and VIIIR:VW), plasma and urinary fibrinopeptide A, euglobulin lysis time, anticoagulant proteins C and S, and plasma viscosity.

RESULTS
All coagulation variables were significantly higher in diabetic patients compared with control subjects. Moreover, when the patients were subdivided according to their levels of HbA1c, the hemostatic disturbances appeared significantly more pronounced in the poorly controlled than in the well-controlled subjects.

CONCLUSIONS
This study confirms the existence of a state of hypercoagulability in type I diabetes. This hypercoagulability may be related to poor glycemic control. Our study suggests that the hemostasis disturbances precede demonstrable vascular complications.
Metabolic Pathways of Glucose in Skeletal Muscle of Lean NIDDM Patients
Authors: Kelley Davids E , Mokan Marian , Mandarino Lawrence J 
Published: March 2007

OBJECTIVE
To characterize the ability of insulin to activate the skeletal muscle metabolic pathways of glucose storage, oxidation, and glycolysis in normal weight patients with NIDDM and nondiabetic volunteer subjects closely matched for age, sex, relative weight, and body composition.

RESEARCH DESIGN AND METHODS
Ten patients with NIDDM (body mass index 23.9 ± 0.74 kg/m2) and 8 nondiabetic volunteer subjects (body mass index 23.4 ± 0.41 kg/m2) were studied. Leg muscle glucose uptake, non-oxidized glycolysis, glucose oxidation, and glucose storage were determined during euglycemic-hyperinsulinemic clamp experiments using the leg balance technique combined with leg indirect calorimetry. Percutaneous muscle biopsies were obtained to assay insulin stimulation of muscle glycogen synthase activity as a biochemical marker of insulin action.

RESULTS
During hyperinsulinemic clamp experiments, leg glucose uptake was equivalent in NIDDM patients and nondiabetic subjects (6.38 ± 1.14 vs. 6.41 ± 0.73 μmol.min−1 · 100 ml tissue−1), as were rates of leg glucose oxidation (1.63 ± 0.25 vs. 2.14 ± 0.17 μmol.min−1 · 100 ml tissue−1) and leg glucose storage (4.35 ± 1.10 vs. 3.48 ± 0.65 μmol·min−1 · 100 ml tissue−1). The combined net balance of lactate and Ala (non-oxidized glycolysis) was lower in NIDDM patients (−0.39 ± 0.06 vs. −0.79 ± 0.11 μmol·min−1 · 100 ml tissue−1, P = 0.01). Muscle glycogen synthase was activated to a similar extent during the hyperinsulinemic clamp in NIDDM patients and nondiabetic volunteer subjects, through basal glycogen synthase activity was lower in NIDDM patients. Nondiabetic subjects and NIDDM patients who were withdrawn from sulfonylurea therapy had impaired insulin secretion during a 75-g oral glucose tolerance test, with similar basal levels as nondiabetic subjects (54 ± 12 vs. 42 ± 6 pM), but reduced peak insulin levels (126 ± 30 vs. 468 ± 102 pM, P &lt; 0.01).

CONCLUSIONS
Detailed in vivo and in vitro assessment of insulin regulation of skeletal muscle glucose metabolism in lean NIDDM patients indicates that insulin action is intact in the muscle tissue of these patients.
Risk Factors for Development of Retinopathy in Elderly Japanese Patients With Diabetes Mellitus
Authors: Araki Atsushi , Ito Hideki , Hattori Akinori , Inoue Junichiro , Sato Tadahiro , Shiraki Masataka , Orimo Hajime 
Published: March 2007

OBJECTIVE
To define the risk factors for the development of diabetic retinopathy in elderly patients with diabetes mellitus.

RESEARCH DESIGN AND METHODS
We studied 110 diabetic outpatients &gt; 60 yr of age who were free of diabetic retinopathy at the first visit and were followed for at least 5 yr to examine the relationships between the initial findings and the subsequent development of retinopathy.

RESULTS
A total of 49 of the subjects developed diabetic retinopathy during the follow-up period; of these, 4 patients progressed to preproliferative and 3 to proliferative retinopathy. Univariate analysis showed that the initial fasting plasma glucose levels, the HbA1 values, the 2-h postload plasma glucose levels, the estimated duration of diabetes, and the presence of persistent proteinuria were all associated with the development of diabetic retinopathy. However, age at the initial examination, estimated age at diabetes onset, sex, body mass index, type of therapy, and hypertension had little impact on the development of retinopathy. Stepwise multiple Cox regression analysis revealed that the initial HbA1 or fasting plasma glucose, the diabetes duration, and the presence of persistent proteinuria are significant independent predictors for the development of retinopathy.

CONCLUSIONS
Initial fasting plasma glucose, diabetes duration, and proteinuria are important risk factors for the development of retinopathy in elderly patients with diabetes mellitus.
Painful Neuropathy and Foot Ulceration in Diabetic Patients
Authors: Veves Aristidis , Manes Christos , Murray Heather J , Young Matthew J , Boulton Andrew J 
Published: March 2007

OBJECTIVE
To examine the prevalence of painful symptoms in neuropathic patients with or without foot ulceration. It has been suggested that there are two clinical presentations of sensory diabetic neuropathy with little overlap: painful (acute or chronic) and painless with recurrent foot ulceration.

RESEARCH DESIGN AND METHODS
We examined three groups of diabetic patients matched for age and duration of diabetes–24 without neuropathy on clinical grounds (mean age 56.1 yr [range 38–76 yr], diabetes duration 12.6 yr [0.4–40 yr]), 30 with neuropathy (mean age 55.3 yr [range 21–73 yr], diabetes duration 17.3 yr [range 0.2–61 yr[), and 40 with neuropathic foot ulceration (mean age 58.1 yr [range 41–72 yr], diabetes duration 18.5 yr [range 1–46 yr])–and compared them with 20 healthy subjects (mean age 50 yr [range 37–69 yr]). For evaluation of neuropathy, the neuropathy symptom score, neuropathy disability score, and vibration perception threshold were measured.

RESULTS
No difference existed between the neuropathic and foot ulcer groups in the neuropathy symptom score (4.2 ± 3.9 [mean ± SD] vs. 2.5 ± 2.1, NS) and neuropathy disability score (15.1 ± 5.7 vs. 16.8 ± 6.1, NS), but the vibration perception threshold was lower in the neuropathic group (30.1 ± 13.4 vs. 40.5 ± 13.8 V, P &lt; 0.001). Painful symptoms (neuropathy symptom score &gt; 3), either in the past or during the time the study was conducted, had been experienced by none of the control subjects, 7 (29%) of the nonneuropathic group, 18 (60%) of the neuropathic group, and 17 (43%) of the foot ulcer group (NS for the last two groups), and were present at the time of examination in 13 (43%) of the neuropathic group and in 13 (33%) of the foot ulcer group (NS in all groups). Duration of symptoms was &lt; 12 mo in 12 (40%) neuropathic and 15 (38%) foot ulcer patients (NS).

CONCLUSIONS
We conclude that painful symptoms are frequent in diabetic neuropathy, irrespective of the presence or absence of foot ulceration and that these symptoms can occur at any stage of the disease. These results suggest that there is a spectrum of neuropathic syndromes from the painful to the patients with foot ulceration, and that much overlap exists.
A Cold Spot of IDDM Incidence in Europe: Macedonia
Authors: Kocova Mirjana , Trucco Massimo , Konstantinova Marina , Dorman Janice S 
Published: March 2007

Objective— To determine, for the first time, the incidence of IDDM among children 0–15 yr of age in Macedonia, the south republic of former Yugoslavia, and to compare these rates with those from neighboring countries.
Research Design and Methods— Children &lt;15 yr of age, with IDDM diagnosed between January 1985 and December 1991, were registered using the criteria established for the WHO Multinational Project for Childhood Diabetes. The primary source of case ascertainment consisted of clinical records from the University Pediatric Clinic in Skopje, the capital of Macedonia. The secondary source consisted of records for insulin supplies from the pharmacy in Skopje and from 15 local hospitals.
Results— During 1985–1991, 112 children &lt;15 yr of age were diagnosed with IDDM in Macedonia. The completeness of case ascertainment was 96.6%. The age-adjusted IDDM incidence rate was very low, only 2.45/100,000 per yr. No significant sex difference in incidence was observed. The highest incidence rate occurred in the 10- to 15-yr age-group. No temporal trends were observed.
Conclusions— The incidence of IDDM in Macedonia is the lowest in Europe and among the lowest reported for Caucasian populations. However, the descriptive epidemiology is similar to that for high incidence populations. Further etiological studies are required to evaluate potential reasons for the very low incidence of IDDM in Macedonia.
Ultrasonographic Abnormalities of the Pancreas in IDDM and NIDDM Patients
Authors: Silva Maria E R , Vezozzo Denise P , Ursich Mileni J M , Rocha Dalva M , Cerri Giovanni G , Wajchenberg Bernardo L 
Published: March 2007

Objective— To evaluate the relationship between the type and duration of diabetes and pancreas size by ultrasonography.
Research Design and Methods— Pancreas images of 40 IDDM and 36 NIDDM patients with 0.3–34 yr of disease were compared with those of 60 normal healthy control subjects.
Results— The diameters ± SD of the head, body, and tail of the pancreas in IDDM patients (1.9 ± 0.3; 0.9 ± 0.2; and 1.4 ± 0.2 cm, respectively) were smaller than in NIDDM patients (2.7 ± 0.4; 1.2 ± 0.3; and 1.8 ± 0.4 cm, respectively) and control group subjects (2.4 ± 0.4; 1.1 ± 0.3; and 1.8 ± 0.4 cm, respectively). The pancreatic shrinkage in IDDM patients was clearly evident after 10 yr of the disease. NIDDM patients and control subjects had similar pancreatic dimensions, except for a greater body thickness in NIDDM patients with &gt;10 yr of disease (1.2 ± 0.4 vs. 1.1 ± 0.3 cm). These results were not related to differences in age, sex, and body size. Pancreas image was hypoechogenic in 72.5% of IDDM patients and hyperechogenic in 83.3% of NIDDM patients.
Conclusions— Smaller pancreases in IDDM patients in comparison with NIDDM patients and control subjects were clearly demonstrated only after 10 yr of disease. Patients with NIDDM were not affected by pancreatic dimensions, except for a greater body thickness after 10 yr of disease. Pancreatic echogenicity increased with age.
Therapeutic Comparison of Metformin and Sulfonylurea, Alone and in Various Combinations: A double-blind controlled study
Authors: Hermann Leif S , Scherstén Bengt , Bitzén Per-Olof , Kjellström Thomas , Lindgärde Folke , Melander Arne 
Published: March 2007

OBJECTIVE
To assess and compare the therapeutic efficacy and safety of metformin (M) and sulfonylurea (glyburide, G), alone and in various combinations, in patients with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS
Of 165 patients (fasting blood glucose [FBG] ≥ 6.7 mmol/l) initially treated with diet alone, 144 (FBG still ≥6.7 mmol/l) were randomized to double-blind, double-dummy controlled treatment with M, G, or primary combination therapy (MG). The dose was titrated, withFBG &lt;6.7 mmol/l as target, using, at most, six dose levels. The first three dose levels comprised increasing single-drug therapy (M or G) or primary combination at increasing but low dosage (MGL), and the second three levels were composed of various high-dose combinations, i.e., add-on therapy (M/G or G/M) and primary combination escalated to high dosage (MGH). Medication was maintained for 6 months after completed dose titration.

RESULTS
The FBG target was achieved in 9% of patients after diet alone. Single-drug therapy was insufficient in 36% and MGL in 25% (NS) of the randomized patients. There was further improvement in glucose control by the high-dose combinations. Mean FBG ± SE was reduced (P = 0.001) from 9.1 ± 0.4 to 7.0 ± 0.2 mmol/l in those maintained on single-drug treatment or low-dose primary combination. Those treated with different high-dose combinations had a large mean FBG reduction, from 13.3 ± 0.8 to 7.8 ± 0.6 mmol/l. HbA1c levels showed corresponding reductions, and glycemic levels rose after drug discontinuation. Fasting C-peptide rose during treatment with G and MGL but not with M, while fasting insulin was not significantly changed. Meal-stimulated C-peptide and insulin levels were unchanged by M but increased by G and, to a lesser extent, by MGL. There were no significant insulin or C-peptide differences between the different high-dose combinations (M/G, G/M, and MGH). Body weight did not change following treatment with M or combination but increased by 2.8 ± 0.7 kg following G alone. Blood pressure was unchanged. Overall effects on plasma lipids were small, with no significant differences between groups. Drug safety was satisfactory, even if the reporting of (usually modest) adverse events was high; the profile, but not the frequency, differed between groups.

CONCLUSIONS
Dose-effect titrated treatment with either metformin or glyburide promotes equal degrees of glycemic control. The former, but not the latter, is able to achieve this control without increasing body weight or hyperinsulinemia. Near-normal glycemia can be obtained by a combination of metformin and sulfonylurea, even in advanced NIDDM.
The Effect of Recurrent Practice at Home on the Acceptability of Capillary Blood Glucose Readings: Accuracy of self blood glucose testing
Authors: Kabadi Udaya M , O'Connell Kathleen M , Johnson Jennal , Kabadi Mary 
Published: March 2007

OBJECTIVE
To judge how reliably patients perform capillary blood glucose testing over time with recurrent practice at home and to assess if a clinic glucose meter is an acceptable alternative to the clinical laboratory for monitoring patient performance.

RESEARCH DESIGN AND METHODS
We compared capillary blood glucose readings obtained by patients with their own equipment and the venous blood glucose determinations by the clinical laboratory at three biweekly visits during the initial phase in 40 subjects attending the diabetes clinic at the Veterans' Affairs Medical Center in Phoenix, Arizona. We also compared patient-generated readings using their own equipment and the readings obtained by the clinic glucose meter and strips at five weekly visits during the second phase in 11 subjects who continued further participation. Error grid analysis was used for both comparisons. Capillary blood glucose readings obtained with clinic glucose meter and strips on one hand were correlated with venous blood glucose levels determined by the clinical laboratory.

RESULTS
During the initial phase, 30 subjects consistently obtained clinically acceptable comparisons (zone A on the error grid, i.e., within 20% of the laboratory value) or improved over time, 9 subjects showed deterioration, and 1 subject failed to obtain zone A results on any of the visits. Three subjects who had consistently obtained zone A results during the initial phase maintained their performance, whereas eight subjects who had failed to achieve zone A values by the end of the initial phase gradually improved and ultimately achieved zone A values by the end of the study. A highly significant correlation was noted between clinic meter readings and laboratory values (r = 0.93, P &lt; 0.00001).

CONCLUSIONS
Clinically acceptable user proficiency in capillary blood glucose testing can be maintained in most subjects, with recurrent intensive education during follow-up clinic visits. Therefore, we recommend that these comparisons be performed and patient's technique be observed at each visit to monitor their performance. The clinic glucose meter is a suitable alternative to a clinical laboratory for user proficiency checks.
Frequency and Determinants of Screening for Diabetes in the U.S
Authors: Cowie Catherine C , Harris Maureen I , Eberhardt Mark S 
Published: March 2007

OBJECTIVE
To determine the prevalence of risk factors for non-insulin-dependent diabetes mellitus (NIDDM) and the frequency of screening for NIDDM in U.S. adults.

RESEARCH DESIGN AND METHODS
A detailed questionnaire was administered to a representative sample of 19,680 adults ≥18 years of age who reported no medical history of diabetes in the 1989 National Health Interview Survey (NHIS). Information was obtained on risk factors for diabetes, complications related to diabetes, and whether the subjects had been screened for diabetes in the past year. Women reporting pregnancy in the past year were excluded from analysis. The prevalence of undiagnosed NIDDM according to the frequency of risk factors for NIDDM was determined based on oral glucose tolerance data from the National Health and Nutrition Examination Survey (NHANES) II and Hispanic Health and Nutrition Examination Survey (HHANES).

RESULTS
Prevalence of undiagnosed NIDDM based on the NHANES II and HHANES increased with age, obesity, and family history of diabetes, reaching 11.7% in people with all three risk factors. Based on the NHIS, 77.5% of U.S. adults with no medical history of diabetes (131 million people) had at least one risk factor for NIDDM or complication related to NIDDM, and 22.9% (38 million people) had three or more risk factors or complications. Approximately 31% of adults reported being screened for diabetes in the past year. Screening rates increased with an increasing number of risk factors, but even among those with three risk factors, only 38.6% were screened for NIDDM.

CONCLUSIONS
More than 7 million U.S. adults have undiagnosed NIDDM. Nevertheless, screening for diabetes in high-risk groups occurs substantially less frequently than necessary to detect undiagnosed NIDDM and institute appropriate hypoglycemic treatment.
Risk Factors For Distal Symmetric Neuropathy in NIDDM: The San Luis Valley Diabetes Study
Authors: Franklin Gary M , Shetterly Susan M , Cohen Jeffrey A , Baxter Judith , Hamman Richard F 
Published: March 2007

OBJECTIVE
To investigate risk factors for distal symmetric (sensory) neuropathy among prevalent cases of non-insulin-dependent diabetes mellitus (NIDDM) in apopulation-based study in southern Colorado.

RESEARCH DESIGN AND METHODS
Prevalent neuropathy was identified in 77 of 277 people with NIDDM by a standardized history and neurologic examination. Fifteen known or suspected risk factors for neuropathy were determined without knowledge of neuropathy status.

RESULTS
Older age at examination, longer duration of diabetes, higher glycohemoglobin percentage, lower fasting C-peptide, insulin use, and presence of retinopathy and nephropathy (microalbumin ≥ 200 µg/ml) were all significantly associated with neuropathy. Sex, ethnicity (Hispanic versus non-Hispanic white), height, systolic blood pressure, peripheral vascular disease, cigarette and alcohol use, and serum lipid levels were not significantly associated with neuropathy. In a multivariate logistic model, increasing age (odds ratio [OR] = 1.3, 95% confidence interval [CI] = 1.1–1.6), longer duration of diabetes (OR = 1.3, CI = 1.0–1.6), increased glycohemoglobin percentage (OR = 1.5, CI = 1.1–2.1), and insulin use (OR = 2.8, CI = 1.3–6.1) were associated with neuropathy. Retinopathy (OR = 3.0, CI = 1.2–7.7), but not nephropathy, was important when added to this model.

CONCLUSIONS
Worse glycemic control and insulin use were independently associated with neuropathy in people with NIDDM. Whether insulin use represents another marker for severity of the metabolic disturbance or is an independent risk factor for neuropathy requires further study. We could not confirm associations of neuropathy with height, with nephropathy, or with retinopathy, independent of duration of diabetes.
Insulin Withholding for Weight Control in Women With Diabetes
Authors: Biggs Melanie M , Basco Monica Ramirez , Patterson Gayle , Raskin Philip 
Published: March 2007

OBJECTIVE
To provide a description of the clinical characteristics that distinguish individuals who withhold insulin for weight control from those who do not. Some individuals with insulin-dependent diabetes mellitus (IDDM) control their weight by withholding insulin and purging excessive calories. This process places patients at risk for developing severe hyperglycemia, diabeticketoacidosis, and increases the risk of long-term complications of diabetes.

RESEARCH DESIGN AND METHODS
Forty-two women with IDDM, ages 16–40, were interviewed and divided into two groups: insulin withholders (IWs) and non-insulin withholders (non-IWs). These groups were compared on physiological, behavioral, psychological, and psychiatric variables.

RESULTS
Compared with non-IWs, patients who withheld insulin to control their weight exhibited poorer glycemic control, reported more negative attitudes toward diabetes, were more likely to have pathological scores on the Eating Disorder Inventory 2, and were more likely to report current or past symptoms of anorexia or bulimia nervosa. IWs were also more likely to report lying to physicians about their degree of compliance with their diabetes regimens.

CONCLUSIONS
The results of this study indicated that IWs exhibit more symptoms associated with the spectrum of eating disorders than non-IWs. This study showed that insulin withholding for weight control not only exists, but is associated with some maladaptive symptoms and behaviors that need to be addressed by diabetes treatment teams.
High Prevalence of NIDDM and IGT in an Elderly South Indian Population With Low Rates of Obesity
Authors: Ramachandran Ambady , Snehalatha Chamukuttan , Shyamala Panchaksharam , Vijay Vlswanathan , Viswanathan Moopil 
Published: March 2007

OBJECTIVE
To assess the prevalence of diabetes and impaired glucose tolerance (IGT) in the urban and rural elderly population in south India.

RESEARCH DESIGN AND METHODS
Urban and rural populations ≥60 years of age and representative of the areas (873 urban and 588 rural subjects) were screened for diabetes and IGT using fasting and 2-h postglucose capillary blood glucose measurements.

RESULTS
In the urban area, 211 (23.7%) had diabetes, and 101 (12.4%) had IGT. In the rural area, 56 (9.9%) had diabetes, and 82 (14.9%) had IGT. The ratio of newly diagnosed to known diabetes was 1:3 in the urban and 1:1 in the rural areas. Positive family history of diabetes, body mass index (BMI), subscapular-to-triceps ratio, and waist-to-hip ratio were significantly associated with diabetes in the urban population. Only age and BMI showed significant association with diabetes in the elderly rural population. None of the tested parameters, except age in the urban subjects, showed association with IGT.

CONCLUSIONS
This study highlights the high prevalence of glucose intolerance in elderly south Indians having low mean BMI (mean ± SD; urban 21.7 ± 4.6, rural 17.9 ±3.3 kg/m2). Although there was a twofold higher prevalence of diabetes in the urban area, the occurrence of IGT was similar in urban and rural populations.