bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Pioglitazone on Endothelial Function, Insulin Sensitivity, and Glucose Control in Subjects With Coronary Artery Disease and New-Onset Type 2 Diabetes
Authors: Sourij Harald , Zweiker Robert , Wascher Thomas C. 
Published: May 2006

OBJECTIVE—About one of five patients with coronary artery disease (CAD) suffers from previously unknown, predominantly postprandial type 2 diabetes. In the process of atherogenesis and the subsequent increased cardiovascular mortality of diabetic patients, endothelial dysfunction is suspected to play an important role, and it is observed in diabetic as well as insulin-resistant states. Thus, the aim of our study was to investigate the effect of pioglitazone on endothelial dysfunction, insulin sensitivity, and glucose control in newly detected type 2 diabetic patients with CAD.
RESEARCH DESIGN AND METHODS—We investigated 42 patients (39 men and 3 women, age 60.25 ± 7.5 years, HbA1c 6.1 ± 0.5%) with manifest CAD and newly detected type 2 diabetes. A randomized, double-blind, placebo-controlled, parallel study with pioglitazone (30 mg/day for 12 weeks) was performed. At study entry and end, we performed an oral glucose tolerance test and measurements of endothelial dysfunction by photoplethysmographic pulse wave analysis.
RESULTS—Endothelial dysfunction was severely impaired at baseline in both groups. After 12 weeks, endothelial dysfunction was significantly better in the pioglitazone group (change of reflection index 6.5 ± 5.1 vs. 1.6 ± 2.9%, P = 0.002) compared with placebo. Insulin sensitivity, as assessed by homeostasis model assessment (2.20 ± 1.62 vs. 3.61 ± 1.87, P = 0.01), or the change of insulin sensitivity index from baseline to study end (0.021 ± 0.023 vs. −0.003 ± 0.012 μmol · kg−1 · min−1 per pmol/l, P = 0.0001) and β-cell function (57.42 ± 49.86 vs. 21.78 ± 18.54 mU/l per mmol/l, P = 0.0014) significantly improved in the pioglitazone group, with no change observed after placebo.
CONCLUSIONS—Pioglitazone improves endothelial dysfunction independently from the observed benefits on insulin sensitivity and β-cell function in patients with newly diagnosed type 2 diabetes and CAD.
Risk Scores for Type 2 Diabetes Can Be Applied in Some Populations but Not All
Authors: Glümer Charlotte , Vistisen Dorte , Borch-Johnsen Knut , Colagiuri Stephen ,   on behalf of the DETECT-2 Collaboration
Published: May 2006

OBJECTIVE—Risk scores based on phenotypic characteristics to identify individuals at high risk of having undiagnosed diabetes have been developed in Caucasian populations. The impact of known risk factors on having undiagnosed type 2 diabetes differs between populations from different ethnic origin, and risk scores developed in Caucasians may not be applicable to other ethnic groups. This study evaluated the performance of one risk score in nine populations of diverse ethnic origin.
RESEARCH DESIGN AND METHODS—Data provided by centers from around the world to the DETECT-2 project were used. The database includes population-based surveys with information on at least 500 people without known diabetes having a 75-g oral glucose tolerance test. To date, 52 centers have contributed data on 190,000 individuals from 34 countries. In this analysis, nine cross-sectional studies were selected representing diverse ethnic and regional backgrounds. The risk score assessed uses information on age, sex, blood pressure treatment, and BMI.
RESULTS—This analysis included 29,758 individuals; 1,805 individuals had undiagnosed diabetes. The performance of the risk score varied widely, with sensitivity, specificity, and percentage needing further testing ranging between 12 and 57%, 72 and 93%, and 2 and 25%, respectively, with the worse performance in non-Caucasian populations. This variation in performance was related to differences in the association between prevalence of undiagnosed diabetes and components of the risk score.
CONCLUSIONS—A typical risk score developed in Caucasian populations cannot be applied to other populations of diverse ethnic origins.
Altered D-Chiro-Inositol Urinary Clearance in Women With Polycystic Ovary Syndrome
Authors: Baillargeon Jean-Patrice , Diamanti-Kandarakis Evanthia , Ostlund Richard E. , Apridonidze Teimuraz , Iuorno Maria J. , Nestler John E. 
Published: May 2006

OBJECTIVE—Evidence suggests that some actions of insulin are effected by inositolphosphoglycan (IPG) mediators. We hypothesize that a deficiency in D-chiro-inositol (DCI) and/or a DCI-containing IPG (DCI-IPG) may contribute to insulin resistance in humans.
RESEARCH DESIGN AND METHODS—To assess this possibility in polycystic ovary syndrome (PCOS), we determined insulin sensitivity (Si by frequently sampled intravenous glucose tolerance test), plasma and urinary DCI and myo-inositol (MYO) levels (by gas chromatography/mass spectrometry), and the release of insulin and DCI-IPG during the oral glucose tolerance test (area under the curve [AUC]) in 23 women with PCOS and 26 normal women.
RESULTS—Women with PCOS were heavier than control subjects (P = 0.002 for BMI), but also had decreased Si (P &lt; 0.001) and increased AUCinsulin (P &lt; 0.001) compared with normal women, even when corrected for BMI. The urinary clearance of DCI (uClDCI) was increased almost sixfold in PCOS compared with normal women (P = 0.001), but not MYO clearance (P = 0.10). uClDCI correlated inversely with Si when all women were analyzed together (n = 49, r = −0.50, P &lt; 0.001) and was one of the three best independent parameters predicting Si. Finally, the ratio of AUCDCI-IPG to AUCinsulin was decreased threefold in women with PCOS (P &lt; 0.001).
CONCLUSIONS—uClDCI is inversely correlated with insulin sensitivity in women and is a strong independent predictor of insulin resistance in multivariate models. PCOS, which is characterized by insulin resistance, is associated with a selective increase in uClDCI and impaired DCI-IPG release in response to insulin. These findings are consistent with a defect in tissue availability or utilization of DCI in PCOS that may contribute to the insulin resistance of the syndrome.
Prevalence of Diabetes and Impaired Glucose Tolerance in 64-Year-Old Swedish Women
Authors: Brohall Gerhard , Behre Carl-Johan , Hulthe Johannes , Wikstrand John , Fagerberg Björn 
Published: May 2006

OBJECTIVE—The purpose of this study was to describe the prevalence of diabetes and impaired glucose tolerance (IGT) in middle-aged women and to examine the variability and practical use of the oral glucose tolerance test (OGTT) in the screening for IGT and diabetes.
RESEARCH DESIGN AND METHODS—All 64-year-old women living in Göteborg, Sweden, were invited to take part in a screening examination (n = 4,856). Of these, 82% (n = 3,998) responded and 53% (n = 2,595) participated and underwent anthropometric measurements and a 75-g standardized OGTT that was repeated within 2 weeks in those not showing normal glucose tolerance (NGT).
RESULTS—The prevalences of known and new diabetes, IGT at both OGTTs, and impaired fasting glucose were 4.7, 4.8, 14.4, and 6.4%, respectively. Half of the women with diabetes were previously undiagnosed, and 37% of the diagnoses were based on OGTT and diabetes 2-h values at both or one of the two examinations. Women with IGT at both OGTTs, in comparison with those with one impaired and one normal OGTT, had higher BMI, waist girth, and blood pressure. More than 40% of the women showed impaired glucose metabolism.
CONCLUSIONS—Among these women, the prevalence of undetected diabetes was high and repeated OGTTs were needed to identify and not misclassify a considerable proportion of patients. The degree of glucose tolerance impairment and the number of abnormal OGTTs were directly associated with occurrence of components of the metabolic syndrome.
Cardiac Autonomic Neuropathy Predicts Cardiovascular Morbidity and Mortality in Type 1 Diabetic Patients With Diabetic Nephropathy
Authors: Astrup Anne Sofie , Tarnow Lise , Rossing Peter , Hansen Birgitte V. , Hilsted Jannik , Parving Hans-Henrik 
Published: May 2006

OBJECTIVE—Cardiac autonomic neuropathy (CAN) has been associated with a poor prognosis in patients with diabetes. Because CAN is common in patients with diabetic nephropathy, we evaluated the predictive value of CAN in type 1 diabetic patients with and without diabetic nephropathy.
RESEARCH DESIGN AND METHODS—In a prospective observational follow-up study, 197 type 1 diabetic patients with diabetic nephropathy and a matched group of 191 patients with long-standing type 1 diabetes and normoalbuminuria were followed for 10.1 years (range 0.0–10.3 years). At baseline, CAN was assessed by heart rate variation (HRV) during deep breathing. HRV was evaluated as a predictor of the primary end point: cardiovascular morbidity and mortality. As secondary end points, all-cause mortality and the influence of HRV on progression of diabetic nephropathy (decline in glomerular filtration rate [GFR]) was evaluated.
RESULTS—During the follow-up, 79 patients (40%) with nephropathy reached the combined primary end point vs. 19 patients (10%) with normoalbuminuria (log-rank test, P &lt; 0.0001). The unadjusted hazard ratio (HR) for reaching the primary end point when having an abnormal HRV (≤10 bpm) measured at baseline compared with a normal HRV was 7.7 (range 1.9–31.5; P = 0.004) in patients with nephropathy. Similarly in the normoalbuminuric patients, the unadjusted HR was 4.4 (1.4–13.6; P = 0.009). In patients with nephropathy, abnormal HRV was significantly associated with fatal and nonfatal cardiovascular disease after adjustment for cardiovascular risk factors. The adjusted HR for reaching the primary end point in a patient with nephropathy and an abnormal HRV was 6.4 (1.5–26.3, P = 0.010), as compared with a normal HRV. The unadjusted HR for dying when having an abnormal HRV compared with a normal HRV was 3.3 (95% CI 1.0–10.7; P = 0.043) in patients with diabetic nephropathy. After adjustment for confounding factors, the impact of HRV on all-cause mortality in patients with nephropathy was no longer significant (P = 0.293). There was no relationship between abnormal HRV and rate of decline in GFR.
CONCLUSIONS—HRV is an independent risk factor for cardiovascular morbidity and mortality in type 1 diabetic patients with nephropathy.
Improved Prandial Glucose Control With Lower Risk of Hypoglycemia With Nateglinide Than With Glibenclamide in Patients With Maturity-Onset Diabetes of the Young Type 3
Authors: Tuomi Tiinamaija , Honkanen Elina H. , Isomaa Bo , Sarelin Leena , Groop Leif C. 
Published: May 2006

OBJECTIVE—To study the effect of the short-acting insulin secretagogue nateglinide in patients with maturity-onset diabetes of the young type 3 (MODY3), which is characterized by a defective insulin response to glucose and hypersensitivity to sulfonylureas.
RESEARCH DESIGN AND METHODS—We compared the acute effect of nateglinide, glibenclamide, and placebo on prandial plasma glucose and serum insulin, C-peptide, and glucagon excursions in 15 patients with MODY3. After an overnight fast, they received on three randomized occasions placebo, 1.25 mg glibenclamide, or 30 mg nateglinide before a standard 450-kcal test meal and light bicycle exercise for 30 min starting 140 min after the ingestion of the first test drug.
RESULTS—Insulin peaked earlier after nateglinide than after glibenclamide or placebo (median [interquartile range] time 70 [50] vs. 110 [20] vs. 110 [30] min, P = 0.0002 and P = 0.0025, respectively). Consequently, compared with glibenclamide and placebo, the peak plasma glucose (P = 0.031 and P &lt; 0.0001) and incremental glucose areas under curve during the first 140 min of the test (P = 0.041 and P &lt; 0.0001) remained lower after nateglinide. The improved prandial glucose control with nateglinide was achieved with a lower peak insulin concentration than after glibenclamide (47.0 [26.0] vs. 80.4 [71.7] mU/l; P = 0.023). Exercise did not induce hypoglycemia after nateglinide or placebo, but after glibenclamide six patients experienced symptomatic hypoglycemia and three had to interrupt the test.
CONCLUSIONS—A low dose of nateglinide prevents the acute postprandial rise in glucose more efficiently than glibenclamide and with less stimulation of peak insulin concentrations and less hypoglycemic symptoms.
Testing the Accelerator Hypothesis
Authors: Dabelea Dana , D’Agostino Ralph B. , Mayer-Davis Elizabeth J. , Pettitt David J. , Imperatore Giuseppina , Dolan Larry M. , Pihoker Catherine , Hillier Teresa A. , Marcovina Santica M. , Linder Barbara , Ruggiero Andrea M. , Hamman Richard F. ,   for the SEARCH for Diabetes in Youth Study Group
Published: May 2006

OBJECTIVE—The “accelerator hypothesis” predicts that fatness is associated with an earlier age at onset of type 1 diabetes. We tested the hypothesis using data from the SEARCH for Diabetes in Youth study.
RESEARCH DESIGN AND METHODS—Subjects were 449 youth aged &lt;20 years at diagnosis who had positive results for diabetes antibodies measured 3–12 months after diagnosis (mean 7.6 months). The relationships between age at diagnosis and fatness were examined using BMI as measured at the SEARCH visit and reported birth weight, both expressed as SD scores (SDSs).
RESULTS—Univariately, BMI SDS was not related to age at diagnosis. In multiple linear regression, adjusted for potential confounders, a significant interaction was found between BMI SDS and fasting C-peptide (FCP) on onset age (P &lt; 0.0001). This interaction remained unchanged after additionally controlling for number and titers of diabetes antibodies. An inverse association between BMI and age at diagnosis was present only among subjects with FCP levels below the median (&lt;0.5 ng/ml) (regression coefficient −7.9, P = 0.003). A decrease of 1 SDS in birth weight (639 g) was also associated with an ∼5-month earlier age at diagnosis (P = 0.008), independent of sex, race/ethnicity, current BMI, FCP, and number of diabetes antibodies.
CONCLUSIONS—Increasing BMI is associated with younger age at diagnosis of type 1 diabetes only among those U.S. youth with reduced β-cell function. The intrauterine environment may also be an important determinant of age at onset of type 1 diabetes.
Periodontal Changes in Children and Adolescents With Diabetes
Authors: Lalla Evanthia , Cheng Bin , Lal Shantanu , Tucker Sid , Greenberg Ellen , Goland Robin , Lamster Ira B. 
Published: May 2006

OBJECTIVE—To evaluate the level of oral disease in children and adolescents with diabetes.
RESEARCH DESIGN AND METHODS—Dental caries and periodontal disease were clinically assessed in 182 children and adolescents (6–18 years of age) with diabetes and 160 nondiabetic control subjects.
RESULTS—There were no differences between case and control subjects with respect to dental caries. Children with diabetes had significantly higher plaque and gingival inflammation levels compared with control subjects. The number of teeth with evidence of attachment loss (the hallmark of periodontal disease) was significantly greater in children with diabetes (5.79 ± 5.34 vs. 1.53 ± 3.05 in control subjects, unadjusted P &lt; 0.001). When controlling for age, sex, ethnicity, gingival bleeding, and frequency of dental visits, diabetes remained a highly significant correlate of periodontitis, especially in the 12- to 18-year-old subgroup. In the case group, BMI was significantly correlated with destruction of connective tissue attachment and bone, but duration of diabetes and mean HbA1c were not.
CONCLUSIONS—Our findings suggest that periodontal destruction can start very early in life in diabetes and becomes more prominent as children become adolescents. Programs designed to promote periodontal disease prevention and treatment should be provided to young patients with diabetes.
Effects of Intravenous Nicorandil Before Reperfusion for Acute Myocardial Infarction in Patients With Stress Hyperglycemia
Authors: Ishii Hideki , Ichimiya Satoshi , Kanashiro Masaaki , Amano Tetsuya , Matsubara Tatsuaki , Murohara Toyoaki 
Published: May 2006

OBJECTIVE—Stress hyperglycemia increases the risk of mortality and poor outcomes in patients with acute myocardial infarction (AMI). We aimed to assess effects of intravenous nicorandil administered before reperfusion on AMI patients with stress hyperglycemia.
RESEARCH DESIGN AND METHODS—This study consisted of 158 consecutive first AMI patients with stress hyperglycemia who underwent percutaneous coronary intervention (PCI) within 24 h from the onset. They were randomly assigned to receive 12 mg of nicorandil (n = 81) or a placebo (n = 77) intravenously just before reperfusion. Stress hyperglycemia was defined as a blood glucose level ≥10 mmol/l (180 mg/dl). We examined various aspects of epicardial flow and microvascular function as immediate data and major adverse cardiac events (MACEs) (coronary heart disease death or unplanned readmission due to congestive heart failure) as late-phase data.
RESULTS—The incidence of slow flow after PCI was lower in the nicorandil group (13.6 vs. 27.3%, P &lt; 0.04). ST segment resolution &gt;50% was observed in 70.4 and 53.2% on nicorandil and placebo, respectively (P &lt; 0.03). Patients treated with nicorandil had a lower peak creatine kinase level (3,137 ± 2,577 vs. 4,333 ± 3,608, P &lt; 0.02). Upon Kaplan-Meier analysis, 5 years’ freedom from MACEs was 86.4% in the nicorandil group and 74.0% in the placebo (P &lt; 0.05).
CONCLUSIONS—Adjunctive therapy with administration of intravenous nicorandil before reperfusion on AMI patients with stress hyperglycemia significantly improves epicardial flow and prevents the occurrence of severe microvascular reperfusion injury, resulting in better outcomes in these patients.
Lifestyle Intervention Is Associated With Lower Prevalence of Urinary Incontinence
Authors: Brown Jeanette S. , Wing Rena , Barrett-Connor Elizabeth , Nyberg Leroy M. , Kusek John W. , Orchard Trevor J. , Ma Yong , Vittinghoff Eric , Kanaya Alka M. ,   for the Diabetes Prevention Program Research Group
Published: May 2006

OBJECTIVE—Diabetes is associated with increased urinary incontinence risk. Weight loss improves incontinence, but exercise may worsen this condition. We examined whether an intensive lifestyle intervention or metformin therapy among overweight pre-diabetic women was associated with a lower prevalence of incontinence.
RESEARCH DESIGN AND METHODS—We analyzed data from the Diabetes Prevention Program, a randomized controlled trial in 27 U.S. centers. Of the 1,957 women included in this analysis, 660 (34%) were randomized to intensive lifestyle therapy, 636 (32%) to metformin, and 661 (34%) to placebo with standard lifestyle advice. The main outcome measure was incontinence symptoms by frequency and type by a validated questionnaire completed at the end-of-trial visit (mean 2.9 years).
RESULTS—The prevalence of total (stress or urge) weekly incontinence was lower among women in the intensive lifestyle group (38.3%) than those randomized to metformin (48.1%) or placebo (45.7%). This difference was most apparent among women with stress incontinence (31.3% for intensive lifestyle group vs. 39.7% for metformin vs. 36.7% for placebo, P = 0.006). Changes in weight accounted for most of the protective effect of the intensive lifestyle intervention on stress incontinence.
CONCLUSIONS—Less-frequent urinary incontinence may be a powerful motivator for women to choose lifestyle modification to prevent diabetes.
Does Measurement Site for Visceral and Abdominal Subcutaneous Adipose Tissue Alter Associations With the Metabolic Syndrome?
Authors: Kuk Jennifer L. , Church Timothy S. , Blair Steven N. , Ross Robert 
Published: May 2006

OBJECTIVE—To determine whether the associations between visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (ASAT), and the metabolic syndrome are altered depending on measurement site for VAT and ASAT and the definition used to identify the metabolic syndrome.
RESEARCH DESIGN AND METHODS—Total VAT and ASAT volume was derived using ∼37 contiguous computed tomography (CT) images from T10–T11 to L5–S1 in 85 men. CT images obtained at eight intervertebral locations (e.g., L4–L5, L3–L4, etc.) were used to determine the associations between partial volumes (single images) and metabolic syndrome. Metabolic syndrome was defined using the National Cholesterol Education Program (NCEP) and International Diabetes Federation (IDF) criteria. Logistic regression was used to calculate the odds ratio (OR) per SD increase in adipose tissue.
RESULTS—For total and all partial volumes, VAT was more strongly associated with metabolic syndrome than ASAT independent of metabolic syndrome criteria. The OR (per SD) for NCEP metabolic syndrome was higher for total VAT volume (OR = 7.26) and for the partial volumes at T12–L1 (7.46) and L1–L2 (8.77) than those at the L4–L5 level (3.94). The OR for metabolic syndrome (∼2.6) was not substantially different among the ASAT measures. A similar pattern of association was observed using the IDF metabolic syndrome criteria.
CONCLUSIONS—The measurement site for VAT, but not for ASAT, has a substantial influence on the magnitude of the association with both metabolic syndrome definitions. However, because VAT remained significantly associated with metabolic syndrome regardless of measurement site, the clinical interpretation was unaltered by measurement protocol or metabolic syndrome definition.
Abdominal Adiposity Is a Stronger Predictor of Insulin Resistance Than Fitness Among 50–95 Year Olds
Authors: Racette Susan B. , Evans Ellen M. , Weiss Edward P. , Hagberg James M. , Holloszy John O. 
Published: May 2006

OBJECTIVE—Physical inactivity and increased adiposity contribute to insulin resistance; less is known, however, about the relative contributions of these factors in older adults. The aim of this study was to determine whether cardiovascular fitness, whole-body adiposity, or abdominal adiposity is the strongest predictor of insulin resistance into old age.
RESEARCH DESIGN AND METHODS—Subjects included 407 men and women aged 50–95 years (means ± SD 69 ± 11 years). Insulin resistance was estimated using the insulin sensitivity index (ISI) of Matsuda and DeFronzo [ISI = 10,000/square root of (fasting glucose × fasting insulin) × (mean glucose × mean insulin during an oral glucose tolerance test); lower ISI = greater insulin resistance]. Fitness was determined with a treadmill maximal oxygen consumption (Vo2max) test. Whole-body adiposity measures included BMI and percent fat by dual-energy X-ray absorptiometry or hydrodensitometry; abdominal adiposity was estimated by waist circumference.
RESULTS—Waist circumference was the strongest independent correlate of ISI (r = −0.52, P &lt; 0.0001), explaining 28% of the variance when controlling for sex, BMI, percent fat, and Vo2max. BMI (r = −0.45), percent fat (r = −0.40), and Vo2max (r = 0.22) independently predicted ISI (all P &lt; 0.0001); however, after controlling for waist circumference, only Vo2max remained significant (r = 0.13, P = 0.009).
CONCLUSIONS—Adiposity and fitness continue to be significant predictors of insulin sensitivity into old age, with abdominal obesity being the most important single factor. These findings support the measurement of waist circumference to assess health risk among older adults.