bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Crossing the Legs Decrease Arterial Pressure In Diabetic Patients With Peripheral Vascular Disease?
Authors: Levin Marvin E , Sicard Gregorio A , Baumann Dirk S , Loechl Barbara 
Published: March 2007

OBJECTIVE
To evaluate the effect of crossing the legs at the knee and the ankle on peripheral arterial pressures.

RESEARCH DESIGN AND METHODS
A prospective study of 6 diabetic patients with known peripheral vascular disease and 5 nondiabetic control subjects without peripheral vascular disease was conducted. Peripheral arterial pressures were taken at the ankle and at the great toe before and after crossing the legs at the knees and ankles. Comparisons were made of measurements obtained in the supine and sitting positions. All crossed leg measurements were taken in the sitting position.

RESULTS
Ankle arm indexes and digital arm indexes pressures taken in the sitting position were equal to or higher than supine pressures, with the exception of one subject, GB. In this patient, ankle arm indexes and digital arm indexes on the right extremity were lower in the sitting position, but increased with the legs crossed at the knees and ankles compared with the uncrossed sitting position. In all patients, lower extremity pressures that decreased slightly with crossing the legs remained higher than pressures obtained in the supine position. Statistical analyses showed no significant differences. Wave forms did not change even when there was a slight decrease in ankle arm indexes or digital arm indexes. Control subjects without peripheral vascular disease showed no change in pressures with crossing the legs.

CONCLUSIONS
Crossing the legs at the knees and ankles does not result in a significant decrease in peripheral arterial pressures in diabetic patients with peripheral vascular disease.
Metformin Improves Glucose, Lipid Metabolism, and Reduces Blood Pressure in Hypertensive, Obese Women
Authors: Giugliano Dario , De Rosa Nicoletta , Di Maro Giosuè , Marfella Raffaele , Acampora Rita , Buoninconti Raffaello , D'Onofrio Felice 
Published: March 2007

OBJECTIVE
To determine the effects of metformin on blood pressure, left ventricular mass, and some metabolic and endocrine parameters in nondiabetic, obese, hypertensive women.

RESEARCH DESIGN AND METHODS
Twelve obese, nondiabetic, hypertensive women received 850 mg metformin 2 times/day for 12 wk and placebo for another 12 wk, according to a double-blind, cross-over, randomized design. All patients were hospitalized 4 times, i.e., before randomization and after each treatment (metformin or placebo), to conduct metabolic and cardiovascular investigations (oral glucose tolerance test, euglycemic clamp associated with indirect calorimetry, and echocardiography).

RESULTS
Fasting glucose, HbA1c, fasting and glucose-stimulated insulin, blood pressure and left ventricular mass, cholesterol, triglycerides, and fibrinogen decreased significantly after metformin treatment, whereas high-density lipoprotein cholesterol increased. The improvement in glucose metabolism resulted from increased sensitivity to insulin.

CONCLUSIONS
These findings suggest that metformin treatment in obese, nondiabetic, hypertensive women produces a more favorable cardiovascular risk profile.
Microalbuminuria in a Middle-Aged Workforce: Effect of hyperglycemia and ethnicity
Authors: Metcalf Patricia A , Baker John R , Scragg Robert K R , Dryson Evan , Scott Alastair J , Wild Chris J 
Published: March 2007

OBJECTIVE
To determine the prevalence of microalbuminuria in a mixed, thnic population and to find the extent that ethnic variation in microalbuminuria can be explained by abnormal glucose metabolism, obesity, hypertension, hypertriglyceridemia, and life-style factors.

RESEARCH DESIGN AND METHODS
Urinary albumin concentrations were measured in 5467 middle-aged Maori, Pacific Islander, and European workers who participated in a health-screening survey of 46 New Zealand companies. Participants provided a first-voided, morning urine sample; had a 75-g oral glucose tolerance test; had weight, height, and blood pressure measured; and completed a self-administered questionnaire about past medical history and sociodemographic status.

RESULTS
A significantly higher prevalence of microalbuminuria was found in individuals with new cases of diabetes mellitus (24.1%), in cases of diabetes mellitus previously diagnosed (20.6%), and in those with impaired glucose tolerance (16.1%) compared with nondiabetic individuals (4.0%). Moreover, in the general population, a piecewise linear relationship was detected between albuminuria and plasma glucose with significant changes of slope corresponding with 2 h plasma glucose concentrations (95% confidence interval) of 6.7 (6.4–7.0) and 9.2 (8.6–9.8) mM, respectively. After adjusting for sex, obesity, hypertension, hypertriglyceridemia, cigarette smoking, and heavy alcohol consumption in a multivariate model, glycemia was the most significant determinant of urinary albumin concentrations in all three ethnic groups. However, blood glucose concentrations did not completely explain the higher relative risk (95% confidence interval) of microalbuminuria in Maori (5.97; 4.48–7.78) and Pacific Islander (5.33; 4.13–6.87) workers compared with European workers.

CONCLUSIONS
Of the variables investigated, hyperglycemia was the most important factor explaining the high prevalence of microalbuminuria in Maori and Pacific Islander workers compared with the European workers. However, only 14.9% of the variation in urinary albumin concentrations was found in our multivariate model, and we have speculated on the contribution of other factors such as diet and coexisting renal diseases.
Incidence of IDDM In Mauritian Children and Adolescents From 1986 to 1990
Authors: Tuomilehto Jaakko , Dabee Jaydev , Karvonen Marjatta , Dowse Gary K , Gareeboo Hassam , Virtala Esa , Tiihonen Marja , Alberti K George M M , Zimmet Paul Z 
Published: March 2007

OBJECTIVE
To document the incidence of IDDM in Mauritian children and adolescents 0–19 yr of age from 1986 to 1990.

RESEARCH DESIGN AND METHODS
We used a population-based register that used pediatricians, physicians, nutritionists, and general practitioners as a primary source of restrospective case ascertainment. The denominator data were obtained from the Statistics Office of the Ministry of Health (Port Louis, Mauritius).

RESULTS
In 1990, 37 newly diagnosed IDDM cases (22 females and 15 males) were identified between 1986 and 1990 among the population ≤19 yr of age. The average incidence density per year was 1.9/100,000 people and was slightly higher among girls (2.2/100,000) than among boys (1.5/100,000). The average agestandardized incidence density was 2.1/100,000 people (95% confidence interval 1.5–3.0) among children ≤14 yr of age, 2.5/100,000 people (95% confidence interval 1.5–3.9) among girls, and 1.8/100,000 people (95% confidence interval 1.0–3.0) among boys. The incidence was similarly low in Mauritians of Asian Indian, Chinese, and Creole (predominantly African) origin.

CONCLUSIONS
The incidence of IDDM in Mauritian children and adolescents is among the lowest yet reported. This sharply contrasts with the very high risk of NIDDM found among the adult population in this rapidly modernizing country.
Prepregnancy Weight and Antepartum Insulin Secretion Predict Glucose Tolerance Five Years After Gestational Diabetes Mellitus
Authors: Metzger Boyd E , Cho Nam H , Roston Susan M , Radvany Ruta 
Published: March 2007

OBJECTIVE
To identify phenotypic, genotypic, and metabolic parameters measured at the time of antepartum diagnosis of gestational diabetes mellitus that can indicate the risk of diabetes mellitus at early postpartum (≤6 mo after delivery) and at a 5-yr follow-up.

RESEARCH DESIGN AND METHODS
The recommendations from the National Diabetes Data Group and International Workshop Conferences on Gestational Diabetes Mellitus were used for screening, diagnosing, and subclassifying gestational diabetes mellitus. National Diabetes Data Group criteria were also used for classification of glucose tolerance postpartum. Plasma glucose, insulin, and free fatty acids were measured after an overnight fast. Plasma glucose and insulin were measured 15, 30, 60, 120, and 180 min after the 100-g oral glucose load. Postpartum glucose tolerance was evaluated at 3–6 mo (early), 1 yr, and annually thereafter.

RESULTS
The 5-yr cumulative incidence of diabetes during follow-up after gestational diabetes mellitus was nearly 50%. Among those who had diabetes within 5 yr, a history of diabetes in only the mother was nearly threefold more common than a history of diabetes in only the father (30 vs. 11%, P &lt; 0.01). Those who displayed diabetes at early postpartum (≤6 mo) testing had significantly higher antepartum glucose levels at 60, 120, and 180 min compared with those whose early postpartum results were normal. They were also relatively insulinopenic at antepartum testing. Their fasting, acutely stimulated (15 and 30 min), and integrated 3-h response to oral glucose were all significantly lower relative to women who remained normal or had impaired glucose tolerance at early postpartum testing. Women who developed diabetes between 6 mo and 5 yr postpartum were more obese before the index pregnancy, and they had lower fasting, acutely stimulated (15 and 30 min), and integrated (1–3 h) insulin levels compared with women who remained normal or displayed impaired glucose tolerance at 5 yr postpartum. A multiple logistic regression model showed that diabetes present at early postpartum testing was independently associated with higher 2-h glucose and lower basal and total integrated insulin level. Later (≤6 mo-5 yr postpartum) development of diabetes was independently associated with prepregnancy weight and impaired insulin secretion at diagnosis of gestational diabetes mellitus.

CONCLUSIONS
Impaired β-cell function and obesity at diagnosis of GDM were associated with the development of diabetes during a 5-yr, follow-up period. Studies designed to prevent diabetes in this high-risk group should examine strategies to maintain both optimal β-cell function and maximum insulin sensitivity.
Diabetes and Associated Risk Factors Among Native Americans
Authors: Muneta Ben , Newman Jeff , Wetterall Scott , Stevenson John 
Published: March 2007

OBJECTIVES
To estimate the prevalence of diabetes and related risk factors among Native Americans.

RESEARCH DESIGN AND METHODS
We used 1988–1989 data from the Behavioral Risk Factor Surveillance System to calculate the overall, age-adjusted prevalence of diabetes, obesity, sedentary life-style, hypertension, and smoking among Native Americans. The SESUDAAN software package was used to derive confidence intervals.

RESULTS
The prevalence of diabetes was 11.6% among the 768 Native American Behavioral Risk Factor Surveillance System respondents (95% confidence interval 7.8–15.4) and 4.7% among the 121,986 white respondents (95% confidence interval 4.6–4.8). The age-adju ted prevalence of diabetes was 2.5 times higher among Native Americans than among whites. The prevalence of obesity was higher among Native Americans (34.4; 95% confidence interval 31.7–37.1) than among whites (23.9%; confidence interval 23.7–24.1). The prevalences of sedentary lifestyle (58%), hypertension (16%), and smoking (28%) were similar among both populations.

CONCLUSIONS
The Behavioral Risk Factor Surveillance System may prove as a useful tool for surveying Native Americans living on and off reservations for inclusion in national estimates of diabetes prevalences.
HLA-DQ Associations Distinguish Insulin-Resistant and Insulin-Sensitive Variants of NIDDM in Black Americans
Authors: Banerji Mary Ann , Norin Allen J , Chaiken Rochelle L , Lebovitz Harold E 
Published: March 2007

OBJECTIVE
NIDDM in black Americans exists as two variants: one with a primary defect in insulin action (insulin-resistant variant) and the other with normal insulin action and a primary defect in insulin secretion (insulin-sensitive variant). The objective of this study was to determine whether these two variants were genetically distinct from each other and from normal control subjects as determined by HLA typing.

RESEARCH DESIGN AND METHODS
Insulin action was measured with the euglycemic insulin clamp with a 1 mU · kg−1 · min−1 insulin infusion with [3-3H]glucose. A glucose disposal of &lt; 278 μmol · kg−1 · min−1 was considered insulin resistant, and a value greater than this was considered insulin sensitive. The study population consisted of 21 insulin-resistant and 25 insulin-sensitive black NIDDM patients and 89 normal, nondiabetic black control subjects from an urban hospital. HLA typing was performed with serological methods.

RESULTS
The frequency of HLA-DQW7 in the insulin-resistant population (76%) was significantly greater than that in the insulin-sensitive population (32%, corrected P &lt; 0.018) and the normal control population (21%, corrected P &lt; 0.001). The frequency of HLA-DQW6 was increased in the insulin-sensitive population (76%), corrected P &lt; 0.023, as compared with the normal control subjects (33%). The relative risk of HLA-DQW7 in identifying insulin-resistant NIDDM patients compared with control subjects was 7.

CONCLUSIONS
At least one component that differentiates insulin-resistant and insulin-sensitive NIDDM in black Americans is under different genetic control. One or more loci responsible for insulin-resistant and insulin-sensitive NIDDM are likely to be in linkage disequilibrium with the DQ locus of the human MHC region of chromosome 6.
Sporting Activity and Hyperglycemia in Middle-Aged Men
Authors: Perry Ivan J , Wannamethee S Goya , Walker Mark K , Shaper A Gerald 
Published: March 2007

OBJECTIVE
To assess the relationship between self-reported frequency of participation in sporting activity and the prevalence of hyperglycemia (nonfasting glucose level &gt; or = 7.8 mM) in middle-aged men.

RESEARCH DESIGN AND METHODS
We used a cross-sectional study of 7617 British middle-aged men, drawn from 24 general practices in England, Wales, and Scotland, who were participants in the British Regional Heart Study. The response rate was 78%. Patients with diabetes (physician-diagnosed) were excluded from our analysis. Frequency of participation in sporting activity was determined by the respondents and reported as none (61%), occasionally (12%), or frequently (27%).

RESULTS
The age-adjusted prevalence odds ratio for hyperglycemia was 0.86 (95% confidence interval, 0.6–1.2) in those reporting occasional, and 0.62 (95% confidence interval, 0.4–0.85) in those reporting frequent sporting activity, compared with those reporting none. This effect of frequent sporting activity on the prevalence of hyperglycemia was independent of body mass index, occupational status, smoking status, systolic blood pressure, use of antihypertensive therapy, and time of sampling.

CONCLUSIONS
Frequent sporting activity in middle-aged men is associated with a reduced prevalence of hyperglycemia and may reduce the risk of NIDDM.
Population-Based Incidence of IDDM in the State of São Paulo, Brazil
Authors: Ferreira Sandra RG , Franco Laercio J , Vivolo Marco A , Negrato Carlos A , Simoes Antonio CP , Ventureli Carlos R 
Published: March 2007

OBJECTIVE
To study the incidence of IDDM among children, infants to 14 yr of age, in the state of São Paulo, Brazil, 1987–1991.

RESEARCH DESIGN AND METHODS
A prospective population-based register was established, using physician reports of newly diagnosed IDDM patients &lt; 15 yr of age as the primary source of case identification and school surveys as the main secondary source. Data were collected according to the methods recommended by the Diabetes Epidemiology Research International group.

RESULTS
Case ascertainment was estimated at 95.0, 92.8, and 98.8% complete for each of the three cities studied. The average annual IDDM incidence was 7.6/100,000 inhabitants (95% confidence interval, 5.6–9.7). We found a higher incidence rate in girls than boys.

CONCLUSIONS
The incidence of childhood IDDM in a tropical region in South America (São Paulo, Brazil) is in the middle incidence range observed in developed countries throughout the world. Increased incidence of IDDM in girls compared with boys will be tested by the ongoing Brazilian incidence study being developed in 18 other centers across the country.
Impact of Resident Participation in a Multidisciplinary Diabetes Team
Authors: Gray Deborah L , Langefeld Carl D , Golden Michael P , Orr Donald P 
Published: March 2007

OBJECTIVE
To determine the impact of participation in a multidisciplinary diabetes team on pediatric residents' perceptions of team members' roles.

RESEARCH DESIGN AND METHODS
Pediatric residents were assigned to a traditional diabetes clinical rotation (n = 34) or to an ambulatory multidiscipl inary diabetes team within their continuity clinic (n = 21). The residents and a smallsample of practicing pediatricians (n = 46) completed a Likert-type instrument at the completion of the 18-mo study.

RESULTS
Multidisciplinary diabetes team residents were significantly more positive about the roles for endocrinological evaluation in monitoring compliance, for the nurse educator/certified diabetes educator in assisting with sick-day management and school behavioral problems, and for the dietitian in helping with cholesterol problems. They were significantly more like practicing pediatricians in their perceptions of pediatric roles in teaching sick-day management, implementing weight reduction, assisting with conflict resolution about diabetes, screening for microvascular complications, and developing behavioral strategies for metabolic control than residents in the traditional rotation. The groups did not differ in their beliefs about patient empowerment.

CONCLUSIONS
Multidisciplinary diabetes team participation may be useful in modifying specific role perceptions of pediatric residents about diabetes care. It does not appear to alter perceptions favoring greater patient empowerment.
Hypersensitivity to Insulin During Remissions in Cyclosporin-Treated IDDM Patients
Authors: Burcelin Rémy G , Eddouks Mohamed , Beylot Michel , Normand Sylvie , Boitard Christian , Feutren Gilles , Landais Paul , Riou Jean Paul , Girard Jean R , Bach Jean François , Assan Roger I 
Published: March 2007

OBJECTIVE— To test the sensitivity to insulin in recent-onset IDDM patients, its course according to treatment, and the advent of remissions.
RESEARCH DESIGN AND METHODS— The euglycemic hyperinsulinemic clamp was used in 54 recent-onset IDDM patients and 14 healthy control subjects. Patients were tested after 1,2, and 4 wk of treatment with either insulin or insulin plus cyclosporin A, during cyclosporin A-associated long-lasting remissions, and during relapses.
RESULTS— Insulin sensitivity was markedly decreased in all patients at onset. It was rapidly restored by insulin therapy, whether immunosuppression was associated with it or not. Insulin sensitivity was even higher than normal in the remission patients, who also were characterized by the reappearance of some endogenous insulin secretion and the sustained normalization of blood glucose profiles. During relapses, the deterioration of the blood glucose profiles was associated with some loss of insulin sensitivity.
CONCLUSIONS— Cyclosporin A-associated remissions represent an original situation that associates euglycemia with the persistence of low endogenous insulin secretion. Cyclosporin A by itself had no influence on sensitivity to insulin, but allowed the reappearance of some insulin secretory capacity that contributed, with the improvement of insulin sensitivity, to the development of the diabetes honeymoon. The secretion of endogenous insulin, although lower than normal, was sufficient to secure a high sensitivity to insulin and the maintenance of normal blood glucose profiles, presumably because of the fact that insulin was released directly into the portal vein in these conditions. This metabolic state was precarious: the optimal sensitivity to insulin disappeared in patients who relapsed. These results have important clinical consequences: the preservation of islet residual secretory capacity by the use of newer nontoxic immunosuppressive protocols, combined with a minimal supportive insulin therapy in remission patients, may prolong remissions and maintain an optimal insulin sensitivity.
Transient State of NIDDM in a Patient With AIDS
Authors: Abourizk Nicolas N , Lyons Robert W , Madden Gayle M 
Published: March 2007

OBJECTIVE— To describe a glucose abnormality in AIDS that is characterized by transient NIDDM followed by hyperinsulinemic normoglycemia.
RESEARCH DESIGN AND METHODS— A 36-yr-old Hispanic man with AIDS was on long-standing aerosolized pentamidine therapy in 1986. He received a course of intravenous pentamidine 5 mo before the onset of diabetes. Nonketotic hyperglycemia responded to sulfonylurea, which had to be discontinued 3 mo later because of normoglycemia.
RESULTS— Diabetes diagnosis was made by three separate fasting blood glucose values of 16.2, 18.1, and 29.9 mM, and HbA1C of 10.1% (normal 4.2–5.9). The patient became euglycemic 5 mo after diagnosis while on no treatment. An oral glucose tolerance test was then normal, and C-peptide stimulation showed supra-normal response.
CONCLUSIONS— Transient severe NIDDM in this case could not be linked to acute stress. Pentamidine, in a progressively increasing cumulative dose, is one possible, albeit unusual, etiology because the diabetes was not permanent. After diabetes remission, the data suggest residual insulin resistance that is unusual in HIV-positive patients. Diverse glucose abnormalities exist in AIDS. Awareness of their presentation is clinically helpful.
Effect of Third-Party Reimbursement on Use of Services and Indexes of Management Among Indigent Diabetic Patients
Authors: Nordberg Beatrice J , Barlow Myra S , Chalew Stuart A , McCarter Robert J 
Published: March 2007

OBJECTIVE
To determine the effect of third-party reimbursement on the use of services and indexes of diabetes-related health management among inner-city diabetic patients.

RESEARCH DESIGN AND METHODS
Adult diabetic patients (n = 158; 67% women, 33% men) from an inner-city diabetes clinic were categorized by level of third-party medical coverage: complete reimbursement for all services (full); partial reimbursement (part); and no reimbursement (none). Patients were followed for 13 mo. Use of billable medical services, diabetes clinic visits, emergency room visits, and hospital admissions were recorded. Use of a free, day-time diabetes telephone hot line was also documented. Indexes of diabetes-related health management, HbA1, blood pressure, and weight were compared from the beginning and the end of the study. Diabetes complications were scored and tabulated.

RESULTS
Univariate analysis showed that patients with full reimbursement were more likely to use services than patients without reimbursement. When the combined effects of reimbursement status, age, sex, type of diabetes, and diabetes complications on use of services were analyzed together in a multivariate analysis, complications was the best predictor of admissions to the hospital and whether a patient called the hot line. IDDM patients and patients with full reimbursement were most likely to have an emergency room visit. Age was the best predictor of diabetes clinic attendance. No difference was noted in blood pressure or weight among the reimbursement groups at the beginning and end of study. However, the trend was toward (P &lt; 0.05) an increase in HbA1 in the none group.

CONCLUSIONS
Among inner-city diabetic patients, multiple factors influence use of medical services. Indigent diabetic patients without third-party reimbursement were observed to have a rise in HbA1. These factors should be taken into consideration when planning strategies to prevent diabetes complications and the most effective allocation of health-care resources.