bluuebunny/crossref_metadata_2025_split huggingface dataset:
Losartan Reduces the Costs Associated With Diabetic End-Stage Renal Disease
Authors: Herman William H. , Shahinfar Shahnaz , Carides George W. , Dasbach Erik J. , Gerth William C. , Alexander Charles M. , Cook John R. , Keane William F. , Brenner Barry M. ,   For the RENAAL Investigators
Published: March 2007

OBJECTIVE—To evaluate the within-trial effect of losartan and conventional antihypertensive therapy (CT) compared with placebo and CT on the economic cost associated with end-stage renal disease (ESRD).
RESEARCH DESIGN AND METHODS—The Reduction of End Points in Type 2 Diabetes With the Angiotensin II Antagonist Losartan (RENAAL) study was a multinational double-blind randomized placebo-controlled clinical trial designed to evaluate the renal protective effects of losartan on a background of CT (excluding ACE inhibitors and angiotensin II receptor agonists [AIIAs]) in patients with type 2 diabetes and nephropathy. The primary composite end point was doubling of serum creatinine, ESRD, or death. Data on the duration of ESRD were used to estimate the economic benefits of slowing the progression of nephropathy. The cost associated with ESRD was estimated by combining the days each patient experienced ESRD with the cost of ESRD over time. The cost of ESRD for individuals with diabetes was estimated using data from the U.S. Renal Data System. Total cost was estimated as the sum of the cost associated with ESRD and the cost of study therapy.
RESULTS—We estimated that losartan and CT compared with placebo and CT reduced the number of days with ESRD by 33.6 per patient over 3.5 years (P = 0.004, 95% CI 10.9–56.3). This reduction in ESRD days resulted in a decrease in cost associated with ESRD of $5,144 per patient (P = 0.003, 95% CI $1,701 to $8,587). After accounting for the cost of losartan, the reduction in ESRD days resulted in a net savings of $3,522 per patient over 3.5 years (P = 0.041, $143 to $6,900).
CONCLUSIONS—Treatment with losartan in patients with type 2 diabetes and nephropathy not only reduced the incidence of ESRD, but also resulted in substantial cost savings.
Clinical Diagnosis of Diabetic Polyneuropathy With the Diabetic Neuropathy Symptom and Diabetic Neuropathy Examination Scores
Authors: Meijer Jan-Willem G. , Bosma Eelke , Lefrandt Johan D. , Links Thera P. , Smit Andries J. , Stewart Roy E. , van der Hoeven Johannes H. , Hoogenberg Klaas 
Published: March 2007

OBJECTIVE—To evaluate the discriminative power of the Diabetic Neuropathy Symptom (DNS) and Diabetic Neuropathy Examination (DNE) scores for diagnosing diabetic polyneuropathy (PNP), as well as their relation with cardiovascular autonomic function testing (cAFT) and electro-diagnostic studies (EDS).
RESEARCH DESIGN AND METHODS—Three groups (matched for age and sex) were selected: 24 diabetic patients with neuropathic foot ulcers (DU), 24 diabetic patients without clinical neuropathy or ulcers (DC), and 21 control subjects without diabetes (C). In all participants, the DNS and DNE scores were assessed and cAFT (heart rate variability [HRV], baroreflex sensitivity [BRS]), and EDS were performed (Nerve Conduction Sum [NCS] score; muscle fiber conduction velocity: fastest/slowest ratio [F/S ratio]).
RESULTS—Both the DNS and the DNE scores discriminated between the DU and DC groups significantly (P &lt; 0.001). The DNE score even discriminated between DC and C (P &lt; 0.05). Spearman’s correlation coefficients between both DNS and DNE scores and cAFT (HRV −0.42 and −0.44; BRS −0.30 and −0.29, respectively) and EDS (NCS 0.51 and 0.62; F/S ratio 0.44 and 0.62, respectively) were high. Odds ratios were calculated for both DNS and DNE scores with cAFT (HRV 4.4 and 5.7; BRS 20.7 and 14.2, respectively) and EDS (NCS 5.6 and 16.8; F/S ratio 7.2 and 18.8, respectively).
CONCLUSIONS—The DNS and DNE scores are able to discriminate between patients with and without PNP and are strongly related to cAFT and EDS. This further confirms the strength of the DNS and DNE scores in diagnosing diabetic PNP in daily clinical practice.
Insulin Sensitivity and the Risk of Incident Hypertension
Authors: Goff David C. , Zaccaro Daniel J. , Haffner Steven M. , Saad Mohammed F. 
Published: March 2007

OBJECTIVE—The insulin resistance syndrome has been described as including hypertension. Previous studies have documented cross-sectional associations between insulin sensitivity (SI) and blood pressure or prevalent hypertension. Prospective data have been sparse.
RESEARCH DESIGN AND METHODS—The Insulin Resistance Atherosclerosis Study (IRAS) is a prospective study of the associations of SI with atherosclerosis and other risk factors for cardiovascular disease. We examined the association between SI, measured using the frequently sampled intravenous glucose tolerance test with minimal model analysis, and incident hypertension (defined as per the Joint National Committee), at the 5-year examination in 840 IRAS participants who were free of hypertension at the baseline examination.
RESULTS—Adjusted for age, sex, ethnicity, and smoking status, for each unit greater SI, the risk of hypertension was 10% lower (95% CI 2–19, P &lt; 0.05).
CONCLUSIONS—These findings, from a prospective study, support the presence of a modest protective association between greater SI and lower risk of hypertension. These findings support the contention that interventions that improve SI may be beneficial with respect to the development of hypertension and cardiovascular disease. This contention should be tested in randomized clinical trials.
Insulin Secretion and Insulin Sensitivity Pattern Is Different in Isolated Impaired Glucose Tolerance and Impaired Fasting Glucose
Authors: Hanefeld Markolf , Koehler Carsta , Fuecker Katja , Henkel Elena , Schaper Frank , Temelkova-Kurktschiev Theodora 
Published: March 2007

OBJECTIVE—Isolated impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are two risk categories for type 2 diabetes. This study compared both categories with respect to the degree of insulin secretion abnormalities and insulin resistance.
RESEARCH DESIGN AND METHODS—This is a crossover comparison of a population at high risk for type 2 diabetes. The subjects were recruited from the Risk Factor in Impaired Glucose Tolerance for Atherosclerosis and Diabetes (RIAD) study. They underwent a 75-g oral glucose tolerance test, with measurement of specific insulin, C-peptide, proinsulin, and free fatty acids at baseline and every 30 min after load for 2 h. Factor analysis was performed to evaluate the importance of insulin resistance and secretion abnormalities in both categories.
RESULTS—All categories of prediabetic hyperglycemia had a higher cardiovascular risk factor level when adjusted for sex, age, and BMI compared to control subjects with normal glucose tolerance. Subjects with isolated IFG were more insulin resistant than those with IGT. By contrast, subjects with isolated IGT exhibited a more severe deficit in early- and late-phase insulin secretion versus IFG subjects. As shown with factor analysis, in IFG the insulin resistance factor explained 28.4% of the variance, whereas in IGT the insulin secretion factor was dominant, explaining 31.1% of the total variance.
CONCLUSIONS—Our cross-sectional data from the RIAD study demonstrate that isolated IFG and isolated IGT are different with respect to the degree of insulin resistance and anomalies in insulin secretion, and that subjects with IGT exhibit a deficit in the early and late phases of insulin secretion. This finding may be important for a differential approach in primary prevention of type 2 diabetes.
Value of Coronary Artery Calcium Scanning by Computed Tomography for Predicting Coronary Heart Disease in Diabetic Subjects
Authors: Qu Wenchun , Le Thuy T. , Azen Stanley P. , Xiang Min , Wong Nathan D. , Doherty Terence M. , Detrano Robert C. 
Published: March 2007

OBJECTIVE—The South Bay Heart Watch is a cohort study designed to determine the significance of coronary calcium in high-risk asymptomatic patients. This is a report of the relative risk (RR) for outcomes of coronary artery calcium in diabetic and nondiabetic subjects.
RESEARCH DESIGN AND METHODS—A total of 1,312 diabetic and nondiabetic subjects underwent risk factor screening and computed tomography testing for coronary calcium at baseline and were followed clinically for 6.3 ± 1.4 years. End points were either 1) hard events of nonfatal myocardial infarction (MI) or coronary death or 2) any cardiovascular event (nonfatal MI, coronary death, coronary revascularization, or stroke).
RESULTS—The incidence rates of a hard event and any cardiovascular event for diabetic and nondiabetic subjects were 14.5 and 6.1% and 23.8 and 12.2%, respectively (P &lt; 0.001). Cox regression analyses of the combined risk relationship of diabetes status and calcium score demonstrated that relative to nondiabetic subjects with low calcium scores (&lt;2.8), diabetic subjects with calcium scores ≥2.8 exhibited at least a fourfold increase in the risk of either a hard or any cardiovascular event (P &lt; 0.001). Cox regression analyses conducted separately for nondiabetic and diabetic subjects revealed that coronary calcium score risk groups were significantly associated with events in nondiabetic subjects (RR ≥ 2.6, P ≤ 0.01), but not in diabetic subjects (RR ≤ 1.7, P &gt; 0.05).
CONCLUSIONS—The risk of coronary heart disease increases with increasing calcium scores and diabetes status. Calcium scores have less prognostic value in diabetic subjects.
Predictive Value of Foot Pressure Assessment as Part of a Population-Based Diabetes Disease Management Program
Authors: Lavery Lawrence A. , Armstrong David G. , Wunderlich Robert P. , Tredwell Jeffrey , Boulton Andrew J.M. 
Published: March 2007

OBJECTIVE—To evaluate the effectiveness of dynamic plantar pressure assessment to determine patients at high risk for neuropathic ulceration. In choosing the cut point, we looked for an optimum combination of sensitivity and specificity of plantar pressure to screen for neuropathic ulceration.RESEARCH DESIGN AND METHODS—A total of 1,666 consecutive individuals with diabetes (50.3% male) presenting to a large urban managed care-based outpatient clinic were enrolled in this longitudinal 2-year outcome study. Patients received a standardized medical and musculoskeletal assessment at the time of enrollment, including evaluation in an onsite gait laboratory.RESULTS—Of the entire population, 263 patients (15.8%) either presented with or developed an ulcer during the 24-month follow-up period. As expected, baseline peak plantar pressure was significantly higher in the ulcerated group than in the group who did not ulcerate (95.5 ± 26.4 vs. 85.1 ± 27.3 N/cm2, P &lt; 0.001). There was also a trend toward increased pressure with increasing numbers of foot deformities, as well as with increasing foot risk classification (P = 0.0001). Peak pressure was not a suitable diagnostic tool by itself to identify high-risk patients. After eliminating patients without loss of protective sensation, using receiver operating characteristic (ROC) analysis, the optimal cut point, as determined by a balance of sensitivity and specificity, was 87.5 N/cm2, yielding a sensitivity of 63.5% and a specificity of 46.3%.CONCLUSIONS—The data from this evaluation continue to support the notion that elevated foot pressure is an important risk factor for foot complications. However, the ROC analysis suggests that foot pressure is a poor tool by itself to predict foot ulcers.
Evolution of Analytical Performance in Portable Glucose Meters in the Last Decade
Authors: Böhme Philip , Floriot Michele , Sirveaux Marie-Aude , Durain Danielle , Ziegler Olivier , Drouin Pierre , Guerci Bruno 
Published: March 2007

OBJECTIVE—To assess and compare the technical accuracy of portable glucose meters during the last decade.
RESEARCH DESIGN AND METHODS—One-thousand preprandial (pre) and postprandial (post) capillary whole-blood glucose values measured with meters owned mainly by diabetic patients were compared with a single laboratory method yearly from 1989 to 1999. A total of 21,950 capillary measurements and their corresponding laboratory reference values were analyzed at our clinic.
RESULTS—The lowest mean absolute difference was found in 1989 (pre: 2 ± 22 mg/dl, post: 9 ± 31 mg/dl) (mean ± SD). The highest mean absolute difference was observed in 1993 (pre: 31 ± 33 mg/dl) and 1996 (post: 50 ± 35 mg/dl). The highest mean relative deviation was observed in 1990 (pre: 16.4%) and 1996 (post: 20.6%). The highest percentage of readings that were within a 5% deviation limit were observed in 1998 (pre: 44.5%) and in 1997 (post: 36.7%). Based on blood glucose levels within ±5 and ±10% of laboratory values, the technical accuracy of meters was similar for 1989 and 1999 (P = 0.27 and 0.52, respectively). The percentage of pre values in zone A of Clarke’s error grid analysis was &gt;90% in 1989, 1997, 1998, and 1999.
CONCLUSIONS—The analytical performance of glucose meters decreased between 1990 and 1996 but was restored between 1997 and 1999. Nevertheless, our data suggest that the technical accuracy of glucose meters has not significantly improved during the last decade. Complementary studies taking into account the preanalytical improvements of the recent meters, as well as their calibration method, appear necessary.
Economic Impact of Diabetic Ketoacidosis in a Multiethnic Indigent Population
Authors: Maldonado Mario R. , Chong Erica R. , Oehl Melissa A. , Balasubramanyam Ashok 
Published: March 2007

OBJECTIVE—Diabetic ketoacidosis (DKA) is a common complication of diabetes. We analyzed the inpatient costs of treating DKA in a multiethnic, indigent population in Houston, Texas.
RESEARCH DESIGN AND METHODS—We measured the cost of resources utilized for all patients admitted to our hospital with DKA from 1 January to 31 December 1998. We also analyzed their medical records to determine the factors that precipitated the episode of DKA and then grouped them into three categories: acute illnesses, noncompliance with diabetes treatment, and new-onset diabetes. The data were analyzed by one-way ANOVA. The Tukey-Kramer procedure was used for post hoc multiple comparisons.
RESULTS—There were 167 admissions for DKA. The mean age was 40 ± 13 years. The ethnic distribution was 49% African American, 32% Hispanic American, and 18% white. The total inhospital cost of treating DKA was $1,816,255. The mean cost per hospitalization was $10, 876 ± 11,024. The frequency distribution by category of DKA-precipitating factor was 18% acute illness, 59% noncompliance, and 23% new onset. There were differences in mean cost of DKA associated with the three categories: $20,864 ± 17,910 for acute illness, $11,863 ± 8,701 for new onset, and $7,470 ± 6,300 for noncompliance (P &lt; 0.0001). The total cost for each category was $671,375 for acute illness, $694,082 for noncompliance, and $450,798 for new onset.
CONCLUSIONS—DKA is an expensive complication among indigent, multiethnic diabetic patients. Although the mean cost per admission was lowest for DKA precipitated by noncompliance, this causal category was responsible in sum for the greatest portion of the economic burden.
Use of Heart Rate Reserve and Rating of Perceived Exertion to Prescribe Exercise Intensity in Diabetic Autonomic Neuropathy
Authors: Colberg Sheri R. , Swain David P. , Vinik Aaron I. 
Published: March 2007

OBJECTIVE—Individuals with diabetic autonomic neuropathy (DAN) exhibit an increased resting heart rate but depressed maximal heart rate. Thus, the purpose of this study was to examine the validity of using either percent of heart rate reserve (HRR) or a rating of perceived exertion (RPE) scale to prescribe exercise intensity in diabetic individuals both with and without DAN.
RESEARCH DESIGN AND METHODS—The subjects consisted of 23 individuals with type 2 diabetes, ages 45–75 years, with (DAN; n = 13) or without (No DAN; n = 10) clinical signs of DAN, as assessed by heart rate variability using the expiration-to-inspiration ratio of the R-R interval. Peak aerobic capacity was determined using a graded protocol on a cycle ergometer, with RPE, heart rate, and Vo2 values recorded at each stage.
RESULTS—The subjects were similar with the exception of depressed autonomic function in DAN subjects. Peak respiratory exchange ratio values were significantly higher (P &lt; 0.05) in the DAN group (1.08 ± 0.02 vs. 1.02 ± 0.01 in No DAN subjects), although DAN subjects exhibited a significantly lower (P &lt; 0.05) peak exercise heart rate. A similarly highly linear relationship between %HRR and percent Vo2 reserve (Vo2R) existed for both groups (r = 0.98). A similar slightly weaker relationship (r = 0.94) was found between RPE and %Vo2R.
CONCLUSIONS—In conclusion, in diabetic individuals, %HRR provides an accurate prediction of %Vo2R and can be used to prescribe and monitor exercise intensity, regardless of the presence of DAN. The RPE scale is also a valid, albeit slightly less accurate, method to monitor exercise intensity in diabetic individuals.
Dietary Fats Do Not Contribute to Hyperlipidemia in Children and Adolescents With Type 1 Diabetes
Authors: Wiltshire Esko J. , Hirte Craig , Couper Jennifer J. 
Published: March 2007

OBJECTIVE—To determine the relative influence of diet, metabolic control, and familial factors on lipids in children with type 1 diabetes and control subjects.
RESEARCH DESIGN AND METHODS—We assessed fasting serum cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, lipoprotein(a), apolipoprotein (apo)-A1, and apoB in 79 children and adolescents with type 1 diabetes and 61 age- and sex-matched control subjects, together with dietary intakes using a quantitative food frequency questionnaire.
RESULTS—Total cholesterol, LDL cholesterol, apoB, HDL cholesterol, and apoA1 were significantly higher in children with diabetes. Children with diabetes had higher percentage energy intake from complex carbohydrates (P = 0.001) and fiber intake (P = 0.02), and they had lower intake of refined sugar (P &lt; 0.001) and percentage energy from saturated fat (P = 0.045) than control subjects. Total cholesterol (β = 0.43, P &lt; 0.001), LDL cholesterol (β = 0.4, P &lt; 0.001), and apoB (β = 0.32, P = 0.006) correlated independently with HbA1c but not dietary intake. HDL cholesterol (β = 0.24, P = 0.05) and apoA1 (β = 0.32, P = 0.004) correlated independently with HbA1c, and HDL cholesterol (β = −0.34, P = 0.009) correlated with percentage energy intake from complex carbohydrates. Triglycerides correlated independently with percentage energy intake from complex carbohydrates (β = 0.33, P = 0.01) and insulin dose (β = 0.26, P = 0.04). Subjects with diabetes and elevated LDL (&gt;3.35 mmol/l, &gt;130 mg/dl), for whom dietary therapy would be recommended, had significantly higher HbA1c (P = 0.007), but they had higher intake of complex carbohydrates than subjects with LDL cholesterol &lt;3.35 mmol/l.
CONCLUSIONS—Lipid abnormalities remain common in children and adolescents with type 1 diabetes who adhere to current dietary recommendations, and they relate to metabolic control but not dietary intake.
Diabetic Foot Syndrome
Authors: Lavery Lawrence A. , Armstrong David G. , Wunderlich Robert P. , Tredwell Jeffrey , Boulton Andrew J.M. 
Published: March 2007

OBJECTIVE—To report the incidence of diabetes-related lower-extremity complications in a cohort of patients enrolled in a diabetes disease management program.RESEARCH DESIGN AND METHODS—We evaluated screening results and clinical outcomes for the first 1,666 patients enrolled in a disease management program for a period of 24 months (50.3% men, aged 69.1 ± 11.1 years).RESULTS—The incidence of ulceration, infection, amputation, and lower-extremity bypass was 68.4, 36.5, 5.9, and 7.7 per 1,000 persons with diabetes per year. Amputation incidence was higher in Mexican Americans than in non-Hispanic whites (7.4/1,000 vs. 4.1/1,000; P = 0.003, odds ratio [OR] 1.8, 95% CI 1.2–2.7). The amputation-to-ulcer ratio was 8.7%. The incidence of Charcot arthropathy was 8.5/1,000 per year. Charcot was more common in non-Hispanic whites than in Mexican Americans (11.7/1,000 vs. 6.4/1,000; P = 0.0001, 1.8, 1.3–2.5). The prevalence of peripheral vascular disease was 13.5%, with no significant difference based on ethnicity (P = 0.3). There was not a significant difference in incidence of foot infection (P = 0.9), lower-extremity bypass (P = 0.3), or ulceration (P = 0.1) based on ethnicity. However, there were more failed bypasses in Mexican Americans (33%) than in non-Hispanic whites (7.1%). Mexican Americans were 3.8 times more likely to have a failed bypass (leading to an amputation) or be diagnosed as “nonbypassable” than non-Hispanic whites (75.0 vs. 44.0%; P = 0.01, 3.8, 1.2–11.8).CONCLUSIONS—The incidence of amputation is higher in Mexican Americans, despite rates of ulceration, infection, vascular disease, and lower-extremity bypass similar to those of non-Hispanic whites. There may be factors associated with failed or failure to bypass that mandate further investigation.
Dermatophyte Test Medium Culture for Evaluating Toenail Infections in Patients With Diabetes
Authors: Rich Phoebe , Harkless Lawrence B. , Atillasoy Ercem S. 
Published: March 2007

OBJECTIVE—To evaluate the performance of the in-office dermatophyte test medium (DTM) culture when used to confirm the diagnosis of onychomycosis in diabetic patients.
RESEARCH DESIGN AND METHODS—Nail samples from 184 diabetic patients who exhibited symptoms consistent with toenail onychomycosis were screened for dermatophyte fungal infection using DTM, potassium hydroxide evaluation, and central mycology laboratory culture tests. The diabetic patient group investigated in this study is a subset of a heterogeneous set of patients who participated in a nationwide survey designed to investigate the use of fungal culture tests by dermatologists, podiatrists, and primary care physicians described in detail elsewhere. The overall sensitivity of the DTM and central laboratory culture methods was estimated and compared. Sensitivity differences between DTM and central laboratory culture methods were tested for statistical significance using the McNemar statistic.
RESULTS—DTM culture was positive in 102 of 184 patients (55%), while the central laboratory culture test detected the existence of fungal infection in 78 of 184 (42%). The two tests were in agreement (both positive or both negative) in 114 of 184 patients (62%). Central laboratory culture identified dermatophytes as the pathogen in 91% of positive cases.
CONCLUSIONS—DTM is a convenient and inexpensive culture test that can be used to confirm dermatophyte infections in diabetic patients with presumed onychomycosis. We found this test to be well suited for use in the primary care setting. Because oral antifungal agents are effective against dermatophyte species, which cause the vast majority of nail infections, diagnosis of onychomycosis requires confirmation of dermatophyte infection only, not identification of genus and species. DTM fulfills this requirement and has a diagnostic yield comparable to central laboratory culture.