bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of the Metabolic Syndrome Among Omani Adults
Authors: Al-Lawati Jawad A. , Mohammed Ali J. , Al-Hinai Halima Q. , Jousilahti Pekka 
Published: March 2007

OBJECTIVE—To estimate the prevalence of the metabolic syndrome by age and sex in the Omani population as defined by the third report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III [ATP III]) of North America.
RESEARCH DESIGN AND METHODS—We analyzed data from a cross-sectional survey conducted in 2001 containing a probability random sample of 1,419 Omani adults aged ≥20 years living in the city of Nizwa. The metabolic syndrome, defined by the ATP III, was defined as having three or more of the following abnormalities: waist circumference &gt;102 cm in men and &gt;88 cm in women, serum triglycerides ≥150 mg/dl (1.69 mmol/l), HDL cholesterol &lt;40 mg/dl (1.04 mmol/l) in men and &lt;50 mg/dl (1.29 mmol/l) in women, systolic blood pressure ≥130 mmHg and/or diastolic ≥85 mmHg or on treatment for hypertension, and fasting serum glucose ≥110 mg/dl (6.1 mmol/l) or on treatment for diabetes.
RESULTS—The age-adjusted prevalence of the metabolic syndrome was 21.0%. The crude prevalence was slightly lower (17.0%). The age-adjusted prevalence was 19.5% among men and 23.0% among women (P = 0.236). Low HDL cholesterol was the most common component (75.4%) of the metabolic syndrome among the study population followed by abdominal obesity (24.6%). Abdominal obesity was markedly higher in women (44.3%) than in men (4.7%).
CONCLUSIONS—The prevalence of the metabolic syndrome in Oman is similar to that in developed countries. Future prevention and control strategies should not overlook the importance of noncommunicable disease risk factors in rapidly developing countries.
Ulcer Recurrence Following First Ray Amputation in Diabetic Patients
Authors: Dalla Paola Luca , Faglia Ezio , Caminiti Maurizio , Clerici Giacomo , Ninkovic Sasa , Deanesi Valter 
Published: March 2007

OBJECTIVE—to evaluate the reulceration and reamputation rates in a cohort of diabetic patients following first ray amputation.
RESEARCH DESIGN AND METHODS—We evaluated a cohort of 89 diabetic patients, 63 men and 26 women, who underwent first ray amputation in the period from January 2000 to December 2001. The first ray lesions were Wagner grade 2 in 3 patients, Wagner grade 3 in 47 patients, and Wagner grade 4 in 39 patients. Following surgical wound healing, all patients wore special footwear with rocker bottom soles and custom molded insoles and were put on an intensive secondary prevention program.
RESULTS—The mean follow-up duration was 16.35 ± 6.76 months (range 7–28). Fifteen patients developed new ulcerations, with 11 lesions occurring ipsilaterally and 4 contralaterally to the first ray amputation. In seven patients, the new lesion was treated and healed with dressing. Eight patients underwent a new surgical procedure: panmetatarsal head resection in four patients, toe amputation in two patients, a transmetatarsal amputation in one patient, and Lisfranc’s amputation in one patient.
CONCLUSIONS—In the population studied, the first ray amputation presented a lower reulceration and reamputation rate with respect to that reported in the literature. This finding should therefore be attributed to the follow-up program, which uses shoes with a rocker bottom sole and custom molded insoles and intensive ambulatory check-ups.
The Association Between Cardiovascular Autonomic Neuropathy and Mortality in Individuals With Diabetes
Authors: Maser Raelene E. , Mitchell Braxton D. , Vinik Aaron I. , Freeman Roy 
Published: March 2007

OBJECTIVE—To examine by meta-analysis the relationship between cardiovascular autonomic neuropathy (CAN) and risk of mortality in individuals with diabetes.
RESEARCH DESIGN AND METHODS—We searched Medline for English-language articles published from 1966 to 2001. Fifteen studies having a baseline assessment of cardiovascular autonomic function and mortality follow-up were identified. The analyses were stratified according to whether a single abnormality or two or more measures of cardiovascular autonomic function were used to define CAN. A global measure of association (i.e., relative risk) was generated for each group by pooling estimates across the studies using the Mantel-Haenszel procedure.
RESULTS—CAN was significantly associated with subsequent mortality in both groups, although the magnitude of the association was stronger for those studies for which two or more measures were used to define CAN. The pooled relative risk for studies that defined CAN with the presence of two or more abnormalities was 3.45 (95% CI 2.66–4.47; P &lt; 0.001) compared with 1.20 (1.02–1.41; P = 0.03) for studies that used one measure.
CONCLUSIONS—These results support an association between CAN and increased risk of mortality. The stronger association observed in studies defining CAN by the presence of two or more abnormalities may be due to more severe autonomic dysfunction in these subjects or a higher frequency of other comorbid complications that contributed to their higher mortality risk. Future studies should evaluate whether early identification of subjects with CAN can lead to a reduction in mortality.
A Flexible, Low-Glycemic Index Mexican-Style Diet in Overweight and Obese Subjects With Type 2 Diabetes Improves Metabolic Parameters During a 6-Week Treatment Period
Authors: Jimenez-Cruz Arturo , Bacardi-Gascon Montserrat , Turnbull Wilfred H. , Rosales-Garay Perla , Severino-Lugo Isis 
Published: March 2007

OBJECTIVE—The aim of this study was to compare the effects of a flexible lower- and higher-glycemic index (GI) Mexican-style diet on biochemical data and BMI during a 6-week treatment period.
RESEARCH DESIGN AND METHODS—This study was a randomized, crossover design of two 6-week periods with a 6-week washout period between treatments. Subjects with type 2 diabetes (n = 36) with a BMI &gt;25 kg/m2 were selected. Fourteen subjects completed the study with eligible dietary records. Dietary instruction was provided on flexible diets with both a high and low GI. Fasting venous blood samples were taken at the start and finish of each dietary period, and biochemical data were analyzed. Multi- and univariate one-factor repeated-measures ANOVA were used to compare biochemical data.
RESULTS—Glycemic load and GI were lower during the low-GI diet, and dietary fiber was lower during the high-GI diet. The participants in the low-GI period consumed significantly fewer carbohydrates, such as white-wheat bread, white long-grain rice, potatoes, high-GI fruits, and carrots, and more carbohydrates, such as pinto beans, whole-meal wheat bread, and low-GI fruits than did participants in the high-GI period. There were no differences in the amount of carbohydrates consumed, such as corn tortillas and dairy products. At the end of the study periods, A1c was improved on the low- compared with the high-GI diet (P &lt; 0.008).
CONCLUSIONS—We conclude that a low-GI diet, containing Mexican-style foods, may help to improve the metabolic control in type 2 obese diabetic subjects during a 6-week period.
Associations of Dietary Fiber With Glucose Metabolism in Nondiabetic Relatives of Subjects With Type 2 Diabetes
Authors: Ylönen Katriina , Saloranta Carola , Kronberg-Kippilä Carina , Groop Leif , Aro Antti , Virtanen Suvi M. ,   the Botnia Research Group
Published: March 2007

OBJECTIVE—To study cross-sectional associations of dietary fiber intake with insulin resistance, insulin secretion, and glucose tolerance in a population at high risk for type 2 diabetes.
RESEARCH DESIGN AND METHODS—The subjects consisted of 248 male and 304 female adult nondiabetic relatives of patients with type 2 diabetes. Dietary intake was measured by means of two 3-day food records. Associations of total, water-insoluble, and water-soluble fiber with measures of glucose metabolism based on an oral glucose tolerance test, were analyzed by multiple linear regression analysis adjusting for sex, age, length of education, physical activity, BMI, waist-to-hip ratio, systolic blood pressure, and serum triglyceride and HDL cholesterol concentrations. The homeostasis model assessment insulin resistance index, the incremental 30-min serum insulin concentration divided by the incremental 30-min glucose concentration, and fasting and 2-h glucose concentrations were the outcome variables.
RESULTS—The dietary intake of total as well as water-insoluble and water-soluble fiber was inversely associated with insulin resistance: −0.17 (0.07), P = 0.012; −0.15 (0.07), P = 0.024; and −0.14 (0.07), P = 0.049 [regression coefficients (SE)]. Fiber variables were unrelated to insulin secretion and plasma glucose concentrations.
CONCLUSIONS—The results support evidence that a high intake of dietary fiber is associated with enhanced insulin sensitivity and therefore may have a role in the prevention of type 2 diabetes.
Treatment of Patients Over 64 Years of Age With Type 2 Diabetes
Authors: Del Prato Stefano , Heine Robert J. , Keilson Leonard , Guitard Christiane , Shen Sharon G. , Emmons Rebecca P. 
Published: March 2007

OBJECTIVE—To evaluate the impact of renal impairment (RI) (estimated creatinine clearance [Clcr] &lt;60 ml/min per 1.73 m2) and low baseline HbA1c (&lt;7.5%) on comorbidity in patients with type 2 diabetes, and to assess the efficacy and safety of nateglinide monotherapy in these patients and in subgroups of patients over age 64 years (elderly) and elderly with RI.RESEARCH DESIGN AND METHODS—Retrospective subgroup analyses were performed on pooled data from all completed nateglinide studies (12 randomized, double blind trials and 1 open trial) in patients with type 2 diabetes. A total of 3,702 patients with ≥1 postbaseline safety evaluation received monotherapy with nateglinide (n = 2,204), metformin (n = 436), glyburide (n = 293), or placebo (n = 769). Efficacy (HbA1c) was evaluated in pooled data from four studies with similar design using 120 mg nateglinide (n = 544) versus placebo (n = 521). Evaluations were performed in the overall population and subgroups of patients over age 64 years. Specific considerations were given to RI, comorbidity, and baseline HbA1c.RESULTS—Patients over age 64 years (n = 1,170) represented 31.6% of the study population. Undiagnosed RI was common in the elderly with 83.4% of all patients being in this subgroup. Patients over 64 years with RI had a higher prevalence of cardio- and microvascular comorbidity compared with the overall population and all patients over age 64 years. Statistically significant HbA1c reductions versus placebo were observed with nateglinide in patients over age 64 years and elderly with RI patients at study end point (−0.9% and −1.1% in each subgroup, P &lt; 0.01). Nateglinide was well tolerated with a low incidence of hypoglycemia in all subgroups, including those with RI and low baseline HbA1c.CONCLUSIONS—RI and comorbidity are common in patients over age 64 years with type 2 diabetes. Nateglinide was effective and well tolerated in all treated patients. In subgroups in which metformin and long-acting sulfonylureas must be used with caution, nateglinide had a low risk of adverse events and hypoglycemia.
Beneficial Effects of Insulin Versus Sulphonylurea on Insulin Secretion and Metabolic Control in Recently Diagnosed Type 2 Diabetic Patients
Authors: Alvarsson Michael , Sundkvist Göran , Lager Ibe , Henricsson Marianne , Berntorp Kerstin , Fernqvist-Forbes Eva , Steen Lars , Westermark Gunilla , Westermark Per , Örn Thomas , Grill Valdemar 
Published: March 2007

OBJECTIVE—To evaluate whether treatment with insulin in recently diagnosed type 2 diabetes is advantageous compared with glibenclamide treatment.
RESEARCH DESIGN AND METHODS—β-Cell function, glycemic control, and quality of life were monitored over 2 years in 39 patients with islet cell antibody-negative type 2 diabetes diagnosed 0–2 years before inclusion in a Swedish multicenter randomized clinical trial. Patients were randomized to either two daily injections of premixed 30% soluble and 70% NPH insulin or glibenclamide (3.5–10.5 mg daily). C-peptide-glucagon tests were performed yearly in duplicate after 2–3 days of temporary withdrawal of treatment.
RESULTS—After 1 year the glucagon-stimulated C-peptide response was increased in the insulin-treated group by 0.14 ± 0.08 nmol/l, whereas it was decreased by 0.12 ± 0.08 nmol/l in the glibenclamide group, P &lt; 0.02 for difference between groups. After 2 years, fasting insulin levels were higher after treatment withdrawal in the insulin-treated versus the glibenclamide-treated group (P = 0.02). HbA1c levels decreased significantly during the first year in both groups; however, at the end of the second year, HbA1c had deteriorated in the glibenclamide group (P &lt; 0.01), but not in the insulin-treated group. The difference in evolution of HbA1c during the second year was significant between groups, P &lt; 0.02. A questionnaire indicated no difference in well-being related to treatment.
CONCLUSIONS—Early insulin versus glibenclamide treatment in type 2 diabetes temporarily prolongs endogenous insulin secretion and promotes better metabolic control.
C-Reactive Protein Predicts the Deterioration of Glycemia in Chinese Subjects With Impaired Glucose Tolerance
Authors: Tan Kathryn C.B. , Wat Nelson M.S. , Tam Sidney C.F. , Janus Edward D. , Lam T.H. , Lam Karen S.L. 
Published: March 2007

OBJECTIVE—Recent studies have shown that C-reactive protein (CRP) predicts future risk of diabetes in healthy Caucasians. We determined whether plasma CRP level was elevated in Chinese subjects with impaired glucose tolerance (IGT) and whether CRP level could be used to predict progression to type 2 diabetes or reversion to normal glucose tolerance (NGT) in these high-risk individuals.
RESEARCH DESIGN AND METHODS—A total of 228 subjects with IGT at baseline from the Hong Kong Cardiovascular Risk Factors Prevalence Study underwent repeat oral glucose tolerance testing after 2 years. Plasma high-sensitivity CRP was measured from their stored baseline samples and from 228 subjects with NGT matched for age and BMI by an immunoturbidimetric assay.
RESULTS—Subjects with IGT at baseline had higher plasma CRP levels than subjects with NGT: 1.18 mg/l (0.52–2.52) vs. 0.87 mg/l (0.37–1.84), median (interquartile range), P = 0.01. At 2 years, 117 subjects with IGT reverted to NGT, 84 remained in IGT, and 21 progressed to diabetes. Individuals who progressed to diabetes had the highest plasma CRP levels at baseline (P &lt; 0.0001). Those with baseline CRP levels in the third and top quartile had a relative risk of remaining in IGT or progressing to diabetes of 2.87 (95% CI 1.06–7.82) and 2.76 (1.06–7.31), respectively, after adjusting for anthropometric measure and lifestyle factors.
CONCLUSIONS—CRP independently predicts the risk of remaining in IGT or progressing to diabetes in Chinese subjects with IGT. CRP might provide an adjunctive measure for identifying subjects with the highest risk of progression to diabetes who would derive the greatest benefits from preventive interventions.
Racial Differences in Diabetic Nephropathy, Cardiovascular Disease, and Mortality in a National Population of Veterans
Authors: Young Bessie A. , Maynard Charles , Boyko Edward J. 
Published: March 2007

OBJECTIVE—To determine racial differences in the prevalence of diabetic nephropathy, cardiovascular disease (CVD), and risk of mortality in a national health care system.
RESEARCH DESIGN AND METHODS—A longitudinal cohort study was conducted in 429,918 veterans with diabetes. Racial minority groups were analyzed for baseline differences in prevalence of early diabetic nephropathy, diabetic end-stage renal disease (ESRD) and CVD, and longitudinal risk of mortality compared with Caucasians.
RESULTS—The 429,918 patients identified with diabetes were of the following racial groups: Caucasian (56.2%), African American (15.3%), Asian (0.5%), Native American (0.4%), and unknown race (21.4%). Minority individuals were, on average, younger and less likely to have CVD but were more likely to have renal disease than Caucasians. After adjustment for age, sex, and economic status, African Americans (adjusted odds ratio [OR] = 1.3, 95% CI 1.2–1.4) and Native Americans (1.5, 1.1–2.1) were more likely to have early diabetic nephropathy than Caucasians. Diabetic ESRD was more likely to be present in African Americans (1.9, 1.9–2.0), Hispanics (1.4, 1.3–1.4), Asians (1.8, 1.5–2.1), and Native Americans (1.9, 1.5–2.3) than Caucasians. Concurrently, the adjusted OR of CVD in racial minority groups was 27–49% less than in Caucasians, whereas the 18-month risk of mortality among people from most racial minority groups was 7–12% lower than in Caucasians.
CONCLUSIONS—We conclude that when access to care is comparable, microvascular complications, macrovascular disease, and subsequent death occur with different frequencies among various racial groups.
Acanthocytes in the Urine
Authors: Heine Gunnar H. , Sester Urban , Girndt Matthias , Köhler Hans 
Published: March 2007

OBJECTIVE—The presence of hematuria has been suggested to indicate nondiabetic nephropathy in diabetic patients with proteinuria. However, hematuria is frequently found in patients with biopsy-proven diabetic glomerulosclerosis without nondiabetic nephropathy. Urine microscopy allows discrimination of glomerular hematuria, which is defined as acanthocyturia (urinary excretion of acanthocytes, which are dysmorphic erythrocytes with vesicle-like protrusions), from nonglomerular hematuria. We hypothesized that acanthocyturia is an uncommon finding in diabetic nephropathy, which suggests the presence of a nondiabetic nephropathy in diabetic patients with proteinuria.
RESEARCH DESIGN AND METHODS—Urine samples of patients with the clinical diagnosis of diabetic nephropathy (n = 68), of patients with biopsy-proven glomerulonephritis (n = 43), and of age-matched healthy control subjects (n = 20) were examined by phase-contrast microscopy for the presence of hematuria (≥8 erythrocytes/μl) and acanthocyturia. Acanthocyturia of ≥5% (5 acanthocytes among 100 excreted erythrocytes) was classified as glomerular hematuria; acanthocyturia of 2–4% was classified as suspected glomerular hematuria.
RESULTS—Hematuria was found in 62% of patients with the clinical diagnosis of diabetic nephropathy, in 84% of patients with glomerulonephritis, and in 20% of the healthy control subjects upon a single urine examination. In contrast, glomerular hematuria occurred in 4% of patients with diabetic nephropathy and in 40% of patients with glomerulonephritis (P &lt; 0.001).
CONCLUSIONS—In contrast to hematuria, acanthocyturia is uncommon in patients with the clinical diagnosis of diabetic nephropathy. In diabetic patients with proteinuria, the finding of acanthocyturia points to nondiabetic glomerulopathies, and renal biopsy should be considered.
Infections in Diabetic Burn Patients
Authors: Memmel Heidi , Kowal-Vern Areta , Latenser Barbara A. 
Published: March 2007

OBJECTIVE— Diabetic burn patients comprise a significant population in burn centers. The purpose of the study was to determine the demographic characteristics of diabetic burn patients and their rate of community-acquired and nosocomial infections.
RESEARCH DESIGN AND METHODS—This was a 46-month retrospective chart and patient registry review comparing diabetic with nondiabetic burn patients. Statistical analysis consisted of means ± SD, descriptive statistics, one-way ANOVA, and χ2 tests.
RESULTS—Of 1,063 adult burn patients (aged 15–54 years), 68 (6%) diabetic burns were compared with burns of 995 adult nondiabetic patients. Of 193, 62 (32%) senior (≥55 years of age) diabetic burns were compared with 131 nondiabetic senior burns. The major mechanism of injury for the diabetic patients was scalding and contact, in contrast to that of nondiabetic patients who were injured mainly by scalding or flame burns. Adult diabetic patients had a significantly increased frequency of foot burns compared with adult nondiabetic patients (32 of 68 [68%] versus 144 of 995 [14%], P = 0.001). Adult diabetic burns had a significant increase in sepsis (P &lt; 0.002) and community-acquired burn wound cellulitis (P &lt; 0.001) compared with adult nondiabetic patients; and senior diabetic patients had a significantly increased frequency of urinary tract infections compared with senior nondiabetic burn patients (P &lt; 0.04). The most common organisms in diabetic burn infections were Streptococcus, Proteus, Pseudomonas, Candida species, and MRSA (methicillin-resistant Staphylococcus aureus). Forty-two percent of the diabetic patients were admitted during the winter months and 25% in the spring. Only 49 of 130 (38%) diabetic burn patients presented for treatment within 48 h after injury compared with 669 of 1,126 (62%) nondiabetic patients (P = 0.001).
CONCLUSIONS—Peripheral neuropathy may have precipitated and delayed medical treatment in lower-extremity burns of diabetic patients. Hospitalized diabetic burn patients were also at an increased risk for nosocomial infections, which prolonged hospitalization. Diabetic patient education must include not only caution about potential burn mishaps but also educate concerning the complications from burns that may ensue.
Prevalence and Trends of a Metabolic Syndrome Phenotype Among U.S. Adolescents, 1999–2000
Authors: Duncan Glen E. , Li Sierra M. , Zhou Xiao-Hua 
Published: March 2007

OBJECTIVE—To determine the prevalence of a metabolic syndrome phenotype among U.S. adolescents using the most recent national data and to examine trends in metabolic syndrome prevalence.
RESEARCH DESIGN AND METHODS—Analysis of data on 991 adolescents (aged 12–19 years) who had fasted for at least 6 h, from the National Health and Nutrition Examination Survey (NHANES 1999–2000). The metabolic syndrome was determined using the National Cholesterol Education Program (Adult Treatment Panel III) definition modified for age.
RESULTS—The overall prevalence of a metabolic syndrome phenotype among U.S. adolescents increased from 4.2% in NHANES III (1988–1992) to 6.4% in NHANES 1999–2000 (P &lt; 0.001). The syndrome was more prevalent (P &lt; 0.01) in male than female adolescents (9.1 vs. 3.7%) and was found in 32.1% of overweight adolescents (BMI ≥95th percentile for age and sex), compared with 7.1% of adolescents at risk for overweight (BMI between 85th and 95th percentiles) (P &lt; 0.001). Based on population-weighted estimates, &gt;2 million U.S. adolescents currently have a metabolic syndrome phenotype.
CONCLUSIONS—The prevalence of a metabolic syndrome phenotype has increased significantly over the past decade among U.S. adolescents and is particularly prevalent (&gt;30%) in overweight adolescents. These findings have important implications for public health because of the well-known health risks associated with the metabolic syndrome in adults.