bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Characteristics of Children Diagnosed With Type 1 Diabetes Through Intensive Screening and Follow-Up
Authors: Barker Jennifer M. , Goehrig Stephanie H. , Barriga Katherine , Hoffman Michelle , Slover Robert , Eisenbarth George S. , Norris Jill M. , Klingensmith Georgeanna J. , Rewers Marian 
Published: March 2007

OBJECTIVE—The objective of this study was to determine whether earlier diagnosis of diabetes in prospectively followed autoantibody-positive children lowered onset morbidity and improved the clinical course after diagnosis.
RESEARCH DESIGN AND METHODS—The Diabetes Autoimmunity Study in the Young (DAISY) follows genetically at-risk children for the development of diabetes. Increased genetic risk is identified by family history of type 1 diabetes or expression of diabetes-associated HLA genotypes. Of the 2,140 prospectively followed children, 112 have developed islet autoantibodies and 30 have progressed to diabetes. Diabetes onset characteristics and early clinical course of these 30 children followed to diabetes were compared with those of 101 age- and sex-matched children concurrently diagnosed with diabetes in the community.
RESULTS—Pre-diabetic children followed to diabetes were less often hospitalized than the community cases (3.3 vs. 44%; P &lt; 0.0001). They had a lower mean HbA1c at onset (7.2 vs. 10.9%; P &lt; 0.0001) and 1 month after diagnosis (6.9 vs. 8.6%; P &lt; 0.0001) but not after 6 months of diabetes. The mean insulin dose was lower in the DAISY group at 1 (0.30 vs. 0.51 U · kg−1 · day−1; P = 0.003), 6 (0.37 vs. 0.58; P = 0.001), and 12 months (0.57 vs. 0.72; P = 0.03). There was no difference in growth parameters between the two groups. Comparisons limited to children with a family history of type 1 diabetes in both groups showed a similar pattern.
CONCLUSIONS—Childhood type 1 diabetes diagnosed through a screening and follow-up program has a less severe onset and a milder clinical course in the first year after diagnosis.
Managed Care Organization and the Quality of Diabetes Care
Authors: Kim Catherine , Williamson David F. , Mangione Carol M. , Safford Monika M. , Selby Joseph V. , Marrero David G. , Curb J. David , Thompson Theodore J. , Venkat Narayan K.M. , Herman William H. ,   the TRIAD Study Group
Published: March 2007

OBJECTIVE—To examine the association between the organizational model and diabetes processes of care.
RESEARCH DESIGN AND METHODS—We used data from the Translating Research into Action for Diabetes (TRIAD), a multicenter study of diabetes care in managed care, including 8,354 patients with diabetes. We identified five model types: for-profit group/network, for-profit independent practice association (IPA), nonprofit group/network, nonprofit IPA, and nonprofit group/staff. Process measures included retinal, renal, foot, lipid, and HbA1c testing; aspirin recommendations; influenza vaccination; and a sum of these seven processes of care over 1 year. Hierarchical regression models were constructed for each process measure and accounted for clustering at the health plan and provider group levels and adjusted for participant age, sex, race, ethnicity, diabetes treatment and duration, education, income, health status, and survey language.
RESULTS—Participant membership in the model types ranged from 9% in nonprofit IPA models to 38% in nonprofit group/staff models. Over 75% of participants received most of the processes of care, regardless of model type. However, among for-profit plans, group/network models provided on average more processes of care than IPA models (5.5 vs. 4.7, P &lt; 0.0001), and group/network models generally increased the probability of receiving a process by ≥10 percentage points. Among nonprofit plans, no effect of model type was found.
CONCLUSIONS—Among for-profit plans, group/network models provided better diabetes processes of care than IPA models. Although reasons are speculative, this may be due to the clinical infrastructure available in group models that is not available in IPA models.
Cerebral Edema in Childhood Diabetic Ketoacidosis
Authors: Muir Andrew B. , Quisling Ronald G. , Yang Mark C.K. , Rosenbloom Arlan L. 
Published: March 2007

OBJECTIVE—Children who develop cerebral edema (CE) during diabetic ketoacidosis (DKA) exhibit definable signs and symptoms of neurological collapse early enough to allow intervention to prevent brain damage. Our objective was to develop a model for early detection of CE in children with DKA.
RESEARCH DESIGN AND METHODS—A training sample of 26 occurrences of DKA complicated by severe CE and 69 episodes of uncomplicated DKA was reviewed. Signs of neurological disease were incorporated into a bedside evaluation protocol that was applied to an independent test sample of 17 patients previously reported to have developed symptomatic CE during treatment for DKA. Head computed tomograms and their reports were reviewed.
RESULTS—The protocol allowed 92% sensitivity and 96% specificity for the recognition of CE sufficiently early for intervention. The diagnostic criteria were fulfilled in two temporal patterns, defining early- and late-onset CE. Although initial computed tomograms were often normal, the findings also included diffuse CE and focal brain injury, the latter only in patients with an early onset of abnormal neurological signs.
CONCLUSIONS—CE may occur in the absence of acute changes on head computed tomograms. Early detection of CE at the bedside using an evidence-based protocol permits intervention in time to prevent permanent brain damage.
A Randomized, Prospective Trial Comparing the Efficacy of Continuous Subcutaneous Insulin Infusion With Multiple Daily Injections Using Insulin Glargine
Authors: Doyle (Boland) Elizabeth A. , Weinzimer Stuart A. , Steffen Amy T. , Ahern Jo Ann H. , Vincent Miranda , Tamborlane William V. 
Published: March 2007

OBJECTIVE—The efficacy of the insulin analogs now available for multiple daily injection (MDI) and continuous subcutaneous insulin infusion (CSII) therapy in type 1 diabetes has not yet been established in pediatric patients. Our principal aim in this short-term study was to compare the efficacy of CSII to MDI with glargine in lowering HbA1c levels in children and adolescents with type 1 diabetes.
RESEARCH DESIGN AND METHODS—Thirty-two youth with type 1 diabetes (age 8–21 years) were randomly assigned to receive either MDI treatment with once-daily glargine and premeal/snack insulin aspart or CSII with insulin aspart. Dose titration in both groups was based on home self-monitored blood glucose measurements and monthly HbA1c. HbA1c, total daily insulin dose (TDD), self-monitored blood glucose readings, and adverse events were compared after 16 weeks of therapy.
RESULTS—While there was no significant change in the glargine group (HbA1c 8.2% at baseline vs. 8.1% at 16 weeks), youth randomized to CSII had a sharp reduction in HbA1c levels, from 8.1 to 7.2% after 16 weeks of therapy (P &lt; 0.02 vs. baseline and &lt;0.05 vs. glargine group). TDD was unchanged in the glargine group, but significantly dropped with CSII (1.4 units/kg at baseline vs. 0.9 units/kg at 16 weeks, P &lt; 0.01). Both groups had similar basal doses and insulin-to-carbohydrate ratios. Fasting self-monitored blood glucose was similar in both groups, but lunch, dinner, and bedtime readings were significantly lower in the CSII group (P &lt; 0.01).
CONCLUSIONS—Lower HbA1c and premeal glucose levels were more achievable in this short-term study with CSII than with glargine-based MDI treatment. CSII is an efficacious treatment to improve metabolic control in youth with type 1 diabetes.
Effectiveness of Diabetic Therapeutic Footwear in Preventing Reulceration
Authors: Maciejewski Matthew L. , Reiber Gayle E. , Smith Douglas G. , Wallace Carolyn , Hayes Shane , Boyko Edward J. 
Published: March 2007

OBJECTIVE—To review the evidence for the effectiveness of therapeutic footwear in preventing foot reulceration in individuals with diabetes and foot risk factors.RESEARCH DESIGN AND METHODS—We conducted a structured literature review based on a Medline search for studies of therapeutic footwear that examined prevention of reulceration. Nine published articles were identified. Characteristics of the study population, components of the intervention, and level of adherence were evaluated. U.S. Preventive Services Task Force criteria for evaluating research were applied to rate each study on study design and internal validity.RESULTS—Risk ratios in all studies assessing the association between therapeutic footwear and reulceration were below 1.0, suggesting some protective footwear benefit. However, in the most rigorous experimental study, no statistically significant benefit was observed between control patients wearing their own footwear and intervention patients wearing study footwear. Annual reulceration in these studies’ control groups ranged from 8.4 to 59.3%. In patients with severe foot deformity or prior toe or ray amputation, observational studies suggested a significant protective benefit from therapeutic footwear.CONCLUSIONS—Therapeutic footwear has been used for decades as one of many strategies to prevent reulceration in patients with diabetes and foot risk factors. The findings of several studies reporting statistically significant protective effects from therapeutic footwear may have been influenced by several design issues. When considering the appropriateness of therapeutic footwear recommendations for moderate-risk patients, clinicians and patients should jointly explore individual strategies to decrease events that lead to foot ulcers.
Circulating 1,5-Anhydroglucitol Levels in Adult Patients With Diabetes Reflect Longitudinal Changes of Glycemia
Authors: McGill Janet B. , Cole Thomas G. , Nowatzke William , Houghton Shannon , Ammirati Erika B. , Gautille Theresa , Sarno Mark J. 
Published: March 2007

OBJECTIVE—1,5-Anhydroglucitol (1,5AG) is a major circulating polyol arising primarily from ingestion and excreted competitively with glucose. Japanese studies have demonstrated reduced concentrations of 1,5AG in serum in hyperglycemic patients in comparison with euglycemic subjects and a gradual normalization of 1,5AG values for patients responding to antihyperglycemic therapies. In this first U.S. study, we assessed the ability of 1,5AG measurements to monitor glycemic control in a cohort of 77 patients with diabetes (22 with type 1 diabetes, 55 with type 2 diabetes) who presented with suboptimal glycemic control at baseline (defined as HbA1c ≥7%).
RESEARCH DESIGN AND METHODS—Each patient received therapies consisting of combinations of diabetes education, nutritional counseling, and addition or dose adjustment of various insulins or oral antihyperglycemic medications. Therapy was targeted to reduce mean HbA1c by ≥1.0% over the monitoring period. 1,5AG, HbA1c, fructosamine, and random glucose measurements were performed at baseline and at 2, 4, and 8 weeks after the initiation of therapy.
RESULTS—1,5AG, fructosamine, and glucose values progressed significantly toward euglycemia by week 2 of monitoring (Wilcoxon’s signed-rank test, P &lt; 0.05), with median changes of 93, −7, and −13% for 1,5AG, fructosamine, and glucose, respectively. In contrast, HbA1c values did not respond significantly to therapy until week 4. On an individual patient basis, 89.6% of patients displayed longitudinal changes of 1,5AG from baseline to week 8 in concordance with HbA1c. 1,5AG was also highly correlated with HbA1c and fructosamine (Spearman ρ = −0.6459 and −0.6751, respectively; both P &lt; 0.0001).
CONCLUSIONS—We conclude that 1,5AG responds sensitively and rapidly to changes in glycemia and monitors glycemic control in accordance with established markers.
Improved Plasma Glucose Control, Whole-Body Glucose Utilization, and Lipid Profile on a Low-Glycemic Index Diet in Type 2 Diabetic Men
Authors: Rizkalla Salwa W. , Taghrid Laika , Laromiguiere Muriel , Huet Dorothée , Boillot Josette , Rigoir Aude , Elgrably Fabienne , Slama Gerard 
Published: March 2007

OBJECTIVE—To determine whether a chronic low-glycemic index (LGI) diet, compared with a high-glycemic index (HGI) diet, has beneficial effects on plasma glucose control, lipid metabolism, total fat mass, and insulin resistance in type 2 diabetic patients.
RESEARCH DESIGN AND METHODS—Twelve type 2 diabetic men were randomly allocated to two periods of 4 weeks of an LGI or HGI carbohydrate diet separated by a 4-week washout interval, in a crossover design.
RESULTS—The LGI diet induced lower postprandial plasma glucose and insulin profiles and areas under the curve than after the HGI diet. At the end of the two dietary periods, the 7-day dietary records demonstrated equal daily total energy and macronutrient intake. Body weight and total fat mass were comparable. Four-week LGI versus HGI diet induced improvement of fasting plasma glucose (P &lt; 0.01, Δ changes during LGI vs. HGI), HbA1c (P &lt; 0.01), and whole-body glucose utilization measured by the euglycemic-hyperinsulinemic clamp (P &lt; 0.05). LGI diet induced a decrease in fasting plasma total and LDL cholesterol (Δ changes LGI vs. HGI, P &lt; 0.01), free fatty acids (P &lt; 0.01), apolipoprotein B, and plasminogen activator inhibitor 1 activity.
CONCLUSIONS—Only 4 weeks of an LGI diet was able to improve glycemic control, glucose utilization, some lipid profiles, and the capacity for fibrinolysis in type 2 diabetes. Even if changes in glycemic control were modest during the 4-week period, the use of an LGI diet in a longer-term manner might play an important role in the treatment and prevention of diabetes and related disorders.
Additive Effects of Glucagon-Like Peptide 1 and Pioglitazone in Patients With Type 2 Diabetes
Authors: Zander Mette , Christiansen Allan , Madsbad Sten , Juul Holst Jens 
Published: March 2007

OBJECTIVE—To evaluate the effect of combination therapy with pioglitazone and glucagon-like peptide (GLP)-1 in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—Eight patients with type 2 diabetes (BMI 32.7 ± 1.3 kg/m2 and fasting plasma glucose 13.5 ± 1.2 mmol/l) underwent four different treatment regimens in random order: saline therapy, monotherapy with continuous subcutaneous infusion of GLP-1 (4.8 pmol · kg−1 · min−1), monotherapy with pioglitazone (30-mg tablet of Actos), and combination therapy with GLP-1 and pioglitazone. The observation period was 48 h. End points were plasma levels of glucose, insulin, glucagon, free fatty acids (FFAs), and sensation of appetite.
RESULTS—Fasting plasma glucose decreased from 13.5 ± 1.2 mmol/l (saline) to 11.7 ± 1.2 (GLP-1) and 11.5 ± 1.2 (pioglitazone) and further decreased to 9.9 ± 1.0 (combination) (P &lt; 0.001). Eight-hour mean plasma glucose levels were reduced from 13.7 ± 1.1 mmol/l (saline) to 10.6 ± 1.0 (GLP-1) and 12.0 ± 1.2 (pioglitazone) and were further reduced to 9.5 ± 0.8 (combination) (P &lt; 0.0001). Insulin levels increased during monotherapy with GLP-1 compared with monotherapy with pioglitazone (P &lt; 0.01). Glucagon levels were reduced in GLP-1 and combination therapy compared with saline and monotherapy with pioglitazone (P &lt; 0.01). FFAs during breakfast (area under the curve, 0–3 h) were reduced in combination therapy compared with saline (P = 0.03). Sensation of appetite was reduced during monotherapy with GLP-1 and combination therapy (P &lt; 0.05).
CONCLUSIONS—GLP-1 and pioglitazone show an additive glucose-lowering effect. A combination of the two agents may, therefore, be a valuable therapeutic approach for the treatment of type 2 diabetes.
Evaluating the Accuracy of Continuous Glucose-Monitoring Sensors
Authors: Kovatchev Boris P. , Gonder-Frederick Linda A. , Cox Daniel J. , Clarke William L. 
Published: March 2007

OBJECTIVE—The objective of this study was to introduce continuous glucose–error grid analysis (CG-EGA) as a method of evaluating the accuracy of continuous glucose-monitoring sensors in terms of both accurate blood glucose (BG) values and accurate direction and rate of BG fluctuations and to illustrate the application of CG-EGA with data from the TheraSense Freestyle Navigator.RESEARCH DESIGN AND METHODS—We approach the design of CG-EGA from the understanding that continuous glucose sensors (CGSs) allow the observation of BG fluctuations as a process in time. We account for specifics of process characterization (location, speed, and direction) and for biological limitations of the observed processes (time lags associated with interstitial sensors). CG-EGA includes two interacting components: 1) point–error grid analysis (P-EGA) evaluates the sensor’s accuracy in terms of correct presentation of BG values and 2) rate–error grid analysis (R-EGA) assesses the sensor’s ability to capture the direction and rate of BG fluctuations.RESULTS—CG-EGA revealed that the accuracy of the Navigator, measured as a percentage of accurate readings plus benign errors, was significantly different at hypoglycemia (73.5%), euglycemia (99%), and hyperglycemia (95.4%). Failure to detect hypoglycemia was the most common error. The point accuracy of the Navigator was relatively stable over a wide range of BG rates of change, and its rate accuracy decreased significantly at high BG levels.CONCLUSIONS—Traditional self-monitoring of BG device evaluation methods fail to capture the important temporal characteristics of the continuous glucose-monitoring process. CG-EGA addresses this problem, thus providing a comprehensive assessment of sensor accuracy that appears to be a useful adjunct to other CGS performance measures.
Female Children and Adolescents With Type 1 Diabetes Have More Pronounced Early Echocardiographic Signs of Diabetic Cardiomyopathy
Authors: Suys Bert E. , Katier Nienke , Rooman Raoul P.A. , Matthys Dirk , Op De Beeck Lieve , Du Caju Mark V.L. , De Wolf Daniel 
Published: March 2007

OBJECTIVE—This study was designed to assess whether children and adolescents with type 1 diabetes have early echocardiographic signs of subclinical cardiac dysfunction and whether sex, state of metabolic control, and diabetes duration are of influence.
RESEARCH DESIGN AND METHODS—Systolic and diastolic blood pressure in supine and upright positions and echocardiographic parameters, including tissue Doppler measurements of the septal mitral annulus, were evaluated in 80 children and adolescents with stable type 1 diabetes and 52 age- and sex-matched control subjects. A possible correlation was examined for age, sex, HbA1c, and diabetes duration with univariate and multivariate regression analysis.
RESULTS—Female diabetic patients showed significantly larger left ventricular wall dimensions (left ventricular posterior wall in diastole 0.54 ± 0.08 vs. 0.48 ± 0.11 cm) and signs of significant diastolic filling abnormalities on conventional and tissue Doppler echocardiography (mitral valve-atrial contraction velocity 0.47 ± 0.12 vs. 0.40 ± 0.09 m/s; tricuspid valve-atrial contraction velocity 0.35 ± 0.09 vs. 0.30 ± 0.07 m/s; early filling velocity/myocardial velocity during early filling 7.15 ± 1.47 vs. 6.17 ± 1.07; isovolumetric relaxation time [IVRT] 66 ± 8 vs. 58 ± 8 ms) compared with female control subjects, suggesting delayed myocardial relaxation. Male diabetic patients only differed significantly from their control subjects for IVRT (66 ± 9 vs. 59 ± 8 ms). The measured parameters showed an expected correlation with age and BMI standard deviation scores in the control group. This correlation was significantly weaker in the diabetic population; only a weak influence was found for diabetes duration and glycosylated hemoglobin levels.
CONCLUSIONS—Young diabetic patients already have significant changes in left ventricular dimensions and myocardial relaxation, with the girls clearly being more affected. Tissue Doppler proved to have additional value in the evaluation of ventricular filling in this population. Almost no correlation was found for diabetes duration and HbA1c with the cardiovascular changes.
Intraepidermal Nerve Fibers Are Indicators of Small-Fiber Neuropathy in Both Diabetic and Nondiabetic Patients
Authors: Pittenger Gary L. , Ray Madhumita , Burcus Niculina I. , McNulty Patricia , Basta Baher , Vinik Aaron I. 
Published: March 2007

OBJECTIVE—Small-fiber neuropathies may be symptomatic yet escape detection by standard tests. We hypothesized that morphologic changes in intraepidermal nerves would correlate with clinical measures of small-fiber neuropathy.
RESEARCH DESIGN AND METHODS—We studied 25 diabetic and 23 nondiabetic patients with neuropathy defined by signs, symptoms, and quantitative testing and 20 control subjects. Skin biopsies were obtained from forearm, thigh, proximal leg, and distal leg, and nerves identified using immunofluorescence with antibody to protein gene product (PGP) 9.5.
RESULTS—Mean dendritic length (MDL) (P &lt; 0.01) and intraepidermal nerve fiber density (IENF) (P &lt; 0.001) progressively decreased from proximal to distal sites only in patients with neuropathy. There was a significant reduction in IENF when comparing control subjects and patient groups in the distal leg (P &lt; 0.001). MDL was significantly decreased in the thigh (P &lt; 0.005) and in the proximal (P &lt; 0.01) and distal (P &lt; 0.002) leg in patients compared with control subjects. IENF was not significantly altered in diabetic patients of &lt;5 years’ duration, but significantly decreased in patients with &gt;5 years’ duration. MDL showed a linear decrease with increasing duration of diabetes. Distal leg IENF showed significant negative correlations with warm (P &lt; 0.02) and cold (P &lt; 0.05) thermal threshold, heat pain (P &lt; 0.05), pressure sense (P &lt; 0.05), and neurological disability score total sensory (P &lt; 0.03) and total neuropathy (P &lt; 0.03) values.
CONCLUSIONS—IENF was not significantly altered in these patients at &lt;5 years’ duration of diabetes, but fell significantly after 5 years of diabetes. MDL exhibited a linear loss with time, suggesting a different mechanism of change. MDL and IENF together may prove a useful end point in therapeutic trials for neuropathy.