bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diabetes in Urban African-Americans. IX. Provider Adherence to Management Protocols
Authors: El-Kebbi Imad M , Ziemer David C , Musey Victoria C , Gallina Daniel L , Bernard Annette M , Phillips Lawrence S 
Published: March 2007

OBJECTIVE
Staged diabetes management should permit glycemic goals to be attained in a timely manner, but the success of such an approach requires conformity by health care providers. To test performance, we analyzed the adherence of practitioners to a protocol for staged management of NIDDM patients.

RESEARCH DESIGN AND METHODS
Records of patients treated at the Grady Memorial Hospital Diabetes Clinic were reviewed retrospectively over a 3-year period. For each patient, intensification of therapy was indicated if fasting plasma glucose was &gt; 7.8 mmol/l and a prior HbA1c was &gt; 7.0%. Protocols dictated a progression from dietary therapy alone to increasing dosages of sulfonylureas to increasing dosages of insulin. Patients were seen at bimonthly intervals.

RESULTS
During the 3-year period, 1,051 patient visits met protocol criteria for intensification. Adherence to the protocol improved significantly in the 3rd year compared with the first 2 years (30, 31, and 47% adherence in the 1st, 2nd, and 3rd years, respectively). Patients treated with diet alone were significantly less likely to have their therapy intensified than patients on sulfonylureas or insulin (intensification rates 25, 41, and 47%, respectively). In the management of patients treated with diet alone, practitioners were reluctant to intensify therapy at early visits, but were more likely to do so later, 19% of patients beyond goal range at the 2-month visit were started on pharmacological therapy vs. 28% at the 4-month visit, and 39% at the 6-month visit (P &lt; 0.01). In contrast, there was no significant difference in the frequency of therapy intensification between early and late visits for patients on sulfonylureas or insulin. Practitioners appeared to base the decision to intensify on the fasting plasma glucose level more than on the most recent HbA1c. Age did not appear to be a significant factor in the decision to intensify.

CONCLUSIONS
Although staged management protocols constitute critical tools to achieve glycemic goals, the adherence of health care providers may be suboptimal. Special efforts may be needed to assure compliance.
Contribution of Central Neuropathy to Postural Instability in IDDM Patients With Peripheral Neuropathy
Authors: Uccioli Luigi , Giacomini Pier Giorgio , Pasqualetti Patrizio , Girolamo Stefano Di , Ferrigno Paola , Monticone Giovanna , Bruno Ernesto , Boccasena Paolo , Magrini Antonio , Parisi Leoluca , Menzinger Guido , Rossini Paolo Maria 
Published: March 2007

OBJECTIVE
To evaluate the contribution of central neuropathy on postural impairment observed in diabetic patients with peripheral neuropathy.

RESEARCH DESIGN AND METHODS
Central sensory and motor nervous propagation, nerve conduction velocity, and static posturography were assessed in the following age-matched subjects: 7 IDDM patients with peripheral neuropathy (group DN), 18 IDDM patients without peripheral neuropathy (group D), and 31 control subjects (group C). Somatosensory-evoked potentials (SEPs) during tibial nerve stimulation were recorded, and the spine-to-scalp sensory central conduction time (SCCT) was evaluated. Motor-evoked potentials (MEPs) were recorded from leg muscles during magnetic transcranial brain stimulation, and the scalp-to-spine motor central conduction time (MCCT) was evaluated. The following posturographic parameters were calculated from the statokinesigram: trace length, trace surface, velocity of body sway with its standard deviation, and VFY (a parameter derived from the velocity variance and the anteroposterior mean position of the body).

RESULTS
SCCT was significantly higher in the DN group than in the C and D groups (P &lt; 0.001). MCCT was similar in all groups. Posturographic parameters were all significantly impaired in the DN group (P &lt; 0.01). While posturographic parameters showed a direct relationship with some parameters of peripheral nerve conduction, no correlations were observed with SEP and MEP central conduction time. These results were also confirmed by logistic regression, which indicates peripheral neuropathy as the only implicating factor in postural instability (odds ratio 0.22, 95% CI 0.07–0.75) after data reduction by means of factor analysis.

CONCLUSIONS
Although diabetic patients with peripheral neuropathy show a delay in central sensory conduction, postural instability may be fully explained by the presence of peripheral neuropathy.
A Prospective Study of Coronary Heart Disease in Relation to Fasting Insulin, Glucose, and Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Folsom Aaron R , Szklo Moyses , Stevens June , Liao Fangzi , Smith Robert , Eckfeldt John H 
Published: March 2007

OBJECTIVE
To determine the association of coronary heart disease (CHD) incidence with diabetes, fasting serum glucose, and insulin in a biracial cohort of middle-aged men and women.

RESEARCH DESIGN AND METHODS
We examined a population-based sample (n = 13,446 free of baseline CHD) from four U.S. communities in 1987–1989. We defined diabetes on the basis of baseline fasting glucose concentration (≥ 7.8 mmol/l), medical history, and current medications. A central laboratory measured fasting insulin with a nonspecific radioimmunoassay. After 4–7 years, 209 men and 96 women developed CHD.

RESULTS
After adjustment for sociodemographic characteristics, smoking status, ethanol intake, sports participation, and hormone replacement therapy, the relative risk of CHD for people with diabetes versus those without diabetes was 3.45 (95% CI 2.16–5.50) among women and 2.52 (1.78–3.56) among men. Relative risks of CHD with diabetes were somewhat lower in blacks than non-blacks, but because diabetes was more than twice as prevalent in blacks, the percentage of CHD cases attributable to diabetes (population attributable risk) was 27% for black women, 15% for non-black women, 8% for black men, and 12% for non-black men. Among people without diabetes, fasting glucose was not independently associated with CHD incidence. Among women without diabetes, there was a positive association between fasting insulin and CHD; multivariable adjusted relative risks of CHD across quintiles of fasting insulin were 1.00, 0.76, 2.08, 2.08 and 2.82 (P for linear trend = 0.02). However, among men without diabetes, fasting insulin and CHD were not associated.

CONCLUSIONS
Diabetes conveys a high risk of CHD in black and non-black middle-aged men and women. Fasting insulin, however, is a CHD risk factor only among women in this cohort.
A Trial of Cognitive Analytic Therapy in Poorly Controlled Type I Patients
Authors: Fosbury Jacqueline A , Bosley Catherine M , Ryle Anthony , Sönksen Peter H , Judd Susan L 
Published: March 2007

OBJECTIVE
This study compared the effect of cognitive analytic therapy (CAT), a focused time-limited psychotherapy, and diabetes specialist nurse education (DSNE) in a controlled trial of 26 chronically poorly controlled adult type I patients.

RESEARCH DESIGN AND METHODS
Patients were randomized to either 16 sessions of CAT (treatment) or 14–18 sessions of DSNE (control). Pre- and post-treatment blood glucose control (HbA1), interpersonal difficulties, and diabetes knowledge were measured before and up to 9 months after treatment was completed.

RESULTS
Although HbA1 levels improved in the DSNE group, at the end of treatment (mean fall 1.2%, P = 0.004) this was not maintained; so by the 9-month follow-up, the overall net fall was limited to 0.9% (P = 0.03 vs. entry value). There were no significant improvements in interpersonal difficulties in DSNE subjects at any retest point (P &gt; 0.05). In contrast, glycemic control and interpersonal difficulties both improved after CAT. In contrast to DSNE, this improvement continued so that at the 9-month follow-up visit, the changes were significant (mean fall in HbA1 = 2%, P = 0.002 and P = 0.03 for the Inventory of Interpersonal Problems [IIP] scores).

CONCLUSIONS
These results suggest that although there is no statistical difference between CAT and DSNE, the effects of CAT produce a more prolonged effect on glycemic control. If psychological difficulties underlying problems with self-care in a type I population are addressed, then improvements in diabetes control are likely to continue.
IDDM Incidence in a Multiracial Population: The Hawaii IDDM Registry, 1980–1990
Authors: Patrick Sarah L , Kadohiro Jane K , Waxman Sorrell H , Curb J David , Orchard Trevor J , Dorman Janice S , Kuller Lewis H , LaPorte Ronald E 
Published: March 2007

OBJECTIVE
The Hawaii IDDM Registry was created to determine the incidence rate of IDDM among children aged &lt; 15 years of Oahu between 1980 and 1990. Because of the multiracial population living in Hawaii, it is an ideal state in which to study the effect of migration on IDDM incidence.

RESEARCH DESIGN AND METHODS
Data were collected by a retrospective hospital chart review and physician survey. Registry criteria included 0–14 years of age at IDDM diagnosis and primary residence on Oahu. Children who were military dependents were excluded. Denominator data were compared from two sources.

RESULTS
A total of 113 new-onset IDDM cases were identified. Case ascertainment was 97%. The unadjusted annual incidence rate was 7.04–7.61 per 100,000 (95% CI 5.83–9.19), depending on which denominator source was used. Race- and ethnicity-specific rates varied greatly (all rates per 100,000): part Hawaiian, 15.34–16.58; Caucasian, 6.21–6.71; Filipino, 3.66–3.96; and Japanese, 2.85–3.08. Temporally, the incidence fluctuated between a low of 2.96 per 100,000 in 1981 to highs of 11.11 and 11.85 per 100,000 in 1985 and 1989, respectively. Ascertainment-corrected rates for these years (3.70, 11.76, and 13.48 per 100,000, respectively) show that the fourfold incidence increase between 1980 and 1989 was not due to ascertainment differences.

CONCLUSIONS
IDDM incidence among children &lt; 15 years of age in Hawaii was the lowest documented in the U.S. The incidence among part-Hawaiian children was 2.5 times &gt; that of Caucasian children in Hawaii. IDDM incidence rates among Japanese children in Hawaii were comparable with rates in Japan. The temporal variation in IDDM incidence corresponded with a mid-1980s pandemic of IDDM documented elsewhere.
Determinants of Progression of Microalbuminuria in Patients With NIDDM: A prospective study
Authors: Smulders Yvo M , Rakic Melina , Stehouwer Coen D A , Weijers Rob N M , Slaats Ed H , Silberbusch Joseph 
Published: March 2007

OBJECTIVE
To assess the degree of interindividual variation in the rate of progression of microalbuminuria and to identify determinants of progression of microalbuminuria in patients with NIDDM.

RESEARCH DESIGN AND METHODS
In a prospective cohort study, 58 microalbuminuric NIDDM patients were followed for a period of at least 24 months. During this period, the level of microalbuminuria in these patients was assessed in triplicate 24-h urine samples on at least four separate visits. All patients had stable metabolic control and controlled blood pressure during follow-up. Microalbuminuria was defined as an albumin-to-creatinine ratio in 24-h urine of between 3 and 30 mg/mmol. The individual rates of progression of microalbuminuria were calculated from linear regression analysis. At baseline, the following data were collected for all patients: age, sex, ethnicity, time since diagnosis of NIDDM, smoking habits, drug use, blood pressure, BMI, HbA1c, serum creatinine, cholesterol, triglyceride, and HDL cholesterol concentrations.

RESULTS
Microalbuminuria was found to progress linearly in time. Considerable differences in rates of progression of microalbuminuria were found, the absolute yearly change in albumin-to-creatinine ratio ranging from −5.2 to 12.9 mg/mmol. In bivariate analyses, serum triglyceride concentration, use of ACE inhibitors, mean arterial blood pressure, HDL cholesterol, and time since diagnosis of NIDDM correlated with progression of microalbuminuria (P ≤ 0.05). In stepwise multiple regression analysis, a high triglyceride-to–HDL cholesterol ratio at baseline (P = 0.006) and the use of ACE inhibitors (P = 0.007) were identified as the only independent predictors of progression of microalbuminuria.

CONCLUSIONS
The rate of progression of microalbuminuria in NIDDM differs considerably between subjects. Diabetic dyslipidemia (high serum triglyceride and low HDL cholesterol) is a predictor of more rapid progression of microalbuminuria in patients with well-controlled blood pressure.
The Unchanging Incidence of Hospitalization for Diabetic Nephropathy in a Population-Based Cohort of IDDM Patients in Finland
Authors: Tuomilehto J , Borch-Johnsen K , Molarius A , Jormanainen V , Lounamaa R , Grönhagen-Riska C , Reunanen A , Sarti C 
Published: March 2007

OBJECTIVE
Finland has the highest documented incidence of childhood IDDM in the world, but the incidence of diabetic nephropathy in Finland is unknown. The aim of the present study was to determine the incidence of hospitalization for diabetic nephropathy in a population-based cohort of Finnish IDDM patients and to analyze the prognostic effect of sex, age at diagnosis, and calendar year of diagnosis of IDDM.

RESEARCH DESIGN AND METHODS
We included all Finnish patients who had onset of IDDM before age 18 years, were diagnosed between January 1965 and December 1979 (n = 5,149), and were traced for hospitalizations between January 1970 and the end of December 1989 in the Hospital Discharge Register, using the unique personal identification code given to all Finnish citizens. The development of diabetic nephropathy was defined as the first hospitalization with a diagnosis of nephropathy (International Classification of Diseases-8th Revision [ICD-8] 250.04, or 9th Revision [ICD-9] 2503B/2503X).

RESULTS
Among the 5,149 patients included, we identified 446 cases of diabetic nephropathy. The incidence of hospitalization for diabetic nephropathy was very low during the first 8 years of diabetes duration, and after that increased to a maximum of 1.6–2.0% per year. Female subjects developed nephropathy slightly earlier than male subjects, but the cumulative risk was independent of sex. Patients diagnosed at ages 5–14 years had the highest risk of hospitalization for diabetic nephropathy. We observed no effect of calendar year of diagnosis.

CONCLUSIONS
We found a 20% cumulative incidence of hospitalization for diabetic nephropathy during a total 24 years of IDDM duration. This finding is compatible with the cumulative incidence of hospitalization for diabetic nephropathy found in other European populations. The incidence of hospitalization for diabetic nephropathy did not decrease during the 20-year observation period.
Low Prevalence of Antibodies to GAD65 in a 50- to 74-Year-Old General Dutch Population: The Hoorn Study
Authors: Ruige Johannes B , Batstra Manou R , Aanstoot Henk-Jan , Bouter Lex M , Bruining G Jan , De Neeling J Nico D , Heine Robert J 
Published: March 2007

OBJECTIVE
To assess the prevalence of antibodies to GAD65 (GAD65-A) in relation to glucose tolerance disturbances and to blood glucose-lowering therapy in a general Dutch population.

RESEARCH DESIGN AND METHODS
A population sample of 2,350 Dutch subjects, age 50–74 years, agreed to undergo an oral glucose tolerance test (OGTT). They were classified as having normal glucose tolerance, impaired glucose tolerance, newly detected diabetes, or known diabetes. GAD65-A levels were measured in serum by means of a standardized radioligand assay and subsequently were expressed as indexes. The prevalence rates were defined as the proportions of individuals of each category of glucose tolerance exceeding the value of the index at the 99th percentile of the entire study population.

RESULTS
The prevalence rates and the 95% CIs of GAD65-A were 0.7% (0.4–1.2%) in cases of normal glucose tolerance, 2.4% (0.9–5.3%) in impaired glucose tolerance, 0% (0–3.3%) in newly detected diabetes, according to the World Health Organization (WHO) criteria, and 3.5% (0.7–10.0%) in known diabetes. A total of 2 out of 3 subjects with GAD65-A indexes above the 99th percentile and 10 out of 18 subjects with GAD65-A indexes above the 85th percentile received insulin therapy for their diabetes, which showed an association between GAD65-A and insulin therapy

CONCLUSIONS
Low prevalence rates of latent autoimmunity to GAD were found in 50- to 74-year-old Dutch subjects with normal and abnormal glucose tolerance, and GAD65-A was associated with insulin use in known diabetic subjects.
Blood Glucose Concentration Influences Postprandial Fullness in IDDM
Authors: Jones KL , Horowitz M , Berry M , Wishart JM , Guha S 
Published: March 2007

OBJECTIVE
Upper gastrointestinal (GI) symptoms and delayed gastric emptying both occur frequently in patients with long-standing IDDM, but the relationship between them is relatively weak. Recent studies in normal subjects have indicated that blood glucose concentration may increase the perception of sensations arising from the upper GI tract. The purpose of this study was to examine the relationships among postprandial fullness, the rate of gastric emptying, and blood glucose concentration in IDDM patients.

RESEARCH DESIGN AND METHODS
We studied measurements of gastric emptying, blood glucose concentrations, cardiovascular autonomic nerve function, upper GI symptoms, and postprandial hunger and fullness in 40 IDDM patients (16 men, 24 women). ages 19–63 years. Gastric emptying of solids and liquids was measured scintigraphically, upper GI symptoms were measured by questionnaire immediately before ingestion of the test meal, and fullness and hunger were measured by visual analog scales every 15 min. Blood glucose concentrations were measured at −5, 30, 60, 90, and 120 min.

RESULTS
Solid gastric emptying was delayed in 58% of the patients, and both solid and liquid gastric emptying were slower (P &lt; 0.05) in women than in men. The score for upper GI symptoms was not significantly related to gastric emptying. In contrast, postprandial fullness, but not hunger, was related to the amount of solid (r = 0.36, P &lt; 0.05) but not liquid in the stomach. Both before (r = 0.39, P &lt; 0.05) and after (r = 0.47, P &lt; 0.01) the meal, fullness was related to blood glucose concentration. Postprandial fullness was also related to autonomic nerve dysfunction (r = 0.39, P &lt; 0.05). Multiple regression analysis confirmed that blood glucose concentration, the rate of solid gastric emptying, and autonomic nerve dysfunction were independent determinants of postprandial fullness, together accounting for 47% of the variance.

CONCLUSIONS
These observations demonstrated that, in IDDM, postprandial fullness is influenced by blood glucose concentration, the rate of solid gastric emptying, and autonomic nerve function.
Incidence of Blindness in Relation to Diabetes: A population-based study
Authors: Trautner Christoph , Icks Andrea , Haastert Burkhard , Plum Frank , Berger Michael 
Published: March 2007

OBJECTIVE
A reduction of diabetes-related blindness was declared a primary objective for Europe (St. Vincent Declaration). We collected data about incidence rates of blindness in the diabetic population compared with the nondiabetic population. Up to now, such data are scarce—even worldwide.

RESEARCH DESIGN AND METHODS
A complete list of newly registered blindness allowance recipients was drawn up in the district of Württemberg-Hohenzollern, Germany, between 1990 and 1993. From these data, we estimated age-specific and standardized incidence rates of blindness in the entire, the diabetic, and the nondiabetic population, as well as relative and attributable risks due to diabetes.

RESULTS
There were 2,714 people meeting the inclusion criteria; 1,823 (67.2%) were female and 781 (28.8%) had diabetes. In 318 subjects, diabetes was likely to be the only cause of blindness; in 192 subjects, it was one of several contributory causes. Age of women was 73.9 ± 19.4 years (mean ± SD) and of men 63.3 ± 25.5 years. Results standardized to the (West) German population are as follows: incidence rates (per 100,000 person-years): total population: 13.5; diabetic population: 60.6; nondiabetic population: 11.6; relative risk: 5.2; attributable risk among exposed: 0.81; and population attributable risk: 0.14. The relative risks decreased considerably with increasing age. When the study is repeated to monitor the St. Vincent targets, a reduction in the incidence rate of blindness in the diabetic population by 17% will be detected with 95% power.

CONCLUSIONS
Great relative and attributable risks, especially in younger age-groups, indicate the need for increased attention to preventive measures for microvascular complications.
Alanine and Terbutaline in the Prevention of Nocturnal Hypoglycemia in IDDM
Authors: Saleh Tarek Y , Cryer Philip E 
Published: March 2007

OBJECTIVE
To test the hypothesis that because of sustained glycemic actions, bedtime administration of the glucagon-releasing amino acid alanine or the epinephrine-simulating β2-adrenergic agonist terbutaline more effectively prevents nocturnal hypoglycemia than a conventional bedtime snack, we studied 15 patients with 1DDM.

RESEARCH DESIGN AND METHODS
On each of four occasions, the same individualized dose of NPH insulin (0.1–0.2 U/kg) was administered with either no treatment (control) or, in random sequence, oral treatment with a snack (240 ml of 2% milk plus one slice of toast, ∼200 kcal), alanine (40 g, plus 10 g of glucose, ∼200 kcal), or terbutaline (5.0 mg) at 2200.

RESULTS
During the first half of the night (2315–0300), mean plasma glucose concentrations were higher after the snack (P &lt; 0.02), alanine plus glucose (P &lt; 0.01), or terbutaline (P &lt; 0.001), compared with no treatment. During the second half of the night, mean plasma glucose levels were no different from control values (73 ± 5 mg/dl, 4.1 ± 0.3 mmol/1) after the snack (73 ± 7 mg/dl, 4.1 ± 0.4 mmol/1), tended to be higher after alanine plus glucose (96 ± 16 mg/dl, 5.3 ± 0.9 mmol/1), and were significantly higher after terbutaline (124 ± 15 mg/dl, 6.9 ± 0.8 mmol/1, P &lt; 0.01). Nocturnal plasma glucose levels of 40 mg/dl (2.2 mmol/1) or less(which were treated with intravenous glucose) occurred on 13 occasions in seven patients in the control arm and 10 occasions in six patients in the snack arm (not significantly different from the control arm), but on only 1 occasion in the alanine-plus-glucose.arm (P &lt; 0.02) and the terbutaline arm (P &lt; 0.02).

CONCLUSIONS
In patients with 1DDM given an evening dose of NPH insulin, a conventional bedtime snack exerts an inconsistent glycemic effect only during the first half of the night, and bedtime administration of the glucagon-releasing amino acid alanine or the epinephrine- simulating β2-adrenergic agonist terbutaline more effectively prevents nocturnal hypoglycemia than a conventional bedtime snack.