bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in Diabetes Prevalence, Incidence, and Mortality Among the Elderly of Four Racial/Ethnic Groups: Whites, Blacks, Hispanics, and Asians
Authors: McBean A. Marshall , Li Shuling , Gilbertson David T. , Collins Allan J. 
Published: March 2007

OBJECTIVE—To examine diabetes prevalence, incidence, and mortality from 1993 to 2001 among fee-for-service Medicare beneficiaries ≥67 years of age.
RESEARCH DESIGN AND METHODS—This study was a retrospective analysis of a 5% random sample of Medicare fee-for-service beneficiaries ≥65 years of age in each year.
RESULTS—In 1993, the prevalence of diabetes among those ≥67 years of age was 145 cases per 1,000 individuals. By 2001, it was 197/1,000, an increase of 36.0%. The 2001 prevalence among Hispanics (334/1,000) was significantly higher than among blacks (296/1,000), Asians (243/1,000), and whites (184/1,000, P &lt; 0.0001). During the 7-year period the greatest increase in diabetes prevalence was among Asians (68.0%). Between 1994 and 2001, the annual rate of newly diagnosed elderly individuals with diabetes increased by 36.9%. Hispanics had the greatest increase at 55.0%. The mortality rate among individuals with diabetes decreased by ∼5% between 1994 and 2001 from 92.1/1,000 to 87.2/1,000 (P &lt; 0.001), due to a 6% decrease among whites. No decrease in mortality was seen among elderly individuals without diabetes, it was 55/1,000 in 1994 and 54/1,000 in 2001.
CONCLUSIONS—The dramatic increase in the incidence and prevalence of diabetes likely reflect a combination of true increases, as well as changes in the diagnostic criteria and increased interest in diagnosing and appropriately treating diabetes in the elderly. Improved treatment may have had an impact on mortality rates among individuals with diabetes, although they could have been influenced by the duration of diabetes before diagnosis, which has likely decreased. Changes in incidence, prevalence, and mortality in elderly individuals with diabetes need to continue to be monitored.
Acute Hyperglycemia Alters Mood State and Impairs Cognitive Performance in People With Type 2 Diabetes
Authors: Sommerfield Andrew J. , Deary Ian J. , Frier Brian M. 
Published: March 2007

OBJECTIVE—To examine the effects of acute hyperglycemia on cognitive function and mood in people with type 2 diabetes.
RESEARCH DESIGN AND METHODS—Twenty subjects with type 2 diabetes, median age 61.5 years (range 53.1–72.0), known duration of diabetes 5.9 years (range 2.8–11.2), BMI 29.8 kg/m2 (range 22.0–34.6), and HbA1c 7.5% (range 6.7–8.4) were studied. Treatment modalities varied from antidiabetic medications to insulin. A hyperinsulinemic glucose clamp was used to maintain arterialized blood glucose at either 4.5 (euglycemia) or 16.5 mmol/l (hyperglycemia) on two occasions in a randomized and counterbalanced fashion. Tests of information processing, immediate and delayed memory, working memory, and attention were administered, along with a mood questionnaire, during each experimental condition.
RESULTS—Speed of information processing, working memory, and some aspects of attention were impaired during acute hyperglycemia. Subjects were significantly more dysphoric during hyperglycemia, with reduced energetic arousal and increased sadness and anxiety.
CONCLUSIONS—During acute hyperglycemia, cognitive function was impaired and mood state deteriorated in a group of people with type 2 diabetes. These findings are of practical importance because intermittent or chronic hyperglycemia is common in people with type 2 diabetes and may interfere with many daily activities through adverse effects on cognitive function and mood.
Insulin Glulisine Provides Improved Glycemic Control in Patients With Type 2 Diabetes
Authors: Dailey George , Rosenstock Julio , Moses Robert G. , Ways Kirk 
Published: March 2007

OBJECTIVE—Insulin glulisine is a novel analog of human insulin designed for use as a rapid-acting insulin. This study compared the safety and efficacy of glulisine with regular human insulin (RHI) in combination with NPH insulin.
RESEARCH DESIGN AND METHODS—In total, 876 relatively well-controlled patients with type 2 diabetes (mean HbA1c 7.55%) were randomized and treated with glulisine/NPH (n = 435) or RHI/NPH (n = 441) for up to 26 weeks in this randomized, multicenter, multinational, open-label, parallel-group study. Subjects were allowed to continue the same dose of prestudy regimens of oral antidiabetic agent (OAD) therapy (unless hypoglycemia necessitated a dose change).
RESULTS—A slightly greater reduction from baseline to end point of HbA1c was seen in the glulisine group versus RHI (−0.46 vs. −0.30% with RHI; P = 0.0029). Also, at end point, lower postbreakfast (156 vs. 162 mg/dl [8.66 vs. 9.02 mmol/l]; P &lt; 0.05) and postdinner (154 vs. 163 mg/dl [8.54 vs. 9.05 mmol/l]; P &lt; 0.05) blood glucose levels were noted. Symptomatic hypoglycemia (overall, nocturnal, and severe) and weight gain were comparable between the two treatment groups. There were no between-group differences in baseline-to-end point changes in insulin dose.
CONCLUSIONS—Twice-daily glulisine associated with NPH can provide small improvements in glycemic control compared with RHI in patients with type 2 diabetes who are already relatively well controlled on insulin alone or insulin plus OADs. The clinical relevance of such a difference remains to be established.
Serum Ferritin and Risk of the Metabolic Syndrome in U.S. Adults
Authors: Jehn Megan , Clark Jeanne M. , Guallar Eliseo 
Published: March 2007

OBJECTIVE—We examined the relationship among iron stores, the metabolic syndrome, and insulin resistance.
RESEARCH DESIGN AND METHODS—We conducted a cross-sectional study of 6,044 adults &gt;20 years of age who participated in the Third National Health and Nutrition Examination Survey. Metabolic syndrome was defined as the presence of at least three of the following: elevated blood pressure, low HDL cholesterol, elevated serum triglycerides, elevated plasma glucose, and abdominal obesity. Insulin resistance was estimated using homeostasis model assessment (for insulin resistance), fasting insulin, and triglyceride–to–HDL cholesterol ratio.
RESULTS—After excluding individuals with likely hemochromatosis, mean serum ferritin values in premenopausal women, postmenopausal women, and men were 33.6, 93.4, and 139.9 μg/l, respectively. Metabolic syndrome was more common in those with the highest compared with the lowest levels of serum ferritin in premenopausal women (14.9 vs. 6.4%, P = 0.002), postmenopausal women (47.5 vs. 28.2%, P &lt; 0.001), and men (27.3 vs. 13.8%, P &lt; 0.001). Insulin resistance also increased across quartiles of serum ferritin for men and postmenopausal women and persisted after adjustment for age, race/ethnicity, C-reactive protein, smoking, alcohol intake, and BMI.
CONCLUSIONS—Elevated iron stores were positively associated with the prevalence of the metabolic syndrome and with insulin resistance.
Efficacy and Safety of Inhaled Insulin (Exubera) Compared With Subcutaneous Insulin Therapy in Patients With Type 1 Diabetes
Authors: Quattrin Teresa , Bélanger André , Bohannon Nancy J.V. , Schwartz Sherwyn L. ,   for the Exubera Phase III Study Group
Published: March 2007

OBJECTIVE—The aim of this study was to determine whether premeal pulmonary delivery of rapid-acting, dry-powder insulin (Exubera) plus Ultralente could provide glycemic control comparable to a conventional insulin regimen in type 1 diabetes.
RESEARCH DESIGN AND METHODS—Three hundred thirty-five subjects were randomly assigned to receive either premeal inhaled insulin plus bedtime Ultralente or two to three injections of regular and NPH insulin for 24 weeks. The primary end point was a change in HbA1c.
RESULTS—Mean decreases in HbA1c values were comparable for inhaled (8.1–7.9%) and conventional groups (8.1–7.7%) (adjusted treatment group difference 0.16% [95% CI −0.01 to 0.32]). There were greater reductions for inhaled versus conventional regimen in fasting and postprandial plasma glucose (adjusted mean change differences −25.17 and −30.28 mg/dl, respectively [95% CI −43.39 to −6.95 and −54.58 to −5.97, respectively]). Hypoglycemia (events/subject month) was lower for the inhaled (8.6) versus the conventional (9.0) group (risk ratio, 0.96 [95% CI 0.93–0.99]). In subjects receiving inhaled insulin, increased insulin antibody levels were observed, but there were no associated clinical or laboratory changes. Adverse events were comparable between groups. Mild to moderate cough was more frequent in the inhaled insulin group (27 vs. 5%) but decreased during the treatment. Pulmonary function tests were not different between the groups except for a greater decrease in carbon monoxide diffusing capacity in the inhaled insulin group. Treatment satisfaction was greater in the inhaled than in the conventional group.
CONCLUSIONS—Inhaled insulin is effective, well tolerated, and well accepted in patients with type 1 diabetes and provides glycemic control comparable to that with a conventional insulin regimen.
Effects of Exenatide (Exendin-4) on Glycemic Control Over 30 Weeks in Sulfonylurea-Treated Patients With Type 2 Diabetes
Authors: Buse John B. , Henry Robert R. , Han Jenny , Kim Dennis D. , Fineman Mark S. , Baron Alain D. ,   for the Exenatide-113 Clinical Study Group
Published: March 2007

OBJECTIVE—This study evaluated the ability of the incretin mimetic exenatide (exendin-4) to improve glycemic control in patients with type 2 diabetes failing maximally effective doses of a sulfonylurea as monotherapy.
RESEARCH DESIGN AND METHODS—This was a triple-blind, placebo-controlled, 30-week study conducted at 101 sites in the U.S. After a 4-week, single-blind, placebo lead-in period, 377 subjects were randomized (60% men, age 55 ± 11 years, BMI 33 ± 6 kg/m2, HbA1c 8.6 ± 1.2% [±SD]) and began 4 weeks at 5 μg subcutaneous exenatide twice daily (before breakfast and dinner; arms A and B) or placebo. Subsequently, subjects in arm B were escalated to 10 μg b.i.d. exenatide. All subjects continued sulfonylurea therapy.
RESULTS—At week 30, HbA1c changes from baseline were −0.86 ± 0.11, −0.46 ± 0.12, and 0.12 ± 0.09% (±SE) in the 10-μg, 5-μg, and placebo arms, respectively (adjusted P &lt; 0.001). Of evaluable subjects with baseline HbA1c &gt; 7% (n = 237), 41% (10 μg), 33% (5 μg), and 9% (placebo) achieved HbA1c ≤ 7% (P &lt; 0.001). Fasting plasma glucose concentrations decreased in the 10-μg arm compared with placebo (P &lt; 0.05). Subjects in the exenatide arms had dose-dependent progressive weight loss, with an end-of-study loss in the 10-μg exenatide arm of −1.6 ± 0.3 kg from baseline (P &lt; 0.05 vs. placebo). The most frequent adverse events were generally mild or moderate and gastrointestinal in nature. No severe hypoglycemia was observed.
CONCLUSIONS—Exenatide significantly reduced HbA1c in patients with type 2 diabetes failing maximally effective doses of a sulfonylurea. Exenatide was generally well tolerated and was associated with weight loss.
Glycemic Index and Dietary Fiber and the Risk of Type 2 Diabetes
Authors: Hodge Allison M. , English Dallas R. , O’Dea Kerin , Giles Graham G. 
Published: March 2007

OBJECTIVE—To examine associations between type 2 diabetes and fiber, glycemic load (GL), dietary glycemic index (GI), and fiber-rich foods.
RESEARCH DESIGN AND METHODS—This was a prospective study of 36,787 men and women aged 40–69 years without diabetes. For all self-reported cases of diabetes at 4-year follow-up, confirmation of diagnosis was sought from medical practitioners. Case subjects were those who reported diabetes at follow-up and for whom there was no evidence that they did not have type 2 diabetes. Data were analyzed with logistic regression, adjusting for country of birth, physical activity, family history of diabetes, alcohol and energy intake, education, 5-year weight change, sex, and age.
RESULTS—Follow-up was completed by 31,641 (86%) participants, and 365 cases were identified. The odds ratio (OR) for the highest quartile of white bread intake compared with the lowest was 1.37 (95% CI 1.04–1.81; P for trend = 0.001). Intakes of carbohydrate (OR per 200 g/day 0.58, 0.36–0.95), sugars (OR per 100 g/day 0.61, 0.47–0.79), and magnesium (OR per 500 mg/day 0.62, 0.43–0.90) were inversely associated with incidence of diabetes, whereas intake of starch (OR per 100 g/day 1.47, 1.06–2.05) and dietary GI (OR per 10 units 1.32, 1.05–1.66) were positively associated with diabetes. These relationships were attenuated after adjustment for BMI and waist-to-hip ratio.
CONCLUSIONS—Reducing dietary GI while maintaining a high carbohydrate intake may reduce the risk of type 2 diabetes. One way to achieve this would be to substitute white bread with low-GI breads.
Risk Factors for the Metabolic Syndrome
Authors: Carnethon Mercedes R. , Loria Catherine M. , Hill James O. , Sidney Stephen , Savage Peter J. , Liu Kiang 
Published: March 2007

OBJECTIVE—The aim of this study was to describe the association of the metabolic syndrome with demographic characteristics and to identify modifiable risk factors for development of the metabolic syndrome.
RESEARCH DESIGN AND METHODS—Men and women (55%) aged 18–30 years from the Coronary Artery Risk Development in Young Adults (CARDIA) study without the metabolic syndrome at baseline (n = 4,192, 49% black) were followed-up from 1985 to 2001. Incident metabolic syndrome, defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria, was ascertained 7, 10, and 15 years after baseline. Risk factors were measured via clinical examination and standardized questionnaires.
RESULTS—The age-adjusted rate of metabolic syndrome was 10 per 1,000 person-years (n = 575). Metabolic syndrome risk increased with age and was higher among black participants and those with less than a high school education. Higher baseline BMI, no alcohol intake (versus one to three drinks per day), higher intake of dietary carbohydrates, and lower intake of crude fiber were each associated with an increased risk for the metabolic syndrome (relative risk [RR] ranging from 1.3 to 1.9), and physical activity was protective (RR 0.84 [95% CI 0.76–0.92]). In models adjusting simultaneously for all factors, black participants and women were less likely to develop metabolic syndrome. Risk for metabolic syndrome increased 23% (20–27%) per 4.5 kg (10 lb) of weight gained, whereas regular physical activity over time versus low activity was protective (RR 0.49 [0.34–0.70]).
CONCLUSIONS—BMI and weight gain are important risk factors for the metabolic syndrome. Regular physical activity may counter this risk.
Trends in the Prevalence and Ratio of Diagnosed to Undiagnosed Diabetes According to Obesity Levels in the U.S.
Authors: Gregg Edward W. , Cadwell Betsy L. , Cheng Yiling J. , Cowie Catherine C. , Williams Desmond E. , Geiss Linda , Engelgau Michael M. , Vinicor Frank 
Published: March 2007

OBJECTIVE—To examine trends in the prevalence of diagnosed and undiagnosed diabetes and the proportion of total cases previously diagnosed, according to obesity status in the U.S. over the past 40 years.
RESEARCH DESIGN AND METHODS—We assembled data from five consecutive cross-sectional national surveys: National Health Examination Survey I (1960–1962), National Health and Nutrition Examination Survey (NHANES) I (1971–1974), NHANES II (1976–1980), NHANES III (1988–1994), and NHANES 1999–2000. Diagnosed diabetes was ascertained, and height and weight were measured in adults aged 20–74 years in all surveys. In NHANES II, NHANES III, and NHANES 1999–2000, a fasting glucose level ≥126 mg/dl was used to identify cases among individuals not reporting diabetes. Design-based analyses and Bayesian models estimate the probability that prevalence of diabetes increased within four BMI groups (&lt;25, 25–29, 30–34, and ≥35 kg/m2).
RESULTS—In the U.S. population aged 20–74 years between 1976–1980 and 1999–2000, significant increases in the prevalence of diagnosed diabetes (3.3–5.8%, probability &gt;99.9%) were accompanied by nonsignificant increases in undiagnosed diabetes (2.0–2.4%, 66.6%). This resulted in an increase in total diabetes (5.3–8.2%, &gt;99.9%) and a modest nonsignificant increase in the proportion of cases that were diagnosed (62–70%, 62.4%). However, these trends varied considerably by BMI level. In individuals with BMI ≥35 kg/m2, diagnosed diabetes increased markedly (from 4.9% in 1960, to 8.6% during 1976–1980, to 15.1% in 1999–2000; probability &gt;99.9%), whereas undiagnosed diabetes declined considerably (12.5% during 1976–1980 to 3.2% in 1999–2000, probability of increase 4.5%) Therefore, the proportion of total diabetes cases that were diagnosed increased from 41 to 83% (probability 99.9%) among individuals with BMI ≥35 kg/m2. By comparison, changes in prevalence within BMI strata &lt;35 kg/m2 were modest and there was no increase in the percent of total cases that were diagnosed.
CONCLUSIONS—National surveys over the last several decades have found large increases in diagnosed diabetes, particularly in overweight and obese individuals, but this has been accompanied by large decreases in undiagnosed diabetes only among individuals with BMI ≥35 kg/m2. This suggests that improvements in diabetes awareness and detection are most prominent among this subgroup.
End-Stage Renal Disease-Associated Managed Care Costs Among Patients With and Without Diabetes
Authors: Joyce Amie T. , Iacoviello John M. , Nag Soma , Sajjan Shiva , Jilinskaia Evguenia , Throop Diane , Pedan Alexander , Ollendorf Daniel A. , Alexander Charles M. 
Published: March 2007

OBJECTIVE—To examine the direct costs of care before and after onset of end-stage renal disease (ESRD) for patients with and without diabetes based on analyses of retrospective healthcare claims data.RESEARCH DESIGN AND METHODS—Patients with onset of ESRD between January 1998 though June 2002 were identified based on use of dialysis, renal transplantation, or other ESRD-related services. Continuous health plan enrollment ≥12 months before and ≥1 month after ESRD onset was required. The costs calculated include both observed and adjusted estimates; the latter were calculated using generalized linear models, controlling for demographic and clinical characteristics, “onset” period, and duration of follow-up. Analyses focus on the diabetic ESRD patient and include a comparison with ESRD patients without diabetes.RESULTS—The study included 2,020 patients with diabetes and 2,170 without diabetes; 63% of patients were &gt;50 years of age. Average costs were relatively stable before ESRD ($1,535 to $4,357 for diabetes, $1,082 to $2,447 for no diabetes) but more than doubled in the month preceding onset ($9,152 and $8,211, respectively). Postonset, average monthly per-patient costs escalated sharply in the 1st month ($26,507 and $26,789), declined steadily through month 6, and remained flat but elevated thereafter. Adjusted annual costs per patient pre- and postonset of ESRD were significantly higher for diabetes (P &lt; 0.0001); annual costs were 69% ($38,041 vs. $22,538) and 79% ($96,014 vs. $53,653) higher pre- and postonset, respectively.CONCLUSIONS—The economic burden of ESRD in the year after onset is substantial, particularly among patients with diabetes.
Twelve- and 52-Week Efficacy of the Dipeptidyl Peptidase IV Inhibitor LAF237 in Metformin-Treated Patients With Type 2 Diabetes
Authors: Ahrén Bo , Gomis Ramon , Standl Eberhard , Mills David , Schweizer Anja 
Published: March 2007

OBJECTIVE—To assess the 12- and 52-week efficacy of the dipeptidyl peptidase IV inhibitor LAF237 versus placebo in patients with type 2 diabetes continuing metformin treatment.
RESEARCH DESIGN AND METHODS—We conducted a 12-week, randomized, double-blind, placebo-controlled trial in 107 patients with type 2 diabetes with a 40-week extension in those completing the core study and agreeing, together with the investigator, to extend treatment to 1 year. Placebo (n = 51) or LAF237 (50 mg once daily, n = 56) was added to ongoing metformin treatment (1,500–3,000 mg/day). HbA1c and fasting plasma glucose (FPG) were measured periodically, and standardized meal tests were performed at baseline, week 12, and week 52.
RESULTS—In patients randomized to LAF237, baseline HbA1c averaged 7.7 ± 0.1% and decreased at week 12 (Δ = −0.6 ± 0.1%), whereas HbA1c did not change from a baseline of 7.9 ± 0.1% in patients given placebo (between-group difference in ΔHbA1c = −0.7 ± 0.1%, P &lt; 0.0001). Mean prandial glucose and FPG were significantly reduced in patients receiving LAF237 versus placebo by 2.2 ± 0.4 mmol/l (P &lt; 0.0001) and 1.2 ± 0.4 mmol/l (P = 0.0057), respectively, but plasma insulin levels were not affected. At end point of the extension, the between-group differences in change in mean prandial glucose, insulin, and FPG were −2.4 ± 0.6 mmol/l (P = 0.0001), 40 ± 16 pmol/l (P = 0.0153), and −1.1 ± 0.5 mmol/l (P = 0.0312), respectively. HbA1c did not change from week 12 to week 52 in LAF237-treated patients (n = 42) but increased in participants given placebo (n = 29). The between-group difference in ΔHbA1c after 1 year was −1.1 ± 0.2% (P &lt; 0.0001).
CONCLUSIONS—Data from this study demonstrate that LAF237 effectively prevents deterioration of glycemic control when added to metformin monotherapy in type 2 diabetes.
Dietary Antioxidant Intake and Risk of Type 2 Diabetes
Authors: Montonen Jukka , Knekt Paul , Järvinen Ritva , Reunanen Antti 
Published: March 2007

OBJECTIVE—The intake of antioxidants was studied for its ability to predict type 2 diabetes.
RESEARCH DESIGN AND METHODS—A cohort of 2,285 men and 2,019 women 40–69 years of age and free of diabetes at baseline (1967–1972) was studied. Food consumption during the previous year was estimated using a dietary history interview. The intake of vitamin C, four tocopherols, four tocotrienols, and six carotenoids was calculated. During a 23-year follow-up, a total of 164 male and 219 female incident cases occurred.
RESULTS—Vitamin E intake was significantly associated with a reduced risk of type 2 diabetes. The relative risk (RR) of type 2 diabetes between the extreme quartiles of the intake was 0.69 (95% CI 0.51–0.94, P for trend = 0.003). Intakes of α-tocopherol, γ-tocopherol, δ-tocopherol, and β-tocotrienol were inversely related to a risk of type 2 diabetes. Among single carotenoids, β-cryptoxanthin intake was significantly associated with a reduced risk of type 2 diabetes (RR 0.58, 95% CI 0.44–0.78, P &lt; 0.001). No association was evident between intake of vitamin C and type 2 diabetes risk.
CONCLUSIONS—This study supports the hypothesis that development of type 2 diabetes may be reduced by the intake of antioxidants in the diet.