bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metabolic Syndrome as a Predictor of All-Cause and Cardiovascular Mortality in Type 2 Diabetes
Authors: Bruno Graziella , Merletti Franco , Biggeri Annibale , Bargero Giuseppe , Ferrero Stefania , Runzo Cristina , Prina Cerai Stefano , Pagano Gianfranco , Cavallo-Perin Paolo 
Published: March 2007

OBJECTIVE—The aim of this study was to assess in an 11-year survival follow-up of a population-based cohort of type 2 diabetes the predictive role of World Health Organization–defined metabolic syndrome, independent of conventional cardiovascular risk factors.
RESEARCH DESIGN AND METHODS—During the follow-up (1991–2001), 1,565 patients were regularly examined with centralized measurements of HbA1c. The independent role of the metabolic syndrome as a predictor of all-cause and cardiovascular mortality was assessed with multivariate Cox proportional hazards modeling.
RESULTS—At baseline, the prevalence of the metabolic syndrome was 75.6% (95% CI 73.6–77.9). Results are based on 685 deaths (520 with the metabolic syndrome and 165 without it) in 10,890.2 person-years of observations. With respect to subjects without the metabolic syndrome, those with the metabolic syndrome had a similar hazard ratio (HR) of cardiovascular mortality after adjustment for age, sex, smoking, total cholesterol level, and coronary heart disease. In contrast, relative to subjects with diabetes only, the HR of subjects with only one component of the syndrome was 2.92 (1.16–7.33), independent of other risk factors.
CONCLUSIONS—We found that 1) the prevalence of the metabolic syndrome in a population-based cohort of type 2 diabetes is high (75.6%); 2) the metabolic syndrome is not a predictor of 11-year all-cause and cardiovascular mortality; and 3) more than twofold higher cardiovascular risk, independent of conventional risk factors, is evident in diabetic subjects with only one component of the syndrome compared with those with diabetes only. Categorizing type 2 diabetic subjects as having or not having the metabolic syndrome does not provide further prediction compared with the knowledge of its single components.
Postabsorptive and Insulin-Stimulated Energy Homeostasis and Leucine Turnover in Offspring of Type 2 Diabetic Patients
Authors: Lattuada Guido , Sereni Lucia Piceni , Ruggieri Dora , Scollo Antonella , Benedini Stefano , Ragogna Francesca , Costantino Federica , Battezzati Alberto , Luzi Livio , Perseghin Gianluca 
Published: March 2007

OBJECTIVE—This study was performed to ascertain whether insulin resistance with respect to protein metabolism is an additional primary metabolic abnormality affecting insulin-resistant offspring of type 2 diabetic parents, along with insulin resistance with respect to glucose and lipid metabolism.
RESEARCH DESIGN AND METHODS—We studied 18 young, nonobese offspring of type 2 diabetic parents and 27 healthy matched (by means of dual-energy X-ray absorption) individuals with the bolus plus continuous infusion of [6,6-2H2]glucose and [1-13C]leucine in combination with the insulin clamp (40 mU · m–2 · min−1).
RESULTS—Fasting plasma leucine, phenylalanine, alanine, and glutamine concentrations, as well as the glucose and leucine turnover (reciprocal pool model: 155 ± 10 vs. 165 ± 5 μmol · kg lean body mass–1 · h−1 in offspring of type 2 diabetic patients and healthy matched individuals, respectively), were also not different. During the clamp, glucose turnover rates were significantly reduced in offspring of type 2 diabetic patients (7.1 ± 0.5) in comparison with healthy matched individuals (9.9 ± 0.6 mg · kg lean body mass–1 · min−1; P &lt; 0.01). Also, the suppression of leucine turnover was impaired in offspring of type 2 diabetic patients (12 ± 1%) in comparison with healthy matched individuals (17 ± 1%; P = 0.04) and correlated with the degree of the impairment of insulin-stimulated glucose metabolism (R2 = 0.13; P = 0.02).
CONCLUSIONS—Nonobese, nondiabetic, insulin-resistant offspring of type 2 diabetic patients were characterized by an impairment of insulin-dependent suppression of protein breakdown, which was proportional to the impairment of glucose metabolism. These results demonstrate that in humans, a primary in vivo impairment of insulin action affects glucose and fatty acid metabolism as previously shown and also protein/amino acid metabolism.
Including Walnuts in a Low-Fat/Modified-Fat Diet Improves HDL Cholesterol-to-Total Cholesterol Ratios in Patients With Type 2 Diabetes
Authors: Tapsell Linda C. , Gillen Lynda J. , Patch Craig S. , Batterham Marijka , Owen Alice , Baré Marian , Kennedy Meredith 
Published: March 2007

OBJECTIVE—The aim of this study was to examine the effect of a moderate-fat diet inclusive of walnuts on blood lipid profiles in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—This was a parallel randomized controlled trial comparing three dietary advice groups each with 30% energy as fat: low fat, modified low fat, and modified low fat inclusive of 30 g of walnuts per day. Fifty-eight men and women, mean age 59.3 ± 8.1 years, started the trial. Dietary advice was given at baseline with monthly follow-up and fortnightly phone calls for support. Body weight, percent body fat, blood lipids, HbA1c, total antioxidant capacity, and erythrocyte fatty acid levels were measured at 0, 3, and 6 months. Data were assessed by repeated-measures ANOVA with an intention-to-treat model.
RESULTS—The walnut group achieved a significantly greater increase in HDL cholesterol–to–total cholesterol ratio (P = 0.049) and HDL (P = 0.046) than the two other treatment groups. A 10% reduction in LDL cholesterol was also achieved in the walnut group, reflecting a significant effect by group (P = 0.032) and time (P = 0.036). There were no significant differences between groups for changes in body weight, percent body fat, total antioxidant capacity, or HbA1c levels. The higher dietary polyunsaturated fat–to–saturated fat ratio and intakes of ω-3 fatty acids in the walnut group were confirmed by erythrocyte biomarkers of dietary intake.
CONCLUSIONS—Structured “whole of diet” advice that included 30 g of walnuts/day delivering substantial amounts of polyunsaturated fatty acid improved the lipid profile of patients with type 2 diabetes.
Outcomes in Type 1 Diabetic Pregnancies
Authors: Jensen Dorte M. , Damm Peter , Moelsted-Pedersen Lars , Ovesen Per , Westergaard Jes G. , Moeller Margrethe , Beck-Nielsen Henning 
Published: March 2007

OBJECTIVE—The aim of this study was to compare pregnancy outcomes in type 1 diabetic pregnancies with the background population.
RESEARCH DESIGN AND METHODS—This nationwide prospective multicenter study took place in eight Danish centers treating pregnant women with type 1 diabetes during 1993–1999. A total of 990 women with 1,218 pregnancies and delivery after 24 weeks (n = 1,215) or early termination due to severe congenital malformations (n = 3) were included. Data were collected prospectively by one to three caregivers in each center and reported to a central registry.
RESULTS—The perinatal mortality rate was 3.1% in type 1 diabetic pregnancies compared with 0.75% in the background population (RR 4.1 [95% CI 2.9–5.6]), and the stillbirth rate was 2.1% compared with 0.45 (4.7 [3.2–7.0]). The congenital malformation rate was 5.0% in the study population and 2.8% (1.7 [1.3–2.2]) in the background population. Six of the perinatal deaths (16%) were related to congenital malformations. Only 34% of women performed daily home monitoring of blood glucose at conception, and 58% received preconceptional guidance. Pregnancies with serious adverse outcomes (perinatal death and/or congenital malformations) were characterized by higher HbA1c values before and during pregnancy and a lesser degree of maternal self-care and preconceptional guidance. Women who performed daily self-monitoring of blood glucose at any time during pregnancy had lower HbA1c values than women who did not measure their daily profile. Likewise, daily self-monitoring was associated with a reduction in serious adverse outcomes. The caesarean section rate was 55.9 and 12.6%, respectively, and the risk of preterm delivery was 41.7 and 6.0%, respectively.
CONCLUSIONS—Type 1 diabetic pregnancies are still complicated by considerably higher rates of severe perinatal complications compared with the background population, and women with poor self-care are at the highest risk. Adequate glycemic control using daily glucose monitoring before and during pregnancy is a crucial step toward reaching the goals of the St. Vincent declaration.
Association Between Urinary Albumin Excretion and Serum Dehydroepiandrosterone Sulfate Concentration in Male Patients With Type 2 Diabetes
Authors: Fukui Michiaki , Kitagawa Yoshihiro , Nakamura Naoto , Kadono Mayuko , Hasegawa Goji , Yoshikawa Toshikazu 
Published: March 2007

OBJECTIVE—Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in patients with type 2 diabetes. Both elevated urinary albumin excretion and low serum concentrations of dehydroepiandrosterone (DHEA) are associated with increased CVD mortality. This raises the possibility of DHEA as a causal intermediate linking urinary albumin excretion to CVD.
RESEARCH DESIGN AND METHODS—Relationships of urinary albumin excretion to serum DHEA sulfate (DHEA-S) concentration and to major cardiovascular risk factors, including blood pressure, serum lipid concentration, glycemic control (HbA1c), and BMI, were investigated in 357 consecutive men with type 2 diabetes.
RESULTS—Serum DHEA-S concentrations were lower in patients with macroalbuminuria (866.5 ± 523.8 ng/ml, P &lt; 0.0001) and in those with microalbuminuria (1,014.4 ± 525.3 ng/ml, P = 0.0006) than in patients with normoalbuminuria (1,232.6 ± 542.4 ng/ml). Serum DHEA-S concentration correlated inversely with log (urinary albumin excretion) (r = −0.227, P &lt; 0.0001). Multiple regression analysis demonstrated that duration of diabetes (β = 0.147, P = 0.0075), HbA1c (β = 0.156, P = 0.0048), BMI (β = 0.194, P = 0.0007), systolic blood pressure (β = 0.195, P = 0.0005), and serum DHEA-S concentration (β = −0.192, P = 0.0010) were independent determinants of log (urinary albumin excretion).
CONCLUSIONS—Serum DHEA-S concentration, which correlated inversely with degree of urinary albumin excretion, may contribute to the link between elevated urinary albumin excretion and higher CVD mortality in male patients with type 2 diabetes.
Radial Artery Tonometry Demonstrates Arterial Stiffness in Children With Type 1 Diabetes
Authors: Haller Michael J. , Samyn Margaret , Nichols Wilmer W. , Brusko Todd , Wasserfall Clive , Schwartz R. Fletcher , Atkinson Mark , Shuster Jonathan J. , Pierce Gary L. , Silverstein Janet H. 
Published: March 2007

OBJECTIVE—To determine if children with type 1 diabetes have increased arterial stiffness by estimating augmentation index with the simple noninvasive technique of radial artery tonometry.
RESEARCH DESIGN AND METHODS—We studied 98 type 1 diabetic children and 57 healthy control subjects, ages 10–18 years, matched for age, sex, race, and BMI, generating 43 matched pairs. Radial artery tonometry was performed, and blood was collected for analysis of fasting lipids, HbA1c, glucose, and cytokines in all children.
RESULTS—Children with diabetes had a significantly higher augmentation index corrected to a heart rate of 75 (AI75) than their matched control subjects. Mean AI75 in type 1 diabetic subjects was 1.11 ± 10.15 versus −3.32 ± 10.36 in control subjects. The case-control difference was 5.20 ± 11.02 (P = 0.0031).
CONCLUSIONS—Children with type 1 diabetes have increased arterial stiffness compared with healthy control subjects. Radial artery tonometry is a simple noninvasive technique that could be added to the armamentarium of tests used to provide cardiovascular risk stratification in children with type 1 diabetes.
The LDIflare
Authors: Krishnan Singhan T.M. , Rayman Gerry 
Published: March 2007

OBJECTIVE—The aim of this study was to evaluate a novel method for assessing the axon reflex and to determine its value in detecting neuropathy in type 2 diabetes.
RESEARCH DESIGN AND METHODS—The neurogenic flare response to nociceptive stimuli is mediated by an axon reflex involving small unmyelinated C-fibers. We developed a method to assess this reflex involving skin heating to 44°C to evoke the flare followed by scanning the site using a laser Doppler imager (LDI) to measure the area; we termed this method LDIflare. To confirm its neurogenic nature, we examined the LDIflare in eight healthy subjects before and after topical administration of anesthesia. We used this technique to detect C-fiber neuropathy in people with type 2 diabetes. A total of 36 subjects were studied: 12 subjects with neuropathy (group DN), 12 subjects without neuropathy (group DC), and 12 age- and sex-matched control subjects (group NC). For comparison, small-fiber function was also assessed using the Computer Aided Sensory Evaluator–IV (CASE IV) (WR Medical Electronics, Stillwater, MN).
RESULTS—In the eight healthy control subjects, LDIflare was markedly reduced after topical administration of anesthesia (1.62 [1.45–1.72] vs. 5.2 cm2 [3.9–5.9], P &lt; 0.0001), confirming its neurogenic nature. Similarly, in neuropathic subjects, LDIflare was significantly smaller compared with normal and diabetic control subjects (LDIflare area: DN 1.3 cm2 [0.9–1.8], NC 5.5 cm2 [3.9–5.8], and DC 2.8 cm2 [2.5–3.8]; P &lt; 0.0001 and P = 0.01, respectively). The group without neuropathy (DC) also demonstrated a reduced flare compared with the NC group (P = 0.01). In contrast, C-fiber function assessed by evaluating the quantitative thermal thresholds (CASE IV) did not detect a difference between the latter two groups.
CONCLUSIONS—This study confirms the neurogenic nature of the LDIflare and clearly demonstrates loss of C-fiber function in neuropathic subjects with type 2 diabetes. Moreover, it demonstrates C-fiber dysfunction before its detection by other currently available methods, including CASE IV. The LDIflare seems to be a simple objective method to detect early neuropathy and may be of value in assessing therapeutic interventions aimed at preventing or reversing C-fiber dysfunction.
Visceral and Central Abdominal Fat and Anthropometry in Relation to Diabetes in Asian Indians
Authors: Anjana Mohan , Sandeep Sreedharan , Deepa Raj , Vimaleswaran Karani Santhanakrishnan , Farooq Syed , Mohan Viswanathan 
Published: March 2007

OBJECTIVE—The objective of the study was to examine body fat distribution using computed tomography (CT), dual-energy X-ray absorptiometry (DEXA), and anthropometry in relation to type 2 diabetes in urban Asian Indians.
RESEARCH DESIGN AND METHODS—This is a case-control study of 82 type 2 diabetic and 82 age- and sex-matched nondiabetic subjects from the Chennai Urban Rural Epidemiology Study, an ongoing epidemiological study in southern India. Visceral, subcutaneous, and total abdominal fat were measured using CT, while DEXA was used to measure central abdominal and total body fat. Anthropometric measures included BMI, waist circumference, sagittal abdominal diameter (SAD), and waist-to-hip ratio.
RESULTS—Visceral and central abdominal fat showed a strong correlation with each other (P &lt; 0.0001), and κ analysis revealed a fairly good agreement between tertiles of visceral and central abdominal fat (κ = 0.44, P &lt; 0.0001). Diabetic subjects had significantly higher visceral (P = 0.005) and central abdominal (P = 0.011) fat compared with nondiabetic subjects. Waist circumference and SAD showed a strong correlation with visceral (P &lt; 0.01) and central abdominal (P &lt; 0.0001) fat in both diabetic and nondiabetic subjects. Logistic regression analysis revealed visceral (odds ratio [OR] 1.011, P = 0.004) and central abdominal (OR 1.001, P = 0.013) fat to be associated with diabetes, even after adjusting for age and sex.
CONCLUSIONS—Visceral and central abdominal fat showed a strong association with type 2 diabetes. Both measures correlated well with each other and with waist circumference and SAD in diabetic and nondiabetic urban Asian Indians.
A Prospective Study of Glycemic Control During Holiday Time in Type 2 Diabetic Patients
Authors: Chen Harn-Shen , Jap Tjin-Shing , Chen Ru-Lin , Lin Hong-Da 
Published: March 2007

OBJECTIVE—In the U.K. Prospective Diabetes Study, A1C increased from 1.2 to 1.7% and fasting plasma glucose from 1.0 to 2.8 mmol/l over 10 years in type 2 diabetic patients. It is not known whether the blood glucose increase observed in long-term studies of type 2 diabetes results from small, steady increases throughout the year or from increases during discrete periods.
RESEARCH DESIGN AND METHODS—To estimate the variation of actual glycemic control and its relation to holiday times, we measured A1C and fructosamine in 110 patients with type 2 diabetes. These measurements were performed four times at intervals of 4–6 weeks; therefore, glycemic change was determined for three periods: preholiday period (from between November 13 and December 20 to between December 20 and January 20), holiday period (from between December 20 and January 20 to between January 28 and February 28), and postholiday period (from between January 28 and February 28 to between March 1 and April 10). A final measurement of A1C was obtained from 90 subjects in the following December or January.
RESULTS—The mean A1C increased, but not significantly, during the preholiday (increase 0.135 ± 0.723%, P = 0.055) and holiday (increase 0.094 ± 0.828%, P = 0.239) periods. The mean A1C decreased, but not significantly, during the postholiday period (decrease 0.022 ± 0.588%, P = 0.695). Altogether, the A1C change during these three periods increased significantly (increase 0.207 ± 0.943%, P = 0.024). The mean fructosamine increased significantly during the preholiday period (increase 0.151 ± 0.460 mmol/l, P = 0.001), but there was no significant change during the holiday period (increase 0.057 ± 0.593 mmol/l, P = 0.321). However, fructosamine decreased significantly during the postholiday period (decrease 0.178 ± 0.448 mmol/l, P &lt; 0.001). Altogether, the fructosamine changes during the study periods showed no significant difference (increase 0.030 ± 0.566 mmol/l, P = 0.579). Between March or early April and the following December or January, there was no additional change in A1C (decrease 0.009 ± 1.039%, P = 0.935) for the 90 participants who returned for follow-up treatment.
CONCLUSIONS—The present study demonstrates an influence of winter holidays on the glycemic control of patients who have type 2 diabetes, and this poor glycemic control might not be reversed during the summer and autumn months. Therefore, the cumulative effects of the yearly A1C gain during the winter holidays are likely to contribute to the substantial increase in A1C that occurs every year among type 2 diabetic individuals.
Problems Paying Out-of-Pocket Medication Costs Among Older Adults With Diabetes
Authors: Piette John D. , Heisler Michele , Wagner Todd H. 
Published: March 2007

OBJECTIVE—To identify problems faced by older adults with diabetes due to out-of-pocket medication costs.
RESEARCH DESIGN AND METHODS—In this cross-sectional national survey of 875 adults with diabetes treated with hypoglycemic medication, respondents reported whether they had underused prescription medications due to cost pressures or had experienced other financial problems associated with medication costs such as forgoing basic necessities. Respondents also described their interactions with clinicians about medication costs.
RESULTS—A total of 19% of respondents reported cutting back on medication use in the prior year due to cost, 11% reported cutting back on their diabetes medications, and 7% reported cutting back on their diabetes medications at least once per month. Moreover, 28% reported forgoing food or other essentials to pay medication costs, 14% increased their credit card debt, and 10% borrowed money from family or friends to pay for their prescriptions. Medication cost problems were especially common among respondents who were younger, had higher monthly out-of-pocket costs, and had no prescription drug coverage. In general, few respondents, including those reporting medication cost problems, reported that their health care providers had given them information or other assistance to address medication cost pressures.
CONCLUSIONS—Out-of-pocket medication costs pose a significant burden to many adults with diabetes and contribute to decreased treatment adherence. Clinicians should actively identify patients with diabetes who are facing medication cost pressures and assist them by modifying their medication regimens, helping them understand the importance of each prescribed medication, providing information on sources of low-cost drugs, and linking patients with coverage programs.
Maternal Anxiety Associated With Newborn Genetic Screening for Type 1 Diabetes
Authors: Bennett Johnson Suzanne , Baughcum Amy E. , Carmichael Stacy K. , She Jin-Xiong , Schatz Desmond A. 
Published: March 2007

OBJECTIVE—To describe maternal anxiety associated with newborn genetic screening for type 1 diabetes during the first year after risk notification.
RESEARCH DESIGN AND METHODS—Mothers of at-risk infants (n = 435), identified through newborn genetic screening as part of the Prospective Assessment of Newborn for Diabetes Autoimmunity (PANDA) study, were administered a short form of the State Trait Anxiety Inventory (STAI) during telephone interviews ∼3.5 weeks, 4 months, and 1 year after risk notification. Statistical analyses were conducted to examine predictors of maternal anxiety at each interview as well as changes in anxiety over time.
RESULTS—For the total sample, initial state STAI scores were not elevated and declined further over time. However, Hispanic mothers, those with low levels of education, those who overestimated the child’s risk for diabetes, and mothers of infants in the highest risk group exhibited significantly elevated initial state STAI scores. At 4 months, higher state STAI scores were associated with higher initial state STAI scores, single parent status, having an infant with a first-degree relative with diabetes, and overestimation of the child’s actual risk. Initial and 4-month STAI scores remained predictive of STAI scores at 1 year. In addition, single mothers and mothers of female children reported higher STAI state scores 1 year after risk notification.
CONCLUSIONS—For most mothers, newborn genetic screening to identify infants at increased risk for type 1 diabetes is not associated with significantly elevated maternal anxiety; anxiety further dissipates over time. However, anxiety levels vary considerably as a function of maternal ethnic status, education, marital status, maternal estimation of infant risk, and sex of the child and may be significantly elevated in some women.