bluuebunny/crossref_metadata_2025_split huggingface dataset:
Translating Lifestyle Intervention to Practice in Obese Patients With Type 2 Diabetes
Authors: Wolf Anne M. , Conaway Mark R. , Crowther Jayne Q. , Hazen Kristen Y. , L.Nadler Jerry , Oneida Beverly , Bovbjerg Viktor E. 
Published: March 2007

OBJECTIVE—To assess the efficacy of a lifestyle intervention program that can be readily translated into clinical practice for obese patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—The study consisted of a 12-month randomized controlled trial of 147 health plan members with type 2 diabetes and obesity (BMI ≥27 kg/m2). Participants were randomized to lifestyle case management or usual care. Case management entailed individual and group education, support, and referral by registered dietitians; intervention cost was $350 per person. Individuals treated with usual care received educational material. Both groups received ongoing primary care. Outcomes were difference between groups for change in weight (kilograms), waist circumference (centimeters), HbA1c, fasting lipid levels, use of prescription medications, and health-related quality of life.
RESULTS—Case management resulted in greater weight loss (P &lt; 0.001), reduced waist circumference (P &lt; 0.001), reduced HbA1c level (P = 0.02), less use of prescription medications (P = 0.03), and improved health-related quality of life (P &lt; 0.001) compared with usual care. The 12-month group difference in weight loss and waist circumference was 3.0 kg (95% CI −5.4 to −0.6) and −4.2 cm (−6.8 to −1.6). HbA1c differences were greatest at 4 months (−0.59%, P = 0.006) but not significant by 12 months (−0.19%, P = 0.45). Participants in the case management group lowered their use of medications, primarily diabetes medications, by 0.8 medications per day more than participants treated with usual care (P = 0.03). In seven of nine quality-of-life domains, the case management group improved compared with usual care (P &lt; 0.05).
CONCLUSIONS—Moderate-cost dietitian-led lifestyle case management may improve diverse health indicators among obese patients with type 2 diabetes.
Prevalence of Lower-Extremity Disease in the U.S. Adult Population ≥40 Years of Age With and Without Diabetes
Authors: Gregg Edward W. , Sorlie Paul , Paulose-Ram Ryne , Gu Qiuping , Eberhardt Mark S. , Wolz Michael , Burt Vicki , Curtin Lester , Engelgau Michael , Geiss Linda 
Published: March 2007

OBJECTIVE—Although lower-extremity disease (LED), which includes lower-extremity peripheral arterial disease (PAD) and peripheral neuropathy (PN), is disabling and costly, no nationally representative estimates of its prevalence exist. The aim of this study was to examine the prevalence of lower-extremity PAD, PN, and overall LED in the overall U.S. population and among those with and without diagnosed diabetes.
RESEARCH DESIGN AND METHODS—The analysis consisted of data for 2,873 men and women aged ≥40 years, including 419 with diagnosed diabetes, from the 1999–2000 National Health and Nutrition Examination Survey. The main outcome measures consisted of the prevalence of lower-extremity PAD (defined as ankle-brachial index &lt;0.9), PN (defined as ≥1 insensate area based on monofilament testing), and of any LED (defined as either PAD, PN, or history of foot ulcer or lower-extremity amputations).
RESULTS—Of the U.S. population aged ≥40 years, 4.5% (95% CI 3.4–5.6) have lower-extremity PAD, 14.8% (12.8–16.8) have PN, and 18.7% (15.9–21.4) have any LED. Prevalence of PAD, PN, and overall LED increases steeply with age and is higher (P &lt; 0.05) in non-Hispanic blacks and Mexican Americans than non-Hispanic whites. The prevalence of LEDs is approximately twice as high for individuals with diagnosed diabetes (PAD 9.5% [5.5–13.4]; PN 28.5% [22.0–35.1]; any LED 30.2% [22.1–38.3]) as the overall population.
CONCLUSIONS—LED is common in the U.S. and twice as high among individuals with diagnosed diabetes. These conditions disproportionately affect the elderly, non-Hispanic blacks, and Mexican Americans.
Reduction of Cardiovascular Events by Simvastatin in Nondiabetic Coronary Heart Disease Patients With and Without the Metabolic Syndrome
Authors: Pyörälä Kalevi , Ballantyne Christie M. , Gumbiner Barry , Lee Michael W. , Shah Arvind , Davies Michael J. , Mitchel Yale B. , Pedersen Terje R. , Kjekshus John ,   for the Scandinavian Simvastatin Survival Study Group
Published: March 2007

OBJECTIVE—To assess the effect of simvastatin treatment on the risk of cardiovascular events in nondiabetic patients with coronary heart disease (CHD) with and without the metabolic syndrome, as defined by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP-III).
RESEARCH DESIGN AND METHODS—Subgroup analyses were performed on data from 3,933 nondiabetic patients with clinically established CHD, serum total cholesterol level 5.5–8.0 mmol/l, and serum triglyceride level ≤2.5 mmol/l who were participating in the Scandinavian Simvastatin Survival Study (4S), a randomized, placebo-controlled trial. End points were total mortality, coronary mortality, major CHD event, myocardial revascularization, any CHD event, stroke, and any atherosclerotic event.
RESULTS—Over the 5.4-year median follow-up period, simvastatin produced similar changes in serum lipid levels in 893 patients with the metabolic syndrome and in 3,040 patients without the metabolic syndrome. The relative risks of main end points in simvastatin-treated patients compared with placebo-treated patients with the metabolic syndrome were as follows: total mortality 0.54 (95% CI 0.36–0.82), coronary mortality 0.39 (0.23–0.65), major CHD event 0.59 (0.45–0.77), and any atherosclerotic event 0.69 (0.56–0.84). The corresponding RRs in patients without the metabolic syndrome were 0.72 (0.56–0.91), 0.62 (0.45–0.84), 0.71 (0.61–0.82), and 0.76 (0.68–0.85).
CONCLUSIONS—Nondiabetic CHD patients with or without the metabolic syndrome realize from simvastatin treatment a similar, substantial relative reduction in the risk of cardiovascular events. The absolute benefit may be greater in patients with the metabolic syndrome because they are at a higher absolute risk.
Association of Carotid Intima-Media Thickness and Arterial Stiffness With Diabetic Retinopathy
Authors: Rema Mohan , Mohan Viswanathan , Deepa Raj , Ravikumar Radhakrishnan 
Published: March 2007

OBJECTIVE—The aim of this study was to assess the association of intima-media thickness (IMT) and arterial stiffness with diabetic retinopathy in an Asian-Indian population that has very high prevalence rates of diabetes and coronary artery disease.
RESEARCH DESIGN AND METHODS—The study was conducted on 600 type 2 diabetic subjects randomly selected from the Chennai Urban Rural Epidemiology Study (CURES), which is an ongoing population-based study of a representative population of Chennai. When present, retinopathy was graded according to a modified Early Treatment Diabetic Retinopathy Study grading system. IMT was determined using high-resolution B-mode ultrasonography. Arterial stiffness was measured by assessing the augmentation index (AI) using the Sphygmocor apparatus.
RESULTS—Retinopathy was diagnosed in 116 of 590 (19.6%) subjects in whom retinal photography was possible. Mean values of IMT (0.93 ± 0.36 vs. 0.85 ± 0.21 mm, P = 0.001) and AI (27.9 ± 8.9 vs. 25.8 ± 9.6%, P = 0.031) were significantly higher among diabetic subjects with retinopathy compared with those without. Both IMT (P = 0.024) and AI (P = 0.050) showed a significant association to diabetic retinopathy, even after adjusting for age, duration of diabetes, HbA1c, serum cholesterol, serum triglycerides, and microalbuminuria.
CONCLUSIONS—Diabetic retinopathy is associated with IMT and AI, suggesting that common pathogenic mechanisms might predispose to diabetic micro- and macroangiopathy.
Costs of Lower-Extremity Ulcers Among Patients With Diabetes
Authors: Stockl Karen , Vanderplas Ann , Tafesse Eskinder , Chang Eunice 
Published: March 2007

OBJECTIVE—The objective of this study was to characterize health care costs associated with diabetic lower-extremity ulcers.
RESEARCH DESIGN AND METHODS—Adult patients with diabetes who had a lower-extremity ulcer episode during 2000 and 2001 were identified using claims data. Ulcer-related direct health care costs were computed for each episode. Episodes were stratified according to severity level based on the Wagner classification.
RESULTS—A total of 2,253 patients were identified. The mean age was 68.9 years, and 59% of the patients were male. The average episode duration was 87.3 ± 82.8 days. Total ulcer-related costs averaged $13,179 per episode and increased with severity level, ranging from $1,892 (level 1) to $27,721 (level 4/5). Inpatient hospital charges accounted for 77% ($10,188) of the overall cost, indicating that hospitalization was a major cost driver. Total ulcer-related costs were significantly higher for patients &lt;65 years of age compared with those of older patients ($16,390 vs. $11,925, P = 0.02) and for patients with inadequate vascular status compared with patients with adequate vascular status ($23,372 vs. $5,218, P &lt; 0.0001). Patients who progressed to a higher severity level also had significantly higher ulcer-related costs compared with patients who did not progress ($20,136 vs. $3,063, P &lt; 0.0001).
CONCLUSIONS—The high costs of treating diabetic lower-extremity ulcers emphasize the value of intensive outpatient interventions designed to prevent ulcer progression.
Effect of Training Status on Regional Disposal of Circulating Free Fatty Acids in the Liver and Skeletal Muscle During Physiological Hyperinsulinemia
Authors: Iozzo Patricia , Takala Teemu , Oikonen Vesa , Bergman Jörgen , Grönroos Tove , Ferrannini Ele , Nuutila Pirjo , Knuuti Juhani 
Published: March 2007

OBJECTIVE—Fat metabolism is increasingly implicated in the pathogenesis of type 2 diabetes. Endurance training has been shown to prevent hepatic steatosis and to alter skeletal muscle fat metabolism, and regional free fatty acid (FFA) uptake adaptations were suggested as a mechanism. Thus, we tested whether endurance training modifies the uptake of plasma FFAs occurring in the liver and in skeletal muscle during anabolic, i.e., hyperinsulinemic, conditions.
RESEARCH DESIGN AND METHODS—Trained and untrained healthy male subjects underwent positron emission tomography scanning of the liver and thigh regions, with the FFA analog 14(R,S)-[18F]fluoro-6-thia-heptadecanoic acid, during euglycemic hyperinsulinemia. Tracer influx rate constants in skeletal muscle (MKi) and liver (LKi) were multiplied by plasma FFA levels to obtain FFA uptake for skeletal muscle (MFU) and liver (LFU), respectively.
RESULTS—Athletes showed increased Vo2max (P &lt; 0.0001), insulin-mediated glucose disposal (M value, 61 ± 4 vs. 46 ± 3 μmol · min−1 · kg−1, P = 0.01), and plasma lactate levels during the clamp and lower percentage of body fat mass (P = 0.002). MKi was 25% higher in athletes than in sedentary men (P = 0.03). In all subjects, MKi and MFU were positively correlated with the M value (r = 0.56, P = 0.02, and r = 0.51, P = 0.03, respectively) and with plasma lactate levels (r = 0.63, P = 0.006, and r = 0.63, P = 0.005, respectively). LKi was significantly reduced by 20% in the athletes (P = 0.04). By multiple regression, LFU was inversely correlated with the two fitness categories (P = 0.008), and it was lower in athletes. Linear fitting of liver data showed time consistency, indicating no release of FFAs as a mechanism for the reduced liver retention in athletes.
CONCLUSIONS—We conclude that endurance training promotes insulin-mediated glucose and FFA disposal in skeletal muscle, while lowering hepatic FFA uptake. Such changes may result in a divergent pattern of fat accumulation in the two organs.
Diabetes Research in the Department of Veterans Affairs
Authors: Reiber Gayle E. , Boyko Edward J. 
Published: March 2007

OBJECTIVE—To provide an overview of the Department of Veterans Affairs (VA) research activities, highlighting diabetes-related research.
RESEARCH DESIGN AND METHODS—Diabetes is an important component of the VA research portfolio. All four VA research services support aspects of diabetes research. VA diabetes research projects and funding were examined from 1998 to 2003.
RESULTS—VA scientists are conducting research on diabetes genetics, etiology, diagnosis, therapy, epidemiology, health services, and rehabilitation. VA research funding is available to answer important veteran-relevant questions through peer review, Center of Excellence activities, and multisite trial mechanisms. Many VA scientists also receive research support from nonfederal sources, including private corporations and nonprofit foundations. The VA Office of Research and Development actively supports training the next generation of researchers through their career development awards and the VA health profession training programs.
CONCLUSIONS—The VA’s diabetes research portfolio is extensive and includes many investigators, trainees, and fellows. There is substantial leveraging of VA diabetes research with support from other federal and nonfederal funding agencies, foundations, and private corporations. VA diabetes research findings benefit the global diabetes care community.
A Two-Center Randomized Controlled Feasibility Trial of Insulin Pump Therapy in Young Children With Diabetes
Authors: Wilson Darrell M. , Buckingham Bruce A. , Kunselman Elizabeth L. , Sullivan Mary M. , Paguntalan Helen U. , Gitelman Stephen E. 
Published: March 2007

OBJECTIVE—Our goals were to determine if continuous subcutaneous insulin infusion (CSII), compared with those continuing multiple daily injections (MDIs), can be safely used in young children, if those on CSII will have superior glycemic control, if subjects using CSII will have less hypoglycemia for their level of control, and if families using CSII will report an improved quality of life.
RESEARCH DESIGN AND METHODS—We conducted a randomized 1-year feasibility trial comparing CSII with continuing MDIs in preschool children with a history of type 1 diabetes for at least 6 months’ duration. Prospective outcomes included measures of overall glycemic control (HbA1c and continuous glucose monitoring system), the incidence of severe hypoglycemia and diabetic ketoacidosis, the percent of glucose values below 3.9 mmol/l, and the parents’ report of quality of life.
RESULTS—The 19 subjects’ ages ranged from 1.7 to 6.1 (mean 3.6) years, duration of diabetes ranged from 0.6 to 2.6 (mean 1.4) years, and baseline HbA1c ranged from 6.7 to 9.6% (mean 7.9%). Seven subjects were male. Nine subjects were randomized to start CSII and 10 to continue on MDI. All baseline characteristics were well balanced. Overall metabolic control, diabetes quality of life, and the incidence of hypoglycemia were similar in the two groups. No subject had diabetic ketoacidosis, while one subject in each group had an episode of severe hypoglycemia. No CSII subject discontinued using the pump during or after the study.
CONCLUSIONS—CSII can be a safe and effective method to deliver insulin in young children.
The Effect of Chronic Pain on Diabetes Patients’ Self-Management
Authors: Krein Sarah L. , Heisler Michele , Piette John D. , Makki Fatima , Kerr Eve A. 
Published: March 2007

OBJECTIVE—Many adults experience chronic pain, yet little is known about the consequences of such pain among individuals with diabetes. The purpose of this study was to examine whether and how chronic pain affects diabetes self-management.
RESEARCH DESIGN AND METHODS—This is a cross-sectional study of 993 patients with diabetes receiving care through the Department of Veterans Affairs (VA). Data on chronic pain, defined as pain present most of the time for 6 months or more during the past year, and diabetes self-management were collected through a written survey. Multivariable regression techniques were used to examine the association between the presence and severity of chronic pain and difficulty with diabetes self-management, adjusting for sociodemographic and other health characteristics including depression.
RESULTS—Approximately 60% of respondents reported chronic pain. Patients with chronic pain had poorer diabetes self-management overall (P = 0.002) and more difficulty following a recommended exercise plan (adjusted odds ratio [OR] 3.0 [95% CI 2.1–4.1]) and eating plan (1.6 [1.2–2.1]). Individuals with severe or very severe pain, compared with mild or moderate, reported significantly poorer diabetes self-management (P = 0.003), including greater difficulty with taking diabetes medications (2.0 [1.2–3.4]) and exercise (2.5 [1.3–5.0]).
CONCLUSIONS—Chronic pain was prevalent in this cohort of patients with diabetes. Even after controlling for general health status and depressive symptoms, chronic pain was a major limiting factor in the performance of self-care behaviors that are important for minimizing diabetes-related complications. Competing demands, such as chronic pain, should be considered when working with patients to develop effective diabetes self-care regimens.
An Endocrinologist-Supported Intervention Aimed at Providers Improves Diabetes Management in a Primary Care Site
Authors: Phillips Lawrence S. , Ziemer David C. , Doyle Joyce P. , Barnes Catherine S. , Kolm Paul , Branch William T. , Caudle Jane M. , Cook Curtiss B. , Dunbar Virginia G. , El-Kebbi Imad M. , Gallina Daniel L. , Hayes Risa P. , Miller Christopher D. , Rhee Mary K. , Thompson Dennis M. , Watkins Clyde 
Published: March 2007

OBJECTIVE—Management of diabetes is frequently suboptimal in primary care settings, where providers often fail to intensify therapy when glucose levels are high, a problem known as clinical inertia. We asked whether interventions targeting clinical inertia can improve outcomes.
RESEARCH DESIGN AND METHODS—A controlled trial over a 3-year period was conducted in a municipal hospital primary care clinic in a large academic medical center. We studied all patients (4,138) with type 2 diabetes who were seen in continuity clinics by 345 internal medicine residents and were randomized to be control subjects or to receive one of three interventions. Instead of consultative advice, the interventions were hard copy computerized reminders that provided patient-specific recommendations for management at the time of each patient’s visit, individual face-to-face feedback on performance for 5 min every 2 weeks, or both.
RESULTS—Over an average patient follow-up of 15 months within the intervention site, improvements in and final HbA1c (A1C) with feedback + reminders (ΔA1C 0.6%, final A1C 7.46%) were significantly better than control (ΔA1C 0.2%, final A1C 7.84%, P &lt; 0.02); changes were smaller with feedback only and reminders only (P = NS vs. control). Trends were similar but not significant with systolic blood pressure (sBP) and LDL cholesterol. Multivariable analysis showed that the feedback intervention independently facilitated attainment of American Diabetes Association goals for both A1C and sBP. Over a 2-year period, overall glycemic control improved in the intervention site but did not change in other primary care sites (final A1C 7.5 vs. 8.2%, P &lt; 0.001).
CONCLUSIONS—Feedback on performance aimed at overcoming clinical inertia and given to internal medicine resident primary care providers improves glycemic control. Partnering generalists with diabetes specialists may be important to enhance diabetes management in other primary care settings.
Metabolic Control of Diabetes Is Associated With an Improved Response of Diabetic Retinopathy to Panretinal Photocoagulation
Authors: Kotoula Maria G. , Koukoulis George N. , Zintzaras Elias , Karabatsas Constantinos H. , Chatzoulis Dimitrios Z. 
Published: March 2007

OBJECTIVE—To study the influence of glycemic control and the presence of microalbuminuria on the initial response to panretinal photocoagulation (PRP) in patients with a high-risk proliferative diabetic retinopathy (PDR).
RESEARCH DESIGN AND METHODS—This was a prospective cohort study with a two-by-two factorial design. We used full-scattered PRP to treat 115 eyes of type 2 diabetic patients who have high-risk PDR. HbA1c (A1C) and albumin levels in 24-h urine were constantly monitored during the preenrollment, treatment, and posttreatment periods. At a follow-up visit 12 weeks after the last PRP session, the fundus was examined for characteristics of regression from high-risk PDR and the response to PRP was determined to be successful or unsuccessful. The eyes were categorized into four groups based on average A1C levels and the presence or absence of microalbuminuria. The data were analyzed using a logistic regression model. Our statistical analysis determined the probability of achieving a satisfactory response to PRP in association with A1C levels and the presence or absence of microalbuminuria.
RESULTS—Of the 115 eyes examined, 65 (56.5%) had a successful initial response to PRP and 50 (43.5%) did not. The probability of a satisfactory response to PRP was related to A1C levels (P &lt; 0.05) but not to microalbuminuria and its interaction with hemoglobin glycosylation (P ≥ 0.05).
CONCLUSIONS—Low levels of hemoglobin glycosylation (A1C &lt;8%) during the pretreatment, treatment, and posttreatment periods are associated with a regression of proliferative diabetic retinopathy after PRP.
Comparison of the Effects of Vitamins and/or Mineral Supplementation on Glomerular and Tubular Dysfunction in Type 2 Diabetes
Authors: Farvid Maryam Sadat , Jalali Mahmoud , Siassi Fereydoun , Hosseini Mostafa 
Published: March 2007

OBJECTIVE—The present study was designed to assess the effect of magnesium plus zinc, vitamins C plus E, and a combination of these micronutrients on nephropathy indexes in type 2 diabetic patients.
RESEARCH DESIGN AND METHODS—In a randomized, double-blind, placebo-controlled clinical trial, 69 type 2 diabetic patients were randomly divided into four groups, each group receiving one of the following daily supplement for 3 months: group M (n = 16), 200 mg Mg and 30 mg Zn; group V (n = 18), 200 mg vitamin C and 100 IU vitamin E; group MV (n = 17), minerals plus vitamins; and group P (n = 18), placebo. Urinary albumin excretion and N-acetyl-β-d-glucosaminidase activity (NAG) in urine were determined at the beginning and at the end of the trial. Treatment effects were analyzed by general linear modeling.
RESULTS—Results indicate that after 3 months of supplementation, levels of urinary albumin excretion decreased in the V and MV groups (P = 0.034 and P = 0.005, respectively). Urinary NAG activity did not significantly change in any treatment groups. Levels of systolic, diastolic, and mean blood pressure significantly decreased in the MV group (P = 0.008, P = 0.017, and P = 0.009, respectively). Also, combination of vitamin and mineral supplementation had significant effects in decreasing fasting serum glucose (P = 0.035) and malondialdehyde concentrations (P = 0.004) and in increasing HDL cholesterol and apolipoprotein A1 levels (P = 0.019). There was no significant change in the levels of these parameters in the other three groups.
CONCLUSIONS—In conclusion, the results of the present study provide evidence for the effects of vitamins C and E and also combination of magnesium, zinc, and vitamins C and E supplementation on improvement of glomerular but not tubular renal function in type 2 diabetic patients.