bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Practical Two-Step Quantitative Clinical and Electrophysiological Assessment for the Diagnosis and Staging of Diabetic Neuropathy
Authors: Feldman Eva L , Stevens M J , Thomas P K , Brown M B , Canal N , Greene D A 
Published: March 2007

OBJECTIVE
Early diagnosis of distal symmetric sensorimotor polyneuropathy, a common complication of diabetes, may decrease patient morbidity by allowing for potential therapeutic interventions. We have designed an outpatient program to facilitate diagnosis of diabetic neuropathy.

RESEARCH DESIGN AND METHODS
Patients are initially administered a brief questionnaire and screening examination, designated the Michigan Neuropathy Screening Instrument (MNSI). Diabetic neuropathy is confirmed in patients with a positive assessment by a quantitative neurological examination coupled with nerve conduction studies, designated the Michigan Diabetic Neuropathy Score (MDNS). In this study, 56 outpatients with confirmed type I or II diabetes were administered the standardized quantitative components required to diagnose and stage diabetic neuropathy according to the San Antonio Consensus Statement (1) and the Mayo Clinic protocol (2). These same patients were then assessed with the MNSI and the MDNS.

RESULTS
Of 29 patients with a clinical MNSI score &gt; 2, 28 had neuropathy. Twenty-eight patients with an MDNS of ≥ 7 had neuropathy, while 21 non-neuropathic patients had a score ≤ 6. Of 35 patients with diabetic neuropathy, 34 had ≥ 2 abnormal nerve conductions. Twenty-one normal patients and one patient with neuropathy had ≤ 1 abnormal nerve conduction.

CONCLUSIONS
The results indicate that the MNSI is a good screening tool for diabetic neuropathy and that the MDNS coupled with nerve conductions provides a simple means to confirm this diagnosis.
Intraperitoneal Insulin Delivery Decreases the Levels of Chylomicron Remnants in Patients With IDDM
Authors: Georgopoulos Angeliki , Saudek Christopher D 
Published: March 2007

OBJECTIVE
To investigate whether intraperitoneal insulin (IPII) decreases the levels of circulating chylomicron remnants in patients with insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS
Eight nonobese, normolipidemic IDDM patients were studied twice: before (while on subcutaneous insulin) and 6 months after initiation of IPII by a programmable implanted medication system. Fasting and mean blood glucose, HbA1, and lipid values were determined. Blood samples were also drawn before and every 2 h for 10 h after ingestion of a fat meal (corn oil + Vitamin A). Triglycerides (TGs), apolipoprotein B (apoB), and retinyl esters were determined over time in two TG-rich lipoprotein subfractions (Sf &gt; 100 and Sf20−100) isolated from plasma by density-gradient ultracentrifugation.

RESULTS
IPII slightly decreased the mean blood glucose from 7.8 ± 1.1 to 7.4 ± 1.1 mmol/l (mean ± SD, P = 0.027, paired Student's t test) and the HbA1 from 9.4 ± 1.5 to 8.7 ± 1.2 (NS). TG and apoB levels in postprandial Sf &gt; 100 and Sf20–100 were not changed by IPII. On IPII, however, retinyl ester levels in Sf &gt; 100 decreased (P = 0.05, analysis of variance [ANOVA]) and tended to be lower in Sf20–100 (P = 0.075). In addition, following IPII, the retinyl ester:apoB ratio was lower in Sf &gt; 100 (P = 0.0002) and marginally lower (P = 0.06) in Sf 20–100.

CONCLUSIONS
IPII decreased chylomicron remnant levels, which might decrease the atherosclerotic risk in IDDM. Since glycemic control was only slightly improved, the effect was most likely due to the intraperitoneal route of delivery.
Human Leukocyte Antigen Class II Polymorphisms and Genetic Susceptibility of IDDM in Egyptian Children
Authors: Gaber Samir A , Mazzola Gina , Berrino Monica , Canale Lorena , Cornaglia Maura , Ghali Isis , Curtoni Emilio Sergio , Amoroso Antonio 
Published: March 2007

OBJECTIVE
To analyze the association between human leukocyte antigen (HLA) and insulin-dependent diabetes mellitus (IDDM) in the Egyptian population for the first time and, thus, to determine the frequency of risk-associated alleles identified by a genomic HLA class II typing. Egyptians are genetically classified as North Africans and considered to be between Caucasoids and Africans (closer to Caucasoids).

RESEARCH DESIGN AND METHODS
HLA class II typing was performed for 50 IDDM patients and 50 healthy control subjects by a restriction fragment-length polymorphism (RFLP) technique. The analysis of position 57 of the DQB1 molecules was conducted by polymerase chain reaction and specific sequence oligonucleotide hybridization.

RESULTS
The frequency of DRB1*0301-DRB3*0201-DQA1*0501-DQB1*0201 haplotype was 43.9% in the IDDM patients and 7.1% in the control subjects (P &lt; 0.00001), reflecting the increased prevalence of DQA1*0501 susceptibility allele coding for arginine (Arg) in position 52 and DQB1*0201 susceptibility allele non-coding aspartic acid (Asp) at position 57. Alleles DQB1*0601 and 0603, both carrying Asp at position 57 of the β-chain, and DQA1*0103, encoding a non-Arg 52 alpha-chain, were significantly decreased among the IDDM patients. The presence of four susceptibility residues (two DQA1 Arg 52+ and two DQB1 Asp 57−) conferred the highest relative risk at 20.2. On the other hand, homozygous genotypes for DQA1 non-Arg 52 and DQB1 Asp 57 were found only in the control group.

CONCLUSIONS
IDDM susceptibility and resistance in the Egyptian population is strongly associated with the expressed DQ α- and β-heterodimers in a dose-effective manner, as already defined in many different ethnic groups.
Beneficial Effect of Chromium Supplementation on Serum Triglyceride Levels in NIDDM
Authors: Lee Nancy A , Reasner Charles A 
Published: March 2007

OBJECTIVE
To investigate the effect of chromium picolinate supplementation on the lipid profile of the predominantly Hispanic population of non-insulin-dependent diabetes mellitus (NIDDM) patients in San Antonio, Texas.

RESEARCH DESIGN AND METHODS
A prospective, double-blind, placebo-controlled, crossover study was performed on 14 men and 16 women. Initially, each patient was randomly assigned to receive either chromium picolinate or placebo for 2 months. This initial treatment phase was followed by a 2-month washout period. Subjects were then crossed-over and received the alternate capsule for an additional 2 months. Fasting blood glucose, HbA1c, and serum lipids were compared at the end of each treatment phase.

RESULTS
Twenty-eight of the originally enrolled 30 patients completed the study. There were no adverse reactions to chromium reported. There were no differences noted between the control and chromium-treated subjects in glucose control, high-density lipoprotein cholesterol levels, or low-density lipoprotein cholesterol levels. Triglyceride (TG) levels were reduced significantly (17.4%; P &lt; 0.05) during the 2 months of chromium supplementation.

CONCLUSIONS
Ours is the first report of a significant reduction in serum TGs in a group of NIDDM patients treated with chromium. The low cost and excellent safety profile of chromium make it an attractive lipid-lowering agent for this population. Long-term studies are needed to determine if the short-term changes in plasma lipids can be sustained.
Lower Prevalence of Impaired Glucose Tolerance and Diabetes Associated With Daily Seal Oil or Salmon Consumption among Alaska Natives
Authors: Adler Amanda I , Boyko Edward J , Schraer Cynthia D , Murphy Neil J 
Published: March 2007

OBJECTIVE
To examine the association of seal oil and salmon consumption with impaired glucose tolerance (IGT) and non-insulin-dependent diabetes mellitus (NIDDM) among Alaska Natives.

RESEARCH DESIGN AND METHODS
Screening was performed on 666 Yup'ik Eskimos and Athabaskan Indians ≥40 years old in 15 villages. Self-administered questionnaires were used to obtain partial food frequency data. A case was defined as IGT or NIDDM, either newly discovered or known. Newly discovered cases (11 patients with NIDDM and 17 with IGT) were determined by random blood glucose testing followed by a 2-h 75-g oral glucose tolerance test (OGTT) for those with values ≥ 6.72 mmol/l or for subjects with unconfirmed histories of glucose intolerance. Known cases included 26 patients with NIDDM and 1 with IGT. Control subjects had random blood glucoses &lt;6.72 or normal OGTT results.

RESULTS
Compared with less-than-daily consumption, both daily seal oil (odds ratio [OR] 0.2, 95% confidence interval [CI] 0.1–0.8) and daily salmon consumption (OR 0.5, CI 0.2–1.1) were associated with a lower prevalence of glucose intolerance, controlling for age, ethnicity, body mass index, and sex. The effects were similar when limited to newly discovered cases: OR 0.3, CI 0.1–1.3 for seal oil and OR 0.4, CI 0.1–1.3 for salmon. Consumption of seal oil at least five times per week was required to reduce risk.

CONCLUSIONS
Consumption of seal oil and salmon, high in ω-3 fatty acids, appears to lower the risk of glucose intolerance and is a potentially modifiable risk factor for NIDDM in Alaska Natives.
Light-to-Moderate Alcohol Intake Is Associated With Enhanced Insulin Sensitivity
Authors: Facchini Francesco , Ida Chen Y-D , Reaven Gerald M 
Published: March 2007

OBJECTIVE
To test the hypothesis that insulin-mediated glucose uptake is enhanced in light-to-moderate alcohol consumption.

RESEARCH DESIGN AND METHODS
This is a case-control study of healthy volunteers, divided into nondrinkers and light-to-moderate drinkers based on their history of alcohol consumption. The study was performed at the General Clinical Research Center at Stanford University Medical Center and involved 40 volunteers, 20 men and 20 women. Measurements were made of the plasma glucose and insulin responses to an oral glucose challenge, fasting plasma lipid and lipoprotein concentrations, and steady-state plasma insulin (SSPI) and steady-state plasma glucose (SSPG) concentrations in response to a continuous infusion of somatostatin, insulin, and glucose.

RESULTS
Light-to-moderate drinkers (10-30 g/day) had lower integrated plasma glucose (17.8 ± 0.8 vs. 19.8 ± 0.9 mM/h, P &lt; 0.02) and insulin (600 ± 65 vs. 1,075 ± 160 pM/h, P &lt; 0.01) responses to the glucose challenge and higher fasting plasma high-density lipoprotein (HDL) cholesterol concentrations (1.46 ± 0.08 vs. 1.25 ± 0.08, P ± 0.02). Despite similar SSPI concentrations of ∼300 pM, SSPG concentrations were lower (P ± 0.01) in light-to-moderate drinkers (6.7 ± 0.8 vs. 10.7 ± 1.2 mM). Results were independent of age, body mass index, ratio of waist-to-hip girth, and estimates of level of habitual physical activity.

CONCLUSIONS
Light-to-moderate alcohol consumption in healthy men and women is associated with enhanced insulin-mediated glucose uptake, lower plasma glucose and insulin concentrations in response to oral glucose, and a higher HDLcholesterol concentration. The changes in glucose and insulin metabolism may contribute to the lower risk of coronary heart disease described in light-to-moderate drinkers.
Detection of Early Sympathetic Cardiovascular Neuropathy by Squatting Test in NIDDM
Authors: Marfella Raffaele , Salvatore Teresa , Glugliano Dario , Maro Giosue Di , Giunta Riccardo , Torella Roberto , Juchmes Jacques , Scheen Andre , Lefebvre Pierre J 
Published: March 2007

OBJECTIVE
To determine the role of the squatting test in the detection of early sympathetic neuropathy in patients with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS
Three groups of nonsmoking, nonobese subjects were studied: 10 healthy subjects, 10 NIDDM patients without autonomic neuropathy (AN), and 10 NIDDM patients with AN defined by the presence of a pathological deep-breathing value. All subjects were given three postural tests: lying-to-standing, sitting-to-standing, and squatting test. Heart rate (HR) and finger arterial pressure were recorded with a noninvasive technique.

RESULTS
Blood pressure (BP) fall (expressed as decremental area) was not significantly different among the groups at standing up after sitting or lying. By contrast, a significantly greater BP drop occurred in NIDDM patients with AN (1,123 ± 245 mm2) compared with NIDDM patients without AN (460 ± 232 mm2) or normal subjects (429 ± 138 mm2, P &lt; 0.001). The HR increase after all the orthostatic maneuvers was smaller in diabetic patients with AN (P &lt; 0.01) compared with that recorded in other groups. Significant correlations were observed between BP fall after squatting and either the expiration:inspiration ratio at deep breathing (r = -0.77, P &lt; 0.001) or the duration of diabetes (r = 0.76, P &lt; 0.001).

CONCLUSIONS
The intrinsic orthostatic load of the squatting test, which is greater than conventional postural maneuvers, makes the squatting test an easy and useful test to detect early orthostatic dysregulation in NIDDM.
Use of Fetal Ultrasound to Select Metabolic Therapy for Pregnancies Complicated by Mild Gestational Diabetes
Authors: Buchanan Thomas A , Kjos Siri L , Montoro Martin N , Wu Paul Y K , Madrilejo Nelson G , Gonzalez Martha , Nunez Victoria , Pantoja Patricia M , Xiang Anny 
Published: March 2007

OBJECTIVE
To determine whether fetal ultrasound early in the third trimester can identify Latina with mild gestational diabetes mellitus (GDM) whose fetuses are at risk for macrosomia and, if so, whether maternal insulin therapy can reduce that risk.

RESEARCH DESIGN AND METHODS
Study subjects included 303 consecutive women with GDM and a fasting serum glucose level &lt;5.8 mM on diet therapy who had a fetal ultrasound between 29 and 33 weeks gestation. Of the women, 98 (32%) had a fetal AC ≥ 75th percentile for gestational age, and 59 women completed a randomized trial of diet therapy (n = 29) or diet plus twice daily insulin (n = 30). Maternal nutrient levels were assessed by meal tolerance testing (MTT) before and during therapy and by capillary glucose monitoring four to seven times a day. Birth weights corrected for gestational age and neonatal glycemia and skin folds were the primary outcome variables compared between treatment groups.

RESULTS
Diet and diet-plus-insulin groups were well matched for maternal age, prepregnancy relative weight, weight gain during pregnancy, and glycemia at entry. Insulin therapy reduced maternal capillary (P &lt; 0.005) and MTT (P &lt; 0.001) glucose levels and prevented a diet-associated rise in MTT triglyceride levels (P &lt; 0.002). Gestational age at delivery was similar in insulin- and diet-treated groups (39.6 ± 0.2 vs. 39.5 ± 0.2 weeks). Birth weights (3,647 ± 67 vs. 3,878 ± 84 g; P &lt; 0.02), the prevalence of large-for-gestational age infants (13 vs. 45%, P &lt; 0.02), and neonatal skin-fold measurements at three sites (P &lt; 0.005) were reduced in the insulin-treated group. Rates of transient neonatal hypoglycemia were low in both treatment groups (14 and 18%, respectively) and didnot differ significantly between groups.

CONCLUSIONS
Fetal ultrasound early in the third trimester identified women with mild GDM whose infants were at high risk for fetal macrosomia in the absence of standard glycemic criteria for insulin therapy. Insulin treatment reduced the macrosomia, indicating that fetal ultrasound can be used to guide metabolic therapy in pregnancies complicated by mild GDM.
The Health and Functional Status of Veterans With Diabetes
Authors: Ahroni Jessie H , Boyko Edward J , Davignon Denise R , Pecoraro Roger E 
Published: March 2007

OBJECTIVE
To determine the extent of functional impairment among veterans with diabetes and investigate whether such functional impairment is associated with measures of glycemic control, sensory neuropathy, lower extremity macrovascular disease, or other comorbid conditions.

RESEARCH DESIGN AND METHODS
A 20-item general health survey (SF-20) developed by the Medical Outcomes Study (MOS) Group, was administered to 577 subjects participating in a prospective study of risk factors for diabetic foot ulceration. Measures of glycemic control and neurovascular disease included GHb, sensory lower extremity neuropathy assessed by aesthesiometry, and segmental lower extremity doppler blood pressures.

RESULTS
Veterans with diabetes have major decreases in all domains of functional status; 87% were in poor health in terms of physical functioning and 86% in terms of health perceptions. Those with advancing age, symptoms of neuropathy and claudication, and a medical history of complications associated with diabetes had significantly more impairment of health status than those without. GHb values did not correlate with functional status measures. Subjects with neuropathy had statistically significant functional impairment. Subjects with vasculopathy had only two significantly low health status measures.

CONCLUSIONS
In summary, the findings from this survey reveal that veterans with diabetes have low functional status scores. The presence of symptoms and complications accounts for only part of the impairments experienced by this group.
Testosterone Concentrations in Women and Men With NIDDM
Authors: Andersson Björn , Märin Per , Lissner Lauren , Vermeulen Alex , Björntorp Per 
Published: March 2007

OBJECTIVE
To evaluate androgen concentrations in relation to insulin resistance in men and women with and without NIDDM. Recent studies have indicated the potential importance of the regulation of insulin sensitivity by androgens in both women and men. Low sex hormone binding globulin (SHBG) concentration is an independent risk factor for the development of non-insulin-dependent diabetes mellitus (NIDDM) in women and is strongly associated statistically with signs of insulin resistance.

RESEARCH DESIGN AND METHODS
We compared measurements of anthropometric variables and SHBG, steroid hormone, and insulin concentrations of women and men who have NIDDM with those of control subjects.

RESULTS
Women with NIDDM had somewhat higher plasma insulin concentrations, lower SHBG, and higher free testosterone values than did control subjects with similar body mass index (BMI). Women with NIDDM had marginally higher waist-to-hip ratios (WHR). Plasma insulin concentrations correlated positively with BMI, WHR, and free testosterone and negatively with SHBG. In multivariate analyses, insulin concentrations remained positively associated with BMI and free testosterone. Men with NIDDM had higher fasting plasma insulin concentrations than did the nondiabetic control subjects. Testosterone and SHBG were lower in the diabetic men than in both control groups. The derived value of free testosterone was not different between groups. Univariate correlation analyses revealed tight statistical couplings between plasma insulin on the one hand and SHBG and testosterone concentrations (negative) on the other. In multivariate analyses, only the insulin-testosterone association remained.

CONCLUSIONS
Women with NIDDM have high levels of free testosterone and low levels of SHBG. Insulin resistance is closely correlated with these signs of hyperandrogenicity as well as with obesity. Men with NIDDM also have low levels of SHBG and, in contrast to women, low testosterone values. Insulin values correlate negatively with these hormonal factors. Based on the results of experimental work and intervention studies, we suggest that these androgen abnormalities might be causally related to insulin resistance in NIDDM.
Variability of Urinary Albumin Excretion in Patients With Microalbuminuria
Authors: Phillipou George , Phillips Patrick J 
Published: March 2007

OBJECTIVE
To estimate the within-person variability (SDi) for the overnight urinary albumin excretion rate (AER) in diabetic patients with persistent microalbuminuria.

RESEARCH DESIGN AND METHODS
Thirteen normotensive diabetic patients in stable medical control, with normal renal function and without any associated cardiovascular or other clinical disorders, collected overnight urines at monthly intervals during one year. AER was determined by radioimmunoassay.

RESULTS
Analysis of individual series of AER showed a significant trend (P ≤ 0.01) in three cases. The remaining patients (eight men, two women; seven with insulin-dependent diabetes mellitus) had a median mean AER 102 μg/min (range 30–238 μg/min). Because the individual mean AERs were significantly associated with their respective SDiS, the data was loge transformed. Log2SDi was estimated as 0.420, and its 90% probability range (0.353–0.490) was calculated using the bootstrap method.

CONCLUSIONS
The high within-person variance for AER means that only people with an initial AER in the range of 53–76 μg/min have a high probability (P ≥ 0.95) of being classified as microalbuminuric (20–200 μg/min) on a subsequent specimen. However, subjects with an initial AER ≥53 or ≥80 μg/min have a 95 and 99% probability of persistent microalbuminuria. The large variability of AER limits its potential as a serial marker to detect any gradual deterioration of established renal dysfunction.
Accuracy of Plasma Glucose Measurements in the Hypoglycemic Range
Authors: Genter Pauline M , Ipp Eli 
Published: March 2007

OBJECTIVE
This study was designed to evaluate three different enzymatic methods for glucose measurement in plasma samples with special emphasis on glucose concentrations in the hypoglycemic range.

RESEARCH DESIGN AND METHODS
Glucose dehydrogenase (Hemo- Cue analyzer), glucose oxidase (YSI analyzer), and hexokinase (Abbott analyzer) methods were used to measure plasma samples that were obtained during research studies.

RESULTS
Mean glucose concentrations (n = 240) were 5.3 ± 0.2, 5.4 ± 0.2, and 5.6 ± 0.2 mM (95.6 ± 3.9, 96.7 ± 3.9, and 101.6 ± 4.0 mg/dl) using glucose dehydrogenase, glucose oxidase, and hexokinase, respectively (NS). In the hypoglycemic range, mean glucose concentrations with each method retained the same hierarchy of measurements: 2.7 ± 0.05, 2.8 ± 0.04, and 2.9 ± 0.03 mM (48.4 ± 0.9, 50.6 ± 0.8, and 52.3 ± 0.6 mg/dl) by glucose dehydrogenase, glucose oxidase, and hexokinase, respectively (P &lt; 0.005). Individual glucose dehydrogenase measurements (n = 240) correlated well with glucose oxidase and hexokinase, r = 0.99, and were considerably easier to perform at the bedside. The differences between the glucose measurement methods were consistent and similar in low, normal, and high concentration ranges.

CONCLUSIONS
We conclude that any interpretation or comparison of critical clinical and research measurements of glucose in different settings take into account methodological differences, particularly in the hypoglycemic range.
Increasing Incidence of Type I Diabetes in The Netherlands: The second nationwide study among children under 20 years of age
Authors: Ruwaard Dirk , Hirasing Remy A , Reeser H Maarten , Buuren Stef Van , Bakker Karel , Heine Rob J , Geerdink Rolf A , Bruining G Jan , Vaandrager Gerrit J , Verloove-Vanhorick S Pauline 
Published: March 2007

OBJECTIVE
A nationwide retrospective study was conducted to assess the incidence of type I diabetes in The Netherlands among children &lt;20 years of age in 1988–1990. The first study with a similar design covered 1978–1980.

RESEARCH DESIGN AND METHODS
The capture recapture census method was chosen for analysis of the data. A questionnaire was sent to all Dutch pediatricians and internists, and for the ascertainment, a similar questionnaire was sent out separately to members of the Dutch Diabetes Association, which is the national patient association.

RESULTS
The average achieved ascertainment rate was 81%. The ascertainmentadjusted annual incidence was 13.2/100,000 for 0- to 19-year-old children, indicating an increase of 23% compared with the 1978–1980 survey; for 0- to 14-year-olds, the increase amounted to 17%.

CONCLUSIONS
This study suggests a sustained increase of type I diabetes in The Netherlands because the cumulative incidence studied previously in the 1960–1970 birth cohorts of male army conscripts 18 years of age was also found to rise. In contrast to Northern European countries, an increase in incidence for the age category 0–4 years could not be found.