bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and Effectiveness of Insulin Pump Therapy in Children and Adolescents With Type 1 Diabetes
Authors: Plotnick Leslie P. , Clark Loretta M. , Brancati Frederick L. , Erlinger Thomas 
Published: March 2007

OBJECTIVE—To evaluate the safety and effectiveness of insulin pump therapy in children and adolescents with type 1 diabetes.
RESEARCH DESIGN AND METHODS—All 95 patients who began insulin pump therapy at Johns Hopkins Hospital between January 1990 and December 2000 were included in the study. The mean age was 12.0 years (range 4–18), and 29% of the patients were &lt;10 years old. Data were obtained by chart review beginning 6–12 months before pump start. The median duration of follow-up was 28 months.
RESULTS—There was a small but significant decrease in HbA1c at 3–6 months after pump start (7.7 vs. 7.5%; P = 0.03). HbA1c levels then gradually increased and remained elevated after 1 year of follow-up; however, this association was confounded by age and diabetes duration, both of which were associated with higher HbA1c levels. After adjusting for duration and age, mean HbA1c after pump start was significantly lower than before pump start (7.7 vs. 8.1%; P &lt; 0.001). The number of medical complications (diabetic ketoacidosis, emergency department visits) was similar before and after pump start. There were fewer hypoglycemic events after pump start (12 vs. 17, rate ratio 0.46, 95% CI 0.21–1.01).
CONCLUSIONS—This study suggests that pump therapy is safe and effective in selected children and adolescents with type 1 diabetes.
Diabetes and Abnormal Glucose Tolerance in Women With Previous Gestational Diabetes
Authors: Albareda Mercè , Caballero Agueda , Badell Gemma , Piquer Sandra , Ortiz Angels , de Leiva Alberto , Corcoy Rosa 
Published: March 2007

OBJECTIVE—In Spanish women with gestational diabetes mellitus (GDM), we aimed to study the progression to diabetes and abnormal glucose tolerance (AGT) and identify predictive factors.
RESEARCH DESIGN AND METHODS—In 696 women with GDM and 70 control women, glucose tolerance was evaluated postpartum and at 5-year intervals.
RESULTS—In the GDM group, the cumulative risk for diabetes and AGT was 13.8 and 42.4% after 11 years compared with 0 and 2.8% in control women, respectively (P &lt; 0.05). Independent predictive factors for diabetes were previous hyperglycemia, four abnormal glucose values on the diagnostic oral glucose tolerance test (OGTT) or overt diabetes during pregnancy, 2-h blood glucose on the diagnostic OGTT ≥11.7 mmol/l, gestational age at diagnosis &lt;24 weeks, and prepregnancy BMI ≥26.4 kg/m2. All of these factors (some with different cutoff points) in addition to fasting glycemia were predictors of AGT also. The risk was nonlinear. Four abnormal glucose values on the diagnostic OGTT or overt diabetes during pregnancy was the strongest predictive factor for diabetes (relative risk 3.92), and prepregnancy BMI was the predictive factor with the highest attributable fraction in the whole group (13.3%). When first postpartum OGTT data were included in the analysis, predictors changed, but the overall prediction was similar.
CONCLUSIONS—Spanish women with GDM have an increased risk of diabetes and AGT. Predictive factors display a nonlinear relationship. The strongest predictive factor for diabetes was four abnormal glucose values on the diagnostic OGTT or overt diabetes during pregnancy; the factor with the highest attributable fraction in the whole group was prepregnancy BMI.
Extrapancreatic Autoimmune Manifestations in Type 1 Diabetes Patients and Their First-Degree Relatives
Authors: Hanukoglu Aaron , Mizrachi Avraam , Dalal Ilan , Admoni Osnat , Rakover Yardena , Bistritzer Zvy , Levine Arie , Somekh Eli , Lehmann Dan , Tuval Myriam , Boaz Mona , Golander Avraham 
Published: March 2007

OBJECTIVE—To investigate the prevalence of autoimmune diseases in young patients (probands) with type 1 diabetes and their first-degree relatives, and to determine the spectrum of extrapancreatic manifestations in these subjects.
RESEARCH DESIGN AND METHODS—The study population included 109 probands age 13 ± 4.9 years and 412 first-degree relatives age 28.7 ± 16.2 years. The prevalence rates of autoimmune thyroiditis and celiac disease were determined in all probands and in 100 of the 412 first-degree relatives. Control groups included 78 subjects age 14.9 ± 10.4 years for the prevalence of autoimmune thyroiditis and 120,000 youth ages 16–17 years for the prevalence of celiac disease. Thyroiditis and celiac disease were diagnosed by abnormally high thyroid peroxidase (TPO), thyroglobulin (TG), antigliadin, and antiendomysial antibody titers. Celiac was confirmed by biopsy. A questionnaire was used to interview probands and relatives to determine the spectrum of autoimmune manifestations.
RESULTS—The prevalence of autoimmune thyroiditis determined by high TPO and/or TG titers was 27 and 25% for probands and relatives, respectively. These rates were higher than those for control subjects (P &lt; 000.1). The prevalence of celiac disease among probands and screened relatives was 8.3 and 6%, respectively. These rates were higher than those for control subjects and the 312 family members interviewed only (0.1 and 0.3%, respectively; P &lt; 0.0001). Interviews of participants revealed a wide range of associated autoimmune diseases. The risk of developing an autoimmune disease was higher (P &lt; 0.001) in families with a proband who had an additional autoimmune manifestation.
CONCLUSIONS—Screening for autoimmune thyroiditis and celiac disease should be performed in patients with type 1 diabetes and their first-degree relatives, especially when the probands have an additional autoimmune manifestation.
Effects of Withdrawal From Metformin on the Development of Diabetes in the Diabetes Prevention Program
Authors:   The Diabetes Prevention Program Research Group
Published: March 2007

OBJECTIVE—In the Diabetes Prevention Program (DPP), metformin significantly reduced the risk of diabetes in individuals with impaired glucose tolerance. Diabetes status was assessed by oral glucose tolerance tests (OGTTs) performed while participants were still taking metformin or placebo. To determine whether the observed benefit was a transient pharmacological effect or more sustained, we performed a repeat OGTT after a short “washout” period during which medications (metformin or placebo) were withheld.
RESEARCH DESIGN AND METHODS—All participants assigned to medication who had not developed diabetes at the end of the DPP were asked to have a repeat OGTT after discontinuing the study medication for 1–2 weeks. The predesignated outcome was the odds of diabetes in metformin versus placebo comparisons during the trial and washout combined
RESULTS—There were 1,274 participants who participated in the washout study and 529 who did not because they had already developed diabetes. Before the washout, the odds of diabetes in the metformin group was lower than that in the placebo group (odds ratio 0.66, 95% CI 0.54–0.82, P &lt; 0.001). After the washout, diabetes was somewhat more frequently diagnosed in the metformin participants (1.49, 0.93–2.38, P = 0.098). Combining diabetes conversions during the DPP and during the washout, diabetes was diagnosed significantly less frequently in the metformin than the placebo group (0.75, 0.62–0.92, P = 0.005).
CONCLUSIONS—The primary analysis of the DPP demonstrated that metformin decreased the risk of diabetes by 31%. The washout study shows that 26% of this effect can be accounted for by a pharmacological effect of metformin that did not persist when the drug was stopped. After the washout the incidence of diabetes was still reduced by 25%.
Risk Factors for Diabetes in Familial Partial Lipodystrophy, Dunnigan Variety
Authors: Haque Wasim A. , Oral Elif Arioglu , Dietz Kelly , Bowcock Anne M. , Agarwal Anil K. , Garg Abhimanyu 
Published: March 2007

OBJECTIVES—Familial partial lipodystrophy, Dunnigan variety (FPLD), is an autosomal dominant disorder due to missense mutations in the lamin A/C (LMNA) gene encoding nuclear lamina proteins. It is characterized by loss of subcutaneous fat from the extremities and trunk and accumulation of fat in the head and neck region beginning at puberty. Patients with FPLD are predisposed to metabolic complications of insulin resistance such as diabetes. We sought to identify risk factors for diabetes in patients with FPLD.
RESEARCH DESIGN AND METHODS—A cross-sectional study comparing clinical, biochemical, and anthropometric variables and LMNA genotypes in FPLD patients with and without diabetes.
RESULTS—We studied 52 women and 24 men with FPLD from 18 different families. Twenty-eight women (54%) but only four men (17%) had diabetes (P &lt; 0.001); therefore further comparisons were mostly limited to women. Compared with women without diabetes, those with diabetes had higher BMI (median values 23 vs. 24 kg/m2, respectively; P = 0.03), increased chin skinfold thickness (10 vs. 20 mm; P = 0.001), lower rates of nulliparity (60% vs. 28%; P = 0.04), and higher levels of fasting serum triglycerides (2.4 vs. 3.5 mmol/l; P &lt; 0.001) but similar serum leptin levels (3.4 vs. 3.6 ng/ml; P = 0.9). The prevalence of diabetes was not related to age, menopausal status, family history of type 2 diabetes in unaffected relatives, or LMNA genotype.
CONCLUSIONS—We conclude that increased adiposity as reflected by excess subcutaneous fat accumulation in the chin region and parity may predispose women with FPLD to develop diabetes.
Audit on Stillbirths in Women With Pregestational Type 1 Diabetes
Authors: Lauenborg Jeannet , Mathiesen Elisabeth , Ovesen Per , Westergaard Jes G. , Ekbom Pia , Mølsted-Pedersen Lars , Damm Peter 
Published: March 2007

OBJECTIVE—To audit stillbirth cases in women with type 1 diabetes to search for specific characteristics in order to improve antenatal care and treatment
RESEARCH DESIGN AND METHODS—Retrospectively identified cases of stillbirths in women with type 1 diabetes during 1990–2000 were analyzed regarding characteristics of the mother, the pregnancy, glycemic control, and the stillborn. The cause of stillbirth was categorized as explainable, likely, or without obvious cause.
RESULTS—We found 22 women with 25 stillbirths among 1,361 singleton births by women with type 1 diabetes. In seven stillbirths the cause was categorized as explainable and in six as likely. In 12 cases no obvious cause was found; however, glycemic control was suboptimal in 9 of these cases. A total of 14 women reported daily smoking, and 10 of 19 with low education were unemployed.
CONCLUSIONS—Women experiencing stillbirth were characterized by a high incidence of suboptimal glycemic control, diabetic nephropathy, smoking, and low social status.
Stages of Change for Healthy Eating in Diabetes
Authors: Vallis Michael , Ruggiero Laurie , Greene Geoffrey , Jones Helen , Zinman Bernard , Rossi Susan , Edwards Lynn , Rossi Joseph S. , Prochaska James O. 
Published: March 2007

OBJECTIVES—To identify diabetes-related characteristics of individuals at different stages of readiness to change to healthy, low-fat eating.
RESEARCH DESIGN AND METHODS—Stage-based differences in demographic, eating-related, health care utilization, and psychosocial factors were examined in a sample of 768 overweight (BMI &gt;27 kg/m2) individuals with diabetes enrolled in a randomized behavioral intervention trial.
RESULTS—Stage-based differences occurred for type 1 diabetic participants on percent of calories from fat and number of daily vegetable servings. For type 2 diabetic participants, sex, disease-specific quality of life, percent calories from fat, and number of daily vegetables servings differed across stages. Those in action stages were more likely to be female and have a better quality of life and healthier eating habits. Type 2 diabetic insulin-requiring participants in action stages were more likely to be married. Social support was highest for those in the contemplation stage and lowest for those in the action stage. Type 2 diabetic participants on pills in the action stages were older, had a lower BMI, ate more fruit, were nonsmokers, recently attended diabetes education, had a better quality of life and social support, and had less stress. One anomalous finding for type 2 diabetic participants was that precontemplators scored similarly to those in action stages.
CONCLUSIONS—These data validate the Transtheoretical Model, where those in the action stages displayed healthier eating. They also indicate that demographic and psychosocial factors may mediate readiness to change diet. Precontemplators were a heterogeneous group and may need individually tailored interventions.
Evaluation of the Impact of Chiropodist Care in the Secondary Prevention of Foot Ulcerations in Diabetic Subjects
Authors: Plank Johannes , Haas Waltraud , Rakovac Ivo , Görzer Evelyn , Sommer Romana , Siebenhofer Andrea , Pieber Thomas R. 
Published: March 2007

OBJECTIVE—To evaluate the influence of regular chiropodist care on the recurrence rate of diabetic foot ulcers within 1 year.
RESEARCH DESIGN AND METHODS—Ninety-one diabetic outpatients with healed foot ulcers (age 65 ± 11 years, 40 women and 51 men, diabetes type 1 (n = 6) or 2 (n = 85), BMI 28.5 ± 4.4, diabetes duration 16 ± 11 years, HbA1c 8.4 ± 1.6%) were randomized to a group that received monthly remunerated routine chiropodist care (n = 47) or a control group (n = 44).
RESULTS—Within a median follow-up of 386 days, ulceration recurred in 18 patients in the chiropodist group and 25 patients in the control group (hazard ratio [HR] 0.60; 95% CI, 0.32, 1.08; P = 0.09). Analysis of ulceration per foot demonstrated a significant reduction (20 vs. 32 ulcerations; Cox relative risk [Cox RR] 0.52; 95% CI, 0.30, 0.93; P = 0.03) in favor of chiropodist care. Per protocol, analysis of patients who actually underwent chiropodist foot care on a regular basis also indicates the beneficial influence of chiropodist care with ulceration in 13 vs. 30 patients (HR, 0.53; 95% CI, 0.30–1.01; P = 0.05) and in 15 vs. 37 feet (Cox RR, 0.46; 95% CI, 0.24–0.90; P = 0.02) for the intervention and control groups, respectively. Minor amputation was required in two patients in the intervention group and one patient in the control group. Four patients in the control group and two patients in the intervention group died during the trial.
CONCLUSIONS—These data suggest that secondary preventive measures by a chiropodist may reduce recurrence of foot ulcers in diabetic patients.
A Simple Meal Plan Emphasizing Healthy Food Choices Is as Effective as an Exchange-Based Meal Plan for Urban African Americans With Type 2 Diabetes
Authors: Ziemer David C. , Berkowitz Kathy J. , Panayioto Rita M. , El-Kebbi Imad M. , Musey Victoria C. , Anderson Lynda A. , Wanko Nancy S. , Fowke Margaret L. , Brazier Carol W. , Dunbar Virginia G. , Slocum Wrenn , Bacha Gael M. , Gallina Daniel L. , Cook Curtiss B. , Phillips Lawrence S. 
Published: March 2007

OBJECTIVE—To compare a simple meal plan emphasizing healthy food choices with a traditional exchange-based meal plan in reducing HbA1c levels in urban African Americans with type 2 diabetes.
RESEARCH DESIGN AND METHODS—A total of 648 patients with type 2 diabetes were randomized to receive instruction in either a healthy food choices meal plan (HFC) or an exchange-based meal plan (EXCH) to compare the impact on glycemic control, weight loss, serum lipids, and blood pressure at 6 months of follow-up. Dietary practices were assessed with food frequency questionnaires.
RESULTS—At presentation, the HFC and EXCH groups were comparable in age (52 years), sex (65% women), weight (94 kg), BMI (33.5), duration of diabetes (4.8 years), fasting plasma glucose (10.5 mmol/l), and HbA1c (9.4%). Improvements in glycemic control over 6 months were significant (P &lt; 0.0001) but similar in both groups: HbA1c decreased from 9.7 to 7.8% with the HFC and from 9.6 to 7.7% with the EXCH. Improvements in HDL cholesterol and triglycerides were comparable in both groups, whereas other lipids and blood pressure were not altered. The HFC and EXCH groups exhibited similar improvement in dietary practices with respect to intake of fats and sugar sweetened foods. Among obese patients, average weight change, the percentage of patients losing weight, and the distribution of weight lost were comparable with the two approaches.
CONCLUSIONS—Medical nutrition therapy is effective in urban African Americans with type 2 diabetes. Either a meal plan emphasizing guidelines for healthy food choices or a low literacy exchange method is equally effective as a meal planning approach. Because the HFC meal plan may be easier to teach and easier for patients to understand, it may be preferable for low-literacy patient populations.
Two-Hour Insulin Determination Improves the Ability of Abdominal Fat Measurement to Identify Risk for the Metabolic Syndrome
Authors: Ribeiro-Filho Fernando F. , Faria Alessandra N. , Kohlmann Narcia E.B. , Zanella Maria-Teresa , Ferreira Sandra R.G. 
Published: March 2007

OBJECTIVE—Visceral obesity is shown to be a predictor of morbidity and mortality. We evaluated the association of measurements of generalized adiposity and visceral fat area (VFA), with abnormalities of metabolic syndrome (MS).
RESEARCH DESIGN AND METHODS—Seventy-six women (47.9 ± 9.2 years) with BMI of 38.7 ± 5.4 kg/m2 underwent anthropometric measurements, laboratory procedures, bioeletrical impedance, and abdominal computed tomography (CT) scan. Diagnosis of MS was based on the presence of abdominal obesity and at least two of the following components: hypertension, dyslipidemia, and glucose intolerance and/or hyperinsulinemia.
RESULTS—BMI was correlated with both components of adipose tissue—subcutaneous (r = 0.66, P &lt; 0.01) and VFA (r = 0.33, P &lt; 0.02)—and leptin levels (r = 0.38, P &lt; 0.01). In contrast, VFA was correlated with 2-h glucose and insulin levels (r = 0.32 and 0.35, P &lt; 0.05, respectively), triglyceride, HDL cholesterol, and uric acid (r = 0.33, −0.34 and 0.24, P &lt; 0.05, respectively). Subjects with high VFA, matched for BMI, showed greater plasma glucose area under the curve (621 ± 127 vs. 558 ± 129 mg · h−1 · dl−1, P &lt; 0.05), 2-h insulin (804 ± 599 vs. 579 ± 347 pmol/l, P &lt; 0.05), and uric acid levels (0.33 ± 0.07 vs. 0.26 ± 0.06 mmol/l, P &lt; 0.05) than subjects with low VFA. In logistic regression analysis, waist circumference, VFA, and 2-h insulin were identified as independent predictors of MS. Receiver operating characteristic curve analysis pointed out the values of 104 cm for waist circumference (58.1% specificity, 84.1% sensitivity), 158.5 cm2 for VFA (78.1% specificity, 52.3% sensitivity), and 559.8 pmol/l for 2-h insulin (71.9% specificity, 69.8% sensitivity); the presence of at least two of the three variables resulted in a degree of concordance of 76%.
CONCLUSIONS—While BMI was unable to differentiate between obese people and those at higher risk for MS, abdominal fat was shown to be associated with its metabolic abnormalities. The usefulness of abdominal fat in the identification of high-risk subjects may be improved when combined with 2-h insulin determination.
Recent Antihyperglycemic Prescribing Trends for U.S. Privately Insured Patients With Type 2 Diabetes
Authors: Cohen Fredric J. , Neslusan Cheryl A. , Conklin Jonathan E. , Song Xue 
Published: March 2007

OBJECTIVE—The mid-1990s witnessed the introduction of new classes of medications to treat hyperglycemia of type 2 diabetes. There is evidence that these newer classes have found a place in the therapeutic armamentarium, but details of their use patterns are not known. We sought to determine whether antihyperglycemic prescribing patterns changed concurrently with new drug introductions, and whether such changes were related to changes in the underlying patient population.
RESEARCH DESIGN AND METHODS—A sample of U.S. privately insured patients with suspected type 2 diabetes was identified from the MarketScan Research Database over the period of 1997–2000. Patients with type 2 diabetes were identified among those continuously enrolled in the database for at least 1 year. Drug therapy episodes were defined by sequential fulfillment of prescriptions implying a continuous supply of a particular drug (or combination) of at least 30 days duration. Univariate analyses were used to explore trends over time in drug prescriptions and patient characteristics. Multivariate logistic regressions were used to isolate the impact of year from other variables on the likelihood of receiving prescriptions for a specific therapy.
RESULTS—A total of 232,020 unique diabetic patients had an average of 1.91 diabetes drug therapy episodes between 1997 and 2000. Monotherapy with sulfonylureas decreased, but monotherapy with thiazolidinedione, metformin, and other oral antihyperglycemics increased over time. Combinations of sulfonylureas and metformin; sulfonylureas and thiazolidinedione; metformin and thiazolidinedione; and sulfonylureas, metformin, and thiazolidinedione each increased over the time interval. Insulin monotherapy decreased, as did insulin combination therapy with sulfonylureas. The combination of insulin and metformin increased, whereas insulin and thiazolidinedione was stable. The influence of year on prescribing patterns remained highly significant (P &lt; 0.001) after adjusting for patient characteristics.
CONCLUSIONS—Antihyperglycemic prescription patterns in the U.S. have changed in recent years in parallel with, and probably as a direct result of, the introduction of different classes of medications to the marketplace. Overall, the prescribing trend has been away from monotherapy with insulins and sulfonylureas and toward combination therapies, presumably in attempts to reduce hypoglycemic symptoms and to achieve better glucose control.
Maternal and Fetal Outcomes if Gestational Impaired Glucose Tolerance Is Not Treated
Authors: Östlund Ingrid , Hanson Ulf , Björklund Anders , Hjertberg Ragnhild , Eva Nord , Nordlander Elisabeth , Marja-Liisa Swahn , Wager Jan 
Published: March 2007

OBJECTIVE—To evaluate whether there is increased maternal or neonatal morbidity in connection with impaired glucose tolerance (IGT) during pregnancy when the condition is not treated.
RESEARCH DESIGN AND METHODS—During the study period of 1997–2001, in a defined geographical area in Sweden, the diagnostic criteria for gestational diabetes mellitus (GDM) were limited to the criteria for diabetes. Prospectively, 213 women who were identified with IGT during pregnancy were undiagnosed and untreated. Data on maternal and fetal outcome was collected from records. For each case subject, four control subjects were taken from the same delivery department.
RESULTS—The proportion of women who underwent cesarean section was significantly higher in the case subjects than in the control subjects and was independently associated with IGT. The adjusted odds ratio (OR) was 1.9 (95% CI 1.2–2.9). The proportion of infants who were large for gestational age (LGA), defined as birth weight &gt;2 SDs greater than the mean for gestation and sex, was independently significantly associated with untreated IGT during pregnancy (OR 7.3, 95% CI 4.1–12.7). Admission to a neonatal intensive care unit (NICU) for 2 days or longer was more common (adjusted OR 2.0, 95% CI 1.1–3.8). However, 71.3% of the children in the IGT group and 87.3% of the control subjects had no neonatal complications.
CONCLUSIONS—There is increased independent association between cesarean section rate, prematurity, LGA, and macrosomic infants born to mothers with untreated IGT. Most of the children were healthy, but there is still increased morbidity. Therefore, to evaluate the effects of treatment, there is a need for a randomized study.