bluuebunny/crossref_metadata_2025_split huggingface dataset:
Racial and Ethnic Differences in Health Care Access and Health Outcomes for Adults With Type 2 Diabetes
Authors: Harris Maureen I. 
Published: March 2007

OBJECTIVE—To evaluate health care access and utilization and health status and outcomes for type 2 diabetic patients according to race and ethnicity and to determine whether health status is influenced by health care access and utilization.
RESEARCH DESIGN AND METHODS—National samples of Caucasians, African-Americans, and Mexican-Americans were studied in the third National Health and Nutrition Examination Survey. Information on medical history and treatment of diabetes, health care access and utilization, and health status and outcomes was obtained by structured questionnaires and by clinical and laboratory assessments.
RESULTS—Almost all patients in each race and ethnic group had one primary source of ambulatory medical care (92–97%), saw one physician at this source (83–92%), and had at least semiannual physician visits (83–90%). Almost all patients ≥65 years of age had health insurance (99–100%), and for those patients &lt;65 years of age, Caucasians (91%) and African-Americans (89%) had higher rates of coverage than Mexican-Americans (66%). Rates of treatment with insulin or oral agents (71–78%), eye examination in the previous year (61–70%), blood pressure check in the previous 6 months (83–89%), and the proportion of hypertension that was diagnosed (84–91%) were similar for each race and ethnic group. Lower proportions of African-Americans and Mexican-Americans self-monitored their blood glucose (insulin-treated, 27 vs. 44% of Caucasians), had their cholesterol checked (62–68 vs. 81%), and had their dyslipidemia diagnosed (45 vs. 58%). African-American and Mexican-American patients had a somewhat higher proportion than Caucasian patients, with HbA1c ≥7% (58–66 vs. 55%), blood pressure ≥140/90 mmHg among those with diagnosed hypertension (60–65 vs. 55%), and clinical proteinuria (11–14 vs. 5%). In contrast, they had better levels of total cholesterol (≥240 mg/dl) (28–30 vs. 34%) and HDL cholesterol (≥45 mg/dl) (46–59 vs. 38%), and African-American and Mexican-American men were less overweight than Caucasian men (BMI ≥30) (34–37 vs. 44%), although the opposite was true for women. LDL cholesterol levels and the proportion of patients who smoked cigarettes or were hospitalized in the past year were similar among all three groups. In logistic regression analysis, there was little evidence that levels of blood glucose, blood pressure, lipids, or albuminuria were associated with access to or utilization of health care or with socioeconomic status.
CONCLUSIONS—There are some differences by race and ethnicity in health care access and utilization and in health status and outcomes for adults with type 2 diabetes. However, the magnitude of these differences pale in comparison with the suboptimal health status of all three race and ethnic groups relative to established treatment goals. Health status does not appear to be influenced by access to health care.
Diagnosing Insulin Resistance in the General Population
Authors: McAuley Kirsten A. , Williams Sheila M. , Mann Jim I. , Walker Robert J. , Lewis-Barned Nick J. , Temple Lara A. , Duncan Ashley W. 
Published: March 2007

OBJECTIVE—Difficulties in measuring insulin sensitivity prevent the identification of insulin-resistant individuals in the general population. Therefore, we compared fasting insulin, homeostasis model assessment (HOMA), insulin-to-glucose ratio, Bennett index, and a score based on weighted combinations of fasting insulin, BMI, and fasting triglycerides with the euglycemic insulin clamp to determine the most appropriate method for assessing insulin resistance in the general population.
RESEARCH DESIGN AND METHODS—Family history of diabetes, BMI, blood pressure, waist and hip circumference, fasting lipids, glucose, insulin, liver enzymes, and insulin sensitivity index (ISI) using the euglycemic insulin clamp were obtained for 178 normoglycemic individuals aged 25–68 years. Product-moment correlations were used to examine the association between ISI and various surrogate measurements of insulin sensitivity. Regression models were used to devise weights for each variable and to identify cutoff points for individual components of the score. A bootstrap procedure was used to identify the most useful predictors of ISI.
RESULTS—Correlation coefficients between ISI and fasting insulin, HOMA, insulin-to-glucose ratio, and the Bennett index were similar in magnitude. The variables that best predicted insulin sensitivity were fasting insulin and fasting triglycerides. The use of a score based on \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \[Mffm{/}I{\,}{\,}{=}{\,}{\,}exp{[}2.63{\,}{\,}{-}{\,}{\,}0.28ln(insulin){\,}{\,}{-}{\,}{\,}0.31ln(TAG){]}\] \end{document}rather than the use of fasting insulin alone resulted in a higher sensitivity and a maintained specificity when predicting insulin sensitivity.
CONCLUSIONS—A weighted combination of two routine laboratory measurements, i.e., fasting insulin and triglycerides, provides a simple means of screening for insulin resistance in the general population.
Anemia With Erythropoietin Deficiency Occurs Early in Diabetic Nephropathy
Authors: Bosman Deborah R. , Winkler Andrea S. , Marsden Joanne T. , Macdougall Iain C. , Watkins Peter J. 
Published: March 2007

OBJECTIVE—The normochromic normocytic anemia of erythropoietin (EPO) deficiency is recognized in advanced renal failure but not in early renal disease. The aim of this study was to determine whether anemia with EPO deficiency is found in type 1 diabetic patients with diabetic nephropathy in the absence of advanced renal failure and to compare them with patients with nondiabetic renal disease of similar severity.
RESEARCH DESIGN AND METHODS—A total of 27 type 1 diabetic patients with diabetic nephropathy (DN), defined as having persistent proteinuria (mean 1,086 mg/day [CI 120–5,190]), a serum creatinine ≤180 μmol/l, and retinopathy, were compared with 26 nondiabetic patients with glomerulonephritis (GN) and persistent proteinuria (1,874 mg/day [349–5,005]). The Hb concentration, red cell indexes, and serum EPO levels were measured, and other causes for the anemia were excluded. The EPO values were compared with a normal reference range obtained from nondiabetic patients with a microcytic anemia. The DN patients were tested for signs of diabetic peripheral and autonomic neuropathy.
RESULTS—We found that 13 of the 27 DN patients were anemic (Hb 10.6 ± 0.9 g/dl) in marked contrast to none of the GN patients (Hb 13.7 ± 1.4 g/dl, P &lt; 0.005). In the DN group, serum EPO concentrations failed to increase in response to anemia compared with the response seen in patients with microcytic anemia. Thus, the anemia of the DN group was associated with EPO deficiency. The anemic DN patients showed evidence of more severe proteinuria and diabetic neuropathy than the nonanemic DN patients.
CONCLUSIONS—Anemia associated with EPO deficiency can occur early in DN before the onset of advanced renal failure, but does not normally occur in nondiabetic renal disease of similar severity. The pathogenesis requires elucidation.
Effectiveness of Self-Management Training in Type 2 Diabetes
Authors: Norris Susan L. , Engelgau Michael M. , Venkat Narayan K.M. 
Published: March 2007

OBJECTIVE—To systematically review the effectiveness of self-management training in type 2 diabetes.
RESEARCH DESIGN AND METHODS—MEDLINE, Educational Resources Information Center (ERIC), and Nursing and Allied Health databases were searched for English-language articles published between 1980 and 1999. Studies were original articles reporting the results of randomized controlled trials of the effectiveness of self-management training in people with type 2 diabetes. Relevant data on study design, population demographics, interventions, outcomes, methodological quality, and external validity were tabulated. Interventions were categorized based on educational focus (information, lifestyle behaviors, mechanical skills, and coping skills), and outcomes were classified as knowledge, attitudes, and self-care skills; lifestyle behaviors, psychological outcomes, and quality of life; glycemic control; cardiovascular disease risk factors; and economic measures and health service utilization.
RESULTS—A total of 72 studies described in 84 articles were identified for this review. Positive effects of self-management training on knowledge, frequency and accuracy of self-monitoring of blood glucose, self-reported dietary habits, and glycemic control were demonstrated in studies with short follow-up (&lt;6 months). Effects of interventions on lipids, physical activity, weight, and blood pressure were variable. With longer follow-up, interventions that used regular reinforcement throughout follow-up were sometimes effective in improving glycemic control. Educational interventions that involved patient collaboration may be more effective than didactic interventions in improving glycemic control, weight, and lipid profiles. No studies demonstrated the effectiveness of self-management training on cardiovascular disease–related events or mortality; no economic analyses included indirect costs; few studies examined health-care utilization. Performance, selection, attrition, and detection bias were common in studies reviewed, and external generalizability was often limited.
CONCLUSIONS—Evidence supports the effectiveness of self-management training in type 2 diabetes, particularly in the short term. Further research is needed to assess the effectiveness of self-management interventions on sustained glycemic control, cardiovascular disease risk factors, and ultimately, microvascular and cardiovascular disease and quality of life.
Long-Term (5-Year) Effects of a Reduced-Fat Diet Intervention in Individuals With Glucose Intolerance
Authors: Swinburn Boyd A. , Metcalf Patricia A. , Ley Sarah J. 
Published: March 2007

OBJECTIVE—To determine whether reducing dietary fat would reduce body weight and improve long-term glycemia in people with glucose intolerance.
RESEARCH DESIGN AND METHODS—A 5-year follow-up of a 1-year randomized controlled trial of a reduced-fat ad libitum diet versus a usual diet. Participants with glucose intolerance (2-h blood glucose 7.0–11.0 mmol/l) were recruited from a Workforce Diabetes Survey. The group that was randomized to a reduced-fat diet participated in monthly small-group education sessions on reduced-fat eating for 1 year. Body weight and glucose tolerance were measured in 136 participants at baseline, 6 months, and 1 year (end of intervention), with follow-up at 2 years (n = 104), 3 years (n = 99), and 5 years (n = 103).
RESULTS—Compared with the control group, weight decreased in the reduced-fat–diet group (P &lt; 0.0001); the greatest difference was noted at 1 year (–3.3 kg), diminished at subsequent follow-up (−3.2 kg at 2 years and −1.6 kg at 3 years), and was no longer present by 5 years (1.1 kg). Glucose tolerance also improved in patients on the reduced-fat diet; a lower proportion had type 2 diabetes or impaired glucose tolerance at 1 year (47 vs. 67%, P &lt; 0.05), but in subsequent years, there were no differences between groups. However, the more compliant 50% of the intervention group maintained lower fasting and 2-h glucose at 5 years (P = 0.041 and P = 0.026, respectively) compared with control subjects.
CONCLUSIONS—The natural history for people at high risk of developing type 2 diabetes is weight gain and deterioration in glucose tolerance. This process may be ameliorated through adherence to a reduced fat intake.
Guidelines for Premeal Insulin Dose Reduction for Postprandial Exercise of Different Intensities and Durations in Type 1 Diabetic Subjects Treated Intensively With a Basal-Bolus Insulin Regimen (Ultralente-Lispro)
Authors: Rabasa-Lhoret Rémi , Bourque Josée , Ducros Francine , Chiasson Jean-Louis 
Published: March 2007

OBJECTIVE—To evaluate and validate appropriate premeal insulin dose reductions for postprandial exercises of different intensities and durations to minimize the risk of exercise-induced hypoglycemia in type 1 diabetic subjects.
RESEARCH DESIGN AND METHODS—Eight male type 1 diabetic patients on a basal-bolus insulin regimen of ultralente (UL) as basal insulin and lispro (LP) as premeal insulin were tested in a randomized, crossover fashion during postprandial exercise at 25% Vo2max for 60 min, 50% Vo2max for 30 and 60 min, and 75% Vo2max for 30 min starting 90 min after a standardized mixed breakfast (600 kcal, 75 g carbohydrates). Each subject served as his own control and was tested after a full dose of insulin LP (LP 100%) and/or 50% (LP 50%) and/or 25% (LP 25%) of the current dose.
RESULTS—At all intensities, the full premeal insulin dose was associated with an increased risk of hypoglycemia. At 25% Vo2max for 60 min, a 50% reduction in the premeal insulin dose resulted in plasma glucose of −0.62 mmol/l compared with baseline at the end of exercise. At 50% Vo2max for 30 and 60 min, 50 and 75% reductions of the premeal insulin dose were associated with plasma glucose of −0.39 and +0.49 mmol/l, respectively, at the end of the exercise. At 75% Vo2max, a 75% reduction of the premeal insulin dose was required to achieve appropriate postexercise plasma glucose (+0.71 mmol/l). Such reductions in the premeal insulin dose resulted in a 75% decrease in the incidence of exercise-induced hypoglycemia.
CONCLUSIONS—In well-controlled type 1 diabetic subjects on intensive insulin therapy with the basal-bolus (UL-LP) insulin regimen, risk of hypoglycemia can be minimized during postprandial exercises of different intensities and different durations by appropriate reduction of premeal insulin LP.
Basal Insulin Therapy in Type 2 Diabetes
Authors: Rosenstock Julio , Schwartz Sherwyn L. , Clark Charles M. , Park Glen D. , Donley David W. , Edwards Mike B. 
Published: March 2007

OBJECTIVE—To determine the safety and efficacy of the long-acting analog insulin glargine compared with NPH insulin in patients with type 2 diabetes who were previously treated with insulin alone.
RESEARCH DESIGN AND METHODS—A total of 518 subjects with type 2 diabetes who were receiving NPH insulin with or without regular insulin for postprandial control were randomized to receive insulin glargine (HOE 901) once daily (n = 259) or NPH insulin once or twice daily (n = 259) for 28 weeks in an open-label, multicenter trial. Doses were adjusted to obtain target fasting glucose &lt;6.7 mmol/l. At study end point, the median total daily insulin dose in both treatment groups was 0.75 IU/kg.
RESULTS—The treatment groups showed similar improvements in HbA1c from baseline to end point on intent-to-treat analysis. The mean change (means ± SD) in HbA1c from baseline to end point was similar in the insulin glargine group (−0.41 ± 0.1%) and the NPH group (−0.59 ± 0.1%) after patients began with an average baseline HbA1c of ∼8.5%. The treatments were associated with similar reductions in fasting glucose levels. Overall, mild symptomatic hypoglycemia was similar in insulin glargine subjects (61.4%) and NPH insulin subjects (66.8%). However, nocturnal hypoglycemia in the insulin glargine group was reduced by 25% during the treatment period after the dose-titration phase (26.5 vs. 35.5%, P = 0.0136). Subjects in the insulin glargine group experienced less weight gain than those in the NPH group (0.4 vs. 1.4 kg, P &lt; 0.0007).
CONCLUSIONS—In patients with type 2 diabetes, once-daily bedtime insulin glargine is as effective as once- or twice-daily NPH in improving and maintaining glycemic control. In addition, insulin glargine demonstrates a lower risk of nocturnal hypoglycemia and less weight gain compared with NPH insulin.
Blood Glucose Awareness Training (BGAT-2)
Authors: Cox Daniel J. , Gonder-Frederick Linda , Polonsky William , Schlundt David , Kovatchev Boris , Clarke William 
Published: March 2007

OBJECTIVE—Blood glucose awareness training (BGAT) has been shown to improve awareness of blood glucose (BG) fluctuations among adults with type 1 diabetes. This study investigates the long-term (12-month) benefits of BGAT-2.
RESEARCH DESIGN AND METHODS—A total of 73 adults with type 1 diabetes participated in a 6-month repeated baseline design with a 12-month follow-up. At 6 months and 1 month before BGAT-2 and at 1, 6, and 12 months after BGAT-2, subjects used a handheld computer for 50 trials and completed psychological tests. Throughout assessment, subjects completed diaries, recording occurrences of diabetic ketoacidosis, severe hypoglycemia, and motor vehicle violations. During follow-up, 50% of the subjects received booster training.
RESULTS—During the first and last halves of both the baseline period and the follow-up period, dependent variables were generally stable. However, from baseline to follow-up, BGAT-2 led to 1) improved detection of hypoglycemia and hyperglycemia; 2) improved judgment regarding when to lower high BG, raise low BG, and not drive while hypoglycemic; 3) reduction in occurrence of diabetic ketoacidosis, severe hypoglycemia, and motor vehicle violations; and 4) improvement in terms of worry about hypoglycemia, quality of life, and diabetes knowledge. Reduction in severe hypoglycemia was not associated with a worsening of metabolic control (HbA1). The presence or absence of booster training did not differentially affect these benefits.
CONCLUSION—BGAT has sustained broad-ranging benefits, independent of booster intervention.
Mini-Dose Glucagon Rescue for Hypoglycemia in Children With Type 1 Diabetes
Authors: Haymond Morey W. , Schreiner Barbara 
Published: March 2007

OBJECTIVE—Children with type 1 diabetes are frequently difficult to manage during times of gastroenteritis or poor oral intake of carbohydrates because of mild or impending hypoglycemia. The present study describes the effective use of small doses of subcutaneous glucagon in these children.
RESEARCH DESIGN AND METHODS—We analyzed 33 episodes of impending or mild hypoglycemia in 28 children (ages 6.6 ± 0.7 years). All were healthy except for type 1 diabetes and an episode of gastroenteritis. Using a standard U-100 insulin syringe, children ages ≤2 years received two “units” (20 μg) of glucagon subcutaneously and those ages &gt;2 years received one unit/year of age up to 15 units (150 μg). If the blood glucose did not increase within 30 min, the initial dosage was doubled and given at that time. We used patients’ self-glucose monitoring devices, aqueous glucagon, standard insulin syringes, and frequent phone contact with a physician and/or a diabetes nurse educator in this study.
RESULTS—Blood glucose was 3.44 ± 0.15 mmol/l before and 8.11 ± 0.72 mmol/l 30 min after glucagon. In 14 children, relative hypoglycemia recurred, requiring retreatment (3.48 ± 0.18 to 6.94 ± 0.72 mmol/l). In four children, a third dose was required. The glucagon was well tolerated. In 28 of the 33 episodes of impending hypoglycemia, the children remained at home and fully recovered. Five children were taken to their local hospital because of concerns of dehydration or fever, but none for hypoglycemia.
CONCLUSIONS—Mini-dose glucagon rescue, using subcutaneous injections, is effective in managing children with type 1 diabetes during episodes of impending hypoglycemia due to gastroenteritis or poor oral intake of carbohydrate.
Type 1 Diabetes Environmental Factors and Correspondence Analysis of HLA Class II Genes in the Yemenite Jewish Community in Israel
Authors: Weintrob Naomi , Sprecher Elliot , Israel Shoshana , Pinhas-Hamiel Orit , Kwon Oh Joong , Bloch Konstantin , Abramov Natali , Arbel Aviva , Josefsberg Zeev , Brautbar Chaim , Vardi Pnina 
Published: March 2007

OBJECTIVE—The Israeli Yemenite Jewish community has displayed an exceptionally rapid increase in the frequency of type 1 diabetes, having the highest rate of all Israeli ethnic groups. We studied the role of the environment, in relation to the nature and frequency of HLA class II genes, to evaluate its possible involvement in the development of diabetes.
RESEARCH DESIGN AND METHODS—We interviewed 196 elderly Yemenite women, who had immigrated to Israel as adults, in programmed encounters about signs and symptoms of type 1 diabetes, infant feeding customs, and infectious diseases in Yemen. We also performed HLA oligotyping of DRB1, DQA1, and DQB1 genes in 120 unrelated Yemenite Jews, including 44 type 1 diabetic patients and 76 healthy control subjects, and used these data in correspondence analysis comparing Yemenites with different Israeli ethnic groups.
RESULTS—Interviews indicated that early exposure to cow’s milk was very common in Yemen. However, none of the women could recall classical presentations of diabetes. HLA oligotyping showed that gene frequencies of non-Asp-57 (of the HLA-DQB chain) in the patients (0.94) and control subjects (0.6) were similar to those of other populations with a known high incidence of type 1 diabetes. Correspondence analysis revealed that Yemenite Jews are genetically distinct from other ethnic groups in Israel.
CONCLUSIONS—The genetic distinctiveness of Yemenite Jews may explain their unusually high incidence of type 1 diabetes in Israel. Despite the presence of highly susceptible diabetogenic HLA class II genes in this community, early exposure to cow’s milk did not cause phenotypic expression of diabetes in Yemen. This finding suggests that in this population, either cow’s milk does not play a crucial role in triggering diabetes, or environmentally conferred protection, such as frequent infectious disease in Yemen, was dominant.
Disordered Eating, Body Mass, and Glycemic Control in Adolescents With Type 1 Diabetes
Authors: Meltzer Lisa J. , Johnson Suzanne Bennett , Prine Jason M. , Banks Richard A. , Desrosiers Paul M. , Silverstein Janet H. 
Published: March 2007

OBJECTIVE—To examine the relationship between disordered eating attitudes and behaviors, BMI, and glycemic control in adolescents with type 1 diabetes.
RESEARCH DESIGN AND METHODS—In a cross-sectional design, 152 adolescents (ages 11–19 years) completed three scales from the Eating Disorders Inventory (EDI): Body Dissatisfaction, Drive for Thinness, and Bulimia. All subjects had diabetes for &gt;1 year. Glycemic control was assessed by glycosylated hemoglobin (HbA1c). Height and weight were measured to assess BMI.
RESULTS—Adolescents with type 1 diabetes did not report more disordered eating attitudes and behaviors than the normative comparison sample. Male subjects with type 1 diabetes reported fewer symptoms of bulimia and female subjects with type 1 diabetes reported greater body satisfaction than the normative group. A higher BMI was a significant predictor of greater body dissatisfaction, more so for female than male subjects. Symptoms of bulimia were associated with older adolescence and female sex. Those with more symptoms of bulimia were also more likely to have a higher BMI. Sex (female) and body dissatisfaction (more dissatisfied) predicted a stronger desire to be thin. Longer duration of disease, more symptoms of bulimia, and obesity all predicted poorer glycemic control.
CONCLUSIONS—Female patients aged 13–14 years seem to be at greatest risk for developing disordered eating patterns. Using the clinical cutoff score (≥5) of the EDI Bulimia subscale as a screener in diabetes clinics may help identify adolescents whose disordered eating patterns are likely to compromise their glycemic control.