bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing a Prediction Rule From Automated Clinical Databases to Identify High-Risk Patients in a Large Population With Diabetes
Authors: Selby Joe V. , Karter Andrew J. , Ackerson Lynn M. , Ferrara Assiamira , Liu Jennifer 
Published: March 2007

OBJECTIVE—To develop and validate a prediction rule for identifying diabetic patients at high short-term risk of complications using automated data in a large managed care organization.
RESEARCH DESIGN AND METHODS—Retrospective cohort analyses were performed in 57,722 diabetic members of Kaiser Permanente, Northern California, aged ≥19 years. Data from 1994 to 1995 were used to model risk for macro- and microvascular complications (n = 3,977), infectious complications (n = 1,580), and metabolic complications (n = 316) during 1996. Candidate predictors (n = 36) included prior inpatient and outpatient diagnoses, laboratory records, pharmacy records, utilization records, and survey data. Using split-sample validation, the risk scores derived from logistic regression models in half of the population were evaluated in the second half. Sensitivity, positive predictive value, and receiver operating characteristics curves were used to compare scores obtained from full models to those derived using simpler approaches.
RESULTS—History of prior complications or related outpatient diagnoses were the strongest predictors in each complications set. For patients without previous events, treatment with insulin alone, serum creatinine ≥1.3 mg/dl, use of two or more antihypertensive medications, HbA1c &gt;10%, and albuminuria/microalbuminuria were independent predictors of two or all three complications. Several risk scores derived from multivariate models were more efficient than simply targeting patients with elevated HbA1c levels for identifying high-risk patients.
CONCLUSIONS—Simple prediction rules based on automated clinical data are useful in planning care management for populations with diabetes.
Treatment Satisfaction With Inhaled Insulin in Patients With Type 1 Diabetes
Authors: Gerber Robert A. , Cappelleri Joseph C. , Kourides Ione A. , Gelfand Robert A. 
Published: March 2007

OBJECTIVE—In patients with type 1 diabetes, glycemic control can be achieved as effectively with an inhaled insulin regimen, comprising preprandial inhaled intrapulmonary insulin plus a bedtime ultralente injection, as with a conventional subcutaneous insulin regimen involving two to three injections per day. Our objective was to compare patient satisfaction between inhaled insulin and subcutaneous insulin.
RESEARCH DESIGN AND METHODS—Subjects with type 1 diabetes participated in a 12-week open-label trial and were randomized to either an inhaled insulin regimen or a subcutaneous insulin regimen. Subjects (n = 69) were asked to complete a 15-item self-administered satisfaction questionnaire, the Patient Satisfaction with Insulin Therapy (PSIT) Questionnaire, at baseline and week 12. Outcomes included mean percentage changes in global (overall) satisfaction and two subscales: convenience/ease of use and social comfort.
RESULTS—The mean percentage improvement in overall satisfaction with inhaled insulin (35.1%, 95% CI 18.0–52.2) was greater than with subcutaneous insulin (10.6%, 4.7–16.5) (P &lt; 0.01), as was the improvement in convenience/ease of use: inhaled insulin 41.3% (22.9–59.6) versus subcutaneous insulin 11.2% (4.1–18.3; P &lt; 0.01). Improvement in social comfort was greater with inhaled insulin but was not statistically significant. The 12-week change in HbA1c was associated with improved overall satisfaction (r = −0.27, P = 0.04).
CONCLUSIONS—Inhaled insulin may offer the first practical, noninvasive alternative to insulin injections. For patients with type 1 diabetes, inhaled insulin maintains glycemic control and provides greater overall satisfaction and convenience/ease of use than subcutaneous insulin.
Elevated Incidence of Type 2 Diabetes in San Antonio, Texas, Compared With That of Mexico City, Mexico
Authors: Burke James P. , Williams Ken , Haffner Steven M. , Villalpando Clicerio Gonzalez , Stern Michael P. 
Published: March 2007

OBJECTIVE—To compare the incidence of type 2 diabetes between low-income Mexican-Americans residing in San Antonio, Texas, and low-income residents in Mexico City, Mexico.
RESEARCH DESIGN AND METHODS—Using data from the San Antonio Heart Study and the Mexico City Diabetes Study, we compared the incidence of type 2 diabetes in 35- to 64-year-old low-income Mexican-American residents of San Antonio with similarly aged low-income residents of Mexico City. Because of the different follow-up times in the two studies, Poisson regression was used to compare the rates of diabetes. Potential risk factors for diabetes were also analyzed to determine whether they explained or contributed to a difference in incidence.
RESULTS—The age- and sex-adjusted incidence of type 2 diabetes was significantly higher in San Antonio (RR 2.01) compared with Mexico City. This difference was seen primarily in the oldest age group (55–64 years of age) and remained statistically significant after adjusting for a number of diabetes risk factors, including demographic, anthropometric, and metabolic variables. Follow-up rates were similar in both cities.
CONCLUSIONS—We conclude that there was a higher incidence of type 2 diabetes in San Antonio than in Mexico City, and that difference occurred primarily in individuals in the oldest age group. The potential mediating factors we examined did not account for this difference. Other factors, such as exercise and diet, which were not available for analysis in this study, in addition to a cohort effect, may have contributed to the difference in incidence of type 2 diabetes in the two cities. In addition, there was no evidence of a higher case fatality among diabetic individuals from Mexico City compared with San Antonio.
Temporal Trends in BMI Among Adults With Diabetes
Authors: Leibson Cynthia L. , Williamson David F. , Melton L. Joseph , Palumbo Pasquale J. , Smith Steven A. , Ransom Jeanine E. , Schilling Peter L. , Narayan K. M. Venkat 
Published: March 2007

OBJECTIVE—Increasing obesity within the general population has been accompanied by rising rates of diabetes. The extent to which obesity has increased among people with diabetes is unknown, as are the potential consequences for diabetes outcomes.
RESEARCH DESIGN AND METHODS—Community medical records (hospital and ambulatory) of all Rochester, Minnesota, residents aged ≥30 years who first met standardized research criteria for diabetes from 1970 to 1989 (n = 1,306) were reviewed to obtain data on BMI and related characteristics as of the diabetes identification date (±3 months). Vital status as of 31 December 1999 and date of death for those who died were obtained from medical records, State of Minnesota death tapes, and active follow-up.
RESULTS—As of the identification date, data on BMI were available for 1,290 cases. Of the 272 who first met diabetes criteria in 1970–1974, 33% were obese (BMI ≥30), including 5% who were extremely obese (BMI ≥40). These proportions increased to 49% (P &lt; 0.001) and 9% (P = 0.012), respectively, for the 426 residents who first met diabetes criteria in 1985–1989. BMI increased significantly with increasing calendar year of diabetes identification in multivariable regression analysis. Analysis of survival revealed an increased hazard of mortality for BMI ≥41, relative to BMI of 23–25 (hazard ratio 1.60, 95% CI 1.09–2.34, P = 0.016).
CONCLUSIONS—The prevalence of obesity and extreme obesity among individuals at the time they first met criteria for diabetes has increased over time. This is disturbing in light of the finding that diabetic individuals who are extremely obese are at increased risk of mortality compared with their nonobese diabetic counterparts.
Smoking as a Modifiable Risk Factor for Type 2 Diabetes in Middle-Aged Men
Authors: Wannamethee S. Goya , Shaper A. Gerald , Perry Ivan J. 
Published: March 2007

OBJECTIVE—To examine the effects of cigarette smoking, giving up smoking, and primary or secondary pipe or cigar smoking on the risk of type 2 diabetes.
RESEARCH DESIGN AND METHODS—A prospective study followed 7,735 men aged 40–59 years from general practices in 24 British towns for an average of 16.8 years. Incident cases of physician-diagnosed diabetes were ascertained by repeated postal questionnaires and systematic reviews of primary care records.
RESULTS—A total of 290 incident cases of diabetes were found in 7,124 men with no history of diabetes, coronary heart disease, or stroke. Cigarette smoking was associated with a significant increase in risk of diabetes, even after adjustment for age, BMI, and other potential confounders. The benefit of giving up smoking was only apparent after 5 years of smoking cessation, and risk reverted to that of never-smokers only after 20 years. The risk of diabetes in those who switched from smoking cigarettes to pipe or cigars remained equal to the risk in continuing cigarette smokers. Men who gave up smoking during the first 5 years of follow-up showed significant weight gain and subsequently higher risk of diabetes than continuing smokers.
CONCLUSIONS—Cigarette smoking is an independent and modifiable risk factor for type 2 diabetes. Smoking cessation is associated with weight gain and a subsequent increase in risk of diabetes, but in the long term, the benefits of giving up smoking outweigh the adverse effects of early weight gain.
Congestive Heart Failure in Type 2 Diabetes
Authors: Nichols Gregory A. , Hillier Teresa A. , Erbey John R. , Brown Jonathan B. 
Published: March 2007

OBJECTIVE—To estimate the prevalence and incidence of congestive heart failure (CHF) in populations with and without type 2 diabetes and to identify risk factors for diabetes-associated CHF.
RESEARCH DESIGN AND METHODS—We searched the inpatient and outpatient electronic medical records of 9,591 individuals diagnosed with type 2 diabetes before 1 January 1997 and those of an age- and sex-matched control group without diabetes for a diagnosis of CHF. Among those without a baseline diagnosis of CHF, we searched forward for 30 months for incident cases of CHF. We constructed multiple logistic regression models to identify risk factors for both prevalent and incident CHF.
RESULTS—CHF was prevalent in 11.8% (n = 1,131) of diabetic subjects and 4.5% (n = 435) of control subjects at baseline. We observed incident cases of CHF in 7.7% of diabetic subjects free of CHF at baseline (650 of 8,460) and in 3.4% of control subjects (314 of 9,156). In diabetic subjects, age, diabetes duration, insulin use, ischemic heart disease, and elevated serum creatinine were independent risk factors for both prevalent and incident CHF. Better glycemic control at baseline, and improved glycemic and blood pressure control at follow-up predicted the development of CHF.
CONCLUSIONS—Despite controlling for age, duration of diabetes, presence of ischemic heart disease, and presence of hypertension, insulin use was associated with both prevalent and incident CHF. Why insulin use and better glycemic control both at baseline and follow-up independently predicted CHF deserves further study.
The Insertion/Deletion Polymorphism of the ACE Gene Is Related to Insulin Sensitivity in Overweight Women
Authors: Ryan Alice S. , Nicklas Barbara J. , Berman Dora M. , Ferrell Robert E. 
Published: March 2007

OBJECTIVE—The ACE insertion/deletion (I/D) polymorphism has been identified as a genetic risk factor for coronary heart disease (CHD). The deletion (D) allele of the ACE gene may be associated with higher insulin sensitivity. Individuals who are homozygous for the DD allele have higher ACE levels and possibly more angiotensin II, which, when infused exogenously, causes an increase in insulin sensitivity. The purpose of this study was to investigate the association of the I/D polymorphism of the ACE gene with insulin sensitivity and CHD risk factors.
RESEARCH DESIGN AND METHODS—The study included 66 women (ages 57 ± 1 years) who were overweight or obese (means ± SEM, BMI = 33 ± 1 kg/m2) and sedentary (Vo2max = 19.6 ± 0.4 ml · kg–1 · min1). Total body fat mass and percent fat were determined by dual-energy X-ray absorptiometry, and abdominal fat was by computed tomography. Insulin sensitivity was measured during the last 30 min of 3-h hyperinsulinemic-euglycemic clamps (40 mU · m−2 · min−1). Comparisons were made among women with the II (n = 9), ID (n = 36), and DD (n = 21) genotypes.
RESULTS—Age, percent body fat, waist-to-hip ratio, visceral and subcutaneous abdominal fat areas, plasma lipid levels, and systolic and diastolic blood pressures did not differ by ACE genotype. Fasting glucose and 2-h glucose levels were similar among genotypes, but fasting plasma insulin levels were lower in DD women than in ID women (P &lt; 0.05). Glucose utilization was higher in women with the DD genotype than in women with the II genotype (53.1 ± 3.9 vs. 36.0 ± 3.8 μmol · kg−1 FFM · min−1, P = 0.01) and was higher in ID women than in II women (48.5 ± 2.5 μmol · kg−1 FFM · min−1, P = 0.04).
CONCLUSIONS—These data suggest that the I/D polymorphism is not associated with risk factors for CHD in overweight sedentary women; however, women who are homozygous for the D allele of the ACE gene are more insulin sensitive, whereas women who are homozygous for the I allele of the ACE gene have greater insulin resistance and potential risk for type 2 diabetes.
Peripheral Artery Disease, Diabetes, and Reduced Lower Extremity Functioning
Authors: Dolan Nancy C. , Liu Kiang , Criqui Michael H. , Greenland Philip , Guralnik Jack M. , Chan Cheeling , Schneider Joseph R. , Mandapat Aimee Luna , Martin Gary , McDermott Mary M. 
Published: March 2007

OBJECTIVE—To characterize lower extremity function and dysfunction in peripheral artery disease (PAD) patients with and without diabetes.
RESEARCH DESIGN AND METHODS—In this cross-sectional study, 460 men and women with PAD (147 with diabetes) were recruited from three academic medical centers. Assessments included ankle brachial index (ABI), neuropathy score, 6-min walk distance, 4-m walking velocity, Walking Impairment Questionnaire (0–100 scale, 100 = best), and summary performance score (SPS) (0–12 scale, 12 = best).
RESULTS—The mean ABI was similar in PAD patients with and without diabetes. PAD patients with diabetes were younger, had a higher BMI, had a worse neuropathy score, and had a greater number of cardiovascular comorbidities compared with those without diabetes. Participants with diabetes were less likely to report classical symptoms of intermittent claudication and more likely to report exertional leg pain, which sometimes started at rest. After adjusting for age, those with diabetes had a shorter mean 6-min walk distance (1,040 vs. 1,168 feet, P &lt; 0.001), slower fast-pace 4-m walk velocity (0.83 vs. 0.90 m/sec, P &lt; 0.001), and a lower SPS (7.3 vs. 8.6, P &lt; 0.001) than those without diabetes. Patients with diet-controlled diabetes performed better than those on diabetes medications. Differences in lower extremity functioning between patients with and without diabetes were largely attenuated but not abolished for SPS and fast-pace 4-m walk velocity after adjustment for type of exertional leg pain, neuropathy score, and number of cardiovascular comorbidities.
CONCLUSIONS—Subjects with PAD and diabetes have poorer lower extremity function than those with PAD alone. This difference in functioning appears to be largely explained by diabetes-associated neuropathy, differences in exertional leg symptoms, and greater cardiovascular disease in patients with diabetes.
“Diabetic Mastopathy,” or Sclerosing Lymphocytic Lobulitis, Is Strongly Associated With Type 1 Diabetes
Authors: Kudva Yogish C. , Reynolds Carol , O’Brien Timothy , Powell Claudia , Oberg Ann L. , Crotty Thomas B. 
Published: March 2007

OBJECTIVE—To demonstrate the strong association of diabetic mastopathy or sclerosing lymphocytic lobulitis with type 1 diabetes mellitus by studying appropriate control groups and to describe risk factors and natural history of the disorder.
RESEARCH DESIGN AND METHODS—This was a retrospective cross-sectional study of four groups of patients conducted at a setting tertiary care medical center. We examined benign breast biopsies (investigator masked to identity) from age-matched patients with types 1 and 2 diabetes, autoimmune thyroid disease, or none of the above disorders for sclerosing lymphocytic lobulitis. Several risk factors proposed for the disorder (age at diagnosis of benign breast disease, duration of diabetes, age at onset of diabetes, prevalence of retinopathy, neuropathy, nephropathy and cheiroarthropathy, glycemic control, parity, oral contraceptive use, menopausal status, or number of breast biopsies) were evaluated, and patients were contacted to describe the natural history of the disorder.
RESULTS—Sclerosing lymphocytic lobulitis was identified in 69.7% of the subjects with type 1 diabetes and 1.8% of those with autoimmune thyroid disease diagnosed with benign breast disease at surgery. It did not occur in patients with type 2 diabetes with or without insulin treatment or in control subjects. Only retinopathy and peripheral neuropathy were associated with sclerosing lymphocytic lobulitis. Breast carcinoma or lymphoma did not occur subsequently in any type 1 diabetes patient with or without sclerosing lymphocytic lobulitis.
CONCLUSIONS—Sclerosing lymphocytic lobulitis is strongly associated with type 1 diabetes. Retinopathy and neuropathy are associated with the disorder. The risk of malignancy is not increased.
Stress Management Improves Long-Term Glycemic Control in Type 2 Diabetes
Authors: Surwit Richard S. , van Tilburg Miranda A.L. , Zucker Nancy , McCaskill Cynthia C. , Parekh Priti , Feinglos Mark N. , Edwards Christopher L. , Williams Paula , Lane James D. 
Published: March 2007

OBJECTIVE—There is conflicting evidence regarding the utility of stress management training in the treatment of diabetes. The few studies that have shown a therapeutic effect of stress management have used time-intensive individual therapy. Unfortunately, widespread use of such interventions is not practical. The aim of the present investigation is to determine whether a cost-effective, group-based stress management training program can improve glucose metabolism in patients with type 2 diabetes and to determine whether a particular subset of patients is more likely to get positive results.
RESEARCH DESIGN AND METHODS—Patients with type 2 diabetes were randomized to undergo a five-session group diabetes education program with or without stress management training. Participants (n = 108) were followed for 1 year, during which HbA1c tests and questionnaires assessing perceived stress, anxiety, and psychological health were administered at regular intervals to evaluate treatment effects.
RESULTS—Stress management training was associated with a small (0.5%) but significant reduction in HbA1c. Compliance with the treatment regimen decreased over time but was similar to that seen in patients receiving stress management for other reasons in the clinic. Trait anxiety (a measure of stable individual differences in anxiety proneness) did not predict response to treatment, showing that highly anxious patients did not derive more benefit from training.
CONCLUSIONS—The current results indicate that a cost-effective, group stress management program in a “real-world” setting can result in clinically significant benefits for patients with type 2 diabetes.
Incidence of Diabetes in American Indians of Three Geographic Areas
Authors: Lee Elisa T. , Welty Thomas K. , Cowan Linda D. , Wang Wenyu , Rhoades Dorothy A. , Devereux Richard , Go Oscar , Fabsitz Richard , Howard Barbara V. 
Published: March 2007

OBJECTIVE—To estimate incidence rates of diabetes and associated risk factors among participants of the Strong Heart Study.
RESEARCH DESIGN AND METHODS—Of the 4,549 Strong Heart Study participants examined at baseline, 3,638 returned for a similar examination after an average of 4 years. The 1985 World Health Organization criteria for diabetes were used to identify new diabetes cases. Rates of diabetes among participants who did not have diabetes at baseline examination were determined. The relationships between the incidence rates of diabetes and a number of risk factors measured at baseline examination were studied.
RESULTS—Significant variables associated with the development of diabetes included triglycerides, obesity, fasting plasma glucose, insulin, and degree of American Indian blood among participants with NGT at baseline. For those with IGT at baseline, significant predictors included fasting plasma glucose, 2-h glucose, BMI, degree of American Indian blood, and albuminuria.
CONCLUSIONS—The high incidence rates found in this study were alarming. To slow down the rapid increase of this disease in the American Indian population, preventive programs must be designed and implemented. Patients with IGT should be treated with diabetes medication or put on a rigid weight-reduction program to reduce the risk of progression to diabetes.
Screening for MODY Mutations, GAD Antibodies, and Type 1 Diabetes– Associated HLA Genotypes in Women With Gestational Diabetes Mellitus
Authors: Weng Jianping , Ekelund Magnus , Lehto Markku , Li Haiyan , Ekberg Göran , Frid Anders , Åberg Anders , Groop Leif C. , Berntorp Kerstin 
Published: March 2007

OBJECTIVE—To investigate whether genetic susceptibility to type 1 diabetes or maturity-onset diabetes of the young (MODY) increases susceptibility to gestational diabetes mellitus (GDM).
RESEARCH DESIGN AND METHODS—We studied mutations in MODY1–4 genes, the presence of GAD antibodies, and HLA DQB1 risk genotypes in 66 Swedish women with GDM and a family history of diabetes. An oral glucose tolerance test was repeated in 46 women at 1 year postpartum.
RESULTS—There was no increase in type 1 diabetes–associated HLA-DQB1 alleles or GAD antibodies when compared with a group of type 2 diabetic patients (n = 82) or healthy control subjects (n = 86). Mutations in known MODY genes were identified in 3 of the 66 subjects (1 MODY2, 1 MODY3, and 1 MODY4). Of the 46 GDM subjects, 2 had diabetes (4%) and 17 had impaired glucose tolerance (IGT) (37%) at 1 year postpartum. Of the two subjects who developed manifest diabetes, one carried a MODY3 mutation (A203H in the hepatocyte nuclear factor-1α gene). There was no increase in high-risk HLA alleles or GAD antibodies in the women who had manifest diabetes or IGT at 1 year postpartum.
CONCLUSIONS—MODY mutations but not autoimmunity contribute to GDM in Swedish women with a family history of diabetes and increase the risk of subsequent diabetes.