bluuebunny/crossref_metadata_2025_split huggingface dataset:
Orlistat Augments Postprandial Increases in Glucagon-like Peptide 1 in Obese Type 2 Diabetic Patients
Authors: Damci Taner , Yalin Serap , Balci Huriye , Osar Zeynep , Korugan Ustun , Ozyazar Mucahit , Ilkova Hasan 
Published: March 2007

OBJECTIVE—Orlistat leads to improved glycemic control in obese type 2 diabetic patients, which is attributed to decreased insulin resistance associated with weight loss. Glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) are gut hormones that are secreted in response to food intake, and they both stimulate insulin secretion. Orlistat decreases fat absorption and increases intestinal fat content, which may lead to increased secretion of these peptides. In this pilot study, we tested the hypothesis that increased levels of these intestinal hormones may be involved in the improvement of postprandial hyperglycemia observed previously with orlistat in type 2 diabetic patients.
RESEARCH DESIGN AND METHODS—A total of 29 type 2 diabetic patients, who were not taking insulin or α-glucosidase inhibitors, were enrolled in the study. On a crossover and single-blind design, after an overnight fasting, the patients received 120-mg orlistat or placebo capsules, followed by a standard 600-kcal mixed meal that contained 38% fat. At baseline and 60 min after the meal, blood samples were obtained for the measurement of GLP-1, GIP, insulin, C-peptide, triglycerides, free fatty acids, and glucose.
RESULTS—All measured parameters increased significantly in response to the mixed meal compared with baseline, both with orlistat or placebo. When compared with the placebo, the orlistat administration resulted in a significantly enhanced postprandial increase in GLP-1 and C-peptide levels and attenuated the postprandial rise in glucose and triglycerides.
CONCLUSIONS—The results of this study suggest that apart from decreasing insulin resistance as a result of weight loss, orlistat may increase postprandial GLP-1 levels, thereby enhancing the insulin secretory response to the meal and blunting the postprandial rise in glucose in type 2 diabetic patients. Increased GLP-1 levels, which lead to decreased food intake, may also contribute to the weight loss that is associated with the use of this drug.
Cost-Effectiveness Analysis of Telemedicine to Evaluate Diabetic Retinopathy in a Prison Population
Authors: Aoki Noriaki , Dunn Kim , Fukui Tsuguya , Beck J. Robert , Schull William J. , Li Helen K. 
Published: March 2007

OBJECTIVE—A cost-effectiveness analysis was conducted to investigate the clinical and economic impact of teleophthalmology in evaluating diabetic retinopathy in prison inmates with type 2 diabetes.
RESEARCH DESIGN AND METHODS—Based on a hypothetical teleophthalmology system to evaluate diabetic retinopathy patients with type 2 diabetes in a prison care setting, a Markov decision model was developed with probability and cost data derived primarily from published epidemiological and outcome studies. A 40-year-old African-American man with type 2 diabetes was used as a reference case subject. The number of quality-adjusted life-years (QALYs) gained was used as the clinical outcome, and the cost in U.S. dollars from the year 2003 was used as the economic outcome. Teleophthalmology and nonteleophthalmology strategies were compared using an expected QALYs calculation and two types of sensitivity analyses: probabilistic and traditional n-way sensitivity analyses.
RESULTS—The teleophthalmology strategy dominates in the cost-effectiveness analysis for the reference case subject: $16,514/18.73 QALYs for teleophthalmology and $17,590/18.58 QALYs for nonteleophthalmology. Ninety percent of the Monte Carlo simulations showed cost effectiveness (annual cost/QALYs ≤$50,000) in the teleophthalmology strategy based on an assumed inmate population. Teleophthalmology is the better strategy if the number of diabetic inmates in the prison community is &gt;500.
CONCLUSIONS—Our cost-effectiveness analysis demonstrates that teleophthalmology holds great promise to reduce the cost of inmate care and reduce blindness caused by diabetic retinopathy in type 2 diabetic patients.
Repaglinide Versus Nateglinide Monotherapy
Authors: Rosenstock Julio , Hassman David R. , Madder Robert D. , Brazinsky Shari A. , Farrell James , Khutoryansky Naum , Hale Paula M. ,   for the Repaglinide Versus Nateglinide Comparison Study Group
Published: March 2007

OBJECTIVE—A randomized, parallel-group, open-label, multicenter 16-week clinical trial compared efficacy and safety of repaglinide monotherapy and nateglinide monotherapy in type 2 diabetic patients previously treated with diet and exercise.RESEARCH DESIGN AND METHODS—Enrolled patients (n = 150) had received treatment with diet and exercise in the previous 3 months with HbA1c &gt;7 and ≤12%. Patients were randomized to receive monotherapy with repaglinide (n = 76) (0.5 mg/meal, maximum dose 4 mg/meal) or nateglinide (n = 74) (60 mg/meal, maximum dose 120 mg/meal) for 16 weeks. Primary and secondary efficacy end points were changes in HbA1c and fasting plasma glucose (FPG) values from baseline, respectively. Postprandial glucose, insulin, and glucagon were assessed after a liquid test meal (baseline, week 16). Safety was assessed by incidence of adverse events or hypoglycemia.RESULTS—Mean baseline HbA1c values were similar in both groups (8.9%). Final HbA1c values were lower for repaglinide monotherapy than nateglinide monotherapy (7.3 vs. 7.9%). Mean final reductions of HbA1c were significantly greater for repaglinide monotherapy than nateglinide monotherapy (−1.57 vs. −1.04%; P = 0.002). Mean changes in FPG also demonstrated significantly greater efficacy for repaglinide than nateglinide (−57 vs. −18 mg/dl; P &lt; 0.001). HbA1c values &lt;7% were achieved by 54% of repaglinide-treated patients versus 42% for nateglinide. Median final doses were 6.0 mg/day for repaglinide and 360 mg/day for nateglinide. There were 7% of subjects treated with repaglinide (five subjects with one episode each) who had minor hypoglycemic episodes (blood glucose &lt;50 mg/dl) versus 0 patients for nateglinide. Mean weight gain at the end of the study was 1.8 kg in the repaglinide group as compared with 0.7 kg for the nateglinide group.CONCLUSIONS—In patients previously treated with diet and exercise, repaglinide and nateglinide had similar postprandial glycemic effects, but repaglinide monotherapy was significantly more effective than nateglinide monotherapy in reducing HbA1c and FPG values after 16 weeks of therapy.
Relation of Lower-Extremity Amputation to All-Cause and Cardiovascular Disease Mortality in American Indians
Authors: Resnick Helaine E. , Carter Elizabeth A. , Lindsay Robert , Henly Susan J. , Ness Frederick K. , Welty Thomas K. , Lee Elisa T. , Howard Barbara V. 
Published: March 2007

OBJECTIVE—To compare risk of all-cause and cardiovascular disease (CVD) mortality in people with a lower-extremity amputation (LEA) attributable to diabetes and people without an LEA.
RESEARCH DESIGN AND METHODS—The Strong Heart Study is a study of CVD and its risk factors in 13 American-Indian communities. LEA was ascertained at baseline by direct examination of the legs and feet. Mortality surveillance is complete through 2000.
RESULTS—Of 2,108 participants with diabetes at baseline, 134 participants (6.4%) had an LEA. Abnormal ankle-brachial index (53%), albuminuria (87%), and long diabetes duration (mean 19.8 years) were common among diabetic subjects with LEA. Mean diabetes duration among diabetic participants without LEA and in those with toe and below-the-knee amputations was 11.9, 18.6, and 21.1 years, respectively. During 8.7 (±2.9) years of follow-up, 102 of the participants with LEA (76%) died from all causes and 35 (26%) died from CVD. Of the 1,974 diabetic participants without LEA at baseline, 604 (31%) died from all causes and 206 (10%) died from CVD. The unadjusted hazard ratios (HRs) for all-cause and CVD mortality in diabetic participants with LEA compared with those without were 4.0 and 4.1, respectively. Adjusting for known and suspected confounders, LEA persisted as a predictor of all-cause (HR 2.2, 95% CI 1.7–2.9) and CVD mortality (HR 1.9, 95% CI 1.3–2.9). We observed a significant interaction between baseline LEA and sex on CVD mortality, with female sex conferring added risk of CVD mortality.
CONCLUSIONS—LEA is a potent predictor of all-cause and CVD mortality in diabetic American Indians. The combination of female sex and LEA is associated with greater risk of CVD mortality than either factor alone.
Use and Abuse of HOMA Modeling
Authors: Wallace Tara M. , Levy Jonathan C. , Matthews David R. 
Published: March 2007

Homeostatic model assessment (HOMA) is a method for assessing β-cell function and insulin resistance (IR) from basal (fasting) glucose and insulin or C-peptide concentrations. It has been reported in &gt;500 publications, 20 times more frequently for the estimation of IR than β-cell function.
This article summarizes the physiological basis of HOMA, a structural model of steady-state insulin and glucose domains, constructed from physiological dose responses of glucose uptake and insulin production. Hepatic and peripheral glucose efflux and uptake were modeled to be dependent on plasma glucose and insulin concentrations. Decreases in β-cell function were modeled by changing the β-cell response to plasma glucose concentrations. The original HOMA model was described in 1985 with a formula for approximate estimation. The computer model is available but has not been as widely used as the approximation formulae. HOMA has been validated against a variety of physiological methods.
We review the use and reporting of HOMA in the literature and give guidance on its appropriate use (e.g., cohort and epidemiological studies) and inappropriate use (e.g., measuring β-cell function in isolation). The HOMA model compares favorably with other models and has the advantage of requiring only a single plasma sample assayed for insulin and glucose.
In conclusion, the HOMA model has become a widely used clinical and epidemiological tool and, when used appropriately, it can yield valuable data. However, as with all models, the primary input data need to be robust, and the data need to be interpreted carefully.
Mortality and Causes of Death in a National Sample of Diabetic Patients in Taiwan
Authors: Tseng Chin-Hsiao 
Published: March 2007

OBJECTIVE—To determine the mortality rate, causes of death, and standardized mortality ratio (SMR) in Taiwanese diabetic patients.
RESEARCH DESIGN AND METHODS—A cohort of 256,036 diabetic patients (118,855 men and 137,181 women, aged 61.2 ± 15.2 years) using the National Health Insurance were assembled during the years 1995–1998 and followed up to the end of 2001. Deaths were verified by indexing to the National Register of Deaths. Underlying causes of death were determined from death certificates coded according to the ninth revision of the International Classification of Diseases. The general population of Taiwan was used as reference for SMR calculation.
RESULTS—With a total of 1,124,348.4 person-years of follow-up, 43,888 patients died and the crude mortality rate was 39.0/1,000 person-years. Mortality rates increased with age, and diabetic men had a significantly higher risk of death than women. However, mortality rate ratio for men versus women attenuated with increasing age. The overall SMR was 1.63 (1.62–1.65), and SMRs also attenuated in the elderly. Causes of death ascribed to diabetes; cancer; cardiopulmonary disease; stroke; disease of arteries, arterioles, and capillaries; nephropathy; infection; digestive diseases; accidents; and suicide were 28.8, 18.5, 9.0, 10.5, 0.3, 4.8, 6.4, 7.9, 3.2, and 0.8%, respectively.
CONCLUSIONS—Approximately 71.2% of the diabetes-related deaths would not be ascribed to diabetes on death certificates in Taiwan. The diabetic men have higher risk of dying than women, and diabetic patients have excess mortality when compared with the general population. For underlying causes of death not listed as diabetes, total cardiovascular death, including cardiopulmonary disease, stroke, and disease of arteries, arterioles, and capillaries, is the most common cause of death, followed by cancer.
Improving Efficacy of Diabetes Management Using Treatment Algorithms in a Mainly Hispanic Population
Authors: Fanning Etta L. , Selwyn Beatrice J. , Larme Anne C. , DeFronzo Ralph A. 
Published: March 2007

OBJECTIVE—To compare clinical outcomes obtained using treatment algorithms versus standard “usual care” to treat patients with type 2 diabetes in a community setting.
RESEARCH DESIGN AND METHODS—An observational group comparison was implemented in three community-based clinics in San Antonio, Texas: 1) a community clinic following treatment algorithms (CC-TA), 2) university clinic following treatment algorithms (UC-TA), and 3) a community clinic following standard “usual care” practices (CC-SC). Three hundred fifty-eight recently diagnosed type 2 diabetic patients (90% Mexican American, from low-income neighborhoods) who were consecutively identified at the three clinics were recruited. Following medical and laboratory evaluation, participants were started on treatment for hyperglycemia, hypertension, and dyslipidemia and followed for 12 months.
RESULTS—Decrements in HbA1c at 12 months in the CC-TA and UC-TA were 3.1 and 3.3%, respectively, compared to 1.3% in the CC-SC (P &lt; 0.0001). Corresponding decrements in fasting plasma glucose at 12 months were 94 and 99 mg/dl, respectively, versus 38 mg/dl in CC-SC (P &lt; 0.0001). Reductions in total cholesterol, LDL cholesterol, and triglycerides at 12 months were greater in both algorithm-managed clinics compared to standard care–managed clinics (P &lt; 0.0001). In algorithm-managed clinics, there were 30% more documented eye exams and 24% more documented foot exams than in standard care–managed patients.
CONCLUSIONS—Adherence to the treatment algorithms improved metabolic outcomes in type 2 diabetic patients to a greater extent than standard care practices. These results have important clinical implications for the treatment of type 2 diabetic patients.
Pancreas Transplantation Improves Vascular Disease in Patients With Type 1 Diabetes
Authors: Larsen Jennifer L. , Colling Christopher W. , Ratanasuwan Tanaporn , Burkman Tab W. , Lynch Thomas G. , Erickson Judi M. , Lyden Elizabeth R. , Lane James T. , Mack-Shipman Lynn R. 
Published: March 2007

OBJECTIVE—Pancreas transplantation (PTX) normalizes glucose and improves microvascular complications, but its impact on macrovascular disease is still debated.RESEARCH DESIGN AND METHODS—Carotid intima-media thickness (IMT), shown to correlate with cardiovascular disease (CVD) risk and events, was determined prospectively by ultrasonography in successful pancreas transplant recipients to evaluate the effect of PTX on CVD risk. Carotid IMT and CVD risk factors of pancreas transplant recipients (n = 25) were compared with three groups: individuals with type 1 diabetes without significant nephropathy (n = 20), nondiabetic kidney transplant recipients (n = 16), and normal control subjects (n = 32). Mean age of pancreas transplant recipients at the time of transplantation was 42.4 ± 1.2 years (mean ± SE) and duration of diabetes was 25.9 ± 1.4 years.RESULTS—After PTX, HbA1c level (P &lt; 0.0001) decreased to normal and, whereas creatinine level (P = 0.0002) decreased, it remained elevated compared with normal control subjects (P &lt; 0.05). Blood pressure, BMI, fasting lipid levels, smoking frequency, and use of hypolipidemic agents were unchanged. Mean carotid IMT was increased in pancreas transplant candidates but decreased by 1.8 ± 0.1 year after PTX (P = 0.0068), no longer different from that in normal control subjects or patients with type 1 diabetes.CONCLUSIONS—Carotid IMT improves after successful PTX within 2 years of the procedure, with normalization of HbA1c and improved renal function, independent of changes in lipid levels, BMI, blood pressure, smoking, or use of hypolipidemic agents. This study suggests that CVD risk, future events, and mortality should improve after PTX in the absence of other significant, untreated CVD risk factors.
Cost-Effectiveness of Early Irbesartan Treatment Versus Control (Standard Antihypertensive Medications Excluding ACE Inhibitors, Other Angiotensin-2 Receptor Antagonists, and Dihydropyridine Calcium Channel Blockers) or Late Irbesartan Treatment in Patients With Type 2 Diabetes, Hypertension, and Renal Disease
Authors: Palmer Andrew J. , Annemans Lieven , Roze Stéphane , Lamotte Mark , Lapuerta Pablo , Chen Roland , Gabriel Sylvie , Carita Paulo , Rodby Roger A. , de Zeeuw Dick , Parving Hans-Henrik 
Published: March 2007

OBJECTIVE—The aim of this study was to determine the most cost-effective time point for initiation of irbesartan treatment in hypertensive patients with type 2 diabetes and renal disease.
RESEARCH DESIGN AND METHODS—This study was a Markov model–simulated progression from microalbuminuria to overt nephropathy, doubling of serum creatinine, end-stage renal disease, and death in hypertensive patients with type 2 diabetes. Two irbesartan strategies were created: early irbesartan 300 mg daily (initiated with microalbuminuria) and late irbesartan (initiated with overt nephropathy). These strategies were compared with control, which consisted of antihypertensive therapy with standard medications (excluding ACE inhibitors, other angiotensin-2 receptor antagonists, and dihydropyridine calcium channel blockers) with comparable blood pressure control, initiated at microalbuminuria. Transition probabilities were taken from the Irbesartan in Reduction of Microalbuminuria-2 study, Irbesartan in Diabetic Nephropathy Trial, and other published sources. Costs and life expectancy, discounted at 3% yearly, were projected over 25 years for 1,000 simulated patients using a third-party payer perspective in a U.S. setting.
RESULTS—Compared with control, early and late irbesartan treatment in 1,000 patients were projected to save (mean ± SD) $11.9 ± 3.3 million and $3.3 ± 2.7 million, respectively. Early use of irbesartan added 1,550 ± 270 undiscounted life-years (discounted 960 ± 180), whereas late irbesartan added 71 ± 40 life-years (discounted 48 ± 27) in 1,000 patients. Early irbesartan treatment was superior under a wide-range of plausible assumptions.
CONCLUSIONS—Early irbesartan treatment was projected to improve life expectancy and reduce costs in hypertensive patients with type 2 diabetes and microalbuminuria. Later use of irbesartan in overt nephropathy is also superior to standard care, but irbesartan should be started earlier and continued long term.
Reduced Forearm Blood Flow in Children and Adolescents With Type 1 Diabetes (Measured by Near-Infrared Spectroscopy)
Authors: Pichler Gerhard , Urlesberger Berndt , Jirak Paul , Zotter Heinz , Reiterer Elke , Müller Wilhelm , Borkenstein Martin 
Published: March 2007

OBJECTIVE—The aim of this study was to measure forearm blood flow (FBF) to detect any possible changes that might indicate vascular disorders in children and adolescents with type 1 diabetes.
RESEARCH DESIGN AND METHODS—FBF was measured by near-infrared spectroscopy (NIRS), venous occlusion at rest, and after handgrip exercise. A total of 40 children and adolescents with type 1 diabetes and 40 healthy children and adolescents (6–18 years) were matched for age and sex for comparison.
RESULTS—In the diabetic group (age 12.79 ± 2.9 years, duration of diabetes 51.5 ± 36 months), FBF at rest was significantly lower (1.39 ± 0.76 ml · 100 g muscle–1 · min–1) than in control subjects (age 12.66 ± 2.9 years, FBF at rest 1.90 ± 1.19 ml · 100 g muscle–1 · min–1). After exercise, FBF increased significantly less in the diabetic group (0.70 ± 0.82 ml · 100 g muscle–1 · min–1) compared with the control subjects (1.15 ± 1.05 ml · 100 g muscle–1 · min–1). FBF at rest decreased with increasing age in both groups. The change in FBF after exercise was independent of age in the diabetic group and increased with increasing age in control subjects. FBF is reduced with impaired hyperemic response after exercise in children and adolescents with type 1 diabetes.
CONCLUSIONS—These data suggest that vascular disorders in childhood are detectable noninvasively by NIRS.
Prevalence and Factor Analysis of Metabolic Syndrome in an Urban Korean Population
Authors: Oh Jee-Young , Hong Young Sun , Sung Yeon-Ah , Barrett-Connor Elizabeth 
Published: March 2007

OBJECTIVE—The aim of this study was to explore the prevalence and pattern of the metabolic syndrome and its association with hyperinsulinemia in an urban Korean population of 269 men and 505 women.
RESEARCH DESIGN AND METHODS—The National Cholesterol Education Program Adult Treatment Panel (ATP) III guidelines were used to calculate the sex-specific prevalence of the metabolic syndrome. After excluding individuals taking medication for hypertension, diabetes, or dyslipidemia, we used factor analysis to examine the pattern of the metabolic syndrome in 206 men and 449 women.
RESULTS—The prevalence of metabolic syndrome was 16.0% in men and 10.7% in women aged 30–80 years. However, ATP III criteria for central obesity are not optimal for an Asian-Pacific population; when waist circumference is reduced from 102 to 90 cm in men and 88 to 80 cm in women, the prevalence of the metabolic syndrome increased to 29.0 and 16.8%, respectively. Sex-specific factor analysis showed four factors in men (obesity, glucose intolerance, hypertension, and dyslipidemia) and three in women (obesity-hypertension, glucose intolerance, and obesity-dyslipidemia). Insulin resistance estimated from fasting insulin levels clustered with three of the four factors in men and two of the three factors in women. By ATP III or Asian-Pacific waist circumference criteria, the prevalence of the metabolic syndrome increased with increasing tertiles of insulin resistance, which was estimated by a homeostasis model assessment.
CONCLUSIONS—The metabolic syndrome is common in an urban Korean population when using Asian-Pacific waist criteria. The prevalence of the metabolic syndrome increased with increasing tertiles of insulin resistance.
Endothelial Nitric Oxide Synthase Gene Is Associated With Diabetic Macular Edema in Type 2 Diabetes
Authors: Awata Takuya , Neda Tamotsu , Iizuka Hiroyuki , Kurihara Susumu , Ohkubo Tomoko , Takata Nobuki , Osaki Masataka , Watanabe Masaki , Nakashima Youhei , Sawa Takahiro , Inukai Kouichi , Inoue Ikuo , Shibuya Masayuki , Mori Keisuke , Yoneya Shin , Katayama Shigehiro 
Published: March 2007

OBJECTIVE—We examined the endothelial nitric oxide (eNOS) gene polymorphisms to assess its possible association with diabetic retinopathy and macular edema.
RESEARCH DESIGN AND METHODS—A total of 226 patients with type 2 diabetes and 186 healthy subjects were studied. Type 2 diabetic patients consisted of 110 patients without retinopathy, 46 patients with nonproliferative diabetic retinopathy, and 71 patients with proliferative diabetic retinopathy. Diabetic macular edema was present in 48 patients. Three polymorphisms of the eNOS gene were determined: T-786C in the promoter region, 27-bp repeat in intron 4, and Glu298Asp in exon 7.
RESULTS—Close linkage disequilibrium was observed between the T-786C polymorphism and the 27-bp repeat, as has been previously reported, but Glu298Asp was not in linkage disequilibrium with the other two polymorphisms. The eNOS gene polymorphisms were not significantly associated with the presence of retinopathy or with retinopathy severity or type 2 diabetes itself. However, by both association study and multiple logistic regression analysis, the T-786C and 27-bp repeat polymorphisms were significantly associated with a risk of developing macular edema with the −786C allele and the “a” allele increasing the risk.
CONCLUSIONS—The present study suggests that the eNOS gene is a novel genetic risk factor for diabetic macular edema. The eNOS gene polymorphisms may contribute to the development of macular edema by impairing basal eNOS expression and resulting in the breakdown of the blood-retina barrier.