bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Combination Sulfonylurea and Insulin Therapy Useful in NIDDM Patients?: A metaanalysis
Authors: Pugh Jacqueline A , Wagner Mary L , Sawyer John , Ramirez Gilbert , Tuley Michael , Friedberg Samuel J 
Published: March 2007

OBJECTIVE
To assess the efficacy of combination therapy with insulin and sulfonylurea in the treatment of NIDDM.

RESEARCH DESIGN AND METHODS
Studies published between January 1966 and January 1991 were identified through a computerized Medline search and by hand searching the bibliographies of identified articles. We identified 17 eligible randomized, controlled trials of combination therapy in NIDDM. These trials had a minimum duration of 8 wk and at least one of three outcome measures (fasting glucose, HbA1, or C-peptide) with SD or SE of the mean reported to do metaanalysis. With standardized forms, three independent reviews abstracted measures of study quality and specific descriptive information about population, intervention, and outcome measurements.

RESULTS
We calculated effect size and weighted mean changes of the three outcome measures for control and treatment groups. In the treatment group, the fasting plasma glucose decreased from a mean of 11.4 mM (206 mg/dl) at baseline to a mean of 9.16 mM (165 mg/dl) posttreatment, whereas the control group decreased from (11.3 to 10.8 mM) (204 to 194 mg/dl) (effect size 0.39, P &lt; 0.0001). For HbA1, the treatment group decreased from a baseline of 11.0 to 10.2% compared to 11.0 and 11.2% in the control group (effect size 0.43, P &lt; 0.0001). For fasting C-peptide, the treatment group increased from 0.49 to 0.58 nM (1.45 to 1.75 ng/ml) compared with 0.47 and 0.43 (1.42 and 1.30) for the control group (effect size 0.26, P &lt; 0.017).

CONCLUSION
Combined insulin-sulfonylurea therapy leads to modest improvement in glycemic control compared with insulin therapy alone. With combined therapy, lower insulin doses may be used to achieve similar control. Obese patients with higher fasting C-peptides may be more likely to respond than others.
Diabetic Ketoacidosis: A rare complication of gestational diabetes
Authors: Maislos Maximo , Harman-Bohem Ilana , Weitzman Simon 
Published: March 2007

OBJECTIVE
To describe a case of severe DKA in an otherwise healthy pregnant woman.

RESEARCH DESIGN AND METHODS
We describe 2.5 yr of close follow-up of a Bedouin woman who was hospitalized for DKA while pregnant with her 11th child. Plasma glucose returned to normal levels immediately after delivery of a dead conceptus. Four months later, while normoglycemic, the patient became pregnant again. During the subsequent pregnancy, GDM was diagnosed at week 20 of gestation. Tight plasma glucose control was achieved with an insulin regimen, and the patient delivered a healthy girl at term. Plasma glucose again returned to normal and remained so to date, 18 mo postpartum. An OGTT and a euglycemic hyperinsulinemic clamp were performed between pregnancies; another OGTT was performed at week 14 of the last pregnancy. Plasma glucose, insulin, and C-peptide were measured in blood samples during these procedures.

RESULTS
We established beyond doubt that the patient developed GDM and returned to essentially normal glucose tolerance after her last (12th) delivery. During the 11th pregnancy, gestational diabetes was complicated by severe DKA.

CONCLUSIONS
GDM is a common abnormality of glucose metabolism during pregnancy, which affects fetal development and leads to peripartum complications. Our report stresses that under certain circumstances, gestational diabetes can be complicated by DKA and become life-threatening to the mother and fetus.
Telephone Modem Access Improves Diabetes Control in Those with Insulin-Requiring Diabetes
Authors: Ahring Kirsten Kiar , Ahring Jørgen Philip Kiaer , Joyce Carol , Farid Nadir R 
Published: March 2007

OBJECTIVE
To assess whether modem access improves diabetes control in IDDM patients.

RESEARCH DESIGN AND METHODS
Forty-two patients participated in the study and were followed for 12 wk. The patients were randomly divided into two groups at baseline, a modem group and a control group. There were no significant differences between HbA1c, random blood glucose, and weight between the groups at the beginning of the study. Patients were asked to perform five blood glucose determinations/day (before breakfast, before lunch, afternoon [1500], before dinner, and at bedtime) twice/week. The modem group transferred their data over the phone once/week. The control group would bring in their results on their regular visits every 6 wk. Patients in the modem group were counseled every week over the telephone after transferring results to adjust insulin and food intake if necessary.

RESULTS
In the modem group, HbA1c improved from 0.106 to 0.092 (13.20%). The control group improved from 0.112 to 0.102 (8.9%). There was no significant change in weight, random blood glucose, or insulin.

CONCLUSIONS
The use of telephone modem-based patient-monitoring systems in diabetes clinical research seems to stimulate the patient to keep closer control of blood glucose levels. It might be especially useful in rural settings, for which this study was designed.
Glomerular Hyperfiltration in NIDDM Patients Without Overt Proteinuria
Authors: Silveiro Sandra P , Friedman Rogério , Gross Jorge L 
Published: March 2007

Objective— To evaluate the frequency and correlates of glomerular hyperfiltration in NIDDM patients without overt proteinuria.
Research Design and Methods— A cross-sectional study was conducted. Seventy-one consecutive NIDDM patients attending an outpatient clinic, with Albustix-tested negative urine and a 24-h AER &lt;200 μgrams/min, were examined for long-term complications of diabetes. We measured their GFR (51Cr-EDTA single-injection method), 24-h AER (RIA), plasma creatinine, HbA1c, total cholesterol, triglycerides, urinary glucose, and urea.
Results— GFR above the upper limit of the normal range for age-matched control subjects (137.1 ml·min−1 · 1.73 m2) was present in 15 of 71 (21%) NIDDM patients. Subjects with normal and hyperfiltration did not differ in terms of age, sex distribution, BMI, duration of NIDDM, BP, AER, or frequency of long-term complications. Plasma glucose was significantly higher in subjects with hyperfiltration (mean [range]: 12.8 [4.3–18.7] vs. 8.7 [2.6–17.5] mM). HbA1c failed to reach statistical significance, although it tended to be higher in the group with hyperfiltration (10.4 [6.7–13.9] vs. 9.4 [4.2–16.5]%, P = 0.10). Age (rS −0.37, P = 0.002), FPG (rS 0.45, P &lt; 0.0005), total cholesterol (rS −0.31, P = 0.008), and glycosuria (rS 0.40, P = 0.001) correlated significantly with GFR. In a stepwise multiple regression analysis, FPG, age, and total cholesterol emerged as significant correlates of the dependent variable GFR.
Conclusions— Hyperfiltration occurred in 21% of NIDDM patients without overt proteinuria. FPG and age significant correlates of the GFR in these patients. Cholesterol is significantly (although only modestly) correlated with the GFR.
Deranged Platelet Calcium Homeostasis in Poorly Controlled IDDM Patients
Authors: Pellegatta Fabio , Folli Franco , Ronchi Paola , Caspani Lucia , Galli Laura , Vicari Aurelio M 
Published: March 2007

Objective— Platelet hyperfunction frequently occurs in IDDM. As in many other cellular systems, cytosolic free Ca plays a key role in platelet activation.
Research Design and Methods— We measured cytosolic free Ca concentration ([Ca2+]i) by means of the fluorescent probe fura-2 in 60 IDDM patients (mean age 30.8 yr, range 18–50 yr) and in 31 age-matched healthy control subjects. Platelets were studied in both resting conditions and after stimulation with thrombin at 0.05, 0.1, and 0.5 U/ml.
Results— No differences were noted between control subjects and diabetic patients, as a whole. Patients with a poor metabolic control (HbA1c &gt;8%) had significantly (P &lt;0.01 and P &lt;0.03) higher [Ca2+]i in resting platelets. The presence or absence of retinopathy did not modify resting platelet [Ca2+]i. After stimulation with thrombin, a significantly (P &lt; 0.009) higher rise of platelet [Ca2+]i was observed only in those patients who were both free from complications and had good metabolic control. A highly significant (P &lt; 0.001) correlation was found between resting [Ca2+]i and both blood cholesterol and HbA1c in the diabetic patients. Platelets from 10 young healthy subjects also were studied after in vitro incubation with various glucose concentrations (from 1.68 to 56 mM): resting and thrombin-stimulated platelet [Ca2+]i and thrombin-induced aggregation were not modified.
Conclusions— These data confirm that platelet hyperfunction is present in IDDM patients who have unsatisfactory metabolic control, and give evidence that such an activation involves Ca homeostasis. Acute variations of blood glucose concentration are probably not influent, in this respect.
Determinants of Diabetes Mellitus in the Pima Indians
Authors: Knowler William C , Saad Mohammed F , Pettitt David J , Nelson Robert G , Bennett Peter H 
Published: March 2007

Objective— To review the research findings on the determinants of diabetes mellitus in Pima Indians.
Research Design and Methods— Pima Indians in Arizona have participated in a longitudinal diabetes study that has provided data on and hypotheses about the development of NIDDM. Findings from this study are reviewed and updated.
Results— Frequency distributions of plasma glucose and HbA1 are bimodal in Pima adults, and substantial risk of the specific vascular complications of diabetes is confined to those in the higher components of these distributions. These findings contributed to the adoption of internationally recognized criteria for classification of glucose tolerance. Diabetes in the Pimas is strongly familial, and probably of genetic origin, although the precise nature of the gene or genes involved remains unknown. Obesity, which is at least in part environmentally determined, is a major factor interacting with the presumed genetic susceptibility to result in diabetes. The incidence of diabetes in the Pimas has increased during the last several decades, providing further evidence for environmental-genetic interaction. Longitudinal studies suggest that the progression from normal to diabetes can be considered to involve two stages. The first, primarily attributable to insulin resistance, leads to impaired glucose tolerance, and the second, which depends on insulin secretory failure, leads to worsening hyperglycemia and overt diabetes.
Conclusions— The Pimas and many other American Indian populations suffer from a high incidence of diabetes and its characteristic disabling or fatal complications, and would benefit from continued research on the pathogenesis and prevention of the disease.
Energy Metabolism in Obesity: Studies in the Pima Indians
Authors: Ravussin Eric 
Published: March 2007

Objective— To review the major data collected over the past 8 yr regarding energy expenditure in relationship to obesity and the development of obesity in the Pima Indian population.
Research Design and Methods— The different components of 24-h energy expenditure (i.e., the RMR, the thermic effect of food, and the energy cost of spontaneous physical activity) were measured in a respiratory chamber after a few days on a weight-maintenance diet.
Results— Fat-free body mass, the major determinant of RMR, explains 82% of its variance. However, an extra 7% of the variance in RMR observed between people is related to family membership. The variability of RMR for a given body size and composition is of importance, because a low metabolic rate is a major risk factor for weight gain in man. Also, genetic factors seem to be the cause of the familial aggregation of metabolic rate in man.
Conclusions— The high prevalence of obesity and NIDDM in the Pima Indian community might be the consequence of a “thrifty genotype.” The increasing evidence that obesity cannot always be attributed to gluttony and sloth forces us to consider obesity as a “real metabolic disease” that needs to be treated as such, using new behavioral and pharmacological therapies.
Diabetes in American Indians: An overview
Authors: Gohdes Dorothy , Kaufman Stephen , Valway Sarah 
Published: March 2007

Objective— To review the growth of diabetes as a major health problem for American Indians and Alaska Natives.
Research Design and Methods— Pertinent studies of diabetes in Indians previously published are reviewed and compared with current data.
Results— Although diabetes rates may vary among different Indian tribes, diabetes has become a widespread health problem.
Conclusions— Our understanding of the natural history of diabetes among Indians has improved, but better strategies to prevent complications and ultimately to prevent diabetes are urgently needed in Indian communities.
Prevalence of Diagnosed Diabetes and Selected Related Conditions of Six Reservations in Montana and Wyoming
Authors: Acton Kelly , Rogers Barbara , Campbell Gregory , Johnson Charlene , Gohdes Dorothy 
Published: March 2007

Objective— To describe the prevalence of diabetes and related complications in Plains Indians.
Research Design and Methods— The medical records of individuals with diagnosed diabetes seen in IHS facilities before 1 January 1987 were reviewed. Records were obtained from primary care clinics and hospitals accessible to the following six reservation communities in Montana and Wyoming: Blackfeet, Crow, Fort Belknap, Fort Peck, Northern Cheyenne, and Wind River. Medical records were reviewed to ascertain accuracy of diagnosis and associated complications.
Results— Age-adjusted prevalence rate of diagnosed diabetes was 119/1000 adults ≥15 yr of age.
Conclusions— Diabetes rates in Plains Indians are higher than rates described for the general U.S. population.
Diabetes in a Northern Minnesota Chippewa Tribe: Prevalence and incidence of diabetes and incidence of major complications, 1986–1988
Authors: Rith-Najarian Stephen J , Valway Sarah E , Gohdes Dorothy M 
Published: March 2007

Objective— To determine the prevalence and incidence of diabetes, and the incidence of major diabetic complications, in a Chippewa Indian population.
Research Design and Methods— The format was a longitudinal population study that used active community and health center–based surveillance. The setting was a North American Indian reservation community of 4075 residents, served by an IHS clinic from 1986 to 1988. Patients were American Indians of Chippewa descent living on or near the Red Lake Reservation.
Results— Midway through the study, 346 people had been diagnosed with diabetes, which yielded an age- and sex-adjusted point prevalence of 148/1000 population. The adjusted rate for individuals ≥25 yr of age was 252/1000 population, 3.82 times the U.S. rate (CI 2.95–4.93). Some 97 new cases of diabetes were identified for an age- and sex-adjusted average annual incidence of 17/1000 population. The incidence of hospitalization for LEA was 26/1000 diabetic person-yr, 4.3 times the 1978 U.S. rate (95% CI 2.8–6.8). Twelve individuals developed proliferative retinopathy, for an incidence of 12/1000 diabetic person-yr. Newly diagnosed ESRD incidence was 6/1000 diabetic person-yr. Twenty-three acute myocardial infarctions were observed, yielding an incidence of 22/1000 diabetic person-yr.
Conclusions— Diabetes and its complications are prevalent in this Chippewa population, and further surveillance is needed to evaluate the effectiveness of prevention efforts.
Prevalence of Diabetes Mellitus in Pregnancy Among Yup'ik Eskimos, 1987–1988
Authors: Murphy Neil J , Bulkow Lisa R , Schraer Cynthia D , Lanier Anne P 
Published: March 2007

OBJECTIVE–To evaluate the prevalence of diabetes mellitus in pregnancy in Yup'ik Eskimos.
RESEARCH DESIGN AND METHODS— A retrospective review of consecutive birth-log data and medical records was conducted. Records were taken from the primary care and tertiary referral facilities in Alaska Area Native Health Service. Some 630 consecutive deliveries were reviewed from 1 March 1987 to 29 February 1988, with 25 excluded for ancestry other than Alaska Native. Another 605 Alaska Native patient charts were reviewed, with 545 Alaska Native patients screened for diabetes in pregnancy. The study population had a mean age of 25.6 yr, mean gravidity of 3.4, mean parity of 1.9, and mean birth weight of 3567 ± 493 g.
RESULTS— Patients were screened with a 50-g glucose oral load with a plasma glucose 1 h later. 156 of 605 (25.7%) patients, with a screen ≥7.8 mM received a 100-g OGTT. Of 605, 35 (5.8%) patients met O'Sullivan criteria, and 2 of 605 (0.3%) patients met WHO criteria for previous diabetes mellitus, for a total 37 of 605 (6.1%) women with diabetes in pregnancy. The subjects who met O'Sullivan criteria had statistically greater mean age (29.9 yr), gravidity (4.9), parity (2.9), and birth weight of their infants (3678 ± 389 g), compared with women with a screen &lt;7.8 mM.
CONCLUSIONS— The prevalence of diabetes in pregnancy among Yup'ik Eskimos is twice the rate for the U.S. for all races, despite the Yup'ik having the lowest rate of diabetes mellitus among Alaska Natives. This may represent a large number of undiagnosed patients with impaired glucose tolerance, and may reflect the wide-spread dietary and life-style changes that have occurred in the Yup'ik in the last 30 yr. The Yup'ik present a unique opportunity to apply prevention techniques in a population with an emerging problem with glucose tolerance.
Diabetic End-Stage Renal Disease Among Native Americans
Authors: Muneta Ben , Newman Jeff , Stevenson John , Eggers Paul 
Published: March 2007

OBJECTIVE— To examine why ESRD has become a major source of morbidity and mortality for Native Americans with diabetes mellitus.
RESEARCH DESIGN AND METHODS— Using data from the Medicare ESRD Program, we examined incidence rates for ESRD among Native Americans for the years 1983–1987.
RESULTS–During this period, the annual incidence of total ESRD in Native Americans increased by 18%, from 170.5/million to 200.1/million. The incidence of diabetic ESRD increased by 47%, from 80.6/million to 118.2/million. In 1987, the age-adjusted incidence rate of diabetic ESRD was 6.8 times higher in Native Americans than in whites.
CONCLUSIONS— Recommendations for the prevention of diabetic ESRD include early identification of renal disease and improved control of hypertension and blood glucose. The magnitude of diabetic ESRD among Native Americans also underscores the need for primary prevention of non-insulin-dependent diabetes mellitus.
Effects of Gemfibrozil on Triglyceride Levels in Patients With NIDDM: Hyperlipidemia in Diabetes Investigators
Authors: Vinik Aaron I , Colwell John A 
Published: March 2007

Objective— Patients with NIDDM have a two- to fourfold increased risk of macrovascular disease. The constellation of elevated TGs and decreased HDL cholesterol are recognized as risk factors and constitute the major dyslipidemia in NIDDM. We therefore sought to determine if gemfibrozil (600 mg b.i.d.) was effective in correcting the dyslipidemia of NIDDM.
Research Design and Methods– After 8 wk of placebo stabilization, 442 patients from 46 study centers were randomized to double-blind treatment, in a designated 2:1 ratio, 295 received gemfibrozil and 147 received placebo for 20 wk. The primary end point was plasma TG; secondary end points were TC, LDL cholesterol, VLDL cholesterol, HDL cholesterol, and HbA1c. No baseline differences were noted between groups in sex, age, weight, type of diabetic therapy, fasting plasma levels of TGs, HbA1c, or C-peptide. About two-thirds received oral hypoglycemic drugs, one-third insulin
Results– TG fell 26.4% in the gemfibrozil group and rose 7.4% in the placebo group (P &lt; 0.023), by an intent-to-treat analysis. When patients who were noncompliant or with inadequate data were excluded, similar results were found—a 30.4% fall with gemfibrozil and a 4.8% increase with placebo (P &lt; 0.0001). TG levels fell within 4 wk and remained low for 20 wk (P &lt; 0.001). Mean HDL cholesterol rose by 4 wk and increased further at 12 wk (8–12%), P &lt; 0.0001. TC fell. We observed a significant rise in LDL cholesterol in both gemfibrozil- and placebo-treated groups, with no significant differences between these groups. Changes in HbA1c were similar in gemfibrozil and placebo groups. No differences were observed in responses in groups treated with insulin and or oral hypoglycemic drugs. Overall AEs that were clinically important occurred in 6.1% in the gemfibrozil group vs. 2.0% in the placebo group (NS).
Conclusions– We conclude that gemfibrozil is an effective and safe agent in combating the dyslipidemia of NIDDM, irrespective of type of diabetic therapy.
Treatment of Diabetic Neuropathy With γ-Linolenic Acid
Authors: Keen Harry , Payan Jose , Allawi Jaffar , Walker James , Jamal Goran A , Weir Andrew I , Henderson Lesley M , Bissessar Elizabeth A , Watkins Peter J , Sampson Michael , Gale Edwin A M , Scarpello John , Boddie Hugh G , Hardy Kevin J , Thomas Peter K , Misra Peter , Halonen Jukka-Pekka ,   The γ-Linolenic Acid Multicenter Trial Group
Published: March 2007

Objective— To compare the effects of placebo and GLA on the course of mild diabetic neuropathy over 1 yr.
Research Design and Methods— We entered 111 patients with mild diabetic neuropathy from seven centers into a randomized, double-blind, placebo-controlled parallel study of GLA at a dose of 480 mg/day. MNCV, SNAP, CMAP, hot and cold thresholds, sensation, tendon reflexes, and muscle strength were assessed by standard tests in upper and lower limbs.
Results— For all 16 parameters, the change over 1 yr in response to GLA was more favorable than the change with placebo, and for 13 parameters, the difference was statistically significant. Sex, age, and type of diabetes did not influence the result, but treatment was more effective in relatively well-controlled than in poorly-controlled diabetic patients.
Conclusions— GLA had a beneficial effect on the course of diabetic neuropathy.
Effectiveness of Glucose Monitoring Systems Modified for the Visually Impaired
Authors: Bernbaum Marla , Albert Stewart G , Brusca Stephanie , McGinnis Joan , Miller Deborah , Hoffmann Joseph W , Mooradian Arshag D 
Published: March 2007

OBJECTIVE
To compare three glucose meters modified for use by individuals with diabetes and visual impairment regarding accuracy, precision, and clinical reliability.

RESEARCH DESIGN AND METHODS
Ten subjects with diabetes and visual impairment performed self-monitoring of blood glucose using each of the three commercially available blood glucose meters modified for visually impaired users (the AccuChek Freedom [Boehringer Mannheim, Indianapolis, IN], the Diascan SVM [Home Diagnostics, Eatontown, NJ], and the One Touch [Lifescan, Milpitas, CA]). The meters were independently evaluated by a laboratory technologist for precision and accuracy determinations.

RESULTS
Only two meters were acceptable with regard to laboratory precision (coefficient of variation &lt;10%)—the Accuchek and the One Touch. The Accuchek and the One Touch did not differ significantly with regard to laboratory estimates of accuracy. A great discrepancy of the clinical reliability results was observed between these two meters. The Accuchek maintained a high degree of reliability (y = 0.99X + 0.44, r = 0.97, P = 0.001). The visually impaired subjects were unable to perform reliable testing using the One Touch system because of a lack of appropriate tactile landmarks and auditory signals.

CONCLUSIONS
In addition to laboratory assessments of glucose meters, monitoring systems designed for the visually impaired must include adequate tactile and audible feedback features to allow for the acquisition and placement of appropriate blood samples.