bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dual Blockade of the Renin-Angiotensin System in Diabetic Nephropathy
Authors: Rossing Kasper , Christensen Per K. , Jensen Berit R. , Parving Hans-Henrik 
Published: March 2007

OBJECTIVE—Many patients with diabetic nephropathy (DN) have levels of albuminuria &gt;1 g/day and blood pressure &gt;135/85 mmHg, despite antihypertensive combination therapy, including recommended doses of ACE inhibitors, e.g., lisinopril/enalapril at 20 mg daily. We tested the concept that such patients might benefit from dual blockade of the renin-angiotensin system (RAS).
RESEARCH DESIGN AND METHODS—We performed a randomized double-blind crossover study of 2 months treatment with candesartan cilexetil 8 mg once daily and placebo in addition to previous antihypertensive treatment. We included 18 type 2 diabetic patients with DN fulfilling the above-mentioned criteria. All received recommended doses of ACE inhibitor and, in addition, 15 patients received diuretics, 11 received a calcium channel antagonist, and 3 received a β-blocker. At the end of each treatment period, we measured the glomerular filtration rate (GFR), 24-h blood pressure, albuminuria, and IgGuria .
RESULTS—The addition of candesartan to usual antihypertensive therapy induced a mean (95% CI) reduction in albuminuria of 25% (2–58), P = 0.036 (geometric mean [95% CI] from 1,764 mg/24 h [1,225–2,540] to 1,334 mg/24 h [890–1,998]). It also produced a mean reduction of 35% (9–53) in the fractional clearance of albumin (P = 0.016), a reduction of 32% (1–54) in fractional clearance of IgG (P = 0.046), a reduction in 24-h systolic blood pressure of 10 mmHg (2–18) (P = 0.019) (mean ± ± SE) from 148 ± 3 to 138 ± 5 mmHg, and a mean reduction in GFR of 5 ml · min−1 · 1.73 m−2 (0.1–9) (P = 0.045).
CONCLUSIONS—Dual blockade of the RAS reduces albuminuria and blood pressure in type 2 diabetic patients with DN responding insufficiently to previous antihypertensive therapy, including ACE inhibitors in recommended doses.
Effect of Fish Oil Versus Corn Oil Supplementation on LDL and HDL Subclasses in Type 2 Diabetic Patients
Authors: Petersen Martin , Pedersen Helle , Major-Pedersen Atheline , Jensen Tonny , Marckmann Peter 
Published: March 2007

OBJECTIVE—The increased risk of coronary heart disease associated with type 2 diabetes may be partially explained by dyslipidemia characterized by high plasma triacylglycerol (TAG), low HDL cholesterol, and a predominance of atherogenic small dense LDLs. Fish oil reduces plasma TAG and has previously been shown to improve the distribution of LDL subclasses in healthy subjects and might, therefore, be a good nonpharmacological treatment for type 2 diabetic patients. In the present study, we investigate the effect of fish oil supplementation on the fasting lipid profile, including LDL and HDL subclasses.
RESEARCH DESIGN AND METHODS—A total of 42 type 2 diabetic patients were randomized to supplementation (capsules) with 4 g daily of either fish oil (n = 20) or corn oil (n = 22) for 8 weeks preceded by a 4-week run-in period of corn oil supplementation. Blood was drawn before and after the 8-week intervention period. Plasma lipoproteins, including LDL and HDL subclasses, were separated by ultracentrifugation.
RESULTS—Fish oil lowered TAG (group difference: P = 0.025) and raised HDL-2b cholesterol (P = 0.012) and HDL-2a cholesterol (P = 0.007) concentrations as compared with corn oil. We observed no significant effects of fish oil on LDL cholesterol, HDL cholesterol, or the concentration of small dense LDL particles.
CONCLUSIONS—Fish oil supplementation may partially correct the dyslipidemia of type 2 diabetic patients. However, the putative very important aspect of diabetic dyslipidemia—the predominance of small dense LDL particles—was unaffected by fish oil.
Dietary Fiber Intake and Glycemic Index and Incidence of Diabetes in African-American and White Adults
Authors: Stevens June , Ahn Kyungmi , Juhaeri  , Houston Denise , Steffan Lyn , Couper David 
Published: March 2007

OBJECTIVE—To determine the association of dietary fiber and glycemic index with incident type 2 diabetes in African-Americans and whites.
RESEARCH DESIGN AND METHODS—We studied 12,251 adults aged 45–64 years and free of diabetes at baseline (1987–1989). A total of 1,447 cases of diabetes were reported between baseline and 9 years of follow-up. Diabetes status was determined by fasting glucose level ≥126 mg/dl (7.0 mmol/l), nonfasting glucose level ≥200 mg/dl (11.1 mmol/l), self-report of physician diagnosis, or use of diabetes medication. Usual dietary intake over the previous year was obtained at baseline using a 66-item food-frequency questionnaire. Nutrients were energy-adjusted using the residuals method. Proportional hazard regression analysis was used to examine dietary fiber intake and glycemic index as predictors of type 2 diabetes in both ethnic groups.
RESULTS—After adjustment for age, BMI, education, smoking status, physical activity, sex, and field center, there were no statistically significant associations of intake of total dietary fiber, fruit fiber, legume fiber, glycemic index, or glycemic load with incident diabetes. The hazard ratio for the fifth compared with the first quintile of cereal fiber was 0.75 (95% CI 0.60–0.92) in whites and 0.86 (0.65–1.15) in African-Americans.
CONCLUSIONS—This finding supports a protective role for cereal fiber in the development of diabetes in whites. More studies are needed to determine the role of dietary fiber and glycemic index in diabetes in African-Americans.
Diabetic Patients Detected by Population-Based Stepwise Screening Already Have a Diabetic Cardiovascular Risk Profile
Authors: Spijkerman Annemieke M.W. , Adriaanse Marcel C. , Dekker Jacqueline M. , Nijpels Giel , Stehouwer Coen D.A. , Bouter Lex M. , Heine Robert J. 
Published: March 2007

OBJECTIVE—To describe a population-based two-step screening procedure for type 2 diabetes and to study the cardiovascular risk profile of the patients identified by the screening.
RESEARCH DESIGN AND METHODS—The first step of the screening procedure consisted of the Symptom Risk Questionnaire (SRQ), and the second step was a fasting capillary glucose measurement. In subjects with an SRQ score of &gt;6 and a capillary glucose level of &gt;5.5 mmol/l, an oral glucose tolerance test was performed.
RESULTS—A total of 11,679 inhabitants of the West-Friesland region of the Netherlands, aged 50–75 years, were invited. Of the inhabitants, 9,169 (78%) responded, and, of those, 417 had previously diagnosed diabetes. The SRQ score was calculated for 7,736 participants, and 3,301 of those had a score of &gt;6. A total of 2,885 subjects (87.3%) attended for capillary glucose measurement. Diagnostic testing was carried out in 509 participants, and we identified 217 diabetic patients. In these patients detected by screening, mean HbA1c was 6.7% (±1.4). Hypertension and high total cholesterol levels (&gt;5.0 mmol/l) were present in 70%, 33% had high triglyceride (&gt;3.0 mmol/l) or low HDL cholesterol levels (&lt;1.0 mmol/l in men and &lt;1.1 mmol/l in women), and 40% were obese (BMI ≥30 kg/m2).
CONCLUSIONS—The high response rate was the main feature of the screening by means of the Symptom Risk Questionnaire and fasting capillary glucose measurement followed by diagnostic testing. The 217 diabetic patients detected by the screening were characterized by relatively low HbA1c levels and by a cardiovascular risk profile typical of diabetic patients.
High Frequency of Vα24+ Vβ11+ T-Cells Observed in Type 1 Diabetes
Authors: Oikawa Yoichi , Shimada Akira , Yamada Satoru , Motohashi Yoshiko , Nakagawa Yoshinori , Irie Jun-ichiro , Maruyama Taro , Saruta Takao 
Published: March 2007

OBJECTIVE—Natural killer T-cells (NKT cells) are believed to play an important role in the regulation of immune response, and a numerical and functional deficit of NKT cells has been reported to be associated with the pathogenesis of autoimmune diseases. Thus far, it has been shown that subjects with type 1 diabetes have a lower frequency of NKT cells than nondiabetic subjects. In this study, we measured the frequency of peripheral Vα24+ Vβ11+ T-cells, which include human NKT cells, in Japanese diabetic patients.RESEARCH DESIGN AND METHODS—Peripheral blood samples were obtained from 164 Japanese diabetic patients and 67 healthy subjects. The diabetic patients were classified into four categories as follows: islet-associated autoantibody–positive (Ab+) and –negative (Ab–) classic type 1 diabetes, latent autoimmune diabetes in adults (LADA), and type 2 diabetes. We measured the frequency of peripheral Vα24+ Vβ11+ CD3+ triple-positive cells.RESULTS—Unexpectedly, a higher frequency of Vα24+ Vβ11+ T-cells was observed in Ab+ and Ab− patients compared with LADA patients (P = 0.0294 and P = 0.0021), type 2 diabetic patients (P &lt; 0.0001 and P &lt; 0.0001), and healthy subjects (P = 0.0046 and P = 0.0001). Moreover, an inverse correlation between Vα24+ Vβ11+ T-cell frequency and disease duration was observed in Ab+ (ρ = −0.455; P = 0.0023) and Ab− (ρ = −0.432; P = 0.0162) patients.CONCLUSIONS—Our findings indicate that a high frequency of Vα24+ Vβ11+ T-cells is a unique finding in recent-onset classic type 1 diabetes, and measurement of Vα24+ Vβ11+ T-cell frequency may be useful to assess the disease activity of classic type 1 diabetes.
Fasting and Postchallenge Glycemia and Cardiovascular Disease Risk
Authors: Meigs James B. , Nathan David M. , D’Agostino Ralph B. , Wilson Peter W.F. 
Published: March 2007

OBJECTIVE—To test the hypothesis that fasting hyperglycemia (FHG) and 2-h postchallenge glycemia (2hPG) independently increase the risk for cardiovascular disease (CVD).
RESEARCH DESIGN AND METHODS—During 1991–1995, we examined 3,370 subjects from the Framingham Offspring Study who were free from clinical CVD (coronary heart disease, stroke, or intermittent claudication) or medication-treated diabetes, and we followed them for 4 years for incident CVD events. We used proportional-hazards regression to assess the risk associated with FHG (fasting plasma glucose ≥7.0 mmol/l) and 2hPG, independent of the risk predicted by standard CVD risk factors.
RESULTS—Mean subject age was 54 years, 54% were women, and previously undiagnosed diabetes was present in 3.2% by FHG and 4.9% (164) by FHG or a 2hPG ≥11.1 mmol/l. Of these 164 subjects, 55 (33.5%) had 2hPG ≥11.1 without FHG, but these 55 subjects represented only 1.7% of the 3,261 subjects without FHG. During 12,242 person-years of follow-up, there were 118 CVD events. In separate sex- and CVD risk-adjusted models, relative risk (RR) for CVD with fasting plasma glucose ≥7.0 mmol/l was 2.8 (95% CI 1.6–5.0); RR for CVD per 2.1 mmol/l increase in 2hPG was 1.2 (1.1–1.3). When modeled together, the RR for FHG decreased to 1.5 (0.7–3.6), whereas the RR for 2hPG remained significant (1.1, 1.02–1.3). The c-statistic for a model including CVD risk factors alone was 0.744; with addition of FHG, it was 0.746, and with FHG and 2hPG, it was 0.752.
CONCLUSIONS—Postchallenge hyperglycemia is an independent risk factor for CVD, but the marginal predictive value of 2hPG beyond knowledge of standard CVD risk factors is small.
Meal-Related Structured Self-Monitoring of Blood Glucose
Authors: Schwedes Ulrich , Siebolds Markus , Mertes Gabriele ,   For the SMBG Study Group
Published: March 2007

OBJECTIVE—To investigate the effect of meal-related self-monitoring of blood glucose on glycemic control and well-being in non-insulin-treated type 2 diabetic patients.
RESEARCH DESIGN AND METHODS—This 6-month study, which included 6 months of follow-up, adopted a prospective, multicenter, randomized controlled design. Subjects were randomized to two groups: one group used a blood glucose-monitoring device, kept a blood glucose/eating diary, and received standardized counseling; the control group received nonstandardized counseling on diet and lifestyle. The primary efficacy parameter was the change in HbA1c. Secondary efficacy variables included changes in body weight, lipids, and microalbumin and changes in treatment satisfaction and well-being.
RESULTS—In the per-protocol analysis, the use of a self-monitoring blood glucose device significantly reduced HbA1c levels by 1.0 ± 1.08% compared with 0.54 ± 1.41% for the control group (P = 0.0086); subgroup analysis showed three types of responders. Body weight, total cholesterol, and microalbumin improved when using a glucometer, but there was no statistically significant difference between the two groups. Treatment satisfaction increased in both groups to a similar extent (P = 0.9). Self-monitoring resulted in a marked improvement of general well-being with significant improvements in the subitems depression (P = 0.032) and lack of well-being (P = 0.02).
CONCLUSIONS—Meal-related self-monitoring of blood glucose within a structured counseling program improved glycemic control in the majority of non-insulin-treated type 2 diabetic patients in this study. The finding of three types of responders will be important for future planning of counseling and educational interventions.
Impact of a Program to Improve Adherence to Diabetes Guidelines by Primary Care Physicians
Authors: Kirkman M. Sue , Williams Susanna R. , Caffrey Helena H. , Marrero David G. 
Published: March 2007

OBJECTIVES—Previous studies have shown that primary care physician (PCP) adherence to diabetes guidelines is suboptimal. We sought to determine the state of diabetes care given by independently practicing PCPs in a rural county in Indiana and whether a multifaceted intervention targeting PCPs, patients, and the health care system would improve adherence to diabetes guidelines.
RESEARCH DESIGN AND METHODS—Baseline audits to assess adherence to diabetes guidelines were done on charts of the seven PCPs in the county. Audits were repeated after development of local consensus guidelines and feedback of baseline performance and after implementation of various interventions (practice aids, physician detailing, patient education sessions, and implementation of computerized individual meal planning).
RESULTS—Before any intervention, rates of adherence to guidelines were low (15% for foot exams, 20% for HbA1c measurement, 23% for eye exam referrals, 33% for urine protein screening, 44% for lipid profiles, 73% for home glucose monitoring, and 78% for blood pressure measurements). One year after development of local consensus guidelines and feedback of baseline performance, significant improvements were seen in blood pressure measurements (71 vs. 83%; P = 0.002), foot exams (19 vs. 42%; P &lt; 0.001), HbA1c measurements (26 vs. 37%; P = 0.012), and PCP eye exams (38 vs. 46%; P = 0.043); a trend toward improvement was seen in referral to eye specialists (25 vs. 33%; P = 0.059). After a second year of multiple interventions, only blood pressure measurements (70 vs. 92%; P &lt; 0.001) and foot exams (22 vs. 47%; P &lt; 0.001) remained significantly improved; all other areas returned to rates indistinguishable from baseline.
CONCLUSIONS—In busy primary care practices lacking organizational support and computerized tracking systems, sustained improvements in diabetes care are difficult to attain using traditional physician-targeted approaches.
The Impact of Planned Care and a Diabetes Electronic Management System on Community-Based Diabetes Care
Authors: Montori Victor M. , Dinneen Sean F. , Gorman Colum A. , Zimmerman Bruce R. , Rizza Robert A. , Bjornsen Susan S. , Green Erin M. , Bryant Sandra C. , Smith Steven A. ,   for The Translation Project Investigator Group
Published: March 2007

OBJECTIVE—The Mayo Health System Diabetes Translation Project sought to assess models of community-based diabetes care and use of a diabetes electronic management system (DEMS). Planned care is a redesigned model of chronic disease care that involves guideline implementation, support of self-management, and use of clinical information systems.
RESEARCH DESIGN AND METHODS—We studied adult diabetic patients attending three primary care practice sites in Wisconsin and Minnesota. We implemented planned care at all sites and DEMS in the practice of 16 primary care providers. We assessed quality of diabetes care using standard indicators for 200 patients randomly selected from each site at baseline and at 24 months of implementation. We used multivariable analyses to estimate the association between planned care and DEMS and each quality indicator.
RESULTS—Planned care was associated with improvements in measurement of HbA1c (odds ratio 7.0 [95% CI 4.2–11.6]), HDL cholesterol (5.6 [4.1–7.5]), and microalbuminuria (5.3 [3.5–8.0]), as well as the provision of tobacco advice (6.9 [4.7–10.1]), among other performance measures. DEMS use was associated with improvements in all indicators, including microalbuminuria (3.2 [1.9–5.2]), retinal examination (2.4 [1.5–3.9]), foot examinations (2.3 [1.2–4.4]), and self-management support (2.6 [1.7–3.8]). Although planned care was associated with improvements in metabolic control, we observed no additional metabolic benefit when providers used DEMS.
CONCLUSIONS—Planned care was associated with improved performance and metabolic outcomes in primary care. DEMS use augmented the impact of planned care on performance outcomes but not on metabolic outcomes. Optimal identification of the best translation of evidence to diabetes practice will require longer follow-up or new care-delivery models.
Clinical Usefulness of Cystatin C for the Estimation of Glomerular Filtration Rate in Type 1 Diabetes
Authors: Tan G.D. , Lewis A.V. , James T.J. , Altmann P. , Taylor R.P. , Levy J.C. 
Published: March 2007

OBJECTIVE—Assessment and follow-up of early renal dysfunction is important in diabetic nephropathy. Plasma creatinine is insensitive for a glomerular filtration rate (GFR) &gt;50 ml/min and creatinine clearance is unwieldy and subject to collection inaccuracies. We aimed to assess the reproducibility, reliability, and accuracy of plasma cystatin C as a measure of GFR ranging from normal to moderate impairment due to type 1 diabetes in the presence of a normal plasma creatinine concentration.
RESEARCH DESIGN AND METHODS—A sensitive immunoturbidimetric cystatin C assay was examined in 29 subjects with type 1 diabetes and 11 nondiabetic subjects. Duplicate measurements of the following were collected from each subject, 2 weeks apart: cystatin C, enzymatic plasma creatinine, 24-h creatinine clearance, GFR estimated from plasma creatinine by the Cockcroft-Gault equation, and iohexol clearance as a gold standard.
RESULTS—Iohexol clearance ranged from 35 to 132 ml · min−1 · 1.73 m−2. Plasma cystatin C compared well with the other clinically used tests. The reliability of cystatin C, as assessed by the discriminant ratio, was superior to creatinine clearance (3.4 vs. 1.5, P &lt; 0.001) and the correlation of cystatin C with iohexol clearance (Rs −0.80) was similar to that of creatinine clearance (Rs −0.74) and superior to that of plasma creatinine and the Cockcroft-Gault estimate (Rs −0.54 and 0.66, respectively). Duplicate estimations were used to provide an unbiased equation to convert plasma cystatin C to GFR.
CONCLUSIONS—Based on this study, cystatin C is a more reliable measure of GFR than creatinine clearance, is more highly correlated with iohexol clearance than plasma creatinine, and is worthy of further investigation as a clinical measure of GFR in type 1 diabetes.
A Direct Comparison of Insulin Aspart and Insulin Lispro in Patients With Type 1 Diabetes
Authors: Plank Johannes , Wutte Andrea , Brunner Gernot , Siebenhofer Andrea , Semlitsch Barbara , Sommer Romana , Hirschberger Sabine , Pieber Thomas R. 
Published: March 2007

OBJECTIVE—Both rapid-acting insulin analogs, insulin aspart and lispro, attenuate prandial glucose excursion compared with human soluble insulin. This trial was performed to study the pharmacokinetic and pharmacodynamic profiles of insulin aspart and insulin lispro in type 1 diabetic patients in a direct comparison and to investigate whether the administration of one analog results in favorable effects on prandial blood glucose control.
RESEARCH DESIGN AND METHODS—A total of 24 type 1 diabetic patients (age 36 ± 8 years, 16 men and 8 women, BMI 24.3 ± 2.6 kg/m2, diabetes duration 17 ± 11 years, HbA1c 7.9 ± 0.8%) on intensified insulin therapy were recruited into a single-center, randomized, double-blind, two-period, cross-over, glucose clamp trial. The subjects were given an individual need-derived dose of prandial insulin lispro or aspart immediately before a standard mixed meal.
RESULTS—With respect to blood glucose excursions from time 0 to 6 h (Excglu(0–6 h)) and from time 0 to 4 h (Excglu(0–4 h)), the pharmacodynamic effect of insulin aspart and insulin lispro can be declared equivalent. This was supported by comparison with maximum postprandial blood glucose excursions (Cmax(glu)) (estimated ratio aspart/lispro ANOVA [90% CI]: 0.95 [0.80–1.13], 0.97 [0.82–1.17], and 1.01 [0.95–1.07] for Excglu(0–6 h), Excglu(0–4 h), and Cmax(glu), respectively). For pharmacokinetic end points (maximum postprandial insulin excursions and area under the curve for insulin from time 0 to 6 h and from time 0 to 4 h), equivalence was indicated. No difference concerning absorption or elimination for time to maximal insulin concentration, time to half-maximum insulin concentration, and time to decrease to 50% of maximum insulin concentration was observed.
CONCLUSIONS—These data suggest that in type 1 diabetic patients, both insulin analogs are equally effective for control of postprandial blood glucose excursions.
Nateglinide Improves Early Insulin Secretion and Controls Postprandial Glucose Excursions in a Prediabetic Population
Authors: Saloranta Carola , Guitard Christiane , Pecher Eckhard , de Pablos-Velasco Pedro , Lahti Kaj , Brunel Patrick , Groop Leif 
Published: March 2007

OBJECTIVE—The purpose of this study was to evaluate the metabolic effectiveness, safety, and tolerability of nateglinide in subjects with impaired glucose tolerance (IGT) and to identify a dose appropriate for use in a diabetes prevention study.
RESEARCH DESIGN AND METHODS—This multicenter, double-blind, randomized, parallel-group, fixed-dose study of 8 weeks’ duration was performed in a total of 288 subjects with IGT using a 2:2:2:1 randomization. Subjects received nateglinide (30, 60, and 120 mg) or placebo before each main meal. Metabolic effectiveness was assessed during a standardized meal challenge performed before and after the 8-week treatment. All adverse events (AEs) were recorded, and confirmed hypoglycemia was defined as symptoms accompanied by a self-monitoring of blood glucose measurement ≤3.3 mmol/l (plasma glucose ≤3.7 mmol/l).
RESULTS—Nateglinide elicited a dose-related increase of insulin and a decrease of glucose during standardized meal challenges, with the predominant effect on early insulin release, leading to a substantial reduction in peak plasma glucose levels. Nateglinide was well tolerated, and symptoms of hypoglycemia were the only treatment-emergent AEs. Confirmed hypoglycemia occurred in 28 subjects receiving nateglinide (30 mg, 0 [0%]; 60 mg, 5 [6.6%]; 120 mg, 23 [26.7%]) and in 1 (2.3%) subject receiving placebo.
CONCLUSIONS—Nateglinide was safe and effective in reducing postprandial hyperglycemia in subjects with IGT. Preprandial doses of 30 or 60 mg nateglinide would be appropriate to use for longer-term studies to determine whether a rapid-onset, rapidly reversible, insulinotropic agent can delay or prevent the development of type 2 diabetes.