bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of Glycemic Control and Blood Pressure in the Development and Progression of Nephropathy in Elderly Japanese NIDDM Patients
Authors: Tanaka Yasushi , Atsumi Yoshihito , Matsuoka Kenpei , Onuma Tomio , Tohjima Toshio , Kawamori Ryuzo 
Published: March 2007

OBJECTIVE
To investigate the role of glycemic control and blood pressure in the development and progression of nephropathy and to suggest goals for glycemic control and blood pressure for the prevention of nephropathy in elderly Japanese NIDDM patients.

RESEARCH DESIGN AND METHODS
A total of 123 age- and diabetes duration-matched elderly Japanese NIDDM patients (aged 60−75 years; 74 normoalbuminuric and 49 microalbuminuric) were retrospectively studied for 6 years.

RESULTS
The group that developed microalbuminuria from normoalbuminuria (group NM: n = 24) showed a higher 6-year mean HbA1c than the group that remained normoalbuminuric (group NN: n = 50; 9.0 ± 0.8 vs. 8.1 ± 0.8%, P &lt; 0.01) in spite of no significant difference in 6-year mean blood pressure (MBP). On the other hand, the group that progressed from microalbuminuria to overt proteinuria (group MP: n = 26) showed a higher 6-year MBP than the group that remained microalbuminuric (group MM: n = 23; 106 ± 5 vs. 95 ± 6 mmHg, P &lt; 0.01) in spite of no significant difference in 6-year mean HbA1c. The cutoff level of HbA1c separating group NN from group NM was 8.5% (normal range ≤ 6.5%), and that of MBP separating group MM from group MP was 100 mmHg.

CONCLUSIONS
Glycemic control is a more potent factor than blood pressure level on the development of microalbuminuria. However, as far as the progression of microalbuminuria to overt proteinuria is concerned, hypertension is the most crucial factor in elderly NIDDM patients. Suggested goals for glycemic control and blood pressure level for the prevention of nephropathy in elderly Japanese patients are an HbA1c of ≤8.5% (equivalent to 7.8% in the current measurement of stable HbA1c; normal range ≤5.8%) and an MBP of ≤ 100 mmHg.
Fractional Esterification Rate of HDL Particles in Patients With Type 2 Diabetes: Relation to coronary heart disease risk factors
Authors: Tan Meng-Hee , Loh Keh-Chuan , Dobiasova Milada , Frohlich Jiri J 
Published: March 2007

OBJECTIVE
To study the fractional esterification rate of cholesterol on HDL particles (FERHDL) in adults with type 2 diabetes and assess its correlation with serum lipids and other coronary heart disease (CHD) risk factors.

RESEARCH DESIGN AND METHODS
FERHDL was measured in 90 adult (57 men, 33 women) patients by an isotopic assay method involving several steps, including preparation of VLDL- and LDL-depleted plasma, labeling of the sample with a trace amount of tritiated cholesterol, separation of free and esterified cholesterol fractions by chromatography post incubation, and subsequent counting of radioactivity in the individual fractions.

RESULTS
Male patients have higher FERHDL values than their female counterparts. When HDL cholesterol was controlled for in a multivariate regression analysis, the sex factor was not significant. There was a significant positive correlation between FERHDL and plasma total cholesterol (r = 0.32), triglycerides (r = 0.82), apolipoprotein B (apo B; r = 0.48), insulin (r = 0.46), BMI (r = 0.31), and waist-to-hip ratio (WHR; r = 0.50). There was a negative correlation between FERHDL and HDL cholesterol (r = −0.76) and apolipoprotein AI (r = −0.60). When both HDL cholesterol and triglycerides were controlled for, the only significant correlation was between FERHDL and BMI.

CONCLUSIONS
Non-insulin-requiring type 2 diabetic patients have FERHDL, which correlated positively with triglycerides and negatively with HDL cholesterol. The positive correlation of FERHDL with serum insulin, WHR, total cholesterol, and apo B, but not that with BMI, loses its significance when HDL cholesterol and triglycerides are controlled. The sex difference between men and women in FERHDL also loses its significance when HDL cholesterol is controlled.
Stimulation of Insulin Secretion by Fructose Ingested With Protein in People With Untreated Type 2 Diabetes
Authors: Gannon Mary C , Nuttall Frank Q , Grant Charles T , Ercan-Fang Sean , Ercan-Fang Nacide 
Published: March 2007

OBJECTIVE
Ingested protein provides substrate for gluconeogenesis and strongly stimulates insulin and glucagon secretion, but it has little effect on the glucose concentration in people with type 2 diabetes. Ingested fructose also is a substrate for gluconeogenesis, modestly stimulates insulin and glucagon secretion, and has little effect on the plasma glucose. Therefore we were interested in determining if ingestion of fructose along with protein would result in an additive, greater than additive, or less than additive effect on circulating insulin, glucagon, and glucose concentrations.

RESEARCH DESIGN AND METHODS
Seven male subjects with untreated type 2 diabetes were fasted overnight and then were given either 25 g fructose, 25 g protein, 25 g fructose plus 25 g protein, or water only at 0800. Subjects also ingested 50 g glucose on two separate occasions. Plasma glucose, insulin, C-peptide, glucagon, α-amino nitrogen, urea nitrogen, nonesterified fatty acids, and triglyceride concentrations were determined over the subsequent 5 h.

RESULTS
The glucose concentration was only modestly increased and the area responses were similar when protein, fructose, or the combination was ingested. Thus, the glucose response to the combination was less than additive. The insulin area response to protein was 2.5-fold greater than to fructose, and the response to the two nutrients was additive and quantitatively similar to the response to 50 g glucose. The glucagon area response was less than additive, i.e., there was an interaction between the protein and fructose that resulted in a smaller than expected response.

CONCLUSIONS
When protein and fructose were ingested together, the insulin response was similar to that following ingestion of 50 g glucose. It also was as expected based on the response to the individual nutrients. In contrast, the glucose and glucagon responses were significantly less than expected. These data may be useful in dietary planning for subjects with type 2 diabetes.
The Epidemiology and Cost of Inpatient Care for Peripheral Vascular Disease, Infection, Neuropathy, and Ulceration in Diabetes
Authors: Currie Craig J , Morgan Christopher LL , Peters John R 
Published: March 2007

OBJECTIVE
To describe the epidemiology and costs of the acute care of peripheral vascular disease, infection, neuropathy, and ulceration in a U.K. population with special consideration of those patients with diabetes.

RESEARCH DESIGN AND METHODS
Routine data describing inpatient care for a 4-year period were analyzed (financial years 1991/1992 to 1994/1995). These data had undergone record-linkage to draw together records from the same patients, and records of patients with diabetes were flagged. Cost estimates were determined by attributing a diagnosis-related group cost-weight to each record.

RESULTS
A total of 4,245 admissions (1.2% of all admissions) had a primary diagnosis of peripheral vascular disease, infection, neuropathy, or ulceration, and 7,379 (2.1%) admissions had these categories recorded in any one of six diagnostic fields. These figures were generated by 3,159 and 4,751 patients, respectively. This represented a range of crude annual incidence of admission of between 1.9 and 2.9 per 1,000 people. Patients with diabetes accounted for 625 (15.4%) of primary admissions, a crude annual incidence of admission of 18.8 per 1,000. The age-standardized relative risk of admission for patients with diabetes to the nondiabetic population was 7.61 for men and 6.85 for women. The length of stay for patients with diabetes was almost twice that of the nondiabetic population (15.5 vs. 8.7 days). The relative risk of hospital mortality (diabetes vs. non-diabetes) was 2.83. Surgical procedures were carried out on 857 patients, 272 (31.2%) with diabetes. This represented an age-standardized relative risk of 31.19. The estimated cost of admissions for primary diagnoses in these categories over 4 years was 6,128,211 pounds ($9,743,855). Patients with diabetes accounted for 1,236,623 pounds ($1,966,230), an excess of 87% attributable to the diabetic state.

CONCLUSIONS
Diabetes is confirmed as a significant risk factor for peripheral vascular disease, infection, neuropathy, and ulceration. The severity of these disorders in terms of increased risk of hospital mortality, length of stay, and risk of surgical procedure is also demonstrated for those patients with diabetes.
Impact of Diabetes on Mortality After the First Myocardial Infarction
Authors: Miettinen Heikki , Lehto Seppo , Salomaa Veikko , Mähönen Markku , Niemelä Matti , Haffner Steven M , Pyörälä Kalevi , Tuomilehto Jaakko ,   The FINMONICA Myocardial Infarction Register Study Group
Published: March 2007

OBJECTIVE
To study diabetic and nondiabetic patients with their first myocardial infarction to determine overall 1-year mortality, out-of-hospital mortality, 28-day mortality of hospitalized patients, and 1-year mortality of 28-day survivors.

RESEARCH DESIGN AND METHODS
This study—based on the FINMONICA Myocardial Infarction Register, a part of the Finnish contribution to the WHO MONICA Project (World Health Organization Multinational Monitoring of Trends and Determinants of Cardiovascular Disease)—covered coronary heart disease (CHD) deaths and acute CHD events occurring during hospitalization among residents of Finland aged 25–64 years in three geographically defined areas. The study population comprised 620 diabetic and 3,445 nondiabetic patients who had their first myocardial infarction during the years 1988–1992.

RESULTS
The age- and area-adjusted mortality rates and hazard ratios (HRs) for diabetic versus nondiabetic patients (95% CI) were as follows: The 1-year mortality rate was 44.2% in diabetic men and 32.6% in nondiabetic men (HR, 1.38; 1.18−1.61) and 36.9% in diabetic women and 20.2% in nondiabetic women (HR, 1.86; 1.40−2.46); the out-of-hospital mortality rate was 28.3% in diabetic men and 22.4% in nondiabetic men (HR, 1.25; 1.03−1.52) and 10.4% in diabetic women and 11.0% in nondiabetic women (HR, 0.95; 0.58−1.54); the 28-day mortality rate of hospitalized patients was 14.4% in diabetic men and 8.8% in nondiabetic men (HR, 1.58; 1.15−2.18) and 21.7% in diabetic women and 7.8% in nondiabetic women (HR, 2.60; 1.71−3.95); and the 1-year mortality rate of 28-day survivors was 9.6% in diabetic men and 5.0% in nondiabetic men (HR, 1.97; 1.25−3.12) and 10.7% in diabetic women and 2.5% in nondiabetic women (HR, 4.17; 2.05−8.51).

CONCLUSIONS
The high mortality rate of diabetic patients after their first myocardial infarction and the high proportion of out-of-hospital deaths in this group imply that vigorous primary and secondary preventive measures should become an integral part of their medical care.
The Veterans Affairs Implantable Insulin Pump Study: Effect on cardiovascular risk factors
Authors: Duckworth William C , Saudek Christopher D , Giobbie-Hurder Anita , Henderson William G , Henry Robert R , Kelley David E , Edelman Steven V , Zieve Franklin J , Adler Robert A , Anderson James W , Anderson Robert J , Hamilton Bruce P , Donner Thomas W , Kirkman M Sue , Morgan Nancy A ,   The Department of Veterans Affairs Implantable Insulin Pump Study Group
Published: March 2007

OBJECTIVE
To determine whether implantable insulin pump (IIP) and multiple-dose insulin (MDI) therapy have different effects on cardiovascular risk factors in insulin-requiring patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS
A randomized clinical trial was conducted at seven Veterans Affairs medical centers in 121 male patients with type 2 diabetes between the ages of 40 and 69 years receiving at least one injection of insulin per day and with HbAlc levels of ≥8% at baseline. Weights, blood pressures, insulin use, and glucose monitoring data were obtained at each visit. Lipid levels were obtained at 0, 4, 8, and 12 months, and free and total insulin levels were obtained at 0, 6, and 12 months. All medications being taken were recorded at each visit.

RESULTS
No difference in absolute blood pressure, neither systolic nor diastolic, was seen between patients receiving MDI or IIP therapy, but significantly more MDI patients required antihypertensive medications. When blood pressure was modeled against weight and time, IIP therapy was significantly better than MDI therapy for systolic blood pressure in patients with BMI &lt;33 and for diastolic blood pressure in patients with BMI &gt;34 kg/m2. Total cholesterol levels decreased in the overall sample, but IIP patients exhibited significantly higher levels than MDI patients. Triglyceride levels increased over time for both groups, with IIP patients having significantly higher levels than patients in the MDI group. BMI was a significant predictor of, and inversely proportional to, HDL cholesterol level. No difference in lipid-lowering drug therapy was seen between the two groups. Free insulin and insulin antibodies tended to decrease in the IIP group as compared with the MDI group. C-peptide levels decreased in both groups.

CONCLUSIONS
IIP therapy in insulinrequiring patients with type 2 diabetes has advantages over MDI therapy in decreasing the requirement for antihypertensive therapy and for decreasing total and free insulin and insulin antibodies. Both therapies reduce total cholesterol and C-peptide levels
Role of Neuropathy and High Foot Pressures in Diabetic Foot Ulceration
Authors: Frykberg Robert G , Lavery Lawrence A , Pham Hau , Harvey Carolyn , Harkless Lawrence , Veves Aristidis 
Published: March 2007

OBJECTIVE
High plantar foot pressures in association with peripheral neuropathy have been ascertained to be important risk factors for ulceration in the diabetic foot. Most studies investigating these parameters have been limited by their size and the homogeneity of study subjects. The objective of this study was therefore to ascertain the risk of ulceration associated with high foot pressures and peripheral neuropathy in a large and diverse diabetic population.

RESEARCH DESIGN AND METHODS
We studied a cross-sectional group of 251 diabetic patients of Caucasian (group C) (n = 121), black (group B) (n = 36), and Hispanic (group H) (n = 94) racial origins with an overall age of 58.5 ± 12.5 years (range 20–83). There was an equal distribution of men and women across the entire study population. All patients underwent a complete medical history and lower extremity evaluation for neuropathy and foot pressures. Neuropathic parameters were dichotomized (0/1) into two high-risk variables: patients with a vibration perception threshold (VPT) ≥25 V were categorized as HiVPT (n = 132) and those with Semmes-Weinstein monofilament tests ≥5.07 were classified as HiSWF (n = 190). The mean dynamic foot pressures of three footsteps were measured using the F-scan mat system with patients walking without shoes. Maximum plantar pressures were dichotomized into a high-pressure variable (Pmax6) indicating those subjects with pressures ≥6 kg/cm2 (n = 96). A total of 99 patients had a current or prior history of ulceration at baseline.

RESULTS
Joint mobility was significantly greater in the Hispanic cohort compared with the other groups at the first metatarsal-phalangeal joint (C 67 ± 23°, B 69 ± 23°, H 82 ± 23°, P = 0.000), while the subtalar joint mobility was reduced in the Caucasian group (C 21 ± 8°, B 26 ± 7°, H 27 ± 11°, P = 0.000). Maximum plantar foot pressures were significantly higher in the Caucasian group (C 6.7 ± 2.9 kg/cm2, B 5.7 ± 2.8 kg/cm2, H 4.4 ±1.9 kg/cm2 P = 0.000). Univariate logistic regression for Pmax6 on the history of ulceration yielded an odds ratio (OR) of 3.9 (P = 0.000). For HiVPT, the OR was 11.7 (P = 0.000), and for HiSWF, the OR was 9.6 (P = 0.000). Controlling for age, diabetes duration, sex, and race (all P &lt; 0.05), multivariate logistic regression yielded the following significant associations with ulceration: Pmax6 (OR = 2.1, P = 0.002), HiVPT (OR = 4.4, P = 0.000), and HiSWF (OR = 4.1, P = 0.000).

CONCLUSIONS
We conclude that both high foot pressures (≥6 kg/cm2) and neuropathy are independently associated with ulceration in a diverse diabetic population, with the latter having the greater magnitude of effect. In black and Hispanic diabetic patients especially, joint mobility and plantar pressures are less predictive of ulceration than in Caucasians.
Oxidative Stress at Onset and in Early Stages of Type 1 Diabetes in Children and Adolescents
Authors: Domínguez Carmen , Ruiz Elena , Gussinye Miguel , Carrascosa Antonia 
Published: March 2007

OBJECTIVE
In diabetes, the persistence of hyperglycemia has been reported to cause increased production of oxygen free radicals through glucose autooxidation and nonenzymatic glycation. The aim of this study was to determine whether oxidative cellular damage occurs at the clinical onset of diabetes and in later stages of the disease in young patients.

RESEARCH DESIGN AND METHODS
Indicative parameters of lipoperoxidation, protein oxidation, and changes in the status of antioxidant defense systems were evaluated in single blood samples from 54 diabetic children, adolescents, and young adults and 60 healthy age- and sex-matched control subjects.

RESULTS
Malondialdehyde and protein carbonyl group levels in plasma were progressively higher in diabetic children and adolescents than in control subjects (P &lt; 0.0001). The highest erythrocyte superoxide dismutase (SOD) activity was found in diabetic children at onset of clinical diabetes. In diabetic adolescents, SOD was also significantly higher (P &lt; 0.0001) than in control subjects. Erythrocyte glutathione peroxidase was significantly lower in diabetic children and adolescents compared with control subjects (P &lt; 0.002). A significant decline in blood glutathione content at the recent onset of diabetes was found (P &lt; 0.0001). Furthermore, our results demonstrated progressive glutathione depletion during diabetes evolution. The plasma α-tocopherol/total lipids ratio and β-carotene levels during diabetes development (P &lt; 0.001) were low.

CONCLUSIONS
This cross-sectional study in young diabetic patients showed that systemic oxidative stress is present upon early onset of type 1 diabetes and is increased by early adulthood. Decreased antioxidant defenses may increase the susceptibility of diabetic patients to oxidative injury. Appropriate support for enhancing antioxidant supply in these young diabetic patients may help prevent clinical complications during the course of the disease.
Efficacy and Safety of Acarbose in Insulin-Treated Patients With Type 2 Diabetes
Authors: Kelley David E , Bidot Pascual , Freedman Zachary , Haag Burritt , Podlecki David , Rendell Marc , Schimel David , Weiss Stuart , Taylor Terry , Krol Alice , Magner James 
Published: March 2007

OBJECTIVE
To demonstrate the efficacy, tolerability, and safety of acarbose compared with placebo in patients with type 2 diabetes inadequately controlled with diet and insulin.

RESEARCH DESIGN AND METHODS
A multicenter randomized double-blind placebo-controlled parallel-group comparison study was conducted. The trial was 26 weeks with a 2-week screening period and a 24-week period of treatment with acarbose or placebo, with forced titration from 25 mg t.i.d. to 50 mg t.i.d. after 4 weeks, and titration of 50 mg t.i.d. to 100 mg t.i.d. after 12 weeks based on glucose control. The dosage of insulin was toremain stable. The primary efficacy variable was mean change from baseline in HbA1c, and secondary efficacy variables included mean changes in fasting and postprandial plasma glucose and triglyceride levels.

RESULTS
The addition of acarbose to the treatment of patients receiving background insulin and diet therapy resulted in a statistically significant reduction in mean HbA1c of 0.69% compared with placebo. Therewere statistically significant reductions in postprandial plasma glucose and glucose area under the curve, and in postprandial serum triglyceride levels in the acarbose-treated patients. Gastrointestinal side effects were more frequently reported in the acarbose-treated patients. There were no significant differences in hypoglycemic events or liver transaminase elevations between groups.

CONCLUSIONS
This study demonstrated that the addition of acarbose to patients with type 2 diabetes who are inadequately controlled with insulin and diet is safe and generally well tolerated and that it significantly lowers HbA1c and postprandial glucose levels.
Hyperfiltration in African-American Patients With Type 2 Diabetes: Cross-sectional and longitudinal data
Authors: Chaiken Rochelle L , Eckert-Norton Margaret , Bard Mara , Banerji Mary Ann , Palmisano Joanne , Sachimechi Isaac , Lebovitz Harold E 
Published: March 2007

OBJECTIVE
Hyperfiltration may play a role in the development of diabetic nephropathy. African-American patients with diabetes have more than a fourfold increase in end-stage renal disease. The purpose of this study is to evaluate the impact of hyperfiltration on renal function in African-American patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS
Renal function of 194 African-American patients with diagnosed type 2 diabetes from 1 month to 36 years was assessed by studies of isotopic glomerular filtration rate (GFR), serum creatinine, creatinine clearance, and 24-h urinary albumin excretion rates. Thirty-four patients with a duration of diagnosed type 2 diabetes from 1 month to 10 years were found to have hyperfiltration (GFR ≥140 ml · min−1 · 1.73 min2). Fifteen of these patients received longitudinal follow-up of renal function for as long as 15 years after the initial study.

RESULTS
Hyperfiltration is present in 15 (36%) of 42 patients whose duration of diagnosed type 2 diabetes is &lt;1 year, and it persists for up to 10 years in 14–20% of patients with diagnosed type 2 diabetes. Patients with hyperfiltration are younger than their counterparts without hyperfiltration when matched for duration of diagnosed diabetes. When followed over time, those patients with hyperfiltration were not more likely to develop impaired renal function as measured by GFR or creatinine clearance.

CONCLUSIONS
Hyperfiltration does not identify patients at risk for deterioration in renal function
High Serum Lipoprotein(a) Levels in Korean Type 2 Diabetic Patients With Proliferative Diabetic Retinopathy
Authors: Kim Chul-Hee , Park Hyung-Joo , Park Joong-Yeol , Hong Sung-Kwan , Yoon Young-Hee , Lee Ki-Up 
Published: March 2007

OBJECTIVE
To examine the possible association between serum lipoprotein(a) [Lp(a)] concentration and proliferative diabetic retinopathy (PDR) in Korean patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS
A total of 412 Korean outpatients with type 2 diabetes were examined. Diabetic retinopathy was determined by an ophthalmologist using fundoscopic examination. Serum Lp(a) levels were measured by two-site sandwich enzymelinked immunosorbent assay.

RESULTS
The patients with PDR had higher serum Lp(a) levels than those with no diabetic retinopathy or with nonproliferative diabetic retinopathy (NPDR). Multiple logistic regression analysis showed that high serum Lp(a) levels and the presence of diabetic nephropathy were independent variables having a statistically significant association with PDR.

CONCLUSIONS
Korean type 2 diabetic patients with PDR had higher serum Lp(a) levels versus those with no diabetic retinopathy or with NPDR. Although these results suggest that Lp(a) might play a role in the occlusion of retinal capillaries leading to PDR, further prospective studies are required to prove the causal relationship.