bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Thiazolidinediones and Risk of Heart Failure in People With Type 2 Diabetes
Authors: Delea Thomas E. , Edelsberg John S. , Hagiwara May , Oster Gerry , Phillips Lawrence S. 
Published: March 2007

OBJECTIVE—To compare the incidence of heart failure in individuals with type 2 diabetes receiving thiazolidinediones (TZDs) versus other oral antihyperglycemic agents.
RESEARCH DESIGN AND METHODS—We conducted a retrospective cohort study using a health insurance claims database. The study sample included patients with type 2 diabetes who received an oral antihyperglycemic agent between January 1995 and March 2001. Those with any claims for TZDs were designated “exposed,” and each was compared with five randomly selected unexposed patients. Those with diagnoses of heart failure or who received digoxin or a diuretic in the year before their index date were excluded. The primary measure of interest was incidence of heart failure, which was defined as a hospitalization or outpatient visit with a diagnosis of heart failure.
RESULTS—TZD patients (n = 5,441) were younger than control subjects (n = 28,103) but more likely to have coronary artery disease or diabetes complications, receive ACE inhibitors, β-blockers, metformin, or insulin, and have undergone HbA1c tests or eye exams; they also had more comorbidities and higher costs (all P &lt; 0.05). However, TZD use was predictive of heart failure even after controlling for these variables (hazard ratio = 1.7, P &lt; 0.001). Adjusted incidence of heart failure at 40 months was 8.2% for TZD patients and 5.3% for control subjects.
CONCLUSIONS—The results of this observational study suggest that TZDs may increase the risk of heart failure. Physicians should use TZDs with caution in patients with heart failure, remain vigilant for manifestations of heart failure in those receiving these drugs (especially patients with cardiovasculopathy), and consider alternate therapies for patients who develop symptoms of heart failure, such as shortness of breath.
Validation of the Archimedes Diabetes Model
Authors: Eddy David M. , Schlessinger Leonard 
Published: March 2007

OBJECTIVE—To validate the Archimedes model of diabetes and its complications for a variety of populations, organ systems, treatments, and outcomes.
RESEARCH DESIGN AND METHODS—We simulated a variety of randomized controlled trials by repeating in the model the steps taken for the real trials and comparing the results calculated by the model with the results of the trial. Eighteen trials were chosen by an independent advisory committee. Half the trials had been used to help build the model (“internal” or “dependent” validations); the other half had not. Those trials comprise “external” or “independent” validations.
RESULTS—A total of 74 validation exercises were conducted involving different treatments and outcomes in the 18 trials. For 71 of the 74 exercises there were no statistically significant differences between the results calculated by the model and the results observed in the trial. Considering only the trials that were never used to help build the model—the independent or external validations—the correlation was r = 0.99. Including all of the exercises, the correlation between the outcomes calculated by the model and the outcomes seen in the trials was r = 0.99. When the absolute differences in outcomes between the control and treatment groups were compared, the correlation coefficient was r = 0.97.
CONCLUSIONS—The Archimedes diabetes model is a realistic representation of the anatomy, pathophysiology, treatments, and outcomes pertinent to diabetes and its complications for applications that involve the populations, treatments, outcomes, and health care settings spanned by the trials.
Semiquantitative Analysis of the Histopathological Features of the Neuropathic Foot Ulcer
Authors: Piaggesi Alberto , Viacava Paolo , Rizzo Loredana , Naccarato Giuseppe , Baccetti Fabio , Romanelli Marco , Zampa Virna , Del Prato Stefano 
Published: March 2007

OBJECTIVE—This study was designed to evaluate the histopathology of neuropathic ulcers and whether pressure relief could change such histological patterns.
RESEARCH DESIGN AND METHODS—We compared neuropathic plantar ulcers tissue excised from 10 diabetic patients (group A) with those taken from 10 patients with comparable lesions and glycemic control after 20 days in a total contact cast (group B). Tissue specimens were blindly examined by two independent pathologists for hyperkeratosis, fibrosis, cutaneous annexes, capillaries, inflammation, cellular debris, and granulating tissue. For each parameter, quantification was obtained according to an arbitrary score: 0, absent; 1, present in &lt;33%; 2, present in 34–66%; and 3, present in &gt;67% of the lesion.
RESULTS—Patients in group B showed a marked reduction in ulcer size after 20 days of casting (P &lt; 0.01). The histopathological features of the two groups markedly differed. Group A patients showed a predominance of inflammatory elements as well as matrix alterations, vessel disruptions, inflammation, and debris. Group B ulcers showed a shift toward a reparative pattern with prevalence of neoformed capillaries and fibroblasts. Semiquantitative analysis confirmed the prevalence of hyperkeratosis, fibrosis, inflammation, and cellular debris in group A patients (P &lt; 0.05), whereas cutaneous annexes, capillaries, and granulating tissue were more prevalent in group B lesions (P &lt; 0.01).
CONCLUSIONS—These results indicate that pressure relief with a total contact cast is associated with changes in the histology of neuropathic foot ulcers, indicating reduction of inflammatory and reactive components and acceleration of reparative processes.
Effects of Pioglitazone Versus Diet and Exercise on Metabolic Health and Fat Distribution in Upper Body Obesity
Authors: Shadid Samyah , Jensen Michael D. 
Published: March 2007

OBJECTIVE—Insulin resistance is associated with visceral adiposity, and interventions that reduce this depot, e.g., diet and exercise, improve insulin resistance. Thiazolidinediones (TZDs) also improve insulin action but paradoxically increase total fat mass, perhaps through remodeling (recruitment of smaller fat cells) and redistribution of adipose tissue. We assessed the effects of pioglitazone versus diet and exercise on fat distribution and the relationship between fat distribution and insulin sensitivity in upper body obesity.
RESEARCH DESIGN AND METHODS—Thirty-nine upper body obese, insulin-resistant, nondiabetic men and premenopausal women were randomly assigned to receive either 30 mg/day pioglitazone or a diet and exercise program for 20 weeks. Before and after the intervention, insulin sensitivity, body composition, body fat distribution (waist-to-hip ratio [WHR], computed tomography abdomen, and dual-energy X-ray absorptiometry), and abdominal and femoral fat cell size were assessed.
RESULTS—Diet and exercise resulted in an 11.8 ± 1.1 kg weight loss. Both diet and exercise and pioglitazone improved insulin sensitivity, but only the former was associated with loss of intra-abdominal fat. Pioglitazone increased total body fat, which preferentially accumulated in the lower body depot in both men and women. WHRs decreased in both groups. Abdominal fat cell size decreased (P = 0.06) after diet and exercise. No statistically significant changes in fat cell size were observed in pioglitazone-treated volunteers.
CONCLUSIONS—In nondiabetic upper body obese subjects, increasing insulin sensitivity via diet and exercise accompanies reductions in visceral fat. Pioglitazone treatment also improves insulin sensitivity and lowers WHR, but this is due to a selective increase in lower body fat. This confirms a site-specific responsiveness of adipose tissue to TZD and suggests that improvements in insulin sensitivity by pioglitazone are achieved independent of changes in intra-abdominal fat.
The Finnish Diabetes Prevention Study (DPS)
Authors: Lindström Jaana , Louheranta Anne , Mannelin Marjo , Rastas Merja , Salminen Virpi , Eriksson Johan , Uusitupa Matti , Tuomilehto Jaakko ,   for the Finnish Diabetes Prevention Study Group
Published: March 2007

OBJECTIVE—To describe the 1) lifestyle intervention used in the Finnish Diabetes Prevention Study, 2) short- and long-term changes in diet and exercise behavior, and 3) effect of the intervention on glucose and lipid metabolism.
RESEARCH DESIGN AND METHODS—There were 522 middle-aged, overweight subjects with impaired glucose tolerance who were randomized to either a usual care control group or an intensive lifestyle intervention group. The control group received general dietary and exercise advice at baseline and had an annual physician’s examination. The subjects in the intervention group received additional individualized dietary counseling from a nutritionist. They were also offered circuit-type resistance training sessions and advised to increase overall physical activity. The intervention was the most intensive during the first year, followed by a maintenance period. The intervention goals were to reduce body weight, reduce dietary and saturated fat, and increase physical activity and dietary fiber.
RESULTS—The intervention group showed significantly greater improvement in each intervention goal. After 1 and 3 years, weight reductions were 4.5 and 3.5 kg in the intervention group and 1.0 and 0.9 kg in the control group, respectively. Measures of glycemia and lipemia improved more in the intervention group.
CONCLUSIONS—The intensive lifestyle intervention produced long-term beneficial changes in diet, physical activity, and clinical and biochemical parameters and reduced diabetes risk. This type of intervention is a feasible option to prevent type 2 diabetes and should be implemented in the primary health care system.
Serum ACE Predicts Severe Hypoglycemia in Children and Adolescents With Type 1 Diabetes
Authors: Nordfeldt Sam , Samuelsson Ulf 
Published: March 2007

OBJECTIVE—To investigate whether risk of severe hypoglycemia is related to serum (S) ACE level during intensive treatment in type 1 diabetic children.
RESEARCH DESIGN AND METHODS—A cohort of 86 intensively treated type 1 diabetic patients was studied during 1999–2000. In 1999, the age range was 7–19 years (median 12.8), diabetes duration was 1.2–14.7 years (5.3), insulin dose was 0.4–1.7 units · kg−1 · 24 h−1 (1.0), and the HbA1c year mean was 4.7–10.2% (6.8). HbA1c, insulin doses, and events of severe hypoglycemia (needing assistance from another person) were prospectively registered at regular visits, scheduled quarterly. S-ACE was determined once.
RESULTS—Severe hypoglycemia was correlated to S-ACE (r = 0.22, 95% CI 0.01–0.41, P = 0.0093). The square root of severe hypoglycemia was correlated to S-ACE (r = 0.27, 95% CI 0.06–0.45, P = 0.0093). Patients with S-ACE at the median level or above (n = 44) reported a mean of 3.0 yearly events of severe hypoglycemia compared with 0.5 events in patients with S-ACE lower than the median (n = 42) (P = 0.0079). Of the patients with an S-ACE at the median level or above, 27 (61%) reported severe hypoglycemia, compared with 17 (40%) patients with an S-ACE lower than the median (P = 0.0527). Insulin dose, HbA1c, age, onset age, duration, C-peptide, and sex did not differ between these two groups. S-ACE was negatively correlated with age (r = −0.27, 95% CI −0.46 to 0.07, P = 0.0265) but not with HbA1c, duration, or blood pressure.
CONCLUSIONS—The elevated rate of severe hypoglycemia among patients with higher S-ACE suggests, among other factors, that a genetic determinant for severe hypoglycemia exists. Further evaluation is needed before the clinical usefulness of this test can be elucidated.
Target-Seeking Behavior of Plasma Glucose With Exercise in Type 1 Diabetes
Authors: Biankin Sandra A. , Jenkins Arthur B. , Campbell Lesley V. , Choi Kin Lam , Forrest Quentin G. , Chisholm Donald J. 
Published: March 2007

OBJECTIVE—To investigate the reproducibility of the plasma glucose (PG) response to exercise in subjects with type 1 diabetes on a nonintensive insulin regimen.
RESEARCH DESIGN AND METHODS—Subjects cycled for 45 min at 50% Vo2max on two occasions (studies 1 and 2) either 1 h after lunch and usual insulin (protocol A) or after overnight fasting without morning insulin (protocol B). Identical diet, activity, and insulin (twice daily neutral and intermediate) were maintained before and during each study day. A total of 13 type 1 diabetic subjects (6 men and 7 women, BMI 24.0 ± 0.9 kg/m2 [means ± SE], age 42.6 ± 2.7 years, diabetes duration 14.1 ± 2.8 years) completed protocol A, and 7 (3 men and 4 women, BMI 25.8 ± 1.3 kg/m2, age 39.7 ± 1.3 years, diabetes duration 14 ± 4.4 years) completed protocol B.
RESULTS—In protocol A (fed), the fall in PG during exercise was 4.5 ± 1.0 and 5.0 ± 0.8 mmol/l in studies 1 and 2, respectively, whereas in protocol B (fasted), it was 0.6 ± 0.8 and 3.4 ± 1.6 mmol/l. Regression analysis of the change in PG in protocol A in study 1 versus study 2 showed poor reproducibility (r2 = 0.12, P = 0.25) despite uniform conditions. In protocol B, the fall in PG was more reproducible (r2 = 0.81, P = 0.006). In fed subjects, there was better (P = 0.01) and clinically useful reproducibility of the PG at exercise completion (r2 = 0.77, P = 0.0001) compared with preexercise.
CONCLUSIONS—These results indicate poor reproducibility of the change in PG during exercise after feeding in type 1 diabetes on nonintensive insulin regimens but reasonable reproducibility when fasting. Exercise apparently decreases the glycemic variability after feeding, so that PG concentrations after exercise seek a reproducible “target.” Thus, the absolute PG level after a typical bout of exercise in the fed state should be a good guide to carbohydrate or insulin adjustment on subsequent occasions.
Epidemiology of Diabetes Among Arab Americans
Authors: Jaber Linda A. , Brown Morton B. , Hammad Adnan , Nowak Sandra N. , Zhu Qian , Ghafoor Anisa , Herman William H. 
Published: March 2007

OBJECTIVE—To examine the prevalence of diabetes and glucose intolerance by age and sex in the Arab-American community of Dearborn, Michigan.
RESEARCH DESIGN AND METHODS—Participants were randomly selected adult Arab Americans, 20–75 years of age, from randomly selected households in Dearborn, Michigan. Demographic and anthropometric data were recorded. Glucose tolerance was assessed with 2-h 75-g oral glucose tolerance tests and classified according to 1997 American Diabetes Association and 1998 World Health Organization criteria.
RESULTS—A total of 626 eligible adults were selected, and 542 participated (87% response rate). Because prevalence increases with age and the overall response rate for women (328/352; 93%) was higher than that for men (214/274; 78%), prevalence rates were adjusted for age and sex. The overall prevalence of diabetes was 15.5% (95% CI 12.2–18.7%) in women and 20.1% (15.0–25.2%) in men (P = 0.13). The prevalence of previously diagnosed diabetes was similar to that of undiagnosed diabetes. Impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG) were present in 16.8% (12.8–20.8%) of women and 29.7% (23.4–35.9%) of men (P = 0.0007). The combined rates of glucose intolerance (diabetes, IGT, and IFG) were 32.3% (27.8–36.7%) for women and 49.8% (43.1–56.4%) for men (P &lt; 0.0001). Among younger adults, the prevalence in men was higher than that in women. As expected, subjects with diabetes or IGT/IFG were older and had greater BMI and waist-to-hip ratios than subjects with normal glucose tolerance.
CONCLUSIONS—The prevalence of diabetes and glucose intolerance is extremely high among adult Arab Americans in Michigan and represents a major clinical and public health problem. Community-based intervention programs to prevent and treat diabetes are urgently needed.
Short-Term, Delayed, and Working Memory Are Impaired During Hypoglycemia in Individuals With Type 1 Diabetes
Authors: Sommerfield Andrew J. , Deary Ian J. , McAulay Vincent , Frier Brian M. 
Published: March 2007

OBJECTIVE—To examine the effects of acute insulin-induced hypoglycemia on short-term, delayed, and working memory in individuals with type 1 diabetes.
RESEARCH DESIGN AND METHODS—A hyperinsulinemic glucose clamp was used to maintain arterialized blood glucose level at either 4.5 mmol/l (euglycemia) or 2.5 mmol/l (hypoglycemia) on two separate occasions in 16 adults with type 1 diabetes. The participants completed tests of immediate and delayed verbal memory, immediate and delayed visual memory, and working memory during each experimental condition. Two other mental tests, the Trail Making B Test and the Digit Symbol Test, were also administered.
RESULTS—Performance in tests of immediate verbal and immediate visual memory was significantly impaired during hypoglycemia. The effect of hypoglycemia on working memory and delayed memory was more profound. Performance in the nonmemory tests, the Trail Making B Test, and the Digit Symbol Test also deteriorated during hypoglycemia.
CONCLUSIONS—All of the memory systems examined in the present study were affected significantly by acute hypoglycemia, particularly working memory and delayed memory. Mild (self-treated) hypoglycemia is common in individuals with insulin-treated diabetes; therefore, these observed effects of hypoglycemia on memory are of potential clinical importance because they could interfere with many everyday activities.
Prevalence and Costs of Major Depression Among Elderly Claimants With Diabetes
Authors: Finkelstein Eric A. , Bray Jeremy W. , Chen Hong , Larson Mary Jo , Miller Kay , Tompkins Christopher , Keme Allen , Manderscheid Ronald 
Published: March 2007

OBJECTIVE—To compare the odds of major depression among Medicare claimants with and without diabetes and to test whether annual medical payments are greater for those with both diabetes and major depression than for those with diabetes alone.
RESEARCH DESIGN AND METHODS—This retrospective analysis relies on claims data from the 1997 Medicare 5% Standard Analytic Files. Using these data, we statistically determined whether the odds of major depression are greater among elderly claimants with diabetes after controlling for age, race/ethnicity, and sex. We then used regression analysis on a sample of over 220,000 elderly claimants with diabetes to test whether payments for non-mental health-related services are greater for those with both diabetes and major depression (n = 4,203) than for those with diabetes alone.
RESULTS—Our findings indicate that the odds of major depression are significantly greater among elderly Medicare claimants with diabetes than among those without diabetes (OR 1.58 ± 0.05). We also found that elderly claimants with both diabetes and major depression seek treatment for more services and spend more time in inpatient facilities, and as a result incur higher medical costs than claimants with diabetes but without major depression. These results hold even after excluding services related to mental health treatment.
CONCLUSIONS—This analysis suggests that treatment for major depression among claimants with diabetes may reduce total medical costs if treatment results in a decrease in utilization for general medical services in the future.
The Influence of Shoe Design on Plantar Pressures in Neuropathic Feet
Authors: Praet Stephan F.E. , Louwerens Jan-Willem K. 
Published: March 2007

OBJECTIVE—The aim of this study was to investigate the effect of shoe design on the plantar pressure dynamics of patients with diabetic neuropathy during walking.RESEARCH DESIGN AND METHODS—Three shoe design categories were tested. Total contact area and biomechanical variables in multiple areas under the foot were measured.RESULTS—Shoes with a rocker bottom principle reduced pressure 35–65% underneath the heel and the central metatarsal heads. Increased contact area did not result in significant pressure reductions underneath the forefoot. Pressure dynamics underneath the heel and medial forefoot (first metatarsal head and hallux) on average showed no significant differences among the different shoes with a cushioning insole.CONCLUSIONS—The most effective way to offload the forefoot of patients with neuropathic feet is through the use of the rocker sole principle. In general, the effect of an insole depends on the design characteristics of a shoe. Predicting the effect of therapeutic footwear on an individual scale, however, remains difficult. Therefore, in-shoe pressure measurements seem to be necessary to evaluate a therapeutic shoe prescription in certain individual cases.
The K121Q Polymorphism of the PC-1 Gene Is Associated With Insulin Resistance but not With Dyslipidemia
Authors: Kubaszek Agata , Pihlajamäki Jussi , Karhapää Pauli , Vauhkonen Ilkka , Laakso Markku 
Published: March 2007

OBJECTIVE—To investigate the relationship of the K121Q polymorphism of the plasma cell glycoprotein 1 (PC-1) gene with insulin resistance, insulin secretion, and lipids and lipoproteins.RESEARCH DESIGN AND METHODS—Altogether, 110 normoglycemic subjects (group I) underwent a hyperinsulinemic-euglycemic clamp for evaluation of insulin sensitivity. The first-phase insulin secretion was determined by the intravenous glucose tolerance test (IVGTT) in a separate sample of 295 normoglycemic subjects (group II).RESULTS—The 121Q allele (genotypes K121Q and Q121Q) compared with the K121K genotype was related to higher fasting insulin levels (group I: 69.6 ± 45.6 vs. 51.9 ± 28.4 pmol/l [mean ± SD], P = 0.050; group II: 66.6 ± 38.8 vs. 53.8 ± 26.6 pmol/l, P = 0.009). In group I, subjects carrying the 121Q allele compared with subjects with the K121K genotype had lower rates of whole-body glucose uptake (51.17 ± 12.07 vs. 60.12 ± 14.86 μmol · kg−1 · min−1, P = 0.012) and nonoxidative glucose disposal (33.71 ± 10.51 vs. 41.51 ± 13.36 μmol · kg−1 · min−1, P = 0.015) during the clamp. In group II, there was no significant difference between the 121Q allele carriers and subjects with the K121K genotype in total first-phase insulin secretion during the first 10 min of the IVGTT (2,973 ± 2,224 vs. 2,520 ± 1,492 pmol · l−1 · min−1, P = 0.415). No association of the K121Q polymorphism with serum lipids and lipoproteins was found.CONCLUSIONS—In healthy normoglycemic Finnish subjects, the K121Q polymorphism of the PC-1 gene is associated with insulin resistance but not with impaired insulin secretion or dyslipidemia.