bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preservation of Physiological Responses to Hypoglycemia 2 Days After Antecedent Hypoglycemia in Patients With IDDM
Authors: George Emad , Marques Jefferson L , Harris Nigel D , Macdonald Ian A , Hardisty Colin A , Heller Simon R 
Published: March 2007

OBJECTIVE
To assess the effects of short-term antecedent hypoglycemia on responses to further hypoglycemia 2 days later in patients with IDDM.

RESEARCH DESIGN AND METHODS
We studied eight type I diabetic patients without hypoglycemia unawareness or autonomic neuropathy during two periods at least 4 weeks apart. On day 1, 2 h of either clamped hyperinsulinemic (60 mU · m−2 · min−1) hypoglycemia at 2.8 mmol/l or euglycemia at 5.0 mmol/l were induced. Hyperinsulinemic hypoglycemia was induced 2 days later with 40 min glucose steps of 5.0, 4.0, 3.5, 3.0, and 2.5 mmol/l. Catecholamine levels and symptomatic and physiological responses were measured every 10–20 min.

RESULTS
When compared with the responses measured following euglycemia, the responses of norepinephrine 2 days after hypoglycemia were reduced (peak, 1.4 ± 0.4 [mean ± SE] vs.1.0 ± 0.3 nmol/l [P &lt; 0.05]; threshold, 3.4 ± 0.1 vs. 2.9 ± 0.1 mmol/l glucose [P &lt; 0.01]). The responses of epinephrine (peak, 4.0 ± 1.4 vs. 3.5 ± 0.8 nmol/l [P = 0.84]; threshold, 3.8 ± 0.1 vs. 3.6 ± 0.1 mmol/l glucose [P = 0.38]), water loss (peak, 194 ± 34 vs. 179 ± 47 g−1 · m−2 · h−1 [P = 0.73]; threshold, 2.9 ± 0.2 vs. 2.9 ± 0.2 mmol/l glucose [P = 0.90]), tremor (peak, 0.28 ± 0.05 vs. 0.37 ± 0.06 root mean square volts (RMS V) [P = 0.19]; threshold, 3.2 ± 0.2 vs. 3.1 ± 0.2 mmol/l glucose [P = 0.70]), total symptom scores (peak, 10.6 ± 2.1 vs. 10.8 ± 1.9 [P = 0.95]; threshold, 3.3 ± 0.2 vs. 3.6 ± 0.1 mmol/l glucose [P = 0.15]), and cognitive function (four-choice reaction time: threshold, 2.9 ± 0.2 vs. 3.0 ± 0.2 mmol/l glucose [P = 0.69]) were unaffected.

CONCLUSIONS
The effect on hypoglycemic physiological responses of 2 h of experimental hypoglycemia lasts for 1–2 days in these patients with IDDM . The pathophysiological effect of antecedent hypoglycemia may be of shorter duration in IDDM patients, compared with nondiabetic subjects.
Lispro Analog for Treatment of Generalized Allergy to Human Insulin
Authors: Kumar Dinesh 
Published: March 2007

OBJECTIVE
To evaluate the clinical usefulness of the human insulin analog lispro in a patient with generalized allergy to human insulin.

RESEARCH DESIGN AND METHODS
A 34-year-old obese female patient developed systemic allergic reactions to human insulin but tolerated insulin lispro. Sequential analyses of the anti-insulin IgE and IgG immunoglobulins were performed.

RESULTS
On intradermal test, the lispro insulin produced a 50% less intense wheal-flare response, compared with human insulin, which was presumed to be due to lispro's molecular form. The intradermal reactivity to both human and lispro insulins decreased with time and disappeared by week 25.125I-labeled lispro and human insulin binding antibody titers of both the IgE and IgG immunoglobulins were high initially, but decreased progressively, becoming very low by the end of 1 year. In in vitro immunoassay, thelispro and human insulins show a complete cross-reactivity.

CONCLUSIONS
Lispro may be useful for the management of allergy to human insulin. This analog of human insulin appears to have a reduced immunogenic potency.
Comparison of a Neurothesiometer and Vibration in Measuring Vibration Perception Thresholds and Relationship to Nerve Conduction Studies
Authors: Bril Vera , Kojic Jasna , Ngo Mylan , Clark Kelly 
Published: March 2007

OBJECTIVE
To compare vibration perception thresholds (VPTs) obtained with two different instruments, a neurothesiometer and a vibratron, and to characterize variability of repeat measures and correlation with sural nerve conduction parameters.

RESEARCH DESIGN AND METHODS
A total of 152 patients with diabetic peripheral neuropathy received electrodiagnostic evaluation and quantitative VPT testing with the Vibratron II and the Horwell Neurothesiometer. Of the patients, 42 returned for repeat nerve conduction studies and VPT testing with both types of equipment on threeseparate occasions.

RESULTS
The variability of repeat testing for the vibratron was 34 and 31% in the right and left first toes, respectively. Variability for neurothesiometer was 8 and 6% for the right and left toes. This variability compares with that of sural nerve conduction velocity of 2% and that of sural nerve amplitude of 8% in this series of patients.

CONCLUSIONS
We conclude that VPT determined with the neurothesiometer is less variable than with the vibratron and more reflective of peripheral nerve function. Our results indicate that the neurothesiometer can be used reliably in clinical research trials.
U.K. Prospective Diabetes Study 22: Effect of age at diagnosis on diabetic tissue damage during the first 6 years of NIDDM
Authors: Davis Timothy ME , Stratton Irene M , Fox Charles J , Holman Rury R , Turner Robert C ,   U.K. Prospective Diabetes Study (UKPDS) Group
Published: March 2007

OBJECTIVE
To assess the effect of age at diagnosis on the initial prevalence and subsequent risk of the progression of diabetic tissue damage in patients with NIDDM.

RESEARCH DESIGN AND METHODS
The prevalence of Q-wave myocardial infarction, absent dorsalis pedis pulses, retinopathy, absent ankle jerks, hypertension, and microalbuminuria were determined at baseline and at 3 and 6 years of follow-up in five consecutive 6-year age-cohorts of 3,027 newly diagnosed white patients aged between 36 and 65 years recruited to the U.K. Prospective Diabetes Study. The effect of age at diagnosis on the initial prevalence and the risk of progression of these complications and associated conditions was analyzed using logistic regression and proportional odds methods, respectively.

RESULTS
Q-wave myocardial infarction and hypertension were more prevalent in older patients at presentation, but age at diagnosis did not have a significant effect on the increased risk of either after 6 years of NIDDM. Absent dorsalis pedis pulses and ankle jerks were also more prevalent in the older age-groups at presentation, but age at diagnosis was a significant predictor of the increasing prevalence of both during follow-up. The baseline prevalence of retinopathy and microalbuminuria was not related to age. The subsequent risk of retinopathy, but not microalbuminuria, increased significantly with age at diagnosis.

CONCLUSIONS
Age at diagnosis has a variable impact on different types of diabetic tissue damage and may thus be an important variable in epidemiological and intervention studies in NIDDM. Regular ophthalmologic surveillance and examination of the feet increase in importance with increasing age since the diagnosis of NIDDM.
Lack of Change of Lipoprotein(a) Levels by the Optimization of Glycemic Control With Insulin Therapy in NIDDM Patients
Authors: Caixàs Assumpta , Pérez Antonio , Qrdóñez-Llanos Jordi , Bonet Rosa , Rigla Mercedes , Castellví Agustina , Bayén L , Leiva Alberto De 
Published: March 2007

OBJECTIVE
To evaluate the effect of glycemic control improvement with insulin therapy on lipoprotein(a) [Lp(a)] levels in patients with NIDDM.

RESEARCH DESIGN AND METHODS
We performed a longitudinal study in a tertiary referral center to compare lipid and Lp(a) levels before and after 3 months of insulin therapy in 60 poorly controlled NIDDM patients (32 men, 28 women). Patients previously treated with oral hypoglycemic agents (n = 50) received one to two insulin doses, and those previously treated with insulin (n = 10) received multiple insulin doses. Lp(a) levels were measured by the Terumo method. Differences between the two periods were assessed by the paired t test and Wilcoxon's test.

RESULTS
After 3 months of insulin therapy, HbA1c decreased from 9.6 ± 1.9 to 6.0 ± 1.4% (P &lt; 0.0005) in all patients and from 9.1 ± 2.1 to 6.1 ± 2.9% (P &lt; 0.05) in patients under multiple insulin doses, being ≤ 6.0% in 59% of patients. Total triglyceride and VLDL cholesterol levels decreased (P &lt; 0.01) and HDL cholesterol increased significantly (P &lt; 0.0005). However, no changes in Lp(a) levels were observed in all patients (25.3 ± 25.0 vs 25.7 ± 27.2% mg/dl) and in patients with baseline Lp(a) levels above (63.5 ± 15.5 vs. 65.1 ± 23.1 mg/dl) or below 30 mg/dl (11.5 ± 7.5 vs. 11.5 ± 7.3 mg/dl). In addition, patients reaching HbA1c levels ≤ 6.0% or &gt; 6.0% presented similar Lp(a) levels (26.0 ± 29.1 vs 25.3 ± 25.0 mg/dl). Moreover, no correlations were observed between changes in Lp(a) levels and in the glycemic control parameters.

CONCLUSIONS
This study shows that the improvement of glycemic control by insulin therapy does not influence plasma Lp(a) levels, measured by the Terumo method, in NIDDM patients, independently of baseline values and the degree of glycemic control reached.
Adherence of Mononuclear Cells to Endothelium In Vitro Is Increased in Patients With NIDDM
Authors: Carantoni M , Abbasi F , Chu L , Chen Y-D I , Reaven G M , Tsao P S , Varasteh B , Cooke J P 
Published: March 2007

OBJECTIVE
To compare the binding to cultured endothelial cells of mononuclear cells isolated from healthy volunteers and patients with NIDDM.

RESEARCH DESIGN AND METHODS
Mononuclear cells were isolated from healthy volunteers (n = 11) and patients with NIDDM (n = 14) and incubated with ECV 304 cells, a human umbilical endothelial cell-derived transformed cell line. Following a period of incubation, the adherence of mononuclear cells to endothelial cells was determined.

RESULTS
Adherence of mononuclear cells from patients with NIDDM was significantly greater (P &lt; 0.05) than that of cells isolated from the healthy volunteers, and this difference persisted when adjusted for age, sex, and degree of obesity. Mononuclear cell binding to ECV 304 cells correlated significantly with fasting plasma glucose (r = 0.52, P &lt; 0.01), insulin (r= 0.51, P &lt; 0.01), triglyceride (r = 0.54, P &lt; 0.01), and VLDL (r = 0.54, P &lt; 0.01) and HDL cholesterol (r = −0.45, P &lt; 0.05) levels, but not with either total or LDL cholesterol levels or blood pressure.

CONCLUSIONS
Since the adherence of mononuclear cells to the endothelium represents the earliest step in atherogenesis, the observation that mononuclear cells from patients with NIDDM bind more avidly to cultured endothelial cells may help explain why accelerated atherosclerosis occurs in patients with NIDDM. The metabolic abnormality, or abnormalities, present in patients with NIDDM that is responsible for the enhanced adhesiveness of mononuclear cells requires further examination.
Early Presentation of Type 2 Diabetes in Mexican-American Youth
Authors: Neufeld Naomi D , Raffel Leslie J , Landon Chris , Chen Y -D Ida , Vadheim Constance M 
Published: March 2007

OBJECTIVE
To describe features of pediatric-onset type 2 diabetes in the Hispanic population.

RESEARCH DESIGN AND METHODS
The medical records of 55 Hispanic subjects with diabetes who were treated from 1990 to 1994 in a pediatric clinic serving lower income Mexican-Americans were reviewed to assess the frequency and clinical features of type 2 diabetes. Additionally, nondiabetic siblings of several patients underwent oral glucose tolerance testing, and a survey of six high schools in the same county was performed.

RESULTS
Seventeen of 55 (31%) of the diabetic children and adolescents had type 2 diabetes. An additional 4 Hispanic children with type 2 diabetes treated in other clinics were also identified, yielding a total of 21 subjects who were used to describe the characteristics of childhood type 2 diabetes. At presentation, all were obese (mean BMI 32.9 ± 6.2 kg/m2), 62% had no ketonuria, and fasting C-peptide levels were elevated (4.28 ± 3.43 ng/ml). Diabetes was easily controlled with diet, sulfonylureas, or low-dose insulin. No autoantibodies were present in those tested, and family histories were positive for type 2 diabetes. Compliance was poor, and 3 subjects developed diabetic complications. Of the tested siblings, 2 of 8 had impaired glucose tolerance and 5 of 8 had stimulated hyperinsulinemia, correlated with BMI (r = 0.80, P &lt; 0.05). The school survey identified 28 diabetic adolescents, 75% more than expected (P &lt; 0.01). The Hispanic enrollment at each school was highly correlated with the number of diabetic students (r = 0.87, P = 0.011).

CONCLUSIONS
Genetic susceptibility to type 2 diabetes, when coupled with obesity, can produce type 2 diabetes in Mexican-American children. This diagnosis should be considered in young Hispanic patients, who might otherwise be assumed to have type 1 diabetes, and also when caring for overweight Hispanic youth with a family history of type 2 diabetes, in whom intervention may prevent or delay diabetes onset.
Effect of Postmenopausal Hormone Therapy on Glucose and Insulin Concentrations
Authors: Espeland Mark A , Hogan Patricia E , Fineberg S Edwin , Howard George , Schrott Helmutt , Waclawiw Myron A , Bush Trudy L ,   The Pepi Investigators
Published: March 2007

OBJECTIVE
To characterize the long-term impact of four hormone therapy regimens on insulin and glucose concentrations measured during a standard oral glucose tolerance test.

RESEARCH DESIGN AND METHODS
The Postmenopausal Estrogen/Progestin Intervention Study was a 3-year placebo-controlled randomized trial to assess effects of four hormone regimens on cardiovascular risk factors. This efficacy analysis describes glucose and insulin concentrations from 788 adherent women at baseline and at 1 and 3 years' postrandomization

RESULTS
When compared with women taking placebo, those taking conjugated equine estrogen (CEE) at 0.625 mg/day with or without a progestational agent had mean fasting insulin levels that were 16.1% lower, mean fasting glucose levels 2.2 mg/dl lower, and mean 2-h glucose levels 6.4 mg/dl higher (each nominal P &lt; 0.05). No significant differences were apparent between women taking CEE only versus the three progestin regimens: medroxyprogesterone acetate (MPA) at 2.5 mg daily (continuous MPA), MPA at 10 mg on days 1–12 (cyclical MPA), and micronized progesterone (MP) (cyclical) at 200 mg on days 1–12. The impact of hormone therapy on insulin and glucose depended on baseline levels of fasting insulin and 1-h glucose (P &lt; 0.05). However, the treatment effects on carbohydrate metabolism appeared to be consistent across participant subgroups formed by lifestyle, clinical, and demographic characteristics.

CONCLUSIONS
Oral hormone therapy involving 0.625 mg/day of CEE may modestly decrease fasting levels of insulin and glucose. Postchallenge glucose concentrations are increased, however, which may indicate delayed glucose clearance.
No Relationship Between Carbohydrate Intake and Effect of Acarbose on HbA1c or Gastrointestinal Symptoms in Type 2 Diabetic Subjects Consuming 30–60% of Energy From Carbohydrate
Authors: Wolever Thomas M S , Chiasson Jean-Louis , Josse Robert G , Hunt John A , Palmason Carol , Rodger N Wilson , Ross Stuart A , Ryan Edmond A , Tan Meng H 
Published: March 2007

OBJECTIVE
To determine the relationship between carbohydrate intake and the effect of acarbose on HbA1c in subjects with type 2 diabetes treated with acarbose alone, acarbose plus sulfonylurea, acarbose plus metformin, or acarbose plus insulin.

RESEARCH DESIGN AND METHODS
We conducted a double-blind randomized placebo-controlled study in which subjects with diabetes in four treatment strata (77 on diet alone, 83 treated with metformin, 103 treated with sulfonylurea, and 91 treated with insulin) were randomized to treatment with placebo or acarbose for 12 months. Before randomization, and 3, 6, 9, and 12 months after randomization, fasting blood was obtained for HbA1c, and 3-day diet records were collected. Subjects who completed at least 6 months of acarbose therapy and provided at least three 3-day diet records were included.

RESULTS
In the 114 subjects included in this analysis, carbohydrate intake varied from ∼30–60% of energy. There was no significant relationship between carbohydrate intake and change in HbAlc in any of the four treatment strata (diet: n = 26, r = 0.35, P = 0.076; metformin: n = 27, r = 0.26, P = 0.19; sulfonylurea: n = 35, r = 0.24, P = 0.16; insulin: n = 25, r = −0.27, P = 0.19). In the 80 subjects consuming &lt;50% of energy from carbohydrate, the fall in HbAlc (7.83 ± 0.17% at baseline to 6.72 ± 0.13% on acarbose, P &lt; 0.001) was no different from that of the 34 subjects consuming &gt;50% of energy from carbohydrate (7.55 ± 0.25% at baseline to 6.66 ± 0.23% on acarbose, P &lt; 0.001). There was no difference in carbohydrate intake between those who dropped out of the study because of gastrointestinal side effects and those who did not, and there was no relationship between severity of symptoms and the composition of the diet.

CONCLUSIONS
In subjects with type 2 diabetes consuming 30–60% of energy from carbohydrate, the effect of acarbose on HbAlc and gastrointestinal symptoms was not related to carbohydrate intake. Because most people consume at least 30% of energy from carbohydrate, we conclude that no special diet is needed for acarbose to be effective in improving blood glucose control in the treatment of type 2 diabetes.
Supporting Autonomy to Motivate Patients With Diabetes for Glucose Control
Authors: Williams Geoffrey C , Freedman Zachary R , Deci Edward L 
Published: March 2007

OBJECTIVE
We applied the self-determination theory of human motivation to examine whether patient perceptions of autonomy supportiveness (i.e., patient centeredness) from their diabetes care providers related to improved glucose control over a 12-month period.

RESEARCH DESIGN AND METHODS
We conducted a prospective cohort study of patients with diabetes from a diabetes treatment center at a university-affiliated community hospital. Participants were 128 patients between 18 and 80 years of age who took medication for diabetes, had no other major medical illnesses, and were responsible for monitoring their glucose and taking their medications. The main outcome measure was a change in HbA1c values over the 12 months of the study.

RESULTS
Patient perception of autonomy support from a health care provider related to a change in HbA1c values at 12 months (P &lt; 0.05). Further analyses showed that perceived autonomy support from the staff related to significant increases in patient autonomous motivation at 12 months (P &lt; 0.05); that increases in autonomous motivation related to significant increases in perceived competence (P &lt; 0.05); and that increases in a patient's perceived competence related to significant reductions in their HbA1c values over 12 months (P &lt; 0.001).

CONCLUSIONS
The findings support the prediction of the self-determination theory that patients with diabetes whose health care providers are autonomy supportive will become more motivated to regulate their glucose levels, feel more able to regulate their glucose, and show improvements in their HbA1c values.
Prevalence of Retinopathy in People With Diabetes, Impaired Glucose Tolerance, and Normal Glucose Tolerance
Authors: Rajala Ulla , Laakso Mauri , Qiao Qing , Keinänen-Kiukaanniemi Sirkka 
Published: March 2007

OBJECTIVE
Recently, an international expert committee published new revised criteria for diagnosing diabetes. According to the new criteria, the 2-h glucose level for diabetes in the oral glucose tolerance test (OGTT) is the same as in the previous World Health Organization criteria, but the cut point for the fasting blood glucose level has been lowered to be equivalent to the 2-h OGTT level. Measurement of the fasting blood glucose level is preferred to the 2-h OGTT glucose level. The ability of the new cut point for fasting blood glucose to discriminate between those at a high and a low risk for retinopathy was tested in a population-based study.

RESEARCH DESIGN AND METHODS
The population consisted of all the 1,008 subjects (456 men) born in 1935 and living in a Finnish city. A screening for type 2 diabetes was carried out in the first phase. All participants who were not on antidiabetic medication were invited for an OGTT in the second phase. A fasting blood glucose value was measured from the diabetic subjects on antidiabetic medication. In addition, measurements of serum cholesterol, HDL cholesterol, and triglycerides were made, and fundus photographs were taken. Altogether, 831 subjects (368 men) (82%) participated and constitute the eligible study population for the present analyses. Fundus photographs were available for 790 subjects (347 men) (95%).

RESULTS
There were 28 subjects (3.5%) who had mild retinopathic changes in the fundus photographs. Retinopathic changes were associated with higher fasting blood glucose levels, but not with any of the other background factors. The prevalence of retinopathy was 10.2% (95% CI 4.8−18.5) in subjects with a fasting blood glucose of ≥6.1 mmol/l, while it was 2.6% (1.5–4.0) in those with a lower fasting blood glucose level. In the former group, a majority (seven of nine) of the subjects with retinopathy were previously diagnosed diabetic patients. Some cases of retinopathy were found regardless the level of glycemia, and measurement of the 2-h OGTT glucose levels did not increase information.

CONCLUSIONS
The results of this population study give support to the use of fasting blood glucose levels in diagnosing type 2 diabetes. The lower limit of the highest decile of the fasting glucose level was 6.1 mmol/l, and it discriminated subjects at a high risk for retinopathy from those at a low risk. Because of the limited number of subjects with retinopathy in this study, the level of hyperglycemia associated with retinopathy cannot be estimated accurately.
Puberty, IDDM, and Death in Japan
Authors: Nishimura Rimei , Tajima Naoko , Matsushima Masato , LaPorte Ronald E ,   For the Diabetes Epidemiology Research International Study Group
Published: March 2007

OBJECTIVE
To investigate the impact of age at onset on the prognosis of childhood IDDM in Japan.

RESEARCH DESIGN AND METHODS
The study population consisted of 987 prepubertal-onset and 345 pubertal-onset IDDM cases who were registered by two nationwide surveys and who were diagnosed between 1965 and 1979. The living status was identified as of 1 January 1990 with the ascertainment rate of 96.5%. Prognosis was evaluated by cause- and agespecific mortality rates and life-table analyses; in addition, an attained-age-matched case-control study was analyzed by conditional logistic regression.

RESULTS
The adjusted mortality rates per 100,000 person-years for the pubertal-onset cases were significantly higher than those of the prepubertal-onset cases (835 [95% CI 573–1,168] vs. 391 [283–526]). Life-table analyses revealed that the survival rate of the pubertal-onset cases was lower than that of the prepubertal-onset cases for each observation period. Life-table analyses after the age of 15 years indicated that the prognosis of pubertal cases was almost the same as that of the prepubertal cases despite having a shorter duration of diabetes. The attained-age–matched case-control study indicated that the pubertal onset was a potent determinant of death.

CONCLUSIONS
The prognosis of pubertal-onset IDDM was considerably poorer than that of prepubertal-onset IDDM.