bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of Coronary Heart Disease in Middle-Aged Adults With Diabetes
Authors: Folsom Aaron R. , Chambless Lloyd E , Duncan Bruce B. , Gilbert Adam C. , Pankow James S. ,   the Atherosclerosis Risk in Communities Study Investigators
Published: March 2007

OBJECTIVE—To determine the 10-year probability of coronary heart disease (CHD) in diabetic adults and how well basic and novel risk factors predict CHD risk.
RESEARCH DESIGN AND METHODS—We measured risk factors in 14,054 participants (1,500 with diabetes) initially free of CHD in the Atherosclerosis Risk in Communities study from 1987 to 1989 and followed them prospectively for CHD incidence through 1998. We used proportional hazards regression models and receiver operating characteristic (ROC) curves for CHD risk prediction.
RESULTS—Based on our model using basic risk factors (age, race, total and HDL cholesterol, systolic blood pressure, antihypertensives, and smoking status), ∼61% of diabetic women and 86% of diabetic men had a predicted 10-year CHD probability ≥10%. This CHD risk-prediction model had an area under the ROC curve of 0.72 in diabetic women and 0.67 in diabetic men. Novel risk factors or subclinical disease markers individually added only modest predictivity, but the addition of multiple markers (BMI, waist-to-hip ratio, Keys dietary score, serum albumin and creatinine, factor VIII, white blood cell count, left ventricular hypertrophy determined by electrocardiogram, and carotid intima-media thickness) increased the area under the curve by ∼10%.
CONCLUSIONS—Although all diabetic adults are at high risk for CHD, their variation in CHD risk can be predicted moderately well by basic risk factors. No single novel risk marker greatly enhanced absolute CHD risk assessment, but a battery of novel markers did. Our model can provide estimates of CHD risk for the primary prevention of this disease in people with type 2 diabetes.
Tele-Screening for Diabetic Retinopathy With the Retinal Thickness Analyzer
Authors: Neubauer Aljoscha S. , Welge-Lüßen Ulrich C. , Thiel Martin J. , Alge Claudia , Priglinger Siegfried G. , Hirneiß Christoph , Ulbig Michael W. , Kampik Anselm 
Published: March 2007

OBJECTIVE—To compare the effectiveness of tele-screening using a novel enhanced retinal thickness analyzer (RTA) with onsite routine ophthalmologic examination for diabetic retinopathy.
RESEARCH DESIGN AND METHODS—A consecutive series of 31 eyes from diabetic patients were included. All underwent ophthalmologic examination, including stereoscopic dilated funduscopy and scanning with the RTA. The RTA reports consisted of a wide-angle, red-free fundus photograph and a macular-region retinal thickness map. Reports were graded by three independent graders in a masked manner. The diagnoses of proliferative retinopathy, macular edema, and treatment decisions made by the RTA graders and the clinical examiner were compared.
RESULTS—On clinical examination 5 of 31 eyes were diagnosed with proliferative diabetic retinopathy (PDR). All five were referred for treatment by two graders and four eyes by one grader. All eyes with PDR and 12 of the 26 eyes with nonproliferative diabetic retinopathy showed severe macular edema. Seven of the 12 eyes with macular edema were clinically eligible for focal laser treatment, and all of them were detected by all RTA graders. Macular thickening was detected in eight eyes by RTA where no treatment was necessary, as judged by clinical examination. Thus, sensitivity was 93% (mean) for detecting PDR and 100% for detecting macular edema, with a specificity of 58–96% depending on the grader. The RTA did not allow valid assessment due to poor image quality in only one case.
CONCLUSIONS—Screening for diabetic retinopathy with a combination of wide-angle fundus photography and macular thickness mapping by an objective method, such as optical coherence tomography or the RTA, offers the prerequisites for establishing a successful tele-screening program.
Effective Exercise Modality to Reduce Insulin Resistance in Women With Type 2 Diabetes
Authors: Cuff Darcye J. , Meneilly Graydon S. , Martin Alan , Ignaszewski Andrew , Tildesley Hugh D. , Frohlich Jiri J. 
Published: March 2007

OBJECTIVE—The purpose of this study was to evaluate whether a combined resistance and aerobic training program would improve insulin sensitivity compared with aerobic training alone in postmenopausal women with type 2 diabetes. A second objective was to relate the improved insulin sensitivity to changes in abdominal adipose tissue (AT) and thigh muscle density.
RESEARCH DESIGN AND METHODS—A total of 28 obese postmenopausal women with type 2 diabetes were randomly assigned to one of three 16-week treatments: control, aerobic only training (Ae only), or aerobic plus resistance training (Ae+RT). Pre- and posttreatment outcome measures included glucose disposal by hyperinsulinemic-euglycemic clamp and computed tomography scans of abdominal AT and mid-thigh skeletal muscle.
RESULTS—Glucose infusion rates increased significantly (P &lt; 0.05) in the Ae+RT group. Both exercise groups had reduced abdominal subcutaneous and visceral AT and increased muscle density. The Ae+RT training group exhibited a significantly greater increase in muscle density than the Ae only group. Improved glucose disposal was independently associated with changes in subcutaneous AT, visceral AT, and muscle density. Muscle density retained a relationship with glucose disposal after controlling for abdominal AT.
CONCLUSIONS—Adding resistance training to aerobic training enhanced glucose disposal in postmenopausal women with type 2 diabetes. The improved insulin sensitivity is related to loss of abdominal subcutaneous and visceral AT and to increased muscle density.
Complications in Young Adults With Early-Onset Type 2 Diabetes
Authors: Hillier Teresa A. , Pedula Kathryn L. 
Published: March 2007

OBJECTIVE—To determine whether adults diagnosed with type 2 diabetes from age 18 to 44 years more aggressively develop clinical complications after diagnosis than adults diagnosed at ≥45 years of age.
RESEARCH DESIGN AND METHODS—We compared outcomes among 7,844 adults in a health maintenance organization who were newly diagnosed with type 2 diabetes between 1996 and 1998. We abstracted clinical data from electronic medical, laboratory, and pharmacy records. To adjust for length of follow-up and sex, we used proportional hazards models to compare incident complication rates through 2001 between onset groups (mean follow-up 3.9 years). To adjust for the increasing prevalence of macrovascular disease with advancing age, onset groups were matched by age and sex to control subjects without diabetes for macrovascular outcomes.
RESULTS—Adults with early-onset type 2 diabetes were 80% more likely to begin insulin therapy than those with usual-onset type 2 diabetes (hazards ratio [HR] 1.8, 95% CI 1.5–2.0), despite a similar average time to requiring insulin (∼2.2 years). Although the combined risk of microvascular complications did not differ overall, microalbuminuria was more likely in early-onset type 2 diabetes than usual-onset type 2 diabetes (HR 1.2, 95% CI 1.1–1.4). The hazard of any macrovascular complication in early-onset type 2 diabetic patients compared with control subjects was twice as high in usual-onset type 2 diabetic patients compared with control subjects (HR 7.9 vs. 3.8, respectively). Myocardial infarction (MI) was the most common macrovascular complication, and the hazard of developing an MI in early-onset type 2 diabetic patients was 14-fold higher than in control subjects (HR 14.0, 95% CI 6.2–31.4). In contrast, adults with usual-onset type 2 diabetes had less than four times the risk of developing an MI compared with control subjects (HR 3.7, P &lt; 0.001).
CONCLUSIONS—Early-onset type 2 diabetes appears to be a more aggressive disease from a cardiovascular standpoint. Although the absolute rate of cardiovascular disease (CVD) is higher in older adults, young adults with early-onset type 2 diabetes have a much higher risk of CVD relative to age-matched control subjects.
The Relationship Between Provider Coordination and Diabetes-Related Foot Outcomes
Authors: Wrobel James S. , Charns Martin P. , Diehr Paula , Robbins Jeffrey M. , Reiber Gayle E. , Bonacker Kristin M. , Haas Linda B. , Pogach Leonard 
Published: March 2007

OBJECTIVE—To investigate the relationship between provider coordination and amputations in patients with diabetes.
RESEARCH DESIGN AND METHODS—The study design was a cross-sectional, descriptive study of process and outcomes for diabetes-related foot care at 10 Department of Veterans Affairs (VA) medical centers representing different geographic regions, population densities, patient populations, and amputation rates. The subjects included all providers of diabetes foot care and a random sample of primary care providers at each medical center. The main outcome measures were the Foot Systems Assessment Tool (FootSAT), nontraumatic lower extremity amputation rates, and investigators’ ordinal ranking of site effectiveness based on site visits.
RESULTS—The survey response rate was 48%. Scale reliability, as measured by Cronbach’s α, ranged from 0.73 to 0.93. The scale scores for programming coordination (i.e., electronic medical record, policies, reminders, protocols, and educational seminars) and feedback coordination (i.e., discharge planning, quality of care meetings, and curbside consultations) were negatively associated with amputation rates, suggesting centers with higher levels of coordination had lower amputation rates. Statistically significant associations were found for programming coordination with minor amputations (P = 0.02) and total amputations (P = 0.04).
CONCLUSIONS—The FootSAT demonstrated a stronger association with amputation rates than site visit rankings. Among these 10 VA facilities, those with higher levels of programming and feedback coordination had significantly lower amputation rates.
Inconsistent Use of Diabetes Medications, Diabetes Complications, and Mortality in Older Mexican Americans Over a 7-Year Period
Authors: Kuo Yong-Fang , Raji Mukaila A. , Markides Kyriakos S. , Ray Laura A. , Espino David V. , Goodwin James S. 
Published: March 2007

OBJECTIVE—The aim of this study was to examine the relationship between inconsistency in use of diabetes drugs and risk of renal, eye, and circulation problems and death over a 7-year period in community-dwelling older Mexican Americans.
RESEARCH DESIGN AND METHODS—Data are from the four waves of the Hispanic Established Population for the Epidemiologic Study of the Elderly. In-home interviewers assessed consistency in use of diabetes medications among 908 diabetic Mexican Americans, aged ≥65 years. Diabetes and complications were by self-report. Subjects with poor consistency in use of medication were those who, at any time during the 7-year follow-up, discontinued or inconsistently used their diabetes medications and those who had no diabetic medications at home despite self-report of taking medicine for diabetes.
RESULTS—Thirty-six percent of our sample were inconsistent with diabetes medication usage. Older age and lack of supplemental health insurance were significantly associated with inconsistency of use of medication. In a multivariate logistic regression model, subjects with poor consistency in use of medication were more likely to report kidney problems (odds ratio [OR] 1.59; 95% CI 1.13–2.23; P = 0.008) at follow-up compared with those with good consistency, after controlling for age, sex, medication type, duration of diabetes, education, income, marital status, language of interview, insurance status, cognitive function, presence of depressive symptoms, activities of daily living, and instrumental activities of daily living. In Cox regression models, poor consistency with diabetic medication was also associated with increased all-cause mortality (hazard ratio [HR] 1.43; 95% CI 1.13–1.82; P = 0.003) and diabetes-related deaths (1.66; 1.20–2.30; P = 0.002) over a 7-year period after adjusting for relevant confounders.
CONCLUSIONS—Inconsistent use of diabetic medication was associated with an increased risk of kidney problems and deaths over a 7-year period in older Mexican Americans.
Controlled Trial of a Multifaceted Intervention for Improving Quality of Care for Rural Patients With Type 2 Diabetes
Authors: Majumdar Sumit R. , Guirguis Lisa M. , Toth Ellen L. , Lewanczuk Richard Z. , Lee T.K. , Johnson Jeffrey A. 
Published: March 2007

OBJECTIVE—Despite good evidence and clinical practice guidelines, studies document that treatment of type 2 diabetes is less than optimal. Lack of resources or limited access may put patients in rural communities at particular risk for suboptimal care.RESEARCH DESIGN AND METHODS—We conducted a prospective, before/after study with concurrent controls to assess the effectiveness of a multidisciplinary diabetes outreach service (intervention) for improving the quality of care for rural patients with type 2 diabetes. Our intervention consisted of six monthly visits by a traveling team of specialist physicians, nurses, dieticians, and a pharmacist. The core of this service was specialist-to-rural primary care physician academic group detailing. Two comparable regions in Northern Alberta were randomly allocated to control or intervention. Data were collected before and 6 months after intervention in a representative volunteer sample. The primary outcome was a 10% improvement in any one of the following: blood pressure, total cholesterol, or HbA1c.RESULTS—Our analysis included 200 intervention and 179 control subjects; 14 subjects were at all three primary outcome targets at baseline. The intervention was associated with a trend toward improvement in primary outcome at 6 months (44% intervention vs. 37% control; odds ratio 1.32, 95% CI 0.87–1.99). The intervention was associated with a significant improvement in blood pressure (42% intervention vs. 25% control, P = 0.004); however, there were only small, nonsignificant changes in cholesterol or HbA1c. The intervention was associated with a significant increase in satisfaction with diabetes care. Multivariate adjustment for baseline differences between intervention and control subjects did not affect any of the main results.CONCLUSIONS—A diabetes outreach service has the potential to improve the quality of diabetes care for rural patients. Future studies need to involve longer timelines and larger sample sizes.
General Quality of Life in Youth With Type 1 Diabetes
Authors: Laffel Lori M.B. , Connell Alexa , Vangsness Laura , Goebel-Fabbri Ann , Mansfield Abigail , Anderson Barbara J. 
Published: March 2007

OBJECTIVE—To evaluate self-report and parent proxy report of child/teen general quality of life in youth with type 1 diabetes, compare their responses with those of a general pediatric population, and identify relationships between diabetes management, diabetes-related family behavior, and diabetes-specific family conflict with quality of life in youth with type 1 diabetes.
RESEARCH DESIGN AND METHODS—Study participants included 100 children, 8–17 years of age (12.1 ± 2.3), with type 1 diabetes for 0.5–6 years (2.7 ± 1.6). Each child and a parent completed the Pediatric Quality of Life Inventory (PedsQL), completed the Diabetes Family Conflict Scale, and provided data on parent involvement in diabetes management. An independent measure of adherence to treatment assessed by the patient’s clinician and a measure of glycemic control (HbA1c) were also collected.
RESULTS—PedsQL responses from youth with type 1 diabetes were stable over 1 year and similar to norms from a healthy standardization sample for all three scales of the PedsQL: total, physical, and psychosocial quality of life. After controlling for age, duration of diabetes, sex, HbA1c, and family involvement, child report of diabetes-specific family conflict (P &lt; 0.01) was the only significant predictor of child report of quality of life (model R2 = 0.21, P &lt; 0.02).
CONCLUSIONS—Youth with type 1 diabetes report remarkably similar quality of life to a nondiabetic youth population. Greater endorsement of diabetes-specific family conflict predicted diminished quality of life for the child. As treatment programs focus on intensifying glycemic control in youth with type 1 diabetes, interventions should include efforts to reduce diabetes-specific family conflict in order to preserve the child’s overall quality of life.
Pramlintide Reduces Postprandial Glucose Excursions When Added to Regular Insulin or Insulin Lispro in Subjects With Type 1 Diabetes
Authors: Weyer Christian , Gottlieb Alan , Kim Dennis D. , Lutz Karen , Schwartz Sherwyn , Gutierrez Maria , Wang Yan , Ruggles James A. , Kolterman Orville G. , Maggs David G. 
Published: March 2007

OBJECTIVE—To assess the postprandial glucose-lowering effect of the human amylin analog pramlintide when given with either regular insulin or insulin lispro in subjects with type 1 diabetes, with an emphasis on the optimal dose timing relative to meals.
RESEARCH DESIGN AND METHODS—In this randomized, single-blind, placebo-controlled, five-way crossover study, 19 subjects with type 1 diabetes using regular insulin and 21 subjects with type 1 diabetes using insulin lispro underwent five consecutive mixed meal tests. In randomized order, subjects received subcutaneous injections of placebo at −15 min or 60 μg pramlintide at −15, 0, +15, or +30 min relative to the meal after an overnight fast. Regular insulin or insulin lispro was injected at −30 and 0 min, respectively, at doses that were adjusted appropriately for both the content of the standardized meal and the anticipated effects of pramlintide. Plasma glucose concentrations were measured before and during the 4-h postmeal period.
RESULTS—In both the regular insulin and insulin lispro groups, pramlintide injections at all four time points lowered the postprandial glucose excursion (36 to &gt;100% reduction in incremental area under the concentration time curve from 0 to 4 h (AUC0–4 h) compared with placebo. However, only preprandial injections of pramlintide (−15 and 0 min) were able to prevent the initial postprandial surge in glucose. The optimal time for pramlintide injection was 0 min, which reduced the postprandial glucose excursion by &gt;100% compared with regular insulin plus placebo (incremental AUC0–4 h: −0.6 ± 2.5 vs. 11.0 ± 2.9 mmol · h−1 · l−1, P &lt; 0.0007) and by 75% compared with insulin lispro plus placebo (incremental AUC0–4 h: 2.5 ± 2.1 vs. 10.0 ± 2.5 mmol · h−1 · l−1, P &lt; 0.0098). No serious adverse events were reported.
CONCLUSIONS—Pramlintide, given at or just before a meal, reduces the postprandial glucose excursion in subjects with type 1 diabetes, regardless of whether added to regular insulin or a rapid-acting insulin analog.
The Treat-to-Target Trial
Authors: Riddle Matthew C. , Rosenstock Julio , Gerich John ,   on behalf of the Insulin Glargine 4002 Study Investigators
Published: March 2007

OBJECTIVE—To compare the abilities and associated hypoglycemia risks of insulin glargine and human NPH insulin added to oral therapy of type 2 diabetes to achieve 7% HbA1c.
RESEARCH DESIGN AND METHODS—In a randomized, open-label, parallel, 24-week multicenter trial, 756 overweight men and women with inadequate glycemic control (HbA1c &gt;7.5%) on one or two oral agents continued prestudy oral agents and received bedtime glargine or NPH once daily, titrated using a simple algorithm seeking a target fasting plasma glucose (FPG) ≤100 mg/dl (5.5 mmol/l). Outcome measures were FPG, HbA1c, hypoglycemia, and percentage of patients reaching HbA1c ≤7% without documented nocturnal hypoglycemia.
RESULTS—Mean FPG at end point was similar with glargine and NPH (117 vs. 120 mg/dl [6.5 vs. 6.7 mmol/l]), as was HbA1c (6.96 vs. 6.97%). A majority of patients (∼60%) attained HbA1c ≤7% with each insulin type. However, nearly 25% more patients attained this without documented nocturnal hypoglycemia (≤72 mg/dl [4.0 mmol/l]) with glargine (33.2 vs. 26.7%, P &lt; 0.05). Moreover, rates of other categories of symptomatic hypoglycemia were 21–48% lower with glargine.
CONCLUSIONS—Systematically titrating bedtime basal insulin added to oral therapy can safely achieve 7% HbA1c in a majority of overweight patients with type 2 diabetes with HbA1c between 7.5 and 10.0% on oral agents alone. In doing this, glargine causes significantly less nocturnal hypoglycemia than NPH, thus reducing a leading barrier to initiating insulin. This simple regimen may facilitate earlier and effective insulin use in routine medical practice, improving achievement of recommended standards of diabetes care.
Insulin Detemir Is Characterized by a Consistent Pharmacokinetic Profile Across Age-Groups in Children, Adolescents, and Adults With Type 1 Diabetes
Authors: Danne Thomas , Lüpke Kerstin , Walte Kerstin , von Schuetz Wolfgang , Gall Mari-Anne 
Published: March 2007

OBJECTIVE—This trial aimed to characterize for the first time the pharmacokinetic profile of insulin detemir, the novel soluble basal insulin analog, in children and adolescents compared with adults. Comparisons were also made with NPH insulin to determine any between-treatment difference in the effect of age on pharmacokinetic profile.
RESEARCH DESIGN AND METHODS—This single-center, open-label, randomized, crossover trial included children (aged 6–12 years, n = 13), adolescents (aged 13–17 years, n = 10), and adults (aged 18–65 years, n = 11) of both sexes. Subjects were given single doses of 0.5 units/kg s.c. insulin detemir or 0.5 IU/kg NPH insulin on 2 separate days. Serial blood sampling was performed for 24 h for analysis of serum insulin detemir, human insulin, and glucose concentrations.
RESULTS—The mean pharmacokinetic profile of insulin detemir was similar across all three age-groups. This was determined by statistical analyses of the data, which showed no overall age effect or between-group differences when pairwise comparisons were made between children (or adolescents) and adults on the parameters of the area under the curve (AUC), AUC from zero to infinity, AUC from 0 to 24 h [AUC(0–24 h)], and the maximum concentration measured during the 24 h after closing. No overall age effect for AUC(0–24 h) and Cmax was detected for NPH insulin, but data were only analyzable from seven adults and pairwise comparisons did indicate that children and adults had different pharmacokinetic profiles. Less total variability in the pharmacokinetics of insulin detemir than NPH insulin was indicated by lower coefficients of variation in AUC, Cmax, and time to maximum concentration in all three age-groups.
CONCLUSIONS—The data suggest that insulin detemir can be used in children and adolescents with type 1 diabetes using titration guidelines similar to those used in adults. Moreover, insulin detemir may offer the advantage of greater predictability of response in comparison to NPH insulin due to lower total variability and a lesser degree of kinetic disparity across age-groups.