bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing Psychosocial Distress in Diabetes
Authors: Polonsky William H. , Fisher Lawrence , Earles Jay , Dudl R. James , Lees Joel , Mullan Joseph , Jackson Richard A. 
Published: March 2007

OBJECTIVE—The purpose of this study was to describe the development of the Diabetes Distress Scale (DDS), a new instrument for the assessment of diabetes-related emotional distress, based on four independent patient samples.
RESEARCH DESIGN AND METHODS—In consultation with patients and professionals from multiple disciplines, a preliminary scale of 28 items was developed, based a priori on four distress-related domains: emotional burden subscale, physician-related distress subscale, regimen-related distress subscale, and diabetes-related interpersonal distress. The new instrument was included in a larger battery of questionnaires used in diabetes studies at four diverse sites: waiting room at a primary care clinic (n = 200), waiting room at a diabetes specialty clinic (n = 179), a diabetes management study program (n = 167), and an ongoing diabetes management program (n = 158).
RESULTS—Exploratory factor analyses revealed four factors consistent across sites (involving 17 of the 28 items) that matched the critical content domains identified earlier. The correlation between the 28-item and 17-item scales was very high (r = 0.99). The mean correlation between the 17-item total score (DDS) and the four subscales was high (r = 0.82), but the pattern of interscale correlations suggested that the subscales, although not totally independent, tapped into relatively different areas of diabetes-related distress. Internal reliability of the DDS and the four subscales was adequate (α &gt; 0.87), and validity coefficients yielded significant linkages with the Center for Epidemiological Studies Depression Scale, meal planning, exercise, and total cholesterol. Insulin users evidenced the highest mean DDS total scores, whereas diet-controlled subjects displayed the lowest scores (P &lt; 0.001).
CONCLUSIONS—The DDS has a consistent, generalizable factor structure and good internal reliability and validity across four different clinical sites. The new instrument may serve as a valuable measure of diabetes-related emotional distress for use in research and clinical practice.
Youth Type 2 Diabetes
Authors: Gungor Neslihan , Bacha Fida , Saad Rola , Janosky Janine , Arslanian Silva 
Published: March 2007

OBJECTIVE—This study evaluates insulin sensitivity, pancreatic β-cell function (BCF), and the balance between the two in youth with type 2 diabetes and assesses the relationship of diabetes duration and HbA1c to insulin sensitivity and BCF.
RESEARCH DESIGN AND METHODS—The subjects were 14 adolescents with type 2 diabetes and 20 obese control subjects of comparable age, BMI, body composition, and puberty. Insulin sensitivity was evaluated with a 3-h hyperinsulinemic (80 mU · m–2 · min–1) euglycemic clamp. First-phase insulin secretion (FPIS) and second-phase insulin secretion (SPIS) were evaluated with a 2-h hyperglycemic (12.5 mmol/l) clamp. Fasting glucose rate of appearance was determined with the use of [6,6-2H2]glucose.
RESULTS—Fasting glucose rate of appearance was higher in type 2 diabetic patients than in obese control subjects (16.5 ± 1.1 vs. 12.3 ± 0.5 μmol · kg–1 · min–1; P = 0.002). Insulin sensitivity was lower in type 2 diabetic patients than in obese control subjects (1.0 ± 0.1 vs. 2.0 ± 0.2 μmol · kg–1 · min–1 per pmol/l; P = 0.001). Fasting insulin was higher in type 2 diabetic patients than in obese control subjects (289.8 ± 24.6 vs. 220.2 ± 18.0 pmol/l; P = 0.007), and FPIS and SPIS were lower (FPIS: 357.6 ± 42.0 vs. 1,365.0 ± 111.0 pmol/l; SPIS: 652.2 ± 88.8 vs. 1,376.4 ± 88.8 pmol/l; P &lt; 0.001 for both). The glucose disposition index (GDI = insulin sensitivity × FPIS) was ∼86% lower in type 2 diabetic patients than in obese control subjects. HbA1c correlated with FPIS (r = −0.61, P = 0.025) with no relationship to insulin sensitivity.
CONCLUSIONS—Despite the impairment in both insulin sensitivity and BCF in youth with type 2 diabetes, the magnitude of the derangement is greater in BCF than insulin sensitivity when compared with that in obese control subjects. The inverse relationship between BCF and HbA1c may either reflect the impact of deteriorating BCF on glycemic control or be a manifestation of a glucotoxic phenomenon on BCF. Future studies in youth type 2 diabetes should target the natural course of β-cell failure and means of retarding and/or preventing it.
Autoantibodies Against Oxidized LDLs and Atherosclerosis in Type 2 Diabetes
Authors: Piarulli Francesco , Lapolla Annunziata , Sartore Giovanni , Rossetti Ciro , Bax Giuseppe , Noale Marianna , Minicuci Nadia , Fiore Cristina , Marchioro Lucio , Manzato Enzo , Fedele Domenico 
Published: March 2007

OBJECTIVE—The aim of our study was to examine, in type 2 diabetic patients, the relationship between autoantibodies against oxidatively modified LDL (oxLDL Ab) and two indexes of atherosclerosis, intimal-medial thickness of the common carotid artery (CCA-IMT), which reflects early atherosclerosis, and the ankle-brachial index (ABI), which reflects advanced atherosclerosis.
RESEARCH DESIGN AND METHODS—Thirty newly diagnosed type 2 diabetic patients, 30 type 2 diabetic patients with long duration of disease, and 56 control subjects were studied. To detect oxLDL Ab, the ImmunoLisa Anti-oxLDL Antibody ELISA was used. ABI was estimated at rest by strain-gauge plethysmography. Carotid B-mode imaging was performed on a high-resolution imaging system (ATL HDI 5000).
RESULTS—In patients with long duration of disease, IgG oxLDL Ab were significantly higher and ABI significantly lower compared with the other two groups. We found a correlation between IgG oxLDL Ab and CCA-IMT in all diabetic patients. A significant inverse correlation between IgG oxLDL Ab and ABI only in patients with long duration of disease was seen, demonstrating a close relationship between these autoantibodies and advanced atherosclerosis.
CONCLUSIONS—IgG OxLDL Ab may be markers of the advanced phase of the atherosclerotic process and the response of the immunological system to the oxLDL, which are present within atherosclerotic lesions.
Leisure Time Physical Activity Is Associated With Poor Glycemic Control in Type 1 Diabetic Women
Authors: Wadén Johan , Tikkanen Heikki , Forsblom Carol , Fagerudd Johan , Pettersson-Fernholm Kim , Lakka Timo , Riska Mikael , Groop Per-Henrik ,   on behalf of the FinnDiane Study Group
Published: March 2007

OBJECTIVE—We studied the association between leisure time physical activity (LTPA) and glycemic control, insulin dose, and estimated glucose disposal rate (eGDR) in type 1 diabetes.
RESEARCH DESIGN AND METHODS—This is a cross-sectional study of 1,030 type 1 diabetic patients participating in the Finnish Diabetic Nephropathy Study, a nationwide multicenter study. LTPA was assessed by a validated 12-month questionnaire and expressed in metabolic equivalent (MET) units. Patients were grouped as sedentary (LTPA &lt;10 MET h/week, n = 247), moderately active (LTPA 10–40 MET h/week, n = 568), and active (LTPA &gt;40 MET h/week, n = 215). Outcome measures were HbA1c, insulin dose, and eGDR (estimate of insulin sensitivity based on waist-to-hip ratio, hypertension, and HbA1c).
RESULTS—LTPA correlated with HbA1c in women (r = −0.12, P = 0.007) but not in men (r = −0.03, P = 0.592). Sedentary women had higher HbA1c than moderately active and active women: 8.8 ± 1.4% vs. 8.3 ± 1.4% vs. 8.3 ± 1.4% (P = 0.004), whereas HbA1c in men was 8.4 ± 1.3% vs. 8.2 ± 1.4% vs. 8.2 ± 1.3% (P = 0.774), respectively. In men, insulin doses were 0.74 ± 0.21 vs. 0.71 ± 0.20 vs. 0.68 ± 0.23 IU · kg–1 · 24 h–1 (P = 0.003). In both sexes, sedentary patients had lower eGDRs than active patients [median (interquartile range) 5.5 (4.0–8.2) vs. 6.8 (4.7–8.8) vs. 6.7 (4.6–8.6) mg · kg–1 · min–1; P &lt; 0.01 for sedentary vs. others]. Age, obesity, smoking, insulin dose, social class, diabetic nephropathy, or cardiovascular disease did not explain the results.
CONCLUSIONS—Low levels of LTPA were associated with poor glycemic control in type 1 diabetic women. Men seem to use less insulin when physically active. Increased LTPA levels were associated with increased estimated insulin sensitivity. Longitudinal studies are needed to further clarify the effects of LTPA on type 1 diabetes.
Use of HLA Typing in Diagnosing Celiac Disease in Patients With Type 1 Diabetes
Authors: Doolan Alessandra , Donaghue Kim , Fairchild Jan , Wong Melanie , Williams Andrew J. 
Published: March 2007

OBJECTIVE—This study examines the use of HLA typing for the diagnosis of celiac disease in a group of Australians with type 1 diabetes.
RESEARCH DESIGN AND METHODS—Subjects included 131 sequential patients with type 1 diabetes (mean age 17 years [range 10–37]), 77 patients with biopsy-proven celiac disease (mean age 52 years [range 12–84]), and 162 healthy control subjects (mean age 17 years [range 2 months to 56 years]). Subjects were prospectively screened for celiac disease using endomysial antibodies (EMAs), tissue transglutaminase antibodies (TTGAs), and celiac disease–specific HLA typing.
RESULTS—Celiac disease was diagnosed in 11 subjects after an intestinal biopsy (prevalence 8.4%). There was 95% agreement between TTGA and EMA for positive results and 100% for negative results. There was no significant difference for HLA DQ2 and DR4 among patients with type 1 diabetes with or without celiac disease.
CONCLUSIONS—The prevalence of celiac disease among patients with type 1 diabetes is higher than previously estimated in Australia. TTGA is a valuable diagnostic tool that can be used for screening celiac disease in patients with type 1 diabetes. HLA typing should not be used in the diagnosis of celiac disease in patients with type 1 diabetes because of the similarities of HLA types between patients with type 1 diabetes and those with celiac disease.
Rosiglitazone Improves Postprandial Triglyceride and Free Fatty Acid Metabolism in Type 2 Diabetes
Authors: van Wijk Jeroen P.H. , de Koning Eelco J.P. , Castro Cabezas Manuel , Rabelink Ton J. 
Published: March 2007

OBJECTIVE—Increased postprandial lipemia is part of diabetic dyslipidemia and is associated with accelerated atherosclerosis. We investigated the effects of the peroxisome proliferator–activated receptor-γ agonist rosiglitazone on postprandial lipemia in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—A randomized, 8-week, crossover, placebo-controlled, double-blind trial was performed in which rosiglitazone at 4 mg was administrated twice daily in 19 patients with type 2 diabetes. Standardized 6-h oral fat-loading tests were performed after each treatment period. Postprandial curves were calculated as the total area under the curve (AUC) and the incremental area under the curve (dAUC).
RESULTS—Rosiglitazone did not change fasting plasma triglycerides compared with placebo (1.97 ± 0.22 vs. 1.88 ± 0.20 mmol/l, respectively) but decreased postprandial triglyceride levels, leading to significantly lower triglyceride dAUC (−37%, P &lt; 0.05), without changing total triglyceride AUC. Significant postprandial triglyceride reductions in the chylomicron fraction (Svedberg flotation rate [Sf] &gt;400) were achieved with rosiglitazone, which resulted in a significant lower triglyceride AUC (−22%) in this fraction. The postprandial triglyceride increase in VLDL1 (Sf 60–400) was also lower after rosiglitazone (−27%), but this did not result in a significant lower triglyceride AUC. In VLDL2 (Sf 20–60), there were no significant differences in triglyceride AUC and triglyceride dAUC between rosiglitazone and placebo. Rosiglitazone decreased free fatty acid (FFA) AUC (−12%) and FFA dAUC (−18%) compared with placebo.
CONCLUSIONS—Rosiglitazone improves the metabolism of large triglyceride-rich lipoproteins and decreases postprandial FFA concentrations in type 2 diabetes. This may have clinical implications, as these effects may contribute to cardiovascular risk reduction.
Proinsulin Concentration Is an Independent Predictor of All-Cause and Cardiovascular Mortality
Authors: Alssema Marjan , Dekker Jacqueline M. , Nijpels Giel , Stehouwer Coen D.A. , Bouter Lex M. , Heine Robert J. 
Published: March 2007

OBJECTIVE—High proinsulin concentration may be a better predictor for cardiovascular disease (CVD) mortality than insulin concentration. Previous observations may have been confounded by glucose tolerance status or lack of precision because of high intraindividual variability. We investigated the longitudinal relation of means of duplicate measurements of insulin and proinsulin with all-cause and CVD mortality in a population-based cohort taking glucose tolerance status into account.
RESEARCH DESIGN AND METHODS—Fasting and post–75-g glucose-load (2-h) glucose, insulin, and proinsulin values were determined in duplicate on separate days in 277 participants with normal glucose metabolism, 208 participants with impaired glucose metabolism, and 119 newly detected patients with type 2 diabetes of the Hoorn Study. Insulin resistance and β-cell function were estimated by homeostasis model assessment (HOMA-IR and HOMA-B, respectively), and the fasting proinsulin-to-insulin ratio was calculated. Subjects were followed with respect to mortality until January 2003.
RESULTS—Fasting proinsulin levels were significantly associated with all-cause and CVD mortality. The hazard ratios (HRs) per increase in interquartile range adjusted for age and sex were 1.21 (95% CI 1.04–1.42) for all-cause mortality and 1.33 (1.06–1.66) for CVD mortality. Adjustment for glucose tolerance status and HOMA-IR did not substantially change the associations.
CONCLUSIONS—Fasting proinsulin was associated with all-cause and CVD mortality, independent of glucose tolerance status and insulin resistance and largely independent of other CVD risk factors. Proinsulin might play a role in the relationship between insulin resistance and CVD.
Maternal Efforts to Prevent Type 1 Diabetes in At-Risk Children
Authors: Baughcum Amy E. , Johnson Suzanne Bennett , Carmichael Stacy K. , Lewin Adam B. , She Jin-Xiong , Schatz Desmond A. 
Published: March 2007

OBJECTIVE—The aim of this study was to assess maternal diabetes prevention efforts aimed at children identified as at risk through newborn genetic screening.
RESEARCH DESIGN AND METHODS—A total of 192 mothers of children identified as at risk for type 1 diabetes through newborn genetic screening were administered a structured interview 3.6 ± 0.8 years after risk notification. The interview assessed possible diabetes prevention behaviors across six domains: health surveillance, diet, physical activity, illness prevention, medications, and stress reduction. A mother’s cognitive (diabetes risk perception and perceived control), affective (anxiety), and coping responses to the child’s at-risk status were assessed.
RESULTS—A total of 67% of mothers reported one or more diabetes prevention behaviors. Monitoring behaviors (e.g., watching for signs of diabetes and checking blood glucose) were the most common, reported in 59%, followed by modifications in the child’s diet in 34% and physical activity in 14%. Potentially harmful prevention behaviors (e.g., limiting contact with other children, delaying immunizations, and giving medications including insulin) were rare. Mothers who engaged in diabetes prevention behaviors reported higher diabetes risk perception, greater anxiety, and more use of certain coping styles. Infants of these mothers were more likely to have a first-degree relative with diabetes.
CONCLUSIONS—In the absence of known methods of preventing type 1 diabetes, most mothers of at-risk children report diabetes prevention behaviors. Such behaviors must be more carefully assessed to ensure accurate interpretation of data obtained from natural history studies and prevention trials.
Effects of Exenatide (Exendin-4) on Glycemic Control Over 30 Weeks in Patients With Type 2 Diabetes Treated With Metformin and a Sulfonylurea
Authors: Kendall David M. , Riddle Matthew C. , Rosenstock Julio , Zhuang Dongliang , Kim Dennis D. , Fineman Mark S. , Baron Alain D. 
Published: March 2007

OBJECTIVE—This study evaluated the effects of exenatide, a novel incretin mimetic, in hyperglycemic patients with type 2 diabetes unable to achieve glycemic control with metformin-sulfonylurea combination therapy.
RESEARCH DESIGN AND METHODS—A 30-week, double-blind, placebo-controlled study was performed in 733 subjects (aged 55 ± 10 years, BMI 33.6 ± 5.7 kg/m2, A1C 8.5 ± 1.0%; means ± SD) randomized to 5 μg subcutaneous exenatide b.i.d. (arms A and B) or placebo for 4 weeks. Thereafter, arm A remained at 5 μg b.i.d. and arm B escalated to 10 μg b.i.d. Subjects continued taking their dose of metformin and were randomized to either maximally effective (MAX) or minimum recommended (MIN) doses of sulfonylurea.
RESULTS—Week 30 A1C changes from baseline (±SE) were −0.8 ± 0.1% (10 μg), −0.6 ± 0.1% (5 μg), and +0.2 ± 0.1% (placebo; adjusted P &lt; 0.0001 vs. placebo), yielding placebo-adjusted reductions of −1.0% (10 μg) and −0.8% (5 μg). In the evaluable population, exenatide-treated subjects were more likely to achieve A1C ≤7% than placebo-treated subjects (34% [10 μg], 27% [5 μg], and 9% [placebo]; P &lt; 0.0001). Both exenatide arms demonstrated significant weight loss (−1.6 ± 0.2 kg from baseline each exenatide arm, −0.9 ± 0.2 kg placebo; P ≤ 0.01 vs. placebo). Mild or moderate nausea was the most frequent adverse event. The incidence of mild/moderate hypoglycemia was 28% (10 μg), 19% (5 μg), and 13% (placebo) and appeared lower with MIN than with MAX sulfonylurea treatment.
CONCLUSIONS—Exenatide significantly reduced A1C in patients with type 2 diabetes unable to achieve adequate glycemic control with maximally effective doses of combined metformin-sulfonylurea therapy. This improvement in glycemic control was associated with no weight gain and was generally well tolerated.
Effects of Exenatide (Exendin-4) on Glycemic Control and Weight Over 30 Weeks in Metformin-Treated Patients With Type 2 Diabetes
Authors: DeFronzo Ralph A. , Ratner Robert E. , Han Jenny , Kim Dennis D. , Fineman Mark S. , Baron Alain D. 
Published: March 2007

OBJECTIVE—This study evaluates the ability of the incretin mimetic exenatide (exendin-4) to improve glycemic control in patients with type 2 diabetes failing to achieve glycemic control with maximally effective metformin doses.
RESEARCH DESIGN AND METHODS—A triple-blind, placebo-controlled, 30-week study at 82 U.S. sites was performed with 336 randomized patients. In all, 272 patients completed the study. The intent-to-treat population baseline was 53 ± 10 years with BMI of 34.2 ± 5.9 kg/m2 and HbA1c of 8.2 ± 1.1%. After 4 weeks of placebo, subjects self-administered 5 μg exenatide or placebo subcutaneously twice daily for 4 weeks followed by 5 or 10 μg exenatide, or placebo subcutaneously twice daily for 26 weeks. All subjects continued metformin therapy.
RESULTS—At week 30, HbA1c changes from baseline ± SE for each group were −0.78 ± 0.10% (10 μg), −0.40 ± 0.11% (5 μg), and +0.08 ± 0.10% (placebo; intent to treat; adjusted P &lt; 0.002). Of evaluable subjects, 46% (10 μg), 32% (5 μg), and 13% (placebo) achieved HbA1c ≤7% (P &lt; 0.01 vs. placebo). Exenatide-treated subjects displayed progressive dose-dependent weight loss (−2.8 ± 0.5 kg [10 μg], −1.6 ± 0.4 kg [5 μg]; P &lt; 0.001 vs. placebo). The most frequent adverse events were gastrointestinal in nature and generally mild to moderate. Incidence of mild to moderate hypoglycemia was low and similar across treatment arms, with no severe hypoglycemia.
CONCLUSIONS—Exenatide was generally well tolerated and reduced HbA1c with no weight gain and no increased incidence of hypoglycemia in patients with type 2 diabetes failing to achieve glycemic control with metformin.
Decreased Lung Function in Female but not Male Subjects With Established Cystic Fibrosis–Related Diabetes
Authors: Sims Erika J. , Green Michael W. , Mehta Anil 
Published: March 2007

OBJECTIVE—Although cystic fibrosis–related diabetes (CFRD) is associated with decreased lung function, sex is not known to influence CFRD. However, compared with male subjects with cystic fibrosis, female subjects with cystic fibrosis have increased morbidity. This study examines the association between female subjects with CFRD and poor lung function relative to male subjects using the percent predicted forced expiratory volume in 1 s (FEV1) as a surrogate measure of morbidity.
RESEARCH DESIGN AND METHODS—We compared 323 patients with established CFRD with 489 cystic fibrosis control subjects with normal glucose tolerance (NGT) listed in the U.K. Cystic Fibrosis Database. Patients stratified by sex and chronic Pseudomonas aeruginosa infection were compared using binary logistic regression, and patients with new CFRD diagnoses were compared prospectively for the year 2002.
RESULTS—CFRD in female subjects (but not male subjects) without chronic P. aeruginosa infection had a 20% lower percent predicted FEV1 compared with control subjects with NGT (95% CI −11.7 to −27.7; P &lt; 0.0001). Genotype, age, treatment center, age at diagnosis of cystic fibrosis, pregnancy, liver function, or dose of pancreatic enzyme replacement therapy did not confound this female disadvantage. Comparison of female subjects with newly diagnosed CFRD free of chronic P. aeruginosa infection with matched control subjects with NGT showed no FEV1 disadvantage in the 1st year after CFRD diagnosis.
CONCLUSIONS—Only female subjects with CFRD have significantly decreased lung function compared with sex-matched NGT control subjects. The absence of poor lung function in the first 12 months after diagnosis of diabetes suggests that an opportunity may exist to intervene and possibly prevent a decline in lung function, which can be as much as 20% in female subjects with CFRD.
Obesity, Inactivity, and the Prevalence of Diabetes and Diabetes-Related Cardiovascular Comorbidities in the U.S., 2000–2002
Authors: Sullivan Patrick W. , Morrato Elaine H. , Ghushchyan Vahram , Wyatt Holly R. , Hill James O. 
Published: March 2007

OBJECTIVE—Obesity and physical inactivity are established risk factors for type 2 diabetes and cardiovascular comorbidities. Whether adiposity or fitness level is more important to health is controversial. The objective of this research is to determine the relative associations of physical activity and BMI with the prevalence of diabetes and diabetes-related cardiovascular comorbidities in the U.S.
RESEARCH DESIGN AND METHODS—The Medical Expenditure Panel Survey (MEPS) is a nationally representative survey of the U.S. population. From 2000 to 2002, detailed information on sociodemographic characteristics and health conditions were collected for 68,500 adults. Normal weight was defined as BMI 18.5 to &lt;25 kg/m2, overweight 25 to ≤30 kg/m2, obese (class I and II) 30 to &lt;40 kg/m2, and obese (class III) ≥40 kg/m2. Physical activity was defined as moderate/vigorous activity ≥30 min ≥3 days per week.
RESULTS—The likelihood of having diabetes and diabetes-related cardiovascular comorbidities increased with BMI regardless of physical activity and increased with physical inactivity regardless of BMI. Compared with normal-weight active adults, the multivariate-adjusted odds ratio (OR) for diabetes was 1.52 (95% CI 1.25–1.86) for normal-weight inactive adults and 1.65 (1.40–1.96) for overweight inactive adults; the OR for diabetes and comorbid hypertension was 1.71 (1.32–2.19) for normal-weight inactive adults and 1.84 (1.47–2.32) for overweight inactive adults.
CONCLUSIONS—Both physical inactivity and obesity seem to be strongly and independently associated with diabetes and diabetes-related comorbidities. These results support continued research investigating the independent causal nature of these factors.