bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychosocial and Socioeconomic Risk Factors for Premature Death in Young People With Type 1 Diabetes
Authors: Laing Susan P. , Jones Michael E. , Swerdlow Anthony J. , Burden Andrew C. , Gatling Wendy 
Published: March 2007

OBJECTIVE—Mortality from acute diabetes-related events is greatly raised in young adults with type 1 diabetes. Psychosocial and socioeconomic risk factors are examined for deaths from acute events separately from deaths due to other causes.
RESEARCH DESIGN AND METHODS—This study had a nested case-control design. The cases were patients from the Diabetes UK cohort who died before age 40 years. Deaths were categorized as acute events or chronic conditions related to diabetes. Where possible, two matched control subjects were selected for each case. Data relating to psychosocial and socioeconomic factors and variables related to diabetes complications were extracted from the case notes. Risks of death were estimated by calculation of odds ratios (ORs).
RESULTS—Case notes were obtained for 98 case and 137 control subjects. Fifty-one deaths were attributed to acute causes, 34 to chronic conditions related to diabetes, and the remaining 13 were unrelated to diabetes. Living alone (OR 4.4), past drug abuse (5.7), and previous psychiatric referral (4.6) were all significantly associated with death from acute events but not death from chronic conditions. There was no association between deaths from acute events and nephropathy, hypertension, neuropathy, or retinopathy, although all of these were associated with deaths from chronic conditions.
CONCLUSIONS—The results indicate that psychosocial factors are powerful risk factors for mortality from acute events in patients with type 1 diabetes, although not for mortality from chronic conditions. The data enable the identification of a high-risk group suitable for targeting with preventive measures to reduce acute event mortality.
Web-Based Care Management in Patients With Poorly Controlled Diabetes
Authors: McMahon Graham T. , Gomes Helen E. , Hickson Hohne Sara , Hu Tang Ming-Jye , Levine Betty A. , Conlin Paul R. 
Published: March 2007

OBJECTIVE—To assess the effects of web-based care management on glucose and blood pressure control over 12 months in patients with poorly controlled diabetes.
RESEARCH DESIGN AND METHODS—For this study, 104 patients with diabetes and HbA1c (A1C) ≥9.0% who received their care at a Department of Veterans Affairs medical center were recruited. All participants completed a diabetes education class and were randomized to continue with their usual care (n = 52) or receive web-based care management (n = 52). The web-based group received a notebook computer, glucose and blood pressure monitoring devices, and access to a care management website. The website provided educational modules, accepted uploads from monitoring devices, and had an internal messaging system for patients to communicate with the care manager.
RESULTS—Participants receiving web-based care management had lower A1C over 12 months (P &lt; 0.05) when compared with education and usual care. Persistent website users had greater improvement in A1C when compared with intermittent users (−1.9 vs. −1.2%; P = 0.051) or education and usual care (−1.4%; P &lt; 0.05). A larger number of website data uploads was associated with a larger decline in A1C (highest tertile −2.1%, lowest tertile −1.0%; P &lt; 0.02). Hypertensive participants in the web-based group had a greater reduction in systolic blood pressure (P &lt; 0.01). HDL cholesterol rose and triglycerides fell in the web-based group (P &lt; 0.05).
CONCLUSIONS—Web-based care management may be a useful adjunct in the care of patients with poorly controlled diabetes.
Impact of Overweight on Chronic Microvascular Complications in Type 1 Diabetic Patients
Authors: De Block Christophe E.M. , De Leeuw Ivo H. , Van Gaal Luc F. 
Published: March 2007

OBJECTIVE—To investigate a possible association of BMI with retinopathy and neuropathy in type 1 diabetes. Retinopathy and neuropathy may not only be related to glycemic control and diabetes duration but also to blood pressure and BMI.
RESEARCH DESIGN AND METHODS—A total of 592 type 1 diabetic patients without nephropathy were studied (M/F: 324/268; age: 41 ± 12 years; duration: 19 ± 11 years; HbA1c [A1C]: 7.9 ± 1.1%). Patients were subdivided according to BMI: 168 men and 146 women with BMI &lt;25 kg/m2, and 156 men and 122 women with BMI ≥25 kg/m2. Retinopathy was examined by fundoscopy and neuropathy by electromyography.
RESULTS—Hypertension (&gt;130/85 mmHg) was present in 40%, retinopathy in 53%, and neuropathy in 43% of patients. Overweight subjects had more retinopathy (63 vs. 45%, P &lt; 0.0001, odds ratio [OR] = 2.1) and neuropathy (49 vs. 38%, P = 0.008, OR = 1.6) than normal-weight patients. Patients with retinopathy were older (45 ± 12 vs. 37 ± 11 years, P &lt; 0.0001) and had a longer diabetes duration (25 ± 10 vs. 12 ± 8 years, P &lt; 0.0001), a higher A1C (8.0 ± 1.1 vs. 7.7 ± 1.1%, P = 0.001), and a higher BMI (25.8 ± 4.1 vs. 24.7 ± 4.2 kg/m2, P = 0.001) than individuals without retinopathy. The same results are found in neuropathy. Logistic regression analysis showed that diabetes duration (β = 0.15, P &lt; 0.0001), blood pressure (β = 0.22, P = 0.0047), and A1C (β = 0.24, P = 0.01), but not BMI, lipid levels, sex, or age, were independent risk factors for retinopathy. Likewise, duration (β = 0.05, P &lt; 0.0001), age (β = 0.04, P = 0.0001), A1C (β = 0.35, P &lt; 0.0001), and sex (β = 0.74, P = 0.0001) but not BMI, lipid levels, or hypertension were independently associated with neuropathy. Men had more neuropathy than women (50 vs. 34%, P &lt; 0.0001, OR = 1.9). Leptin and adiponectin levels did not differ between individuals with or without microvascular complications.
CONCLUSIONS—Retinopathy and neuropathy are more prevalent in overweight (BMI ≥25 kg/m2) type 1 diabetic subjects. However, logistic regression analysis showed that diabetes duration and A1C remain the main determinants for retinopathy and neuropathy.
No Effect of Statin Therapy on Silent Myocardial Ischemia in Patients With Type 2 Diabetes Without Manifest Cardiovascular Disease
Authors: Beishuizen Edith D. , Jukema J. Wouter , Tamsma Jouke T. , van de Ree Marcel A. , van der Vijver J. Carel M. , Putter Hein , Maan Arie C. , Meinders A. Edo , Huisman Menno V. 
Published: March 2007

OBJECTIVE—Coronary artery disease is the most important cause of mortality in patients with type 2 diabetes. We aimed to determine the prevalence of silent myocardial ischemia (SMI) and the effect of statin therapy on SMI in type 2 diabetic patients without manifest cardiovascular disease.
RESEARCH DESIGN AND METHODS—A randomized, placebo-controlled, double-blind trial was performed in 250 patients with type 2 diabetes without manifest cardiovascular disease. Patients were given either 0.4 mg cerivastatin or placebo daily. In August 2001, when cerivastatin was withdrawn from the market, cerivastatin 0.4 mg was replaced by 20 mg simvastatin without deblinding the study. The primary end point was the change in ischemic episodes, duration, and burden as measured by 48-h ambulatory electrocardiography (AECG) over 2 years.
RESULTS—At baseline, 47 of 233 (20%) evaluable ambulatory electrocardiograms showed evidence of ischemia. After 2 years, there was a trend toward more ischemia in both treatment groups, without significant differences between the changes in ischemic parameters (episodes P = 0.498; duration P = 0.697; burden P = 0.798) in the two treatment groups. Cardiovascular events occurred in 12 patients in the placebo group and in two patients in the statin group (P = 0.006). There was no relationship between these cardiovascular events and the presence of SMI at baseline.
CONCLUSIONS—SMI occurred in 20% of type 2 diabetes patients without manifest cardiovascular disease. There was no effect from 2 years of statin therapy on SMI. In contrast, we observed a significantly lower cardiovascular event rate on statin therapy. AECG may not be a proper tool for risk stratification in patients with type 2 diabetes.
Subcutaneous Use of a Fast-Acting Insulin Analog
Authors: Della Manna Thais , Steinmetz Leandra , Campos Paula R. , Farhat Sylvia C.L. , Schvartsman Cláudio , Kuperman Hilton , Setian Nuvarte , Damiani Durval 
Published: March 2007

OBJECTIVE—To look for technical simplification and economic efficiency in the treatment of pediatric diabetic ketoacidosis (DKA) with subcutaneous use of the fast-acting insulin analog (lispro) and compare its use with regular intravenous insulin treatment.
RESEARCH DESIGN AND METHODS—In this controlled clinical trial from June 2001 to June 2003, we randomized 60 episodes of DKA with a blood glucose level ≥16.6 mmol/l (300 mg/dl), venous pH &lt;7.3 and/or bicarbonate &lt;15 mmol/l, or ketonuria greater than ++. Of the 60 episodes, 30 were treated with subcutaneous lispro (0.15 units/kg) given every 2 h (lispro group) and the other 30 cases received continuous intravenous regular insulin (0.1 unit · kg−1 · h−1; CIRI group). Volume deficit was repaired with 10-ml/kg aliquots of 0.9% sodium chloride. Laboratory monitoring included hourly bedside capillary glucose, venous blood gas, β-hydroxybutyrate, and electrolytes. Plasma blood glucose levels were measured on admission, 2 h after admission, when capillary blood glucose reached ≤13.8 mmol/l (250 mg/dl), and 6, 12, and 24 h thereafter.
RESULTS—Capillary glucose levels decreased by 2.9 and 2.6 mmol · l−1 · h−1 in the lispro and CIRI groups, respectively, but blood glucose fluctuated at different time intervals. In the CIRI group, metabolic acidosis and ketosis resolved in the first 6-h period after capillary glucose reached 13.8 mmol/l, whereas in the lispro group, they resolved in the next 6-h interval; however, both groups met DKA recovery criteria without complications.
CONCLUSIONS—DKA treatment with a subcutaneous fast-acting insulin analog represents a cost-effective and technically simplified procedure that precludes intensive care unit admission.
Annual Incidence and Clinical Characteristics of Type 2 Diabetes in Children as Detected by Urine Glucose Screening in the Tokyo Metropolitan Area
Authors: Urakami Tatsuhiko , Kubota Shigeki , Nitadori Yoshikazu , Harada Kensuke , Owada Misao , Kitagawa Teruo 
Published: March 2007

OBJECTIVE—This study investigates the annual incidence and clinical characteristics of type 2 diabetes among school-aged children as detected by urine glucose screening from 1974 to 2002 in the Tokyo metropolitan area.
RESEARCH DESIGN AND METHODS— In total, 8,812,356 school children were examined for glucosuria. Morning urine was used for the analysis. When the urine was positive for glucose, an oral glucose tolerance test was carried out to confirm diabetes.
RESULTS—In all, 232 students were identified to have type 2 diabetes. The overall annual incidence of type 2 diabetes was 2.63/100,000. The annual incidence after 1981 was significantly higher than that before 1980 (1.73 vs. 2.76/100,000, P &lt; 0.0001). The annual incidence was significantly higher for junior high school students compared with primary school students (0.78 vs. 6.43/100,000, P &lt; 0.0001). The overall male-to-female ratio of students with type 2 diabetes was 1.0:1.19 (P = 0.296), but it was 1.0:1.56 (P = 0.278) for primary school students. Overall, 83.4% of children with diabetes were obese (≥20% overweight). However, nonobese girls (&lt;20% overweight) with diabetes accounted for 23.0% of the patients, whereas markedly obese boys (≥40% overweight) accounted for 61.5% of the patients. The frequency of a family history of type 2 diabetes in second- and first-degree relatives was 56.5%.
CONCLUSIONS—We confirmed that the incidence of young people with type 2 diabetes increased after 1981 in the Tokyo metropolitan area. The increase in the frequency of this disorder seemed to be strongly related to an increasing prevalence of obesity. Age and genetic susceptibility may be associated with the occurrence of type 2 diabetes.
Efficacy of Inhaled Insulin in Patients With Type 2 Diabetes not Controlled With Diet and Exercise
Authors: DeFronzo Ralph A. , Bergenstal Richard M. , Cefalu William T. , Pullman John , Lerman Sam , Bode Bruce W. , Phillips Lawrence S. ,   for the Exubera Phase III Study Group
Published: March 2007

OBJECTIVE—Effective type 2 diabetes management requires prompt intervention if glycemic control is not achieved by nonpharmacological means. This study investigates whether inhaled insulin (INH; Exubera) can achieve target glycemic control in patients failing on diet and exercise.
RESEARCH DESIGN AND METHODS—Patients with suboptimal control on diet and exercise (HbA1c [A1C] 8–11%) were randomized to 3 months’ treatment with either INH before meals (n = 76) or rosiglitazone 4 mg twice a day (n = 69), in conjunction with a diet and exercise regimen. The primary end point was percentage of patients achieving A1C &lt;8.0%.
RESULTS—The INH and rosiglitazone groups had comparable baseline A1C values (9.5 vs. 9.4%, respectively). Significantly more patients achieved A1C &lt;8.0% (83 vs. 58%, adjusted odds ratio 7.14 [95% CI 2.48–20.58], P = 0.0003), A1C &lt;7.0% (44 vs. 18%, 4.43 [1.94–10.12]), and A1C ≤6.5% (28 vs. 7.5% 5.34 [1.83–15.57]) with INH. A1C decrease was greater with INH (−2.3% vs. −1.4%, adjusted treatment group difference: −0.89% [95% CI −1.23 to −0.55]) with final mean A1C values of 7.2 and 8.0% for INH and rosiglitazone, respectively. Hypoglycemia (episodes per subject-month) was higher with INH (0.7 vs. 0.05, risk ratio 14.72 [95% CI 7.51–28.83]), with no severe hypoglycemic episodes. Pulmonary function changes were small and comparable between groups.
CONCLUSIONS—INH could be an effective therapy for people with type 2 diabetes early in the course of their disease.
Ethnicity, Race, and Baseline Retinopathy Correlates in the Veterans Affairs Diabetes Trial
Authors: Emanuele Nicholas , Sacks Jerome , Klein Ronald , Reda Domenic , Anderson Robert , Duckworth William , Abraira Carlos ,   for the Veterans Affairs Diabetes Trial Group
Published: March 2007

OBJECTIVE—The Veterans Affairs Diabetes Trial (VADT) cohort is enriched with ∼20% Hispanics and 20% African Americans, affording a unique opportunity to study ethnic differences in retinopathy.
RESEARCH DESIGN AND METHODS—Cross-sectional analyses on the baseline seven-field stereo fundus photos of 1,283 patients are reported here. Diabetic retinopathy scores are grouped into four classes of increasing severity: none (10–14), minimal nonproliferative diabetic retinopathy (NPDR) (15–39), moderate to severe NPDR (40–59), and proliferative diabetic retinopathy (60+). These four groups have also been dichotomized to none or minimal (10–39) and moderate to severe diabetic retinopathy (40+).
RESULTS—The prevalence of diabetic retinopathy scores &gt;40 was higher for Hispanics (36%) and African Americans (29%) than for non-Hispanic whites (22%). The difference between Hispanics and non-Hispanic whites was significant (P &lt; 0.05). Similarly, the prevalence of diabetic retinopathy scores &gt;40 was significantly higher in African Americans than in non-Hispanic whites (P &lt; 0.05). These differences could not be accounted for by an imbalance in traditional risk factors such as age, duration of diagnosed diabetes, HbA1c (A1C), and blood pressure. Diabetic retinopathy severity scores were also significantly associated with increasing years of disease duration, A1C, systolic and diastolic blood pressure, the degree of microalbuminuria, fibrinogen, and the percentage of patients with amputations. There was no relationship between retinopathy severity and the percentage of people who had strokes or cardiac revascularization procedures. There was an inverse relationship between retinopathy severity and total cholesterol, triglycerides, and plasminogen activator inhibitor-1 as well as with smoking history. Diabetic retinopathy scores were not associated with age.
CONCLUSIONS—In addition to many well-known associations with retinopathy, a higher frequency of severe diabetic retinopathy was found in the Hispanic and African-American patients at entry into the VADT that is not accounted for by traditional risk factors for diabetic retinopathy, and these substantial ethnic differences remain to be explained.
Efficacy of Multilayered Hosiery in Reducing In-Shoe Plantar Foot Pressure in High-Risk Patients With Diabetes
Authors: Garrow Adam P. , van Schie Carine H.M. , Boulton Andrew J.M. 
Published: March 2007

OBJECTIVE—High plantar pressure is an acknowledged risk factor in the development of plantar ulcers in the diabetic neuropathic foot. This study examines the ability of preventive foot care (PFC) socks to reduce plantar foot pressures in a sample of high-risk patients with diabetes.
RESEARCH DESIGN AND METHODS—Nineteen patients with established peripheral neuropathy attending a complications clinic of the Manchester Diabetes Centre were recruited to the study. Fifteen (78%) of the patients were male, 40–80 years of age, and ulcer-free at the time of recruitment. In-shoe plantar pressure measurements were recorded using the F-Scan and compared PFC socks with ordinary supermarket socks. The analysis measured differences in maximum foot contact area and plantar pressure for the whole foot, forefoot, and peak plantar pressure areas.
RESULTS—The results showed a significant increase in maximum foot contact area of 11 cm2 (95% CI 7–11) when subjects wore the PFC socks (P &lt; 0.01). This was accompanied by 5.4 kPa (3.5–7.3) or 9% reduction in total foot pressure (P &lt; 0.01). Similar results were observed at the forefoot, which showed a 14.2% increase in contact area and a 10.2% reduction in peak forefoot pressure.
CONCLUSIONS—These results suggest that the wearing of PFC socks increases the underfoot contact area and hence decreases plantar foot pressures. Further studies are required to determine whether the pressure and friction reductions achieved by this simple intervention would be effective in reducing the incidence of foot ulcers in high-risk patients.
The Impact of Psychiatric Comorbidities on Readmissions for Diabetes in Youth
Authors: Garrison Michelle M. , Katon Wayne J. , Richardson Laura P. 
Published: March 2007

OBJECTIVE—Comorbid psychiatric disorders have been associated with poorer disease outcomes in diabetic youth. Less is known, however, about the relationship between psychiatric disorders and repeat hospitalizations for youth with diabetes.
RESEARCH DESIGN AND METHODS—We performed a retrospective cohort study using data from the Pediatric Health Information System, which included detailed discharge data from 37 noncompeting children’s hospitals in the U.S. Using logistic regression, we examined whether the presence of coded diagnoses for internalizing or externalizing disorders at an index hospitalization for diabetes was associated with increased risk for rehospitalization during follow-up (duration of follow-up ranged from 3 to 24 months). The analysis was stratified by age-groups, and we controlled for potential confounders including sex, age, race/ethnicity, type 1 versus type 2 diabetes, Medicaid status, intensive care unit utilization, length of stay during index admission, and duration of follow-up.
RESULTS—Among adolescents aged 13–18, internalizing disorders were associated with significantly increased odds of rehospitalization (odds ratio 1.79 [95% CI 1.27–2.52]); the point estimate for externalizing disorders was similar, but the finding was not statistically significant at the α = 0.05 level (1.74 [0.96–3.15]). No significant association between psychiatric diagnoses and odds of repeat hospitalization was observed in diabetic children aged 5–12 years.
CONCLUSIONS—Internalizing disorders are associated with increases in repeat hospitalizations for diabetes among adolescents. Future research is needed to explore the reasons for this finding, such as degree to which treatment nonadherence mediates this relationship and whether appropriate treatment of internalizing disorders results in improved diabetes outcomes and decreased readmissions.
Low Plasma Adiponectin Levels Are Associated With Increased Hepatic Lipase Activity In Vivo
Authors: Schneider Jochen G. , von Eynatten Maximilian , Schiekofer Stephan , Nawroth Peter P. , Dugi Klaus A. 
Published: March 2007

OBJECTIVE—Hepatic lipase plays a key role in hydrolyzing triglycerides and phospholipids present in circulating plasma lipoproteins. Plasma hepatic lipase activity is known to be regulated by several hormonal and metabolic factors, but hepatic lipase responsiveness to insulin is still controversial. Hypoadiponectinemia is known to be associated with insulin resistance, diabetes, and obesity. These conditions are often characterized by high plasma triglyceride and low HDL cholesterol levels, and they have been shown to be associated with high plasma hepatic lipase activity. We therefore raised the question whether adiponectin may be associated with plasma hepatic lipase activity in vivo.
RESEARCH DESIGN AND METHODS—We measured plasma adiponectin and postheparin hepatic lipase activity in 206 nondiabetic men and in a second group of 110 patients with type 2 diabetes. The correlation of these parameters with markers of insulin resistance and systemic inflammation was investigated.
RESULTS—In nondiabetic patients, adiponectin levels were significantly inversely correlated with plasma hepatic lipase activity (r = −0.4, P &lt; 0.01). These results were confirmed in the group of patients with type 2 diabetes (r = −0.32, P = 0.004). Multivariate analysis revealed that adiponectin was the strongest factor influencing hepatic lipase activity. The association was independent of age, sex, BMI, plasma triglycerides, insulin, HDL cholesterol, and high-sensitivity C-reactive protein and accounted for ∼10 and 12% of the variation in hepatic lipase activity in the two different patient cohorts, respectively.
CONCLUSIONS—These results demonstrate for the first time a significant inverse association between adiponectin and postheparin plasma hepatic lipase activity that is independent of other factors such as markers of insulin resistance or inflammation. Therefore, adiponectin, rather than insulin, may represent an important factor contributing to the regulation of hepatic lipase activity in both nondiabetic individuals and patients with type 2 diabetes. The effect of adiponectin on hepatic lipase activity may also help to explain the HDL cholesterol–elevating action of adiponectin.