bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sonographic Evaluation of Fetal Growth and Body Composition in Women With Different Degrees of Normal Glucose Metabolism
Authors: Parretti Elena , Carignani Lucia , Cioni Riccardo , Bartoli Elisa , Borri Patrizia , La Torre Pasquale , Mecacci Federico , Martini Elisabetta , Scarselli Gianfranco , Mello Giorgio 
Published: March 2007

OBJECTIVE—To investigate the maternal demographic and metabolic factors contributing to the growth of fetal lean and fat body mass in women whose degree of glucose intolerance is less than that defining gestational diabetes in comparison with women with normal glucose metabolism.
RESEARCH DESIGN AND METHODS—Longitudinal sonographic examinations of 66 singleton fetuses without anomalies of nonobese mothers with abnormal oral glucose challenge test (GCT) results and without gestational diabetes (group 1) were compared with those of 123 singleton fetuses without anomalies of nonobese mothers with normal GCT values (group 2). Lean body mass measurements included head circumference, femur length, mid-upper arm, and mid-thigh central areas. Fat body mass measurements included the anterior abdominal wall thickness, the subscapular thickness, and the mid-upper arm and mid-thigh subcutaneous areas. All the women performed a 24-h glucose profile on the day preceding the ultrasound scan. Multivariate logistic regression analysis established best-fit equations for fetal sonographic measurements of fat and lean body mass. Independent variables included groups 1 and 2, maternal age, parity, prepregnancy BMI, gestational age, weight gain during pregnancy, fetal sex, and the following averaged 24-h profile maternal capillary blood glucose values: preprandial, 1-h postprandial, and 2-h postprandial.
RESULTS—No difference was found between the two groups with respect to fetal lean body mass parameters; the factors that contributed significantly and most frequently were gestational age and fetal sex (male). With respect to fetal fat body mass, all the measurements were significantly higher in group 1 than in group 2. In all instances, the significantly contributing factors were gestational age and maternal 1-h postprandial glucose values, whereas another frequent contributor was prepregnancy BMI.
CONCLUSIONS—Our study suggests the possibility of using sonographically determined fetal fat and lean mass measurements as indicators of body composition. The assessment of these parameters, achievable in a noninvasive and reproducible fashion in pregnancies complicated by glucose intolerance, might enable the real-time detection of fetal overgrowth and disproportion, thus opening the possibility of exploring interventions to limit fetal fat accretion, birth weight, and potential resulting morbidity.
French Multicentric Survey of Outcome of Pregnancy in Women With Pregestational Diabetes
Authors:   Diabetes and Pregnancy Group, France
Published: March 2007

OBJECTIVE—To evaluate perinatal outcome in pregnancies in women with type 1 and type 2 diabetes and the influence of preconception care 10 years after the St. Vincent’s declaration.RESEARCH DESIGN AND METHODS—A cross-sectional study was conducted in 12 perinatal centers in France in 2000-2001. The main investigated outcomes were perinatal mortality, major congenital malformations, and preterm delivery.RESULTS—Among 435 single pregnancies, 289 (66.4%) were from women with type 1 and 146 (33.6%) from women with type 2 diabetes. Perinatal mortality rate was 4.4% (0.7% national rate), severe congenital malformations rate was 4.1% (2.2% national rate), and preterm delivery rate was 38.2% (4.7% national rate). Preconception care was provided in 48.5% women with type 1 diabetes and in 24.0% women with type 2 diabetes. Women whose first trimester HbA1c was &gt;8% had higher rates of perinatal mortality (9.2 vs. 2.5%; odds ratio 3.9; 95% CI 1.5–9.7; P &lt; 0.005), major congenital malformations (8.3 vs. 2.5%; 3.5; 1.3–8.9; P &lt; 0.01), and preterm delivery (57.6 vs. 24.8%; 1.4; 1.1–1.7; P &lt; 0.005) than those with first trimester HbA1c &lt;8%. These results are similar to those reported in France in 1986–1988.CONCLUSIONS—Pregnancies in women with diabetes are still poorly planned and complicated by higher rates of perinatal mortality and major congenital malformations. Despite knowledge of the importance of intensified glycemic control before pregnancy, reaching the St. Vincent’s target needs further implementation in France.
Identifying Hepatic Nuclear Factor 1α Mutations in Children and Young Adults With a Clinical Diagnosis of Type 1 Diabetes
Authors: Lambert A. Paul , Ellard Sian , Allen Lisa I.S. , Gallen Ian W. , Gillespie Kathleen M. , Bingley Polly J. , Hattersley Andrew T. 
Published: March 2007

OBJECTIVE—HNF-1α gene mutations (MODY3) present with marked hyperglycemia in lean young adults and may, therefore, be mistaken for type 1 diabetes, with implications for individual treatment and risk of diabetes in other family members. We examined the prevalence of HNF-1α mutations in families with three generations of diabetes identified in a population-based study of childhood diabetes, representing a subpopulation in which misclassification was likely.
RESEARCH DESIGN AND METHODS—In a study population of 1,470 families, 36 families (2.4%) with three affected generations were identified. In the 18 families in whom DNA samples were available, islet autoantibody testing, HLA class II genotyping, and HNF-1α sequencing were performed.
RESULTS—At least one islet autoantibody was found in 13 of 14 probands, and diabetes-associated HLA class II haplotypes were found in 17 of 18. One proband, who had no islet autoantibodies and was homozygous for the protective HLA haplotype DRB1*02-DQB1*0602, had a novel HNF-1α heterozygous nonsense mutation (R54X). This mutation cosegregated with diabetes in the family. The proband, his brother, mother, and maternal grandmother were diagnosed with type 1 diabetes aged 14–18 years and treated with insulin (0.39–0.74 units/kg) from diagnosis. The mother has since been successfully transferred to sulfonylurea treatment.
CONCLUSIONS—Family history alone is of limited value in identification of individuals with HNF-1α mutations, and we propose a stepwise approach that restricts sequencing of the HNF-1α gene to those with a family history of diabetes who also test negative for islet autoantibodies.
Delineation of Prevalence and Risk Factors for Early Coronary Artery Disease by Electron Beam Computed Tomography in Young Adults With Type 1 Diabetes
Authors: Starkman Harold S. , Cable Gregory , Hala Virginia , Hecht Harvey , Donnelly Christine M. 
Published: March 2007

OBJECTIVE—Type 1 diabetes increases the risk for coronary artery disease (CAD), but limited information is available regarding the early natural history of this process. Electron beam tomography (EBT) can measure coronary artery calcification (CAC), an early marker for CAD. This study was designed to assess the prevalence and risk factors for CAC in young adults with established type 1 diabetes.
RESEARCH DESIGN AND METHODS—A total of 101 subjects aged 17–28 years with type 1 diabetes of over 5 years’ duration and no history of heart disease underwent cardiac EBT with calcium scoring. Medical histories were obtained and physical examinations were conducted to document the presence of cardiac risk factors as well as evidence of microvasculopathy and diabetic arthropathy. Laboratory evaluation included measurement of fasting lipoproteins, homocysteine concentration, lipoprotein(a) [Lp(a)], urinary microalbumin, and HbA1c. Contingency table analysis was used to assess bivariate relationships. Logistic regression was employed to construct a parsimonious model of independent risk factors.
RESULTS—Eleven subjects (10.9%) had CAC. Smokers were nearly five times more likely than nonsmokers to have CAC (P = 0.03). In addition, each 0.36-mm/l increment of Lp(a) was associated with a 10% increased risk for CAC (P = 0.05) after controlling for potentially confounding factors. There was no association of other CAD or diabetes risk factors studied with CAC.
CONCLUSIONS—The prevalence of early CAD as evidenced by CAC in young adults with type 1 diabetes is significant. Smoking and Lp(a) levels independently predict the presence of CAC. Additional study is necessary to delineate the natural history of CAC and the role of risk factor modification to prevent progression of CAD in this high-risk population.
Enhancement of Endothelial Function by Pregnancy
Authors: Ramsay Jane E. , Simms Roslyn J. , Ferrell William R. , Crawford Lynn , Greer Ian A. , Lumsden Mary-Anne , Sattar Naveed 
Published: March 2007

OBJECTIVE—Pregnant women with type 1 diabetes have a substantially increased risk of vascular complications. Our aim was to study vascular function and metabolic and inflammatory risk factors during the antenatal and postpartum periods in women with type 1 diabetes compared with healthy control subjects.
RESEARCH DESIGN AND METHODS—A total of 15 women with diabetes and 30 control subjects were recruited in the third trimester of pregnancy. Of these women, 9 case subjects and 16 control subjects were reinvestigated in the postnatal period. Blood samples were collected and microvascular skin perfusion was assessed in vivo using laser Doppler imaging and iontophoretic administration of endothelial-dependent (acetylcholine [ACH]) and endothelial-independent (sodium nitroprusside [SNP]) vasodilators.
RESULTS—Microvascular responses in both control subjects (ACH, P = 0.018; SNP, P = 0.01) and diabetic women (ACH, P = 0.029; SNP, P = 0.105) were better during pregnancy than in the postnatal period, although responses in women with diabetes were significantly inferior to those in control subjects during both periods (all P &lt; 0.001, two-way ANOVA). This dysfunction existed despite similar lipoprotein profiles. The difference in vascular responsivity between case and control subjects was significantly attenuated by adjustment for differences in HbA1c but not C-reactive protein concentrations in the two groups.
CONCLUSIONS—Pregnancy enhances microvascular function, but in women with diabetes, such improvements are insufficient to attain responses seen in healthy nonpregnant women. This suggests a persistent vascular defect in young women with type 1 diabetes that may contribute to adverse pregnancy outcome. Our data suggest a role for the chronic effects of hyperglycemia in the impaired vascular responsiveness in such women.
Renal and Metabolic Effects of Insulin Lispro in Type 2 Diabetic Subjects With Overt Nephropathy
Authors: Ruggenenti Piero , Flores Claudio , Aros Claudio , Ene-Iordache Bogdan , Trevisan Roberto , Ottomano Cosimo , Remuzzi Giuseppe 
Published: March 2007

OBJECTIVE—To assess whether the insulin analog lispro may antagonize the renal effects of IGF-1, a mediator of glomerular hyperfiltration involved in the progression of diabetic and nondiabetic chronic nephropathies.
RESEARCH DESIGN AND METHODS—In a randomized crossover study, we compared the renal and metabolic responses to regular or lispro insulin (0.1 units/kg body wt) administered after a euglycemic clamp and 5 and 30 min before a standard meal to 11 type 2 diabetic patients with macroalbuminuria.
RESULTS—Two- and four-hour postprandial changes (vs. preprandial euglycemia) in glomerular filtration rate (GFR) followed a significantly different trend (5.8 ± 5.0 vs. −6.3 ± 4.7, P &lt; 0.05; and 11.0 ± 6.8 vs. 0.7 ± 5.1%, P &lt; 0.05) after regular insulin and lispro injection, respectively. After lispro, postprandial GFR changes were negatively correlated (r = −0.48, P = 0.0001) with plasma insulin concentration. After regular insulin, renal plasma flow increased in parallel with a decrease in renal vascular resistances. Both changes were fully prevented by lispro. Postprandial blood glucose maximum concentration (278 ± 16 vs. 240 ± 16 mg/dl, P &lt; 0.01) and area under the curve (79,381 ± 19,237 vs. 72,810 ± 16,211 mg/dl per min, P &lt; 0,05) were significantly lower after insulin lispro than after regular insulin injection, respectively, despite comparable postprandial insulin profiles. Changes in total and gluconeogenic amino acids followed a similar trend. Changes in blood glucose and plasma amino acids did not correlate with concomitant changes in GFR.
CONCLUSIONS—In overt nephropathy of type 2 diabetes, lispro prevents glomerular hyperfiltration and offsets the renal effects of meal or meal-associated hyperglycemia by mechanisms possibly related to IGF-1 antagonism.
Prospective Analysis of Mortality, Morbidity, and Risk Factors in Elderly Diabetic Subjects
Authors: Katakura Masafumi , Naka Motoji , Kondo Teruki , Nishii Nakako , Komatsu Mitsuhisa , Sato Yoshihiko , Yamauchi Keishi , Hiramatsu Kunihide , Ikeda Mitsuru , Aizawa Toru , Hashizume Kiyoshi 
Published: March 2007

OBJECTIVE—To clarify mortality and morbidity of intensively managed elderly diabetic individuals and to explore factors predicting mortality and diabetes-related end points.
RESEARCH DESIGN AND METHODS—A total of 390 elderly (≥65 years of age) outpatients with type 2 diabetes ( 173 men and 217 women, mean age 73.0 years) were analyzed. The mean HbA1c upon entry was 6.8% (332 receiving oral hypoglycemics and/or insulin) and blood pressure upon entry was 136/74 mmHg (219 receiving antihypertensive drugs). The patients have been followed-up for 3 years with HbA1c &lt;7.0% and blood pressure &lt;145/80 mmHg as targets, with mortality and an aggregate of fatal and nonfatal diabetes-related events as end points. Mortality rate and causes of mortality, as well as risk factors for mortality and morbidity, were determined.
RESULTS—The mortality rate, 2.9% per year, was comparable to that of the age- and sex-matched general population. Stroke was a leading cause of mortality after malignancy. By the univariate Cox proportional hazards model, only high serum creatinine and prior stroke were highly significant and strong risks for both end points. In those without prior stroke and receiving antihypertensive agents, the incidence of the diabetes-related end point based on their systolic blood pressure (SBP) quartile was U-shaped, with the nadir at the 3rd (SBP, 137–147 mmHg) and the peak at the 1st (SBP ≤ 125 mmHg) quartile.
CONCLUSIONS—In well-controlled elderly diabetic subjects, there was no excessive mortality compared to the age- and sex-matched general population. Renal dysfunction and prior stroke were independent risks for mortality and morbidity. In those without prior stroke, a risk of too much lowering of blood pressure was suggested.
Comparison of a Clinical Model, the Oral Glucose Tolerance Test, and Fasting Glucose for Prediction of Type 2 Diabetes Risk in Japanese Americans
Authors: McNeely Marguerite J. , Boyko Edward J. , Leonetti Donna L. , Kahn Steven E. , Fujimoto Wilfred Y. 
Published: March 2007

OBJECTIVE—To test the validity of a published clinical model for predicting incident diabetes in Japanese Americans.
RESEARCH DESIGN AND METHODS—A total of 465 nondiabetic Japanese Americans (243 men, 222 women), aged 34–75 years, were studied at baseline and at 5–6 years. A total of 412 subjects were studied at 10 years. The clinical model included age, sex, ethnicity, BMI, systolic blood pressure, fasting plasma glucose (FPG), HDL cholesterol, and family history of diabetes at baseline. Diabetes status at 5–6 and 10 years was determined by 75-g oral glucose tolerance test. The clinical model, 2-h glucose, and FPG were compared using receiver-operating characteristic (ROC) curves.
RESULTS—The diabetes risk associated with BMI, sex, and HDL cholesterol differed by age (P ≤ 0.011). At 5–6 years, the clinical model ROC curve area (0.896) was higher than that for FPG (0.776, P = 0.008), but not for 2-h glucose (0.851, P = 0.341), for subjects aged ≤55 years. For older subjects, the clinical model ROC curve area (0.599) was lower than that for 2-h glucose (0.792, P ≤ 0.001), but not for FPG (0.627, P = 0.467). At 10 years, there were no significant differences between the clinical model, FPG, and 2-h glucose ROC curve areas in either age group.
CONCLUSIONS—In Japanese Americans aged ≤55 years, a clinical model was better than FPG for predicting diabetes after 5–6 years but not after 10 years. The model was not useful in older Japanese Americans, whereas 2-h glucose was useful for predicting diabetes risk regardless of age.
Poor Prognosis of Young Adults With Type 1 Diabetes
Authors: Bryden Kathryn S. , Dunger David B. , Mayou Richard A. , Peveler Robert C. , Neil H. Andrew W. 
Published: March 2007

OBJECTIVE—To determine the role of early behavioral and psychological factors on later outcomes in young adults with childhood- or adolescent-onset type 1 diabetes.
RESEARCH DESIGN AND METHODS—We conducted a longitudinal cohort study of patients recruited from the register of the young adult outpatient diabetes clinic, Oxford, U.K. A total of 113 individuals (51 male subjects) aged 17–25 years completed assessments, and 87 (77%) were reinterviewed as older adults (aged 28–37 years). Longitudinal assessments were made of glycemic control (HbA1c) and complications. Psychological state at baseline was assessed using the Present State Examination and self-report Symptom Checklist, with corresponding interview schedules administered at follow-up.
RESULTS—There was no significant improvement between baseline and follow-up in mean HbA1c levels (8.5 vs. 8.6% in men, 9.3 vs. 8.7% in women). The proportion of individuals with serious complications (preproliferative or laser-treated retinopathy, proteinuria or more severe renal disease, peripheral neuropathy, and autonomic neuropathy) increased from 3–37% during the 11-year period. Women were more likely than men to have multiple complications (23 vs. 6%, difference 17%, 95% CI 4–29%, P = 0.02). Psychiatric disorders increased from 16 to 28% (20% in men, 36% in women at follow-up, difference NS), and 8% had psychiatric disorders at both assessments. Baseline psychiatric symptom scores predicted follow-up scores (β = 0.32, SE [β] 0.12, P = 0.008, 95% CI 0.09–0.56) and recurrent admissions with diabetic ketoacidosis (odds ratio 9.1, 95% CI 2.9–28.6, P &lt; 0.0001).
CONCLUSIONS—The clinical and psychiatric outcome in this cohort was poor. Psychiatric symptoms in later adolescence and young adulthood appeared to predict later psychiatric problems.
Rapid A1c Availability Improves Clinical Decision-Making in an Urban Primary Care Clinic
Authors: Miller Christopher D. , Barnes Catherine S. , Phillips Lawrence S. , Ziemer David C. , Gallina Daniel L. , Cook Curtiss B. , Maryman Sandra D. , El-Kebbi Imad M. 
Published: March 2007

OBJECTIVE—Failure to meet goals for glycemic control in primary care settings may be due in part to lack of information critical to guide intensification of therapy. Our objective is to determine whether rapid-turnaround A1c availability would improve intensification of diabetes therapy and reduce A1c levels in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—In this prospective controlled trial, A1c was determined on capillary glucose samples and made available to providers, either during (“rapid”) or after (“routine”) the patient visit. Frequency of intensification of pharmacological diabetes therapy in inadequately controlled patients and A1c levels were assessed at baseline and after follow-up.
RESULTS—We recruited 597 subjects. Patients were 79% female and 96% African American, with average age of 61 years, duration of diabetes 10 years, BMI 33 kg/m2, and A1c 8.5%. The rapid and routine groups had similar clinical demographics. Rapid A1c availability resulted in more frequent intensification of therapy when A1c was ≥7.0% at the baseline visit (51 vs. 32% of patients, P = 0.01), particularly when A1c was &gt;8.0% and/or random glucose was in the 8.4–14.4 mmol/l range (151–250 mg/dl). In 275 patients with two follow-up visits, A1c fell significantly in the rapid group (from 8.4 to 8.1%, P = 0.04) but not in the routine group (from 8.1 to 8.0%, P = 0.31).
CONCLUSIONS—Availability of rapid A1c measurements increased the frequency of intensification of therapy and lowered A1c levels in patients with type 2 diabetes in an urban neighborhood health center.
Unrecognized Anemia in Patients With Diabetes
Authors: Thomas Merlin C. , MacIsaac Richard J. , Tsalamandris Con , Power David , Jerums George 
Published: March 2007

OBJECTIVE—Anemia is common in diabetes, potentially contributing to the pathogenesis of diabetes complications. This study aims to establish the prevalence and independent predictors of anemia in a cross-sectional survey of 820 patients with diabetes in long-term follow-up in a single clinic.
RESEARCH DESIGN AND METHODS—A full blood count was obtained in addition to routine blood and urine test results for all patients over a 2-year period to encompass all patterns of review. Predictors of the most recent Hb concentration and anemia were identified using multiple and logistic regression analysis.
RESULTS—A total of 190 patients (23%) had unrecognized anemia (Hb &lt;12 g/dl for women and &lt;13 g/dl for men). This prevalence is two to three times higher than for patients with comparable renal impairment and iron stores in the general population. Independent predictors for Hb were transferrin saturation, glomerular filtration rate (GFR), sex, albumin excretion rate, and HbA1c level (all P &lt; 0.0001). Microalbuminuric patients were &gt;2 times (odds ratio [OR] 2.3) and macroalbuminuric patients &gt;10 times (OR 10.1) as likely to have anemia than normoalbuminuric patients with preserved renal function (GFR &gt;80 ml/min).
CONCLUSIONS—Anemia is a common accompaniment to diabetes, particularly in those with albuminuria or reduced renal function. Additional factors present in diabetes may contribute to the development of increased risk for anemia in patients with diabetes.
Detection of Undiagnosed Diabetes and Other Hyperglycemia States
Authors: Schmidt Maria Inês , Duncan Bruce B. , Vigo Alvaro , Pankow James , Ballantyne Christie M. , Couper David , Brancati Frederick , Folsom Aaron R. ,   for the ARIC Investigators
Published: March 2007

OBJECTIVE—To evaluate screening strategies based on fasting plasma glucose (FPG), clinical information, and the oral glucose tolerance test (OGTT) for detection of diabetes or other hyperglycemic states—impaired fasting glucose (IFG) and impaired glucose tolerance—meriting clinical intervention.
RESEARCH DESIGN AND METHODS—We studied 8,286 African-American and white men and women without known diabetes, aged 53–75 years, who received an OGTT during the fourth exam of the Atherosclerosis Risk in Communities Study. Using a split sample technique, we estimated the diagnostic properties of various clinical detection rules derived from logistic regression modeling. Screening strategies utilizing FPG, these detection rules, and/or the OGTT were then compared in terms of both the fraction of hyperglycemia cases detected and the sample fraction receiving different screening tests and identified as screen positive.
RESULTS—Screening based on the IFG cut point (≥6.1 mmol/l), followed by a clinical detection rule for those below this value, detected 86.3% of diabetic case subjects and 66.0% of all hyperglycemia cases, identifying 42% of the sample as screen positive. Applying an OGTT for those positive by the rule provides diagnostic labeling and reduces the fraction that is screen positive to 29%. Another strategy, to apply an OGTT to those with an FPG cut point between 5.6 and 6.1 mmol/l, also identifies 29% of the sample as screen positive, although it detects slightly fewer hyperglycemia cases.
CONCLUSIONS—Screening strategies based on FPG, complemented by clinical detection rules and/or an OGTT, are effective and practical in the detection of hyperglycemic states meriting clinical intervention.