bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Decisions Regarding HbA1c Results in Primary Care
Authors: Parnes Bennett L. , Main Deborah S. , Dickinson L. Miriam , Niebauer Linda , Holcomb Sherry , Westfall John M. , Pace Wilson D. 
Published: March 2007

OBJECTIVE—To describe decisions made by primary care providers on elevated HbA1c results and their reasons for not intensifying therapy.
RESEARCH DESIGN AND METHODS—In this cross-sectional study, a provider survey was administered in two practice-based research networks when HbA1c results were reviewed on all nonpregnant patients &gt;18 years old with type 2 diabetes. Univariate and Mantel-Hantel analyses assessed associations between patient characteristics and clinical decisions.
RESULTS—A total of 483 surveys were completed by at least 88 providers at 19 clinics. Most patients were female (62.5%), mean age was 60 years, and 28.6% were Hispanic. The overall action rate on HbA1c results ≥7% (n = 294) was 70.7%. Patients who were black or had Medicare without medication insurance had lower rates of action on HbA1c ≥7 and ≥8%, respectively (P &lt; 0.05). The most common reasons providers reported for inaction were “patient improving/doing well,” “competing demands,” and “hypoglycemic risk.”
CONCLUSIONS—Primary care providers generally adhere to national glycemic control guidelines, although there may be disparities in black patients and patients without medication insurance coverage. A variety of reasons were given when control was not intensified.
Inflammation and Glucose Intolerance
Authors: Wolf Myles , Sauk Jenny , Shah Anand , Vossen Smirnakis Karen , Jimenez-Kimble Ricardo , Ecker Jeffrey L. , Thadhani Ravi 
Published: March 2007

OBJECTIVE—Increased leukocyte count is a marker of inflammation that has been associated with the development of type 2 diabetes in prospective studies. Although gestational diabetes mellitus (GDM) and type 2 diabetes share certain pathophysiological mechanisms, few studies have examined inflammation and risk of GDM.
RESEARCH DESIGN AND METHODS—We prospectively examined routine leukocyte counts collected at the first prenatal visit in a cohort of 2,753 nulliparous euglycemic women, 98 (3.6%) of whom were later diagnosed with GDM. Subjects were divided into quartiles of leukocyte count, and the results of third-trimester glucose screening tests and the incidence of GDM among these quartiles were compared. Logistic regression was used to calculate univariate and multivariable-adjusted relative risks (RRs) of GDM according to leukocyte quartiles.
RESULTS—Leukocyte counts were increased among women who subsequently developed GDM compared with those who remained free of GDM (10.5 ± 2.2 vs. 9.2 ± 2.2 × 103 cells/ml; P &lt; 0.01). There was a linear increase in postloading mean glucose levels (P for trend &lt;0.01), the area under the glucose tolerance test curves (P for trend &lt;0.01), and the incidence of GDM (quartile 1, 1.1; quartile 2, 2.5; quartile 3, 4.2; and quartile 4, 6.4%; P for trend &lt;0.01) with increasing leukocyte quartiles. In the multivariable-adjusted analysis, the linear trend in the RR of GDM with increasing leukocyte quartiles remained statistically significant (quartile 1, reference; quartile 2, RR 2.3 [95% CI 0.9–5.7]; quartile 3, 3.3 [1.4–7.8]; quartile 4, 4.9 [2.1–11.2]; P for trend &lt;0.01).
CONCLUSIONS—Increased leukocyte count early in pregnancy is independently and linearly associated with the results of GDM screening tests and the risk of GDM. Although overlap in the leukocyte count distributions precludes it from being a clinically useful biomarker, these data suggest that inflammation is associated with the development of GDM and may be another pathophysiological link between GDM and future type 2 diabetes.
White Blood Cell Count Is Associated With Macro- and Microvascular Complications in Chinese Patients With Type 2 Diabetes
Authors: Tong Peter C. , Lee Ka-Fai , So Wing-Yee , Ng Margaret H. , Chan Wing-Bun , Lo Matthew K. , Chan Norman N. , Chan Juliana C. 
Published: March 2007

OBJECTIVES—There are close associations among raised white blood cell (WBC) count, coronary heart disease, and metabolic syndrome in the general population. The association between WBC count and vascular complications of diabetes has not been explored. We carried out a cross-sectional cohort study to determine the association between WBC count and the presence of macro- and microvascular complications in type 2 diabetes.
RESEARCH DESIGN AND METHODS—In this study, 3,776 patients with type 2 diabetes and normal WBC count (3.5–12.5 × 109/l) underwent a comprehensive assessment of complications and cardiovascular risk factors based on the European DiabCare protocol. Demographic and anthropometric parameters were recorded. Metabolic profiles, including complete blood picture and urinary albumin excretion, were measured.
RESULTS—Patients with higher WBC counts (categorized into quintiles) had adverse metabolic profiles as evidenced by higher blood pressure, BMI, HbA1c, fasting plasma glucose, LDL cholesterol, triglycerides, and urinary albumin excretion, but lower HDL cholesterol (all P &lt;0.001 for trend). The prevalence of macro- and microvascular complications increased in a dosage-related manner with WBC count. After adjustments for smoking and other known cardiovascular risk factors, a 1-unit (1 × 109/l) increment of WBC count was associated with a 15.8% (95% CI 9.3–22.6; P &lt; 0.001) and 12.3% increase (5.8–19.1; P &lt; 0.001) in the prevalence of macro- and microvascular complications, respectively.
CONCLUSIONS—Elevated WBC count, even within the normal range, is associated with both macro- and microvascular complications in type 2 diabetes. Chronic inflammation, as indicated by a higher WBC count, may play a linkage role in the development of macro- and microvascular complications in diabetes.
The Prevalence of the Metabolic Syndrome Among Arab Americans
Authors: Jaber Linda A. , Brown Morton B. , Hammad Adnan , Zhu Qian , Herman William H. 
Published: March 2007

OBJECTIVE—To estimate the prevalence of the metabolic syndrome in Arab Americans by age, sex, and BMI and to examine the association between insulin resistance and each of the components of the metabolic syndrome.
RESEARCH DESIGN AND METHODS—We studied a representative, cross-sectional, population-based sample of 542 Arab Americans aged 20–75 years. The metabolic syndrome was defined by Adult Treatment Panel III (ATP III) and World Health Organization (WHO) diagnostic criteria. Insulin resistance was estimated by homeostasis model assessment (HOMA-IR).
RESULTS—The age-adjusted prevalence of the metabolic syndrome was 23% (95% CI 19–26%) by the ATP III definition and 28% (24–32%) by the WHO definition. Although the prevalence increased significantly with age and BMI in both sexes by both definitions, differences in estimates were noted. With ATP III, the age-specific rates were similar for men and women aged 20–49 years but were significantly higher for women aged ≥50 years. With WHO, rates were higher for men than women aged 20–49 years and similar for those aged ≥50 years. The most common component of the metabolic syndrome in men and women was low HDL cholesterol with the ATP III and the presence of glucose intolerance and HOMA-IR with the WHO. Strong associations between HOMA-IR and individual components of the metabolic syndrome were observed. After fitting a model with HOMA-IR as the outcome, waist circumference, triglyceride level, and fasting plasma glucose level were significantly associated with HOMA-IR.
CONCLUSIONS—The metabolic syndrome is common among Arab Americans and is related to modifiable risk factors.
Concept, Strategies, and Feasibility of Noninvasive Insulin Delivery
Authors: Cefalu William T. 
Published: March 2007

OBJECTIVE—To comprehensively review the progress to date on the development of alternative routes for insulin delivery.
RESEARCH DESIGN AND METHODS—Study data were collected through a Medline review.
RESULTS—Proof of principle has been established for many routes of administration including dermal, nasal, oral, buccal, and pulmonary insulin delivery.
CONCLUSIONS—Of all the approaches to date, pulmonary delivery appears to be most feasible. Ongoing phase III studies will ultimately determine safety, tolerability, and efficacy before approval for clinical use.
Effects of Moderate Weight Loss and Orlistat on Insulin Resistance, Regional Adiposity, and Fatty Acids in Type 2 Diabetes
Authors: Kelley David E. , Kuller Lewis H. , McKolanis Therese M. , Harper Patricia , Mancino Juliet , Kalhan Satish 
Published: March 2007

OBJECTIVE—Moderate weight loss is recommended for overweight and obese patients with type 2 diabetes, and conjunctive use of weight loss medication has been advocated. The current study examined weight loss–dependent and –independent effects of the intestinal lipase inhibitor orlistat at 6 months of treatment, using behavioral intervention (Int) combined with randomized, double-blinded, placebo (P)-controlled treatment with orlistat (O).
RESEARCH DESIGN AND METHODS—Metabolic control, insulin sensitivity (IS), regional fat distribution, and fat content in liver and muscle were measured in 39 volunteers with type 2 diabetes in whom all antidiabetic medication was withdrawn 1 month preceding randomization. Weight loss was equivalent in the Int+O and Int+P groups, respectively (−10.3 ± 1.3 vs. −8.9 ± 1.1%), and there were identical decreases in visceral adipose tissue (VAT), fat mass (FM), thigh adiposity, and hepatic steatosis.
RESULTS—Weight loss resulted in substantial improvement (P &lt; 0.001) in HbA1c (−1.6 ± 0.3 vs. −1.0 ± 0.4%; NS between groups). IS improved significantly more with orlistat (Δ2.2 ± 0.4 vs. Δ1.2 ± 0.4 mg · min−1 · kg−1 fat-free mass [FFM]; P &lt; 0.05), and plasma free fatty acid (FFA) levels were strongly correlated with IS (r = 0.56; P &lt; 0.001). Orlistat caused greater reductions in fasting plasma FFA (Δ–154 ± 22 vs. Δ–51 ± 33 μmol/l; P &lt; 0.05), insulin-suppressed FFA (Δ–119 ± 23 vs. Δ–87 ± 34 μmol/l; P &lt; 0.05), and fasting plasma glucose (FPG; −62 ± 9 vs. −32 ± 8 mg/dl; P = 0.02). Changes in HbA1c were correlated with ΔIS (r = −0.41; P &lt; 0.01) but not with weight loss per se.
CONCLUSIONS—At equivalent weight loss, conjunctive use of orlistat resulted in greater improvement in FFA levels and IS.
Dietary Magnesium Intake in Relation to Plasma Insulin Levels and Risk of Type 2 Diabetes in Women
Authors: Song Yiqing , Manson JoAnn E. , Buring Julie E. , Liu Simin 
Published: March 2007

OBJECTIVE—Higher intake of magnesium appears to improve glucose and insulin homeostasis; however, there are sparse prospective data on the association between magnesium intake and incidence of type 2 diabetes.
RESEARCH DESIGN AND METHODS—In the Women’s Health Study, a cohort of 39,345 U.S. women aged ≥45 years with no previous history of cardiovascular disease, cancer, or type 2 diabetes completed validated semiquantitative food frequency questionnaires in 1993 and were followed for an average of 6 years. We used Cox proportional hazard models to estimate multivariate relative risks (RRs) of type 2 diabetes across quintiles of magnesium intake compared with the lowest quintile. In a sample of 349 apparently healthy women from this study, we measured plasma fasting insulin levels to examine their relation to magnesium intake.
RESULTS—During 222,523 person-years of follow-up, we documented 918 confirmed incident cases of type 2 diabetes. There was a significant inverse association between magnesium intake and risk of type 2 diabetes, independent of age and BMI (P = 0.007 for trend). After further adjustment for physical activity, alcohol intake, smoking, family history of diabetes, and total calorie intake, the multivariate-adjusted RRs of diabetes from the lowest to highest quintiles of magnesium intake were attenuated at 1.0, 1.06, 0.81, 0.86, and 0.89 (P = 0.05 for trend). Among women with BMI ≥25 kg/m2, the inverse trend was significant; multivariate-adjusted RRs were 1.0, 0.96, 0.76, 0.84, and 0.78 (P = 0.02 for trend). Multivariate-adjusted geometric mean insulin levels for overweight women in the lowest quartile of magnesium intake was 53.5 compared with 41.5 pmol/l among those at the highest quartile (P = 0.03 for trend).
CONCLUSIONS—These findings support a protective role of higher intake of magnesium in reducing the risk of developing type 2 diabetes, especially in overweight women.
Diabetes and Outcome of Community-Acquired Pneumococcal Bacteremia
Authors: Thomsen Reimar W. , Hundborg Heidi H. , Lervang Hans-Henrik , Johnsen Søren P. , Sørensen Henrik T. , Schønheyder Henrik C. 
Published: March 2007

OBJECTIVE—Patients with diabetes may carry a higher case fatality of invasive pneumococcal infection compared with nondiabetic patients due to decreased immunity, risk of metabolic derangement, or angiopathy. We conducted a population-based cohort study to assess the impact of diabetes on mortality within 90 days in patients with pneumococcal bacteremia.
RESEARCH DESIGN AND METHODS—All patients with community-acquired pneumococcal bacteremia in North Jutland County, Denmark, from January 1992 to December 2001 were retrieved from the County Bacteremia Registry. Using civil registry numbers, patients with diabetes were identified by record linkage with the County Prescription Database (for antidiabetic drugs) and the County Hospital Discharge Registry. Mortality within 90 days was determined through the Central Population Registry. Mortality rates were compared for diabetic and nondiabetic patients and adjusted for sex, age, and comorbidity.
RESULTS— Among 628 patients aged &gt;15 years with community-acquired pneumococcal bacteremia, 63 (10.0%) had diabetes. The diabetic patients were slightly older (median age 71.7 years) than the nondiabetic patients (67.0 years), and the proportion of patients with comorbidity was higher in the diabetic group (59 vs. 46%). Mortality in diabetic patients compared with nondiabetic patients was 11.1 vs. 16.5% after 30 days and 16.0 vs. 19.5% after 90 days, respectively. After adjustment for sex, age, and comorbidity, the mortality rate ratio for diabetic patients was 0.6 (95% CI 0.3–1.2) compared with the nondiabetic patients.
CONCLUSIONS—Diabetic patients with community-acquired pneumococcal bacteremia appear not to have a higher case fatality than nondiabetic patients.
Organizational Factors Affecting the Adoption of Diabetes Care Management Processes in Physician Organizations
Authors: Li Rui , Simon Jodi , Bodenheimer Thomas , Gillies Robin R. , Casalino Lawrence , Schmittdiel Julie , Shortell Stephen M. 
Published: March 2007

OBJECTIVE—To describe the extent of adoption of diabetes care management processes in physician organizations in the U.S. and to investigate the organizational factors that affect the adoption of diabetes care management processes.RESEARCH DESIGN AND METHODS—Data are derived from the National Survey of Physician Organizations and the Management of Chronic Illness, conducted in 2000–2001. A total of 1,104 of the 1,590 physician organizations identified responded to the survey. The extent of adoption of four diabetes care management processes is measured by an index consisting of the organization’s use of diabetic patient registries, clinical practice guidelines, case management, and physician feedback. The ordinary least-squares model is used to determine the association of organizational characteristics with the adoption of diabetes care management processes in physician organizations. A logistic regression model is used to determine the association of organizational characteristics with the adoption of individual diabetes care management processes.RESULTS—Of the 987 physician organizations studied that treat patients with diabetes, 48% either do not use any or use only one of the four diabetes care management processes. A total of 20% use two care management processes, and 32% use three or four processes. External incentives to improve quality, computerized clinical information systems, and ownership by hospitals or health maintenance organizations are strongly associated with the diabetes care management index and the adoption of individual diabetes care management processes.CONCLUSIONS—Policies to encourage external incentives to improve quality and to facilitate the adoption of computerized clinical information technology may promote greater use of diabetes care management processes.
Aldose Reductase Inhibition by AS-3201 in Sural Nerve From Patients With Diabetic Sensorimotor Polyneuropathy
Authors: Bril Vera , Buchanan Robert A. ,   the AS-3201 Study Group
Published: March 2007

OBJECTIVE—The primary purpose of this investigation was to determine whether AS-3201, a new aldose reductase inhibitor, penetrates the sural nerve and inhibits sorbitol and fructose accumulation in patients with diabetic sensorimotor polyneuropathy (DSP). An additional aim was to determine whether any changes in nerve function would manifest with AS-3201 therapy.
RESEARCH DESIGN AND METHODS—Patients with mild to moderate DSP based on nerve conduction studies were randomized into one of three treatment groups in a double-blind fashion: placebo or AS-3201 at 5 or 20 mg/day. After 12 weeks of administration, the sural nerve was biopsied for measurement of sorbitol, fructose, and AS-3201.
RESULTS—At baseline, no important clinical, electrophysiological, or laboratory differences were found between the three groups. The nerve sorbitol concentration of 3.14 × 10−2 nmol/mg wet nerve in patients in the placebo group was inhibited by 65 and 84% in patients on AS-3201 at 5 and 20 mg/day, respectively (P &lt; 0.001). Fructose levels were similarly inhibited. Sensory nerve conduction velocities improved by ≥1 m/s (P &lt; 0.05).
CONCLUSIONS—AS-3201 penetrates the sural nerve and inhibits sorbitol accumulation in patients with DSP. Additional studies are needed to confirm the electrophysiological suggestion that AS-3201 delays progression or leads to regression of DSP.
Chronic Obstructive Pulmonary Disease, Asthma, and Risk of Type 2 Diabetes in Women
Authors: Rana Jamal S. , Mittleman Murray A. , Sheikh Javed , Hu Frank B. , Manson JoAnn E. , Colditz Graham A. , Speizer Frank E. , Barr R. Graham , Camargo Carlos A. 
Published: March 2007

OBJECTIVE—Inflammation plays a key role in chronic obstructive pulmonary disease (COPD) and asthma. Increasing evidence points toward a role of inflammation in the pathogenesis of type 2 diabetes. We wanted to determine the relation of COPD and asthma with the development of type 2 diabetes.
RESEARCH DESIGN AND METHODS—The Nurses’ Health Study is a prospective cohort study. From 1988–1996, 103,614 female nurses were asked biennially about a physician diagnosis of emphysema, chronic bronchitis, asthma, and diabetes.
RESULTS—During 8 years of follow-up, we documented a total of 2,959 new cases of type 2 diabetes. The risk of type 2 diabetes was significantly higher for patients with COPD than those without (multivariate relative risk 1.8, 95% CI 1.1–2.8). By contrast, the risk of type 2 diabetes among asthmatic patients was not increased (1.0, 0.8–1.2). The asthma results remained nonsignificant even when we evaluated diabetes risk by duration of asthma exposure.
CONCLUSIONS—Our findings suggest that COPD may be a risk factor for developing type 2 diabetes. Differences in the inflammation and cytokine profile between COPD and asthma might explain why COPD, but not asthma, is associated with increased risk of type 2 diabetes.
Induction of Long-term Glycemic Control in Newly Diagnosed Type 2 Diabetic Patients Is Associated With Improvement of β-Cell Function
Authors: Li Yanbing , Xu Wen , Liao Zhihong , Yao Bin , Chen Xiahua , Huang Zhimin , Hu Guoliang , Weng JianPing 
Published: March 2007

OBJECTIVE—To investigate whether long-term optimal glycemic control can be achieved without medication by transient continuous subcutaneous insulin infusion (CSII) and the possible mechanisms responsible for this remission.
RESEARCH DESIGN AND METHODS—Newly diagnosed type 2 diabetic patients (n = 138, fasting glucose &gt;11.1mmol/l) were hospitalized and treated with CSII for 2 weeks. Intravenous glucose tolerance tests (IVGTTs) were performed, and blood glucose, HbA1c, lipid profiles, proinsulin, insulin, and C-peptide were measured before and after CSII. Patients were followed longitudinally on diet alone after withdrawal of insulin.
RESULTS—Optimal glycemic control was achieved within 6.3 ± 3.9 days by CSII in 126 patients. The remission rates (percentages maintaining near euglycemia) at the third, sixth, twelfth, and twenty-fourth month were 72.6, 67.0, 47.1, and 42.3%, respectively. Patients who maintained glycemic control &gt;12 months (remission group) had greater recovery of β-cell function than those who did not (nonremission group) when assessed immediately after CSII. Homeostasis model assessment of β-cell function (HOMA-B) and the area under the curve (AUC) of insulin during IVGTT were higher in the remission group (145.4 ± 89.6 vs. 78.5 ± 68.5, P = 0.002, and 1,423.4 ± 523.2 vs. 1,159.5 ± 476.8 pmol · l−1 · min−1, P = 0.044). Change in acute insulin response was also greater in the remission group than that in the nonremission group (621.8 ± 430.4 vs. 387.3 ± 428.8 pmol · l−1 · min−1, P = 0.033).
CONCLUSIONS—Short-term intensive insulin therapy can induce long-term glycemic control in newly diagnosed type 2 diabetic patients with severe hyperglycemia. The improvement of β-cell function, especially the restoration of first-phase insulin secretion, could be responsible for the remission.
Diabetes Is the Main Factor Accounting for the High Ferritin Levels Detected in Chronic Hepatitis C Virus Infection
Authors: Lecube Albert , Hernández Cristina , Genescà Joan , Esteban Joan I. , Jardí Rosend , García Lydia , Simó Rafael 
Published: March 2007

OBJECTIVE—A high prevalence of diabetes has been reported in patients with hepatitis C virus (HCV) infection. Both diabetes and HCV infection are associated with high serum ferritin levels. Although HCV infection could be the main factor responsible for the high ferritin levels, it is also possible that diabetes rather than HCV infection might be a major contributor to the high ferritin levels observed in patients with HCV infection. The aim of this study was to investigate the contribution of diabetes to the high ferritin levels observed in HCV-infected patients with chronic hepatitis.
RESEARCH DESIGN AND METHODS—A total of 634 noncirrhotic individuals were prospectively recruited at a university hospital. According to the HCV antibody status and the presence of diabetes, the subjects were divided into four groups: group A (anti–HCV-positive diabetic patients, n = 53), group B (anti–HCV-negative diabetic patients, n = 242), group C (anti–HCV-positive nondiabetic patients, n = 191), and group D (anti–HCV-negative nondiabetic control subjects, n = 148). Multiple regression analyses were used to explore the variables independently related to ferritin levels.
RESULTS—Serum ferritin levels in group A were significantly higher than in the other groups (A &gt; B, P &lt; 0.01; A &gt; C, P &lt; 0.001; A &gt; D, P &lt; 0.001). Ferritin levels were higher in group B than in group D (P = 0.001). However, group C has ferritin values similar to those of group D. In multivariate analyses, diabetes but not HCV infection was independently related to serum ferritin concentrations.
CONCLUSIONS—Diabetes rather than HCV infection itself is the main factor associated with the increased ferritin levels detected in patients with HCV infection. Therefore, the presence of diabetes should be taken into account when iron metabolism is evaluated in HCV-infected patients.