bluuebunny/crossref_metadata_2025_split huggingface dataset:
Archimedes
Authors: Eddy David M. , Schlessinger Leonard 
Published: March 2007

OBJECTIVE—To build a mathematical model of the anatomy, pathophysiology, tests, treatments, and outcomes pertaining to diabetes that could be applied to a wide variety of clinical and administrative problems and that could be validated.
RESEARCH DESIGN AND METHODS—We used an object-oriented approach, differential equations, and a construct we call “features.” The level of detail and realism was determined by what clinicians considered important, by the need to distinguish clinically relevant variables, and by the level of detail used in the conduct of clinical trials.
RESULTS—The model includes the pertinent organ systems, more than 50 continuously interacting biological variables, and the major symptoms, tests, treatments, and outcomes. The level of detail corresponds to that found in general medical textbooks, patient charts, clinical practice guidelines, and designs of clinical trials. The model is continuous in time and represents biological variables continuously. As demonstrated in a companion article, the equations can simulate a variety of clinical trials and reproduce their results with good accuracy.
CONCLUSIONS—It is possible to build a mathematical model that replicates the pathophysiology of diabetes at a high level of biological and clinical detail and that can be tested by simulating clinical trials.
Association of the p22phox Component of NAD(P)H Oxidase With Susceptibility to Diabetic Nephropathy in Patients With Type 1 Diabetes
Authors: Hodgkinson Andrea D. , Millward Beverley A. , Demaine Andrew G. 
Published: March 2007

OBJECTIVE—Increased production of reactive oxygen species (ROS) in diabetes is thought to play a major role in the pathogenesis of diabetic microvascular complications such as nephropathy and retinopathy. The NAD(P)H oxidase complex is an important source of ROS in the vasculature. The p22 subunit is polymorphic with a C242T variant that changes histidine-72 for a tyrosine in the potential heme binding site, together with a A640G in the 3′ untranslated region. The aim was to investigate the frequency of these polymorphisms in 268 patients with type 1 diabetes with or without microvascular complications.
RESEARCH DESIGN AND METHODS—There was a highly significant increase in the frequency of the T/T242 genotype in patients with nephropathy compared with those with retinopathy alone or no microvascular disease after 20 years’ diabetes duration (uncomplicated) or normal healthy control subjects (33.3 vs. 6.5, 5.7, and 0.0%, respectively, P &lt; 0.000001). Furthermore, the T242/G640 haplotype was found in 39.4% of the patients with nephropathy but in only 26.5% of the patients with retinopathy and 15.3 and 10.6% of the uncomplicated and normal control subjects, respectively.
RESULTS—When these variants of NAD(P)H oxidase were analyzed together with aldose reductase (5′ALR2) susceptibility genotypes, &gt;46.0% of the patients with nephropathy possessed a T242 allele with the Z-2 5′ALR2 allele compared with only 11.2% of the uncomplicated patients (P &lt; 0.00003).
CONCLUSIONS—In conclusion, these results suggest NAD(P)H oxidase together with the polyol pathway may contribute to the pathogenesis of diabetic nephropathy.
Effects of Stress Hyperglycemia on Acute Myocardial Infarction
Authors: Marfella Raffaele , Siniscalchi Mario , Esposito Katherine , Sellitto Ausilia , de Fanis Umberto , Romano Ciro , Portoghese Michele , Siciliano Silvio , Nappo Francesco , Sasso Ferdinando Carlo , Mininni Nicola , Cacciapuoti Federico , Lucivero Giacomo , Giunta Riccardo , Verza Mario , Giugliano Dario 
Published: March 2007

OBJECTIVE—Stress hyperglycemia has been associated with increased mortality in patients with myocardial infarction (MI). We examined the association between plasma glucose levels, circulating inflammatory markers, T-cell activation, and functional cardiac outcome in patients with first MI.
RESEARCH DESIGN AND METHODS—Echocardiographic parameters, circulating levels of interleukin-18 (IL-18), C-reactive protein (CPR), and the percent of CD16-CD56, CD4/CD8, CD152, and HLA-DR expression were investigated in 108 patients with acute MI on admission to the emergency ward.
RESULTS—Our review found that 31 new hyperglycemic patients (glycemia ≥7 mmol/l) had higher infarct segment length (P &lt; 0.05) and myocardial performance index (P &lt; 0.02) and reduced transmitral Doppler flow (P &lt; 0.05), pulmonary flow analysis (P &lt; 0.02), and ejection fraction (P &lt; 0.05) compared with 36 hyperglycemic diabetic patients and 41 normoglycemic patients. Plasma IL-18 and CRP were higher in the hyperglycemic than in the normoglycemic patients (P &lt; 0.005), with the highest values in patients with new hyperglycemia (P &lt; 0.05). Hyperglycemic patients had a higher percent of CD16+/CD56+ cells and CD4/CD8 ratio (P &lt; 0.01), whereas they had lower CD152 expression (which has a negative regulatory function in T-cell activation) compared with normoglycemic patients (P &lt; 0.001).
CONCLUSIONS—During MI, hyperglycemia is associated with increased levels of inflammatory markers, enhanced expression of cytotoxic T-cells, and reduced expression of T-cells, which are implicated in limiting the immune process. An increased inflammatory immune process seems a likely mechanism linking acute hyperglycemia to poor cardiac outcome in MI patients.
The Metabolic Syndrome as Predictor of Type 2 Diabetes
Authors: Lorenzo Carlos , Okoloise Mayor , Williams Ken , Stern Michael P. , Haffner Steven M. 
Published: March 2007

OBJECTIVE—The oral glucose tolerance test identifies high-risk subjects for diabetes, but it is costly and inconvenient. To find better predictors of type 2 diabetes, we evaluated two different definitions of the metabolic syndrome because insulin resistance, which is commonly associated with this clustering of metabolic factors, frequently precedes the onset of type 2 diabetes.
RESEARCH DESIGN AND METHODS—We compared the ability of the National Cholesterol Education Program (NCEP) definition, a modified version of the 1999 World Health Organization (WHO) definition that excludes the 2-h glucose requirement, and impaired glucose tolerance (IGT) to predict incident type 2 diabetes. In the San Antonio Heart Study, 1,734 participants completed a 7- to 8-year follow-up examination.
RESULTS—IGT and the NCEP definition had higher sensitivity than the modified WHO definition (51.9, 52.8, and 42.8%, respectively). IGT had a higher positive predictive value than the NCEP and modified WHO definitions (43.0, 30.8, and 30.4%, respectively). The combination of the IGT and NCEP definitions increased the sensitivity to 70.8% with an acceptable positive predictive value of 29.7%. Risk for incidence of type 2 diabetes using the NCEP definition was independent of other risk factors, including IGT and fasting insulin (odds ratio 3.30, 95% CI 2.27-4.80). The NCEP definition performed better with fasting glucose ≥5.4 mmol/l (sensitivity 62.0% and positive predictive value 30.9%).
CONCLUSIONS—The metabolic syndrome predicts diabetes independently of other factors. However, the NCEP definition performs better than the modified 1999 WHO definition. Lowering the fasting glucose cutoff to 5.4 mmol/l improves the prediction of diabetes by the metabolic syndrome.
Primary Prevention of Cardiovascular Events With Low-Dose Aspirin and Vitamin E in Type 2 Diabetic Patients
Authors: Sacco Michele , Pellegrini Fabio , Roncaglioni Maria C. , Avanzini Fausto , Tognoni Gianni , Nicolucci Antonio ,   on behalf of the PPP Collaborative Group
Published: March 2007

OBJECTIVE—We investigated in general practice the efficacy of antiplatelets and antioxidants in primary prevention of cardiovascular events in people with type 2 diabetes.
RESEARCH DESIGN AND METHODS—The Primary Prevention Project (PPP) is a randomized, open trial with a two-by-two factorial design aimed to investigate low-dose aspirin (100 mg/day) and vitamin E (300 mg/day) in the prevention of cardiovascular events in patients with one or more cardiovascular risk factors. The primary end point was a composite end point of cardiovascular death, stroke, or myocardial infarction. A total of 1,031 people with diabetes in the PPP, aged ≥50 years, without a previous cardiovascular event were enrolled by 316 general practitioners and 14 diabetes outpatient clinics.
RESULTS—The PPP trial was prematurely stopped (after a median of 3.7 years) by the independent data safety and monitoring board because of a consistent benefit of aspirin compared with the control group in a population of 4,495 patients with one or more major cardiovascular risk factors. In diabetic patients, aspirin treatment was associated with a nonsignificant reduction in the main end point (relative risk [RR] = 0.90, 95% CI 0.50–1.62) and in total cardiovascular events (0.89, 0.62–1.26) and with a nonsignificant increase in cardiovascular deaths (1.23, 0.69–2.19). In nondiabetic subjects, RRs for the main end point, total cardiovascular events, and cardiovascular deaths were 0.59 (0.37–0.94), 0.69 (0.53–0.90), and 0.32 (0.14–0.72), respectively. No significant reduction in any of the end points considered could be found with vitamin E in either diabetic or nondiabetic subjects.
CONCLUSIONS—Our data suggest a lower effect of primary prevention of cardiovascular disease (CVD) with low-dose aspirin in diabetic patients as opposed to subjects with other cardiovascular risk factors. If confirmed, these findings might indicate that the antiplatelet effects of aspirin in diabetic patients are overwhelmed by aspirin-insensitive mechanisms of platelet activation and thrombus formation, thus making the balance between benefits and harms of aspirin treatment unfavorable. Further large-scale trials investigating the role of aspirin in the primary prevention of CVD in diabetic patients are urgently needed.
Benefits and Risks of Solitary Islet Transplantation for Type 1 Diabetes Using Steroid-Sparing Immunosuppression
Authors: Hirshberg Boaz , Rother Kristina I. , Digon Benigno J. , Lee Janet , Gaglia Jason L. , Hines Kenneth , Read Elizabeth J. , Chang Richard , Wood Bradford J. , Harlan David M. 
Published: March 2007

OBJECTIVE—The aim of this study was to describe the National Institutes of Health’s experience initiating an islet isolation and transplantation center, including descriptions of our first six recipients, and lessons learned.
RESEARCH DESIGN AND METHODS—Six females with chronic type 1 diabetes, hypoglycemia unawareness, and no endogenous insulin secretion (undetectable serum C-peptide) were transplanted with allogenic islets procured from brain dead donors. To prevent islet rejection, patients received daclizumab, sirolimus, and tacrolimus.
RESULTS—All patients noted less frequent and less severe hypoglycemia, and one-half were insulin independent at 1 year. Serum C-peptide persists in all but one patient (follow-up 17–22 months), indicating continued islet function. Two major procedure-related complications occurred: partial portal vein thrombosis and intra-abdominal hemorrhage. While we observed no cytomegalovirus infection or malignancy, recipients frequently developed transient mouth ulcers, diarrhea, edema, hypercholesterolemia, weight loss, myelosuppression, and other symptoms. Three patients discontinued immunosuppressive therapy: two because of intolerable toxicity (deteriorating kidney function and sirolimus-induced pneumonitis) while having evidence for continued islet function (one was insulin independent) and one because of gradually disappearing islet function.
CONCLUSIONS—We established an islet isolation and transplantation program and achieved a 50% insulin-independence rate after at most two islet infusions. Our experience demonstrates that centers not previously engaged in islet transplantation can initiate a program, and our data and literature analysis support not only the promise of islet transplantation but also its remaining hurdles, which include the limited islet supply, procedure-associated complications, imperfect immunosuppressive regimens, suboptimal glycemia control, and loss of function over time.
Contribution of Visceral Adiposity to the Exaggerated Postprandial Lipemia of Men With Impaired Glucose Tolerance
Authors: Blackburn Patricia , Lamarche Benoît , Couillard Charles , Pascot Agnés , Tremblay Angelo , Bergeron Jean , Lemieux Isabelle , Després Jean-Pierre 
Published: March 2007

OBJECTIVE—Impaired glucose tolerance (IGT) has been associated with alterations in numerous coronary heart disease risk factors, including postprandial hyperlipidemia. An excess visceral adipose tissue accumulation is also predictive of IGT and of an exaggerated postprandial lipemia. The objective of the present study was therefore to compare the respective contributions of visceral adipose tissue accumulation versus IGT with the variation in postprandial lipemia.
RESEARCH DESIGN AND METHODS—Potential differences in postprandial triglyceride (TG)-rich lipoprotein (TRL) levels following a standardized breakfast with a high fat content were examined among men characterized by normal glucose tolerance (NGT) or IGT. Sixty-seven men were classified according to their glucose tolerance status (&lt;7.8 mmol/l [NGT] or between 7.8 and 11.1 mmol/l [IGT] 2 h after a 75-g oral glucose test).
RESULTS—Men with IGT showed the highest TRL-TG concentrations (P &lt; 0.05) at the 4-, 6-, and 8-h time points compared with men with NGT. These higher postprandial TRL-TG levels among men with IGT were also accompanied by a greater postprandial TG total area under the incremental curve in all TRL fractions (large, medium, and small) (P &lt; 0.05). Furthermore, subjects characterized by IGT had also the highest visceral adipose tissue accumulation (P &lt; 0.009). When subgroups of IGT and NGT men were individually matched (n = 11) for similar visceral adipose tissue accumulation, no significant difference was found in postprandial responses of all TRL-TG fractions between the two groups.
CONCLUSIONS—These results provide evidence that visceral adipose tissue accumulation is an important factor involved in the deterioration of postprandial lipemia noted among men with IGT.
Diagnosing Insulin Resistance by Simple Quantitative Methods in Subjects With Normal Glucose Metabolism
Authors: Ascaso Juan F. , Pardo Susana , Real José T. , Lorente Rosario I. , Priego Antonia , Carmena Rafael 
Published: March 2007

OBJECTIVE—To identify a reliable yet simple indirect method for detection of insulin resistance (IR).
RESEARCH DESIGN AND METHODS—A total of 65 subjects (44 men and 21 women aged 30–60 years) were selected by a simple random sampling method. Inclusion criteria were voluntary participation from staff and hospital personnel, absence of abnormal glucose tolerance, and normal results of lipid profile and basic blood chemistry. A blood sample was taken after a 12-h overnight fast to determine plasma lipid, glucose, and insulin levels. An intravenous glucose tolerance test with administration of insulin after 20 min and extraction of multiple blood samples for glucose and insulin measurements and calculation of the minimal model approximation of the metabolism of glucose (MMAMG) Si value were performed. Three indirect indexes used to predict insulin sensitivity or IR were calculated, and metabolic syndrome was diagnosed using the Adult Treatment Panel III (ATP III) criteria. All results were correlated with those of the MMAMG.
RESULTS—The 75th percentile value as the cutoff point to define IR corresponded with a fasting plasma glucose level of 12 mU/l, a homeostasis model assessment of 2.6, a 25th percentile for Si value of 21, and QUICKI (quantitative insulin sensitivity check index) and McAuley indexes of 0.33 and 5.8, respectively. The Si index correlated (P &lt; 0.001) with all the indirect indexes and parameters of the metabolic syndrome.
CONCLUSIONS—When compared with the Si index, the most sensitive and specific indirect method was the score proposed by McAuley et al. (specificity 0.91, sensitivity 0.75, 9.2 probability ratio of a positive test), followed by the existence of metabolic syndrome (specificity 0.91, sensitivity 0.66, 7.8 probability ratio of a positive test).
Dietary Fat Intake as Risk Factor for the Development of Diabetes
Authors: Thanopoulou Anastasia C. , Karamanos Basil G. , Angelico Francesco V. , Assaad-Khalil Samir H. , Barbato Alfredo F. , Del Ben Maria P. , Djordjevic Predrag B. , Dimitrijevic-Sreckovic Vesna S. , Gallotti Cristina A. , Katsilambros Nikolaos L. , Migdalis Ilias N. , Mrabet Mansouria M. , Petkova Malina K. , Roussi Demetra P. , Tenconi Maria-Teresa P. 
Published: March 2007

OBJECTIVE—To investigate the role of dietary factors in the development of type 2 diabetes.
RESEARCH DESIGN AND METHODS—In the context of the Multinational MGSD Nutrition Study, three groups of subjects were studied: 204 subjects with recently diagnosed diabetes (RDM), 42 subjects with undiagnosed diabetes (UDM) (American Diabetes Association criteria—fasting plasma glucose [FPG] ≥126 mg/dl), and 55 subjects with impaired fasting glucose (IFG) (FPG ≥110 and &lt;126 mg/dl). Each group was compared with a control group of nondiabetic subjects, matched one by one for center, sex, age, and BMI. Nutritional habits were evaluated by a dietary history method, validated against the 3-day diet diary. In RDM, the questionnaire referred to the nutritional habits before the diagnosis of diabetes. Demographic data were collected, and anthropometrical and biochemical measurements were taken.
RESULTS—Compared with control subjects, RDM more frequently had a family history of diabetes (49.0 vs. 14.2%; P &lt; 0.001), exercised less (exercise index 53.5 vs. 64.4; P &lt; 0.01), and more frequently had sedentary professions (47.5 vs. 27.4%; P &lt; 0.001). Carbohydrates contributed less to their energy intake (53.5 vs. 55.1%; P &lt; 0.05), whereas total fat (30.2 ± 0.5 vs. 27.8 ± 0.5%; P &lt; 0.001) and animal fat (12.2 ± 0.3 vs. 10.8 ± 0.3%; P &lt; 0.01) contributed more and the plant-to-animal fat ratio was lower (1.5 ± 0.1 vs. 1.8 ± 0.1; P &lt; 0.01). UDM more frequently had a family history of diabetes (38.1 vs. 19.0%; P &lt; 0.05) and sedentary professions (58.5 vs. 34.1%; P &lt; 0.05), carbohydrates contributed less to their energy intake (47.6 ± 1.7 vs. 52.8 ± 1.4%; P &lt; 0.05), total fat (34.7 ± 1.5 vs. 30.4 ± 1.2%; P &lt; 0.05) and animal fat (14.2 ± 0.9 vs. 10.6 ± 0.7%; P &lt; 0.05) contributed more, and the plant-to-animal fat ratio was lower (1.6 ± 0.2 vs. 2.3 ± 0.4; P &lt; 0.05). IFG differed only in the prevalence of family history of diabetes (32.7 vs. 16.4%; P &lt; 0.05).
CONCLUSIONS—Our data support the view that increased animal fat intake is associated with the presence of diabetes.
Quality of Care for Patients Diagnosed With Diabetes at Screening
Authors: Edelman David , Olsen Maren K. , Dudley Tara K. , Harris Amy C. , Oddone Eugene Z. 
Published: March 2007

OBJECTIVE—Screening for diabetes has the potential to be an effective intervention, especially if patients have intensive treatment of their newly diagnosed diabetes and comorbid hypertension. We wished to determine the process and quality of diabetes care for patients diagnosed with diabetes by systematic screening.
RESEARCH DESIGN AND METHODS—A total of 1,253 users of the Durham Veterans Affairs Medical Center aged 45–64 years who did not report having diabetes were screened for diabetes with an HbA1c test. All subjects with an HbA1c level ≥6.0% were invited for follow-up blood pressure and fasting plasma glucose (FPG) measurements. A case of unrecognized diabetes was defined as HbA1c ≥7.0% or FPG ≥126 mg/dl. For each of the 56 patients for whom we made a new diagnosis of diabetes, we notified the patient’s primary care provider of this diagnosis. One year after diagnosis, we reviewed these patients’ medical records for traditional diabetes performance measures as well as blood pressure. Follow-up blood pressure was also ascertained from medical record review for all subjects with HbA1c ≥6.0% who did not have diabetes. We compared blood pressure changes between patients with and without diabetes.
RESULTS—Among patients diagnosed with diabetes at screening, 34 of 53 (64%) had evidence of diet or medical treatment for their diabetes, 42 of 53 (79%) had HbA1c measured within the year after diagnosis, 32 of 53 (60%) had cholesterol measured, 25 of 53 (47%) received foot examinations, 29 of 53 (55%) had eye examinations performed by an eye specialist, and 16 of 53 (30%) had any measure of urine protein. The mean blood pressure decline over the year after diagnosis for patients with diabetes was 2.3 mmHg; this decline was similar to that found for 183 patients in the study without diabetes (change in blood pressure, −3.6 mmHg). At baseline, 48% of patients with diabetes had blood pressure &lt;140/90, compared with 40% of patients without diabetes; 1 year later, the same 48% of patients with diabetes had blood pressure &lt;140/90, compared with 56% of patients without diabetes (P = 0.31 for comparing the change in percent in control between groups).
CONCLUSIONS—Patients with diabetes diagnosed at screening achieve less tight blood pressure control than similar patients without diabetes. Primary care providers do not appear to manage diabetes diagnosed at screening as intensively as long-standing diabetes and do not improve the management of hypertension given the new diagnosis of diabetes.
Prevalence and Predictors of Sexual Dysfunction in Patients With Type 1 Diabetes
Authors: Enzlin Paul , Mathieu Chantal , Van den Bruel Annick , Vanderschueren Dirk , Demyttenaere Koen 
Published: March 2007

OBJECTIVE—This study aimed to 1) measure the prevalence of sexual dysfunction in patients with diabetes; 2) describe how descriptive variables, psychological variables, diabetic complications, and sexual dysfunction relate in patients with diabetes; and 3) describe the predictors of sexual dysfunction in patients with diabetes.RESEARCH DESIGN AND METHODS—A total of 240 adult type 1 diabetic patients visiting the outpatient diabetes clinic of a university hospital completed questionnaires evaluating psychological adjustment to diabetes and sexual functioning. Medical records were used to obtain HbA1c values as well as information on microvascular diabetic complications.RESULTS—Sexual dysfunction was reported by 27% of women and 22% of men. No differences were found between sexes in type of reported sexual dysfunction. In men, but not in women, sexual dysfunction was related to age, BMI, duration of diabetes, and diabetic complications. No correlation with HbA1c was found in either sex. In women, but not in men, sexual dysfunction was related to depression and the quality of the partner relationship. Binary logistic regression demonstrated that, in men, the significant predictors of sexual dysfunction were higher age and presence of complications, whereas, in women, sexual dysfunction was related to depression.CONCLUSIONS—Both women and men with diabetes are at increased risk for sexual dysfunction. This study suggests that in men with diabetes, sexual dysfunction is related to somatic and psychological factors, whereas in women with diabetes, psychological factors are more predominant.