bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Arterial Transfer Functions for the Derivation of Central Aortic Waveform Characteristics in Subjects With Type 2 Diabetes and Cardiovascular Disease
Authors: Hope Sarah A. , Tay David B. , Meredith Ian T. , Cameron James D. 
Published: March 2007

OBJECTIVE—Optimal blood pressure control in subjects with diabetes reduces cardiovascular complications. There is theoretical benefit in the assessment of central aortic waveforms including the augmentation index, which is taken as a putative index of stiffness. Transfer functions may be used to reconstruct aortic from radial pressure waveforms; however, a single generalized transfer function may not be appropriate for all patients. We aimed to evaluate the technique in subjects with diabetes.
RESEARCH DESIGN AND METHODS—Simultaneous invasive central aortic and noninvasive radial waveforms were acquired in 19 subjects with type 2 diabetes, and a diabetes-specific transfer function was derived. Similar data were acquired from 38 age- and sex-matched subjects without diabetes. Central waveforms were reconstructed using a generalized transfer function in all patients and the diabetes-specific transfer function in individuals with diabetes.
RESULTS—There was no difference between groups in measured central pressures. The error in generalized transfer function-derived systolic pressure was greater in individuals with diabetes (6 ± 7 mmHg) (mean ± SD) than without diabetes (2 ± 8 mmHg) (P &lt; 0.05). Errors in other parameters were no different. The diabetes-specific transfer function reduced the error in derived systolic pressure to 0 ± 7 mmHg in individuals with diabetes—no different than that with the generalized transfer function in individuals without diabetes. The central augmentation index reconstructed by either transfer function was unrelated to that directly measured.
CONCLUSIONS—A generalized transfer function is inappropriate for the derivation of central waveforms in subjects with type 2 diabetes. Errors in subjects with diabetes might be reduced with a diabetes-specific transfer function.
Glycemic Exposure Is Associated With Reduced Pulmonary Function in Type 2 Diabetes
Authors: Davis Wendy A. , Knuiman Matthew , Kendall Peter , Grange Valerie , Davis Timothy M.E. 
Published: March 2007

OBJECTIVE—To examine prospectively the relationship between diabetes, glycemic control, and spirometric measures.RESEARCH DESIGN AND METHODS—From a community-based cohort, 495 Europid (i.e., of European descent) patients with type 2 diabetes who had no history of pulmonary disease underwent baseline spirometry between 1993 and 1994. A subset of 125 patients was restudied a mean of 7.0 years later. The main outcome measures included forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), vital capacity (VC), and peak expiratory flow (PEF) corrected for body temperature, air pressure, and water saturation and were expressed either in absolute terms or as percentage-predicted value for age, sex, and height.RESULTS—Mean percentage-predicted values of each spirometric measure were decreased &gt;10% in the whole cohort at baseline and absolute measures continued to decline at an annual rate of 68, 71, and 84 ml/year and 17 l/min for FVC, FEV1, VC, and PEF, respectively, in the 125 prospectively studied patients. Declining lung function measures were consistently predicted by poor glycemic control in the form of a higher updated mean HbA1c, follow-up HbA1c, or follow-up fasting plasma glucose. In a Cox proportional hazards model, decreased FEV1 percentage-predicted value was an independent predictor of all-cause mortality.CONCLUSIONS—Reduced lung volumes and airflow limitation are likely to be chronic complications of type 2 diabetes, the severity of which relates to glycemic exposure. Airflow limitation is a predictor of death in type 2 diabetes after adjusting for other recognized risk factors.
Association of Bioavailable, Free, and Total Testosterone With Insulin Resistance
Authors: Tsai Elaine C. , Matsumoto Alvin M. , Fujimoto Wilfred Y. , Boyko Edward J. 
Published: March 2007

OBJECTIVE—Previous reports of an association between low testosterone levels and diabetes risk were often confounded by covariation of sex hormone-binding globulin (SHBG) and testosterone measurements. Measurements of bioavailable and free testosterone, more reliable indexes of biologically active testosterone, were examined for their associations with markers of insulin resistance and body fat measures in 221 middle-aged nondiabetic men.
RESEARCH DESIGN AND METHODS—Bioavailable and free testosterone were calculated from the concentrations of total testosterone, SHBG, and albumin, and they were not significantly correlated with SHBG (r = 0.07–0.1). In contrast, total testosterone correlated significantly with SHBG (r = 0.63). We evaluated the relationship between these measures of circulating testosterone and markers for insulin resistance (i.e., fasting insulin, C-peptide, and homeostasis model assessment for insulin resistance [HOMA-IR]) as well as total body fat (assessed by dual-energy X-ray absorptiometry [DEXA]) and abdominal fat distribution (assessed by single-slice computed tomography [CT]).
RESULTS—Bioavailable, free, and total testosterone and SHBG all correlated significantly with fasting insulin (age-adjusted r = −0.15 [P = 0.03], −0.14 [P = 0.03], −0.32 [P &lt; 0.0001], and −0.38 [P &lt; 0.0001], respectively), fasting C-peptide (r = −0.18 [P = 0.009] to −0.41 [P &lt; 0.0001]), HOMA-IR (r = −0.15 [P = 0.03] to − 0.39 [P &lt; 0.0001]), and body fat measures (r = −0.17 [P = 0.008] to −0.44 [P &lt; 0.0001]). Only SHBG and total testosterone were significantly associated with fasting glucose (r = −0.20 [P = 0.003] to −0.21 [P = 0.002]). In multivariate analysis, bioavailable or free testosterone was significantly and inversely associated with insulin, C-peptide, and HOMA-IR, but this was not independent of total body or abdominal fat. SHBG was a significant determinant of insulin, C-peptide, and HOMA-IR, independent of body fat. The associations between total testosterone and insulin resistance were confounded by SHBG.
CONCLUSIONS—The inverse association between testosterone and insulin resistance, independent of SHBG, was mediated through body fat.
Intraoral Tactile Sensitivity in Adults With Diabetes
Authors: Shinkai Rosemary S.A. , Hatch John P. , Cornell John E. , Yeh Chih-Ko 
Published: March 2007

OBJECTIVE—The intraoral tactile sensitivity (ITS) of diabetic and nondiabetic subjects was compared. The effects of age, ethnicity, sex, and intraoral site were considered.
RESEARCH DESIGN AND METHODS—The sample comprised 589 participants of the Oral Health: San Antonio Longitudinal Study of Aging. A total of 107 subjects (61.8 ± 10.0 years; 48 women, 59 men) met American Diabetes Association diagnostic criteria for diabetes and 482 subjects (58.8 ± 11.1 years; 274 women, 208 men) did not. ITS was assessed with an oral microaesthesiometer with a cross-modality matching procedure. The dependent variable was the slope of the psychophysical function relating physical stimulus intensity (air pressure) and subjects’ judgments of stimulus intensity. Data were analyzed using ANOVA for repeated measures with between-subject factors of age, sex, ethnicity, and diabetes and the within-subject factor of intraoral site.
RESULTS—Diabetic and nondiabetic subjects showed no significant differences in ITS at any of the three test sites. European Americans demonstrated greater soft-palate sensitivity (mean ± SD 0.26 ± 0.15) compared with Mexican Americans (0.24 ± 0.16; P = 0.046). The three intraoral test sites differed in tactile sensitivity (P &lt; 0.001); posterior tongue (0.33 ± 0.22) was most sensitive, followed by the soft palate (0.25 ± 0.15) and the anterior tongue (0.23 ± 0.13). Potentially confounding factors were not associated with ITS.
CONCLUSIONS—Our results suggest that diabetes per se may not influence ITS.
C-Reactive Protein and Incident Cardiovascular Events Among Men With Diabetes
Authors: Schulze Matthias B. , Rimm Eric B. , Li Tricia , Rifai Nader , Stampfer Meir J. , Hu Frank B. 
Published: March 2007

OBJECTIVE—Several large prospective studies have shown that baseline levels of C-reactive protein (CRP) are an independent predictor of cardiovascular events among apparently healthy individuals. However, prospective data on whether CRP predicts cardiovascular events in diabetic patients are limited so far.
RESEARCH DESIGN AND METHODS—To investigate the association between plasma CRP levels and incidence of cardiovascular events among men with type 2 diabetes, we followed prospectively a cohort of 746 American men aged 46–81 years who were free of cardiovascular diseases at the time of blood collection in 1993–1994.
RESULTS—During an average of 5 years of follow-up (3,986 person-years), we identified 103 incident cardiovascular events (18 myocardial infarction, 70 coronary artery bypass grafting or angioplasty, and 15 stroke), confirmed by medical records. After adjustment for age, BMI, smoking, alcohol consumption, physical activity, family history of coronary heart disease, history of high blood pressure, history of high serum cholesterol, aspirin use, and fasting status as well as for fibrinogen, creatinine, HbA1c, and non-HDL cholesterol levels, CRP remained significantly associated with an increased risk of cardiovascular events. The relative risks for quartiles were 1.00, 1.51, 2.52, and 2.62 (95% CI: 1.29–5.32; P for trend: 0.011). We observed no effect modifications by plasma levels of LDL cholesterol, HDL cholesterol, non-HDL cholesterol, apolipoprotein B, HbA1c, and fibrinogen or by BMI.
CONCLUSIONS—High plasma levels of CRP were associated with an increased risk of incident cardiovascular events among diabetic men, independent of currently established lifestyle risk factors, blood lipids, and glycemic control.
Cost-Effectiveness of Prevention and Treatment of the Diabetic Foot
Authors: Ortegon Monica Maria , Redekop William Ken , Niessen Louis Wilhelmus 
Published: March 2007

OBJECTIVE—To estimate the lifetime health and economic effects of optimal prevention and treatment of the diabetic foot according to international standards and to determine the cost-effectiveness of these interventions in the Netherlands.
RESEARCH DESIGN AND METHODS—A risk-based Markov model was developed to simulate the onset and progression of diabetic foot disease in patients with newly diagnosed type 2 diabetes managed with care according to guidelines for their lifetime. Mean survival time, quality of life, foot complications, and costs were the outcome measures assessed. Current care was the reference comparison. Data from Dutch studies on the epidemiology of diabetic foot disease, health care use, and costs, complemented with information from international studies, were used to feed the model.
RESULTS—Compared with current care, guideline-based care resulted in improved life expectancy, gain of quality-adjusted life-years (QALYs), and reduced incidence of foot complications. The lifetime costs of management of the diabetic foot following guideline-based care resulted in a cost per QALY gained of &lt;$25,000, even for levels of preventive foot care as low as 10%. The cost-effectiveness varied sharply, depending on the level of foot ulcer reduction attained.
CONCLUSIONS—Management of the diabetic foot according to guideline-based care improves survival, reduces diabetic foot complications, and is cost-effective and even cost saving compared with standard care.
Diabetes and Impaired Fasting Glycemia in the Tribes of Khagrachari Hill Tracts of Bangladesh
Authors: Sayeed M. Abu , Mahtab Hajera , Khanam Parvin Akter , Ahsan Khandaker Abul , Banu Akhter , Rashid A.N.M. Bazlur , Khan A.K. Azad 
Published: March 2007

OBJECTIVE—To determine the prevalence of type 2 diabetes and impaired fasting glycemia (IFG) in a tribal population of Bangladesh.
RESEARCH DESIGN AND METHODS—A cluster sampling of 1,287 tribal subjects of age ≥20 years was investigated. They live in a hilly area of Khagrachari in the far northeast of Bangladesh. Fasting plasma glucose, blood pressure, height, weight, waist girth, and hip girth were measured. Lipid fractions were also estimated. We used the 1997 American Diabetes Association diagnostic criteria.
RESULTS—The crude prevalence of type 2 diabetes was 6.6% and IFG was 8.5%. The age-standardized (20–70 years) prevalence of type 2 diabetes (95% CI) was 6.4% (4.96–7.87) and of IFG was 8.4% (6.48–10.37). Both tribesmen and women had equal risk for diabetes and IFG. Compared with the lower-income group, the participants with higher income had a significantly higher prevalence of type 2 diabetes (18.8 vs. 3.1%, P &lt; 0.001) and IFG (17.2 vs. 4.3%, P &lt; 0.001). Using logistic regression, we found that increased age, high-income group, and increased central obesity were the important risk factors of diabetes.
CONCLUSIONS—The prevalence of diabetes in the tribal population was higher than that of the nontribal population of Bangladesh. Older age, higher central obesity, and higher income were proven significant risk factors of diabetes. High prevalence of diabetes among these tribes indicates that the prevalence of diabetes and its complications will continue to increase. Evidently, health professionals and planners should initiate diabetes care in these tribal communities.
Are Low-Income Elderly Patients at Risk for Poor Diabetes Care?
Authors: McCall Daniel T. , Sauaia Angela , Hamman Richard F. , Reusch Jane E. , Barton Phoebe 
Published: March 2007

OBJECTIVE—Diabetes is common among low-income elderly, dual-eligible (DE) Medicare/Medicaid patients resulting in significant morbidity, mortality, and cost. However, the quality of diabetes care delivered to these patients has not been evaluated. The aims of this study were to describe the quality of diabetes care provided to DE patients and compare it with non-DE patients.
RESEARCH DESIGN AND METHODS—This was a cross-sectional analysis of administrative claims from 1 January 1997 through 31 December 1998. A total of 9,453 patients aged 65–75 years with diabetes participated in the study. These were Colorado Medicare fee-for-service (FFS) outpatients. The main outcome measures consisted of a proportion of patients receiving an annual hemoglobin A1c test, biennial eye examination, biennial lipid test, and all three of these care processes.
RESULTS—The mean patient age was 71 ± 2.8 years. Over 22% of patients were identified as dual eligible, and they were significantly more likely to be younger, female, and of minority race/ethnicity; reside in a rural location; and have comorbid conditions compared with the non-DE population. DE patients had more visits to primary care physicians, emergency departments, and hospitalizations but were less likely to visit endocrinologists. DE patients were significantly less likely to receive an annual A1c test (73 vs. 81%; P &lt; 0.0001), biennial ophthalmologic examination (63 vs. 75%; P &lt; 0.0001), and biennial lipid testing (43 vs. 57%; P &lt; 0.0001). The adjusted odds ratio of urban DE patients receiving all three care measures was 0.60 (95% CI 0.52–0.69) compared with urban non-DE patients. Minority race/ethnicity and emergency department use were significantly associated with not receiving diabetes care, whereas endocrinology visits were associated with an increased odds of receiving diabetes care.
CONCLUSIONS—DE Medicare/Medicaid status was independently associated with not receiving diabetes care, especially among those in urban areas.
An Explanation for the Increase in Heart Disease Mortality Rates in Diabetic Pima Indians
Authors: Pavkov Meda E. , Sievers Maurice L. , Knowler William C. , Bennett Peter H. , Nelson Robert G. 
Published: March 2007

OBJECTIVE—Diabetic nephropathy (DN) became the leading cause of death in diabetic Pima Indians in the 1970s, but was superseded by ischemic heart disease (IHD) in the 1980s. This study tests the hypothesis that the rise in the IHD death rate between 1965 and 1998 is attributable to access to renal replacement therapy (RRT).
RESEARCH DESIGN AND METHODS—Underlying causes of death were determined among 2,095 diabetic Pima Indians ≥35 years old during four 8.5-year time intervals. To assess the effect of access to RRT on IHD death rates, trends were reexamined after subjects receiving RRT were classified as if they had died of DN.
RESULTS—During a median follow-up of 11.1 years (range 0.01–34), 818 subjects died. The age- and sex-adjusted DN death rate decreased over the 34-year study (P = 0.05), whereas the IHD death rate increased from 3.3 deaths/1,000 person-years (95% CI 1.4–5.2) to 6.3 deaths/1,000 person-years (95% CI 4.5–8.0; P = 0.03). After 151 subjects on RRT were reclassified as if they had died of DN, the death rate for DN increased from 4.8 deaths/1,000 person-years (95% CI 2.6–7) to 11.3 deaths/1,000 person-years (95% CI 9–13.6; P = 0.0007), whereas the increase in the IHD death rate disappeared (P = 0.57).
CONCLUSIONS—The incidence rate of renal failure attributable to diabetes has increased rapidly over the past 34 years in Pima Indians. IHD has emerged as the leading cause of death due largely to the availability of RRT and to changes in the pattern of death among those with DN.
High Prevalence of Glucose Abnormalities in Patients With Hepatitis C Virus Infection
Authors: Lecube Albert , Hernández Cristina , Genescà Joan , Esteban Joan I. , Jardí Rosend , Simó Rafael 
Published: March 2007

OBJECTIVE—The aim of this study was to compare the prevalence of both impaired fasting glucose (IFG) and diabetes between hepatitis C virus (HCV)-infected patients and patients with other liver diseases but anti-HCV−, taking into account the degree of liver damage.
RESEARCH DESIGN AND METHODS—A total of 642 consecutive patients attending the outpatient liver unit of a university hospital (498 anti-HCV+ and 144 anti-HCV−) were prospectively recruited. Patients were classified as having chronic hepatitis (n = 472) or cirrhosis (n = 170) by means of the result of either a liver biopsy or by typical clinical features. A logistic regression model was used to determine independent associations of covariates (age, sex, BMI, HCV antibody status, and triglycerides) with the presence of glucose abnormalities.
RESULTS—A threefold increase in the prevalence of glucose abnormalities was observed in HCV+ patients with chronic hepatitis in comparison with HCV− subjects (32 vs. 12%; P = 0.0003). In contrast, among patients with cirrhosis, although both diabetes and IFG were more prevalent in anti-HCV+ patients (40%) than in anti-HCV− patients (36%), the differences were not statistically significant. Finally, the logistic regression analysis showed that HCV infection was independently related to glucose abnormalities in those patients with chronic hepatitis (odds ratio 4.26 [95% CI 2.03–8.93]). In contrast, HCV was not an independent predictor of glucose abnormalities in cirrhotic patients.
CONCLUSIONS—The high prevalence of IFG and diabetes found in HCV-infected patients observed in our study suggests that screening for glucose abnormalities should be indicated in these patients. In addition, we provide evidence that the genuine connection between HCV infection and diabetes is initiated at early stages of hepatic disease.
Parallel Increase in Urinary Excretion Rates of Immunoglobulin G, Ceruloplasmin, Transferrin, and Orosomucoid in Normoalbuminuric Type 2 Diabetic Patients
Authors: Narita Takuma , Sasaki Hiroshi , Hosoba Mihoko , Miura Takeshi , Yoshioka Naomi , Morii Tsukasa , Shimotomai Takashi , Koshimura Jun , Fujita Hiroki , Kakei Masafumi , Ito Seiki 
Published: March 2007

OBJECTIVE—Increased urinary excretions of several plasma proteins with different molecular radii &lt;55 Å and different isoelectric points (pI), such as IgG, ceruloplasmin, transferrin, and orosomucoid, have been independently reported to precede the development of microalbuminuria in diabetic patients. We examined whether increases in urinary excretions of these proteins would be in parallel in the same patient.
RESEARCH DESIGN AND METHODS—Urinary excretion rates of proteins mentioned above in timed overnight urine samples were evaluated in 61 normoalbuminuric type 2 diabetic patients (group D) aged 40–60 years and in 17 age-matched control subjects (group C).
RESULTS—The excretion rates of these proteins were significantly higher in group D than in group C. These exhibited a strong linear correlation with each other and had a weak correlation with the excretion rate of N-acethylglucosaminidase. The excretion rate of α2-macroglobulin with large molecular radii of 88 Å was not different between groups C and D, nor did they have any correlations with the excretion rates of the other proteins. Creatinine clearance and blood pressure levels in group D were significantly higher than those in group C.
CONCLUSIONS—In normoalbuminuric diabetic patients, excretion rates of plasma proteins with molecular radii &lt;55 Å increased in parallel with each other. In view of our previous finding that urinary excretions of these plasma proteins selectively increased in parallel with enhanced glomerular filtration rate after acute protein loading, the present finding may be explained by renal hemodynamic changes, such as increased intraglomerular hydraulic pressure.
Improvements in Patient-Reported Outcomes Associated With an Intervention to Enhance Quality of Care for Rural Patients With Type 2 Diabetes
Authors: Maddigan Sheri L. , Majumdar Sumit R. , Guirguis Lisa M. , Lewanczuk Richard Z. , Lee T. K. , Toth Ellen L. , Johnson Jeffrey A. 
Published: March 2007

OBJECTIVE—The aim of this study was to examine patient-reported outcomes in a controlled trial of a multifaceted provider-level intervention to improve quality of care for rural patients with type 2 diabetes.RESEARCH DESIGN AND METHODS—We conducted a before/after intervention study with concurrent controls in two rural regions in Alberta, Canada. The intervention consisted of six monthly visits by a multidisciplinary health care team and was primarily directed at primary care providers. Clinical and patient-reported outcomes were assessed after 6 months. Patient-reported outcomes included changes in health-related quality of life (Health Utilities Index Mark 3 [HUI3]), satisfaction with care, lifestyle (Diabetes Lifestyle Form), and adherence to self-care activities. Analysis of covariance was used to assess differences over time between the control and intervention regions.RESULTS—A total of 200 intervention and 172 control subjects were included in this analysis. After adjusting for important clinical and demographic differences, a statistically significant and clinically important improvement in the overall HUI3 score was seen at the 6-month follow-up in the intervention region (0.06 [95% CI 0.02–0.10]) compared with the control region (0.01 [−0.04 to 0.04]) (P = 0.03 for the difference between groups). Satisfaction with general medical care (P &lt; 0.001 between groups) and diabetes care (P &lt; 0.001 between groups) increased among patients in the intervention region compared with the control region. Self-efficacy, attitudes, and beliefs about diabetes control all increased in the intervention region when compared with the control region, but adherence to self-care activities did not.CONCLUSIONS—A provider-level intervention directed at improving quality of clinical care for patients with type 2 diabetes also had a favorable impact on overall health-related quality of life, satisfaction with care, and other humanistic outcomes.