bluuebunny/crossref_metadata_2025_split huggingface dataset:
Skin Autofluorescence as a Noninvasive Marker of Vascular Damage in Patients With Type 2 Diabetes
Authors: Lutgers Helen L. , Graaff Reindert , Links Thera P. , Ubink-Veltmaat Lielith J. , Bilo Henk J. , Gans Rijk O. , Smit Andries J. 
Published: November 2006

OBJECTIVE—Advanced glycation end products (AGEs) are thought to have a role in the pathogenesis of diabetes complications. We recently reported the association between skin autofluorescence, as a measure of tissue AGE accumulation, and diabetic neuropathy in a selected diabetic population. In this study, we investigated the relation between skin autofluorescence and clinical variables including micro- and macrovascular complications in a type 2 diabetes primary care population.RESEARCH DESIGN AND METHODS—Clinical data and skin autofluorescence were obtained in the type 2 diabetes group (n = 973) and in a control group (n = 231). Skin autofluorescence was assessed by illumination of the lower arm with a fluorescent tube (peak intensity ∼370 nm).RESULTS—Skin autofluorescence was significantly higher in type 2 diabetic patients compared with control subjects in each age category. Multiple regression analysis showed significant correlation of skin autofluorescence with age, sex, diabetes duration, BMI, smoking, HbA1c, plasma creatinine, HDL cholesterol, and albumin-to-creatinine ratio in the type 2 diabetes group (R2 = 25%) and with age and smoking in the control group (R2 = 46%). Skin autofluorescence was significantly higher in the type 2 diabetes group, with both micro- and macrovascular disease, compared with the group without complications and the group with only microvascular complications.CONCLUSIONS—This study confirms in a large group of type 2 diabetic patients that skin autofluorescence is higher compared with age-matched control subjects and is associated with the severity of diabetes-related complications. Skin autofluorescence reflecting vascular damage might be a rapid and helpful tool in the diabetes outpatient clinic for identifying diabetic patients who are at risk for developing complications.
Changes in Inflammatory Cytokines Are Related to Impaired Glucose Tolerance in Offspring of Type 2 Diabetic Subjects
Authors: Ruotsalainen Eija , Salmenniemi Urpu , Vauhkonen Ilkka , Pihlajamäki Jussi , Punnonen Kari , Kainulainen Sakari , Laakso Markku 
Published: November 2006

OBJECTIVE—We sought to determine whether levels of inflammatory markers and different cytokines are abnormal in nondiabetic offspring of type 2 diabetic subjects.
RESEARCH DESIGN AND METHODS—Cytokine levels were measured in 19 healthy control subjects and 129 offspring of patients with type 2 diabetes (109 with normal glucose tolerance [NGT] and 20 with impaired glucose tolerance [IGT]). Insulin sensitivity was determined with the hyperinsulinemic-euglycemic clamp, insulin secretion with the intravenous glucose tolerance test, and abdominal fat distribution with computed tomography.
RESULTS—Levels of C-reactive protein and inflammatory cytokines were elevated in nondiabetic offspring of type 2 diabetic subjects. Interleukin (IL)-1β was increased in the NGT group and decreased in the IGT group. In contrast, levels of IL-1 receptor antagonist (IL-1Ra) were increased in both groups. IL-1β and -Ra levels correlated inversely (P &lt; 0.05) with rates of whole-body glucose uptake and IL-1β positively with visceral fat mass (P &lt; 0.05) in normoglycemic offspring.
CONCLUSIONS—Nondiabetic offspring of type 2 diabetic subjects have changes in the levels of inflammatory cytokines. The level of IL-1Ra seems to be the most sensitive marker of cytokine response in the pre-diabetic state.
Early Involvement of the Spinal Cord in Diabetic Peripheral Neuropathy
Authors: Selvarajah Dinesh , Wilkinson Iain D. , Emery Celia J. , Harris Nigel D. , Shaw Pamela J. , Witte Daniel R. , Griffiths Paul D. , Tesfaye Solomon 
Published: November 2006

OBJECTIVE—The pathogenesis of diabetic peripheral neuropathy (DPN) is poorly understood. We have recently reported a significant reduction in spinal cord cross-sectional area at the stage of clinically detectable DPN. In this study, we investigated whether spinal cord atrophy occurs in early (subclinical) DPN.
RESEARCH DESIGN AND METHODS—Eighty-one male type 1 diabetic subjects, 24 nondiabetic control subjects, and 8 subjects with hereditary sensory motor neuropathy (HSMN) type 1A underwent detailed clinical and neurophysiological assessments. Diabetic subjects were subsequently divided into three groups based on neuropathy severity (19 with no DPN, 23 with subclinical DPN, and 39 with clinically detectable DPN). All subjects underwent magnetic resonance imaging of the cervical spine and cord area measurements at disc level C2/C3.
RESULTS—Mean corrected spinal cord area index (SCAI) (corrected for age, height, and weight) was 67.5 mm [95% CI 64.1–70.9] in diabetic subjects without DPN. Those with subclinical (62.4 mm [59.5–65.3]) and clinically detectable DPN (57.2 mm [54.9–59.6]) had lower mean SCAIs compared with subjects with no DPN (P = 0.03 and P &lt; 0.001, respectively). No significant difference was found between diabetic subjects without DPN and nondiabetic control subjects (69.2 mm [66.3–72.0], P = 0.47). Mean SCAIs in subjects with HSMN type 1A (71.07 mm [65.3–76.9]) were not significantly different from those for nondiabetic control subjects and diabetic subjects without DPN. Among diabetic subjects, SCAI was significantly related to sural sensory conduction velocities and the Neuropathy Composite and Symptom Scores.
CONCLUSIONS—Spinal cord involvement occurs early in DPN. There is also a significant relation between reduction in SCAI and neurophysiological assessments of DPN.
Effect of the Dipeptidyl Peptidase-4 Inhibitor Sitagliptin as Monotherapy on Glycemic Control in Patients With Type 2 Diabetes
Authors: Aschner Pablo , Kipnes Mark S. , Lunceford Jared K. , Sanchez Matilde , Mickel Carolyn , Williams-Herman Debora E. ,   for the Sitagliptin Study 021 Group
Published: November 2006

OBJECTIVE—To examine the efficacy and safety of once-daily oral sitagliptin as monotherapy in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—In a randomized, double-blind, placebo-controlled study, 741 patients (baseline HbA1c [A1C] 8.0%) were randomized to sitagliptin 100 or 200 mg or placebo for 24 weeks.
RESULTS—Sitagliptin 100 and 200 mg produced significant (P &lt; 0.001) placebo-subtracted reductions in A1C (−0.79 and −0.94%, respectively) and fasting plasma glucose (−1.0 mmol/l [−17.1 mg/dl] and −1.2 mmol/l [−21.3 mg/dl], respectively). Patients with baseline A1C ≥9% had greater reductions in placebo-subtracted A1C with sitagliptin 100 and 200 mg (−1.52 and −1.50%, respectively) than those with baseline A1C &lt;8% (−0.57 and −0.65%) or ≥8 to &lt;9.0% (−0.80 and −1.13%, respectively). In a meal tolerance test, sitagliptin 100 and 200 mg significantly decreased 2-h postprandial glucose (PPG) (placebo-subtracted PPG −2.6 mmol/l [−46.7 mg/dl] and −3.0 mmol/l [−54.1 mg/dl], respectively). Results for the above key efficacy parameters were not significantly different between sitagliptin doses. Homeostasis model assessment of β-cell function and proinsulin-to-insulin ratio improved with sitagliptin. The incidence of hypoglycemia was similar, and overall gastrointestinal adverse experiences were slightly higher with sitagliptin. No meaningful body weight changes from baseline were observed with sitagliptin 100 (−0.2 kg) or 200 mg (−0.1 kg). The body weight change with placebo (−1.1 kg) was significantly (P &lt; 0.01) different from that observed with sitagliptin.
CONCLUSIONS—In this 24-week study, once-daily sitagliptin monotherapy improved glycemic control in the fasting and postprandial states, improved measures of β-cell function, and was well tolerated in patients with type 2 diabetes.
Accuracy and Predictive Value of Classification Schemes for Ketosis-Prone Diabetes
Authors: Balasubramanyam Ashok , Garza Gilberto , Rodriguez Lucille , Hampe Christiane S. , Gaur Lakshmi , Lernmark Åke , Maldonado Mario R. 
Published: November 2006

OBJECTIVE—Ketosis-prone diabetes (KPD) is an emerging, heterogeneous syndrome. A sound classification scheme for KPD is essential to guide clinical practice and pathophysiologic studies. Four schemes have been used and are based on immunologic criteria, immunologic criteria and insulin requirement, BMI, and immunologic criteria and β-cell function (Aβ classification). The aim of the present study is to compare the four schemes for accuracy and predictive value in determining whether KPD patients have absent or preserved β-cell function, which is a strong determinant of long-term insulin dependence and clinical phenotype.
RESEARCH DESIGN AND METHODS—Consecutive patients (n = 294) presenting with diabetic ketoacidosis and followed for 12–60 months were classified according to all four schemes. They were evaluated longitudinally for β-cell autoimmunity, clinical and biochemical features, β-cell function, and insulin dependence. β-Cell function was defined by peak plasma C-peptide response to glucagon ≥1.5 ng/ml. The accuracy of each scheme to predict absent or preserved β-cell function after 12 months of follow-up was tested using multiple statistical analyses.
RESULTS—The “Aβ” classification scheme was the most accurate overall, with a sensitivity and specificity of 99.4 and 95.9%, respectively, positive and negative likelihood ratios of 24.55 and 0.01, respectively, and an area under the receiver operator characteristic curve of 0.972.
CONCLUSIONS—The Aβ scheme has the highest accuracy and predictive value in classifying KPD patients with regard to clinical outcomes and pathophysiologic subtypes.
Hyperinsulinemia and Cognitive Decline in a Middle-Aged Cohort
Authors: Young Sara E. , Mainous Arch G. , Carnemolla Mark 
Published: November 2006

OBJECTIVE—Determining modifiable risks factors for cognitive decline and dementia are a public health priority as we seek to prevent dementia. Type 2 diabetes and related disorders such as hyperinsulinemia increase with aging and are increasing in the U.S. population. Our objective was to determine whether hyperinsulinemia is associated with cognitive decline among middle-aged adults without type 2 diabetes, dementia, or stroke in the Atherosclerosis Risk in Communities (ARIC) cohort.
RESEARCH DESIGN AND METHODS—Middle-aged adults (aged 45–64 years at baseline) in the ARIC cohort had fasting insulin and glucose assessed between 1987 and 1989. Subjects with dementia, type 2 diabetes, or stroke at baseline were excluded from analysis. Three tests of cognitive function available at baseline and 6 years later were delayed word recall (DWR), digit symbol subtest (DSS), and first letter word fluency (WF). Cross-sectional comparisons and linear regression models were computed for cognitive tests at baseline and change in cognitive test scores to determine whether cognitive function was associated with two measures of insulin resistance, fasting insulin and homeostasis model assessment (HOMA). Linear regression models controlled for age, sex, race, marital status, education level, smoking status, alcohol use, depression, hypertension, and hyperlipidemia.
RESULTS—In unadjusted and adjusted analyses, hyperinsulinemia based on fasting insulin and HOMA at baseline was associated with significantly lower baseline DWR, DSS, and WF scores and a greater decline over 6 years in DWR and WF.
CONCLUSIONS—Insulin resistance is a potentially modifiable midlife risk factor for cognitive decline and dementia.
The Metabolic Syndrome Is a Risk Indicator of Microvascular and Macrovascular Complications in Diabetes
Authors:   the Metascreen Writing Committee
Published: November 2006

OBJECTIVE—We aimed at assessing the degree of association and the predictive power of the metabolic syndrome with regard to clinically detectable complications in patients with diabetes.
RESEARCH DESIGN AND METHODS—Metascreen is a cross-sectional survey of metabolic syndrome and clinically detected diabetes complications performed in 8,497 patients (7,859 with type 2 diabetes and 638 with type 1 diabetes) randomly chosen in 176 diabetes outpatient clinics throughout Italy. The metabolic syndrome was defined according to either the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) or the International Diabetes Federation (IDF) diagnostic criteria. Multivariate analyses of the association(s) between either AHA/NHLBI or IDF metabolic syndrome and clinical complications were performed. Receiver-operator characteristic (ROC) curves were constructed to compare the predictive power of the two sets of diagnostic criteria of the metabolic syndrome.
RESULTS—Either definition of the metabolic syndrome was an independent statistical indicator of the presence of nephropathy and neuropathy (P &lt; 0.02–0.01) in type 1 diabetes and of all complications (P &lt; 0.0001), including cardiovascular disease and retinopathy, in type 2 diabetes. For each complication, the ROC curves based on either AHA/NHLBI or IDF metabolic syndrome were similar to each other and to the ROC curves constructed with all continuous traits compounding the metabolic syndrome.
CONCLUSIONS—The metabolic syndrome, defined according to AHA/NHLBI or IDF diagnostic criteria, is an independent clinical indicator and may be involved in the pathogenesis of both macro- and microvascular complications of diabetes.
Age, Sex, and Ethnic Variations in Serum Insulin Concentrations Among U.S. Youth
Authors: Ford Earl S. , Li Chaoyang , Imperatore Giuseppina , Cook Stephen 
Published: November 2006

OBJECTIVE—Distributions of serum concentrations of insulin among adolescents and young adults are poorly understood in the U.S. The objective of this study was to describe the distribution of serum insulin across demographic characteristics of U.S. adolescents and young adults.
RESEARCH DESIGN AND METHODS—A total of 1,791 male and female subjects aged 12–19 years who participated in the National Health and Nutrition Examination Surveys for 1999–2002 were included in the analyses.
RESULTS—Among male participants, serum concentrations of insulin increased from age 12 to 14 years before decreasing. Among female participants, concentrations were highest at age 13 years before decreasing steadily through age 19 years. Among participants aged 12–17 years but not those aged 18–19 years, females had higher mean log-transformed concentrations than males (P, Wald, F = 0.038 and 0.125, respectively) after adjusting for age and ethnicity. After adjusting for age and BMI percentile, mean log-transformed concentrations were higher in African-American females aged 12–17 years than in white or Mexican-American participants. No significant ethnic differences were found among female participants aged 18–19 years or male participants aged 12–19 years. Concentrations of insulin increased strongly with increasing levels of BMI.
CONCLUSIONS—These results provide detailed information about serum concentrations of insulin in a representative sample of U.S. adolescents and young adults and may be useful to monitor future trends of this risk factor for diabetes and cardiovascular disease.
Action or Inaction? Decision Making in Patients With Diabetes and Elevated Blood Pressure in Primary Care
Authors: Hicks Paul C. , Westfall John M. , Van Vorst Rebecca F. , Bublitz Emsermann Caroline , Dickinson L. Miriam , Pace Wilson , Parnes Bennett 
Published: November 2006

OBJECTIVE—Hypertension increases micro- and macrovascular complications of diabetes. The goal for blood pressure is &lt;130/80 mmHg. In primary care, however, blood pressure in many patients exceeds this goal. In this study, we evaluated the clinical decision-making process when a patient with diabetes presents with elevated blood pressure.
RESEARCH DESIGN AND METHODS—Twenty-six primary care practices in two practice-based research networks in Colorado participated. Questionnaires were completed after each encounter with an adult with type 2 diabetes. Data obtained from the survey included 1) demographic information, 2) blood pressure results, 3) action taken, 4) type of action if action was taken, and 5) reasons for inaction if action was not taken. Bivariate and multivariate analyses were performed to identify predictors of action.
RESULTS—Completed surveys totaled 778. Blood pressure was 130/74 ± 18.8/12.0 mmHg (mean ± SD). Sixty-two percent of patients exceeded goals. Action was taken to lower blood pressure in 34.9% of those. Predictors of action were 1) blood pressure level, 2) total number of medicines the patient was taking, and 3) patient already taking medicines for blood pressure. As blood pressure rose, providers attributed inaction more often to “competing demands” and reasons other than “blood pressure being at or near goal.”
CONCLUSIONS—No evidence was found for patterns of poor care among primary care physicians. Providers balance the clinical circumstances, including how elevated the blood pressure is, and issues of polypharmacy, medication side effects, and costs when determining the best course of action. Knowledge deficit is not a common cause of inaction.
Community Center–Based Resistance Training for the Maintenance of Glycemic Control in Adults With Type 2 Diabetes
Authors: Dunstan David W. , Vulikh Elena , Owen Neville , Jolley Damien , Shaw Jonathan , Zimmet Paul 
Published: November 2006

OBJECTIVE—The purpose of this study was to determine whether beneficial effects on glycemic control of an initial laboratory-supervised resistance training program could be sustained through a community center–based maintenance program.
RESEARCH DESIGN AND METHODS—We studied 57 overweight (BMI ≥27 kg/m2) sedentary men and women aged 40–80 years with established (&gt;6 months) type 2 diabetes. Initially, all participants attended a twice-weekly 2-month supervised resistance training program conducted in the exercise laboratory. Thereafter, participants undertook a resistance training maintenance program (2 times/week) for 12 months and were randomly assigned to carry this out either in a community fitness and recreation center (center) or in their domestic environment (home). Glycemic control (HbA1c [A1C]) was assessed at 0, 2, and 14 months.
RESULTS—Pooling data from the two groups for the 2-month supervised resistance training program showed that compared with baseline, mean A1C fell by −0.4% [95% CI −0.6 to −0.2]. Within-group comparisons showed that A1C remained lower than baseline values at 14 months in the center group (−0.4% [−0.7 to −0.03]) but not in the home group (−0.1% [−0.4 to 0.3]). However, no between-group differences were observed at each time point. Changes in A1C during the maintenance period were positively associated with exercise adherence in the center group only.
CONCLUSIONS—Center-based but not home-based resistance training was associated with the maintenance of modestly improved glycemic control from baseline, which was proportional to program adherence. Our findings emphasize the need to develop and test behavioral methods to promote healthy lifestyles including increased physical activity in adults with type 2 diabetes.
Differences in Glucose Tolerance Between Fixed-Dose Antihypertensive Drug Combinations in People With Metabolic Syndrome
Authors: Bakris George , Molitch Mark , Hewkin Ann , Kipnes Mark , Sarafidis Pantelis , Fakouhi Kaffa , Bacher Peter , Sowers James ,   on behalf of the STAR Investigators
Published: November 2006

OBJECTIVE—We sought to test the hypothesis that a fixed-dose combination of trandolapril/verapamil-SR (T/V) is superior to a fixed-dose combination of losartan/hydrochlorothiazide (L/H) on glucose tolerance in hypertensive patients with impaired glucose tolerance (IGT).
RESEARCH DESIGN AND METHODS—A prospective, randomized, open-label, blinded–end points design was used to assess the effects of a T/V versus L/H combination in patients with IGT and hypertension (n = 240) followed for up to 1 year. Doses were titrated to a systolic blood pressure &lt;130 mmHg. Primary outcome was change from baseline in a 2-h glucose on oral glucose tolerance test (OGTT) at study end (mean [±SD] at follow-up, 46.9 ± 13.5 weeks). Secondary outcomes included changes in insulin sensitivity, office and 24-h ambulatory blood pressure, incidence of new-onset diabetes, lipids, and inflammatory markers. Data are expressed as means ± SE unless otherwise noted.
RESULTS—Changes at study end were noted in 2-h OGTT glucose (T/V −0.21 ± 0.36 vs. L/H +1.44 ± 0.36 mmol/l; P &lt; 0.001) and insulin level (−30.13 ± 38.38 vs. +84.86 ± 38.33 pmol/l, respectively; P = 0.025). Worsening of insulin resistance occurred by week 12 (T/V 0.000 ± 0.001 vs. L/H −0.005 ± 0.001; P = 0.016). A higher incidence of new-onset diabetes (T/V 11.0 vs. L/H 26.6%; P = 0.002) and HbA1c &gt;7% (2.6 vs. 9.6%, respectively; P = 0.05) occurred at study end.
CONCLUSIONS—In patients with IGT, normal kidney function, and hypertension, the fixed-dose combination of T/V reduces the risk of new-onset diabetes compared with an L/H-based therapy.
Patient Interpretation of Neuropathy (PIN) Questionnaire
Authors: Vileikyte Loretta , Gonzalez Jeffrey S. , Leventhal Howard , Peyrot Mark F. , Rubin Richard R. , Garrow Adam , Ulbrecht Jan S. , Cavanagh Peter R. , Boulton Andrew J.M. 
Published: November 2006

OBJECTIVE—Using the common-sense model of illness behavior, we developed and validated a self-report instrument for assessment of patients’ cognitive and emotional representations of diabetic peripheral neuropathy (DPN) influencing foot self-care.
RESEARCH DESIGN AND METHODS—The Patient Interpretation of Neuropathy (PIN) questionnaire, generated from discussions with clinicians and interviews with patients with DPN, was administered to patients with DPN attending U.K. (n = 325) and U.S. (n = 170) diabetes centers. Psychometric tests of the PIN questionnaire comprised factor analysis, internal consistency, and test-retest reliability. Partial correlations and multivariate regressions established construct and criterion-related validity. The associations of PIN scales to past foot ulceration and foot self-care behaviors were compared with those using a generic measure of illness perception and emotion, the Revised Illness Perception Questionnaire (IPQ-R), which was adapted to neuropathy.
RESULTS—Factor analysis of the PIN questionnaire produced 11 scales, which explained 69% of item variance. Nine factors measured patients’ common-sense beliefs about DPN and their levels of understanding of DPN-related medical information. Two factors assessed the emotions of worry about potential consequences and anger at practitioners. Most scales demonstrated adequate internal (Cronbach’s α = 0.62–0.90) and test-retest reliability (Pearson’s r = 0.51–0.64). Partial correlations between the PIN and IPQ-R scales in corresponding domains were significant but modest (rp = 0.15–0.26). Finally, PIN scales showed significant associations with past foot ulceration and foot self-care behaviors, thereby confirming criterion validity.
CONCLUSIONS—The 39-item PIN questionnaire is a reliable and valid measure of patients’ cognitive and emotional representations of neuropathy affecting foot self-care.
Synthesis of Glyco‐Silicas by Cu(I)‐Catalyzed “Click‐Chemistry” and their Applications in Affinity Chromatography
Authors: Ortega‐Muñoz Mariano , Lopez‐Jaramillo Javier , Hernandez‐Mateo Fernando , Santoyo‐Gonzalez Francisco 
Published: November 2006

AbstractThe covalent immobilization of suitable alkyne/azide carbohydrate derivatives on complementarily functionalizated azide/alkyne silica was performed by click ligation througth the Cu(I)‐catalyzed 1,3‐dipolar cycloaddition reaction of such compounds. The new glyco‐silicas have shown to be efficient and valuable bio‐selective affinity chromatographic supports for the purification of lectins as well as for the one‐pot fluorescent labeling of those proteins. The synthetic methodology is simple, high yielding and flexible, allowing the preparation of tailored glyco‐silicas with potential future applications in the inmobilization of other biomolecules.