bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of the Diabetic Foot Risk Classification System of the International Working Group on the Diabetic Foot
Authors: Peters Edgar J.G. , Lavery Lawrence A. 
Published: March 2007

OBJECTIVE—To evaluate the effectiveness of a diabetic foot risk classification system by the International Working Group on the Diabetic Foot to predict clinical outcomes.
RESEARCH DESIGN AND METHODS—A total of 225 diabetic patients were initially evaluated as part of a prospective case-control study at the University of Texas Health Science Center at San Antonio. Complete records were available for 213 patients for follow-up evaluation after 29 months. Upon enrollment, subjects were stratified into four risk groups based on the presence of risk factors according to the consensus of the International Working Group on the Diabetic Foot. Group 0 consisted of subjects without neuropathy, group 1 consisted of patients with neuropathy but without deformity or peripheral vascular disease (PVD), group 2 consisted of subjects with neuropathy and deformity or PVD, and group 3 consisted of patients with a history of foot ulceration or a lower-extremity amputation.
RESULTS—Upon enrollment, patients in higher-risk groups had longer duration of diabetes, worse glycemic control, vascular and neuropathic variables, and more systemic complications of diabetes. During 3 years of follow-up, ulceration occurred in 5.1, 14.3, 18.8, and 55.8% of the patients in groups 0, 1, 2, and 3, respectively (linear-by-linear association, P &lt; 0.001). All amputations were found in Groups 2 and 3 (3.1 and 20.9%, P &lt; 0.001).
CONCLUSIONS—The foot risk classification of the International Working Group on the Diabetic Foot predicts ulceration and amputation and can function as a tool to prevent lower-extremity complications of diabetes.
Parental History of Diabetes Modifies the Association Between Abdominal Adiposity and Hyperglycemia
Authors: van Dam Rob M. , Boer Jolanda M.A. , Feskens Edith J.M. , Seidell Jaap C. 
Published: March 2007

OBJECTIVE—To examine whether the association between abdominal obesity and hyperglycemia differs according to the presence of a parental history of diabetes.
RESEARCH DESIGN AND METHODS—We conducted a cross-sectional study of 3,068 men and women, aged 20–65 years, without known diabetes who were fasting participants of a population-based study in three Dutch towns. Hyperglycemia was defined as a fasting plasma glucose concentration of 6.1 mmol/l (American Diabetes Association criterion). Waist circumference was categorized according to previously defined waist action levels. All estimates were adjusted for age and town.
RESULTS—The regression coefficients for the association between waist circumference and fasting plasma glucose were larger in participants who had a parental history of diabetes than in those who did not (men β = 0.31 vs. 0.16 mmol/SD, P [for interaction] = 0.003; women β = 0.24 vs. 0.11 mmol/SD, P = 0.002). Furthermore, larger waist circumference (men ≥94 vs. &lt;94 cm, women ≥88 vs. &lt;80 cm) was associated with a greater excess prevalence of hyperglycemia in participants who had a parental history of diabetes than in those who did not (men 12.4 vs. 2.0%, P = 0.03; women 13.6 vs. 5.9%, P = 0.05). Adjustment for physical activity, alcohol intake, smoking, and educational level did not materially change the results.
CONCLUSIONS—These findings indicate that the association between abdominal obesity and hyperglycemia is stronger in the presence of a parental history of diabetes. Blood glucose screening may be warranted at lower levels of waist circumference in individuals with a parental history of diabetes.
Neuropsychological Profiles of Children With Type 1 Diabetes 6 Years After Disease Onset
Authors: Northam Elisabeth A. , Anderson Peter J. , Jacobs Rani , Hughes Matthew , Warne Garry L , Werther George A. 
Published: March 2007

OBJECTIVE—To describe neuropsychological profiles and their relationship to metabolic control in children with type 1 diabetes 6 years after the onset of disease.
RESEARCH DESIGN AND METHODS—Children with type 1 diabetes (n = 90), aged 6–17 years, who had previously been assessed soon after diagnosis and 2 years later, were reevaluated 6 years after the onset of disease. Their neuropsychological profiles were compared with those of individuals in a community control group (n = 84), who had been assessed at similar intervals. Relationships between illness variables, such as age at the onset of disease and metabolic control history, and neuropsychological status were also examined.
RESULTS—Six years after onset of disease, children with type 1 diabetes performed more poorly than control subjects on measures of intelligence, attention, processing speed, long-term memory, and executive skills. Attention, processing speed, and executive skills were particularly affected in children with onset of disease before 4 years of age, whereas severe hypoglycemia was associated with lower verbal and full-scale intelligence quotient scores.
CONCLUSIONS—Neuropsychological profiles of children with type 1 diabetes 6 years after the onset of disease are consistent with subtle compromise of anterior and medial temporal brain regions. Severe hypoglycemia, particularly in very young children, is the most plausible explanation for neuropsychological deficits, but the contributory role of chronic hyperglycemia warrants further exploration.
Advanced Glycation End Products in Nondiabetic Patients With Coronary Artery Disease
Authors: Kanauchi Masao , Tsujimoto Nobuhiro , Hashimoto Toshio 
Published: March 2007

OBJECTIVE—To investigate whether advanced glycation end products (AGEs) participate in the development of coronary artery disease (CAD) in nondiabetic and diabetic subjects.
RESEARCH DESIGN AND METHODS—Serum concentrations of AGEs were measured using a newly established enzyme-linked immunosorbent assay in 48 nondiabetic patients (normal glucose tolerance, n = 20; impaired glucose tolerance, n = 28) who received coronary angiography for the study of chest pain or suspected CAD. Insulin sensitivity was examined by the euglycemic-hyperinsulinemic glucose clamp technique and was estimated as the mean glucose infusion rate during the last 30 min of clamp time (M value).
RESULTS—Patients were classified into four groups based on the number of significantly stenosed vessels, defined as 0-, 1-, 2-, or 3-vessel disease. Serum concentrations of AGEs were significantly higher in nondiabetic subjects with CAD than in control subjects (2.42 ± 0.65 vs. 1.96 ± 0.40 mU/ml, P &lt; 0.01) and significantly correlated with the number of significantly stenosed vessels (r = 0.678, P &lt; 0.001). M values significantly inversely correlated with serum concentrations of AGEs (r = −0.490, P &lt; 0.05). In multiple regression analysis, with the number of significantly stenosed vessels as the dependent variable, serum concentrations of AGEs, 2-h plasma glucose, and areas under the plasma glucose response curve were independently associated.
CONCLUSIONS—This pilot study indicates the relation between AGEs and the severity of CAD in nondiabetic patients. The measurement of serum AGE concentrations may be predictive of vascular damage.
Variations of Ambulatory Blood Pressure With Position in Patients With Type 1 Diabetes
Authors: Benhamou Pierre Y. , Mouret Sandrine , Quesada Jean L. , Boizel Robert , Baguet Jean P. , Halimi Serge , Mallion Jean M. 
Published: March 2007

OBJECTIVE—To study the influence of position changes on 24-h ambulatory blood pressure (ABP) in normotensive or mildly hypertensive normoalbuminuric patients with type 1 diabetes.
RESEARCH DESIGN AND METHODS—A cross-sectional evaluation of patients was staged according to the duration of diabetes (DD) and the presence of microangiopathy. We recruited 37 patients (30 men and 7 women), aged 38 ± 12 years, who were normotensive or mildly hypertensive (diastolic blood pressure [DBP] &lt;105 mmHg) and free of antihypertensive treatment and microalbuminuria. They were included according to DD (group 1, &lt;5 years; group 2, ≥10 years). An additional group of seven diabetic patients with microalbuminuria and mild untreated hypertension was also investigated. We recorded 24-h ambulatory blood pressure every 15 min with a position sensor, which allowed for the discrimination between standing or supine/sitting position in the patient.
RESULTS—Mean daytime (10:00 a.m. to 8:00 p.m.) ABP in supine/sitting position did not significantly differ between groups 1 and 2. However, standing ambulatory systolic blood pressure (ASBP) and ambulatory DBP (ADBP) were significantly higher than supine/sitting ASBP and ADBP in group 1 (ΔSBP 4 ± 5, ΔDPB 4 ± 6 mmHg, P &lt; 0.01) but not in group 2 (ΔSBP 2 ± 8, ΔDBP 2 ± 4 mmHg, P = NS). Patients free of microangiopathy presented with significantly higher ABP in standing position than in sitting/lying position, whereas patients with retinopathy and/or nephropathy exhibited no significant increase of ABP during standing.
CONCLUSION—The monitoring of position during ambulatory measurement of blood pressure in type 1 diabetic patients shows different patterns in relation to disease duration and the presence of microangiopathy.
Repaglinide Versus Metformin in Combination With Bedtime NPH Insulin in Patients With Type 2 Diabetes Established on Insulin/Metformin Combination Therapy
Authors: Furlong Niall J. , Hulme Shirley A. , O’Brien Sarah V. , Hardy Kevin J. 
Published: March 2007

OBJECTIVE—To compare the effect on glycemic control and weight gain of repaglinide versus metformin combined with bedtime NPH insulin in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—A total of 80 subjects treated with 850 or 1,000 mg t.i.d. metformin combined with bedtime NPH insulin were randomized to 13 weeks of open-label treatment with 4 mg t.i.d. repaglinide (n = 39) or metformin (dose unchanged) (n = 41). Insulin dose was titrated at the clinician’s discretion, aiming for a fasting blood glucose (FBG) ≤6.0 mmol/l.
RESULTS—Baseline age, diabetes duration, insulin requirement, weight, BMI, FBG, and HbA1c (Diabetes Control and Complications Trial–aligned assay, normal range 4.6–6.2%) were similar. Glycemic control improved (nonsignificantly) with insulin/metformin by (mean) 0.4%, from 8.4 to 8.1% (P = 0.09) but deteriorated with insulin/repaglinide by (mean) 0.4%, from 8.1 to 8.6% (P = 0.03; P = 0.005 between groups). Weight gain was less with insulin/metformin: 0.9 ± 0.4 kg (means ± SE) (P = 0.01) versus 2.7 ± 0.4 kg (P &lt; 0.0001) (P = 0.002 between groups). The Diabetes Treatment Satisfaction Questionnaire score (potential range 0 [minimum] to 36 [maximum]) increased from 32.4 ± 0.8 to 34.1 ± 0.5 (P = 0.01) with insulin/metformin but decreased from 32.5 ± 0.9 to 29.1 ± 1.3 (P &lt; 0.002) with insulin/repaglinide.
CONCLUSIONS—Combined with bedtime NPH insulin, metformin provides superior glycemic control to repaglinide with less weight gain and improved diabetes treatment satisfaction.
Comparison of Insulin Monotherapy and Combination Therapy With Insulin and Metformin or Insulin and Troglitazone in Type 2 Diabetes
Authors: Strowig Suzanne M. , Avilés-Santa M. Larissa , Raskin Philip 
Published: March 2007

OBJECTIVE—To evaluate the safety and efficacy of treatment with insulin alone, insulin plus metformin, or insulin plus troglitazone in individuals with type 2 diabetes.
RESEARCH DESIGN AND METHODS—A total of 88 type 2 diabetic subjects using insulin monotherapy (baseline HbAlc 8.7%) were randomly assigned to insulin alone (n = 31), insulin plus metformin (n = 27), or insulin plus troglitazone (n = 30) for 4 months. The insulin dose was increased only in the insulin group. Metformin was titrated to a maximum dose of 2,000 mg and troglitazone to 600 mg.
RESULTS—HbAlc levels decreased in all groups, the lowest level occurring in the insulin plus troglitazone group (insulin alone to 7.0%, insulin plus metformin to 7.1%, and insulin plus troglitazone to 6.4%, P &lt; 0.0001). The dose of insulin increased by 55 units/day in the insulin alone group (P &lt; 0.0001) and decreased by 1.4 units/day in the insulin plus metformin group and 12.8 units/day in the insulin plus troglitazone group (insulin plus metformin versus insulin plus troglitazone, P = 0.004). Body weight increased by 0.5 kg in the insulin plus metformin group, whereas the other two groups gained 4.4 kg (P &lt; 0.0001 vs. baseline). Triglyceride and VLDL triglyceride levels significantly improved only in the insulin plus troglitazone group. Subjects taking metformin experienced significantly more gastrointestinal side effects and less hypoglycemia.
CONCLUSIONS—Aggressive insulin therapy significantly improved glycemic control in type 2 diabetic subjects to levels comparable with those achieved by adding metformin to insulin therapy. Troglitazone was the most effective in lowering HbAlc, total daily insulin dose, and triglyceride levels. However, treatment with insulin plus metformin was advantageous in avoiding weight gain and hypoglycemia.
Treatment of Chronic Painful Diabetic Neuropathy With Isosorbide Dinitrate Spray
Authors: Yuen Kevin C.J. , Baker Neil R. , Rayman Gerry 
Published: March 2007

OBJECTIVE—Considerable evidence implicates impaired nitric oxide (NO) generation in the pathogenesis of diabetic neuropathic pain. We therefore conducted a pilot study to examine the effects of isosorbide dinitrate (ISDN), a NO donor with local vasodilating properties, in spray form in the management of chronic neuropathic pain.
RESEARCH DESIGN AND METHODS—The study was of double-blind, randomized, placebo-controlled, and two-period cross-over design. After a 2-week run-in period, 22 diabetic patients (13 men, 20 with type 2 diabetes, age [mean ± SE] 63.7 ± 1.8 years, duration of diabetes 9.1 ± 1.5 years, duration of painful neuropathy 2.6 ± 0.4 years) were randomized to receive ISDN or placebo sprays for 4 weeks, exchanging their treatment for a further 4 weeks after a 2-week wash-out period. The patients administered the spray to both feet before bedtime. Biweekly pain and other sensory symptoms were assessed using a visual analog scale (VAS) and the Lickert scale, respectively.
RESULTS—ISDN spray reduced overall neuropathic pain (P = 0.02) and burning sensation (P = 0.006). No treatment difference was observed with other sensory modalities (hot/cold sensation, tingling, numbness, hyperesthesia, and jabbing-like sensation). At study completion, 11 patients (50%) reported benefit and wished to continue using the ISDN spray, 4 (18%) preferred the placebo spray, and the remaining 7 (32%) were undecided.
CONCLUSIONS—ISDN spray offers an alternative and effective pharmacological option in relieving overall pain and burning sensation in the management of painful diabetic neuropathy. The potential of ISDN spray in alleviating other specific sensory symptoms associated with diabetic peripheral neuropathy merits further study.
Diet and Exercise Among Adults With Type 2 Diabetes
Authors: Nelson Karin M. , Reiber Gayle , Boyko Edward J. 
Published: March 2007

OBJECTIVE—To describe diet and exercise practices from a nationally representative sample of U.S. adults with type 2 diabetes.
METHODS—We analyzed data from 1,480 adults older than 17 years with a self-reported diagnosis of type 2 diabetes in the Third National Health and Nutrition Examination Survey (NHANES III). Fruit and vegetable consumption was obtained from a food frequency questionnaire; the percentages of total calories from fat and saturated fat were obtained from a 24-h food recall. Physical activity was based on self report during the month before the survey.
RESULTS—Of individuals with type 2 diabetes, 31% reported no regular physical activity and another 38% reported less than recommended levels of physical activity. Sixty-two percent of respondents ate fewer than five servings of fruits and vegetables per day. Almost two thirds of the respondents consumed &gt;30% of their daily calories from fat and &gt;10% of total calories from saturated fat. Mexican Americans and individuals over the age of 65 years ate a higher number of fruits and vegetables and a lower percentage of total calories from fat. Lower income and increasing age were associated with physical inactivity. Thirty-six percent of the sample were overweight and another 46% were obese.
CONCLUSIONS—The majority of individuals with type 2 diabetes were overweight, did not engage in recommended levels of physical activity, and did not follow dietary guidelines for fat and fruit and vegetable consumption. Additional measures are needed to encourage regular physical activity and improve dietary habits in this population.
Reduced IGFBP-1 Is Associated With Thickening of the Carotid Wall in Type 2 Diabetes
Authors: Leinonen Eeva S. , Salonen Jukka T. , Salonen Riitta M. , Koistinen Riitta A. , Leinonen Pekka J. , Sarna Seppo S. , Taskinen Marja-Riitta 
Published: March 2007

OBJECTIVE—The aim of the present study was to assess the role of the insulin-like growth factor (IGF) system and lipids in predicting the carotid intima-media thickness (IMT) in type 2 diabetes.
RESEARCH DESIGN AND METHODS—A total of 239 type 2 diabetic participants in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study (76 women) aged 50–75 years were examined before fenofibrate intervention. Patients underwent carotid ultrasonography for determination of IMT. IGF-I, IGF binding protein 1 (IGFBP-1), IGFBP-3, cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, apolipoprotein B (apoB), lipoprotein(a) (Lp(a)), glucose, HbA1c, and C-peptide were measured in fasting samples. Patients were divided in groups without (n = 168) and with (n = 71) clinical cardiovascular disease (CVD).
RESULTS—Partial correlations adjusted for age, sex, BMI, and diabetes duration showed an inverse association of IGFBP-1 with C-peptide (r = −0. 24, P = 0.018) and with maximal IMT (r = −0.42, P &lt; 0.001), whereas IGF I and IGFBP-3 correlated positively with several risk-promoting lipid parameters. In linear regression analysis controlling for age, sex, BMI, diabetes duration, and presence or absence of oral antihyperglycemic or insulin medication, determinants of IMT were age, IGFBP-1, pulse pressure, Lp(a), diabetes duration, and insulin treatment. IGFBP-1 persisted in the model for subjects with CVD.
CONCLUSIONS—In summary, a decrease in IGFBP-1 is a marker of carotid IMT thickening in patients with type 2 diabetes.
Projected Impact of Implementing the Results of the Diabetes Prevention Program in the U.S. Population
Authors: Saydah Sharon H. , Byrd-Holt Danita , Harris Maureen I. 
Published: March 2007

OBJECTIVE—To determine the feasibility of using either fasting plasma glucose or HbA1c to identify individuals in the U.S. population who meet the Diabetes Prevention Program (DPP) criteria for intervention, defined as BMI ≥24 kg/m2, fasting plasma glucose level 96–125 mg/dl, and 2-h glucose level 140–199 mg/dl in an oral glucose tolerance test (OGTT).
RESEARCH DESIGN AND METHODS—Analysis of a representative sample of U.S. adults aged 40–74 years with no medical history of diabetes for whom data on height, weight, fasting plasma glucose, HbA1c, and 2-h plasma glucose during an OGTT were obtained. Sensitivity, specificity, positive predictive value (PPV), and receiver operator characteristic (ROC) curves for fasting glucose and HbA1c were determined.
RESULTS—Using BMI &lt;24 kg/m2 as an initial criterion eliminated 27.2% of U.S. adults from further testing. Of the remaining group, 41.1% did not have to be considered for an OGTT because their fasting glucose level was below or above 96–125 mg/dl. Overall, 10.6% of adults aged 40–74 years without medical history of diabetes met the DPP eligibility criteria for intervention. Among individuals with BMI ≥24 kg/m2 and fasting glucose level 96–125 mg/dl, applying a fasting plasma glucose cutoff of ≥105 mg/dl excluded 62.5% of this group and resulted in 56.0% of those with 2-h glucose level 140–199 mg/dl in this group being identified, with a specificity of 72.0% and a PPV of 17.1%. Similar values were obtained for an HbA1c cutoff value of ≥5.5%.
CONCLUSIONS—Using data on BMI and setting cutoff values for fasting glucose and HbA1c would greatly reduce the number of individuals who would need to undergo an OGTT while achieving adequate sensitivity, specificity, and PPV.
Prospective Study of C-Reactive Protein in Relation to the Development of Diabetes and Metabolic Syndrome in the Mexico City Diabetes Study
Authors: Han Thang S. , Sattar Naveed , Williams Ken , Gonzalez-Villalpando Clicerio , Lean Michael E.J. , Haffner Steven M. 
Published: March 2007

OBJECTIVE—Recent evidence suggests that C-reactive protein (CRP) may predict development of diabetes in Caucasian populations. We evaluated CRP as a possible risk factor of the development of diabetes and metabolic syndrome in a 6-year study of 515 men and 729 women from the Mexico City Diabetes Study.
RESEARCH DESIGN AND METHODS—Baseline CRP, indexes of adiposity, and insulin resistance (homeostasis model assessment [HOMA-IR]) were used to predict development of the metabolic syndrome, defined as including two or more of the following: 1) dyslipidemia (triglyceride ≥2.26 mmol/l or HDL cholesterol ≤0.91 mmol/l in men and ≤1.17 mmol/l in women; &lt;35 and 40 mg/dl for men and women); 2) hypertension (blood pressure &gt;140/90 mmHg or on hypertensive medication); or 3) diabetes (1999 World Health Organization criteria).
RESULTS—At baseline, CRP correlated significantly (P &lt; 0.001) with all metabolic indexes in women, but less so in men. After 6 years, 14.2% of men and 16.0% of women developed the metabolic syndrome. Compared with tertile 1, women with CRP in the highest tertile had an increased relative risk of developing the metabolic syndrome by 4.0 (95% CI 2.0–7.9) and diabetes by 5.5 (2.2–13.5); these risks changed minimally after adjusting for BMI or HOMA-IR. The area under receiver-operating characteristic (ROC) curve for the prediction of the development of the syndrome was 0.684 for CRP, increasing to 0.706 when combined with BMI and to 0.710 for a complex model of CRP, BMI, and HOMA-IR.
CONCLUSIONS—CRP was not a significant predictor of the development of the metabolic syndrome in men. Our data strongly support the notion that inflammation is important in the pathogenesis of diabetes and metabolic disorders in women.