bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spectrum of Autonomic Cardiovascular Neuropathy in Diabetes
Authors: Jacob Giris , Costa Fernando , Biaggioni Italo 
Published: March 2007

OBJECTIVE—Diabetic patients with incapacitating orthostatic hypotension can have either a “hyperadrenergic” or “hypoadrenergic” presentation. Although the latter is related to overt autonomic neuropathy, the former is proposed to be explained by appropriate autonomic responses. We hypothesize, however, that both conditions are part of a spectrum of autonomic dysfunction.
RESEARCH DESIGN AND METHODS—We studied 16 consecutive diabetic patients with preserved renal function referred for incapacitating orthostatic hypotension and characterized their autonomic and neurohumoral cardiovascular regulation.
RESULTS—Six patients had a hyperadrenergic orthostatic response: systolic blood pressure fell 42 ± 15 mmHg, heart rate increased 20 ± 3 bpm, and plasma norepinephrine increased from 340 ± 80 to 910 ± 100 pg/ml. Ten patients had a hypoadrenergic response: systolic blood pressure fell 78 ± 5 mmHg, heart rate increased only 7 ± 3 bpm, and norepinephrine increased only from 130 ± 28 to 230 ± 40 pg/ml. Vagal (sinus arrhythmia, Valsalva ratio) and sympathetic (response to hyperventilation, postprandial hypotension) responses were impaired in both groups, but to a greater extent in the hypoadrenergic group. Notwithstanding severe orthostatic hypotension, the postural increase in plasma renin was blunted in both groups, more so in the hypoadrenergic group. Despite preserved renal function, patients had mild anemia due to impaired erythropoietin release, as seen in primary cases of autonomic failure.
CONCLUSIONS—Our results suggest that diabetic patients presenting with hyperadrenergic orthostatic hypotension have an initial stage of autonomic neuropathy, with overtly abnormal vagal function and early signs of sympathetic impairment. Furthermore, altered renin response can contribute to the patients’ orthostatic hypotension.
Prevalences of Diabetes and Impaired Glucose Regulation in a Danish Population
Authors: Glümer Charlotte , Jørgensen Torben , Borch-Johnsen Knut 
Published: March 2007

OBJECTIVE—To determine the age- and sex-specific prevalence of impaired fasting glycemia, impaired glucose tolerance, screen-detected diabetes, and known diabetes in a Danish population aged 30–60 years and to examine the phenotype and the cardiovascular risk profile in individuals with impaired glucose regulation.
RESEARCH DESIGN AND METHODS—In the Inter99 study, 13,016 inhabitants living in Copenhagen County were invited. All participants underwent anthropometric measurements, blood samples, and a 75-g standardized oral glucose tolerance test.
RESULTS—The age-specific prevalences in men were as follows: impaired fasting glycemia: 1.4–16.3%; impaired glucose tolerance: 6.9–17.8%; screen-detected diabetes: 0.7–9.7%; and known diabetes: 0–5.8%. The corresponding figures in women were 0–5.1, 10.5–17.3, 0.6–6.3, and 0.5–9%. The prevalence of impaired glucose regulation increased with age. Among individuals with diabetes, 65.6% were previously undiagnosed; this proportion was highest in the youngest age-group (82% among 45-year-old men vs. 63% among 60-year-old men, and 70% among 45-year-old women vs. 52% among 60-year-old women). Mean BMI, waist, HbA1c, systolic blood pressure, diastolic blood pressure, and total cholesterol were significantly higher (P &lt; 0.0001) in the individuals with impaired glucose regulation compared with individuals with normal glucose tolerance.
CONCLUSIONS—This study revealed that the prevalence of type 2 diabetes is high and that still two out of three individuals are undiagnosed, indicating a need for more attention to the disease in society.
Low Incidence of End-Stage Renal Disease and Chronic Renal Failure in Type 2 Diabetes
Authors: Bruno Graziella , Biggeri Annibale , Merletti Franco , Bargero Giuseppe , Ferrero Stefania , Pagano Gianfranco , Perin Paolo Cavallo 
Published: March 2007

OBJECTIVE—Data on the incidence of end-stage renal disease (ESRD) and chronic renal failure from population-based studies in Caucasian type 2 diabetic patients are lacking. To provide such data, a population-based cohort of type 2 diabetic patients was identified in Casale Monferrato, Italy, and prospectively examined from 1991 to 2001.
RESEARCH DESIGN AND METHODS—During the follow-up period, patients were regularly examined with centralized measurements of plasma creatinine and HbA1c. Independent predictors of progression to renal events were identified with multivariate Cox proportional hazards modeling, with sex, age, and individual follow-up time as confounders.
RESULTS—We followed 1,408 of 1,540 (91.4%) patients (average follow-up time 6.7 years, range 0.011–11.1); 10 new cases of ESRD and 72 of chronic renal failure (plasma values of creatinine ≥2.0 mg/dl) were identified, giving incidence rates/1,000 person-years of 1.04 (95% CI 0.56–1.94) and 7.63 (6.06–9.61), respectively. Cumulative risks for chronic renal failure adjusted for competing mortality were 6.1 and 9.3% after 20 and 30 years from diagnosis of diabetes, respectively. Incidence rates and cumulative risks of chronic renal failure defined by plasma creatinine values &gt;1.5 mg/dl increased to 13.1/1,000 person-years, 8.6 and 14.8%, respectively. In Cox regression analysis, predictors of progression (after adjustment for confounders) were hypertension (P = 0.078), diastolic blood pressure (P = 0.034), BMI (P = 0.03), and albumin excretion rate (AER) (P &lt; 0.0001).
CONCLUSIONS—We provide evidence that the individual risk of ESRD and chronic renal failure is low. AER and diastolic blood pressure are independent predictors of progression. These findings underline the relevance of primary prevention to reduce the number of diabetic patients with ESRD.
Effect on Glycemic Control of Exenatide (Synthetic Exendin-4) Additive to Existing Metformin and/or Sulfonylurea Treatment in Patients With Type 2 Diabetes
Authors: Fineman Mark S. , Bicsak Thomas A. , Shen Larry Z. , Taylor Kristin , Gaines Eling , Varns Amanda , Kim Dennis , Baron Alain D. 
Published: March 2007

OBJECTIVE—AC2993 (synthetic exendin-4; exenatide) is a peptide that enhances glucose-dependent insulin secretion, suppresses inappropriately elevated glucagon secretion, and slows gastric emptying. AC2993 also promotes β-cell proliferation and neogenesis in vitro and in animal models. This study examines the activity and safety of subcutaneously injected AC2993 in patients with type 2 diabetes currently treated with diet and/or oral antidiabetic agents (OAAs).
RESEARCH DESIGN AND METHODS—A total of 109 patients treated with diet and a sulfonylurea and/or metformin were enrolled in a blinded study. Patients were randomly assigned to one of three subcutaneously (SC) injected regimens of AC2993 (0.08 μg/kg) or placebo for 28 days.
RESULTS—All three AC2993 regimens led to significant reductions in serum fructosamine relative to placebo (P ≤ 0.004). Mean reductions ranged from 39 to 46 μmol/l. All AC2993 groups had reductions in HbA1c ranging from 0.7 to 1.1% (P ≤ 0.006). An end-of-study HbA1c &lt;7% was achieved by 15% of AC2993 patients versus 4% of placebo patients, confirming AC2993 effects on fasting and postprandial glycemia. On days 14 and 28, the β-cell index (homeostasis model assessment) for patients treated with AC2993 was 50–100% higher than baseline, contrasting with unchanged levels for placebo. The most common adverse event was transient mild-to-moderate nausea.
CONCLUSIONS—AC2993 is a promising therapeutic for patients with type 2 diabetes. In this study, it had significant effects on HbA1c levels in patients not currently achieving optimal glucose control with diet and/or OAAs.
Hyperbaric Oxygenation Accelerates the Healing Rate of Nonischemic Chronic Diabetic Foot Ulcers
Authors: Kessler Laurence , Bilbault Pascal , Ortéga Francoise , Grasso Claire , Passemard Raphael , Stephan Dominique , Pinget Michel , Schneider Francis 
Published: March 2007

OBJECTIVE—To study the effect of systemic hyperbaric oxygenation (HBO) therapy on the healing course of nonischemic chronic diabetic foot ulcers.
RESEARCH DESIGN AND METHODS—From 1999 to 2000, 28 patients (average age 60.2 ± 9.7 years, diabetes duration 18.2 ± 6.6 years), of whom 87% had type 2 diabetes, demonstrating chronic Wagner grades I–III foot ulcers without clinical symptoms of arteriopathy, were studied. They were randomized to undergo HBO because their ulcers did not improve over 3 months of full standard treatment. All the patients demonstrated signs of neuropathy. HBO was applied twice a day, 5 days a week for 2 weeks; each session lasted 90 min at 2.5 ATA (absolute temperature air). The main parameter studied was the size of the foot ulcer measured on tracing graphs with a computer. It was evaluated before HBO and at day 15 and 30 after the baseline.
RESULTS—HBO was well tolerated in all but one patient (barotraumatic otitis). The transcutaneous oxygen pressure (TcPo2) measured on the dorsum of the feet of the patients was 45.6 ± 18.1 mmHg (room air). During HBO, the TcPo2 measured around the ulcer increased significantly from 21.9 ± 12.1 to 454.2 ± 128.1 mmHg (P &lt; 0.001). At day 15 (i.e., after completion of HBO), the size of ulcers decreased significantly in the HBO group (41.8 ± 25.5 vs. 21.7 ± 16.9% in the control group [P = 0.037]). Such a difference could no longer be observed at day 30 (48.1 ± 30.3 vs. 41.7 ± 27.3%). Four weeks later, complete healing was observed in two patients having undergone HBO and none in the control group.
CONCLUSIONS—In addition to standard multidisciplinary management, HBO doubles the mean healing rate of nonischemic chronic foot ulcers in selected diabetic patients. The time dependence of the effect of HBO warrants further investigations.
Physiological Differences Between Interstitial Glucose and Blood Glucose Measured in Human Subjects
Authors: Kulcu Eray , Tamada Janet A. , Reach Gerard , Potts Russell O. , Lesho Matthew J. 
Published: March 2007

OBJECTIVE—This study investigated whether glucose readings from a sensor sampling in interstitial fluid differ substantially from blood glucose (BG) values measured at the same time.
RESEARCH DESIGN AND METHODS—We have evaluated the relationship between BG and glucose extracted from interstitial fluid using the GlucoWatch (Cygnus, Redwood City, CA) biographer, a device that collects glucose from subcutaneous interstitial space through intact skin by application of a low electric current. We evaluated the relative change in the interstitial glucose (IG) signal (IGS) as measured by the biographer versus BG using a normalized two-point sensitivity index (NSI).
RESULTS—The results show that biographer measures of IG differ in time and magnitude from the corresponding BG values. In particular, the biographer values were shifted in time due to instrumental and physiological lag. Results show an average total lag of 17.2 ± 7.2 min for all subjects evaluated. The instrumental lag was 13.5 min, suggesting that physiological lag is ∼5 min. In addition, when glucose was increasing, the change in IGS was less than that in BG, while when BG was decreasing, the change in IGS was greater than that in BG.
CONCLUSIONS—Similar results have been reported for other measures of IG, suggesting that differences reflect physiological variation in glucose uptake, utilization, and elimination in blood and interstitial space. This further evidence of the difference between IG and BG should be considered when interpreting glucose measurements from devices that sample interstitial fluid.
Community-Based Lifestyle Interventions to Prevent Type 2 Diabetes
Authors: Satterfield Dawn W. , Volansky Michele , Caspersen Carl J. , Engelgau Michael M. , Bowman Barbara A. , Gregg Ed W. , Geiss Linda S. , Hosey Gwen M. , May Jeannette , Vinicor Frank 
Published: March 2007

OBJECTIVE—To conduct a literature review of community-based interventions intended to prevent or delay type 2 diabetes.
RESEARCH DESIGN AND METHODS—Recently published findings about the potential to prevent or delay type 2 diabetes with intensive lifestyle interventions prompted a literature search for community-based diabetes prevention interventions. The literature review design was a search of databases for publications in 1990–2001 that identified reports on community-based interventions designed to prevent or modify risk factors for type 2 diabetes.
RESULTS—The search revealed 16 published interventions, 8 of which were conducted in the U.S. and involved populations disproportionately burdened by diabetes (e.g., American Indians, Native Hawaiians, Mexican Americans, and African Americans). Of the studies reporting results among youth, there were posttest improvements in intervention groups in knowledge, preventive behaviors, and self-esteem. Among studies reporting results among adults, most reported improvements in intervention groups in knowledge or adoption of regular physical activity. Several investigators offered important reflections about the process of engaging communities and sharing decision making in participatory research approaches, as well as insights about the expectations and limitations of community-based diabetes prevention research. Many of the studies reported limitations in their design, including the lack of control or comparison groups, low response rates or lack of information on nonresponders, or brief intervention periods.
CONCLUSIONS—There is a critical need to conduct and publish reports on well-designed community-based diabetes prevention research and share information on the process, results, and lessons learned. Armed with recent positive findings about diabetes prevention and literature documenting community-based efforts, advocates at local, state, and national levels can collaborate to stem the rising tide of diabetes in communities.
Economic Consequences of Epidemiological Changes in Diabetes in Middle-Income Countries
Authors: Arredondo Armando , Zúñiga Alexis 
Published: March 2007

OBJECTIVE—To identify the costs and economic consequences of expected changes in the demand for health care services for type 2 diabetes in the three main public institutions of the Mexican health care system.
RESEARCH DESIGN AND METHODS—The cost evaluation method to estimate direct and indirect costs was based on instrumentation and consensus techniques. To estimate the costs and epidemiological changes for 2003–2005, three probabilistic models were constructed according to the Box-Jenkins technique.
RESULTS—Comparing the economic impact in 2003 versus 2005 (P &lt; 0.05), there is a 26% increase in financial requirements. The total amount for diabetes in 2005 (in U.S. dollars) will be $317,631,206, including $140,410,816 in direct costs and $177,220,390 in indirect costs. The total direct costs, representing financial requirements to provide health care for expected cases of type 2 diabetes and its main complications in the three main public institutions in Mexico, up to 2005, will be $37,079,587 for the Ministry of Health (or Secretaría de Salud [SSA], serving the uninsured population) and $103,331,235 for the Mexican Social Security Institute, or Instituto Mexicano del Seguro Social (IMSS), and the Institute for Social Security and Services for State Workers, or Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), both of which serve the insured population.
CONCLUSIONS—Our data suggest that changes in the demand for health care services for patients with diabetes will continue with an increasing trend, mainly in the insured population. In economic terms, the results of direct and indirect costs are one of the main challenges to be solved to decrease the economic burden that diabetes represents for the population, the health care institutions, and for society as a whole.
Physician, Organizational, and Patient Factors Associated With Suboptimal Blood Pressure Management in Type 2 Diabetic Patients in Primary Care
Authors: Schaars Carel F. , Denig Petra , Kasje Willeke N. , Stewart Roy E. , Wolffenbuttel Bruce H.R. , Haaijer-Ruskamp Flora M. 
Published: March 2007

OBJECTIVE—To assess the quality of hypertension care in patients with type 2 diabetes in general practice and identify physician, organizational, and patient factors associated with suboptimal care.
RESEARCH DESIGN AND METHODS—Data from 895 randomly selected diabetic patients were extracted from the electronic medical records of 95 general practitioners. Physician and organizational characteristics were collected with a questionnaire. We conducted a multilevel analysis to identify associations with blood pressure registration, hypertension treatment, and achievement of target blood pressure levels.
RESULTS—For 652 patients (73%), a blood pressure measurement was recorded in the last year. Of these patients, 132 (20%) reached a target level of 135/85 mmHg. In total, 595 patients were classified as having hypertension, of whom 192 received no treatment (32%), 193 received an ACE inhibitor (32%), and 210 received other antihypertensives. Patients visiting a diabetes facility, referred to a specialist, with a female general practitioner, or with a general practitioner with ≤10 years work experience had better recordings of their blood pressure. Suboptimal treatment was higher in older patients and smoking patients. Treatment was better in patients with coronary comorbidity, hyperlipidemia, or those referred to a specialist. Not achieving the blood pressure target was related to older age of the patients.
CONCLUSIONS—Hypertension management of type 2 diabetic patients in primary care is suboptimal. Characteristics of general practitioners as well as additional care provided by a diabetes facility or a specialist are associated with better processes of care, but blood pressure outcomes are not as clearly related to these factors.
Acute Effects of Different Intensities of Exercise in Normoalbuminuric/ Normotensive Patients With Type 1 Diabetes
Authors: Lane James T. , Ford Timothy C. , Larson LuAnn R. , Chambers Ward A. , Lane Pascale H. 
Published: March 2007

OBJECTIVE—The purpose of this study was to investigate the effect of exercise occurrence and intensity on albumin excretion in normotensive, normoalbuminuric patients with type 1 diabetes.
RESEARCH DESIGN AND METHODS—Eighteen patients (aged 29 ± 2 years, duration of diabetes 14 ± 2 years, blood pressure 120 ± 2/74 ± 1 mmHg, HbA1c 7.0 ± 0.2% [mean ± SE]) without microalbuminuria, hypertension, or anti–angiotensin II therapy participated in two exercise studies in a clinical research center. Exercise intensities were defined as moderate (50% heart rate reserve [HRR]) and intense (75% HRR) and were performed in random order. Subjects collected urine for albumin determination on the days before and after exercise. On the day of exercise, subjects exercised for 30 min on a treadmill at the assigned intensity. Timed urine collections were obtained over the day. Blood pressures were measured using an ambulatory blood pressure monitor.
RESULTS—Moderate exercise demonstrated no changes in albumin excretion. Intense exercise demonstrated a significant increase in albumin excretion during the first 4 h compared with the rest of the day (P = 0.03) but returned to normal thereafter. Albumin excretion did not exceed normal levels throughout the study. There was no difference in albumin excretion surrounding days of intense exercise. Ambulatory blood pressures demonstrated nocturnal dipping after moderate and intense exercise (P &lt; 0.001).
CONCLUSIONS—We have demonstrated that normotensive, normoalbuminuric patients without anti–angiotensin II therapy do not have elevated albumin excretion following exercise intensities experienced by most patients with type 1 diabetes.
Low Synthesis and High Absorption of Cholesterol Characterize Type 1 Diabetes
Authors: Miettinen Tatu A. , Gylling Helena , Tuominen Juha , Simonen Piia , Koivisto Veikko 
Published: March 2007

OBJECTIVE—Streptozotocin-induced type 1 diabetes in experimental animals inhibits cholesterol synthesis and increases cholesterol absorption. In contrast to human type 2 diabetes, virtually no information is available on cholesterol synthesis and absorption in type 1 diabetes.
RESEARCH DESIGN AND METHODS—We studied the variables of cholesterol metabolism in 27 patients with type 1 diabetes and in 10 patients with type 2 diabetes matched for body weight, using cholesterol precursor sterol ratios to cholesterol as surrogate markers of synthesis, and those of cholestanol and plant sterols of cholesterol absorption. Glucose control was good in all subjects.
RESULTS—Total and HDL cholesterol and LDL triglycerides were higher in type 2 than in type 1 diabetes. Serum sterols, measured also in VLDL, intermediate-density lipoprotein (IDL), LDL, and HDL, were transported up to &gt;90% by LDL and HDL in type 1 diabetes. The ratios of all absorption sterols in serum and in each lipoprotein were higher, and those of the synthesis markers, especially cholestenol and lathosterol, were lower in type 1 than in type 2 diabetes.
CONCLUSIONS—In contrast to type 2 diabetes, the findings in type 1 diabetes could be related to low expression of ABC G/5 G/8 genes, resulting in high absorption of cholesterol and sterols in general and low synthesis of cholesterol.
Fasting Plasma Free Fatty Acids and Risk of Type 2 Diabetes
Authors: Pankow James S. , Duncan Bruce B. , Schmidt Maria Inês , Ballantyne Christie M. , Couper David J. , Hoogeveen Ron C. , Golden Sherita H. 
Published: March 2007

OBJECTIVE—To evaluate whether plasma levels of free fatty acids (FFAs) are independently associated with incidence of type 2 diabetes.
RESEARCH DESIGN AND METHODS—A case-cohort design was used to randomly select 580 incident cases of diabetes and 566 noncases from 10,275 African-American and white men and women in the Atherosclerosis Risk in Communities study, aged 45–64 years and without prevalent diabetes at the baseline exam. Incident diabetes was ascertained at three exams over 9 years of follow-up. FFA levels were measured in plasma samples collected at the baseline exam.
RESULTS—At baseline, FFA level was inversely associated with height and positively associated with female sex, BMI, waist circumference, waist-to-hip ratio, heart rate, plasma triglycerides, and an inflammation score quantifying levels of six systemic inflammation markers. Relative risks for incident diabetes (fourth vs. first quartile of FFAs) were increased in a basic model adjusted for age, sex, race, and center (hazard ratio 1.68, 95% CI 1.20–2.34) and in a model further adjusted for baseline fasting glucose, insulin, BMI, waist circumference, triglycerides, and the inflammation score (1.63, 1.04–2.57). Relative risks associated with a greater FFA level were lowest among those of normal weight and highest among the obese, but a formal test of interaction between FFAs and BMI was not statistically significant.
CONCLUSIONS—Individuals with higher fasting levels of plasma FFAs were at modestly higher risk of type 2 diabetes in this cohort of middle-aged adults.