bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Number of Physician Visits and Influenza Vaccination Coverage Among Diabetic Adults With Access to Care
Authors: Egede Leonard E. 
Published: March 2007

OBJECTIVE—The proportion of diabetic adults that receives the influenza vaccine is less than ideal. This study determined the relationship between the number of physician visits in the previous 12 months and the likelihood of influenza vaccination among diabetic adults with access to care.
RESEARCH DESIGN AND METHODS—Data on 1,807 diabetic adults with access to care in the 1999 National Health Interview Survey (NHIS) were analyzed. Prevalence of influenza vaccination was determined by number of physician visits. Logistic regression was used to determine the independent association between number of physician visits and influenza vaccination coverage, controlling for age, sex, race/ethnicity, education, income, employment census region, and comorbidity. STATA was used for analyses to account for the complex sampling design of NHIS.
RESULTS—Overall, 56% of subjects received the influenza vaccine. Proportions vaccinated by number of physician visits were as follows: 35% (no visit), 47% (1–3 visits), 58% (4–9 visits), and 61% (≥10 visits). Compared with people with no physician visit, people with 4–9 visits (odds ratio [OR] 2.61) and ≥10 visits (2.96) were significantly more likely to be vaccinated. However, after controlling for covariates, only people with ≥10 visits (2.34) were significantly more likely to be vaccinated.
CONCLUSIONS—In this nationally representative sample, repeated physician visits by diabetic adults with access to care were associated with only modest increases in influenza vaccination coverage. In adjusted analysis, odds of influenza vaccination were not significantly associated with number of physician visits, except in people with ≥10 visits.
No Hypoglycemia After Subcutaneous Administration of Glucagon-Like Peptide-1 in Lean Type 2 Diabetic Patients and in Patients With Diabetes Secondary to Chronic Pancreatitis
Authors: Knop Filip K. , Vilsbøll Tina , Larsen Steen , Madsbad Sten , Holst Jens J. , Krarup Thure 
Published: March 2007

OBJECTIVE—Glucagon-like peptide 1 (GLP-1) is a proglucagon derivative secreted primarily from the L-cells of the small intestinal mucosa in response to the ingestion of meals. GLP-1 stimulates insulin secretion and inhibits glucagon secretion. It has previously been shown that intravenous or subcutaneous administration of GLP-1 concomitant with intravenous glucose results in hypoglycemia in healthy subjects. Because GLP-1 is also effective in type 2 diabetic patients and is currently being evaluated as a therapeutic agent, it is important to investigate whether GLP-1 may cause hypoglycemia in such patients. We have previously shown that GLP-1 does not cause hypoglycemia in obese type 2 diabetic patients with insulin resistance amounting to 5.4 ± 1.1 according to homeostasis model assessment (HOMA). In this study, we investigated diabetic patients with normal or close to normal insulin sensitivity.
RESEARCH DESIGN AND METHODS—Eight lean type 2 diabetic patients (group 1) aged 60 years (range 50–72) with BMI 23.1 kg/m2 (20.3–25.5) and HbA1c 8.0% (6.9–11.4) and eight patients with type 2 diabetes secondary to chronic pancreatitis (group 2) aged 52 years (41–62) with BMI 21.9 kg/m2 (17.6–27.3) and HbA1c 7.8% (6.2–12.4) were given a subcutaneous injection of 1.5 nmol GLP-1/kg body wt. Then, 15 min later, at the time of peak GLP-1 concentration, plasma glucose (PG) was raised to 15 mmol/l with an intravenous glucose bolus. HOMA (mean ± SEM) showed insulin resistance amounting to 1.9 ± 0.3 and 1.7 ± 0.5 in the two groups, respectively.
RESULTS—In both groups, PG decreased rapidly and stabilized at 7.5 mmol/l (range 3.9–10.1) and 7.2 mmol/l (3.1–10.9) in groups 1 and 2, respectively, after 90 min. Neither symptoms of hypoglycemia nor biochemical hypoglycemia were observed in any patient.
CONCLUSIONS—We conclude that a GLP-1-based therapy would not be expected to be associated with an increased risk of hypoglycemia in insulin-sensitive type 2 diabetic patients.
Microvascular Complications at Time of Diagnosis of Type 2 Diabetes Are Similar Among Diabetic Patients Detected by Targeted Screening and Patients Newly Diagnosed in General Practice
Authors: Spijkerman Annemieke M.W. , Dekker Jacqueline M. , Nijpels Giel , Adriaanse Marcel C. , Kostense Piet J. , Ruwaard Dirk , Stehouwer Coen D.A. , Bouter Lex M. , Heine Robert J. 
Published: March 2007

OBJECTIVE—To investigate whether screening-detected diabetic patients differ from diabetic patients newly diagnosed in general practice with regard to the presence of microvascular complications.
RESEARCH AND DESIGN METHODS—Diabetic patients, identified by a population-based targeted screening procedure consisting of a screening questionnaire and a fasting capillary whole-blood glucose measurement followed by diagnostic testing, were compared with patients newly diagnosed with diabetes in general practice. Retinopathy was assessed with fundus photography, impaired foot sensitivity was assessed with Semmes-Weinstein monofilaments, and the presence of microalbuminuria was measured by means of the albumin-to-creatinine ratio (ACR).
RESULTS—A total of 195 screening-detected type 2 diabetic patients and 60 patients newly diagnosed in general practice participated in the medical examination. The prevalence of retinopathy was higher in screening-detected type 2 diabetic patients than in patients newly diagnosed in general practice, but not significantly higher. The prevalence of retinopathy was 7.6% (95% CI 4.6–12.4) in screening-detected type 2 diabetic patients and 1.9% (0.3–9.8) in patients newly diagnosed in general practice. The prevalence of impaired foot sensitivity was similar in both groups, 48.1% (40.9–55.3) and 48.3% (36.2–60.7), respectively. The ACR was 0.61 (interquartile range 0.41–1.50) in screening-detected type 2 diabetic patients and 0.99 (0.53–2.49) in patients newly diagnosed in general practice. The difference in prevalence of microalbuminuria was not statistically significant. The prevalence of microalbuminuria was 17.2% (95% CI 12.5–23.2) and 26.7% (17.1–39.0) in screening-detected type 2 diabetic patients and patients newly diagnosed in general practice, respectively.
CONCLUSIONS—Targeted screening for type 2 diabetes (with a screening questionnaire as a first step) resulted in the identification of previously undiagnosed diabetic patients with a considerable prevalence of microvascular complications.
Impact of Metabolic Control and Serum Lipids on the Concentration of Advanced Glycation End Products in the Serum of Children and Adolescents With Type 1 Diabetes, as Determined by Fluorescence Spectroscopy and Nε-(Carboxymethyl)Lysine ELISA
Authors: Galler Angela , Müller Grit , Schinzel Reinhard , Kratzsch Juergen , Kiess Wieland , Münch Gerald 
Published: March 2007

OBJECTIVE—Advanced glycation end products (AGEs) are a complex and heterogenous group of proteins that are formed by nonenzymatic glycation in a series of reactions. It is hypothesized that they may play a role in the pathogenesis of diabetes-related complications; at present, however, their exact biological role is scarcely understood. Clinical studies so far have shown that serum levels of AGEs are correlated with clinical stages of diabetes complications such as retinopathy and nephropathy. This study was performed in children and adolescents with type 1 diabetes to examine the putative role of serum AGEs in respect to metabolic control and diabetes complications in relation to a number of clinical and laboratory parameters.
RESEARCH DESIGN AND METHODS—We studied 99 children and adolescents up to the age of 20 years with type 1 diabetes and 60 control subjects. Serum levels of AGEs were measured with two different methods [fluorescence spectroscopy and Nε-(carboxymethyl)lysine (CML) enzyme-linked immunosorbent assay] and correlated with clinical data, such as age, diabetes duration, BMI, and long-term metabolic control determined by HbA1c, and laboratory parameters, such as serum lipids.
RESULTS—Serum levels of fluorescent AGEs, but not of CML-AGEs, in children and adolescents with type 1 diabetes were significantly higher compared with control subjects. There was an age-dependent increase of fluorescent AGEs in children and adolescents with diabetes that was not seen in healthy children and adolescents. Levels of fluorescent AGEs in patients with diabetes between 13 and 16 years of age correlated positively with HbA1c levels. No significant association between levels of AGEs and diabetes duration was found. Children and adolescents with diabetes and high serum triglycerides had significantly higher serum levels of fluorescent AGEs. Children and adolescents with diabetes between the age of 13 and 16 years with high levels of LDL had significantly higher levels of fluorescent AGEs.
CONCLUSIONS—In this study we demonstrated a clear age-dependent increase of fluorescent AGEs but not of CML-AGEs in children and adolescents with diabetes type 1. Moreover we showed a strong association between serum AGEs and serum triglycerides and cholesterol. The observed effect may be caused by a loss of optimal regulation of lipid metabolism. It could suggest a link between triglycerides and formation of AGEs. This new and interesting finding and its impact on metabolic control and the development of diabetes complications should be examined in the future.
Sympathetic Vasomotor Response of the Radial Artery in Patients With Diabetic Foot Syndrome
Authors: Eicke Bernhard M. , Bauer Julian , Mink Susanne , Kuhl Valerio , Hlawatsch Alexander , Küstner Ernst , Victor Anja 
Published: March 2007

OBJECTIVE—Neurophysiological assessment of the peripheral autonomic system is characterized by various limitations. An alternative approach to laser Doppler and venous plethymography is the assessment of the sympathetic vasomotor response of the radial artery obtained by continuous wave Doppler sonography. Nomogram data have been established and demonstrate the temporary disappearance of diastolic flow after coughing or deep inspiration.
RESEARCH DESIGN AND METHODS—We assessed the sympathetic vasomotor response in 25 patients (mean age 64 years, range 43–76) with diabetic foot syndrome. The Doppler data were correlated with nerve conduction studies of the median and peroneal nerve, the extent of radiologically diagnosed media sclerosis, and compared with nomogram values (n = 41).
RESULTS—Although similar mean flow velocities were found under baseline conditions, the flow pattern was characterized by higher pulsatility in the diabetic group (resistance index [RI] 1.1 vs. 0.7). No significant difference in RI was observed after coughing. The latency of onset of the response was prolonged (2.1 vs. 1.5 s), while the duration of the response did not differ (18 vs. 15 s). Only the nerve conduction velocity of the peroneal nerve correlated inversely with the RI. The extent of radiologically proven calcification tended to correlate with the pulsatility of the baseline signal and the response latencies.
CONCLUSIONS—The data obtained by this study suggest the concurrent existence of reduced vessel elasticity due to media sclerosis and dysfunction of the autonomic vasomotor system.
Improvement in Diabetes Care of Underinsured Patients Enrolled in Project Dulce
Authors: Philis-Tsimikas Athena , Walker Chris , Rivard Lisa , Talavera Gregory , Reimann Joachim O.F. , Salmon Michelle , Araujo Rachel 
Published: March 2007

OBJECTIVE—To improve clinical diabetes care, patient knowledge, and treatment satisfaction and to reduce health-adverse culture-based beliefs in underserved and underinsured populations with diabetes.
RESEARCH DESIGN AND METHODS—A total of 153 high-risk patients with diabetes recruited from six community clinic sites in San Diego County, California were enrolled in a nurse case management (NCM) and peer education/empowerment group. Baseline and 1-year levels of HbA1c, lipid parameters, systolic and diastolic blood pressure, knowledge of diabetes, culture-based beliefs in ineffective remedies, and treatment satisfaction were prospectively measured. The NCM and peer education/empowerment group was compared with 76 individuals in a matched control group (CG) derived from patients referred but not enrolled in Project Dulce.
RESULTS—After 1 year in Project Dulce, the NCM and peer education/empowerment group had significant improvements in HbA1c (12.0–8.3%, P &lt; 0.0001), total cholesterol (5.82–4.86 mmol/l, P &lt; 0.0001), LDL cholesterol (3.39–2.79 mmol/l, P &lt; 0.0001), and diastolic blood pressure (80–76 mmHg, P &lt; 0.009), which were significantly better than in the CG, in which no significant changes were noted. Accepted American Diabetes Association standards of diabetes care, knowledge of diabetes (P = 0.024), treatment satisfaction (P = 0.001), and culture-based beliefs (P = 0.001) were also improved.
CONCLUSIONS—A novel, culturally appropriate, community-based, nurse case management/peer education diabetes care model leads to significant improvement in clinical diabetes care, self-awareness, and understanding of diabetes in underinsured populations.
One-Year Glycemic Control With a Sulfonylurea Plus Pioglitazone Versus a Sulfonylurea Plus Metformin in Patients With Type 2 Diabetes
Authors: Hanefeld Markolf , Brunetti Paolo , Schernthaner Guntram H. , Matthews David R. , Charbonnel Bernard H. ,   on behalf of the QUARTET Study Group
Published: March 2007

OBJECTIVE—The goal was to assess the 1-year efficacy and safety of the addition of pioglitazone or metformin to existing sulfonylurea (SU) therapy in patients with inadequately controlled type 2 diabetes.RESEARCH DESIGN AND METHODS—In this multicenter, double-blind study, patients were randomized to receive either pioglitazone 15 mg (n = 319) or metformin 850 mg (n = 320) and up to 45 mg/day and 2,550 mg/day, respectively. The primary efficacy endpoint was HbA1c at week 52. Fasting plasma glucose, insulin, and lipid profiles were also measured.RESULTS—HbA1c was reduced by 1.20% in the SU plus pioglitazone group and 1.36% in the SU plus metformin group, and fasting plasma glucose was reduced by 2.2 and 2.3 mmol/l in the respective groups. Fasting insulin levels were also reduced (pioglitazone arm −1.3 μIU/ml; metformin arm −0.8 μIU/ml). There were no significant between-treatment differences in these three parameters. Pioglitazone addition to SU significantly reduced triglycerides (−16 vs. −9%; P = 0.008) and increased HDL cholesterol (14 vs. 8%; P &lt; 0.001) compared with metformin addition. LDL cholesterol was increased 2% by the addition of pioglitazone and decreased 5% by the addition of metformin to SU (P &lt; 0.001). Urinary albumin-to-creatinine ratio was reduced by 15% in the SU plus pioglitazone group and increased 2% in the SU plus metformin group (P = 0.017). Both combinations were well tolerated with no evidence of hepatic or cardiac toxicity in either group.CONCLUSIONS—Clinically equivalent improvements in glycemic control were observed for both combinations. Compared with metformin plus SU, addition of pioglitazone to SU resulted in a reduction of the urinary albumin-to-creatinine ratio, a small but significant rise in LDL cholesterol, and significantly greater improvements in triglyceride levels and HDL cholesterol levels. Metformin plus SU was associated with a significant reduction in LDL cholesterol. SU plus pioglitazone is an effective and well-tolerated combination regimen that may provide additional beneficial effects for patients with type 2 diabetes.
Effects of Troglitazone in Young First-Degree Relatives of Patients With Type 2 Diabetes
Authors: Levin Klaus , Hother-Nielsen Ole , Henriksen Jan Erik , Beck-Nielsen Henning 
Published: March 2007

OBJECTIVE—Insulin resistance is a key characteristic of first-degree relatives of patients with type 2 diabetes. We therefore treated young, glucose-tolerant relatives with the insulin action enhancer troglitazone in order to determine the effects on insulin sensitivity, glucose metabolism, and glycogen synthase activity.
RESEARCH DESIGN AND METHODS—Relatives were randomized in a double-blind manner and treated for 12 weeks with either 200 mg troglitazone or placebo. Before and after treatment, an oral glucose tolerance test (OGTT) and a euglycemic-hyperinsulinemic clamp (40 mU · m−2 · min−1) were performed, including 3-3H glucose infusion, glycolytic flux calculations, indirect calorimetry, and muscle biopsies.
RESULTS—Twelve relatives received troglitazone and 12 placebo (aged 30.8 ± 2.0 vs. 30.3 ± 1.6 years, BMI 29.6 ± 0.8 vs. 30.5 ± 1.3 kg/m2; means ± SE). Area under the curve (AUC) for plasma glucose at the second OGTT was unchanged after troglitazone. In contrast, troglitazone reduced fasting (from 70.3 ± 6.9 to 52.2 ± 5.8 vs. 73.6 ± 11.0 to 73.3 ± 6.5 pmol/l, P &lt; 0.02) and AUC plasma insulin (mean [CI] from 335.7 [230.9–488.1] to 277.4 [179.4–428.8] vs. 313.8 [218.2–451.2] to 353.9 [208.3–601.3] pmol/l, P &lt; 0.05). Additionally, fasting plasma triglycerides were reduced by troglitazone (from 1.86 ± 0.33 to 1.38 ± 0.27 vs. 2.22 ± 0.44 to 2.35 ± 0.46 mmol/l, P &lt; 0.01). Insulin-stimulated glucose disposal increased in the troglitazone group (from 208.3 ± 23.7 to 263.5 ± 30.4 vs. 197.1 ± 20.0 to 200.8 ± 20.8 mg · m−2 · min−1, P &lt; 0.02) mainly due to increased glucose storage (from 99.9 ± 17.9 to 146.0 ± 25.3 vs. 87.1 ± 16.7 to 87.9 ± 15.7 mg · m−2 · min−1, P &lt; 0.02), which took place without altering insulin-stimulated glycogen synthase activity.
CONCLUSIONS—In glucose-tolerant first-degree relatives, treatment with troglitazone improved insulin sensitivity almost 50%, primarily due to increased glucose storage. It is suggested that the use of insulin action enhancers can be especially valuable in this group of subjects with a known high risk for developing type 2 diabetes.
Asp299Gly and Thr399Ile Genotypes of the TLR4 Gene Are Associated With a Reduced Prevalence of Diabetic Neuropathy in Patients With Type 2 Diabetes
Authors: Rudofsky Gottfried , Reismann Peter , Witte Steffen , Humpert Per M. , Isermann Berend , Chavakis Triantafyllos , Tafel Jörg , Nosikov Valery V. , Hamann Andreas , Nawroth Peter , Bierhaus Angelika 
Published: March 2007

OBJECTIVE—To establish whether single nucleotide polymorphisms (Asp299Gly and Thr399Ile) of the toll-like receptor 4 have an association with late diabetic complications.
RESEARCH DESIGN AND METHODS—The study was conducted in 246 type 1 and 530 type 2 diabetic patients. The alleles of both polymorphisms were detected using PCR and subsequent cleavage by NcoI and HinfI restriction endonucleases.
RESULTS—No difference was found between type 1 and type 2 diabetic patients in the prevalence of alleles of the Asp299Gly and Thr399Ile polymorphisms. In most cases, the alleles Gly299 and Ile399 occurred in a co-segregatory manner. The prevalence of the Gly299/Ile399 haplotype was 10.6 and 12.1% in type 1 and type 2 diabetic patients, respectively (P = 0.63). No association with diabetic nephropathy or diabetic neuropathy was found in type 1 diabetic patients. In type 2 diabetic patients, however, heterozygote carriers of the Asp299Gly and Thr399Ile genotypes had a significantly reduced prevalence of diabetic neuropathy (odds ratio 0.35 [95% CI 0.19–0.61]; P = 0.0002); no association with diabetic nephropathy was found.
CONCLUSIONS—Our data indicate that Asp299Gly and Thr399Ile genotypes of the TLR4 gene are associated with reduced prevalence of diabetic neuropathy in type 2, but not in type 1, diabetes. Thus different mechanisms may be involved in the pathophysiology of diabetic neuropathy in type 1 and type 2 diabetes.
Association Between Acute-Phase Reactants and Advanced Glycation End Products in Type 2 Diabetes
Authors: Tan Kathryn C.B. , Chow Wing-Sun , Tam Sidney , Bucala Richard , Betteridge John 
Published: March 2007

OBJECTIVE—Type 2 diabetes is associated with chronic low-grade inflammation, but the underlying mechanism(s) is not well understood. Because in vitro studies have shown that advanced glycation end products (AGEs) can trigger inflammatory responses, the present study has investigated whether serum concentration of AGEs is an important determinant of circulating levels of inflammatory markers, like C-reactive protein (CRP), in type 2 diabetic patients.
RESEARCH DESIGN AND METHODS—Diabetic patients (n = 210) and healthy control subjects (n = 110) of similar BMI were recruited. Serum AGEs were assayed by competitive enzyme-linked immunosorbent assay using a polyclonal rabbit anti-sera raised against AGE-RNase. Plasma high-sensitivity CRP was measured by an immunoturbidimetric assay and interleukin (IL)-6 by enzyme-linked immunosorbent assay.
RESULTS—Serum AGEs were increased in diabetic patients compared with control subjects (4.24 ± 0.88 vs. 3.15 ± 0.81 unit/ml, respectively, P &lt; 0.01). Both plasma CRP (1.55 [0.81–2.95] vs. 0.88 mg/dl [0.51–1.89], respectively, P &lt; 0.01; median [interquartile range]) and IL-6 (0.80 [0.68–0.97] vs. 0.69 pg/ml [0.48–0.84], respectively, P &lt; 0.01) were also higher in diabetic patients than in control subjects. In the diabetic patients, log(CRP) correlated with AGEs (r = 0.22, P = 0.002) and with log(IL-6) (r = 0.29, P &lt; 0.001). Forward stepwise linear regression analysis showed that BMI, log(IL-6), and AGEs were significant independent determinants of log(CRP) in the diabetic patients, accounting for 17, 12, and 10% of the variation in log(CRP), respectively.
CONCLUSIONS—Serum concentration of AGEs is increased in patients with diabetes and is an independent determinant of plasma CRP levels. Subclinical inflammation in these patients may therefore be partly due to activation of the inflammatory response by AGEs.
Favorable Effects of Pioglitazone and Metformin Compared With Gliclazide on Lipoprotein Subfractions in Overweight Patients With Early Type 2 Diabetes
Authors: Lawrence James M. , Reid Julia , Taylor Gordon J. , Stirling Chris , Reckless John P.D. 
Published: March 2007

OBJECTIVE—To compare effects of different oral hypoglycemic drugs as first-line therapy on lipoprotein subfractions in type 2 diabetes.
RESEARCH DESIGN AND METHODS—Sixty overweight type 2 diabetic patients not on lipid-lowering therapy were randomized to metformin, pioglitazone, or gliclazide after a 3-month dietary run-in. Drug doses were uptitrated for 3 months to optimize glycemia and were kept fixed for a further 3 months. LDL subfractions (LDL1, LDL2, and LDL3) were prepared by density gradient ultracentrifugation at randomization and study end. Triglycerides, cholesterol, total protein, and phospholipids were measured and mass of subfractions calculated. HDL subfractions were prepared by precipitation. The primary end point was change in proportion of LDL as LDL3.
RESULTS—HbA1c, triglycerides, glucose, and cholesterol were comparable across groups at baseline and over time. LDL3 mass and the LDL3-to-LDL ratio fell with pioglitazone (LDL3 mass 36.2 to 28.0 mg/dl, P &lt; 0.01; LDL3-to-LDL 19.2:13.3%, P &lt; 0.01) and metformin (42.7 to 31.5 mg/dl, P &lt; 0.01; 21.3:16.2%, P &lt; 0.01, respectively) with no change on gliclazide. LDL3 reductions were associated with reciprocal LDL1 increases. Changes were independent of BMI, glycemic control, and triglycerides. Total HDL cholesterol increased on pioglitazone (1.28 to 1.36 mmol/l, P = 0.02) but not gliclazide (1.39 to 1.37 mmol/l, P = NS) or metformin (1.26 to 1.18 mmol/l, P = NS), largely due to an HDL2 increase (0.3 to 0.4 mmol/l, P &lt; 0.05). HDL3 cholesterol fell on metformin (0.9 to 0.85 mmol/l, P &lt; 0.01). On pioglitazone and metformin, the HDL2-to-HDL3 ratio increased compared with no change on gliclazide.
CONCLUSIONS—For the same improvement in glycemic control, pioglitazone and metformin produce favorable changes in HDL and LDL subfractions compared with gliclazide in overweight type 2 diabetic patients. Such changes may be associated with reduced atherosclerosis risk and may inform the choice of initial oral hypoglycemic agent.