bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for Foot Infections in Individuals With Diabetes
Authors: Lavery Lawrence A. , Armstrong David G. , Wunderlich Robert P. , Mohler M. Jane , Wendel Christopher S. , Lipsky Benjamin A. 
Published: May 2006

OBJECTIVE—To prospectively determine risk factors for foot infection in a cohort of people with diabetes.RESEARCH DESIGN AND METHODS—We evaluated then followed 1,666 consecutive diabetic patients enrolled in a managed care–based outpatient clinic in a 2-year longitudinal outcomes study. At enrollment, patients underwent a standardized general medical examination and detailed foot assessment and were educated about proper foot care. They were then rescreened at scheduled intervals and also seen promptly if they developed any foot problem.RESULTS—During the evaluation period, 151 (9.1%) patients developed 199 foot infections, all but one involving a wound or penetrating injury. Most patients had infections involving only the soft tissue, but 19.9% had bone culture–proven osteomyelitis. For those who developed a foot infection, compared with those who did not, the risk of hospitalization was 55.7 times greater (95% CI 30.3–102.2; P &lt; 0.001) and the risk of amputation was 154.5 times greater (58.5–468.5; P &lt; 0.001). Foot wounds preceded all but one infection. Significant (P &lt; 0.05) independent risk factors for foot infection from a multivariate analysis included wounds that penetrated to bone (odds ratio 6.7), wounds with a duration &gt;30 days (4.7), recurrent wounds (2.4), wounds with a traumatic etiology (2.4), and presence of peripheral vascular disease (1.9).CONCLUSIONS—Foot infections occur relatively frequently in individuals with diabetes, almost always follow trauma, and dramatically increase the risk of hospitalization and amputation. Efforts to prevent infections should be targeted at people with traumatic foot wounds, especially those that are chronic, deep, recurrent, or associated with peripheral vascular disease.
Physician and Nurse Use of Psychosocial Strategies in Diabetes Care
Authors: Peyrot Mark , Rubin Richard R. , Siminerio Linda M. ,   on behalf of the International DAWN Advisory Panel
Published: May 2006

OBJECTIVE—To determine the use of psychosocial strategies by health care providers in treating patients with diabetes and the factors associated with use of these strategies.
RESEARCH DESIGN AND METHODS—Cross-sectional survey of national samples of generalist and diabetes specialist physicians (n = 2,705) and nurses (n = 1,122) from the multinational study of Diabetes Attitudes, Wishes and Needs. Respondents were from 13 countries in Asia, Australia, Europe, and North America. Two psychosocial strategies were examined: provider psychosocial care, which provides psychosocial support by diabetes care providers to their own patients, and psychosocial specialist care, which refers diabetic patients to psychosocial specialists.
RESULTS—Compared with physicians, nurses perceived significantly higher prevalence and severity of psychosocial problems and used psychosocial strategies significantly more frequently, even though they rated their own psychosocial skills lower. Among both physicians and nurses, diabetes specialists were significantly more likely than generalists to utilize psychosocial strategies. Physicians and nurses used psychosocial strategies significantly more when they believed that more patients have psychosocial problems and that problems interfere more with diabetes control. Referral to psychosocial specialists was significantly more likely when physicians and nurses perceived that professional psychological resources were more available. There were substantial country differences in all factors studied. Compared with other countries, U.S. providers provided more psychosocial care themselves but were less likely to refer to psychosocial specialists.
CONCLUSIONS—Psychosocial strategies are important parts of the diabetes care provider repertoire; understanding their determinants may facilitate efforts to increase their use.
Prevalence and Risk Factors for Urinary Incontinence in Women With Type 2 Diabetes and Impaired Fasting Glucose
Authors: Brown Jeanette S. , Vittinghoff Eric , Lin Feng , Nyberg Leroy M. , Kusek John W. , Kanaya Alka M. 
Published: May 2006

OBJECTIVE—Diabetes is associated with increased risk of urinary incontinence. It is unknown whether women with pre-diabetes, or impaired fasting glucose (IFG), have increased prevalence of incontinence. We determined the prevalence of, and risk factors for, incontinence among U.S. women with diabetes and IFG.
RESEARCH DESIGN AND METHODS—The 2001–2002 National Health and Nutrition Examination Survey measured fasting plasma glucose and obtained information about diabetes and urinary incontinence among 1,461 nonpregnant adult women. Self-reported weekly or more frequent incontinence, both overall and by type (urge and stress), was our outcome.
RESULTS—Of the 1,461 women, 17% had diabetes and 11% met criteria for IFG. Prevalence of weekly incontinence was similar among women in these two groups (35.4 and 33.4%, respectively) and significantly higher than among women with normal fasting glucose (16.8%); both urge and stress incontinence were increased. In addition to well-recognized risk factors including age, weight, and oral estrogen use, two microvascular complications caused by diabetes, specifically macroalbuminuria and peripheral neuropathic pain, were associated with incontinence.
CONCLUSIONS—Physicians should be alert for incontinence, an often unrecognized and therefore undertreated disorder, among women with diabetes and IFG, in particular those with microvascular complications. The additional prospect of improvements in their incontinence may help motivate some high-risk women to undertake difficult lifestyle changes to reduce their more serious risk of diabetes and its sequelae.
Effect of Lowering LDL Cholesterol Substantially Below Currently Recommended Levels in Patients With Coronary Heart Disease and Diabetes
Authors: Shepherd James , Barter Philip , Carmena Rafael , Deedwania Prakash , Fruchart Jean-Charles , Haffner Steven , Hsia Judith , Breazna Andrei , LaRosa John , Grundy Scott , Waters David ,   for the Treating to New Targets Investigators
Published: May 2006

OBJECTIVE—The Treating to New Targets study showed that intensive lipid-lowering therapy with atorvastatin 80 mg/day provides significant clinical benefit beyond that afforded by atorvastatin 10 mg/day in patients with stable coronary heart disease (CHD). The objective of our study was to investigate whether similar benefits of high-dose intensive atorvastatin therapy can be achieved in patients with CHD and diabetes.
RESEARCH DESIGN AND METHODS—A total of 1,501 patients with diabetes and CHD, with LDL cholesterol levels of &lt;130 mg/dl, were randomized to double-blind therapy with either atorvastatin 10 (n = 753) or 80 (n = 748) mg/day. Patients were followed for a median of 4.9 years. The primary end point was the time to first major cardiovascular event, defined as death from CHD, nonfatal non–procedure-related myocardial infarction, resuscitated cardiac arrest, or fatal or nonfatal stroke.
RESULTS—End-of-treatment mean LDL cholesterol levels were 98.6 mg/dl with atorvastatin 10 mg and 77.0 mg/dl with atorvastatin 80 mg. A primary event occurred in 135 patients (17.9%) receiving atorvastatin 10 mg, compared with 103 patients (13.8%) receiving atorvastatin 80 mg (hazard ratio 0.75 [95% CI 0.58–0.97], P = 0.026). Significant differences between the groups in favor of atorvastatin 80 mg were also observed for time to cerebrovascular event (0.69 [0.48–0.98], P = 0.037) and any cardiovascular event (0.85 [0.73–1.00], P = 0.044). There were no significant differences between the treatment groups in the rates of treatment-related adverse events and persistent elevations in liver enzymes.
CONCLUSIONS—Among patients with clinically evident CHD and diabetes, intensive therapy with atorvastatin 80 mg significantly reduced the rate of major cardiovascular events by 25% compared with atorvastatin 10 mg.
The 11482G&gt;A Polymorphism in the Perilipin Gene Is Associated With Weight Gain With Rosiglitazone Treatment in Type 2 Diabetes
Authors: Kang Eun Seok , Cha Bong Soo , Kim Hyeong Jin , Kim Hae Jin , Kim So Hun , Hur Kyu Yeon , Lee Hyun Joo , Shim Wan Sub , Ahn Chul Woo , Lee Hyun Chul 
Published: May 2006

OBJECTIVE—The aim of this study was to examine the effects of perilipin gene (PLIN) polymorphisms on weight gain with rosiglitazone treatment in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—A total of 160 type 2 diabetic patients were treated with rosiglitazone (4 mg/day) for 12 weeks in addition to their previous medications, which were unchanged. Four single nucleotide polymorphisms (SNPs) at the PLIN locus were genotyped: PLIN 6209T&gt;C, PLIN 11482G&gt;A, PLIN 13041A&gt;G, and PLIN 14995A&gt;T.
RESULTS—Although fasting plasma glucose and HbA1c levels decreased; mean body weight increased significantly after rosiglitazone treatment. Among the four SNPs tested, only the PLIN 11482G&gt;A polymorphism was associated with weight gain from rosiglitazone treatment. In addition, there was a significant difference in the increase in the body weight among the genotypes. Patients with the 11482A/A genotype showed less increase in body weight than those with other genotypes.
CONCLUSIONS—These data suggest that genetic variations in the perilipin gene can affect weight gain associated with rosiglitazone treatment in patients with type 2 diabetes.
Prevalence of Diabetes Complications in Adolescents With Type 2 Compared With Type 1 Diabetes
Authors: Eppens Maike C. , Craig Maria E. , Cusumano Janine , Hing Stephen , Chan Albert K.F. , Howard Neville J. , Silink Martin , Donaghue Kim C. 
Published: May 2006

OBJECTIVE—To compare the prevalence of diabetes complications and their risk factors in youth with type 1 versus type 2 diabetes.
RESEARCH DESIGN AND METHODS—We performed a comparative clinic-based study of 1,433 patients with type 1 diabetes and 68 patients with type 2 diabetes aged &lt;18 years from New South Wales, Australia. Retinopathy was assessed by seven-field stereoscopic retinal photography; albumin excretion rate from three consecutive, timed, overnight urine collections; peripheral neuropathy by thermal and vibration threshold; and autonomic neuropathy by pupillometry. HbA1c (A1C) and lipids were measured in all patients and C-peptide in patients with type 2 diabetes.
RESULTS—In patients with type 1 versus type 2 diabetes, median (interquartile range) age was 15.7 years (13.9–17.0) and 15.3 years (13.6–16.4), respectively (P = 0.2), whereas median diabetes duration was 6.8 years (4.7–9.6) and 1.3 years (0.6–3.1), respectively (P &lt; 0.0001). Retinopathy was significantly more common in patients with type 1 diabetes (20 vs. 4%, P = 0.04), while microalbuminuria and hypertension were significantly less common (6 and 16% in type 1 diabetes vs. 28 and 36% in type 2 diabetes). Rates of peripheral and autonomic neuropathy were similar (27 and 61% in type 1 diabetes vs. 21 and 57% in type 2 diabetes). In multivariate analyses, microalbuminuria was significantly associated with older age (odds ratio 1.3 [95% CI 1.2–1.5], P &lt; 0.001) and systolic hypertension (3.63 [2.0–6.3], P &lt; 0.001) in type 1 diabetes, while only higher A1C (1.7 [1.3–2.9], P = 0.002) was significant in patients with type 2 diabetes.
CONCLUSIONS—Youth with type 2 diabetes have significantly higher rates of microalbuminuria and hypertension than their peers with type 1 diabetes, despite shorter diabetes duration and lower A1C. The results of this study support recommendations for early complications screening and aggressive targeting of glycemic control in patients with type 2 diabetes.
Health Care and Patient-Reported Outcomes
Authors: Rubin Richard R. , Peyrot Mark , Siminerio Linda M. ,   on behalf of the International DAWN Advisory Panel
Published: May 2006

OBJECTIVE—The purpose of this study was to assess the relationship of patients’ self-reported well-being, self-management, and diabetes control with factors related to the patient’s health care.
RESEARCH DESIGN AND METHODS—This was a cross-sectional survey of national samples of patients with diabetes (n = 5,104) from the multinational study of Diabetes Attitudes, Wishes and Needs (DAWN). Patients from 13 countries in Asia, Australia, Europe, and North America reported their level of well-being, self-management, and diabetes control. Hierarchical multiple regression analysis (blocks are countries, respondent characteristics, and health care features) was used to examine predictors of diabetes-related distress and general well-being, adherence to lifestyle and medical treatment recommendations, and perceived diabetes control and hyperglycemic symptoms.
RESULTS—Country, respondent demographic and disease characteristics, and health care features were all associated with patient-reported outcomes. Better patient-provider collaboration was associated with more favorable ratings on all outcomes, and better access to the provider and availability of team care were associated with some positive outcomes. Country differences were only partly accounted for by patient and health care factors. Relationships between health care factors and outcomes varied across countries.
CONCLUSIONS—Patients’ reports of well-being, self-management, and diabetes control were related to the countries in which they live, their demographic and disease characteristics, and features of their health care. Opportunities to enhance patient-provider collaboration, access to care, and availability of team care should be pursued.
Perilipin Gene Variation Determines Higher Susceptibility to Insulin Resistance in Asian Women When Consuming a High–Saturated Fat, Low-Carbohydrate Diet
Authors: Corella Dolores , Qi Lu , Tai E. Shyong , Deurenberg-Yap Mabel , Tan Chee Eng , Chew Suok Kai , Ordovas Jose M. 
Published: May 2006

OBJECTIVE—To investigate the association between genetic variation in the adipocyte protein perilipin (PLIN) and insulin resistance in an Asian population as well as to examine their modulation by macronutrient intake.RESEARCH DESIGN AND METHODS—A nationally representative sample (Chinese, Malays, and Indians) was selected in the Singapore National Health Survey following the World Health Organization–recommended model for field surveys of diabetes. A total of 1,909 men and 2,198 women (aged 18–69 years) were studied. Genetic (PLIN 11482G→A and 14995A→T), lifestyle, clinical, and biochemical data were obtained. Homeostasis model assessment of insulin resistance (HOMA-IR) was used to evaluate insulin resistance. Diet was measured by a validated food frequency questionnaire in one of every two subjects.RESULTS—We did not find a significant between-genotype difference in insulin resistance measures. However, in women we found statistically significant gene-diet interactions (recessive model) between PLIN 11482G→A/14995A→T polymorphisms (in high linkage disequilibrium) and saturated fatty acids (SFAs; P = 0.003/0.005) and carbohydrate (P = 0.004/0.012) in determining HOMA-IR. These interactions were in opposite directions and were more significant for 11482G→A, considered the tag polymorphism. Thus, women in the highest SFA tertile (11.8–19%) had higher HOMA-IR (48% increase; P trend = 0.006) than women in the lowest (3.1–9.4%) only if they were homozygotes for the PLIN minor allele. Conversely, HOMA-IR decreased (−24%; P trend = 0.046) as carbohydrate intake increased. These effects were stronger when SFAs and carbohydrate were combined as an SFA-to-carbohydrate ratio. Moreover, this gene-diet interaction was homogeneously found across the three ethnic groups.CONCLUSIONS—PLIN 11482G→A/14995A→T polymorphisms modulate the association between SFAs/carbohydrate in diet and insulin resistance in Asian women.
Prevalence of Diabetes and Impaired Fasting Glucose in Adults in the U.S. Population
Authors: Cowie Catherine C. , Rust Keith F. , Byrd-Holt Danita D. , Eberhardt Mark S. , Flegal Katherine M. , Engelgau Michael M. , Saydah Sharon H. , Williams Desmond E. , Geiss Linda S. , Gregg Edward W. 
Published: May 2006

OBJECTIVE—The purpose of this study was to examine the prevalences of diagnosed and undiagnosed diabetes, and impaired fasting glucose (IFG) in U.S. adults during 1999–2002, and compare prevalences to those in 1988–1994.
RESEARCH DESIGN AND METHODS—The National Health and Nutrition Examination Survey (NHANES) contains a probability sample of adults aged ≥20 years. In the NHANES 1999–2002, 4,761 adults were classified on glycemic status using standard criteria, based on an interview for diagnosed diabetes and fasting plasma glucose measured in a subsample.
RESULTS—The crude prevalence of total diabetes in 1999–2002 was 9.3% (19.3 million, 2002 U.S. population), consisting of 6.5% diagnosed and 2.8% undiagnosed. An additional 26.0% had IFG, totaling 35.3% (73.3 million) with either diabetes or IFG. The prevalence of total diabetes rose with age, reaching 21.6% for those aged ≥65 years. The prevalence of diagnosed diabetes was twice as high in non-Hispanic blacks and Mexican Americans compared with non-Hispanic whites (both P &lt; 0.00001), whereas the prevalence of undiagnosed diabetes was similar by race/ethnicity, adjusted for age and sex. The prevalence of diagnosed diabetes was similar by sex, but prevalences of undiagnosed diabetes and IFG were significantly higher in men. The crude prevalence of diagnosed diabetes rose significantly from 5.1% in 1988–1994 to 6.5% in 1999–2002, but the crude prevalences were stable for undiagnosed diabetes (from 2.7 to 2.8%) and IFG (from 24.7 to 26.0%). Results were similar after adjustment for age and sex.
CONCLUSIONS—Although the prevalence of diagnosed diabetes has increased significantly over the last decade, the prevalences of undiagnosed diabetes and IFG have remained relatively stable. Minority groups remain disproportionately affected.
Iron Intake and the Risk of Type 2 Diabetes in Women
Authors: Rajpathak Swapnil , Ma Jing , Manson JoAnn , Willett Walter C. , Hu Frank B. 
Published: May 2006

OBJECTIVE—Epidemiological studies suggest that high body iron stores are associated with insulin resistance and type 2 diabetes. The aim of this study was to evaluate the association between dietary intake of iron and the risk of type 2 diabetes.RESEARCH DESIGN AND METHODS—We conducted a prospective cohort study within the Nurses’ Health Study. We followed 85,031 healthy women aged 34–59 years from 1980 to 2000. Dietary data were collected every 4 years, and data on medical history and lifestyle factors were updated biennially.RESULTS—During the 20 years of follow-up, we documented 4,599 incident cases of type 2 diabetes. We found no association between total, dietary, supplemental, or nonheme iron and the risk of type 2 diabetes. However, heme iron intake (derived from animal products) was positively associated with risk; relative risks (RRs) across increasing quintiles of cumulative intake were 1.00, 1.08 (95% CI 0.97–1.19), 1.20 (1.09–1.33), 1.27 (1.14–1.41), and 1.28 (1.14–1.45) (Ptrend &lt; 0.0001) after controlling for age, BMI, and other nondietary and dietary risk factors. In addition, when we modeled heme iron in seven categories, the multivariate RR comparing women who consumed ≥2.25 mg/day and those with intake &lt;0.75 mg/day was 1.52 (1.22–1.88). The association between heme iron and the risk of diabetes was significant in both overweight and lean women.CONCLUSIONS—This large cohort study suggests that higher heme iron intake is associated with a significantly increased risk of type 2 diabetes.
Relations Between Carotid Artery Wall Thickness and Liver Histology in Subjects With Nonalcoholic Fatty Liver Disease
Authors: Targher Giovanni , Bertolini Lorenzo , Padovani Roberto , Rodella Stefano , Zoppini Giacomo , Zenari Luciano , Cigolini Massimo , Falezza Giancarlo , Arcaro Guido 
Published: May 2006

OBJECTIVE—Nonalcoholic fatty liver disease (NAFLD) is closely associated with several metabolic syndrome features. We assessed whether NAFLD is associated with carotid artery intima-media thickness (IMT) as a marker of subclinical atherosclerosis and whether such an association is independent of classical risk factors, insulin resistance, and metabolic syndrome features.
RESEARCH DESIGN AND METHODS—We compared carotid IMT, as assessed by ultrasonography, in 85 consecutive patients with biopsy-proven NAFLD and 160 age-, sex-, and BMI-matched healthy control subjects.
RESULTS—NAFLD patients had a markedly greater carotid IMT (1.14 ± 0.20 vs. 0.82 ± 0.12 mm; P &lt; 0.001) than control subjects. The metabolic syndrome (according to Adult Treatment Panel III criteria) and its individual components were more frequent in those with NAFLD (P &lt; 0.001). The marked differences in carotid IMT observed between the groups were only slightly weakened after adjustment for age, sex, BMI, smoking history, LDL cholesterol, insulin resistance (by homeostasis model assessment), and metabolic syndrome components. Notably, carotid IMT was strongly associated with degree of hepatic steatosis, necroinflammation, and fibrosis among NAFLD patients (P &lt; 0.001 for all). Similarly, by logistic regression analysis, the severity of histological features of NAFLD independently predicted carotid IMT (P &lt; 0.001) after adjustment for all potential confounders.
CONCLUSIONS—These results suggest that the severity of liver histopathology among NAFLD patients is strongly associated with early carotid atherosclerosis, independent of classical risk factors, insulin resistance, and the presence of metabolic syndrome.
Lifestyle Intervention for Pre-Diabetic Neuropathy
Authors: Smith A. Gordon , Russell James , Feldman Eva L. , Goldstein Jonathan , Peltier Amanda , Smith Sheldon , Hamwi Jouhaina , Pollari Donald , Bixby Billie , Howard James , Singleton J. Robinson 
Published: May 2006

OBJECTIVE—The purpose of this study was to evaluate intraepidermal nerve fiber density (IENFD) as a sensitive measure of neuropathy change in patients with neuropathy associated with impaired glucose tolerance (IGT) receiving lifestyle intervention based on that used in the Diabetes Prevention Program.
RESEARCH DESIGN AND METHODS—We performed 3-mm skin biopsies with measurement of IENFD at the distal leg and proximal thigh at baseline and after 1 year in 32 subjects with IGT. Each received individualized diet and exercise counseling as a standard of care. Nerve conduction studies, quantitative sensory testing, quantitative sudomotor axon reflex testing, and the Michigan Diabetic Neuropathy score were performed, and a visual analog pain scale was completed. Two-hour oral glucose tolerance tests (OGTTs) following the American Diabetes Association guidelines were performed, and serum lipid levels were measured at baseline and 1 year later.
RESULTS—Baseline distal IENFD was 0.9 ± 1.2 fibers/mm and proximal IENFD was 4.8 ± 2.3 fibers/mm. Baseline distal IENFD correlated with fasting glucose (P &lt; 0.001) and OGTT (P &lt; 0.01). After 1 year of treatment, there was a 0.3 ± 1.1-fiber/mm improvement in distal IENFD and a 1.4 ± 2.3-fiber/mm improvement in proximal IENFD (P &lt; 0.004). The change in proximal IENFD correlated with decreased neuropathic pain (P &lt; 0.05) and a change in sural sensory amplitude (P &lt; 0.03).
CONCLUSIONS—These findings indicate that diet and exercise counseling for IGT results in cutaneous reinnervation and improved pain. Skin biopsy was the most sensitive measure of neuropathy change over 1 year. IENFD should be included as an end point in future neuropathy trials.