bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ten-Year Experience with an Exercise-Based Outpatient Life-Style Modification Program in the Treatment of Diabetes Mellitus
Authors: Schneider Stephen H , Khachadurian Avedis K , Amorosa Louis F , Clemow Lynn , Ruderman Neil B 
Published: March 2007

Exercise is frequently recommended in the treatment of diabetes mellitus. Nevertheless, its use has been limited in clinical practice, and concerns about safety and efficacy persist. We have reviewed a 10-yr experience with 255 patients enrolled in a comprehensive diabetes program that emphasized physical training.
A low maximal oxygen uptake () was found in patients with non-insulin-dependent diabetes mellitus compared with sedentary control subjects. This was not accounted for by autonomic neuropathy and is unlikely to be due to subtle differences in life-style. Exercise-related proteinuria was common and occurred in 29% of patients and was associated with higher blood pressure levels at rest and during exercise, impaired , and decreased R-R interval variation.
Regular exercise was associated with a modest decrease in resting and exercise blood pressure. Glycosylated hemoglobin levels and plasma triglycerides improved only in patients with non-insulin-dependent diabetes mellitus. Insulin requirements were significantly reduced in patients with insulin-dependent diabetes mellitus. Compliance for up to 3 mo in the program was acceptable but longer-term compliance was poor. Serious complications during the program were rare.
Our experience suggests a program of regular aerobic training can be safely and effectively used in an outpatient population with diabetes mellitus for up to 3 mo.
Epidemiology of Proliferative Diabetic Retinopathy
Authors: Klein Ronald , Klein Barbara E K , Moss Scot E 
Published: March 2007

OBJECTIVE
This review examines recent epidemiological data about the prevalence and incidence of and risk factors for proliferative diabetic retinopathy. In addition, the relation of proliferative retinopathy to other systemic complications associated with diabetes is reviewed.

RESEARCH DESIGN AND METHODS
The data come mostly from the baseline and 4-yr follow-up examinations of a large population-based study, the WESDR, which involved 996 younger-onset insulin-dependent people whose diabetes was diagnosed at &lt; 30 yr of age and 1370 older-onset people whose diabetes was diagnosed at ≥ 30 yr of age, and who were taking or not taking insulin.

RESULTS
The major finding is that proliferative retinopathy is a prevalent complication (23% in the WESDR younger-onset group, 10% in the WESDR older-onset group that takes insulin, and 3% in the group that does not take insulin). Hyperglycemia, longer duration of diabetes, and more severe retinopathy at baseline were associated with an increased 4-yr risk of developing proliferative retinopathy. However, higher blood pressure at baseline was associated only with the development of proliferative retinopathy in the younger-onset group. The presence of proliferative diabetic retinopathy was associated with an increased 4-yr risk of loss of vision, cardiovascular disease, diabetic nephropathy, and mortality. In the WESDR, a significant number of diabetic people with proliferative retinopathy at risk for vision loss were not under the care of an ophthalmologist or had not undergone panretinal photocoagulation.

CONCLUSIONS
These data suggest that hyperglycemia and, possibly, high blood pressure are related to proliferative retinopathy. They also suggest that once proliferative diabetic retinopathy is detected, people should have a medical evaluation, because it is a strong indicator for the presence and development of systemic disease. These data also indicate that diabetic patients and their physicians should be aware of the need for routine ophthalmological examinations to detect and treat proliferative retinopathy.
Metabolic Effects of New Oral Hypoglycemic Agent CS-045 in NIDDM Subjects
Authors: Suter Stephan L , Nolan John J , Wallace Penny , Gumbiner Barry , Olefsky Jerrold M 
Published: March 2007

Objective
— To study the metabolic effects of a new oral antidiabetic agent, CS-045, in subjects with non-insulin-dependent diabetes mellitus (NIDDM).

Research Design And Methods
— Eleven NIDDM subjects (mean age 59 yr and body mass index 32.3) were treated with 400 mg/day CS-045 for 6-12 wk. Patients were hospitalized before and at the end of the drug-treatment period for metabolic studies, including oral glucose tolerance test (OGTT), meal tolerance test (MTT), euglycemic glucose-clamp studies, and lipid analyses.

Results
— Eight subjects showed a marked clinical response to the drug, whereas 3 were nonresponders. The data were analyzed both for the total group and for the responders. Fasting plasma glucose (FPG) fell from 12.5 ± 0.7 to 10.7 ± 1.0 mM in the total group but fell more dramatically from 12.7 ± 0.5 to 8.3 ± 0.6 mM in the responder group. The area under the OGTT glucose curve improved by 17% in the total group and by 29% in the responders. The area under the MTT glucose curve improved by 38 and 52%, respectively. MTT levels of insulin, free fatty acids, and glucagon were significantly lower after treatment. Glucose disposal rates during glucose-clamp studies were increased in all subjects after CS-045 treatment. Mean increases were 63% at 120 mU · m−2 · min−1 and 41% at 300 mU · m−2 · min−1. Basal hepatic glucose production fell by 17% in the total group and by 28% in the responders.

Conclusions
— CS-045 improves insulin resistance, reduces insulinemia, lowers hepatic glucose production, and improves both fasting and postprandial glycemia in NIDDM subjects. CS-045 may represent a new therapeutic option for NIDDM.
Alterations in Glucose Metabolism During Menstrual Cycle in Women With IDDM
Authors: Widom Barbara , Diamond Michael P , Simonson Donald C 
Published: March 2007

Objective
— To examine the hormonal mechanisms underlying the variability in glycemic control during the different phases of the menstrual cycle in women with insulin-dependent diabetes mellitus (IDDM).

Research Design And Methods
— Hyperglycemic (11.7 ± 0.1 mM), hyperinsulinemic (24 ± 3 mU/L) clamp studies were performed in 16 women with IDDM during the follicular (day 8 ± 1) and luteal (day 23 ± 1) phases of the menstrual cycle. Seven of the patients (group 1) experienced worsening glucose control during the luteal phase, whereas nine patients (group 2) did not.

Results
— In group 1, glucose metabolism fell from 30.2 ± 3.8 μmol·kg−1·min−1 during the follicular phase to 24.5 ± 2.0 μmol·kg−1·min−1 during the luteal phase (P = 0.09), whereas in group 2 it increased from 18.5 ± 1.2 to 23.2 ± 2.3 μmol·kg−1·min−1 (P = 0.03). The decrease in glucose metabolism during the luteal phase in patients in group 1 was associated with a significant rise in the serum estradiol levels from the follicular to luteal phase (164 ± 39 vs. 352 ± 59 pM, P = 0.006), whereas this rise was not observed in group 2 (334 ± 156 vs. 423 ± 74 pM, NS). Changes in other reproductive hormones (progesterone, testosterone, dihydrotestosterone, androstenedione, luteinizing hormone, follicular-stimulating hormone, or prolactin) were not related to the differences in glucose uptake in the two groups.

Conclusions
— 1) Marked heterogeneity in glucose metabolism is seen throughout the menstrual cycle in women with IDDM, 2) a subgroup of patients exhibits worsening premenstrual hyperglycemia and a decline in insulin sensitivity during the luteal phase, and 3) the deterioration in glucose uptake in this subgroup was associated with a greater increment in estradiol levels from the follicular to the luteal phase.
Combination Therapy for NIDDM With Biosynthetic Human Insulin and Glyburide
Authors: Mezitis Nicholas H E , Heshka Stanley , Saitas Valerie , Bailey Timothy S , Costa Rafaella , Pi-Sunyer F Xavier 
Published: March 2007

Objective
To investigate the effects of the addition of glyburide to the regimen of insulin-treated non-insulin-dependent diabetes mellitus (NIDDM) patients with regard to their overall insulin requirement and dosage schedule and to assess persistence of these effects.

Research Design and Methods
A double-blind randomized parallel-group, placebo-controlled, 20-wk outpatient trial at the Clinical Research Unit (CRU) at St. Luke's/Roosevelt Hospital (New York). Subjects were 20 insulindependent NIDDM patients previously managed on insulin alone. After a baseline period of satisfactory diabetes control on biosynthetic human insulin alone, insulin dosage was halved, and patients were placed on a combination with either glyburide or placebo. Diabetes control equivalent to baseline was reestablished by adjusting insulin as required on subsequent visits to the CRU.

Results
Insulin requirements in the glyburide group decreased by 29 U at 14 wk compared with 9 U in the placebo group (P &lt; 0.05). At 20 wk, the decreases remained significant (25 vs. 11 U, respectively; P &lt; 0.05). The mean ± SD reduction in insulin requirement in the glyburide group was relatively constant (25 ± 10 U) and was not related to premedication insulin requirement. Successful response to glyburide was inversely correlated with initial serum alkaline phosphatase level.

Conclusions
Glyburide reduces insulin requirements for 20 wk of combination therapy in NIDDM patients. Patients whose initial insulin requirement is ≤25 U have a 50% chance of achieving equivalent glycemic control on glyburide alone.
Prevalence and Health-Care Features of Hyperglycemia in Semiurban-Rural Communities in Southern Saudi Arabia
Authors: Abu-Zeid Hassan A H , Al-Kassab Abdul Salam K 
Published: March 2007

Objective
To determine the prevalence of hyperglycemia in semiurban-rural Saudi Arabian communities and to assess some of its important health-care related aspects.

Research Design and Methods
A cluster of 12 villages near the city of Abha, the capital of the southern region in Saudi Arabia, with a total population of 2150 (290 families) has been included in this study. The family head was interviewed about diagnosed diabetes among family members. Also, the capillary blood glucose level was measured in subjects ≥ 10 yr (the target population, n = 1419) with a reflectance meter after 2-h fasting after the main midday meal.

Results
The 87% of the target population who responded for screening showed a prevalence of 4.6% of diabetes, which was higher among men (5.5%, age adjusted, P &lt;0.05) than among women (3.6%). Estimates were based on 57 cases ascertained by positive history of the disease (n = 49) or blood glucose level ≥ 11.1 mM (200 mg/dl) without previous diagnosis of diabetes (n = 8). The prevalence of impaired glucose tolerance (blood glucose between 7.8 (140 mg/dl) and 11.0 mM (199 mg/dl) with no history of diabetes) was 3.7%, being higher among women than among men (P &lt;0.01). Eighty-eight percent of the previously diagnosed cases were receiving treatment at the time of screening. However, in only 12.2% of those receiving treatment was glucose found to be controlled (level &lt;7.8 mM [140 mg/dl]).

Conclusions
Diabetes frequency in this Saudi community is relatively high. There is a pressing need to promote public awareness about the disease and to improve the competency of the health-care team for achieving better control and early detection of the disease.
Urinary Excretion of IGF-I and Growth Hormone in Children With IDDM
Authors: Quattrin Teresa , Albini Christine H , Reiter Edward O , Mills Barbara J , MacGillivray Margaret H 
Published: March 2007

Objective
To compare the urinary output of insulinlike growth factor I (IGF-I) and growth hormone (GH) in prepubertal and pubertal children with insulin-dependent diabetes mellitus (IDDM) versus nondiabetic subjects and to analyze the relationship between the urinary excretion of these peptides and degree of metabolic control.

Research Design and Methods
Group 1 included 30 IDDM patients who had had diabetes for 4.9 ± 0.7 yr and had normal renal function (mean age 11.6 ± 0.9 yr); group 2 consisted of 31 control subjects (mean age 9.2 ± 0.6 yr). Sensitive radioimmunoassays were used to measure IGF-I and GH in urine aliquots from 12-h timed overnight collections that had been dialyzed, concentrated 50-fold, and lyophilized.

Results
Significantly lower IGF-I and GH outputs per kilogram body weight per 12 h were observed in IDDM subjects compared with control subjects. When data were expressed per kilogram of body weight, no difference was observed between the urinary output of IGF-I and GH between prepubertal and pubertal subjects within group 1 or group 2. The prepubertal children had significantly lower HbA1 than the pubertal population; however, no correlation was found between urinary output of IGF-I or GH and HbA1. A positive correlation was observed between urinary IGF-I and GH (r = 0.85, P &lt; .001).

Conclusions
Patients with long-standing IDDM excrete significantly lower urinary levels of IGF-I and GH compared with normal subjects. Serial measurements of these peptides from onset of IDDM are needed to define whether the changes observed are present at diagnosis or are secondary to duration of disease.
Day-to-Day Variation of Blood Glucose and Insulin Responses in NIDDM Subjects After Starch-Rich Meal
Authors: Rasmussen Ole W , Gregersen Søren , Dørup Jens , Hermansen Kjeld 
Published: March 2007

Objective
To study day-to-day variation of postprandial blood glucose and insulin increments in non-insulin-dependent diabetes mellitus (NIDDM) subjects and to analyze intra- and interperson variance of response.

Research Design and Methods
Ten NIDDM subjects attending the outpatient clinic at Aarhus Kommunehospital were studied. The subjects ate three meals of 90 g of white bread, with 7 days between tests.

Results
Mean ± SD areas under the blood glucose response curve (above basal) over a 3-h period were 557 ± 60, 569 ± 74, and 565 ± 67 mM × 180 min (NS), and areas under the insulin-response curve were 3350 ± 448, 2815 ± 359 and 3551 ± 679 mU/L × 180 min (NS) on each of the three occasions. The 95% confidence intervals of blood glucose and insulin areas for the test meal repeated three times were 564 ± 120 mM × 180 min and 3240 ± 1645 mU/L } 180 min, respectively. Intra- and interperson components of variance were 25 vs. 75% (glucose) and 78 vs. 22% (insulin) of the total variance. The intraperson components of variance included all sources of variation other than between-person variation. There was no significant correlation between blood glucose and insulin response areas.

Conclusions
A valid estimate of the glycemic response in a single patient is obtained after a single meal. Because of the large between-person variation, paired data should preferably be used when comparing glycemic responses to different foods.
Erythrocyte Spermidine Levels in IDDM Patients
Authors: Seghieri Giuseppe , Gironi Alfredo , Mammini Piero , Alviggi Lorenzo , De Giorgio Lamberto A , Bartolomei Giancarlo , Ignesti Giovanni , Franconi Flavia 
Published: March 2007

Objectives
To evaluate whether erythrocyte levels of polyamines spermidine and spermine (expressed in nmol/ml packed erythrocytes [PRBCs]) are modified in insulin-dependent diabetes mellitus (IDDM) and are associated with the presence of retinopathy or nephropathy.

Research Design and Methods
We studied erythrocyte spermidine and spermine levels in 38 IDDM patients with or without persistent microalbuminuria (urinary albumin excretion rate [AER] between 20 and 200 μg/min), macroalbuminuria (AER &gt;200 μg/min), or retinopathy compared with 60 sex- and age-matched control subjects.

Results
Mean ± SD erythrocyte spermine content was similar in both diabetic (9.7 ± 5.5 nmol/ml PRBCs) and control (8.8 ± 3.5 nmol/ml PRBCs) subjects, whereas spermidine was higher in diabetic (19.1 ± 7.2 nmol/ml PRBCs) than in control (14.5 ± 4 nmol/ml PRBCs, P = 0.0007) subjects. Moreover, spermidine was significantly higher in the groups with microalbuminuria (n = 11, 22.5 ± 9.2 nmol/ml PRBCs) and macroalbuminuria (n = 4, 22.2 ± 5.7 nmol/ml PRBCs) than in both normoalbuminuric (n = 23, 16.9 ± 5.6 nmol/ml PRBCs) and control (F = 9.78, P = 0.0001) subjects, and correlated with log AER (r = 0.41, P = 0.009). Similarly, proliferative retinopathy was associated with a significant increase in spermidine (n = 5, 20 ± 7 nmol/ml PRBCs compared with control subjects [P = 0.0009]).

Conclusions
Our data suggest that erythrocyte spermidine content is increased in IDDM patients associated with both diabetic nephropathy and advanced retinopathy.
Vascular Endothelial Cell Antibodies in Diabetic Patients: Association With Diabetic Retinopathy
Authors: Jones David B , Wallace Robert , Frier Brian M 
Published: March 2007

Objectives
To determine the incidence of antiendothelial cell antibodies in diabetic patients with and without retinopathy.

Research Design and Methods
The study consisted of 70 insulin-dependent diabetic (IDDM) subjects, 36 non-insulin-dependent diabetic (NIDDM) subjects, and 40 nondiabetic control subjects. Blood samples were obtained from diabetic patients and control subjects and patients with background and proliferative retinopathy were identified.

Results
Vascular endothelial cell (VEC) antibodies were examined in the sera of 36 NIDDM subjects, 70 IDDM subjects, and 40 nondiabetic control subjects by indirect immunofluorescence. VEC antibodies were present in 5 of 40 (12%) control subjects, 7 of 23 (30%) newly diagnosed IDDM patients, 6 of 17 (35%) IDDM patients without retinopathy, 12 of 18 (67%) IDDM patients with background retinopathy (P &lt;0.05), and 9 of 12 (75%) IDDM patients with proliferative retinopathy (P &lt;0.01). Three of 13 (23%) NIDDM patients with retinopathy and 6 of 23 (26%) without retinopathy were VEC antibody positive. No associations were observed between the presence of VEC antibodies and either the quality of glycemic control or the duration of diabetes. A significant association between VEC antibodies and large-vessel disease was found in IDDM patients with retinopathy (P &lt;0.05).

Conclusions
Antibodies directed against vascular endothelial cells may play a role in the development of microvascular, and possibly macrovascular, disease in diabetes.
Accurate Estimation of Glomerular Filtration Rate in Diabetic Nephropathy From Age, Body Weight, and Serum Creatinine
Authors: Sampson Michael J , Drury Paul L 
Published: March 2007

Objective
To assess, in diabetic nephropathy, the accuracy of a method that estimates glomerular function with age, body weight, and serum creatinine as parameters.

Research Desihn and Methods
Glomerular filtration rate (GFR) was measured 57 times in 20 subjects with insulin-dependent diabetes mellitus and nephropathy with a single injection of 51Cr-EDTA. At the same time, the estimated creatinine clearance (ml/min) was calculated with the Cockroft-Gault formula
These values were then corrected for body surface area (1.73 m2).

Results
For GFR measurements &lt;100 ml · min−1 · 1.73 m−2 (n = 41), there was a strong positive correlation with the estimated creatinine clearance corrected for body surface area (r = 0.94, P &lt;0.0001). The slope of this regression line did not differ significantly from identity or the y-intercept from zero. On average, the Cockroft-Gault formula (corrected for body surface area) underestimated the GFR by only 3.1 ml·min−1·1.73 m−2 (9.7 SD).

Conclusions
This formula, corrected for body surface area, gives accurate estimates of GFR when GFR &lt;100 ml·min−1·1.73 m–2. This formula could be used with an acceptable degree of confidence when repeated isotope assessments of renal function in diabetic nephropathy are impracticable.
Early Infant Diet and Risk of IDDM in Blacks and Whites: A Matched Case-Control Study
Authors: Kostraba Jill N , Dorman Janice S , LaPorte Ronald E , Scott Fraser W , Steenkiste Ann R , Gloninger Margaret , Drash Allan L 
Published: March 2007

Objective
To investigate the role of early infant feeding in the development of insulin-dependent diabetes mellitus (IDDM) and to determine whether an association exists in both blacks and whites.

Resarch Design and Methods
Black and white diabetic subjects were recruited from the Allegheny County and Children's Hospital of Pittsburgh IDDM Registries. Extensive infant diet histories were obtained from the diabetic subjects and their nondiabetic siblings, who were used as nondiabetic control subjects. Each diabetic subject was matched outside his/her family to an unrelated nondiabetic control subject on birth order, birth year (± 2 yr), and race, which resulted in 211 case-control pairs with a mean birth year of 1967.

Results
In whites, diabetic subjects were less likely to have been breast-fed than control subjects (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.3, 0.9). Breast-feeding prevalence did not differ between black diabetic subjects and control subjects. Duration of overall and exclusive breast-feeding did not differ between diabetic and control subjects in the black and white cohorts. The following analyses, which examined whether the timing of the first breast milk substitute to which the infant was exposed differed between diabetic and control subjects, were conducted for exposure to any breast milk substitute and to breast milk substitutes that were cow's milk based. In whites, age at exposure to any breast milk substitutes and cow's milk-based substitutes were similar between diabetic and control subjects. In blacks, the first exposure to breast milk substitutes occurred significantly earlier for any substitute (5.1 vs. 11.9 wk, P = 0.02) and marginally earlier for cow's milk-based substitutes (3.9 vs. 8.5 wk, P = 0.07) in diabetic subjects compared with control subjects. The first exposure to breast milk substitutes was more likely to occur by 3 mo of age in black diabetic subjects compared with black control subjects (OR 3.3, 95% CI 1.1–10.0) after adjusting for maternal age at birth. The addition of breast-feeding status to the model only slightly weakened this association in blacks.

Conclusions
The analyses of this study cohort suggest that the observed protective effect of breast-feeding on the risk of IDDM may be related to differences in the age at exposure to breast milk substitutes in blacks but not in whites.
Elevated Proinsulin Levels Related to Islet Cell Antibodies in First-Degree Relatives of IDDM Patients
Authors: Spinas Giatgen A , Snorgaard Ole , Hartling Svend G , Oberholzer Martin , Berger Willi 
Published: March 2007

Objective
To assess whether proinsulin levels are elevated in first-degree relatives of insulin-dependent diabetes mellitus (IDDM) patients and whether there is a relationship between proinsulin levels and the occurrence of immunological markers.

Research Design and Methods
Fasting proinsulin concentrations were measured in 85 first-degree relatives (54 siblings, 20 parents, 11 children) of IDDM patients and in 90 age- and weight-matched control subjects with no family history of diabetes mellitus.

Results
Fasting proinsulin levels (median, 25th, and 75th percentiles) were 8 pM (range 3.2–14 pM) in first-degree relatives and 1.7 pM (range 1.7–4 pM) in control subjects (P &lt;0.0001). Proinsulin was significantly elevated in siblings (7.2 pM, range 3.8–15 pM; P &lt;0.0001), parents (9.8 pM, range 6.4–13 pM; P &lt;0.0001), and children (6.6 pM, range 1.8–12 pM, P = 0.04) compared with control subjects but without differences between these groups. Islet cell antibody positive (ICA+) IDDM relatives had significantly higher proinsulin levels than ICA- (16 pM; range 7.2–25 vs. 6.9 pM, range 3.1–12 pM; P = 0.02). There was no difference between individuals with and without insulin autoantibodies. No difference in proinsulin levels was observed if the relatives were subdivided according to HLA-DR sharing with the diabetic proband.

Conclusions
Fasting proinsulin concentrations were raised not only in siblings but also in parents and children of IDDM patients. Because proinsulin is more elevated in ICA+ than in ICA− subjects, increased proinsulin levels could reflect minor β-cell damage due to previous immunological attack.