bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microalbuminuria: Invalidity of Simple Concentration-Based Screening Tests for Early Nephropathy Due to Urinary Volumes of Diabetic Patients
Authors: Kouri Timo T , Viikari Jorma S A , Mattila Kari S , Irjala Kerttu M A 
Published: March 2007

Objective
To evaluate the possibility of replacing quantitative albumin excretion rate (AER) measurements with rapid screening tests for microalbuminuria.

Research Design and Methods
Dipstick-negative specimens from 363 consecutive insulin-dependent diabetes mellitus (IDDM) and 46 non-insulin-dependent diabetes mellitus (NIDDM) patients from primary-care and hospital clinics (11% inpatients) within the district of Turku University Hospital were studied. Albumin concentrations and 12-h nightly excretion rates (N-AER) were measured by nephelometry (sensitivity 2 mg∕L).

Results
An increased N-AER (&gt; 15 μgrams∕min) was seen in 99 IDDM (27%) and 15 NIDDM (33%) patients. The median urinary volume was 900 ml∕12 h, with a maximum of 3000 ml. At the level of 20 mg albumin∕L, the sensitivity to detect elevated N-AER was 70% among IDDM patients and 60% among NIDDM patients. At a lower albumin concentration of 10 mg∕L, the sensitivities were increased to 91 and 87% in IDDM and NIDDM patients, respectively, but the specificities were reduced to 77 and 71% respectively.

Conclusions
To evaluate incipient nephropathy, we recommend quantitative measurements of N-AER from timed urine collections only. Dipstick tests are either insensitive or nonspecific.
Psychological Responses of Obese Type II Diabetic Subjects to Very-Low-Calorie Diet
Authors: Wing Rena R , Marcus Marsha D , Blair Elaine H , Burton Lisa R 
Published: March 2007

Objective
Very-low-calorie diets have been shown to produce dramatic improvements in glycemic control in obese subjects with non-insulin-dependent (type II) diabetes. There have been no studies of the psychological responses of diabetic subjects to these diets.

Research Design and Methods
This study examined changes in hunger, depression, and anxiety in 33 obese type II diabetic subjects who were randomly assigned to behavior modification programs that used either a balanced diet of 4185–6277 J∕day (1000–1500 cal∕day) throughout or included an 8-wk period of a very-low-calorie diet (1674 J∕day or 400 cal∕day of lean meat, fish, or fowl). Subjects completed the Beck Depression Inventory, the Spielberger State Anxiety Questionnaire, and self-report measures of hunger frequently throughout the 20-wk program.

Results
Both groups experienced significant improvements in depressive symptomatology, anxiety, and lessening of hunger during the course of the program, with no significant differences observed between the balanced diet and the very-low-calorie diet groups.

Conclusions
Very-low-calorie diets, used in the context of a behavioral weight-control program, result in reductions in hunger and improvements in mood state comparable to those observed on more moderate weight-loss regimens.
Hypoglycemic Symptoms and Frequency of Severe Hypoglycemia in Patients Treated With Human and Animal Insulin Preparations
Authors: Mühlhauser Ingrid , Heinemann Lutz , Fritsche Esther , von Lennep Katja , Berger Michael 
Published: March 2007

Objectives
To compare hypoglycemic warning symptoms (main objective) and incidence of severe hypoglycemia (secondary objective) between patients treated with animal and human insulin preparations.

Research Design And Methods
Two hundred forty-seven patients on treatment with animal insulin preparations and 276 patients on human insulins, matched for duration of diabetes (16 ± 11 vs. 15 ± 10 yr), were recruited for the study. Patients were interviewed with a standardized questionnaire.

Results
When asked which symptom usually occurs first during hypoglycemia, 19% of the animal insulin group and 22% of the human insulin group answered “sweating,” 19 and 17%, respectively, answered “trembling,” and 15 and 11%, respectively, answered “unrest.” According to the patients' perception, in both groups, their most reliable hypoglycemic warning symptoms were “trembling” (26 and 22%) and “sweating” (15 and 18%). Six and eight percent of patients, respectively, reported hypoglycemia unawareness and 17 and 18%, respectively, impaired awareness of hypoglycemia. The incidence of severe hypoglycemia was 0.45 cases/patient-yr in patients treated with animal insulins and 0.46 cases/patient-yr in patients treated with human insulin preparations. The differences were not statistically significant.

Conclusions
This study shows that hypoglycemic warning symptoms and the incidence of severe hypoglycemia are comparable between patients on treatment with human and animal insulin preparations.
Care of Diabetic Pregnant Women by Primary-Care Physicians: Reported Strategies for Managing Pregestational and Gestational Diabetes
Authors: Marrero David G , Moore Patricia , Langefeld Carl D , Golichowski Alan , Clark Charles M 
Published: March 2007

Objective
—To ascertain the strategies used by primary-care physicians for treating pregestational and gestational diabetes mellitus (GDM) during pregnancy, because many women with pregnancies complicated by these types of diabetes are treated by physicians who have no special training in intensive diabetes management.

Research Design and Methods
—Two hundred twenty-four family-practice (FP) physicians and 184 obstetrics/gynecology (OB/GYN) physicians were surveyed by mail.

Results
—When compared with OB/GYNs, FPs were less likely to screen all pregnant women for GDM (P = 0.03), use multiple-injection insulin regimens (P = 0.004) or self-monitoring of blood glucose (SMBG) (P = 0.01) for Pre-GDM patients, and refer these patients to a specialist for medical (P = 0.01) or ophthalmologic (P &lt; 0.001) care. FPs were more likely to implement insulin therapy (P = 0.003), SMBG (P = 0.02), and examine eyes for retinopathy (P &lt; 0.001) when treating gestational patients.

Conclusions
—These data show that there are considerable discrepancies between the strategies used by FPs and OB/GYNs and also suggest that physicians in both groups are under-utilizing recommended treatment strategies described in publications targeted specifically to primary-care physicians. Increased exposure to and dissemination of guidelines for diabetes management and additional medical school and postgraduate education programs are recommended as methods to improve utilization of these strategies.
Double-Blind Randomized Trial of Nicotinamide on Early-Onset Diabetes
Authors: Lewis Cynthia M , Canafax Damiel M , Sprafka J Michael , Barbosa Jose J 
Published: March 2007

Objective
—To determine the efficacy of nicotinamide in inducing remission in early-onset insulin-dependent diabetes mellitus.

Research Design and Methods
—This study was a double-blind, randomized clinical trial.

Results
—Nicotinamide failed to induce remission or differences on β-cell secretion between the two groups.
Effect of Conventional and Intensified Insulin Therapy on Free-Insulin Profiles and Glycemic Control in NIDDM
Authors: Lindström Torbjörn H , Arnqvist Hans J , Schenck Henning H von 
Published: March 2007

Objective
–To investigate the effects on 24-h insulin and glucose profiles of two- and four-dose insulin regimens in patients with non-insulin-dependent diabetes mellitus (NIDDM) who have failed oral agent therapy.

Research Design and Methods
–Ten patients with NIDDM and 10 matched nondiabetic control subjects took part in the study, a randomized crossover trial with 8-wk treatment periods. We determined 24-h profiles of blood glucose and free insulin in control subjects and patients when they were taking oral agents and at the end of each treatment period. The two-dose regimen was mixed (15% regular, 85% NPH) insulin given before breakfast and dinner, and the four-dose regimen was regular insulin given before meals and NPH given at 2200.

Results
–Patients taking oral agents had higher mean blood glucose than control subjects (mean ± SE 12.6 ± 0.6 vs. 4.5 ± 0.1 mM, P &lt; 0.0001) and similar 24-h insulin concentrations but lower postprandial insulin concentrations (at breakfast, 87.6 ± 13.8 vs. 228.6 ± 29.4 pM, P &lt; 0.01). Mean 24-h insulin concentrations were the same on two- and four-dose regimens, and both regimens caused basal hyperinsulinemia. Glycemic control also improved. Postprandial insulin peaks were higher at lunch and dinner on the four-dose regimen, and postprandial blood glucose was lower. Fasting proinsulin was elevated in patients compared with the control subjects (25.1 ± 4.7 pM vs. 5.0 ± 0.9 pM, P &lt; 0.001) and was suppressed to normal during insulin treatment.

Conclusions
–Two- and four-dose insulin regimens can achieve similar glycemic control. Both regimens cause basal hyperinsulinemia but normalize the hyperproinsulinemia observed during failure of oral agent therapy. Four-dose insulin regimens offer few advantages to the glycemic control achieved with two-dose regimens but may be more physiological.
Inhibitory Effect of Circulating Insulin on Glucagon Secretion During Hypoglycemia in Type I Diabetic Patients
Authors: Liu Dating , Adamson Ule C K , Lins Per-Eric S , Kollind Magnus E , Moberg Erik A R , Andréasson Karin 
Published: March 2007

Objective
–To clarify whether the circulating insulin level influences hormonal responses, glucagon secretion in particular, during hypoglycemia in patients with insulin-dependent (type I) diabetes.

Research Design and Methods
–Nine type I diabetic patients were studied. During two separate experiments, hypoglycemia was induced by low-dose (244 pmol.kg−1.h−1) and high-dose (1034 pmol.kg−1.h−1) intravenous insulin infusions for 180 min in each case. The arterial blood glucose level was directly monitored every 1.5 min, and glucose was infused in the high-dose test to clamp the arterial blood glucose level to be identical as in the low-dose test.

Results
–Despite the fact that the plasma insulin level was four times higher in the high-dose than in the low-dose test (740 ± 50 vs. 180 ± 14 pM), a close to identical arterial hypoglycemia of ∼ 3.3 mM was obtained in the two experiments. During hypoglycemia, a significant rise of the plasma glucagon level was found only in the low-dose test (188 ± 29 vs. 237 ± 37 ng/L, P &lt; 0.05), and the incremental area under the glucagon curve was significantly greater in the low-dose than in the high-dose test (140 ± 19 vs. −22.7 ± 34 ng/L.h−1, P &lt; 0.005). The responses of plasma epinephrine, norepinephrine, growth hormone, pancreatic polypeptide, and somatostatin were similar in both tests and, consequently, were not significantly modified by the circulating insulin level.

Conclusions
–This study demonstrates that, in type I diabetic patients, the glucagon response to hypoglycemia is suppressed by a high level of circulating insulin within the physiological range. Our findings may help to explain the impairment of glucagon secretion during hypoglycemia frequently seen in these patients.
Permanent Diabetes Without Serological Evidence of Autoimmunity After Transient Neonatal Diabetes
Authors: Gottschalk Michael E , Schatz Desmond A , Clare-Salzler Michael , Kaufman Daniel L , Ting Grace S P , Geffner Mitchell E 
Published: March 2007

OBJECTIVE
To describe a probable association between TNDM and subsequent permanent IDDM.

RESEARCH DESIGN AND METHODS
A longitudinal follow-up of a single case from birth to 12 yr of age was conducted analyzing sequential OGTTs, ICAs, AIAs, anti-GAD antibodies, and other organ-specific and nonspecific antibodies.

RESULTS
A small-for-gestational-age infant developed hyperglycemia at 20 h of age and required insulin therapy for the 1st 14 wk of life (TNDM). Transient hyperglycemia and ketonuria were noted again at age 2 yr 10 mo during an intercurrent illness, but OGTT was normal; and ICA, AIA, anti-GAD65 and anti-GAD67 antibodies, antithyroid microsomal, anti-gastric parietal cell, antiadrenal, antisteroidal, and antinuclear antibodies were negative 3 wk later. At age 9 yr, hyperglycemia returned and persisted in the setting of hypoinsulinemia; ICA, AIA, anti-GAD65 and anti-GAD67 antibodies, and other organ-specific and nonspecific antibodies were again negative. Insulin therapy was initiated and has been maintained over 3 yr of follow-up.

CONCLUSIONS
Our case is the fifth reported with permanent diabetes occurring after resolution of TNDM. The etiology of permanent diabetes in this setting is unknown but, unlike classical IDDM, appears unrelated to autoimmunity in our patient. The true frequency of this association remains unknown.
Greater Effect of Glycemia on Incidence of Hypertension in Women Than in Men
Authors: Haffner Steven M , Valdez Rodolfo , Morales Philip A , Mitchell Braxton D , Hazuda Helen P , Stern Michael P 
Published: March 2007

OBJECTIVE
In subjects with NIDDM, diabetic women have a greater relative excess of CHD relative to nondiabetic women than do diabetic men relative to nondiabetic men. This excess in diabetic women is explained partially by the particularly atherogenic pattern of lipoproteins in this group. We hypothesize that diabetic women also may have a higher incidence of hypertension than diabetic men.

RESEARCH DESIGN AND METHODS
We examined the effect of NIDDM and IGT relative to NGT on the incidence of hypertension separately in men (n = 844) and women (n = 618) in the 8-yr follow-up of the San Antonio Heart Study, a population-based study of diabetes and cardiovascular disease.

RESULTS
Women had a greater risk of hypertension with worsening glucose tolerance (RR NIDDM/NGT = 2.65 and RR IGT/NGT = 1.94) compared with men (RR NIDDM/NGT = 1.61 and RR IGT/NGT = 0.91). Controlling for other possible confounding variables such as age, obesity, body fat distribution, and fasting insulin concentration did not alter the interaction of sex and glycemia on incidence of hypertension.

CONCLUSIONS
The especially increased risk of hypertension in women with abnormal glucose tolerance may explain partly the high risk of CHD in this group.
High Incidence Rate of IDDM in Sardinia
Authors: Muntoni Sergio , Songini Marco 
Published: March 2007

OBJECTIVE
To provide reliable data on the incidence of IDDM in Sardinia and contribute to a better understanding of its geographical variability throughout Europe.

RESEARCH DESIGN AND METHODS
All newly diagnosed cases of IDDM with onset &lt; 30 yr of age between 1 January 1989 and 31 December 1990 among residents in Sardinia were recorded. Primary ascertainment was based on notification by all Sardinian hospitals, outpatient clinics, family doctors, and pediatricians. The local IDDM patient association served as the secondary and independent source.

RESULTS
The completeness of ascertainment was 92.8%. The annual incidence rate of IDDM (per 100,000) over the 2-yr period was 30.7 in the 0–14–yr-old age-group and 24.1 in the entire 0–29–yr-old range, respectively, with no significant differences between the two groups. Male/female ratios were 1.25 and 1.55, respectively. No significant seasonal variation in incidence was observed.

CONCLUSIONS
Sardinia appears to have the second-highest IDDM incidence rate in Europe after Finland, and the island contradicts the generally accepted rule of a south-to-north incidence gradient.
Metabolic Effects of Dietary Fructose in Diabetic Subjects
Authors: Bantle John P , Swanson Joyce E , Thomas William , Laine Dawn C 
Published: March 2007

OBJECTIVE
To assess the metabolic effects of chronic dietary fructose consumption in diabetic subjects.

RESEARCH DESIGN AND METHODS
Six type I and 12 type II diabetic subjects consumed, in random order, two isocaloric study diets for 28 days. In one diet, 20% of energy was derived from fructose. In the other diet, &lt;3% of energy came from fructose, and carbohydrate energy was derived primarily from starch. Both study diets were composed of common foods. All meals were prepared in a metabolic kitchen where all foods were weighed during meal preparation.

RESULTS
Mean plasma glucose, urine glucose, and serum glycosylated albumin values were lower during the fructose diet than during the starch diet, but the differences achieved only marginal statistical significance. The day-28 value for mean plasma glucose was 12.5% lower (P = 0.03) during the fructose diet than during the starch diet. At days 14, 21, and 28, fasting serum cholesterol and LDL cholesterol were both significantly higher during the fructose diet than during the starch diet. The day-28 values for serum cholesterol and LDL cholesterol during the fructose diet were 6.9% (P = 0.008) and 10.9% (P = 0.002) higher, respectively, than the corresponding values during the starch diet. No differences were observed between the study diets in fasting serum HDL cholesterol, fasting serum triglycerides, peak postprandial serum triglycerides, or fasting serum lactate. Peak postprandial serum lactate was significantly higher during the fructose diet. Type I and type II diabetic subjects responded to the diets in a consistent way, but type I subjects experienced significantly more hypoglycemia during the fructose diet than during the starch diet.

CONCLUSIONS
A high-fructose diet may result in reduced glycemia in diabetic subjects but at the expense of increased fasting serum total and LDL cholesterol.
Nitrate Levels in Community Drinking Waters and Risk of IDDM: An ecological analysis
Authors: Kostraba Jill N , Gay Elizabeth C , Rewers Marian , Hamman Richard F 
Published: March 2007

OBJECTIVE
To investigate whether higher IDDM incidence rates occurred in areas with high nitrate levels in their potable water supplies.

RESEARCH DESIGN AND METHODS
Incidence rates for the 63 counties in Colorado were calculated using the Colorado IDDM Registry of children diagnosed &lt; 18 yr of age between 1978 and 1988 (n = 1280). A weighted average of the nitrate levels from each water district within each county was calculated using data collected by the Colorado Department of Health between 1984 and 1988.

RESULTS
The rs between nitrate levels and IDDM incidence was 0.26 (P = 0.03). After controlling for differences in ethnicity, counties with water nitrate levels in the third tertile (0.77-8.2 mg/L) had a significantly increased risk of IDDM compared with those in the first tertile (0.0-0.084 mg/L) (rp = 0.29, P = 0.02).

CONCLUSIONS
This ecological analysis suggests that low-level nitrate exposure through drinking water may play a role in the etiology of IDDM, perhaps as a promoter through the generation of free radicals.
Multicenter Study of the Prevalence of Diabetes Mellitus and Impaired Glucose Tolerance in the Urban Brazilian Population Aged 30–69 yr
Authors: Malerbi Domingos A , Franco Laercio J ,   The Brazilian Cooperative Group on the Study of Diabetes Prevalence
Published: March 2007

OBJECTIVE
To assess the prevalence of diabetes and IGT in the urban adult Brazilian population.

RESEARCH DESIGN AND METHODS
We used a two-stage, multicenter, cross-sectional survey in a random sample of 21,847 individuals aged 30–69 yr from nine large cities. Subjects were first screened by FCG. All positive screenees (FCG ≥ 5.6 mM/L) and every sixth consecutive negative screenee were administered a 75 g OGTT and classified as diabetic, IGT, or normal (nondiabetic) according to WHO recommendations. OGTT findings from the negative screenees were extrapolated to all negative screenees after adjustments for potential biases.

RESULTS
The overall rates were 7.6 and 7.8% for diabetes and IGT, respectively. Men (7.5%) and women (7.6%) had similar rates of diabetes. Similar rates resulted with whites (7.8%) and nonwhites (7.3%). Diabetes prevalence increased from 2.7% in the 30–39-yr age-group to 17.4% in the 60–69-yr age-group. Diabetes was more prevalent among less educated people, but this difference disappeared after adjusting for age. Family history of diabetes was associated with a twofold increase in diabetes prevalence (12.5 vs. 5.8%); the same increase occurred with obesity (11.6 vs. 5.2%). Undiagnosed diabetes accounted for 46% of the total prevalence. Among previously diagnosed cases, 22.3% were not under treatment, 7.9% were on insulin, 40.7% were on oral agents, and 29.1% were on dietary treatment only. Self-reported diabetes prevalence was 0.1, 3.2, and 11.6% in the age groups &lt; 30, 30–69, and &gt; 70 yr, respectively.

CONCLUSIONS
The prevalence of diabetes in Brazil is comparable with that of more developed countries, where it is considered a major health problem.
Epidemiology of Childhood Type I Diabetes in Sudan, 1987–1990
Authors: Elamin Abdelaziz , Omer Mohamed I A , Zein Kamel , Tuvemo Torsten 
Published: March 2007

OBJECTIVE
To determine the incidence of type I diabetes in children 0–14 yr of age in Khartoum, Sudan.

RESEARCH DESIGN AND METHODS
Prospective registration of newly diagnosed patients in a hospital-based registry with independent validation of completeness of case ascertainment. Eligible patients were Sudanese children &lt; 15 yr of age, who developed type I diabetes during the period 1 January 1987 through 31 December 1990, and who were living in Khartoum city at the time of diagnosis. The denominator is the stable childhood population of Khartoum city, as estimated by the National Bureau of Statistics.

RESULTS
In 4 yr, 239 cases were notified in the primary source and 268 in the secondary source. Some 196 patients were registered in both sources. Using the capture-recapture method to correct for underascertainment, the estimated total number of cases was 327, and the overall degree of ascertainment was 95%. The incidence of type I diabetes in children 0–14 yr of age increased from 5.9/105) in 1987 to 10.1/105) in 1990 (P &lt; 0.001). Girls exhibited slightly higher incidence rates than boys in the 10–14-yr age-group throughout the 4 yr, but the differences were not statistically significant. The age distribution at onset was bimodal with a clear peak at age 12 yr in girls and age 14 yr in boys and another smaller peak at age 7 yr in both sexes. The number of new cases was markedly higher in the cooler months of the year, with a peak in January and a nadir in June (P &lt; 0.01). This trend was consistent over the period of observation.

CONCLUSIONS
Childhood diabetes is increasing in Sudan. Our incidence figures are higher than those reported from other Arab countries and is similar to reports from France and Italy.
Screening for Microalbuminuria: A comparison of single sample methods of collection and techniques of albumin analysis
Authors: Schwab Steve J , Dunn Fredrick L , Feinglos Mark N 
Published: March 2007

OBJECTIVE
To evaluate single-sample urine collections to determine their ability to screen patients for the presence of microalbuminuria. Microalbuminuria in patients with type I diabetes predicts the development of diabetic renal disease.

RESEARCH DESIGN AND METHODS
Cross-sectional analysis of single-sample urine collection techniques (first morning void, random upright void) and methods of albumin analysis (RIA, reagent tablet) were compared with conventional 24-h urine collections (RIA). The study included 94 patients (45 males, 49 females; mean serum creatinine 88 μM) with type I diabetes, selected from a screened population of 301 patients from the University Hospital Subspecialty Clinics.

RESULTS
A 24-hour urine collection RIA analysis for albumin revealed 36 normal patients (&lt; 30 mg), 27 with microalbuminuria (30–300 mg), and 31 with albuminuria (&gt; 300 mg). Random upright urine samples were more sensitive (RIA 89%, tablets 78%) for the detection of microalbuminuria than first morning void specimens (RIA 70%, tablets 60%). Specificity was &gt; 80% with both random and first morning voids.

CONCLUSIONS
Screening for microalbuminuria can be performed in the clinic by random upright single-sample urine collections. When reagent tablets were used, these results are available immediately. Patients who screen positive should be confirmed by 24-h or other timed urine collections.