bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multicenter Study of the Incidence of and Predictive Risk Factors for Diabetic Neuropathic Foot Ulceration
Authors: Abbott Caroline A , Vileikyte Loretta , Williamson Sheila , Carrington Anne L , Boulton Andrew JM 
Published: March 2007

OBJECTIVE
To investigate longitudinally prognostic factors for foot ulceration in a large population of diabetic patients with established neuropathy.

RESEARCH DESIGN AND METHODS
A double-blind multicenter study of a potential new agent for diabetic neuropathy provided the opportunity for this 1-year investigation since intervention demonstrated no efficacy in the condition. A total of 1,035 patients with N1DDM and IDDM were included. Inclusion criteria were vibration perception threshold (VPT) at the great toe ≥25 V in at least one foot and ≤50 V in both feet, normal peripheral circulation, and no previous foot ulceration. VPT and clinical components of the Michigan diabetic polyneuropathy (DPN) score were assessed at baseline and subsequent visits.

RESULTS
After 1 year, the incidence of first foot ulcers for the total population was 7.2%. Neuropathy parameters were the same between the treatment and placebo groups at baseline and were unchanged at 1 year; therefore, baseline data were combined for multiple regression analysis. VPT, age, and Michigan DPN scores for muscle strength and reflexes were significant independent predictors for first foot ulceration (P &lt; 0.01). For each 1-U increase in VPT values at baseline, the hazard of the first foot ulcer increased by 5.6%. Similarly, for each 1-U increase in muscle strength and reflex components of the Michigan DPN scores, the hazard of the first foot ulcer increased by 5.0%.

CONCLUSIONS
Tests of VPT and Michigan DPN scores for muscle strength and reflexes are useful clinical predictors for foot ulceration in diabetic patients with established neuropathy. The rate of subsequent ulceration in the following year was alarmingly high, however, despite standardized foot care education at baseline and regular follow-up visits.
Asp905Tyr Polymorphism of the Gene for the Skeletal Muscle-Specific Glycogen-Targeting Subunit of Protein Phosphatase 1 in NIDDM
Authors: Shen Gong-Qing , Ikegami Hiroshi , Kawaguchi Yoshihiko , Fujisawa Tomomi , Hamada Yoichi , Ueda Hironori , Shintani Maki , Nojima Koji , Kawabata Yumiko , Yamada Kazunori , Babaya Naru , Ogihara Toshio 
Published: March 2007

OBJECTIVE
To clarify the contribution of the Asp905Tyr polymorphism of the musclespecific glycogen-targeting subunit of protein phosphatase 1 (PP1G) to insulin resistance and related diseases.

RESEARCH DESIGN AND METHODS
We investigated the Asp905Tyr polymorphism of the PPP1R3 gene, which encodes the muscle-specific glycogen-targeting subunit of PP1G, in 259 Japanese patients with NIDDM and 194 healthy control subjects.

RESULTS
No significant difference was found in the genotype distribution between NIDDM patients (n = 259; Asp/Asp = 0.10, Asp/Tyr = 0.44, Tyr/Tyr = 0.46) and healthy control subjects (n = 194; Asp/Asp = 0.13, Asp/Tyr = 0.37, Tyr/Tyr = 0.50) or between patient groups subdivided by the mode of treatment: NIDDM patients with insulin therapy (Asp/Asp = 0.14, Asp/Tyr = 0.46, Tyr/Tyr = 0.40) and those without insulin therapy (Asp/Asp = 0.07, Asp/Tyr = 0.43, Tyr/Tyr = 0.50). However, NIDDM patients with the Tyr allele, which was previously reported to be associated with insulin resistance, tended to have lower BMIs than those without this allele (Asp/Asp: 24.5 ±1.1 kg/m2, Asp/Tyr: 22.6 ± 0.4 kg/m2, Tyr/Tyr: 22.8 + 0.3 kg/m2, P = 0.06 by analysis of variance).

CONCLUSIONS
These data suggest that the Asp905Tyr polymorphism of the PPP1R3 gene is not associated with NIDDM or high BMI, both of which are known to be insulin-resistant states, in the Japanese population.
Diabetes in the African-American Medicare Population: Morbidity, quality of care, and resource utilization
Authors: Chin Marshall H , Zhang James X , Merrell Katie 
Published: March 2007

OBJECTIVE
To determine whether African-American Medicare recipients with diabetes are at increased risk for morbidity, poor quality of care, and high resource utilization.

RESEARCH DESIGN AND METHODS
We analyzed 1,376 patients with diabetes who were ≥65 years of age and in the 1993 Medicare Current Beneficiary Survey. Morbidity measures were the Katz Index of Activities of Daily Living, Instrumental Activities of Daily Living, overall health perception, Charlson Comorbidity Index score, and diabetic complications. Quality of care standards were glycosylated hemoglobin measurements, ophthalmological visits, lipid testing, mammography, influenza vaccination, readmission within 30 days of hospital discharge, and outpatient visits within 4 weeks of hospital discharge. We stratified Medicare reimbursement by type of service and adjusted for sex, education, and age in multivariable analyses.

RESULTS
Compared with white patients, African-American patients had worse health perception and lower quality of care. They were more likely to visit the emergency department and had fewer physician visits per year. African-Americans had higher reimbursement for home health services, but total reimbursement was similar after case-mix adjustment.

CONCLUSIONS
Improved access to preventive care for older African-Americans with diabetes may improve health perception and use of the emergency department. The potential effect on total reimbursement is unclear. Future policy interventions to improve quality of care among Medicare patients with diabetes should especially target African-Americans.
Direct Medical Costs of Complications Resulting From Type 2 Diabetes in Hie U.S.
Authors: O'Brien Judith A , Shomphe Lori A , Kavanagh Patricia L , Raggio Gabriel , Caro J Jaime 
Published: March 2007

OBJECTIVE
To estimate direct medical costs of managing the complications of type 2 diabetes.

RESEARCH DESIGN AND METHODS
Costs were estimated for 15 diabetic complications by applying unit costs to typical resource-use profiles. Resource use and unit costs were estimated from many sources, including acute care discharge databases, clinical guidelines, government reports, fee schedules, and peer-reviewed literature. For each complication, the event costs are those associated with resource use that is specific to the acute episode and any subsequent care occurring in the 1st year. State costs are the annual costs of continued management. All costs are expressed in 1996 U.S. dollars.

RESULTS
As expected, the more severe or debilitating events, such as acute myocardial infarction ($27,630 event cost; $2,185 state cost), generate a greater financial burden than do early-stage complications, such as microalbuminuria ($62 event cost; $14 state cost). Yet, complications that are initially relatively low in cost (e.g., microalbuminuria) can progress to more costly advanced stages (e.g., end-stage renal disease, $53,659 state cost); therefore, minor complications should also be considered in any economic analysis of diabetes.

CONCLUSIONS
The recent literature has lacked cost estimates that may be readily translated into patient-level cost inputs for an economic model. Emerging therapies that may reduce the incidence of some diabetic complications will need to be scrutinized economically in today's cost-conscious environment. The cost estimates from this study provide one piece of the economic analysis needed to evaluate these new interventional therapies.
Usefulness of Revised Fasting Plasma Glucose Criterion and Characteristics of the Insulin Response to an Oral Glucose Load in Newly Diagnosed Japanese Diabetic Subjects
Authors: Tanaka Yasushi , Atsumi Yoshihito , Asahina Takayuki , Hosokawa Kazuhiro , Matsuoka Kenpei , Kinoshita Junichiro , Onuma Tomio , Kawamori Ryuzo 
Published: March 2007

OBJECTIVE
To examine the usefulness of the revised criterion for fasting plasma glucose (FPG) in the diagnosis of diabetes recommended by the American Diabetic Association (ADA) (126 mg/dl, 7 mmol/1), and to characterize insulin response during the 75-g oral glucose tolerance test (OGTT) in newly diagnosed Japanese diabetic subjects.

RESEARCH DESIGN AND METHODS
A series of 2,121 Japanese subjects underwent a 75-g OGTT (0–3 h) and were divided into three groups (normal glucose tolerance [NGT], impaired glucose tolerance [IGT], and diabetes mellitus [DM]) according to the current World Health Organization criteria. After the cutoff values of FPG that distinguish NGT and IGT from diabetes were analyzed, the usefulness of the ADA criterion for FPG was examined by comparing diagnostic parameters (sensitivity, specificity, and accuracy) with those for the cutoff value of 140 mg/dl. To assess insulin response, both the insulinogenic index (Islx), a marker of early secretion, and the area under the insulin response curve (AUCIns), a marker of total secretion, were compared between the DM, NGT, and 1GT groups.

RESULTS
First, the FPG cutoff value distinguishing NGT from diabetes was 109 mg/dl. An FPG of 126 mg/dl showed a higher sensitivity (0.52 vs. 0.31), the same specificity (1.00), and a higher accuracy (0.82 vs. 0.74) than an FPG of 140 mg/dl, and it had a higher specificity (1.00 vs. 0.86) with a slightly lower accuracy (0.82 vs. 0.85) than an FPG of 109 mg/dl. Second, the FPG cutoff value differentiating IGT from diabetes was 113 mg/dl. An FPG of 126 mg/dl showed a higher sensitivity (0.52 vs. 0.31) and accuracy (0.80 vs. 0.74) and a similar specificity (0.97 vs. 1.00) compared with an FPG of 140 mg/dl, and it had a higher specificity (0.97 vs. 0.82) with the same accuracy (0.80) as an FPG of 113 mg/dl. Third, the DM group showed the lowest Islx among the three groups at all FPG values. The AUCIns in the DM group increased along with FPG, reached the maximum level at an FPG of 110 mg/dl, and declined thereafter. AUCIns was higher in the DM group than in the NGT group at FPG values ≥100 mg/dl.

CONCLUSIONS
The revised ADA criterion for FPG of 126 mg/dl may improve diagnostic sensitivity without loss of specificity in Japanese diabetic subjects when compared with an FPG criterion of 140 mg/dl. Although early insulin secretion was impaired, total insulin secretion did not seem to be reduced in newly diagnosed Japanese diabetic subjects.
Mortality in Adults With and Without Diabetes in a National Cohort of the U.S. Population, 1971–1993
Authors: Gu Ken , Cowie Catherine C , Harris Maureen I 
Published: March 2007

OBJECTIVE
To examine 22-year mortality (1971–1993), causes of death, life expectancy, and survival in a national sample of diabetic and nondiabetic adults according to age, sex, and race.

RESEARCH DESIGN AND METHODS
A representative national cohort of 14,374 adults aged 25–74 years was identified in 1971–1975 in the First National Health and Nutrition Examination Survey (NHANES I). Diabetes was ascertained by medical history interview. The cohort was followed for mortality through 1992–1993, with verification of vital status for 96.2% (n = 13,830). Causes of death were determined from death certificates.

RESULTS
Diabetic subjects comprised 5.1% of the cohort and accounted for 10.6% of the deaths. Mortality for diabetic subjects increased from 12.4 per 1,000 person-years for those aged 25–44 years at baseline to 89.7 per 1,000 person-years for those aged 65–74 years. The age-adjusted mortality rate was 57% higher for diabetic men than for diabetic women; the rate was 27% higher for diabetic non-Hispanic blacks than for diabetic non-Hispanic whites. Mortality rates were highest for insulin-treated subjects and for those with ≥15 years' duration of diabetes. Diabetes was listed on the death certificate as the underlying cause of death for only 7.7% of diabetic men and 13.4% of diabetic women. Considering multiple causes of death, heart disease was listed the most frequently and was present on 69.5% of death certificates of people with diabetes. Death rates were higher for diabetic than for nondiabetic subjects in all age, sex, and race groups. The relative risk of death (diabetic versus nondiabetic subjects) declined with age from a value of 3.6 for those aged 25–44 years at baseline to 1.5 for those aged 65–74 years. The relative risk was elevated in diabetic subjects for all major causes of death except malignant neoplasms. Survival of diabetic subjects was lower than that of nondiabetic subjects in all age, sex, and race groups. Median life expectancy was 8 years lower for diabetic adults aged 55–64 years and 4 years lower for those aged 65–74 years.

CONCLUSIONS
In this representative national sample of adults, mortality rates were higher for diabetic men than for diabetic women and for diabetic blacks than for diabetic whites. The study confirms the substantially higher risk of death, lower survival, and lower life expectancy of diabetic adults compared with nondiabetic adults.
Optimization of Evening Insulin Dose in Patients Using the Short-Acting Insulin Analog Lispro
Authors: Ahmed Abu Baker E , Mallias John , Home Philip D 
Published: March 2007

OBJECTIVE
A three-way, crossover, open-label, randomized study was designed to compare the evening and night (1800–0800) glycemic control when the evening premeal lispro dose was reduced by 20% and the bedtime basal NPH dose increased by 25%, or when the basal NPH dose was moved to before dinner at 1800, compared with the control arm on standard premeal human regular insulin and pre-bedtime NPH insulin.

RESEARCH DESIGN AND METHODS
A total of 13 type 1 diabetic patients who use a premeal plus basal insulin regimen were studied on three separate days, with identical meals and snacks at the same times on each study day. On the control study day, patients received human regular insulin before dinner and NPH at bedtime in their usual doses. On another day, lispro was given before dinner with a dose reduction of 20%, and NPH at bedtime at 125% of usual dose. In the third regimen, the lispro and NPH were administered together in their usual dose before the evening meal by separate injections. The three regimens were tested in random order.

RESULTS
Postprandial (1800–2200) blood glucose concentrations were lower after reduced-dose lispro compared with human regular insulin (6.0 ± 0.3 [SEM] vs. 7.4 ± 0.3 mmol/1, P &lt; 0.05). Nighttime (2400–0400) blood glucose concentrations were not different (8.6 ± 0.3 vs. 9.2 ± 0.3 mmol/1, NS), and prebreakfast concentrations were also unchanged (7.7 ± 0.9 vs. 8.7 ± 0.8 mmol/1) after lispro with increased-dose NPH compared with standard insulin. By contrast, both nighttime (10.0 ± 0.3 mmol/1, P &lt; 0.05) and fasting glucose concentrations (10.8 ± 0.6 mmol/1, P &lt; 0.05) were significantly higher with dinnertime usual-dose lispro plus dinnertime usual-dose NPH compared with standard human insulin. Hypoglycemia at night (blood glucose &lt;3.0 mmol/1) did not differ between study days, but it was more frequent postprandially after dinner usual-dose lispro plus early NPH (2 vs. 7 patients, P = 0.062).

CONCLUSIONS
With lower mealtime and higher basal bedtime insulin doses, patients using insulin lispro may be able to gain an overall improvement in evening blood glucose control without deteriorated nighttime glucose levels. Earlier basal NPH dosage alone does not ameliorate the nighttime hyperglycemia of short-acting insulin analog regimens.
Stiffness Indexes β of the Common Carotid and Femoral Arteries Are Associated With Insulin Resistance in NIDDM
Authors: Emoto Masanori , Nishizawa Yoshiki , Kawagishi Takahiko , Maekawa Kiyoshi , Hiura Yoshikazu , Kanda Hiroyuki , Izumotani Kyoko , Shoji Tetsuo , Ishimura Eiji , Inaba Masaaki , Okuno Yasuhisa , Morii Hirotoshi 
Published: March 2007

OBJECTIVE
To investigate the association between arterial wall stiffness indexes β of the common carotid artery (CCA) and the femoral artery (FA) and insulin resistance in NIDDM subjects in a cross-sectional study.

RESEARCH DESIGN AND METHODS
We evaluated the arterial stiffness indexes β of CCA and FA using an ultrasonic phase-locked echo-tracking system in 60 NIDDM subjects attending the diabetes center in Osaka City University Hospital, compared with 120 ageand sex-matched control subjects. Insulin sensitivity indexes were evaluated using a euglycemic-hyperinsulinemic clamp.

RESULTS
Stiffness indexes β of both CCA and FA were significantly higher in NIDDM subjects than in control subjects (CCA 18.1 ± 0.9 vs. 11.7 ± 0.3, respectively, P &lt; 0.001; FA 35.7 ± 2.3 vs. 23.7 ± 0.8, respectively, P &lt; 0.001). The mean insulin sensitivity index in NIDDM subjects was 4.69 ± 0.29 mg · kg−1 · min−1 · mU−1 · 1. The stiffness indexes β of both CCA and FA were inversely correlated with insulin sensitivity indexes (CCA r = −0.393, P = 0.002; FA r = −0.329, P = 0.010), as well as with age, duration of diabetes, and mean blood pressure. In stepwise multiple regression analyses, insulin sensitivity index and duration of diabetes were identified as significant independent variables for stiffness indexes 3 in both CCA and FA (CCA R2 = 0.249, P = 0.0003; FA R2 = 0.336, P &lt; 0.0001).

CONCLUSIONS
Arterial stiffness indexes β of CCA and FA were associated with insulin resistance in NIDDM subjects.
Diabetes Care for Medicare Beneficiaries: Attitudes and behaviors of primary care physicians
Authors: Drass Jan , Kell Sherron , Osborn Morris , Bausell Barker , Corcoran James , Moskowitz Alan , Fleming Barbara 
Published: March 2007

OBJECTIVE
To obtain information related to primary care physician (PCP) attitudes, knowledge, and practice patterns, as well as perceptions about barriers to care and the use of materials to assist in the delivery of diabetes care for elderly patients in the office setting.

RESEARCH DESIGN AND METHODS
A survey was mailed to a random sample (n = 900) of PCPs (internal medicine, family practice, and general practice physicians and endocrinologists) from the states of Alabama, Iowa, and Maryland who met selection criteria and provided diabetes care to ≥25 Medicare beneficiaries during calendar year 1993.

RESULTS
Respondents provided self-reported information regarding diabetes care for elderly patients. PCP respondents (n = 370) considered blood glucose control to be the most important treatment goal. Most respondents (92%) considered acceptable GHb values to be those &lt; 8%. Blood pressure measurement and foot inspections for the detection of ulcers and infection were the most commonly reported routine procedures performed as part of an office visit. Laboratory tests reported to be frequently ordered included GHb, serum creatinine, and proteinuria tests. Patient nonadherence to the treatment regimen was reported to be the most common barrier to care. The majority of respondents reported using two treatment aids in caring for patients with diabetes.

CONCLUSIONS
The results of this study provide some evidence that PCP self-reported attitudes, knowledge, and practice patterns in delivering diabetes care for elderly patients in the office setting more closely reflect current recommended practice than reported in previous physician surveys. Opportunities for improvement still exist.
Hydroperoxides in Plasma Are Reduced by Intensified Insulin Treatment: A randomized controlled study of IDDM patients with microalbuminuria
Authors: Berg Tore Julsrud , Nourooz-Zadeh Jaffar , Wolff Simon P , Tritschler Hans J , Bangstad Hans-Jacob , Hanssen Kristian F 
Published: March 2007

OBJECTIVE
An association between reactive oxygen species and diabetic micro- and macrovascular complications has been proposed. In the present study, we have examined the effect of an improved blood glucose control on plasma levels of hydroperoxides in patients with IDDM.

RESEARCH DESIGN AND METHODS
Subjects included 30 young IDDM patients with microalbuminuria who were randomized to receive either continuous subcutaneous insulin infusion (CSII) by a portable insulin pump (n = 15) or conventional insulin treatment (CIT) (n = 15) for 24 months. Plasma levels of hydroperoxides were measured by the ferrous oxidation with Xylenol Orange, version 2 (FOX2) assay. This method measures total lipid hydroperoxides and, unlike other methods, does not suffer from extraction losses.

RESULTS
The mean HbA1c level was lower in the CSII group at the end of the study than in the CIT group: (mean [95% CI]) 8.6 (8.1–9.1) vs. 9.6 (9.0–10.3)%, respectively (P &lt; 0.002). The level of plasma hydroperoxides was very similar at the start of the study but was significantly lower in the CSII group compared with the CIT group at the end of the study: 2.9 (2.1–3.7) vs. 4.3 (3.2–5.4) μmol/l, respectively (P &lt; 0.02). In the CSII group, hydroperoxides were reduced by 31% from baseline (P &lt; 0.001), whereas there was no change in levels of hydroperoxides in the CIT group. Mean hydroperoxide levels correlated with mean HbA1c during the study (r = 0.39, P &lt; 0.04). Hydroperoxide levels were associated with the levels of microalbuminuria (r = 0.45, P &lt; 0.02).

CONCLUSIONS
This study provides support for the hypothesis that hyperglycemia is an important factor in the generation of hydroperoxides, and, thus, reactive oxygen species, in the circulation of IDDM patients.
Diabetic Peripheral Neuropathy: Effectiveness of electrotherapy and amitriptyline for symptomatic relief
Authors: Kumar Dinesh , Alvaro Michael S , Julka Inderjeet S , Marshall Howard J 
Published: March 2007

OBJECTIVE
To evaluate the efficacy of combining electrotherapy with amitriptyline for the management of chronic painful peripheral neuropathy in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS
Patients (n = 26) with peripheral neuropathy were treated with amitriptyline. After 4 weeks, those patients (n = 23) who failed to respond to amitriptyline or who only had partial relief were randomized between a sham treatment group (control) or an electrotherapy group. Transcutaneous electrotherapy was given for 12 weeks by a portable unit (H-wave machine) that generated a biphasic exponentially decaying waveform (pulse width 4 ms, 25–35 V, ≥ 2 Hz). The degree of pain and discomfort was graded on a scale of 0–5. An analog scale was used to record the overall change in symptoms.

RESULTS
Amitriptyline produced some degree of symptomatic relief in 15 (60%) of the 26 patients by the 4th week; pain scores decreased from 3.8 ± 0.1 to 2.9 ± 0.2 (P &lt; 0.1) and the overall reduction in pain was 26 ± 5% on an analog scale. In the amitriptyline plus sham treatment group (n = 9), pain scores declined from 2.8 ± 0.3 to 1.9 ± 0.5 (P &lt; 0.03) and the overall reduction in pain was 55 ± 12%, suggesting a procedure-related placebo effect. In the group receiving combined electrotherapy and amitriptyline (n = 14), symptomatic improvement occurred in 12 (85%) patients. Five (36%) of the patients in this group became asymptomatic. Pain scores declined from 3.2 ± 0.2 to 1.4 ± 0.4 (P &lt; 0.01) and the overall reduction in pain was 66 ± 10%. The degree of reduction in pain scores and the incremental relief (above the amitriptyline effect) were significantly greater (P &lt; 0.03) with electrotherapy as compared with sham treatment. The outcomes indicate a substantial beneficial effect of electrotherapy over and above any placebo influence.

CONCLUSIONS
Our clinical observations suggest that transcutaneous electrotherapy is effective in reducing the pain associated with peripheral neuropathy. This form of therapy may be a useful adjunctive modality when it is combined with a pharmacological agent, such as amitriptyline, to augment symptomatic relief.