bluuebunny/crossref_metadata_2025_split huggingface dataset:
Body Iron Stores Are Associated With Serum Insulin and Blood Glucose Concentrations: Population study in 1,013 eastern Finnish men
Authors: Tuomainen Tomi-Pekka , Nyyssönen Kristiina , Salonen Riitita , Tervahauta Arja , Korpela Heikki , Lakka Timo , Kaplan George A , Salonen Jukka T 
Published: March 2007

OBJECTIVE
To study if there is an association between mildly elevated body iron and glucose homeostasis indexes.

RESEARCH DESIGN AND METHODS
A cross-sectional population study was conducted in 1,013 middle-aged men, and an association of serum ferritin with concentrations of serum insulin, blood glucose, and serum fructosamine was tested.

RESULTS
The mean concentration of fasting serum insulin was 21.6% higher (95% CI 7.3–37.9%, P &lt; 0.001) in the 5th quintile of serum ferritin compared with the 1st quintile. The elevation in blood glucose was 6.1% (95% CI 2.3–9.9%, P &lt; 0.001) and in serum fructosamine 3.9% (1.5–6.9%, P &lt; 0.01).

CONCLUSIONS
Mildly elevated body iron stores are associated with statistically significant elevations in glucose homeostasis indexes.
Is the Quality of Diabetes Care Better in a Diabetes Clinic or in a General Medicine Clinic?
Authors: Ho Marion , Marger Michael , Beart Jenna , Yip Ian , Shekelle Paul 
Published: March 2007

OBJECTIVE
To compare the quality of ambulatory diabetes care delivered by physicians in the diabetes clinic versus the general medicine clinic of a university-affiliated Veterans Administration medical center.

RESEARCH DESIGN AND METHODS
This is a retrospective study that involved the review of medical records against predetermined process-of-care criteria. A total of 112 patients with diabetes were randomly selected, of whom 56 were cared for in the general medicine clinic and 56 in the diabetes clinic. The following main outcome measures were examined: 1) the compliance with individual criteria; and 2) the proportion of patient visits in each clinic receiving minimally acceptable quality, defined as a blood pressure measurement, a record of type of hypoglycemic medication, a glycated hemoglobin measurement within the past year, a urinalysis within the past year, an ophthalmologist or optometrist eye examination within the past year or scheduled in the next six months, a record of change in therapeutic management, and a scheduled return visit.

RESULTS
The diabetes clinic performed significantly better than the general medicine clinic on the following criteria: a record of a patient's self-monitoring of blood glucose levels; a foot examination; a comprehensive eye examination; a glycated hemoglobin measurement; and a referral for diabetic education. The proportion of patient visits meeting the minimally acceptable levels of quality was better in the diabetes clinic than the general medicine clinic (73 vs. 52%, P = 0.02).

CONCLUSIONS
Patients cared for by physicians in the diabetes clinic receive better quality of diabetes care than do patients cared for by physicians in the general medical clinic. If patient care is to be shifted from specialists to generalists, additional attention needs to be paid to ensure that generalists have the knowledge and system resources necessary to deliver an acceptable quality of diabetes care.
Sulfonylurea Treatment Prevents Recurrence of Hyperglycemia in Obese African-American Patients With a History of Hyperglycemic Crises
Authors: Umpierrez Guillermo E , Clark W Scott , Steen Mark T 
Published: March 2007

OBJECTIVE
Many newly diagnosed obese African-American patients with history of severe hyperglycemia or diabetic ketoacidosis (DKA) are able to discontinue pharmacological treatment with continued good metabolic control. However, many of these individuals relapse into hyperglycemia within 1 year. In such patients, we compared the effect of low-dose sulfonylurea and dietary therapy in the prevention of recurrence of hyperglycemia.

RESEARCH DESIGN AND METHODS
We conducted an intention-to-treat study in 35 obese newly diagnosed diabetic patients (17 with DKA and 18 with severe hyperglycemia). After discontinuation of insulin, seven of 17 patients with DKA and seven of 18 patients with hyperglycemia were managed with diet and glyburide (1.25–2.5 mg/day), whereas other patients were followed with diet alone. In all patients, pancreatic insulin reserve was documented 1 day after resolution of hyperglycemic crises and within 1 week of discontinuation of insulin. Recurrence of hyperglycemia was defined as fasting blood glucose &gt; 7.8 mmol/l (140 mg/dl) or random blood glucose &gt; 10 mmol/l (180 mg/dl) on two or more consecutive determinations, or HbA1c &gt; 7.5%.

RESULTS
Both treatment groups were comparable in age, sex, duration of diabetes, months of insulin therapy, BMI, glucose, and HbA1c. At presentation, the acute C-peptide response to glucagon in obese DKA patients was lower than in patients with hyperglycemia (P &lt; 0.01), but responses were comparable after discontinuation of insulin. Sulfonylurea treatment significantly reduced recurrence of hyperglycemia in both obese DKA and obese hyperglycemic patients (P = 0.03). With a median follow-up of 16 months, hyperglycemia recurred in six of 10 DKA patients and in five of 11 hyperglycemia patients treated with diet alone, compared with one of seven DKA and one of seven hyperglycemia patients treated with glyburide. Readmission with metabolic decompensation occurred in four patients treated with diet but in none of the patients treated with diet and glyburide.

CONCLUSIONS
Low-dose sulfonylurea therapy prevents recurrence of hyperglycemia in newly diagnosed obese African-American patients with a history of hyperglycemic crises.
Unchanged Insulin Absorption After 4 Days' Use of Subcutaneous Indwelling Catheters for Insulin Injections
Authors: Hanas S Ragnar , Carlsson Sten , Frid Anders , Ludvigsson Johnny 
Published: March 2007

OBJECTIVE
Since 1985, we have used indwelling catheters (Insuflon, Maersk Medical, Lynge, Denmark; Chronimed, Minnetonka, MN) to lessen pain when injecting insulin. However, some patients experience a rise in blood glucose after using indwelling catheters for a few days. We therefore studied the absorption of 125I-labeled insulin when using indwelling catheters.

RESEARCH DESIGN AND METHODS
Five men and five women participated (age 18–25 years, C-peptide negative, HbA1c 9.0 ± 1.0% [mean ± SD, DCA-2000 method], diabetes duration 5–21 [median 9.5] years). After thyroid blockage with potassium iodide, we injected 5IU of 125I-labeled short-acting insulin subcutaneously in the abdomen (“ordinary injection”) and 5 IU on the contralateral side through an indwelling catheter (“catheter injection”). The injection/insertion area was free of lipohyper- and lipohypotrophies. Disappearance rate was measured for 180 min with a gamma camera. The patients injected all premeal injections of short-acting insulin through the same indwelling catheter in the following 4 days. The investigation procedure was repeated day 3 and 5.

RESULTS
We found no statistically or clinically (95% CI) significant difference in residual activity of 125I-insulin after 60 min or in time for 50% of the injected depot to disappear (T-50%) among catheter injections on day 1, 3, and 5; ordinary injections on days 1, 3, and 5; or catheter and ordinary injections on days 1, 3, and 5, respectively. HbA1c correlated both to T-50% (r = 0.73, P = 0.016) and residual activity of 125I-insulin after 60 min (r = 0.69, P = 0.028), indicating that patients with a slower absorption will have a less ideal metabolic control when using premeal bolus injections.

CONCLUSIONS
We conclude that using indwelling subcutaneous catheters for insulin injections for up to 4 days does not affect the absorption of short-acting insulin.
An Intervention for Enhancing Compliance With Screening Recommendations for Diabetic Retinopathy: A bicoastal experience
Authors: Legorreta Antonio P , Hasan Malik M , Peters Anne L , Pelletier Kenneth R , Leung Kwan-Moon 
Published: March 2007

OBJECTIVE
To determine whether an intervention at both the provider and patient level can increase the utilization of diabetic retinal examination among diabetic patients and to compare the results from a comparable study conducted on the East Coast.

RESEARCH DESIGN AND METHODS
For the regional intervention study, all diabetic patients 18 years or older who enrolled in a large network-based health maintenance organization (HMO) in California were identified (n = 19,397). The identified diabetic patients received educational materials and a notification of their prior diabetic retinal examination status. Also, their primary care physicians received the current American Diabetes Association (ADA) guidelines for dilated retinal examinations and a list of patients due for diabetic retinal examination.

RESULTS
There were 25 and 27% increases in the percentage of diabetic patients who received diabetic retinal examinations in 1995 compared with the percentages in 1993 and 1994, respectively. The increase in diabetic retinal examinations was most significant after the intervention (odds ratio = 1.4). Furthermore, the improvements in compliance after the intervention were almost identical between the studies implemented on the East and West Coasts.

CONCLUSIONS
This study and the prior study demonstrate that such a “reminder” intervention can improve compliance with diabetic retinal screening recommendations. A generalizable intervention, such as this, may be applicable on a national level. For these programs to be successful, however, HMOs and physicians must have a collaborative relationship.
Incidence of IDDM in German Children Aged 0–14 years: A 6-year population-based study (1987–1993)
Authors: Neu Andreas , Kehrer Martin , Hub Regine , Ranke Michael B 
Published: March 2007

OBJECTIVE
Generally accepted data on the incidence of childhood diabetes in Germany have not been available up to now. To register the total number of newly diagnosed cases in Baden-Wuerttemberg (a federal state in southwest Germany), data on 1,160 children were retrospectively collected for the years 1987–1993.

RESEARCH DESIGN AND METHODS
Hospital records were the primary data source. There were 32 hospital units in Baden-Wuerttemberg included in this study. A secondary independent data source was a questionnaire circulated among the patients' association, Deutscher Diabetiker Bund. Case definition was done according to criteria EURODIAB ACE, a collaborative European study set up to assess the incidence of childhood diabetes. The degree of ascertainment was 96.2%, using the capture-mark-recapture method. The study includes a population at risk, entailing 1.5 million children, corresponding to 12.3% of all German children.

RESULTS
The incidence was found to be 11.6/100,000 (95% CI 10.9–12.2) for children aged 0–14 years. There was no significant difference between the incidence rates of boys and girls. Seasonal variation was observed, with cases increasing between November and February and incidence increasing with age. Peaks were found in early childhood (3–4 years of age) and prepuberty (10–12 years of age). There was marked geographical variation that did not correlate significantly with population density.

CONCLUSIONS
For the first time, internationally comparable data on the incidence of diabetes in children up to 15 years of age are available for Germany. The yearly incidence of 11.6/100,000 proved to be much higher than assumed so far.
Effects of Diet and Exercise in Preventing NIDDM in People With Impaired Glucose Tolerance: The Da Qing IGT and Diabetes Study
Authors: Pan Xiao-Ren , Li Guang-Wei , Hu Ying-Hua , Wang Ji-Xing , Yang Wen-Ying , An Zuo-Xin , Hu Ze-Xi , Juan-Lin  , Xiao Jina-Zhong , Cao Hui-Bi , Liu Ping-An , Jiang Xi-Gui , Jiang Ya-Yan , Wang Jin-Ping , Zheng Hui , Zhang Hui , Bennett Peter H , Howard Barbara V 
Published: March 2007

OBJECTIVE
Individuals with impaired glucose tolerance (IGT) have a high risk of developing NIDDM. The purpose of this study was to determine whether diet and exercise interventions in those with IGT may delay the development of NIDDM, i.e., reduce the incidence of NIDDM, and thereby reduce the overall incidence of diabetic complications, such as cardiovascular, renal, and retinal disease, and the excess mortality attributable to these complications.

RESEARCH DESIGN AND METHODS
In 1986, 110,660 men and women from 33 health care clinics in the city of Da Qing, China, were screened for IGT and NIDDM. Of these individuals, 577 were classified (using World Health Organization criteria) as having IGT. Subjects were randomized by clinic into a clinical trial, either to a control group or to one of three active treatment groups: diet only, exercise only, or diet plus exercise. Follow-up evaluation examinations were conducted at 2-year intervals over a 6-year period to identify subjects who developed NIDDM. Cox's proportional hazard analysis was used to determine if the incidence of NIDDM varied by treatment assignment.

RESULTS
The cumulative incidence of diabetes at 6 years was 67.7% (95% CI, 59.8–75.2) in the control group compared with 43.8% (95% CI, 35.5–52.3) in the diet group, 41.1% (95% CI, 33.4–49.4) in the exercise group, and 46.0% (95% CI, 37.3–54.7) in the diet-plus-exercise group (P &lt; 0.05). When analyzed by clinic, each of the active intervention groups differed significantly from the control clinics (P &lt; 0.05). The relative decrease in rate of development of diabetes in the active treatment groups was similar when subjects were stratified as lean or overweight (BMI &lt; or ≥ 25 kg/m2). In a proportional hazards analysis adjusted for differences in baseline BMI and fasting glucose, the diet, exercise, and diet-plus-exercise interventions were associated with 31% (P &lt; 0.03), 46% (P &lt; 0.0005), and 42% (P &lt; 0.005) reductions in risk of developing diabetes, respectively.

CONCLUSIONS
Diet and/or exercise interventions led to a significant decrease in the incidence of diabetes over a 6-year period among those with IGT.
Dietary Fiber, Glycemic Load, and Risk of NIDDM in Men
Authors: Salmerón Jorge , Ascherio Alberto , Rimm Eric B , Colditz Graham A , Spiegelman Donna , Jenkins David J , Stampfer Meir J , Wing Alvin L , Willett Walter C 
Published: March 2007

OBJECTIVE
Intake of carbohydrates that provide a large glycemic response has been hypothesized to increase the risk of NIDDM, whereas dietary fiber is suspected to reduce incidence. These hypotheses have not been evaluated prospectively.

RESEARCH DESIGN AND METHODS
We examined the relationship between diet and risk of NIDDM in a cohort of 42,759 men without NIDDM or cardiovascular disease, who were 40–75 years of age in 1986. Diet was assessed at baseline by a validated semiquantitative food frequency questionnaire. During 6-years of follow-up, 523 incident cases of NIDDM were documented.

RESULTS
The dietary glycemic index (an indicator of carbohydrate's ability to raise blood glucose levels) was positively associated with risk of NIDDM after adjustment for age, BMI, smoking, physical activity, family history of diabetes, alcohol consumption, cereal fiber, and total energy intake. Comparing the highest and lowest quintiles, the relative risk (RR) of NIDDM was 1.37 (95% CI, 1.02–1.83, P trend = 0.03). Cereal fiber was inversely associated with risk of NIDDM (RR = 0.70; 95% CI, 0.51–0.96, P trend = 0.007; for &gt; 8.1 g/day vs. &lt; 3.2 g/day). The combination of a high glycemic load and a low cereal fiber intake further increased the risk of NIDDM (RR = 2.17, 95% CI, 1.04–4.54) when compared with a low glycemic load and high cereal fiber intake.

CONCLUSIONS
These findings support the hypothesis that diets with a high glycemic load and a low cereal fiber content increase risk of NIDDM in men. Further, they suggest that grains should be consumed in a minimally refined form to reduce the incidence of NIDDM.
Alternate Site Testing for HbA1c Using the Primus CLC330 GHb Analyzer
Authors: Phillipov George , Charles Peter , Beng Clive , Phillips Patrick J 
Published: March 2007

OBJECTIVE
To determine whether the Primus high-pressure liquid chromatography (HPLC) is suited to alternate site testing (AST) for HbA1c in a hospital diabetes outpatient clinic.

RESEARCH DESIGN AND METHODS
Patients were attending the clinic for routine management of their diabetes. A number of diabetic patients with uremia (n = 11) were also investigated. HbA1c levels were measured in the outpatient setting by the Primus HPLC and in a more limited study the DCA-2000 instrument using the new 6-min assay cartridge. HbA1c measurements were also performed with Pierce affinity minicolumns and a Bio-Rad Variant HPLC.

RESULTS
The Primus HPLC assay had low imprecision of 2.3, 1.6, and 1.0% for HbA1c levels of 4.7, 7.3, and 11.1%, respectively, and was not prone to interference by carbamylated hemoglobin as found for the ion-exchange Variant HPLC method. Method comparison studies showed that the bias and proportional error between the Pierce affinity minicolumn procedure (standardized with respect to an external quality control program) and the Primus HPLC (Y) was −0.4 and 1.2% respectively (n = 32). Similarly the bias and proportional error between the Primus and DCA-2000 methods was 0.7 and −2.5%. The Primus was shown to give falsely elevated HbA1c concentrations if the time between sequential injections was &gt; 28 min.

CONCLUSIONS
The Primus HPLC has a decided advantage over specialty AST instruments, like the DCA-2000, in not only meeting AST requirements but also allowing rapid automated batch processing of all laboratory HbA1c samples.
Catheter Survival During Long-Term Insulin Therapy With an Implanted Programmable Pump
Authors: Scavini Marina , Galli Laura , Reich Sanford , Eaton R Philip , Charles M Arthur , Dunn Fredrick L ,   The Implantable Insulin Pump Trial Study Group
Published: March 2007

OBJECTIVE
To survey catheter complications and to analyze catheter survival during long-term intraperitoneal and intravenous insulin therapy with an implanted programmable pump with a sideport.

RESEARCH DESIGN AND METHODS
Catheter occlusions were documented by measuring dynamic catheter resistance. Catheter migrations or breaks were demonstrated by × ray. When flushing the catheter with buffer solution through the sideport failed to clear the occlusion, catheters were replaced or laparoscopy was performed for the excision of fibrous tissue growth. Broken or migrated catheters were replaced.

RESULTS
Occlusions were the most common catheter complications, and the majority of them (79% intraperitoneal and 84% intravenous) were cleared by flushing the catheter. Survival at 3 years was significantly higher for intraperitoneal catheters compared with intravenous catheters (60% intraperitoneal and 22% intravenous).

CONCLUSIONS
Nonsurgical management of catheter occlusions contributed to extend catheter lifetime. Intraperitoneal catheters have a lower morbidity and a higher survival than intravenous catheters.
Effect of Long-Acting Somatostatin Analog (Somatulin) on Renal Hyperfiltration in Patients With IDDM
Authors: Jacobs Marloes L , Derkx Frans H M , Stijnen Theo , Lamberts Steven W J , Weber Rob F A 
Published: March 2007

OBJECTIVE
To investigate whether long-acting somatostatin (SMS) can suppress renal hyperfiltration in patients with IDDM.

RESEARCH DESIGN AND METHODS
A double-blind, randomized treatment of nine patients with IDDM was used. Selection criteria were renal hyperfiltration (glomerular filtration rate [GFR] ≥ 129 ml · min−1 · 1.73 m2) and absence of hypertension and macroalbuminuria. Treatment was either with a long-acting SMS analog (Somatulin, 30 mg) or with placebo, given by intramuscular injections every 10 days for 9 months. GFR, effective renal plasma flow (ERPF), IGF-I, and 24-h growth hormone (GH) profiles were used as evaluation parameters.

RESULTS
Five patients were randomized to Somatulin, four patients to placebo. One of the patients treated with Somatulin stopped after 3 months because of persistent abdominal discomfort after the injections. Somatulin treatment for 3 months lowered GFR and ERPF compared with placebo (P &lt; 0.05). After 9 months, the differences were no longer significant. After 3 months, IGF-I concentrations were decreased in all Somatulin-treated patients. GH secretion tended to increase in the placebo group.

CONCLUSIONS
The administration of long-acting Somatulin to patients with IDDM and renal hyperfiltration leads to only a temporary reduction of ERPF/GFR.
Fluctuations in GAD65 Antibodies After Clinical Diagnosis of IDDM in Young Children
Authors: Batstra Manou R , Pina Mònica , Quan Joanne , Mulder Paul , de Beaufort Carine E , Bruining G Jan , Aanstoot Henk-Jan 
Published: March 2007

OBJECTIVE
To investigate whether the presence of GAD antibodies at onset of IDDM correlates to a more aggressive rate of β-cell destruction after clinical onset.

RESEARCH DESIGN AND METHODS
We studied GAD antibodies at onset of disease, after 1 year, and after 6 years in 33 consecutively referred children (mean age 8.08, range 1.7–16.3). In a subset of 11 patients, GAD antibodies were studied very frequently. The correlation between GAD antibodies and clinical parameters, including glycosylated hemoglobin, residual insulin secretion, and insulin dosage, was evaluated.

RESULTS
GAD antibody titers were highly variable. Four patients became GAD antibody positive weeks to years after clinical onset. Other patients switched between testing positive and negative for GAD antibodies shortly after clinical onset. No correlation was found between the presence of GAD antibodies and the rate of β-cell destruction, but patients with high GAD antibody indexes at onset had significantly higher glycosylated hemoglobin levels.

CONCLUSIONS
GAD antibodies at clinical onset do not predict the rate of β-cell destruction in young children with newly diagnosed IDDM. The highly variable GAD antibody levels suggest variation of the autoimmune process.
Given Diabetes, Is Fat Better Than Thin?
Authors: Ross Carolyn , Langer Robert D , Barrett-Connor Elizabeth 
Published: March 2007

OBJECTIVE
To evaluate the association between BMI and mortality in women and men with type II diabetes.

RESEARCH DESIGN AND METHODS
Fasting plasma glucose (FPG), height and weight measurements, and medical history were obtained from 4,483 community-dwelling adults, aged 40–79 years, in 1972–1974. A total of 373 persons with either a history of diabetes or FPG ≥ 7.77 mmol/l were studied. Subjects were grouped into four sex-specific weight categories based on U.S. population data. Vital status after 14 years was known for 99.9% of the patients studied. Cox models were used to assess relative survival by weight category.

RESULTS
Diabetic men and women of average weight had the lowest mortality. A J-shaped relative risk curve by weight category was found, with a poorer survival rate for those who were thin, overweight, or obese. This effect was not explained by early mortality or cigarette smoking.

CONCLUSIONS
Being thin may not provide a mortality benefit for diabetic men and women. Average weight appears to be desirable.