bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative Effects of Irbesartan on Ambulatory and Office Blood Pressure
Authors: Rossing Kasper , Christensen Per K. , Andersen Steen , Hovind Peter , Hansen Henrik Post , Parving Hans-Henrik 
Published: March 2007

OBJECTIVE—Irbesartan was renoprotective independently of its blood pressure-lowering effect in the Irbesartan in Patients With Type 2 Diabetes and Microalbuminuria (IRMA2) study. However, blood pressure was evaluated by trough office blood pressure (OBP), which may underestimate reductions in 24-h ambulatory blood pressure (ABP). In the present study, we evaluated 24-h blood pressure patterns in a subpopulation of the IRMA2 trial.
RESEARCH DESIGN AND METHODS—Type 2 diabetic patients (n = 43) with persistent microalbuminuria (as determined by repeated overnight measurements of urinary albumin excretion [UAE]) and hypertension who were included in the IRMA2 study at the Steno Diabetes Center were subjected to 24-h ABP (Takeda, TM2420) measurements before and 2 years after randomization to placebo (n = 15), irbesartan 150 mg daily (Irb150; n = 13), or irbesartan 300 mg daily (Irb300; n = 15).
RESULTS—At baseline, the placebo, Irb150, and Irb300 groups were comparable: OBP: 157 ± 15/89 ± 7, 156 ±15/91 ± 11, and 159 ± 16/90 ± 9 mmHg (NS); 24-h ABP: 148 ± 13/83 ± 11, 148 ± 16/82 ± 7 and 147 ± 16/81 ± 10 mmHg (NS); and UAE (geometric mean with 95% CI): 43 (32–57), 46 (30–70), and 59 (42–85) μg/min (NS), respectively. We found that 2 years after randomization, OBP was significantly reduced in all three groups (by 11/7, 13/8, and 13/8 mmHg in the placebo, Irb150, and Irb300 groups, respectively), but that there were no significant differences among groups. Reductions in 24-h ABP were similar in the three groups (11/10, 5/7, and 7/8 mmHg, respectively; NS), as were reductions in day ABP (11/9, 7/7, and 8/9 mmHg, respectively; NS) and night ABP (4/11, 7/7, and 3/3 mmHg, respectively; NS). The reduction in UAE at the end of the study was 0% (−86 to 42), 38% (−14 to 66), and 73% (59 to 82), respectively (overall, P &lt; 0.01).
CONCLUSION—Irbesartan is renoprotective independently of its beneficial effect in lowering 24-h blood pressure in patients with type 2 diabetes and persistent microalbuminuria.
A Comparison of the Prevalence of the Metabolic Syndrome Using Two Proposed Definitions
Authors: Ford Earl S. , Giles Wayne H. 
Published: March 2007

OBJECTIVE—To compare the prevalence of the metabolic syndrome using two definitions: one proposed by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III [ATP III]) and one by the World Health Organization (WHO).
RESEARCH DESIGN AND METHODS—We used data from a nationally representative sample of the noninstitutionalized civilian population of the U.S. from the Third National Health and Nutrition Examination Survey, a cross-sectional health examination survey (1988–1994).
RESULTS—Among 8,608 participants aged ≥20 years, the age-adjusted prevalence was 23.9% using the ATP III definition and 25.1% using the WHO definition. Among all participants, 86.2% were classified as either having or not having the metabolic syndrome under both definitions. Estimates differed substantially for some subgroups, however. For example, in African-American men, the WHO estimate was 24.9%, compared with the ATP III estimate of 16.5%.
CONCLUSIONS—A universally accepted definition of the metabolic syndrome is needed.
The PedsQL™ in Type 1 and Type 2 Diabetes
Authors: Varni James W. , Burwinkle Tasha M. , Jacobs Jenifer R. , Gottschalk Michael , Kaufman Francine , Jones Kenneth L. 
Published: March 2007

OBJECTIVE—The Pediatric Quality of Life Inventory (PedsQL) is a modular instrument designed to measure health-related quality of life (HRQOL) in children and adolescents aged 2–18 years. The PedsQL 4.0 Generic Core Scales are child self-report and parent proxy-report scales developed as the generic core measure to be integrated with the PedsQL disease-specific modules. The PedsQL 3.0 Type 1 Diabetes Module was designed to measure diabetes-specific HRQOL.
RESEARCH DESIGN AND METHODS—The PedsQL Generic Core Scales and Diabetes Module were administered to 300 pediatric patients with type 1 or type 2 diabetes and 308 parents.
RESULTS—Internal consistency reliability for the PedsQL Generic Core Total Scale score (α = 0.88 child, 0.89 parent-report) and most Diabetes Module scales (average α = 0.71 child, 0.77 parent-report) was acceptable for group comparisons. The PedsQL 4.0 distinguished between healthy children and children with diabetes. The Diabetes Module demonstrated intercorrelations with dimensions of generic and diabetes-specific HRQOL.
CONCLUSIONS—The results demonstrate the reliability and validity of the PedsQL in diabetes. The PedsQL may be used as an outcome measure for diabetes clinical trials and research.
Visceral Adiposity and the Risk of Impaired Glucose Tolerance
Authors: Hayashi Tomoshige , Boyko Edward J. , Leonetti Donna L. , McNeely Marguerite J. , Newell-Morris Laura , Kahn Steven E. , Fujimoto Wilfred Y. 
Published: March 2007

OBJECTIVE—Greater visceral adiposity, higher insulin resistance, and impaired insulin secretion increase the risk of type 2 diabetes. Whether visceral adiposity increases risk of impaired glucose tolerance (IGT) independent of other adipose depots, insulin resistance, and insulin secretion is not known.
RESEARCH DESIGN AND METHODS—Study subjects included 128 Japanese Americans with normal glucose tolerance at entry. Baseline variables included plasma glucose and insulin measured after an overnight fast and during a 75-g oral glucose tolerance test, fat areas by computed tomography, insulin secretion (incremental insulin response [IIR] [30 min insulin − fasting insulin]/30 min glucose), and insulin resistance index (homeostasis model assessment for insulin resistance [HOMA-IR]).
RESULTS—During the 10- to 11-year follow-up period, we confirmed 57 cases of IGT. Significant predictors of IGT included intra-abdominal fat area (IAFA) (odds ratio [OR] for a 1 SD increase 3.82, 95% CI 1.63–8.94 at a fasting plasma glucose [FPG] level of 4.5 mmol/l), HOMA-IR (2.41, 1.15–5.04), IIR (0.30, 0.13–0.69 at an FPG level of 4.5 mmol/l), the interactions of IAFA by FPG (P = 0.003), and IIR by FPG (P = 0.030) after adjusting for age, sex, FPG, and BMI. The multiple-adjusted OR of IAFA increased and that of IIR decreased as FPG level decreased because of these interactions. Even after adjustment for total fat area, total subcutaneous fat area, or abdominal subcutaneous fat area, all of these associations remained a significant predictor of IGT incidence.
CONCLUSIONS—Greater visceral adiposity increases the risk of IGT independent of insulin resistance, insulin secretion, and other adipose depots in Japanese Americans.
How Well Do Patients’ Assessments of Their Diabetes Self-Management Correlate With Actual Glycemic Control and Receipt of Recommended Diabetes Services?
Authors: Heisler Michele , Smith Dylan M. , Hayward Rodney A. , Krein Sarah L. , Kerr Eve A. 
Published: March 2007

OBJECTIVE—Although patient diabetes self-management is a key determinant of health outcomes, there is little evidence on whether patients’ own assessments of their self-management correlates with glycemic control and key aspects of high-quality diabetes care. We explored these associations in a nationwide sample of Veterans’ Affairs (VA) patients with diabetes.
RESEARCH DESIGN AND METHODS—We abstracted information on achieved level of glycemic control (HbA1c) and diabetes processes of care (receipt of HbA1c test, eye examination, and nephropathy screen) from medical records of 1,032 diabetic patients who received care from 21 VA facilities and had answered the Diabetes Quality Improvement Program survey in 2000. The survey included sociodemographic measures and a five-item scale assessing the patients’ diabetes self-management (medication use, blood glucose monitoring, diet, exercise, and foot care [α = 0.68]). Using multivariable regression, we examined the associations of patients’ reported self-management with HbA1c level and receipt of each diabetes process of care. We adjusted for diabetes severity and comorbidities, insulin use, age, ethnicity, income, education, use of VA services, and clustering at the facility level.
RESULTS—Higher patient evaluations of their diabetes self-management were significantly associated with lower HbA1c levels (P &lt; 0.01) and receipt of diabetes services. Those in the 95th percentile for self-management had a mean HbA1c level of 7.3 (95% CI 6.4–8.3), whereas those in the 5th percentile had mean levels of 8.3 (7.4–9.2). For every 10-point increase in patients’ ratings of their diabetes self-management, even after adjusting for number of outpatient visits, the odds of receiving an HbA1c test in the past year increased by 15% (4–27%), of receiving an eye examination increased by 16% (7–27%), and of receiving a nephropathy screen increased by 13% (2–26%).
CONCLUSIONS—In this sample, patients’ assessments of their diabetes self-care using a simple five-question instrument were significantly associated both with actual HbA1c control and with receiving recommended diabetes services. These findings reinforce the usefulness of patient evaluations of their own self-management for understanding and improving glycemic control. The mechanisms by which those patients who are more actively engaged in their diabetes self-care are also more likely to receive necessary services warrant further study.
The Sensory Symptoms of Diabetic Polyneuropathy Are Improved With α-Lipoic Acid
Authors:   The SYDNEY Trial Authors, for the SYDNEY Trial Study Group:, Ametov Alexander S. , Barinov Alexei , Dyck Peter J. , Hermann Robert , Kozlova Natalia , Litchy William J. , Low Phillip A. , Nehrdich Detlef , Novosadova Maria , O’Brien Peter C. , Reljanovic Miroslav , Samigullin Rustem , Schuette Klemens , Strokov Igor , Tritschler Hans J. , Wessel Klaus , Yakhno Nikolai , Ziegler Dan 
Published: March 2007

OBJECTIVE— Because α-lipoic acid (ALA), a potent antioxidant, prevents or improves nerve conduction attributes, endoneurial blood flow, and nerve (Na(+) K(+) ATPase activity in experimental diabetes and in humans and may improve positive neuropathic sensory symptoms, in this report we further assess the safety and efficacy of ALA on the Total Symptom Score (TSS), a measure of positive neuropathic sensory symptoms.
RESEARCH DESIGN AND METHODS— Metabolically stable diabetic patients with symptomatic (stage 2) diabetic sensorimotor polyneuropathy (DSPN) were randomized to a parallel, double-blind study of ALA (600 mg) (n = 60) or placebo (n = 60) infused daily intravenously for 5 days/week for 14 treatments. The primary end point was change of the sum score of daily assessments of severity and duration of TSS. Secondary end points were sum scores of neuropathy signs (NIS), symptoms (NSC), attributes of nerve conduction, quantitative sensation tests (QSTs), and an autonomic test.
RESULTS— At randomization, the groups were not significantly different by the criteria of metabolic control or neuropathic end points. After 14 treatments, the TSS of the ALA group had improved from baseline by an average of 5.7 points and the placebo group by an average of 1.8 points (P &lt; 0.001). Statistically significant improvement from baseline of the ALA, as compared with the placebo group, was also found for each item of the TSS (lancinating and burning pain, asleep numbness and prickling), NIS, one attribute of nerve conduction, and global assessment of efficacy.
CONCLUSIONS— Intravenous racemic ALA, a potent antioxidant, rapidly and to a significant and meaningful degree, improved such positive neuropathic sensory symptoms as pain and several other neuropathic end points. This improvement of symptoms was attributed to improved nerve pathophysiology, not to increased nerve fiber degeneration. Because of its safety profile and its effect on positive neuropathic sensory symptoms and other neuropathic end points, this drug appears to be a useful ancillary treatment for the symptoms of diabetic polyneuropathy.
Impact of Incident Diabetes and Incident Nonfatal Cardiovascular Disease on 18-Year Mortality
Authors: Eberly Lynn E. , Cohen Jerome D. , Prineas Ronald , Yang Lingfeng ,   For The Multiple Risk Factor Intervention Trial Research Group
Published: March 2007

OBJECTIVE— To report long-term risks for total, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality associated with incident diabetes (using current diagnostic criteria) and with incident nonfatal CVD (NF-CVD).
RESEARCH DESIGN AND METHODS— A total of 11,645 participants without diabetes or CVD at baseline from the Multiple Risk Factor Intervention Trial who survived to the end of the trial were grouped by during-trial incident diabetes and/or NF-CVD events: neither diabetes nor NF-CVD, diabetes only, NF-CVD only, or both diabetes and NF-CVD. Incident diabetes was defined by use of hypoglycemic agents or fasting glucose ≥126 mg/dl at any time over the 6 trial years. Proportional hazards models tested group differences in mortality over 18 post-trial years.
RESULTS— Among 3,859 total deaths were 1,846 from CVD and 1,277 from CHD, with death rates per 10,000 person-years of 203, 97, and 67, respectively. Multivariate-adjusted hazard ratios (HRs) for total mortality were 2.75 (P &lt; 0.0001) for those with NF-CVD and diabetes both, 1.92 (P &lt; 0.0001) for those with NF-CVD only, and 1.49 (P &lt; 0.0001) for those with diabetes only, relative to neither diabetes nor NF-CVD. NF-CVD was associated with a higher hazard of death than diabetes for total (HR 1.29, P = 0.0004), CVD (HR 1.76, P &lt; 0.0001), and CHD (HR 1.88, P &lt; 0.0001) mortality. Only the subgroup of participants on hypoglycemic agents showed an equivalent risk of total mortality relative to participants with NF-CVD (HR 0.93, P = 0.54).
CONCLUSIONS— Current diabetes diagnostic criteria conferred significantly increased total, CVD, and CHD mortality risks independent of the impact of NF-CVD. NF-CVD was more strongly predictive of mortality.
Insulin Resistance, the Metabolic Syndrome, and Risk of Incident Cardiovascular Disease in Nondiabetic American Indians
Authors: Resnick Helaine E. , Jones Kristina , Ruotolo Giacomo , Jain Arvind K. , Henderson Jeffrey , Lu Weiquan , Howard Barbara V. 
Published: March 2007

OBJECTIVE—Insulin resistance (IR) and the metabolic syndrome (MS) are associated with type 2 diabetes and adverse cardiovascular disease (CVD) risk factor profiles. Whether IR and MS predict CVD independently of diabetes and other CVD risk factors is not known. This study examines whether IR and/or presence of MS are independently associated with CVD in nondiabetic American Indians (AI).
RESEARCH DESIGN AND METHODS—We examined 2,283 nondiabetic AI who were free of CVD at the baseline examination of the Strong Heart Study (SHS). CVD risk factors were measured, IR was quantified using the homeostasis model assessment (HOMA), and MS as defined by the National Cholesterol Education Program Adult Treatment Panel (ATP III) was assessed for each participant. Incident CVD and diabetes were ascertained during follow-up.
RESULTS—MS was present in 798 individuals (35%), and 181 participants (7.9%) developed CVD over 7.6 ± 1.8 years of follow-up. Age, BMI, waist circumference, and triglyceride levels increased and HDL cholesterol decreased across tertiles of HOMA-IR. Risk of diabetes increased as a function of baseline HOMA-IR (6.3, 14.6, and 30.1%; P &lt; 0.001) and MS (12.8 vs. 24.5%). In Cox models adjusted for CVD risk factors, risk of CVD did not increase either as a function of baseline HOMA-IR or MS, but individual CVD risk factors predicted subsequent CVD.
CONCLUSIONS—Among nondiabetic AI in the SHS, HOMA-IR and MS both predict diabetes, but neither predicts CVD independently of other established CVD risk factors.
Type 2 Diabetic Individuals Have Impaired Leg Blood Flow Responses to Exercise
Authors: Kingwell Bronwyn A. , Formosa Melissa , Muhlmann Michael , Bradley Scott J. , McConell Glenn K. 
Published: March 2007

OBJECTIVE— Diabetic individuals have impaired endothelium-dependent forearm vasodilatory responses to ischemia, acetylcholine, and other endothelium-dependent agonists. The functional significance of impaired endothelium-dependent dilation in diabetic individuals is uncertain but is most likely to be manifest during leg muscle exercise and may have relevance to peripheral vascular disease and leg ischemia, which is prevalent in diabetic individuals. The current study aimed to determine the relationship between leg blood flow (LBF) responses to endothelium-dependent vasodilation and dynamic large muscle exercise.
RESEARCH DESIGN AND METHODS— LBF responses (thermodilution) to intrafemoral arterial infusions of an endothelium-dependent (acetylcholine) and endothelium-independent (sodium nitroprusside) vasodilator and a standardized 25-min cycling bout at 60% Vo2peak were compared in nine male type 2 diabetic subjects and nine age-, sex-, Vo2peak-, and weight-matched control subjects.
RESULTS— LBF responses to acetylcholine and exercise but not sodium nitroprusside were significantly (P &lt; 0.05) attenuated in patients with diabetes compared with healthy control subjects. The percentage increase in LBF in response to exercise and acetylcholine were significantly correlated (r = 0.54, P = 0.02). Furthermore, resting plasma glucose was significantly related to the LBF response to exercise (r = −0.66, P = 0.003) independently of insulin, HbA1c, lipids, BMI, and blood pressure.
CONCLUSIONS— The increase in LBF during exercise is substantially attenuated in type 2 diabetic compared with matched control subjects. Impaired endothelium-dependent vasodilation secondary to elevated plasma glucose may underlie this observation. This mechanism may be of importance in determining the leg ischemic threshold in diabetic individuals with peripheral vascular disease.
Insulin Pump Therapy
Authors: Weissberg-Benchell Jill , Antisdel-Lomaglio Jeanne , Seshadri Roopa 
Published: March 2007

OBJECTIVE—To conduct a meta-analysis of the metabolic and psychosocial impact of continuous subcutaneous insulin infusion (CSII) therapy on adults, adolescents, and children.
RESEARCH DESIGN AND METHODS—Studies were identified and data regarding study design, year of publication, sample size, patient’s age, diabetes duration, and duration of CSII therapy were collected. Means and SDs for glycohemoglobin, blood glucose, insulin dosages, and body weight for CSII and comparison conditions were subjected to meta-analytic procedures. Data regarding pump complications and psychosocial functioning were reviewed descriptively.
RESULTS—A total of 52 studies, consisting of 1,547 patients, were included in the meta-analysis. Results indicate that CSII therapy is associated with significant improvements in glycemic control (decreased glycohemoglobin and mean blood glucose). A descriptive review of potential complications of CSII use (e.g., hypoglycemia, diabetic ketoacidosis [DKA], pump malfunction, and site infections) suggests a decreased frequency of hypoglycemic episodes but an increased frequency of DKA in studies published before 1993.
CONCLUSIONS—CSII therapy is associated with improved glycemic control compared with traditional insulin therapies (conventional therapy and multiple daily injections) and does not appear to be associated with significant adverse outcomes. Additional studies are needed to further examine the relative risks of CSII therapy, including the potential psychosocial impact of this technologically advanced therapy.
International Comparison of Health Resource Utilization in Subjects With Diabetes
Authors: Klarenbach Scott W. , Jacobs Philip 
Published: March 2007

OBJECTIVE—To compare health resource utilization in patients with diabetes between the U.S. and Canada.
RESEARCH DESIGN AND METHODS—We combined measures of health care utilization, personal, demographic, health status, functional status, and comorbid conditions from the current National Health Interview Survey (U.S.) and the National Public Health Survey (Canada). A binary logistic regression analysis was used to examine how country of residence influences the probability of accessing health care resources in adult Caucasian subjects after controlling for potential confounders.
RESULTS—Subjects from Canada (n = 521) were more likely to have contact with a general physician (odds ratio [OR] 4.01, 95% CI 2.26–7.14), eye specialists (1.46, 1.08–1. 98), and any physician (3.02, 1.03–8.84) in the past year than their American counterparts (n = 825) but were less likely to have had contact with other medical specialists (0.33, 0.24–0.46). Subjects in Canada were also more likely to have been hospitalized overnight (1.79, 1.17–2.75) or to have contact with a health care professional in the previous 12 months (3.35, 1.01–12.81).
CONCLUSIONS—Significant disparities exist in health service utilization for adult Caucasian individuals with diabetes in Canada versus the U.S. after controlling for various confounders. From what is known regarding optimal treatment of diabetes, those with diabetes in the U.S. have a greater chance of not receiving recommended care.
Long-Term Beneficial Effect of Islet Transplantation on Diabetic Macro-/Microangiopathy in Type 1 Diabetic Kidney-Transplanted Patients
Authors: Fiorina Paolo , Folli Franco , Bertuzzi Federico , Maffi Paola , Finzi Giovanna , Venturini Massimo , Socci Carlo , Davalli Alberto , Orsenigo Elena , Monti Lucilla , Falqui Luca , Uccella Silvia , La Rosa Stefano , Usellini Luciana , Properzi Giuliana , Di Carlo Valerio , Del Maschio Alessandro , Capella Carlo , Secchi Antonio 
Published: March 2007

OBJECTIVE—Our aim was to evaluate the long-term effects of transplanted islets on diabetic macro-/microangiopathy in type 1 diabetic kidney-transplanted patients.
RESEARCH DESIGN AND METHODS—A total of 34 type 1 diabetic kidney-transplanted patients underwent islet transplantation and were divided into two groups: successful islet-kidney transplantation (SI-K; 21 patients, fasting C-peptide serum concentration &gt;0.5 ng/ml for &gt;1 year) and unsuccessful islet-kidney transplantation (UI-K; 13 patients, fasting C-peptide serum concentration &lt;0.5 ng/ml). Patients cumulative survival, cardiovascular death rate, and atherosclerosis progression were compared in the two groups. Skin biopsies, endothelial dependent dilation (EDD), nitric oxide (NO) levels, and atherothrombotic risk factors [von Willebrand factor (vWF) and d-dimer fragment (DDF)] were studied cross-sectionally.
RESULTS—The SI-K group showed a significant better patient survival rate (SI-K 100, 100, and 90% vs. UI-K 84, 74, and 51% at 1, 4, and 7 years, respectively, P = 0.04), lower cardiovascular death rate (SI-K 1/21 vs. UI-K 4/13, χ2 = 3.9, P = 0.04), and lower intima-media thickness progression than the UI-K group (SI-K group: Δ1–3 years −13 ± 30 μm vs. UI-K group: Δ1–3 years 245 ± 20 μm, P = 0.03) with decreased signs of endothelial injuring at skin biopsy. Furthermore, the SI-K group showed a higher EDD than the UI-K group (EDD: SI-K 7.8 ± 4.5% vs. UI-K 0.5 ± 2.7%, P = 0.02), higher basal NO (SI-K 42.9 ± 6.5 vs. UI-K 20.2 ± 6.8 μmol/l, P = 0.02), and lower levels of vWF (SI-K 138.6 ± 15.3 vs. UI-K 180.6 ± 7.0%, P = 0.02) and DDF (SI-K 0.61 ± 0.22 vs. UI-K 3.07 ± 0.68 μg/ml, P &lt; 0.01). C-peptide-to-creatinine ratio correlated positively with EDD and NO and negatively with vWF and DDF.
CONCLUSIONS—Successful islet transplantation improves survival, cardiovascular, and endothelial function in type 1 diabetic kidney-transplanted patients.