bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vessel Wall Properties of Large Arteries in Uncomplicated IDDM
Authors: Kool Mirian J , Lambert Jan , Stehouwer Coen D , Hoeks Arnold P , Boudier Harry A Struijker , Bortel Luc M Van 
Published: March 2007

OBJECTIVE
Patients with insulin-dependent diabetes mellitus (IDDM) are at high risk for cardiovascular disease. Arterial distensibility and compliance are vessel wall properties of large arteries. Altered large artery wall properties can be an early feature of vascular dysfunction. This study investigates vessel wall properties in 30 patients with uncomplicated IDDM and 30 matched healthy control subjects.

RESEARCH DESIGN AND METHODS
Vessel wall properties of the elastic common carotid (CCA) and the muscular femoral (FA) and brachial arteries (BA) were measured with a vessel wall movement detector system. Blood pressure and heart rate were recorded simultaneously with a semiautomated device. Aortic pulse wave velocity was estimated from the carotido-femoral transit time.

RESULTS
Blood pressure (IDDM patients: 118 ± 10/69 ± 5 mmHg), pulse pressure (IDDM patients: 49 ± 8 mmHg), and heart rate (IDDM patients: 65 ± 9 beats/min) were similar in IDDM patients and control subjects. No statistically significant changes between IDDM patients and control subjects were found for diameter, distensibility, and compliance of the elastic CCA and the muscular BA. Distensibility (IDDM patients: 16.9 ± 6.4 10-3/ kPa; control subjects: 22.4 ± 11.8 10-3/kPa) of the muscular FA was decreased in IDDM (P &lt; 0.05). However, FA compliance (IDDM patients: 0.80 ± 0.23 mm-2/kPa; control subjects: 0.94 ± 0.41 mm2/kPa) and FA diameter (IDDM patients: 7.87 ±1.10 mm; control subjects: 7.57 ±1.11 mm) did not differ statistically between IDDM patients and control subjects. Aortic pulse wave velocity was the same in IDDM patients and control subjects (IDDM patients: 5.1 ± 0.6 m/s). No relation was found between vessel wall properties and duration of disease, actual glucose level, and HbA1c for all three arteries (CCA, BA, and FA). But the groups might have been too small to draw conclusions.

CONCLUSIONS
The results of the present study show that in this group of patients with uncomplicated IDDM, vessel wall properties of elastic and muscular large arteries were not obviously reduced when compared with healthy control subjects. However, distensibility of the FA was lower in IDDM patients. Early atherosclerotic changes in IDDM frequently occur at this site. A difference related to the duration of diabetes could not be excluded.
Evaluation of a Structured Outpatient Group Education Program for Intensive Insulin Therapy
Authors: Pieber Thomas R , Brunner Gernot A , Schnedl Wolfgang J , Schattenberg Susanne , Kaufmann Peter , Krejs Guenter J 
Published: March 2007

OBJECTIVE
To determine the efficacy and safety of a structured diabetes teaching and treatment program (DTTP) in patients with insulin-dependent diabetes mel-litus (IDDM) in an outpatient setting.

RESEARCH DESIGN AND METHODS
All patients with IDDM who completed a structured 5-day outpatient DTTP were reevaluated after a mean follow-up of 3 years. A standardized interview was used to assess frequency of severe hypoglycemia, type of insulin treatment, self-monitoring, and other diabetes-related parameters. HbA1c was measured by high-performance liquid chromatography.

RESULTS
Of 205 patients, 4 (2%) died during the observation period. HbA1c in the 201 surviving patients decreased significantly from 8.7 ± 2.0 to 7.5 ± 1.2% at follow-up (P &lt; 0.001); frequency of severe hypoglycemia decreased from a mean of 0.46 to 0.13 per patient per year (P &lt; 0.001). Hospital admission due to acute metabolic disturbances decreased from 4.5 ± 11.1 to 1.4 ± 6.7 days/patient-year (P &lt; 0.001). At follow-up, intensive insulin therapy was carried out by 98% of the patients, and 80% of the patients reported three or more measurements of blood glucose per day. Diabetes-related knowledge had a positive (P &lt; 0.01) and body mass index a negative (P &lt; 0.02) influence on improving HbA1c assessed by multiple regression analysis. Severe hypoglycemia after DTTP was associated with a history of severe hypoglycemia before DTTP (P &lt; 0.001) and the existence of overt diabetic nephrop-athy (P &lt; 0.05).

CONCLUSIONS
A structured outpatient DTTP as used in this study is able to improve overall metabolic control and decrease the frequency of severe hypoglycemia in patients with IDDM.
Metabolic Control and Progression of Retinopathy: The Diabetes in Early Pregnancy Study
Authors: Chew Emily Y , Mills James L , Metzger Boyd E , Remaley Nancy A , Jovanovic-Peterson Lois , Knopp Robert H , Conley Mary , Rand Lawrence , Simpson Joe L , Holmes Lewis B , Aarons Jerome H ,   National Institute of Child Health and Human Development Diabetes in Early Pregnancy Study
Published: March 2007

OBJECTIVE
To evaluate the role of metabolic control in the progression of diabetic retinopathy during pregnancy.

RESEARCH DESIGN AND METHODS
We conducted a prospective cohort study of 155 diabetic women in the Diabetes in Early Pregnancy Study followed from the periconceptional period to 1 month postpartum. Fundus photographs were obtained shortly after conception (95% within 5 weeks of conception) and within 1 month postpartum. Glycosylated hemoglobin was measured weekly during the 1st trimester and monthly thereafter.

RESULTS
In the 140 patients who did not have proliferative retinopathy at baseline, progression of retinopathy was seen in 10.3, 21.1, 18.8, and 54.8% of patients with no retinopathy, microaneurysms only, mild nonproliferative retinopathy, and moderate-to-severe nonproliferative retinopathy at baseline, respectively. Proliferative retinopathy developed in 6.3% with mild and 29% with moderate-to-severe baseline retinopathy. Elevated glycosylated hemoglobin at baseline and the magnitude of improvement of glucose control through week 14 were associated with a higher risk of progression of retinopathy (adjusted odds ratio for progression in those with glycohe-moglobin ≥ 6 SD above the control mean versus those within 2 SD was 2.7; 95% confidence interval was 1.1-7.2; P = 0.039).

CONCLUSIONS
The risk for progression of diabetic retinopathy was increased by initial glycosylated hemoglobin elevations as low as 6 SD above the control mean. This increased risk maybe due to suboptimal control itself or to the rapid improvement in metabolic control that occurred in early pregnancy. Excellent metabolic control before conception may be required to avoid this increase in risk. Those with moderate-to-severe retinopathy at conception need more careful ophthalmic monitoring, particularly if their diabetes was suboptimally controlled at conception.
HLA-DQβl Typing and Non-Asp57 Alleles in the Aborigine Population of Senegal
Authors: Chauffert Maryline , Cisse Aynina , Chevenne Didier , Parfait Béatrice , Michel Simone , Trivin François 
Published: March 2007

OBJECTIVE
To investigate, in Senegalese subjects, the frequency of human leukocyte antigen (HLA)-DQβ1 alleles and their role in susceptibility to insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS
HLA-DQβ1 typing was done in 55 IDDM subjects and 118 nondiabetic control subjects by means of polymerase chain reaction restriction fragment length polymorphism.

RESULTS
All;eles bearing a codon for an Asp residue at position 57 in the DQ β-chain were associated with a significantly lower risk of IDDM. Alleles 0201 and 0302 (Ala57) were positively associated with diabetes, but allele 0501 (Val57) was less frequent in IDDM subjects than in control subjects.

CONCLUSIONS
HLA-DQβl alleles may be genetic susceptibility markers for IDDM in the Senegalese population, as they are in Caucasian populations.
Short-Term and Long-Term Memory in Elderly Patients with NIDDM
Authors: Helkala Eeva-Liisa , Niskanen Leo , Viinamaki Heimo , Partanen Juhani , Uusitupa Matti 
Published: March 2007

OBJECTIVE
To determine cognitive and memory dysfunction associated with non-insulin-dependent diabetes mellitus (NIDDM) and its relationship with depression, metabolic control, and serum lipids.

RESEARCH DESIGN AND METHODS
We studied a well-characterized group of 20 elderly patients with NIDDM and 22 control subjects with normal glucose tolerance recruited from a larger population-based sample. In addition to clinical and laboratory examinations, self-rating questionnaires that assess minor psychiatric disorder (General Health Questionnaire) and depression (Zung scale) were completed by patients and control subjects. Memory was examined with digit and block-span tests, word-list learning, Heaton Visual Memory Test, and Moss Visual Span Test. Executive functions were examined by Trail-Making A and A and B test and by Verbal and Category Fluency Tests. Visuoconstructive reasoning was examined with the block design subtest of the Wechsler Adult Intelligence Scale.

RESULTS
The NIDDM patients showed preserved memory span, but poor performance in learning tasks compared with control subjects. The patients recalled no fewer words than the control subjects, but the process of learning seemed to be different in the two groups. The recognition of the learned words was not impaired. Elevated serum total and very-low-density lipoprotein triglyceride levels, measured either before examinations or 5 or 10 years earlier, were associated with effects on retrieval from semantic memory in NIDDM patients.

CONCLUSIONS
The NIDDM patients had impaired control of their learning processes. Elevated serum triglyceride levels may be related to control of mental processing in diabetic patients.
Mortality Risk by Body Weight and Weight Change in People with NIDDM: The WHO Multinational Study of Vascular Disease in Diabetes
Authors: Chaturvedi Nishi , Fuller John H ,   The WHO Multinational Study Group
Published: March 2007

OBJECTIVE
Care guidelines for people with non-insulin-dependent diabetes mellitus (NIDDM) emphasize the importance of weight loss in reducing mortality risk. However, existing evidence regarding the relationship between weight and mortality and the effects of weight change is conflicting. We examined these relationships in the World Health Organization Multinational Study of Vascular Disease in Diabetes.

RESEARCH DESIGN AND METHODS
This was a cohort study of 1,416 men and 1,544 women. Baseline examinations were performed in 1975 through 1977, a morbidity follow-up was performed in 1983, and a mortality follow-up continued until 1988. Data were analyzed according to geographical groups: Europeans, East Asians, and Native Americans. The relationship between weight change and mortality was analyzed for Europeans only.

RESULTS
Generally, body mass index (BMI) was positively associated with age, blood pressure, and cholesterol but was negatively associated with duration of diabetes, prevalence of retinopathy, and use of insulin. There was no clear relationship between BMI and mortality across the geographical groups. In Europeans, weight loss in the leanest subjects at baseline (BMI &lt; 26 kg/m2) was associated with a threefold increase in mortality risk compared with those who had maintained a steady weight (relative risk [RR] 3.05, 95% confidence interval [CI] 1.26–7.36). Only in the most obese group was weight loss associated with a reduction in mortality risk (BMI &gt; 29 kg/m2, RR 0.84, 95% CI 0.40–1.74).

CONCLUSIONS
The positive association of BMI with age, blood pressure, and cholesterol and the negative association with duration of diabetes, retinopathy, and use of insulin may explain why there is no strong relationship between BMI and mortality in NIDDM. Weight loss, particularly in the relatively lean diabetic person, may be associated with an increased mortality risk.
Daily Walking Combined With Diet Therapy Is a Useful Means for Obese NIDDM Patients Not Only to Reduce Body Weight But Also to Improve Insulin Sensitivity
Authors: Yamanouchi Kunio , Shinozaki Takashi , Chikada Kiwami , Nishikawa Toshihiko , Ito Katsunori , Shimizu Shoji , Ozawa Norihito , Suzuki Yoichiro , Maeno Hitoshi , Kato Katsumi , Oshida Yoshiharu , Sato Yuzo 
Published: March 2007

OBJECTIVE
To evaluate the effects of walking combined with diet therapy (1,000–1,600 kcal/day) on insulin sensitivity in obese non-insulin-dependent diabetes mellitus (NIDDM) patients.

RESEARCH DESIGN AND METHODS
Subjects were divided into two groups: 10 patients were managed by diet alone (group D), and 14 patients were placed in the diet and exercise group (group DE). Group DE was instructed to walk at least 10,000 steps/day on a flat field as monitored by pedometer (19,200 ± 2,100 steps/day), and group D was told to maintain a normal daily routine (4,500 ± 290 steps/day). A glucose clamp procedure at an insulin infusion rate of 40 mU · m−2 · min−1 was performed before and after the 6-; to 8-week training program. Mean serum insulin concentrations ranged from 720 to 790 pmol/l.

RESULTS
While body weight (BW) in groups D and DE decreased significantly (P &lt; 0.01) during the study, the amount of BW reduction in group DE was &gt; that in group D (7.8 ± 0.8 vs. 4.2 ± 0.5 kg, P &lt; 0.01). After training, glucose infusion rate (GIR) and metabolic clearance rate (MCR) in group D did not significantly increase; however, GIR and MCR increased significantly in group DE, from 17.21 ± 1.11 to 26.09 ± 1.11 μmol·kg−1 · min−1 (P &lt; 0.001) and from 3.0 ± 0.3 to 5.3 ± 0.4 ml·kg−1 · min−1 (P &lt; 0.001), respectively. The analysis of variance showed significant effects of exercise (time × exercise, P = 0.0005) for the improvement of MCR. Significant correlations were also observed between Δ MCR and average steps per day (r = 0.7257, P &lt; 0.005) in group DE.

CONCLUSIONS
Walking, which can be safely performed and easily incorporated into daily life, can be recommended as an adjunct therapy to diet treatment in obese NIDDM patients, not only for BW reduction, but also for improvement of insulin sensitivity.
Role of Metformin Accumulation in Metformin-Associated Lactic Acidosis
Authors: Lalau Jean D , Lacroix Christian , Compagnon Patricia , Cagny Bertrand de , Rigaud Jean P , Bleichner Gérard , Chauveau Paul , Dulbecco Patricia , Guérin Claude , Haegy Jean M , Loirat Philippe , Marchand Bruno , Ravaud Yves , Weyne Philippe , Fournier Albert 
Published: March 2007

OBJECTIVE
To investigate the role of metformin accumulation in the pathophysiology of metformin-associated lactic acidosis.

RESEARCH DESIGN AND METHODS
We used high-performance liquid chromatography to measure plasma metformin concentrations in 14 patients who experienced lactic acidosis (pH &lt;7.35 and lactate concentration &gt;5 mmol/l) while receiving chronic metformin treatment. Their treatment was generally based on alkalinization and dialysis therapy.

RESULTS
Clinical shock and/or evidence of tissue hypoxia was found in all patients with the exception of one who had a nonsteroidal anti-inflammatory drug-induced anuria. Ten patients had significant metformin accumulation (plasma metformin concentrations 4.1-84.9 mg/l, normal value 0.6 ± 0.5 mg/l before drug intake), generally because of failure to withdraw metformin despite intercurrent pathological conditions affecting its renal elimination (serum creatinine concentrations ranging from 269 to 1,091 μmol/l). There was no metformin accumulation (plasma metformin 0.03–0.7 mg/l) in the four other patients, who had less severe renal failure (serum creatinine 140–349 mumol/l). The severity of the patient's general condition did not predict early hospital mortality (death before discharge from the intensive care unit) even in patients in shock. Whereas it was high in those without metformin accumulation (only 1 of 4 patients recovered), early hospital mortality was low in the 10 patients with metformin accumulation and was not related to its extent (3 patients died with end-stage hepatic failure or cardiac failure). Correlation studies showed a positive correlation between serum creatinine and plasma metformin and between plasma metformin and arterial lactate but, for the latter correlation, only in patients with metformin accumulation.

CONCLUSION
Metformin-associated lactic acidosis is not necessarily due to metformin accumulation; true type B (aerobic) lactic acidosis, i.e., without an apparent associated hypoxic factor, seems exceptional. Neither the severity of the clinical picture nor the degree of metformin accumulation predicted survival; rather, the prognosis was dependent upon the severity of the associated pathological conditions.
Insulin Sensitivity Is Not Impaired In Mexican-American Women Without a Family History Of Diabetes
Authors: Bonora Enzo , Gulli Giovanni , Bonadonna Riccardo , Prato Stefano Del , Solini Anna , DeFronzo Ralph A. 
Published: March 2007

OBJECTIVE
The purpose of this research was to compare insulin sensitivity in Mexican-Americans and non-Hispanic whites without a family history of diabetes to establish whether insulin resistance is a defect intrinsically related to subjects of Mexican origin.

RESEARCH DESIGN AND METHODS
In study A, we compared insulin sensitivity in 12 Mexican-American and 12 non-Hispanic white women with normal glucose tolerance and no family history of diabetes. In study B, we compared insulin sensitivity in two groups of normal glucose-tolerant Mexican-Americans, nine with a positive (FHD+) and nine with a negative (FHD−) family history of diabetes. In both studies, the groups were closely matched for age, total body fat content, and fat topography. Insulin sensitivity was assessed with the euglycemic insulin clamp (20 mU·min−1·m2 surface area) which was performed in combination with tritiated glucose infusion and indirect calorimetry. Total fat mass and fat-free mass (FFM) were assessed by a tritiated water dilution technique, and regional fat distribution was evaluated by anthropometry and magnetic resonance imaging.

RESULTS
During a 4-h euglycemic insulin clamp (study A), rates (mg·min−1·kg FFM−1) of total (6.32 ± 0.64 vs. 6.62 ± 0.81), oxidative (3.54 ± 0.24 vs. 3.51 ± 0.19), and nonoxidative (2.78 ± 0.48 vs. 3.11 ± 0.75) glucose utilization were similar in Mexican-Americans and non-Hispanic whites; hepatic glucose production (0.33 ± 0.13 vs. 0.35 ± 0.13) was suppressed similarly in both groups. During a 2-h euglycemic insulin clamp (study B), Mexican-Americans with FHD+ had lower rates of insulin-mediated total (3.55 ± 0.39 vs. 5.93 ± 0.59, P &lt; 0.001), oxidative (3.31 ± 0.25 vs. 4.32 ± 0.17, P &lt; 0.01), and nonoxidative (0.24 ± 0.28 vs. 1.61 ± 0.49, P &lt; 0.01) glucose disposal than subjects with FHD− suppression of hepatic glucose production (0.24 ± 0.14 vs. 0.18 ± 0.12) was similar in both groups.

CONCLUSIONS
These results indicate that in the absence of a family history of non-insulin-dependent diabetes mellitus, Mexican-American women are not less sensitive to insulin than non-Hispanic white women.
Similar Insulin Sensitivity in NIDDM Patients With Normo- and Microalbuminuria
Authors: Nielsen Søren , Schmitz Ole , Ørskov Hans , Mogensen Carl Erik 
Published: March 2007

OBJECTIVE
To investigate whether insulin resistance and microalbuminuria are associated in non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS
Insulin sensitivity was assessed using a hyperinsulinemic euglycemic clamp in 11 normoalbuminuric and 9 microalbuminuric NIDDM patients matched for sex, age, body composition, glycemic control, diabetes duration, and therapy.

RESULTS
Isotopically determined glucose disposal was similar in normo- and microalbuminuric patients in the basal state (mean ± SD; 3.30 ± 1.01 vs. 3.46 ± 0.82 mg·kg lean body mass [LBM]−1 · min−1; NS) and during hyperinsulinemia (7.16 ± 2.65 vs. 6.63 ± 2.88 mg·kg LBM−1 · min−1;NS). No difference was observed in nonoxidative glucose disposal or lipid oxidation. Endogenous glucose production was equally suppressed by insulin (−0.08 ± 0.99 vs. 0.30 ± 1.12 mg·kg−1 LBM·min−1; NS). Glucose oxidation tended to be lower in the normoalbuminuric patients in the basal state (1.16 ± 0.37 vs. 1.41 ± 0.36 mg·kg LBM· min−1) and during hyperinsulinemia (2.35 ± 0.72 vs. 2.90 ± 0.77 mg·kg LBM· min−1; both P &lt; 0.15). Urinary albumin excretion rate correlated with the insulin-stimulated glucose oxidation rate (r = 0.59, P = 0.0064), and a similar trend was seen in the basal state (r = 0.42, P = 0.063). Protein oxidation was higher in normoalbuminuric patients (1.6 ± 0.5 vs. 1.0 ± 0.4 mg·kg LBM · min−1; P = 0.017) and correlated inversely with albuminuria (r = −0.70, P = 0.0007). Serum growth hormone increased during insulin infusion; however, the increase was significantly greater in microalbuminuric patients. Plasma lipoproteins, maximal aerobic capacity, and 24-h ambulatory blood pressure were similar in the two groups.

CONCLUSIONS
Basal and insulin-stimulated glucose uptakes are comparable in carefully matched normo- and microalbuminuric NIDDM patients, and glucose oxidation may be positively related to albuminuria. The inverse relation between protein oxidation and albuminuria may be due to higher growth hormone levels during daily life perturbations in glucose in microalbuminuric patients.
Factors Determining the Blood Pressure Response to Enalapril and Nifedipine in Hypertension Associated With NIDDM
Authors: Chan Juliana C N , Nicholls M Gary , Cheung Chi-Keung , Law Lap-Kay , Swaminathan Ramasmyiyer , Cockram Clive S 
Published: March 2007

OBJECTIVE
To examine the factors that determine the blood pressure response to enalapril and nifedipine monotherapy in the treatment of hypertension associated with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS
After a 6-week placebo baseline period, 102 hypertensive NIDDM patients were randomly assigned, double-blindly, to treatment with nifedipine retard (slow release) (n = 52) or enalapril (n = 50). The daily dosage of enalapril was increased, if required, from 10 to 20 to 40 mg and that of nifedipine from 40 to 60 to 80 mg at 4-week intervals during the 12-week titration period. Blood pressure, 24-h urinary albumin excretion (UAE), biochemical data, and serum angiotensin-converting enzyme (ACE) activity were measured at weeks −6, −4, 0, 4, 8, and 12. At week 0, venous blood was also sampled for baseline plasma atrial natriuretic peptide, renin, aldosterone, and serum insulin concentrations.

RESULTS
At week 12, the mean daily dose of enalapril was 35 ± 11.4 mg, and 27 (57%) patients were receiving the maximum daily dose of 40 mg. In the nifedipine group, the mean daily drug dose was 50 ± 12.9 mg, and 4 (8%) were receiving the maximum daily dose of 80 mg. Despite a dose-dependent fall in the serum ACE activity in the enalapril group, the mean arterial pressure (MAP) was reduced by only 8 mmHg throughout the 12-week titration period compared to a decline of 15, 18, and 19 mmHg at weeks 0, 4, and 12, respectively, in the nifedipine group (P = 0.01 between groups). In the enalapril group, changes in MAP between weeks 0 and 12 correlated significantly with baseline plasma glucose (r = 0.45, P = 0.001) and aldosterone concentrations (r = −0.32, P = 0.02) and UAE (r = 0.3, P = 0.04). There was no statistically significant correlation between the changes in MAP and baseline plasma renin concentration. On multivariate analysis, the baseline renal function, glycemic control, and plasma aldosterone and serum insulin concentrations were all independently related to the changes in blood pressure in the enalapril-treated patients. No such statistical associations were observed in the nifedipine group.

CONCLUSIONS
In hypertensive NIDDM patients, the activity of the renin-angiotensin-aldosterone system, the level of serum insulin, glycemic control, renal function, and proteinuria may be important determinants of the blood pressure response to ACE inhibition. Good glycemic control may optimize the antihypertensive efficacy of concomitant ACE inhibitor therapy.