bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effectiveness of β-Blockers After Myocardial Infarction in Patients With Type 2 Diabetes
Authors: McDonald Charlotte G. , Majumdar Sumit R. , Mahon Jeffrey L. , Johnson Jeffrey A. 
Published: March 2007

OBJECTIVE—β-Blocker therapy has been proven to reduce mortality and reinfarction after myocardial infarction (MI), but the impact of β-blockers on cardiac outcomes in patients with type 2 diabetes in routine practice is not clear. The purpose of this study was to determine the effectiveness of β-blockers after MI in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS—Using the Saskatchewan Health Databases, 12,272 patients with newly treated diabetes were identified between 1991 and 1996; 625 patients were subsequently admitted for MI. β-Blocker exposure within 30 days of discharge was identified in 298 patients, and all were followed until death, coverage termination, or 31 December 1999. Multivariate proportional hazards models were used to assess differences in all-cause mortality, recurrent MI, and 30-day all-cause rehospitalization (the latter a proxy measure for drug safety).RESULTS—Patients were aged 69 ± 11 years old, 66% were male, and mean follow-up was 2.7 ± 2.1 years. Overall, β-blockers were prescribed for 48% of patients. There were fewer deaths in the β-blocker group versus control subjects (55 of 298 [18.5%] vs. 126 of 327 [38.5%], respectively, P &lt; 0.001). However, β-blockers were not associated with improved survival in multivariate analyses (hazard ratio [HR] 0.89 [95% CI 0.63–1.25]). There were no differences in rates of recurrent MI (adjusted HR 1.35 [0.93–1.95]) or rehospitalizations (adjusted odds ratio 1.40 [0.83–2.37]) between the groups.CONCLUSIONS—β-Blocker therapy post-MI was not associated with reduced mortality or fewer recurrent events in people with type 2 diabetes in routine practice, although these medications were safe in this population.
The Effect of Insulin Antibodies on the Metabolic Action of Inhaled and Subcutaneous Insulin
Authors: Heise Tim , Bott Susanne , Tusek Corinna , Stephan Jens-Armin , Kawabata Tom , Finco-Kent Deborah , Liu Cameron , Krasner Alan 
Published: March 2007

OBJECTIVE—To assess the impact of the development of high- or low-affinity insulin antibodies (IABs) on postprandial glucose tolerance, duration of insulin action, and clinical safety in patients with type 1 diabetes receiving inhaled insulin (Exubera).
RESEARCH DESIGN AND METHODS—This study consisted of a prospective, randomized, open-label, parallel-group trial in which 47 patients with type 1 diabetes received NPH insulin twice daily plus either premeal inhaled insulin (INH group; n = 24) or premeal subcutaneous regular insulin (SC group; n = 23) for 24 weeks. Meal challenge and euglycemic clamp studies were performed on consecutive days at baseline, week 12, and week 24. Adverse events were monitored.
RESULTS—For the INH and SC groups, mean (±SD) IAB levels were 3.5 ± 3.9 and 2.6 ± 4.1 μU/ml at baseline, respectively, compared with 101.4 ± 140.4 and 4.3 ± 9.4 μU/ml at week 24. At week 24, the changes from baseline were similar for the INH and SC groups for maximal plasma glucose concentration (Cmax) (adjusted ratio for treatment group difference 0.99 [90% CI 0.95–1.03]), area under the plasma glucose concentration time curve (adjusted ratio for treatment group difference 0.98 [0.88–1.08]), and duration of insulin action (adjusted treatment group difference 29 min [−49 to 108]). No adverse events were attributed to IABs.
CONCLUSIONS—In patients with type 1 diabetes treated with inhaled insulin, development of high- or low-affinity IABs did not impair postprandial glucose tolerance, alter the time-action profile of insulin, or impact tolerability. No clinical relevance of IABs was identified in this study.
Monotonicity of Nerve Tests in Diabetes
Authors: Dyck Peter J. , O’Brien Peter C. , Litchy William J. , Harper C. Michel , Klein Christopher J. , Dyck P. James B. 
Published: March 2007

OBJECTIVE—The objective of this study was to test whether monotone worsening of nerve function, attributable to diabetes, can be demonstrated before criteria for diabetic sensorimotor polyneuropathy (DSPN) have been met. Which nerve tests are best?
RESEARCH DESIGN AND METHODS—From a prevalence cohort of 504 individuals in the Rochester Diabetic Neuropathy study (RDNS), we identified 238 individuals (group 1) who at first examination were without polyneuropathy (DSPN) by a sum score of the normal deviates (from percentiles) of five attributes of nerve conduction of the legs (i.e., their five nerve conduction normal deviate values were &lt;97.5th percentile) and were followed longitudinally two or more times. Of these 238, 90 (group 2) were followed six or more times at yearly or biyearly intervals. We compared different nerve tests for the ones most sensitive and reliable in showing latent nerve dysfunction and monotone (the extent to which a variable measured repeatedly over time reveals a significant trend of worsening or improvement).
RESULTS—In group 1 patients, the mean sum score of five attributes of nerve conduction (Σ 5 NC nds) at baseline was 1.08 and at the last examination (only patients with Σ 5 NC nds &lt;97.5th percentile) was 3.63, markedly higher than that in healthy subjects (only of individuals with Σ 5 NC nds &lt;97.5th percentile) (−0.12), indicating a subtle latent shift of nerve conduction tests toward abnormality. Serial evaluations of many individual and especially sum scores of nerve conduction tests in group 2 patients showed statistically significant worsening with time, even when nerve conduction tests were still well within normal limits. Neurologic signs also worsened but barely to significant levels; however, symptoms and quantitative sensation tests did not. Considering the composite score Σ 5 NC nds, 42 (of 90 group 2 patients) showed significant worsening, 22 were still without DSPN by nerve conduction test criteria, and some were even below the 50th percentile at the last evaluation.
CONCLUSIONS—Subtle and latent functional worsening of nerve conduction can be demonstrated even before nerve conduction test criteria for DSPN have been met. For demonstrating monotone worsening, the order (from best to worst) of tests was: some composite scores of nerve conduction and individual attributes of nerve conduction. We did not show monotone worsening of symptoms or of quantitative sensation test results. In multivariate analysis of risk factors and their association with worsening Σ 5 NC nds, 24-h microalbuminuria (a marker of microvessel disease) was found to be a significant covariate, an indication that the asymptomatic alterations of nerve conduction are meaningful.
Quantitative Coronary Angiographic Studies of Patients With Angina Pectoris and Impaired Glucose Tolerance
Authors: Kataoka Yu , Yasuda Satoshi , Morii Isao , Otsuka Yoritaka , Kawamura Atsushi , Miyazaki Shunichi 
Published: March 2007

OBJECTIVE—We investigated the morphological characteristics of coronary arteries in patients with impaired glucose tolerance (IGT) using computer-assisted quantitative coronary angiography. IGT is an independent risk factor for cardiovascular disease. However, the morphological changes developing in the coronary arteries of patients with IGT remain unknown.
RESEARCH DESIGN AND METHODS—A total of 534 patients with angina pectoris were studied. Of these, 144 patients were being treated for diabetes. The remaining 390 patients were classified as follows depending on the results of a 75-g oral glucose tolerance test: normal glucose tolerance (NGT) (n = 117), impaired fasting glucose (n = 3), IGT (n = 136), and diabetes pattern (preclinical diabetes) (n = 134). The diameters of the middle section of all major coronary artery segments were measured and averaged to determine the averaged vessel diameter (AVD). We defined segments of a diameter of ≤1.5 mm as diseased lesions and determined the averaged lesion length (ALL).
RESULTS—AVD and ALL were significantly different among patients with IGT and those with NGT. Patients with diabetes (preclinical and/or treated) had smaller AVD and longer ALL than those with IGT. By multivariate analysis, postprandial glucose levels were shown to be independently associated with an AVD &lt;3.0 mm and an ALL &gt;20 mm.
CONCLUSIONS—Diffuse coronary artery narrowing develops not only in patients with diabetes but also in those with IGT. This morphological change is associated with postprandial hyperglycemia.
Higher Medical Care Costs Accompany Impaired Fasting Glucose
Authors: Nichols Gregory A. , Brown Jonathan B. 
Published: March 2007

OBJECTIVE—The purpose of this study was to estimate medical costs associated with elevated fasting plasma glucose (FPG) and to determine whether costs differed for patients who met the 2003 (≥100 mg/dl) versus the 1997 (≥110 mg/dl) American Diabetes Association (ADA) cut point for impaired fasting glucose.
RESEARCH DESIGN AND METHODS—We identified 28,335 patients with two or more FPG test results of at least 100 mg/dl between 1 January 1994 and 31 December 2003. Those with evidence of diabetes before the second test were excluded. We categorized patients into two stages of abnormal glucose (100–109 mg/dl and 110–125 mg/dl) and matched each of these subjects to a patient with a normal FPG test (&lt;100 mg/dl) on age, sex, and year of FPG test. All subjects were followed until an FPG test qualified them for a higher stage, dispensing of an antihyperglycemic drug, health plan termination, or 31 December 2003.
RESULTS—Adjusted annual costs were $4,357 among patients with normal FPG, $4,580 among stage 1 patients, and $4,960 among stage 2 patients (P &lt; 0.001, all comparisons). After removing patients with normal FPG tests whose condition progressed to a higher stage or diabetes, costs in the normal FPG stage were $3,799. Patients in both stages 1 and 2 had more cardiovascular comorbidities than patients with normal FPG.
CONCLUSIONS—Our results demonstrate that abnormal glucose metabolism is associated with higher medical care costs. Much of the excess cost was attributable to concurrent cardiovascular disease. The 2003 ADA cut point identifies a group of patients with greater costs and comorbidity than normoglycemic patients but with lower costs and less comorbidity than patients with FPG above the 1997 cut point.
The Memphis Diabetes Continuing Care Program
Authors: Runyan John W , Vander Zwaag Roger , Joyner M Beverly , Miller Stephen T 
Published: March 2007

Since 1963 a network of nurse-operated, physician-backed decentralized clinics has provided continuing care for more than 5000 diabetic patients referred from the medical center clinics. Protocols that provide therapy goals and management details are used by the nurses and nutritionists in this network. To reduce fragmentation of care, intercurrent illnesses as well as other chronic diseases are treated using protocols in these clinics or in the home.
This study examines certain outcome data in a subset of 556 diabetic patients under continuing care over a 7-yr period in this network, with comparisons being made to care before referral. Blood glucose is maintained at comparable levels in both decentralized and hospital clinics. Blood pressure levels in hypertensive patients are maintained in a satisfactory range. Total hospitalization rates are reduced by 47%. For ketoacidosis and amputation, hospitalization is decreased by 69% compared with the experience before referral. The maintenance care costs are decreased substantially compared with costs before referral due to the less expensive ambulatory services and the reduced need for hospitalization. The data support the concept that decentralization is an effective means of providing continuing care to patients with diabetes mellitus.
Implanted Electroenzymatic Glucose Sensors
Authors: Clark Leland C , Duggan Carol A 
Published: March 2007

The advent of electrochemical sensors for intermittent sampling of blood gases and hydrogen ions in the clinic, intensive care, and surgical units has revolutionized diagnostic and critical care medical technics. The use of electrochemical sensors for continuous transcutaneous monitoring of blood gases is further enhancing the medical surveillance of patients. The more recent introduction of glucose and other electroenzymatic sensors has stimulated broad research in the development of metabolic monitoring.
For the present research, the glucose sensor widely used for the rapid specific micro-analysis of whole blood and plasma is explored for possible use as an in vivo intravascular or tissue-implanted sensor. This sensor is based on the polarographic measurement of hydrogen peroxide generated by glucose oxidase (EC 1.1.3.4) held between two membranes. The first membrane allows the diffusion of glucose, ions, and many other small molecules, while the second membrane allows the diffusion of the glucose-generated hydrogen peroxide to the platinum surface, but excludes ascorbic acid, bilirubin, and uric acid. Such sensors respond rapidly and specifically when acutely implanted subcutaneously in cats and dogs. They function well as glucose-sensor-tipped venous catheters. One sensor was repeatedly used for in vitro polarograms, subcutaneous and blood glucose monitoring, over a period of ten months, with storage in the cold between uses, with the complete retention of its response characteristics.
Subcutaneous Insulin Infusion: Change in Basal Infusion Rate has No Immediate Effect on Insulin Absorption Rate
Authors: Hildebrandt P , Birch K , Jensen B M , Kühl C 
Published: March 2007

Eight insulin-dependent diabetic patients were simultaneously given subcutaneous infusions (1.12 IU/h each) of 1251-labeled Actrapid insulin in each side of the abdominal wall. After 24 h of infusion, the size of the infused insulin depots was measured by external counting for 5 h. The basal infusion rate was then doubled in one side and halved in the other for the next 4 h. Finally, 1.12 IU/h of insulin was given in both sides of the abdominal wall for an additional 3 h. The changes in the size of the depots were measured, and the absorption rates for each hour were calculated. During the first 5 h of infusion, the depot size was almost constant (∼5 IU) with an absorption rate that equaled the infusion rate. Doubling the infusion rate led to a significant increase in depot size, but the absorption rate remained unchanged for the first 3 h, and only thereafter was a significant increase seen. When the infusion rate was reduced to the initial 1.12 IU/h, the absorption rate remained elevated during the next 3 h. Correspondingly, when the infusion rate was decreased, the depot size also decreased, but the absorption rate remained unchanged for the first 3 h.
The results show that a change in the basal insulin infusion rate does not lead to any immediate change in the insulin absorption rate. This should be considered when planning an insulin-infusion program that includes alteration(s) in the basal-rate setting.
Insulin Strategies for Primary Care Providers
Authors: Herbst Karen L. , Hirsch Irl B. 
Published: March 2007

IN BRIEF
Primary care providers take care of the majority of patients with diabetes in the United States. The introduction of new insulin analogs over the past few years should help primary practitioners and their patients with diabetes achieve physiological insulin replacement and near-normal glucose levels. This article reviews currently available insulins and replacement of insulin in a physiological manner for patients with type 1 or type 2 diabetes and provides examples of patients for whom insulin dosages changed over time.
Treatment of Obesity: An Overview
Authors: Fabricatore Anthony N. , Wadden Thomas A. 
Published: March 2007

In Brief
Obesity and type 2 diabetes commonly co-occur. Weight loss is associated with significant health benefits, including improved glycemic control and reduced blood pressure. This article reviews approaches to the treatment of obesity, considers special issues relevant to obese patients with type 2 diabetes, and presents suggestions for the prevention of obesity.
Cognitive and Physical Disabilities and Aging-Related Complications of Diabetes
Authors: Gregg Edward W. , Brown Arleen 
Published: March 2007

In Brief
As older adults make up an increasingly larger portion of the diabetic population, the spectrum of diabetes complications will likely expand. In addition to the traditional vascular complications, diabetes has been associated with excess risk for cognitive and physical decline, falls, fractures, and depression. These complications, which are common and can profoundly affect quality of life, will challenge clinicians, health care systems, and public health organizations to identify effective ways of optimizing quality of life among older adults with diabetes.
Osteoporosis: An Under-appreciated Complication of Diabetes
Authors: Brown Sue A. , Sharpless Julie L. 
Published: March 2007

In Brief
Care of patients with diabetes should include an assessment of bone health. It is now clear that patients with type 1 diabetes have lower bone mineral density (BMD) and higher risk of fractures. Evidence is accumulating that patients with type 2 diabetes who have complications are also at increased risk of certain types of osteoporotic fractures despite having a higher BMD when compared to patients with type 1 diabetes. Therapeutic interventions are key to preventing fractures, both by improving bone density and decreasing the risk for falls.
Heart Failure: A Serious and Common Comorbidity of Diabetes
Authors: Bell David S.H. 
Published: March 2007

In Brief
Because of the cardiotoxic triad (diabetic cardiomyopathy, hypertension, and coronary artery disease), heart failure (HF) has an increased prevalence and worse prognosis in diabetic patients. Treatment of HF is directed to glycemic control and blockade of the renin-angiotensin and sympathetic nervous system, primarily with angiotensin-converting enzyme inhibitors and a combined α-/β-blocker. The goal is preventing and reversing myocardial remodeling, which will improve ventricular function.
Effects of Glycemic Control on Diabetes Complications and on the Prevention of Diabetes
Authors: Skyler Jay S. 
Published: March 2007

IN BRIEF
Randomized, controlled clinical trials (RCTs), completed during the past several years or currently underway, are defining the scientific basis of contemporary diabetes care. In terms of glycemic control, landmark RCTs have demonstrated that meticulous glycemic control reduces risk of microvascular and neurological complications of diabetes. Studies in pre-diabetes have shown that early intervention slows progression to diabetes. Ongoing studies are examining the effects of glycemic interventions on macrovascular complications of diabetes, the impact of early treatment on the course of diabetes, and whether there are differences depending on the nature of the intervention used.
Laminar xanthine oxidase, superoxide dismutase and catalase activities in the prodromal stage of black‐walnut induced equine laminitis
Authors: LOFTUS J. P. , BELKNAP J. K. , STANKIEWICZ K. M. , BLACK S. J. 
Published: March 2007

SummaryReasons for study: Xanthine oxidase (XO)‐dependent production of superoxide anion and hydrogen peroxide, a characteristic of ischaemia‐reperfusion injury, may contribute to the development of equine laminitis.Objective: To determine the levels of XO and antioxidant enzymes (catalase, superoxide dismutase [SOD]) in the digital laminae of normal horses (CON) and horses in the developmental stage of laminitis using the black walnut extract (BWE) model.Methods: Healthy horses (n = 12) were administered BWE (BWE group, n = 6), or water (CON group, n = 6) through a nasogastric tube. At the onset of leucopenia in the BWE‐treated animals, all horses were anaesthetised, digital laminae and other samples collected rapidly and flash frozen, and the animals subjected to euthanasia. Extracts of the frozen tissues were assayed for the 2 conformational forms of xanthine: oxygen oxidoreductase (XOR), namely, xanthine dehydrogenase (XDH) and xanthine oxidase (XO), as well as the antioxidant enzymes, SOD and catalase.Results: Extracts of liver, lungs and skin, but not digital laminae, from either CON or BWE‐treated horses had endogenous SOD, whereas all had endogenous XO and catalase. The levels of XDH, XO and catalase were similar in extracts of laminae from CON and BWE‐treated horses as was the ratio of XDH to XO in extracts.Conclusions and potential relevance: The absence of increased XO activity suggest against the involvement of this reactive oxygen intermediate‐generating system in the development of laminar pathology in BWE‐treated horses. Conversely, the absence of SOD from extracts of equine digital laminae, but not other tissues, suggests that the equine digital laminae are highly susceptible to damage by superoxide anion, produced, for example, by emigrant inflammatory leucocytes.
Ultrasound‐guided coxofemoral arthrocentesis in horses
Authors: DAVID F. , ROUGIER M. , ALEXANDER K. , MORISSET S. 
Published: March 2007

Summary Reason for performing study: Coxofemoral joint pain is probably underestimated due to difficulties in identifying hip pain. The deep location of the joint and proximity of the sciatic nerve make arthrocentesis based on external landmarks a difficult and potentially risky procedure in mature horses. Objectives: To describe an ultrasound‐guided injection technique of the coxofemoral joint in standing horses and to evaluate its accuracy and potential difficulties/complications. Methods: Nine mature horses had both pelvic areas prepared for sterile ultrasound examination (3.5 MHz curvilinear probe). Coxofemoral joints were located and penetrated at their craniodorsolateral aspect under ultrasonographic guidance and injected with sterile contrast medium. A standing ventrodorsal radiographic view of each hemipelvis centred on the hip was obtained for each horse to assess the injection site. Horses were evaluated for 10 days following injection for possible complications. Results: Intra‐articular injection was successful in all 18 joints. The procedure was well tolerated by horses under minimal restraint. Mean ± s.d. needle repositionings required before accurate placement was 1.5 ± 1.3 per joint. Once the needle was in the joint, synovial fluid was obtained in 7/18 joints. Minimal periarticular contrast medium was detected in 2/18 joints. Mean ± s.d. ultrasonographic examination time required for coxofemoral localisation, accurate needle positioning and injection was 4.3 ± 2.1 min. No complications were observed in the 10 days following injection. Conclusion: The ultrasound‐guided coxofemoral arthrocentesis is an accurate, reliable and safe technique that offers a real time evaluation of needle introduction into the deep and narrow coxofemoral joint space. Potential relevance: Although this technique remains to be tested on clinical cases, it is a promising tool to facilitate diagnosis of coxofemoral pain, septic arthritis or administration of intra‐articular medication.