bluuebunny/crossref_metadata_2025_split huggingface dataset:
l-Arginine-Induced Vasodilation of the Renal Vasculature Is Not Altered in Hypertensive Patients With Type 2 Diabetes
Authors: Delles Christian , Schneider Markus P. , Oehmer Sebastian , Fleischmann Erwin H. , Schmieder Roland E. 
Published: March 2007

OBJECTIVE—Diabetes, arterial hypertension, hypercholesterolemia, and aging are associated with endothelial dysfunction in various vasculatures. Endothelium-dependent vasodilation of the renal vasculature cannot be easily assessed, but infusion of l-arginine, the substrate of endothelial nitric oxide synthase, leads to an increase in renal plasma flow (RPF) in humans. We have examined the effect of l-arginine infusion on renal hemodynamics in hypertensive patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—Twenty-three elderly patients with type 2 diabetes (age, 65 ± 6 years; HbA1c, 7.8 ± 1.6%) with coexisting arterial hypertension (158 ± 19/83 ± 11 mmHg) and elevated cholesterol levels (total cholesterol, 215 ± 33 mg/dl) were examined. These patients were compared with a young and healthy reference group (n = 20; age, 26 ± 2 years). The effect of l-arginine infusion (100 mg/kg over 30 min) on RPF and glomerular filtration rate were measured using the constant input clearance technique with p-aminohippurate and inulin, respectively.
RESULTS—l-Arginine infusion similarly influenced renal hemodynamics in patients and reference subjects: RPF increased by 7 ± 11 and 7 ± 11% in diabetic and reference subjects, respectively (P = NS). Other parameters of renal hemodynamics such as glomerular filtration rate (5 ± 5 vs. 4 ± 4%) and filtration fraction (−1 ± 8 vs. −1 ± 9%) were not significantly different between diabetic and reference subjects, too.
CONCLUSIONS—l-Arginine-induced vasodilation of the renal vasculature is not different between a group of hypertensive diabetic patients and a young, healthy reference group. These data were obtained using low-dose l-arginine infusion.
Human Epidermal Growth Factor Enhances Healing of Diabetic Foot Ulcers
Authors: Tsang Man Wo , Wong Wan Keung R. , Hung Chi Sang , Lai Kwok-Man , Tang Wegin , Cheung Elaine Y.N. , Kam Grace , Leung Leo , Chan Chi Wai , Chu Chung Min , Lam Edward K.H. 
Published: March 2007

OBJECTIVE—To study the healing effect of recombinant human epidermal growth factor (hEGF) on diabetic foot ulcers.
RESEARCH DESIGN AND METHODS—A total of 127 consecutive patients were screened and 61 diabetic subjects were recruited into this double-blind randomized controlled study. Predetermined criteria were used for diagnosis and classification of the diabetic wound. The patients were randomized into three groups. All patients attended our Diabetes Ambulatory Care Center every other week for joint consultation with the diabetologist and the podiatrist. Group 1 (control) was treated with Actovegin 5% cream (Actovegin), group 2 with Actovegin plus 0.02% (wt/wt) hEGF, and group 3 with Actovegin plus 0.04% (wt/wt) hEGF. The study end point was the complete closure of the wound. Failure to heal was arbitrarily defined as incomplete healing after 12 weeks.
RESULTS—Final data were obtained from 61 patients randomly assigned into three groups. The mean ages of the patients, wound sizes, wound duration, metabolic measurements, and comorbidities were comparable within groups, except that group 3 had more female patients. Mean follow-up for the patients was 24 weeks. Data were cutoff at 12 weeks, and results were analyzed by intention to treat. After 12 weeks, in group 1 (control) eight patients had complete healing, two patients underwent toe amputation, and nine had nonhealing ulcers. In group 2 (0.02% [wt/wt] hEGF) 12 patients experienced wound healing, 2 had toe amputations, and 7 had nonhealing ulcers. Some 20 of 21 patients in group 3 (0.04% [wt/wt] hEGF) showed complete wound healing. Healing rates were 42.10, 57.14, and 95% for the control, 0.02% (wt/wt) hEGF, and 0.04% (wt/wt) hEGF groups, respectively. Kaplan-Meier survival analysis suggested that application of cream with 0.04% (wt/wt) hEGF caused more ulcers to heal by 12 weeks and increased the rate of healing compared with the other treatments (log-rank test, P = 0.0003).
CONCLUSIONS—Our data support the contention that application of hEGF-containing cream, in addition to good foot care from a multidisciplinary team, significantly enhances diabetic foot ulcer wound healing and reduces the healing time.
Percent Change in Wound Area of Diabetic Foot Ulcers Over a 4-Week Period Is a Robust Predictor of Complete Healing in a 12-Week Prospective Trial
Authors: Sheehan Peter , Jones Peter , Caselli Antonella , Giurini John M. , Veves Aristidis 
Published: March 2007

OBJECTIVE—To assess the ability of the 4-week healing rate to predict complete healing over a 12-week period in a large prospective multicenter trial of diabetic patients with foot ulceration.RESEARCH DESIGN AND METHODS—We examined the change in ulcer area over a 4-week period as a predictor of wound healing within 12 weeks in patients who were seen weekly in a prospective, randomized controlled trial.RESULTS—Wound area measurements at baseline and after 4 weeks were performed in 203 patients. The midpoint between the percentage area reduction from baseline at 4 weeks in patients healed versus those not healed at 12 weeks was found to be 53%. Subjects with a reduction in ulcer area greater than the 4-week median had a 12-week healing rate of 58%, whereas those with reduction in ulcer area less than the 4-week median had a healing rate of only 9% (P &lt; 0.01). The absolute change in ulcer area at 4 weeks was significantly greater in healers versus nonhealers (1.5 vs. 0.8 cm2, P &lt; 0.02). The percent change in wound area at 4 weeks in those who healed was 82% (95% CI 70–94), whereas in those who failed to heal, the percent change in wound area was 25% (15–35; P &lt; 0.001).CONCLUSIONS—The percent change in foot ulcer area after 4 weeks of observation is a robust predictor of healing at 12 weeks. This simple tool may serve as a pivotal clinical decision point in the care of diabetic foot ulcers for early identification of patients who may not respond to standard care and may need additional treatment.
Cutaneous Blood Flow in Type 2 Diabetic Individuals After an Acute Bout of Maximal Exercise
Authors: Colberg Sheri R. , Parson Henri K. , Holton D. Robb , Nunnold Tanja , Vinik Aaron I. 
Published: March 2007

OBJECTIVE—We previously demonstrated a positive association between chronic aerobic exercise and dorsal foot skin blood flow during local heating in type 2 diabetic individuals. Thus, we hypothesized that a prior acute bout of maximal exercise would also have positive effects on postexercise blood flow.RESEARCH DESIGN AND METHODS—Subjects consisted of 32 individuals with type 2 diabetes and 26 nondiabetic control subjects further subdivided based on their physical activity status: diabetic exerciser (DE), diabetic sedentary (DS), control exerciser (CE), or control sedentary. Dorsal foot cutaneous blood flow was measured noninvasively by continuous laser-Doppler assessment at baseline and during local heating to 44°C before and after a maximal bout of cycle exercise. Interstitial nitric oxide (NO) levels were measured concurrently in the foot dorsum.RESULTS—Increases in blood flow and its responsiveness to local heating to 44°C were significantly lower in both diabetic groups compared with CE before maximal exercise, but perfusion responsiveness remained lower in DS subjects only after exercise (P &lt; 0.05). Baseline skin blood flow was not different among groups preexercise, but it was significantly increased postexercise in DE subjects only. Interstitial NO levels were not significantly different at either time. At baseline, groups differed only in HbA1c, fasting serum glucose, HDL cholesterol, and insulin resistance (homeostasis model assessment method).CONCLUSIONS—All diabetic individuals exhibit a blunted responsiveness of cutaneous blood flow with local heating to 44°C before maximal exercise compared with active nondiabetic individuals, but after an exercise bout, it remains significantly blunted only in diabetic individuals who are sedentary. These findings occur independently of changes in interstitial NO levels.
The Epidemiology of Diabetes in the Manitoba-Registered First Nation Population
Authors: Green Chris , Blanchard James F. , Young T. Kue , Griffith Jane 
Published: March 2007

OBJECTIVE—This study provides an overview of the epidemiology of diabetes in the Manitoba First Nation population.
RESEARCH DESIGN AND METHODS—The study uses data derived from the population-based Manitoba Diabetes Database to compare the demographic and geographic patterns of diabetes in the Manitoba First Nation population to the non–First Nation population.
RESULTS—Although the prevalence of diabetes rose steadily in both the First Nation and the non–First Nation populations between 1989 and 1998, the epidemiological pattern of diabetes in these two populations differed significantly. The First Nation population was observed to have age-standardized incidence and prevalence rates of diabetes up to 4.5 times higher than those found in the non–First Nation population. The sex ratio and the geographic patterning of diabetes incidence and prevalence in the two study populations were reversed.
CONCLUSIONS—The results of the study suggest that diabetes prevalence will likely continue to rise in the Manitoba First Nation population into the foreseeable future, and that the impact of this rising diabetes prevalence can only be effectively managed through a population-based public health approach focusing on primary and secondary prevention. The dramatically higher rates of diabetes in Manitoba First Nation population as compared with the non–First Nation population highlight the urgency of this activity. These prevention efforts need to be supported by further research into the reasons for the unique epidemiological patterns of diabetes incidence and prevalence in the First Nation population observed in this study. These include investigating why First Nation populations living in the Northern areas of the province seem to be protected from developing high rates of diabetes and why First Nation women experience much higher rates of the disease.
A Population Perspective on Diabetes Prevention
Authors: Burke James P. , Williams Ken , Narayan K.M. Venkat , Leibson Cynthia , Haffner Steven M. , Stern Michael P. 
Published: March 2007

OBJECTIVE—To examine the influence of obesity and prevention of weight gain on the incidence of type 2 diabetes.
RESEARCH DESIGN AND METHODS—We examined participants in the San Antonio Heart Study, a prospective population-based study of Mexican Americans and non-Hispanic whites residing in San Antonio, Texas. BMI was stratified into four categories: normal (&lt;25 kg/m2), overweight (≥25 kg/m2 and &lt;30 kg/m2), obese (≥30 kg/m2 and &lt;35 kg/m2), and very obese (≥35 kg/m2). The number and proportion of incident cases prevented by targeting each BMI category were estimated. In addition, we calculated the decrease in risk of developing type 2 diabetes associated with weight gain prevention across both the BMI and age spectra.
RESULTS—Preventing normal individuals from becoming overweight would result in the greatest reduction in incidence of type 2 diabetes. This would result in a 62 and 74% reduction in the incidence of type 2 diabetes in Mexican Americans and non-Hispanic whites, respectively. Preventing the entire population from gaining, on average, 1 BMI unit would result in a reduction in incidence of type 2 diabetes of 12.4 and 13.0% in Mexican Americans and non-Hispanic whites, respectively.
CONCLUSIONS—The majority of cases of type 2 diabetes were in individuals who were overweight or mildly obese with a family history of type 2 diabetes. Public health resources should be directed toward the prevention of weight gain among normal and overweight individuals in order to prevent the maximum number of cases of type 2 diabetes.
Lack of Acculturation Is a Risk Factor for Diabetes in Arab Immigrants in the U.S.
Authors: Jaber Linda A. , Brown Morton B. , Hammad Adnan , Zhu Qian , Herman William H. 
Published: March 2007

OBJECTIVE—To examine the relationship between dysglycemia (impaired fasting glucose, impaired glucose tolerance, and diabetes) and acculturation, physical activity, and perceived stress in Arab immigrants in the U.S.
RESEARCH DESIGN AND METHODS—In a cross-sectional population-based study, we examined 520 Arab Americans, aged 20–75 years, who were born in the Middle East and immigrated to southeastern Michigan. Dysglycemia was assessed by history and with a 2-h 75-g oral glucose tolerance test. Acculturation, physical activity, and perceived stress were measured with standardized questionnaires.
RESULTS—Associations were found between dysglycemia in men and older age at immigration, unemployment, speaking Arabic with friends, being less active in Arabic organizations, more frequent consumption of Arabic food, and less integration into American society. Dysglycemia in women was associated with being raised in rural areas of the Middle East, older age at immigration, longer length of stay in the U.S., not being employed outside the home, less than high school education, not attending Arabic or American schools, and not being able to read Arabic. Among men, older age at immigration, shorter length of stay in the U.S., less activity in Arab organizations, and eating Arabic food were associated with dysglycemia independent of age and BMI. Among women, acculturation was very low and was confounded with age and BMI as powerful risk factors for dysglycemia. No association was found between physical activity, perceived stress, and the risk of dysglycemia in either sex.
CONCLUSIONS—Lack of acculturation is an important risk factor for dysglycemia in immigrant Arab Americans. Intervention programs aimed at diabetes prevention should consider the acculturation process.
Decreased Serum Levels of Adiponectin Are a Risk Factor for the Progression to Type 2 Diabetes in the Japanese Population
Authors: Daimon Makoto , Oizumi Toshihide , Saitoh Tamotsu , Kameda Wataru , Hirata Akihiko , Yamaguchi Hiroshi , Ohnuma Hiroshi , Igarashi Masahiko , Tominaga Makoto , Kato Takeo 
Published: March 2007

OBJECTIVE—To examine whether decreased serum levels of adiponectin are an independent risk factor for the progression to type 2 diabetes in a Japanese population.
RESEARCH DESIGN AND METHODS—The serum levels of adiponectin and tumor necrosis factor-α (TNF-α) at baseline (from 1995 to 1997) were evaluated in 1,792 individuals (1,023 women and 769 men, aged 58.5 ± 12.5 years) from a cohort population (n = 3,706) of the Funagata study. Glucose tolerance was evaluated at baseline and also at 5-year follow-up examinations (n = 978, follow-up rate, 54.6%) according to the 1985 World Health Organization criteria. The correlation of clinical traits with serum levels of adiponectin was examined. The association of the traits with the progression to type 2 diabetes at the 5-year follow-up was also examined.
RESULTS—Among the traits examined, the correlation with aging was highest (r = 0.312, P &lt; 0.001). Eighteen subjects with normal glucose tolerance (NGT) developed diabetes, and 709 remained NGT at the 5-year follow-up examinations. The subjects who became diabetic had decreased serum levels of adiponectin (7.29 ± 2.35 vs. 9.13 ± 2.35 10 × log μg/ml, P = 0.009). Multiple logistic regression analysis with age, sex, waist-to-hip ratio, and 2-h plasma glucose as the variables revealed that serum adiponectin level (odds ratio [per 0.1 log μg/ml] 0.766, P = 0.029) was an independent risk factor for the progression to type 2 diabetes. The subjects whose serum levels of adiponectin were in the lowest tertile were 9.320 times (95% CI 1.046–83.1) more likely to develop diabetes than those in the highest tertile (P = 0.046).
CONCLUSIONS—Decreased serum adiponectin level is an independent risk factor for progression to type 2 diabetes.
Utility of B-Type Natriuretic Peptide (BNP) as a Screen for Left Ventricular Dysfunction in Patients With Diabetes
Authors: Epshteyn Victoria , Morrison Katherine , Krishnaswamy Padma , Kazanegra Radmila , Clopton Paul , Mudaliar Sunder , Edelman Steven , Henry Robert , Maisel Alan 
Published: March 2007

OBJECTIVE—Routine screening of diabetic patients with echocardiography is not feasible due to its limited availability and high cost. B-type natriuretic peptide (BNP) is secreted from the left ventricle in response to pressure overload and is elevated in both systolic and diastolic dysfunction.
RESEARCH DESIGN AND METHODS—BNP levels were compared to echocardiographic findings in 263 patients. Patients were divided into two groups: clinical indication for echocardiography (CIE) (n = 172) and those without clinical indication for echocardiography (no-CIE) (n = 91). Cardiologists making the assessment of left ventricular function were blinded when measuring plasma levels of BNP.
RESULTS—The 91 patients with no-CIE with echos had similar BNP levels (83 ± 16 pg/ml) to the 215 patients with no-CIE without echos (63 ± 10, P = 0.10). Patients with CIE and subsequent abnormal left ventricular function (n = 112) had a mean BNP concentration of 435 ± 41 pg/ml, compared with those with no-CIE, but had abnormal left ventricular function on echo (n = 32) (161 ± 40 pg/ml). Twenty-one of 32 patients with no-CIE but with abnormal left ventricular function had diastolic dysfunction (BNP 190 ± 60pg/ml). A receiver-operating characteristic (ROC) curve revealed that the area under the curve was 0.91 for CIE patients and 0.81 for no-CIE patients (P &lt; 0.001). For those with no congestive heart failure (CHF) symptoms, BNP levels showed a high negative predictive value (91% for BNP values &lt;39 pg/ml), while in those patients who had a CIE, BNP levels showed a high positive predictive value for the detection of left ventricular dysfunction (96% with BNP levels &gt;90 pg/ml).
CONCLUSIONS—BNP can reliably screen diabetic patients for the presence or absence of left ventricular dysfunction.
Contribution of Abnormal Insulin Secretion and Insulin Resistance to the Pathogenesis of Type 2 Diabetes in Myotonic Dystrophy
Authors: Perseghin Gianluca , Caumo Andrea , Arcelloni Cinzia , Benedini Stefano , Lanzi Roberto , Pagliato Emanuela , Sereni Lucia Piceni , Testolin Giulio , Battezzati Alberto , Comi Giancarlo , Comola Mauro , Luzi Livio 
Published: March 2007

OBJECTIVE—Myotonic dystrophy (MyD), the most common adult form of muscular dystrophy, is often complicated by diabetes. MyD is dominantly inherited and is due to heterozygosity for a trinucleotide repeat expansion mutation in a protein kinase gene able to induce derangement of RNA metabolism responsible of an aberrant insulin receptor expression.
RESEARCH DESIGN AND METHODS—To assess insulin sensitivity and secretion before the onset of diabetes, we studied 10 MyD patients, 10 offspring of type 2 diabetes (OFF), and 10 healthy subjects with no family history of diabetes (control subjects) with dual X-ray energy absorption, euglycemic-hyperinsulinemic clamp (40 mU/[m2 · min]) combined with infusion of [6,6-d2]-glucose and oral glucose tolerance test (OGTT).
RESULTS—MyD had reduced lean body mass, but peripheral insulin sensitivity was not different to that of control subjects in contrast to OFF, which showed insulin resistance. Insulin secretion, obtained by deconvolution of OGTT data, was also shown to be comparable with that of OFF and control subjects (index of β-cell function = Φ; P = 0.91) even if increased parameters of insulin secretion were found during the first 30 min (Φ30; P = 0.05) of the oral glucose challenge. Fasting plasma proinsulin concentrations (P = 0.01) and the ratio to insulin (P = 0.01) were increased in MyD patients. The proinsulin levels also failed to be suppressed during the clamp and showed exaggerated response after the OGTT. Increased proinsulin levels were shown to be peculiar of MyD patients when compared with OFF.
CONCLUSIONS—In nondiabetic, young MyD patients, insulin sensitivity was preserved, and an increased early secretory response to oral glucose was detected. Abnormal plasma proinsulin levels in the fasting state, during the clamp, and during the OGTT were shown to be secretory dysfunctions peculiar of MyD patients and may be more important than insulin resistance in determining the high risk to develop diabetes in these patients.
Lifestyle Modification Improves Endothelial Function in Obese Subjects With the Insulin Resistance Syndrome
Authors: Hamdy Osama , Ledbury Sarah , Mullooly Cathy , Jarema Catherine , Porter Satoko , Ovalle Kerry , Moussa Amr , Caselli Antonella , Caballero A. Enrique , Economides Panayiotis A. , Veves Aristidis , Horton Edward S. 
Published: March 2007

OBJECTIVE—Endothelial dysfunction has been reported in type 2 diabetic patients and in obese subjects with insulin resistance syndrome (IRS). This study evaluates the effects of weight reduction and exercise on vascular reactivity of the macro- and the microcirculation in obese subjects with IRS.
RESEARCH DESIGN AND METHODS—We studied 24 obese subjects (9 men and 15 women, age 49.3 ± 1.9 years, BMI 36.7 ± 0.94 kg/m2, mean ± SEM) with IRS at baseline and after 6 months of weight reduction and exercise. Brachial artery flow-mediated dilation (FMD) and response to sublingual glyceryltrinitrate (GTN) were assessed by high-resolution ultrasound. Microvascular reactivity was evaluated by the laser-Doppler perfusion imaging after iontophoresis of acetylcholine and sodium nitroprusside. We also measured plasma levels of soluble intercellular adhesion molecule (sICAM), vascular adhesion molecule, von Willebrand factor, plasminogen activator inhibitor-1 (PAI-1) antigen, and tissue plasminogen activator antigen.
RESULTS—This intervention resulted in 6.6 ± 1% reduction in body weight (P &lt; 0.001) and significant improvement of insulin sensitivity index (2.9 ± 0.36 vs. 1.9 ± 0.33 [10−4 · min−1 · (μU ml−1)], P &lt; 0.001). FMD significantly improved (12.9 ± 1.2% vs. 7.9 ± 1.0%, P &lt; 0.001), whereas response to GTN and microvascular reactivity did not change. Similar observations were seen when the subjects were subclassified according to their glucose tolerance to normal glucose tolerance, impaired glucose tolerance, and type 2 diabetes. sICAM and PAI-1 significantly decreased (251.3 ± 7.7 vs. 265.6 ± 9.3 ng/ml, P = 0.018 and 36.2 ± 3.6 vs. 48.6 ± 3.9 ng/ml, P = 0.001, respectively). The relationship between percentage weight reduction and improved FMD was linear (R2 = 0.47, P = 0.001).
CONCLUSIONS—We conclude that 6 months of weight reduction and exercise improve macrovascular endothelial function and reduces selective markers of endothelial activation and coagulation in obese subjects with IRS regardless of the degree of glucose tolerance.