bluuebunny/crossref_metadata_2025_split huggingface dataset:
XENical in the Prevention of Diabetes in Obese Subjects (XENDOS) Study
Authors: Torgerson Jarl S. , Hauptman Jonathan , Boldrin Mark N. , Sjöström Lars 
Published: March 2007

OBJECTIVE—It is well established that the risk of developing type 2 diabetes is closely linked to the presence and duration of overweight and obesity. A reduction in the incidence of type 2 diabetes with lifestyle changes has previously been demonstrated. We hypothesized that adding a weight-reducing agent to lifestyle changes may lead to an even greater decrease in body weight, and thus the incidence of type 2 diabetes, in obese patients.
RESEARCH DESIGN AND METHODS—In a 4-year, double-blind, prospective study, we randomized 3,305 patients to lifestyle changes plus either orlistat 120 mg or placebo, three times daily. Participants had a BMI ≥30 kg/m2 and normal (79%) or impaired (21%) glucose tolerance (IGT). Primary endpoints were time to onset of type 2 diabetes and change in body weight. Analyses were by intention to treat.
RESULTS—Of orlistat-treated patients, 52% completed treatment compared with 34% of placebo recipients (P &lt; 0.0001). After 4 years’ treatment, the cumulative incidence of diabetes was 9.0% with placebo and 6.2% with orlistat, corresponding to a risk reduction of 37.3% (P = 0.0032). Exploratory analyses indicated that the preventive effect was explained by the difference in subjects with IGT. Mean weight loss after 4 years was significantly greater with orlistat (5.8 vs. 3.0 kg with placebo; P &lt; 0.001) and similar between orlistat recipients with impaired (5.7 kg) or normal glucose tolerance (NGT) (5.8 kg) at baseline. A second analysis in which the baseline weights of subjects who dropped out of the study was carried forward also demonstrated greater weight loss in the orlistat group (3.6 vs. 1.4 kg; P &lt; 0.001).
CONCLUSIONS—Compared with lifestyle changes alone, orlistat plus lifestyle changes resulted in a greater reduction in the incidence of type 2 diabetes over 4 years and produced greater weight loss in a clinically representative obese population. Difference in diabetes incidence was detectable only in the IGT subgroup; weight loss was similar in subjects with IGT and or NGT.
Glycemic Control From 1988 to 2000 Among U.S. Adults Diagnosed With Type 2 Diabetes
Authors: Koro Carol E. , Bowlin Steven J. , Bourgeois Nancy , Fedder Donald O. 
Published: March 2007

OBJECTIVE—To describe the changes in demographics, antidiabetic treatment, and glycemic control among the prevalent U.S. adult diagnosed type 2 diabetes population between the National Health and Nutrition Examination Survey (NHANES) III (1988–1994) and the initial release of NHANES 1999–2000.
RESEARCH DESIGN AND METHODS—The study population was derived from NHANES III (n = 1,215) and NHANES 1999–2000 (n = 372) subjects who reported a diagnosis of type 2 diabetes with available data on diabetes medication and HbA1c. Four therapeutic regimens were defined: diet only, insulin only, oral antidiabetic drugs (OADs) only, or OADs plus insulin. Multiple logistic regression was used to examine changes in antidiabetic regimens and glycemic control rates over time, adjusted for demographic and clinical risk factors. The outcome measure for glycemic control was HbA1c. Glycemic control rates were defined as the proportion of type 2 diabetic patients with HbA1c level &lt;7%.
RESULTS—Dietary treatment in individuals with diabetes decreased as the sole therapy from 27.4 to 20.2% between the surveys. Insulin use also decreased from 24.2 to 16.4%, while those on OADs only increased from 45.4 to 52.5%. Combination of OADs and insulin increased from 3.1 to 11.0%. Glycemic control rates declined from 44.5% in NHANES III (1988–1994) to 35.8% in NHANES 1999–2000.
CONCLUSIONS—Treatment regimens among U.S. adults diagnosed with type 2 diabetes have changed substantially over the past 10 years. However, a decrease in glycemic control rates was also observed during this time period. This trend may contribute to increased rates of macrovascular and microvascular diabetic complications, which may impact health care costs. Our data support the public health message of implementation of early, aggressive management of diabetes.
Postural Control Mechanisms During Quiet Standing in Patients With Diabetic Sensory Neuropathy
Authors: Lafond Danik , Corriveau Hélène , Prince Francois 
Published: March 2007

OBJECTIVE—The objective of the present study was to compare postural mechanisms identified by using dual force platform in healthy elderly community-dwelling subjects and diabetic sensory neuropathy (DSN) patients under different visual conditions.
RESEARCH DESIGN AND METHODS—The presence and the severity of the sensory neuropathy was evaluated with a clinical scale. Postural mechanisms and motor strategies of the ankle and hip joints were quantified by testing subjects in quiet stance on a dual force platform under two visual conditions (eyes open and eyes closed). Root mean square (RMS) values of the center of pressure (COP) time-varying signals and normalized cross-correlation function were used to estimate the contribution and the interdependence of postural control mechanisms.
RESULTS—DSN patients show larger RMS values of the COPnet displacement in both anteroposterior and mediolateral (ML) directions. Motor strategies at the ankle joints are altered in DSN patients compared with healthy elderly subjects particularly in the ML direction.
CONCLUSIONS—This experiment is the first to highlight that even with vision, postural mechanisms at the ankle joints are impaired in DSN patients during quiet standing. Our results point out the importance of focusing on postural control instability in ML of DSN patients.
Improving Diabetes Care in Midwest Community Health Centers With the Health Disparities Collaborative
Authors: Chin Marshall H. , Cook Sandy , Drum Melinda L. , Jin Lei , Guillen Myriam , Humikowski Catherine A. , Koppert Julie , Harrison James F. , Lippold Susan , Schaefer Cynthia T. 
Published: March 2007

OBJECTIVE—To evaluate the Diabetes Health Disparities Collaborative, an initiative by the Bureau of Primary Health Care to reduce health disparities and improve the quality of diabetes care in community health centers.
RESEARCH DESIGN AND METHODS—One year before- after trial. Beginning in 1998, 19 Midwestern health centers undertook a diabetes quality improvement initiative based on a model including rapid Plan-Do-Study-Act cycles from the continuous quality improvement field; a Chronic Care Model emphasizing patient self-management, delivery system redesign, decision support, clinical information systems, leadership, health system organization, and community outreach; and collaborative learning sessions. We reviewed charts of 969 random adults for American Diabetes Association standards, surveyed 79 diabetes quality improvement team members, and performed qualitative interviews.
RESULTS—The performance of several key processes of care assessed by chart review increased, including rates of HbA1c measurement (80–90%; adjusted odds ratio 2.1, 95% CI 1.6–2.8), eye examination referral (36–47%; 1.6, 1.1–2.3), foot examination (40–64%; 2.7, 1.8–4.1), and lipid assessment (55–66%; 1.6, 1.1–2.3). Mean value of HbA1c tended to improve (8.5–8.3%; difference −0.2, 95% CI −0.4 to 0.03). Over 90% of survey respondents stated that the Diabetes Collaborative was worth the effort and was successful. Major challenges included needing more time and resources, initial difficulty developing computerized patient registries, team and staff turnover, and occasional need for more support by senior management.
CONCLUSIONS—The Health Disparities Collaborative improved diabetes care in health centers in 1 year.
A Controlled Trial of Population Management
Authors: Grant Richard W. , Cagliero Enrico , Sullivan Christine M. , Dubey Anil K. , Estey Greg A. , Weil Eric M. , Gesmundo Joseph , Nathan David M. , Singer Daniel E. , Chueh Henry C. , Meigs James B. 
Published: March 2007

OBJECTIVE—Population-level strategies to organize and deliver care may improve diabetes management. We conducted a multiclinic controlled trial of population management in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—We created diabetic patient registries (n = 3,079) for four primary care clinics within a single academic health center. In the intervention clinic (n = 898), a nurse practitioner used novel clinical software (PopMan) to identify patients on a weekly basis with outlying values for visit and testing intervals and last measured levels of HbA1c, LDL cholesterol, and blood pressure. For these patients, the nurse practitioner e-mailed a concise patient-specific summary of evidence-based management suggestions directly to primary care providers (PCPs). Population changes in risk factor testing, medication prescription, and risk factor levels from baseline (1 January 2000 to 31 August 2001) to follow-up (1 December 2001 to 31 July 2003) were compared with the three usual-care control clinics (n = 2,181).
RESULTS—Patients had a mean age of 65 years, were mostly white (81%), and the majority were insured by Medicare/Medicaid (62%). From baseline to follow-up, the increase in proportion of patients tested for HbA1c (P = 0.004) and LDL cholesterol (P &lt; 0.001) was greater in the intervention than control sites. Improvements in diabetes-related medication prescription and levels of HbA1c, LDL cholesterol, and blood pressure in the intervention clinic were balanced by similar improvements in the control sites.
CONCLUSIONS—Population-level clinical registries combined with summarized recommendations to PCPs had a modest effect on management. The intervention was limited by good overall quality of care at baseline and temporal improvements in all control clinics. It is unknown whether this intervention would have had greater impact in clinical settings with lower overall quality. Further research into more effective methods of translating population registry information into action is required.
A Population-Based Study of Diabetes and Its Characteristics During the Fasting Month of Ramadan in 13 Countries
Authors: Salti Ibrahim , Bénard Eric , Detournay Bruno , Bianchi-Biscay Monique , Le Brigand Corinne , Voinet Céline , Jabbar Abdul ,   on behalf of the EPIDIAR Study Group
Published: March 2007

OBJECTIVE—The aim of this study was to assess the characteristics and care of patients with diabetes in countries with a sizable Muslim population and to study diabetes features during Ramadan and the effect of fasting.
RESEARCH DESIGN AND METHODS—This was a population-based, retrospective, transversal survey conducted in 13 countries. A total of 12,914 patients with diabetes were recruited using a stratified sampling method, and 12,243 were considered for the analysis.
RESULTS—Investigators recruited 1,070 (8.7%) patients with type 1 diabetes and 11,173 (91.3%) patients with type 2 diabetes. During Ramadan, 42.8% of patients with type 1 diabetes and 78.7% with type 2 diabetes fasted for at least 15 days. Less than 50% of the whole population changed their treatment dose (approximately one-fourth of patients treated with oral antidiabetic drugs [OADs] and one-third of patients using insulin). Severe hypoglycemic episodes were significantly more frequent during Ramadan compared with other months (type 1 diabetes, 0.14 vs. 0.03 episode/month, P = 0.0174; type 2 diabetes, 0.03 vs. 0.004 episode/month, P &lt; 0.0001). Severe hypoglycemia was more frequent in subjects who changed their dose of OADs or insulin or modified their level of physical activity.
CONCLUSIONS—The large proportion of both type 1 and type 2 diabetic subjects who fast during Ramadan represent a challenge to their physicians. There is a need to provide more intensive education before fasting, to disseminate guidelines, and to propose further studies assessing the impact of fasting on morbidity and mortality.
The Metabolic Syndrome Defined by Factor Analysis and Incident Type 2 Diabetes in a Chinese Population With High Postprandial Glucose
Authors: Wang Jian-jun , Qiao Qing , Miettinen Maija E. , Lappalainen Jani , Hu Gang , Tuomilehto Jaakko 
Published: March 2007

OBJECTIVE—The aim of this study was to examine how the major components of the metabolic syndrome relate to each other and to the development of diabetes using factor analysis.
RESEARCH DESIGN AND METHODS—The screening survey for type 2 diabetes was conducted in 1994, and a follow-up study of nondiabetic individuals at baseline was carried out in 1999 in the Beijing area. Among 934 nondiabetic and 305 diabetic subjects at baseline, factor analysis was performed using the principle components analysis with varimax orthogonal rotation of continuously distributed variables considered to represent the components of the metabolic syndrome. Fasting insulin was used as a marker for insulin resistance. Of the 559 subjects without diabetes at baseline, 129 developed diabetes during the 5-year follow-up. Factors identified at baseline were used as independent variables in univariate and multivariate logistic regression models to determine risk factor clusters predicting the development of diabetes.
RESULTS—Four factors were identified in nondiabetic and diabetic subjects. Fasting insulin levels, BMI, and waist-to-hip ratio were associated with one factor. Systolic and diastolic blood pressures were associated with the second factor. Two-hour postload plasma glucose (2-h PG) and serum insulin and fasting plasma glucose were associated with the third factor. Serum total cholesterol and triglycerides were associated with the fourth factor. The first and the third factors predicted the development of diabetes. In diabetic patients at baseline, the combination of systolic and diastolic blood pressure was the most important factor, and urinary albumin excretion rate clustered with fasting and 2-h PG levels.
CONCLUSIONS—Insulin resistance alone does not underlie all features of the metabolic syndrome. Different physiological processes associated with various components of the metabolic syndrome contain unique information about diabetes risk. Microalbunuria is more likely to be a complication of type 2 diabetes or hypertension than a marker for the metabolic syndrome.
Decreased Plasma Lipoprotein Lipase in Hypoadiponectinemia
Authors: von Eynatten Maximilian , Schneider Jochen G. , Humpert Per M. , Rudofsky Gottfried , Schmidt Nikolaus , Barosch Patrizia , Hamann Andreas , Morcos Michael , Kreuzer Joerg , Bierhaus Angelika , Nawroth Peter P. , Dugi Klaus A. 
Published: March 2007

OBJECTIVE—Adiponectin is a plasma protein expressed in adipose tissue. Hypoadiponectinemia is associated with low HDL cholesterol and high plasma triglycerides, which also characterize lipoprotein lipase (LPL) deficiency syndromes. Recently, dramatically increased LPL activity was reported in mice overexpressing adiponectin. We therefore speculated that adiponectin may directly affect LPL in humans.
RESEARCH DESIGN AND METHODS—We measured plasma adiponectin and postheparin LPL in 206 nondiabetic men and in a second group of 110 patients with type 2 diabetes. Parameters were correlated with markers of systemic inflammation (C-reactive protein [CRP]) and insulin resistance (homeostatis model assessment of insulin resistance [HOMA-IR]).
RESULTS—Nondiabetic subjects with decreased plasma adiponectin had lower LPL activity (r = 0.42, P &lt; 0.0001). This association of plasma adiponectin with LPL activity was confirmed in the second group of patients with type 2 diabetes (r = 0.37, P &lt; 0.0001). Multivariate analysis revealed that adiponectin was the strongest factor influencing LPL activity, accounting for 23% of the variation in LPL activity in nondiabetic subjects and for 26% of the variation in LPL activity in type 2 diabetic patients. These associations were independent of plasma CRP and HOMA-IR.
CONCLUSIONS—These results demonstrate an association of decreased postheparin LPL activity with low plasma adiponectin that is independent of systemic inflammation and insulin resistance. Therefore, LPL may represent a link between low adiponectin levels and dyslipidemia in both nondiabetic individuals and patients with type 2 diabetes.
Prospective Association Between Lung Function and the Incidence of Diabetes
Authors: Ford Earl S. , Mannino David M. 
Published: March 2007

OBJECTIVE—To determine whether impaired pulmonary function is a significant predictor of the incidence of diabetes.
RESEARCH DESIGN AND METHODS—Using data from the National Health and Nutrition Examination Survey Epidemiologic Follow-Up Study, a cohort study of a representative sample of U.S. adults, we examined the prospective associations between pulmonary function and incidence of diabetes. Our analyses included 4,830 U.S. men and women aged 25–74 years who had a baseline interview and examination (including spirometry) from 1971 through 1975 and were followed through 1992–1993. Incident diabetes (n = 443) was based on self- or proxy reports, hospitalization, or death certificates.
RESULTS—After multiple adjustment, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), percentage of predicted FEV1, and percentage of predicted FVC were significantly and inversely associated with the incidence of diabetes, but the ratio of FEV1 to FVC was not. Obstructive lung disease (defined by the Global Initiative for Chronic Obstructive Lung Disease classification) was not significantly associated with the incidence of diabetes, but restrictive lung disease was (hazard ratio = 1.45, 95% CI 1.04–2.03). The association did not differ significantly by smoking status.
CONCLUSIONS—Although several prospective studies have found that impaired pulmonary function may increase the risk for developing diabetes, additional research is needed to better understand these relationships and their possible implications.
Treatment of Type 2 Diabetes in Childhood Using a Very-Low-Calorie Diet
Authors: Willi Steven M. , Martin Kelley , Datko Farrah M. , Brant Bethany P. 
Published: March 2007

OBJECTIVE—Pharmacologic agents currently approved for use in children with type 2 diabetes (metformin and insulin) are less than optimal for some patients. We evaluated the use of a ketogenic, very-low-calorie diet (VLCD) in the treatment of type 2 diabetes.
RESEARCH DESIGN AND METHODS—We conducted a chart review of 20 children (mean age 14.5 ± 0.4 years) who consumed a ketogenic VLCD in the treatment of type 2 diabetes. Several response variables (BMI, blood pressure, HbA1c, blood glucose, and treatment regimens) were examined before, during, and up to 2 years after the diet and compared with a matched diabetic control group.
RESULTS—Before starting the diet, 11 of 20 patients were treated with insulin and 6 with metformin. Mean daily blood glucose values fell from 8.9 ± 1.1 to 5.5 ± 0.38 mmol/l (P &lt; 0.0001) in the first 3 days of the VLCD, allowing insulin and oral agents to be discontinued in all but one subject. BMI fell from 43.5 ± 1.8 to 39.3 ± 1.8 kg/m2 (P &lt; 0.0001) and HbA1c dropped from 8.8 ± 0.6 to 7.4 ± 0.6% (P &lt; 0.005) as the diet was continued for a mean of 60 ± 8 days (range 4–130 days), and none required resumption of antidiabetic medications. Sustained decreases in BMI and insulin requirements were observed in patients remaining on the VLCD for at least 6 weeks when compared with those of the control group.
CONCLUSIONS—The ketogenic VLCD is an effective short-term, and possibly long-term, therapy for pediatric patients with type 2 diabetes. Blood glucose control and BMI improve, allowing the discontinuation of exogenous insulin and other antidiabetic agents. This diet, although strict, has potential as an alternative to pharmacologic therapies for this emerging subset of diabetic individuals.
Health-Related Quality of Life and Metabolic Control in Children With Type 1 Diabetes
Authors: Hesketh Kylie D. , Wake Melissa A. , Cameron Fergus J. 
Published: March 2007

OBJECTIVE—To assess change in health-related quality of life (HRQOL) in children with diabetes over 2 years and determine its relationship to change in metabolic control.
RESEARCH DESIGN AND METHODS—In 1998, parents of children aged 5–18 years attending a tertiary diabetes clinic reported their child’s HRQOL using the Child Health Questionnaire PF-50. Those aged 12–18 years also self-reported their HRQOL using the analogous Child Health Questionnaire CF-80. HbA1c levels were recorded. In 2000, identical measures were collected for those who were aged ≤18 years and still attending the clinic.
RESULTS—Of 117 eligible subjects, 83 (71%) participated. Parents reported no significant difference in children’s HRQOL at baseline and follow-up. However, adolescents reported significant improvements on the Family Activities (P &lt; 0.001), Bodily Pain (P = 0.04), and General Health Perceptions (P = 0.001) scales and worsening on the Behavior (P = 0.04) scale. HbA1c at baseline and follow-up were strongly correlated (r = 0.57). HbA1c increased significantly (mean 7.8% in 1998 vs. 8.5% in 2000; P &lt; 0.001), with lower baseline HbA1c strongly predicting an increase in HbA1c over the 2 years (r2 = 0.25, P &lt; 0.001). Lower parent-reported Physical Summary and adolescent-reported Physical Functioning scores at baseline also predicted increasing HbA1c. Poorer parent-reported Psychosocial Summary scores were related to higher HbA1c at both times but did not predict change in HbA1c.
CONCLUSIONS—Changes in parent and adolescent reports of HRQOL differ. Better physical functioning may protect against deteriorating HbA1c, at least in the medium term. While the HRQOL of children with diabetes does not appear to deteriorate over time, we should not be complacent, as it is consistently poorer than that of their healthy peers.
Fasting Intact Proinsulin Is a Highly Specific Predictor of Insulin Resistance in Type 2 Diabetes
Authors: Pfützner Andreas , Kunt Thomas , Hohberg Cloth , Mondok Agnes , Pahler Sabine , Konrad Thomas , Lübben Georg , Forst Thomas 
Published: March 2007

OBJECTIVE—In later stages of type 2 diabetes, proinsulin and proinsulin-like molecules are secreted in increasing amounts with insulin. A recently introduced chemiluminescence assay is able to detect the uncleaved “intact” proinsulin and differentiate it from proinsulin-like molecules. This investigation explored the predictive value of intact proinsulin as an insulin resistance marker.
RESEARCH DESIGN AND METHODS—In total, 48 patients with type 2 diabetes (20 women and 28 men, aged 60 ± 9 years [means ± SD], diabetes duration 5.1 ± 3.8 years, BMI 31.2 ± 4.8 kg/m2, and HbA1c 6.9 ± 1.2%) were studied by means of an intravenous glucose tolerance test and determination of fasting values of intact proinsulin, insulin, resistin, adiponectin, and glucose. Insulin resistance was determined by means of minimal model analysis (MMA) (as the gold standard) and homeostatis model assessment (HOMA).
RESULTS—There was a significant correlation between intact proinsulin values and insulin resistance (MMA P &lt; 0.05 and HOMA P &lt; 0.01). Elevation of intact proinsulin values above the reference range (&gt;10 pmmol/l) showed a very high specificity (MMA 100% and HOMA 92.9%) and a moderate sensitivity (MMA 48.6% and HOMA 47.1%) as marker for insulin resistance. Adiponectin values were slightly lower in the insulin resistant group, but no correlation to insulin resistance could be detected for resisitin in the cross-sectional design.
CONCLUSIONS—Elevated intact proinsulin seems to indicate an advanced stage of β-cell exhaustion and is a highly specific marker for insulin resistance. It might be used as arbitrary marker for the therapeutic decision between secretagogue, sensitizer, or insulin therapy in type 2 diabetes.