bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alcohol Consumption and the Prevalence of the Metabolic Syndrome in the U.S.
Authors: Freiberg Matthew S. , Cabral Howard J. , Heeren Tim C. , Vasan Ramachandran S. , Curtis Ellison R. 
Published: March 2007

OBJECTIVE—The aim of this study was to examine the relations of alcohol consumption to the prevalence of the metabolic syndrome and its components in the U.S. population.
RESEARCH DESIGN AND METHODS—We performed a cross-sectional analysis on data from 8,125 participants from the Third National Health and Nutrition Examination Survey who were evaluated for each component of the metabolic syndrome, using the National Cholesterol Education Program criteria, fasting insulin, and alcohol consumption. Current alcohol consumption was defined as ≥1 alcoholic drink per month.
RESULTS—After adjustment for age, sex, race/ethnicity, education, income, tobacco use, physical activity, and diet, subjects who consumed 1–19 and ≥20 drinks of alcohol per month had odds ratios (ORs) for the prevalence of the metabolic syndrome of 0.65 and 0.34, respectively (P &lt; 0.05 for all), compared with current nondrinkers. These findings were particularly noteworthy for beer and wine drinkers. The association of ≥20 alcoholic drinks per month with the prevalence of the metabolic syndrome was consistent across ethnicities but was most striking in white men and women (ORs 0.35 and 0.22, respectively; P &lt; 0.05). Alcohol consumption was significantly and inversely associated with the prevalence of the following three components of the metabolic syndrome: low serum HDL cholesterol, elevated serum triglycerides, high waist circumference, as well as hyperinsulinemia (P &lt; 0.05 for all).
CONCLUSIONS—Mild to moderate alcohol consumption is associated with a lower prevalence of the metabolic syndrome, with a favorable influence on lipids, waist circumference, and fasting insulin. This association was strongest among whites and among beer and wine drinkers.
Screening for Type 2 Diabetes and Impaired Glucose Metabolism
Authors: Colagiuri Stephen , Hussain Zafirul , Zimmet Paul , Cameron Adrian , Shaw Jonathan 
Published: March 2007

OBJECTIVE—To assess the Australian protocol for identifying undiagnosed type 2 diabetes and impaired glucose metabolism.
RESEARCH DESIGN AND METHODS—The Australian screening protocol recommends a stepped approach to detecting undiagnosed type 2 diabetes based on assessment of risk status, measurement of fasting plasma glucose (FPG) in individuals at risk, and further testing according to FPG. The performance of and variations to this protocol were assessed in a population-based sample of 10,508 Australians.
RESULTS—The protocol had a sensitivity of 79.9%, specificity of 79.9%, and a positive predictive value (PPV) of 13.7% for detecting undiagnosed type 2 diabetes and sensitivity of 51.9% and specificity of 86.7% for detecting impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). To achieve these diagnostic rates, 20.7% of the Australian adult population would require an oral glucose tolerance test (OGTT). Increasing the FPG cut point to 6.1 mmol/l (110 mg/dl) or using HbA1c instead of FPG to determine the need for an OGTT in people with risk factors reduced sensitivity, increased specificity and PPV, and reduced the proportion requiring an OGTT. However, each of these protocol variations substantially reduced the detection of IGT or IFG.
CONCLUSIONS—The Australian screening protocol identified one new case of diabetes for every 32 people screened, with 4 of 10 people screened requiring FPG measurement and 1 in 5 requiring an OGTT. In addition, 1 in 11 people screened had IGT or IFG. Including HbA1c measurement substantially reduced both the number requiring an OGTT and the detection of IGT or IFG.
Health-Related Quality of Life and Health-Adjusted Life Expectancy of People With Diabetes in Ontario, Canada, 1996–1997
Authors: Manuel Douglas G. , Schultz Susan E. 
Published: March 2007

OBJECTIVE—To estimate the burden of illness from diabetes using a population health survey linked to a population-based diabetes registry.RESEARCH DESIGN AND METHODS—Measures of health-related quality of life (HRQOL) from the 1996/97 Ontario Health Survey (n = 35,517) were combined with diabetes prevalence and mortality data from the Ontario Diabetes Database (n = 487,576) to estimate the impact of diabetes on life expectancy, health-adjusted life expectancy (HALE), and HRQOL.RESULTS—Life expectancy of people with diabetes was 64.7 and 70.7 years for men and women, respectively—12.8 and 12.2 years less than that for men and women without diabetes. Diabetes had a large impact on instrumental and basic activities of daily living, more so than on functional health. HALE was 58.3 and 62.7 years, respectively, for men and women—11.9 and 10.7 years less than that of men and women without diabetes. Eliminating diabetes would increase Ontario life expectancy by 2.8 years for men and 2.6 years for women; HALE would increase by 2.7 and 3.2 years for men and women, respectively.CONCLUSIONS—The burden of illness from diabetes in Ontario is considerable. Efforts to reduce diabetes would likely result in a “compression of morbidity.” An approach of estimating diabetes burden using linked data sources provides a robust approach for the surveillance of diabetes.
Intensification of Therapeutic Approaches Reduces Mortality in Diabetic Patients With Acute Myocardial Infarction
Authors: Schnell Oliver , Schäfer Oliver , Kleybrink Sonja , Doering Wittich , Standl Eberhard , Otter Wolfgang 
Published: March 2007

OBJECTIVE—The myocardial infarction (MI) registry of the Academic Schwabing Hospital, Munich, investigates the hospital course of diabetic and nondiabetic patients with acute MI. The aim of this study was to improve quality care management and to compare hospital mortality and therapeutic approaches (i.e., PTCA, stenting, GPIIb/IIIa receptor antagonists, glucose-insulin infusion).
RESEARCH DESIGN AND METHODS—Data of diabetic patients and nondiabetic patients were analyzed. All diabetic and nondiabetic subjects who were admitted in 1999 and 2001 were included: 1999, 126 (38%) diabetic and 204 (62%) nondiabetic patients; 2001, 91 (31%) diabetic and 205 (59%) nondiabetic patients.
RESULTS—In 1999, coronary angiography (P &lt; 0.01), percutaneous transluminal coronary angioplasty (PTCA) (P &lt; 0.001), and stenting (P &lt; 0.001) were performed less frequently in diabetic than in nondiabetic patients. During this period, total hospital mortality (29 vs. 16%, P &lt; 0.01) and mortality within 24 h after admission (14 vs. 5%, P = 0.01) were higher in diabetic than in nondiabetic patients. In 2001, frequencies of coronary angiography, PTCA, and stenting were increased in diabetic patients (P &lt; 0.001 vs. 1999), and the interventions were comparable with those performed in nondiabetic patients. Furthermore, glucose-insulin infusion was administered in 46% of diabetic subjects. In 2001, total hospital mortality decreased to 17% in diabetic subjects (P = 0.028 vs. 1999) and mortality within 24 h after admission declined to 4% (P = 0.027 vs. 1999). Logistic regression analysis revealed that an increase in the number of therapeutic approaches (also when adjusted for clinical variables) is associated with a reduction in mortality of diabetic patients with acute MI (adjusted odds ratio 0.14, P &lt; 0.0001).
CONCLUSIONS—Intensification of multiple advanced therapeutic strategies in diabetic patients with acute MI enables a substantial reduction in hospital mortality. The enforcement leads to rates of hospital mortality that are comparable to those of nondiabetic patients.
Elevated White Blood Cell Count in Subjects With Impaired Glucose Tolerance
Authors: Ohshita Kayo , Yamane Kiminori , Hanafusa Miki , Mori Hiroshi , Mito Kazuyo , Okubo Masamichi , Hara Hitoshi , Kohno Nobuoki 
Published: March 2007

OBJECTIVE—Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) differ in their risk of all-cause and cardiovascular mortality, but previous cross-sectional studies have suggested little difference in their levels of lipids or blood pressure. We compared the white blood cell (WBC) count between subjects with IFG and IGT.
RESEARCH DESIGN AND METHODS—The subjects were 4,720 nondiabetic Japanese men aged 24–84 years. Based on the 75-g oral glucose tolerance test, the subjects were classified into the following four groups: normal fasting glucose/normal glucose tolerance (n = 3,753), isolated IFG (n = 290), isolated IGT (n = 476), and IFG/IGT (n = 201). We compared the WBC count among the four groups and investigated variables that showed a significant association with the WBC count.
RESULTS—The isolated IGT group had a significantly higher WBC count than the isolated IFG group (6,530 vs. 6,210/mm3, P &lt; 0.05). By stepwise analyses, age, triglycerides, HDL cholesterol, fasting insulin, and 2-h postchallenge plasma glucose (PG) showed an independent association with the WBC count (adjusted R2 = 0.057). In the analysis stratified by smoking status, the WBC count was independently associated with 2-h PG and triglycerides, irrespective of smoking status.
CONCLUSIONS—Individuals with isolated IGT had a significantly higher WBC count than those with isolated IFG. The WBC count was associated with 2-h PG and various components of the metabolic syndrome.
Leucine 7 to Proline 7 Polymorphism in the Preproneuropeptide Y Is Associated With Proteinuria, Coronary Heart Disease, and Glycemic Control in Type 1 Diabetic Patients
Authors: Pettersson-Fernholm Kim , Karvonen Matti K. , Kallio Jaana , Forsblom Carol M. , Koulu Markku , Pesonen Ullamari , Fagerudd Johan A. , Groop Per-Henrik ,   FinnDiane Study Group
Published: March 2007

OBJECTIVE—Neuropeptide Y is a potent vasoconstrictor thought to enhance the development of atherosclerosis. The leucine 7 to proline 7 (Leu7Pro) polymorphism, located in the signal peptide part of the human preproneuropeptide Y, has been associated with serum lipid levels, intima-media thickness of the common carotid arteries, and diabetic retinopathy in type 2 diabetic patients. Therefore, we investigated the impact of the Leu7Pro polymorphism on diabetic nephropathy, cardiovascular risk factors, and cardiovascular disease in type 1 diabetic patients.
RESEARCH DESIGN AND METHODS—A total of 996 patients from the Finnish Diabetic Nephropathy study were studied in a case-control, cross-sectional study. The carrier frequency of the Pro7 substitution was 13% in the entire study population.
RESULTS—The Pro7 substitution was more common in patients with proteinuria than in those with a normal albumin excretion rate (16 vs. 11%, P &lt; 0.05). Patients with the Pro7 allele had worse glycemic control (HbA1c 8.8 vs. 8.5%, P &lt; 0.005), more coronary heart disease (CHD) (14 vs. 8%, P &lt; 0.05), and higher serum triglycerides (1.65 vs. 1.35 mmol/l, P &lt; 0.005) than patients with the wild-type genotype. There were no differences in the plasma neuropeptide Y levels between the patients with Pro7 compared with those with the wild-type genotype. The Leu7Pro polymorphism was independently associated with HbA1c (P &lt; 0.001), proteinuria (P &lt; 0.01), and CHD (P &lt; 0.01) in multiple regression analyses.
CONCLUSIONS—We conclude that the Leu7Pro polymorphism may contribute to the genetic susceptibility to diabetic nephropathy and CHD in type 1 diabetic patients, possibly by influencing glycemic control and triglycerides.
A 5-Year Randomized Controlled Study of Learning, Problem Solving Ability, and Quality of Life Modifications in People With Type 2 Diabetes Managed by Group Care
Authors: Trento Marina , Passera Pietro , Borgo Enrica , Tomalino Marco , Bajardi Marina , Cavallo Franco , Porta Massimo 
Published: March 2007

OBJECTIVE—To study time course changes in knowledge, problem solving ability, and quality of life in patients with type 2 diabetes managed by group compared with individual care and education.
RESEARCH DESIGN AND METHODS—We conducted a 5-year randomized controlled clinical trial of continuing systemic education delivered by group versus individual diabetes care in a hospital-based secondary care diabetes unit. There were 120 patients with non–insulin-treated type 2 diabetes enrolled and randomly allocated to group or individual care. Eight did not start and 28 did not complete the study. The main outcome measures were knowledge of diabetes, problem solving ability, quality of life, HbA1c, BMI, and HDL cholesterol.
RESULTS—Knowledge of diabetes and problem solving ability improved from year 1 with group care and worsened among control subjects (P &lt; 0.001 for both). Quality of life improved from year 2 with group care but worsened with individual care (P &lt; 0.001). HbA1c level progressively increased over 5 years among control subjects (+1.7%, 95% CI 1.1–2.2) but not group care patients (+0.1%, −0.5 to 0.4), in whom BMI decreased (−1.4, −2.0 to −0.7) and HDL cholesterol increased (+0.14 mmol/l, 0.07–0.22).
CONCLUSIONS—Adults with type 2 diabetes can acquire specific knowledge and conscious behaviors if exposed to educational procedures and settings tailored to their needs. Traditional one-to-one care, although delivered according to optimized criteria, is associated with progressive deterioration of knowledge, problem solving ability, and quality of life. Better cognitive and psychosocial results are associated with more favorable clinical outcomes.
A Danish Diabetes Risk Score for Targeted Screening
Authors: Glümer Charlotte , Carstensen Bendix , Sandbæk Annelli , Lauritzen Torsten , Jørgensen Torben , Borch-Johnsen Knut 
Published: March 2007

OBJECTIVE—To develop a simple self-administered questionnaire identifying individuals with undiagnosed diabetes with a sensitivity of 75% and minimizing the high-risk group needing subsequent testing.
RESEARCH DESIGN AND METHODS—A population-based sample (Inter99 study) of 6,784 individuals aged 30–60 years completed a questionnaire on diabetes-related symptoms and risk factors. The participants underwent an oral glucose tolerance test. The risk score was derived from the first half and validated on the second half of the study population. External validation was performed based on the Danish Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care (ADDITION) pilot study. The risk score was developed by stepwise backward multiple logistic regression.
RESULTS—The final risk score included age, sex, BMI, known hypertension, physical activity at leisure time, and family history of diabetes, items independently and significantly (P &lt; 0.05) associated with the presence of previously undiagnosed diabetes. The area under the receiver operating curve was 0.804 (95% CI 0.765–0.838) for the first half of the Inter99 population, 0.761 (0.720–0.803) for the second half of the Inter99 population, and 0.803 (0.721–0.876) for the ADDITION pilot study. The sensitivity, specificity, and percentage that needed subsequent testing were 76, 72, and 29%, respectively. The false-negative individuals in the risk score had a lower absolute risk of ischemic heart disease compared with the true-positive individuals (11.3 vs. 20.4%; P &lt; 0.0001).
CONCLUSIONS—We developed a questionnaire to be used in a stepwise screening strategy for type 2 diabetes, decreasing the numbers of subsequent tests and thereby possibly minimizing the economical and personal costs of the screening strategy.
Renin Angiotensin Aldosterone System Blockade and Renal Disease in Patients With Type 2 Diabetes
Authors: Chan Juliana C.N. , Wat Nelson M.S. , So Wing-Yee , Lam Karen S.L. , Chua Chin-Teong , Wong Kok-Seng , Morad Zaki , Dickson Tania Z. , Hille Darcy , Zhang Zhongxin , Cooper Mark E. , Shahinfar Shahnaz , Brenner Barry M. , Kurokawa Kiyoshi ,   on behalf of the Asian RENAAL Study Investigators
Published: March 2007

OBJECTIVE—Asia is predicted to have the largest population of patients with diabetes who are at high risk for renal disease. In the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) study, ∼17% of patients were Asians. In this subgroup analysis, we examined the characteristics, response, and adherence to treatment of the Asian population, as well as their baseline predictors of risk of renal end points.
RESEARCH DESIGN AND METHODS—A total of 252 Asian patients were enrolled in the RENAAL study, which compared losartan (50 mg titrated to 100 mg) to placebo in addition to conventional antihypertensive medications in type 2 diabetic patients with nephropathy. Mean follow-up was 3.2 years. The effect of losartan therapy on renal and cardiovascular outcomes was examined, and baseline predictors of risk were determined using a Cox proportional hazards model with prespecified baseline covariates.
RESULTS—Losartan reduced the risk of the primary composite end point composed of a doubling of serum creatinine, end-stage renal disease, or all-cause mortality in Asian patients by 35% (P = 0.02). No difference between losartan and placebo was observed for the cardiovascular composite outcomes. Losartan reduced the level of proteinuria by 47% (P &lt; 0.001) and rate of decrease in renal function by 31% (0.0074). Discontinuations were lower in the losartan-treated patients. The strongest baseline predictors of risk of renal end points were proteinuria (hazard ratio 1.42, P &lt; 0.0001) and low Hb (0.81, P &lt; 0.0001).
CONCLUSIONS—In this subgroup analysis of the RENAAL study, losartan conferred significant renal benefits and was well tolerated in Asian patients with type 2 diabetes and clinical nephropathy. Baseline proteinuria and low Hb were strong predictors of risk of renal outcomes.
The Effect of Vitamin Therapy on the Progression of Coronary Artery Atherosclerosis Varies by Haptoglobin Type in Postmenopausal Women
Authors: Levy Andrew P. , Friedenberg Paula , Lotan Rachel , Ouyang Pamela , Tripputi Mark , Higginson Lyall , Cobb Frederick R. , Tardif Jean-Claude , Bittner Vera , Howard Barbara V. 
Published: March 2007

OBJECTIVE—Antioxidant trials have not demonstrated efficacy in slowing cardiovascular disease but could not rule out benefit for specific patient subgroups. Antioxidant therapy reduces LDL oxidizability in haptoglobin 1 allele homozygotes (Hp 1-1), but not in individuals with the haptoglobin 2 allele (Hp 2-1 or Hp 2-2). We therefore hypothesized that haptoglobin type would be predictive of the effect of vitamin therapy on coronary atherosclerosis as assessed by angiography.
RESEARCH DESIGN AND METHODS—We tested this hypothesis in the Women’s Angiographic Vitamin and Estrogen (WAVE) trial, a prospective angiographic study of vitamins C and E with or without hormone replacement therapy (HRT) in postmenopausal women. Haptoglobin type was determined in 299 women who underwent baseline and follow-up angiography. The annualized change in the minimum luminal diameter (MLD) was examined in analyses stratified by vitamin use, haptoglobin type, and diabetes status.
RESULTS—We found a significant benefit on the change in MLD with vitamin therapy as compared with placebo in Hp 1-1 subjects (0.079 ± 0.040 mm, P = 0.049). This benefit was more marked in diabetic subjects (0.149 ± 0.064 mm, P = 0.021). On the other hand, there was a trend toward a more rapid decrease in MLD with vitamin therapy in Hp 2-2 subjects, which was more marked in diabetic subjects (0.128 ± 0.057 mm, P = 0.027). HRT had no effect on these outcomes.
CONCLUSIONS—The relative benefit or harm of vitamin therapy on the progression of coronary artery stenoses in women in the WAVE study was dependent on haptoglobin type. This influence of haptoglobin type seemed to be stronger in women with diabetes.
Association of Triglyceride–to–HDL Cholesterol Ratio With Heart Rate Recovery
Authors: Shishehbor Mehdi H. , Hoogwerf Byron J. , Lauer Michael S. 
Published: March 2007

OBJECTIVE—Insulin resistance is associated with autonomic dysfunction. An attenuated decrease in heart rate after exercise (or heart rate recovery [HRR]) predicts all-cause mortality and is believed to reflect decreased parasympathetic activity. Utilizing triglyceride/HDL cholesterol concentration as a marker of insulin resistance, we sought to assess the association between insulin resistance and HRR.
RESEARCH DESIGN AND METHODS—Our study population included 4,963 healthy adults who participated in the Lipid Research Clinics Prevalence Study and underwent exercise testing. HRR was considered abnormal if it did not drop ≥42 bpm 2 min after completion of exercise. Fasting blood specimens were drawn.
RESULTS—Individuals in the highest quartile of triglyceride/HDL cholesterol had a significantly higher prevalence of abnormal HRR (40 vs. 30%, multivariable-adjusted prevalence ratio 1.18, 95% CI 1.01–1.39; P = 0.04). As a continuous variable, an increase in 1 SD of triglyceride–to–HDL cholesterol ratio was associated with a greater likelihood of an abnormal HRR, even after adjusting for &gt;20 covariates (adjusted OR 1.16, 95% CI 1.07–1.25; P &lt; 0.001). During 12 years of follow-up, there were 284 deaths. In age- and sex-adjusted analysis, participants with an abnormal HRR and high triglyceride–to–HDL cholesterol ratio had significantly higher mortality than those with a normal HRR and high triglyceride–to–HDL cholesterol ratio (hazard ratio = 1.49, 95% CI 1.08–2.04; P = 0.015).
CONCLUSIONS—HRR is associated with triglyceride–to–HDL cholesterol ratio and identifies patients with insulin resistance who are at increased risk of death.
The Role of Limited Joint Mobility in Diabetic Patients With an At-Risk Foot
Authors: Zimny Stefan , Schatz Helmut , Pfohl Martin 
Published: March 2007

OBJECTIVE—To assess the role of limited joint mobility (LJM) in causing abnormal high plantar pressures in the forefoot of diabetic patients with an at-risk foot.
RESEARCH DESIGN AND METHODS—A total of 70 type 1 or type 2 diabetic patients and 30 control subjects participated in this cross-sectional study. Thirty-five diabetic patients with an at-risk foot, defined as a foot with neuropathy but without ulceration or previous ulceration, and 35 diabetic control subjects without neuropathy were selected for the subgroups. Joint mobility was assessed in the foot at the ankle and metatarsophalangeal I (first MTP) joints. Using the FastScan plantar pressure analyzer, the pressure-time integrals (PTIs) as dynamic variables were measured in each foot. The clinical assessment included standard measures of peripheral neuropathy.
RESULTS—The mobility at the ankle and first MTP joint were significantly reduced in the foot-at-risk group compared with the diabetic control group and the control subjects (P &lt; 0.0001). The PTIs were significantly higher in the foot-at-risk group compared with the two other groups (P &lt; 0.0001). There was a strong inverse correlation between the mobility of the ankle or first MTP joint and the PTI of the diabetic patients (r = −0.67, P &lt; 0.0001, and r = −0.71, P &lt; 0.0001, respectively). The vibration perception threshold was positively correlated with the PTI of the diabetic patients (r = 0.44, P = 0.0001).
CONCLUSIONS—Diabetic patients with an at-risk foot have reduced joint mobility and elevated PTIs on the plantar forefoot, placing them at risk for subsequent ulceration. Therefore, LJM may be a possible factor in causing high plantar pressures and may contribute to foot ulceration in the susceptible neuropathic at-risk foot.