bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival During Renal Replacement Therapy for Diabetic End-Stage Renal Disease in Pima Indians
Authors: Nelson Robert G , Hanson Robert L , Pettitt David J , Knowler William C , Bennett Peter H 
Published: March 2007

OBJECTIVE
To examine survival in Pima Indians receiving renal replacement therapy for end-stage renal disease attributed to NIDDM.

RESEARCH DESIGN AND METHODS
Vital status through 1994 was determined for 136 diabetic Pima Indians from the Gila River Indian Community who began renal replacement therapy between 1973 and 1990.

RESULTS
Median survival from the onset of renal replacement therapy was 39 months (95% CI, 31–54), 31 months (95% CI, 11–48) in those who began treatment between 1973 and 1981, and 44 months (95% CI, 32–56) in those who began treatment between 1982 and 1990 (P = 0.020). During these periods, mean age at onset of treatment increased from 53.3 to 56.1 years (P = 0.166), and mean duration of diabetes at the onset of treatment increased from 16.5 to 20.2 years (P = 0.003). After adjustment for sex, duration of diabetes, initial dialysis type, and kidney transplantation by an age-stratified proportional-hazards analysis, the death rate after starting renal replacement therapy in the second half of the study was 0.54 times (95% CI, 0.33–0.88) that in the first half. If this analysis was restricted to those who survived at least 90 days of therapy, the difference between the time periods was diminished (death rate ratio = 0.76; 95% CI, 0.43–1.32).

CONCLUSIONS
Survival in Pima Indians receiving renal replacement therapy improved significantly over the study despite an increase in the average age and diabetes duration of those beginning dialysis. Much of the improvement in survival is attributable to a reduction in the number of deaths within the first 90 days of therapy. The median survival of 47 months in Pima Indians &lt; 65 years old at the initiation of therapy is substantially longer than the 30 months reported in blacks and 16 months reported in whites of similar age with NIDDM.
The Recurrence Rate of Gestational Diabetes in Subsequent Pregnancies
Authors: Moses Robert G 
Published: March 2007

OBJECTIVE
To define the recurrence rate of gestational diabetes mellitus (GDM) in a subsequent pregnancy and to determine what factors could be predictive.

RESEARCH DESIGN AND METHODS
The subjects of the index pregnancy were 480 personally cared for women with GDM. One hundred women had had a subsequent pregnancy and had been tested for GDM.

RESULTS
The recurrence rate of GDM was 35% (95% CI, 25.5–44.5). An increase in weight between the two pregnancies and a higher maternal age and parity were risk associates for a recurrence. A recurrence of GDM was not associated with a higher glucose level, insulin use, or fetal birth weight in the index pregnancy.

CONCLUSIONS
GDM occurs in only one-third of subsequent pregnancies. Those women who had a recurrence of their GDM were older, more parous, and also had an increase in weight between the pregnancies.
Deviation from Developmentally Appropriate Self-Care Autonomy: Association with diabetes outcomes
Authors: Wysocki Tim , Taylor Alexandra , Hough Brenda S , Linscheid Thomas R , Yeates Keith O , Naglieri Jack A 
Published: March 2007

OBJECTIVE
Treatment of IDDM in youth emphasized balancing children's self-care autonomy with their psychological maturity. However, few data exist to guide clinicians or parents, and little is known about correlates of deviations from this ideal.

RESEARCH DESIGN AND METHODS
In this cross-sectional study, IDDM self-care autonomy of 100 youth was assessed using two well-validated measures. Three measures of psychological maturity (cognitive function, social-cognitive development, and academic achievement) were also collected for each child. Composite indexes of self-care autonomy and of psychological maturity were formed, and the ratio of the self-care autonomy index to the psychological maturity index quantified each child's deviation from developmentally appropriate IDDM self-care autonomy. Based on these scores, participants were categorized as exhibiting constrained (lower tertile), appropriate (middle tertile), or excessive (higher tertile) self-care autonomy. Between-group differences in treatment adherence, diabetes knowledge, glycemic control, and hospitalization rates were explored.

RESULTS
Analysis of covariance controlling for age revealed that the excessive self-care autonomy group demonstrated less favorable treatment adherence, diabetes knowledge, hospitalization rates, and, marginally, glycemic control. Excessive self-care autonomy increased with age and was less common among intact two-parent families but was unrelated to other demographic factors.

CONCLUSIONS
The findings indicate caution about encouragement of maximal self-care autonomy among youth with IDDM and suggest that families who succeed in maintaining parental involvement in diabetes management may have better outcomes.
No Difference in Cardiac Innervation of Diabetic Patients With Painful and Asymptomatic Coronary Artery Disease
Authors: Koistinen M Juhani , Airaksinen K E Juhani , Huikuri Heikki V , Linnaluoto Markku M K , Heikkila Juhani , Torniainen Pentti , Ahonen Aapo 
Published: March 2007

OBJECTIVE
To test the hypothesis that diabetic autonomic neuropathy interfering with sensory impulses from the heart by sympathetic denervation is the major cause of the high prevalence of asymptomatic coronary artery disease (CAD) in diabetic patients.

RESEARCH DESIGN AND METHODS
We evaluated cardiac sympathetic innervation in a population-based group of 10 asymptomatic diabetic patients with angiographically proven CAD and in an age- and sex-matched group of 10 diabetic patients with symptomatic CAD using [123I]metaiodobenzylguanide (MIBG) scintigraphy. Exercise electrocardiography and myocardial perfusion imaging by 201Tl were used to detect myocardial ischemia, and standard cardiovascular tests were used to diagnose autonomic nervous dysfunction.

RESULTS
Thallium scintigraphy revealed perfusion defects in all 10 symptomatic patients and in 9 of the asymptomatic patients. MIBG accumulation defects were found in all cases with painless and with painful disease. In the asymptomatic group, the denervation area exceeded the ischemic area in six cases and areas with total MIBG accumulation defects were seen in four cases. In one case, the MIBG defect was not in the ischemic region. In the symptomatic group, the denervation area exceeded the area of the ischemic region in all cases and areas of total denervation were seen in six cases. The autonomic nervous function tests were abnormal in two asymptomatic and three symptomatic patients with CAD.

CONCLUSIONS
Cardiac sympathetic denervation is common in both patients with painful CAD and patients with asymptomatic CAD regardless of diabetic autonomic neuropathy. This finding supports the view that sympathetic innervation of the heart is highly sensitive to ischemia and this profound effect of ischemia masks the potential effects of autonomic neuropathy on sympathetic innervation. Mechanisms leading to the lack of ischemic pain in diabetic patients with CAD are complex and are not solely explained by autonomic neuropathy.
Renal Function in Long-Duration Type I Diabetes
Authors: Mackin Paul , Macleod Jean M , New John P , Marshall Sally M 
Published: March 2007

OBJECTIVE
The development of persistent proteinuria is reported to be uncommon after 30 years of type I diabetes, and the significance of microalbuminuria in patients with long-duration diabetes is unclear. We therefore undertook to study, in detail, renal function in patients with long-duration type I diabetes.

RESEARCH DESIGN AND METHODS
We measured albumin excretion rate (AER), glomerular filtration rate (GFR), and serum creatinine in 140 patients with ≥30 years of type I diabetes. We also assessed patients for other micro- macrovascular complications of diabetes together with factors implicated in the development of diabetic renal disease.

RESULTS
Of the patients, 23% had microalbuminuria (AER 20–200 μg/min and/or urinary albumin-to-creatinine ratio [ACR] &gt; 2.5 mg/mmol [men] or &gt; 3.5 mg/mmol [women] and dipstick negative for proteinuria), 4% had overt nephropathy (AER &gt; 200 μg/min or persistent dipstick positive proteinuria), and 73% were normoalbuminuric (AER &lt; 20 μg/min or ACR &lt; 2.5 mg/mmol [men], &lt; 3.5 mg/mmol [women]). Patients with microalbuminuria had lower GFR (81.5 ± 30.2 vs. 96.0 ± 20.3 ml · min−1 · 1.73 m−2; P = 0.06) and higher serum creatinine (104 ± 32 vs. 92 ± 16 μmol/l; P = 0.06) than those patients with normoalbuminuria. Both serum creatinine (P &lt; 0.05) and tobacco consumption (P = 0.01) were significantly and independently related to elevated albumin excretion.

CONCLUSIONS
A substantial proportion of these patients have microalbuminuria and evidence of impaired renal function, suggesting that progression to end-stage renal failure may still be inevitable. Clinicians should continue to monitor renal function in these patients. The relationship between tobacco consumption and nephropathy also makes clear the need to reduce cigarette smoking in the diabetic population.
Human Insulin-Induced Lipoatrophy: Successful treatment using a jet-injection device
Authors: Logwin S , Conget I , Jansa M , Vidal M , Nicolau C , Gomis R 
Published: March 2007

OBJECTIVE
To evaluate the efficacy of the administration of insulin by a jet-injector device in stopping and reversing severe human insulin-induced lipoatrophy.

CASE
We report a case of a woman with severe human insulin-induced lipoatrophy who has been treated exclusively with recombinant DNA human insulin since the onset of IDDM.

RESULTS
The loss of subcutaneous tissue in the injection areas was demonstrated and measured by high-frequency ultrasound. Dermatologic exam demonstrated a severe reduction of fat tissue. After 8 months of administration of human insulin by a jet injector, there were no more new lesions of lipoatrophy and those affected areas were substantially ameliorated.

CONCLUSIONS
Jet-injection devices might constitute a helpful method to treat those patients affected by severe human insulin-induced lipoatrophy.
Time-Space Clustering of Date at Birth in Childhood-Onset Diabetes
Authors: Dahlquist Gisela G , Källen Bengt AJ 
Published: March 2007

OBJECTIVE
To investigate whether there was a temporal and geographical clustering of time of birth for infants with childhood-onset diabetes.

RESEARCH DESIGN AND METHODS
The nationwide Swedish Childhood Diabetes Registry, which ascertains 99% of children with recent-onset diabetes (0-14 years), was linked with the Swedish Medical Birth Registry. Clustering of 3,725 patients as to place and time of birth was studied compared with the general population. For each municipality (and in the three large cities of Sweden for each parish), the observed number of patients was compared with the expected number calculated from the average total rate and the number of births in that municipality. Clustering in time of birth within municipality was analyzed using a modification of a set technique by Chen (14).

RESULTS
There was no consistent variability in diabetes risk by calendar birth month, but for specific years, the risk varied during the year. When geographic localization for place of birth was studied on a municipality level, four municipalities snowed a statistically significant case excess while one would have been expected by chance. When we looked for clusters in both time and space for date of birth, clearly more clusters than expected were identified (P &lt; 0.01). Of the total of 198 primary clusters, 42 included three or more patients being born in the same municipality within an unlikely short period always &lt;2 years.

CONCLUSIONS
This is the first study indicating a clustering according to place and time of birth for later risk to develop type I diabetes. Such a phenomenon would agree with the hypothesis that infections in early life, including fetal infections, can increase the risk for diabetes.
Use of Dermagraft, a Cultured Human Dermis, to Treat Diabetic Foot Ulcers
Authors: Gentzkow Gary D , Iwasaki Scott D , Hershon Kenneth S , Mengel Marvin , Prendergast J Joseph , Ricotta John J , Steed David P , Lipkin Scott 
Published: March 2007

OBJECTIVE
To assess the effect of a tissue-engineered human dermis (Dermagraft) in healing diabetic foot ulcers.

RESEARCH DESIGN AND METHODS
This controlled prospective multicenter randomized single-blinded pilot study evaluated healing over a 12-week period in 50 patients with diabetic foot ulcers. These patients were randomized into four groups (three different dosage regimens of Dermagraft and one control group). All patients received identical care except for the use of Dermagraft tissue. Ulcer healing was assessed by percentage of wounds achieving complete or 50% closure, time to complete or 50% closure, and volume and area measurements.

RESULTS
Ulcers treated with the highest dosage of Dermagraft, one piece applied weekly for 8 weeks (group A), healed significantly more often than those treated with conventional wound closure methods; 50% (6 of 12) of the Dermagraft-treated and 8% (1 of 13) of the control ulcers healed completely (P = 0.03). The percentage of wounds achieving 50% closure was also significantly higher (75 vs. 23%; P = 0.018), and the time to complete or 50% closure was faster (P = 0.056). The group A regimen was more effective than other treatment regimens. All three were better than the control, however, and a dose-response was observed. There were no safety concerns. After a mean of 14 months of follow-up (range 11-22 months), there were no recurrences in the Dermagraft-healed ulcers.

CONCLUSIONS
Dermagraft was associated with more complete and rapid healing in diabetic foot ulcers. The recurrence data may indicate an improved quality of wound healing.
A Comparison of the Effects of n-3 Fatty Acids From Linseed Oil and Fish Oil in Well-Controlled Type II Diabetes
Authors: McManus Ruth M , Jumpson Jacqueline , Finegood Diane T , Clandinin M Thomas , Ryan Edmond A 
Published: March 2007

OBJECTIVE
Supplementation of type II diabetic diets with n-3 fatty acids (FAs) from fish oil (FO) has been associated with lowered triglyceride and VLDL levels, although reports of impaired glycemic control have limited their use. Effects of n-3FAs from nonmarine sources are less well documented. Therefore, an investigation comparing the effects of linseed oil (LO) with FO supplementation was undertaken in subjects with type II diabetes.

RESEARCH DESIGN AND METHODS
Eleven subjects with type II diabetes were given supplements with LO and FO for 3 months each in a randomized double-blind crossover fashion after 3 months of olive oil placebo. Oils were given as 35 mg FA · kg body wt−1 · day−1. After each 3-month period, fasting glucose and insulin levels, HbA1c, lipid profiles, insulin sensitivity (SI), glucose effectiveness (SG), and acute insulin response to glucose (AIRG) were evaluated.

RESULTS
HbA1c and lipid values were within the normal range at randomization. Repeated measures analysis of variance testing found no significant differences in weight; fasting glucose and insulin levels; HbA1c; total, LDL, and HDL cholesterol levels; SI; SG; or AIRG with either active oil. FO was associated with significant reductions in triglycerides and a trend toward decreased SI.

CONCLUSIONS
In a population with well-controlled type II diabetes, 3 months of FO but not LO resulted in lowered triglyceride levels. Neither LO nor FO significantly affected glycemic control, cholesterol values, SG, or insulin secretion, while a nonsignificant trend toward decreased insulin sensitivity was found with FO.
Erythrocyte Na+-K+-ATPase Activity, Metabolic Control, and Neuropathy in IDDM Patients
Authors: Raccah Denis , Fabreguettes Claudie , Azulay Jean-Philippe , Vague Phillippe 
Published: March 2007

OBJECTIVE
To study the relationship among red blood cell Na+-K+-ATPase activity, metabolic control, and diabetic neuropathy.

RESEARCH DESIGN AND METHODS
Na+-K+-ATPase activity has been measured in the red cell membrane of 43 long-standing IDDM patients (duration of diabetes 17.5 ± 2 years, mean ± SE), with 20 of the patients presenting with peripheral neuropathy. There were 23 healthy subjects serving as the control group.

RESULTS
Na+-K+-ATPase activity was significantly lower in diabetic patients than in healthy subjects (236.5 ± 7.5 vs. 294 ± 10 nmol P1 · mg protein−1 · h−1, P &lt; 0.05). Among diabetic patients, Na+/K+-ATPase activity was not dependent on the degree of diabetic control, nor was it correlated with either fasting blood glucose (r = 0.16, NS) or HbA1c (r = 0.01, NS). Na+-K+-ATPase activity was lower in patients with neuropathy than in those without it (212 ± 8.5 vs. 261 ± 6.6, P &lt; 0.05). Furthermore, in a subgroup of 20 patients, a positive correlation was observed between erythrocyte Na+-K+-ATPase activity and nerve conduction velocity in the peroneal (r = 0.558, P &lt; 0.02) and tibial nerve (r = 0.528, P &lt; 0.05).

CONCLUSIONS
These results suggest that diabetes-induced Na+-K+-ATPase activity dysfunction could be implicated in the pathogenesis of human diabetic neuropathy and the electrophysiological abnormalities observed in these patients.
An Importance of Carbohydrate Ingestion for the Expression of the Effect of α-Glucosidase Inhibitor in NIDDM
Authors: Hara Tomohiro , Nakamura Jiro , Koh Naoki , Sakakibara Fumihiko , Takeuchi Naohide , Hotta Nigishi 
Published: March 2007

OBJECTIVE
To examine the usefulness of α-glucosidase inhibitors in glycemic control of patients with NIDDM. The involvement of carbohydrate ingestion in manifestation of the effects of α-glucosidase inhibitors was also investigated.

RESEARCH DESIGN AND METHODS
A total of 41 patients hospitalized with NIDDM (22 patients receiving sulfonylurea and 19 receiving insulin therapy) were given α-glucosidase inhibitors during the period when their blood glucose levels were well controlled. They were followed for 3 weeks as inpatients and for an additional 6 months as outpatients. They were retrospectively divided into two groups according to the percentage of carbohydrates in all sources of calories during outpatient management: the &lt;50% group and the &gt;50% group. Between these two groups, we compared circadian variation in blood glucose levels, HbA1c, and urine C-peptide.

RESULTS
Treatment with alpha-glucosidase inhibitors during the hospital stay markedly improved circadian variation in blood glucose levels and HbA1c and decreased urine C-peptide in both groups. While HbA1c returned to its pretreatment level at 6 months after the treatment in the &lt;50% group, HbA1c had further improved in the &gt;50% group at 6 months.

CONCLUSIONS
α-Glucosidase inhibitors are useful for glycemic control in patients with NIDDM and the percentage of carbohydrate in all calorie sources is an important factor for the expression of their effects.
The Medical Management of Hyperglycemia Over a 10-Year Period in People With Diabetes
Authors: Klein Ronald , Klein Barbara E K , Moss Scot E , Cruickshanks Karen J 
Published: March 2007

OBJECTIVE
The purpose of the study was to examine changes in the medical management of glycemia in diabetes and its relation to changes in hyperglycemia as measured by glycated hemoglobin.

RESEARCH DESIGN AND METHODS
A total of 765 patients with younger-onset diabetes diagnosed before 30 years of age and 533 older-onset diabetic patients participated in a population-based study in southern Wisconsin, at baseline (1980–1982), at 4 years (1984–1986), and at 10 years (1990–1992). Glycated hemoglobin, the presence of complications, and information regarding medical management of glycemia, hypoglycemic reactions, and socioeconomic factors were determined using standardized protocols at the three examinations.

RESULTS
In the younger-onset group, there was a significant increase (P &lt; 0.001) in the use of three or more insulin injections per day or in the use of an insulin infusion pump from 3.6% of the cohort at baseline to 24.4% at the 10-year follow-up. This increase was associated with female sex, the presence of gross proteinuria, more education, and better glycemic control at baseline. In the older-onset group, there was a significant (P &lt; 0.05) increase in the proportion of patients taking insulin, from 49.2% at baseline to 61.9% at the 10-year follow-up. This was associated with being younger, having a longer duration of diabetes, having higher glycated hemoglobin values, and having more education at baseline, or developing proliferative diabetic retinopathy or macular edema between baseline and the 4-year follow-up.

CONCLUSIONS
These data suggest a change in the pattern of use of insulin to treat people with diabetes. However, there is still a large number of individuals with poorly controlled diabetes in the population.
Clinical and Radiographic Findings That Lead to Intervention in Diabetic Patients With Foot Ulcers: A nationwide survey of primary care physicians
Authors: Edelman David , Matchar David B , Oddone Eugene Z 
Published: March 2007

OBJECTIVE
To determine which elements of clinical history, physical examination, and diagnostic tests are important to primary care physicians in their management of foot ulcers in diabetic patients.

RESEARCH DESIGN AND METHODS
We conducted a national mail survey of 600 primary care physicians to determine which patient characteristics and diagnostic test results were important in their decisions to seek radiographic studies, surgical referrals, and hospitalization for diabetic patients with foot ulcers.

RESULTS
The case characteristics most likely to influence physicians to order advanced diagnostic or therapeutic interventions are the presence of osteomyelitis on plain radiographs, the failure of the ulcer to improve with conservative therapy, and the presence of visible bone, crepitus, or necrosis within the ulcer (P &lt; 0.001). Information from the initial clinical history was less likely to influence physicians to order advanced diagnostic or therapeutic interventions (P &lt; 0.001) than was information from the physical examination.

CONCLUSIONS
We conclude that 1) the patient's history is relatively unimportant to primary care physicians in their management of diabetic foot ulcers; 2) the failure of conservative management is a major reason that primary care physicians order surgical referral, hospitalization, or radiographic testing for diabetic patients with foot ulcers; and 3) primary care physicians rely heavily on plain × ray of the foot, a test with poor sensitivity and specificity, in deciding whether to order further interventions for their diabetic patients with foot ulcers.