bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Computer Simulation Model of Diabetes Progression, Quality of Life, and Cost
Authors: Zhou Honghong , Isaman Deanna J.M. , Messinger Shari , Brown Morton B. , Klein Ronald , Brandle Michael , Herman William H. 
Published: March 2007

OBJECTIVE—To develop and validate a comprehensive computer simulation model to assess the impact of screening, prevention, and treatment strategies on type 2 diabetes and its complications, comorbidities, quality of life, and cost.
RESEARCH DESIGN AND METHODS—The incidence of type 2 diabetes and its complications and comorbidities were derived from population-based epidemiologic studies and randomized, controlled clinical trials. Health utility scores were derived for patients with type 2 diabetes using the Quality of Well Being–Self-Administered. Direct medical costs were derived for managed care patients with type 2 diabetes using paid insurance claims. Monte Carlo techniques were used to implement a semi-Markov model. Performance of the model was assessed using baseline and 4- and 10-year follow-up data from the older-onset diabetic population studied in the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR).
RESULTS—Applying the model to the baseline WESDR population with type 2 diabetes, we predicted mortality to be 51% at 10 years. The prevalences of stroke and myocardial infarction were predicted to be 18 and 19% at 10 years. The prevalences of nonproliferative diabetic retinopathy, proliferative retinopathy, and macular edema were predicted to be 45, 16, and 18%, respectively; the prevalences of microalbuminuria, proteinuria, and end-stage renal disease were predicted to be 19, 39, and 3%, respectively; and the prevalences of clinical neuropathy and amputation were predicted to be 52 and 5%, respectively, at 10 years. Over 10 years, average undiscounted total direct medical costs were estimated to be $53,000 per person. Among survivors, the average utility score was estimated to be 0.56 at 10 years.
CONCLUSIONS—Our computer simulation model accurately predicted survival and the cardiovascular, microvascular, and neuropathic complications observed in the WESDR cohort with type 2 diabetes over 10 years. The model can be used to predict the progression of diabetes and its complications, comorbidities, quality of life, and cost and to assess the relative effectiveness, cost-effectiveness, and cost-utility of alternative strategies for the prevention and treatment of type 2 diabetes.
Modulation of Food Intake by Glucose in Patients With Type 2 Diabetes
Authors: Schultes Bernd , Peters Achim , Hallschmid Manfred , Benedict Christian , Merl Volker , Oltmanns Kerstin M. , Born Jan , Fehm Horst L. , Kern Werner 
Published: March 2007

OBJECTIVE—A gain in body weight is a common adverse effect of glucose-lowering therapies in patients with type 2 diabetes, the mechanisms of which are not completely understood. Blood glucose is considered to play a crucial role in the regulation of food intake. On this background, we hypothesized that a short-term reduction of blood glucose concentration to normal values acutely increases food intake in type 2 diabetic patients.
RESEARCH DESIGN AND METHODS—To test this hypothesis, 12 patients with type 2 diabetes were examined twice, once during a euglycemic (5.0 mmol/l) clamp experiment and another time during a hyperglycemic (10.5 mmol/l) clamp. The experiments were performed in a single-blind fashion with the order of conditions balanced across patients. On both clamp conditions, insulin was infused at a constant rate of 2.5 mU/kg per min for 125 min. Simultaneously, a glucose solution was infused at a variable rate to achieve target glycemic levels. During the final 30 min of the clamps, the patients were allowed to eat as much as they liked from a standard breakfast buffet.
RESULTS—Compared with the hyperglycemic condition, the patients ingested on average 25 ± 10% more energy during euglycemia (645 ± 75 vs. 483 ± 37 kcal; P = 0.029). The increased energy intake during euglycemia was equally distributed across macronutrient components, i.e., during euglycemia the patients ate more carbohydrates (+27.1 ± 11.4%; P = 0.037), fat (+22.5 ± 10.0%; P = 0.046), and proteins (+25.2 ± 11.2%; P = 0.046) than during hyperglycemia. Circulating levels of insulin, amylin, leptin, ghrelin, and glucagon-like peptide-1 did not differ between the euglycemic and hyperglycemia clamp, excluding a major contribution of these hormones to the difference in food intake. Summing up the glucose administered intravenously and the food ingested yielded a remarkably similar total energy influx in both conditions (794 ± 64 vs. 790 ± 53 kcal; P = 0.961).
CONCLUSIONS—Together our data suggest that total energy supply to the organism is tightly regulated on a short-term basis independent of the route of influx. Alternatively, it can be hypothesized that euglycemia stimulated or that hyperglycemia suppressed food intake at the subsequent buffet meal in our type 2 diabetic patients. Regardless of these different interpretations, our data indicate an important regulatory role of glucose for food intake in type 2 diabetic patients that is of considerable clinical relevance.
“Pressure Gradient” as an Indicator of Plantar Skin Injury
Authors: Mueller Michael J. , Zou Dequan , Lott Donovan J. 
Published: March 2007

OBJECTIVE—Peak plantar pressures (PPPs) have been studied extensively as a contributing factor to skin breakdown, especially in the forefoot where most plantar neuropathic ulcers occur. The purposes of this article were to 1) describe an additional pressure variable, the peak pressure gradient (PPG), 2) determine whether the PPG is higher in the forefoot than in the rearfoot (even when compared with PPP), and 3) determine the correlation between the PPG and PPP at the forefoot and rearfoot in subjects with diabetes, peripheral neuropathy, and a history of plantar ulcer.
RESEARCH DESIGN AND METHODS—Twenty subjects (12 male and 8 female) with diabetes, peripheral neuropathy, and a mean ± SD age of 57 ± 9 years participated. Plantar pressures were collected during walking in footwear. The PPP and the PPG (defined as the spatial change in plantar pressure across adjacent sites of the foot surface around the PPP) were determined for the forefoot and rearfoot, and the forefoot-to-rearfoot ratios for each variable were calculated.
RESULTS—The mean PPG was 143% higher in the forefoot than in the rearfoot, whereas the mean PPP was only 36% higher in the forefoot than in the rearfoot (P &lt; 0.0001). The PPG forefoot-to-rearfoot ratio (2.84 ± 1.36) was nearly two times greater than the PPP forefoot-to-rearfoot ratio (1.48 ± 0.58) (P &lt; 0.0001). The correlation between PPP and PPG was r = 0.59 at the forefoot and r = 0.75 at the rearfoot.
CONCLUSIONS—The PPG was substantially higher in the forefoot than in the rearfoot even when compared with the PPP. The PPG appears to be providing additional information about the stresses experienced by the soft tissues of the foot, especially in the forefoot. The PPG may be a useful indicator of skin trauma because spatial changes in high plantar pressures may identify high stress concentrations within the soft tissue.
Alcohol Consumption and Risk of Type 2 Diabetes Among Older Women
Authors: Beulens Joline W.J. , Stolk Ronald P. , van der Schouw Yvonne T. , Grobbee Diederick E. , Hendriks Henk F.J. , Bots Michiel L. 
Published: March 2007

OBJECTIVE—This study aimed to investigate the relation between alcohol consumption and type 2 diabetes among older women.
RESEARCH DESIGN AND METHODS—Between 1993 and 1997, 16,330 women aged 49–70 years and free from diabetes were enrolled in one of the Dutch Prospect-EPIC (European Prospective Study Into Cancer and Nutrition) cohorts and followed for 6.2 years (range 0.1–10.1). At enrollment, women filled in questionnaires and blood samples were collected.
RESULTS—During follow-up, 760 cases of type 2 diabetes were documented. A linear inverse association (P = 0.007) between alcohol consumption and type 2 diabetes risk was observed, adjusting for potential confounders. Compared with abstainers, the hazard ratio for type 2 diabetes was 0.86 (95% CI 0.66–1.12) for women consuming 5–30 g alcohol per week, 0.66 (0.48–0.91) for 30–70 g per week, 0.91 (0.67–1.24) for 70–140 g per week, 0.64 (0.44–0.93) for 140–210 g per week, and 0.69 (0.47–1.02) for &gt;210 g alcohol per week. Beverage type did not influence this association. Lifetime alcohol consumption was associated with type 2 diabetes in a U-shaped fashion.
CONCLUSIONS—Our findings support the evidence of a decreased risk of type 2 diabetes with moderate alcohol consumption and expand this to a population of older women.
Reducing Amputation Rates in Patients With Diabetes at a Military Medical Center
Authors: Driver Vickie R. , Madsen Jeff , Goodman Russell A. 
Published: March 2007

OBJECTIVE— To describe and evaluate the Limb Preservation Service (LPS), a multidisciplinary, state-of-the-art, foot care clinic for patients with diabetes at Madigan Army Medical Center (MAMC). Evaluation criteria include the overall incidence of lower-extremity amputation (LEA) and the distribution of the anatomic level of amputation between 1999 and 2003.
RESEARCH DESIGN AND METHODS— This is a retrospective study of the incidence and types of LEAs performed in patients with diabetes at MAMC. Patients with diagnosed diabetes and LEA procedures were identified by ICD-9-Clinical Modification (CM) codes. Hospital and clinic characteristics that are integral to the success of the program are described.
RESULTS— The number of patients at MAMC with diagnosed diabetes increased 48% from 1999 to 2003; however, the number of LEAs decreased 82% from 33 in 1999 to 9 in 2003. Amputations of the foot, ankle, and toe comprise 71% of amputations among patients with diabetes.
CONCLUSIONS— The results of this study provide evidence of the value of a focused multidisciplinary foot care program for patients with diabetes. Associations between the creation of the LPS and LEA rates are discussed.
Comparison of Effect of Pioglitazone With Metformin or Sulfonylurea (Monotherapy and Combination Therapy) on Postload Glycemia and Composite Insulin Sensitivity Index During an Oral Glucose Tolerance Test in Patients With Type 2 Diabetes
Authors: Ceriello Antonio , Johns Don , Widel Mario , Eckland David J. , Gilmore Kathryn J. , Tan Meng H. 
Published: March 2007

OBJECTIVE— Pioglitazone, metformin, and gliclazide lower HbA1c and fasting plasma glucose in patients with type 2 diabetes. We compared the effects of these three drugs, used as monotherapy and in combination, on postload glycemia and composite insulin sensitivity index (CISI) in these patients.
RESEARCH DESIGN AND METHODS— Postload glycemia and CISI were analyzed for 940 patients who had oral glucose tolerance tests (OGTTs) in four multicenter, randomized, double-blind, double-dummy, parallel group clinical trials (pioglitazone versus metformin, pioglitazone versus gliclazide, pioglitazone plus sulfonylurea versus metformin plus sulfonylurea, and pioglitazone plus metformin versus gliclazide plus metformin). Plasma glucose and insulin were determined during the 3-h OGTT performed at baseline and after 1 year of therapy. Incremental area under the curve for glucose was the surrogate for postload glycemia. CISI was calculated using the formula {10,000/√ of [(fasting glucose × fasting insulin) × (mean glucose × mean insulin)]} during the OGTT.
RESULTS— In monotherapy, pioglitazone reduced postload glycemia and enhanced CISI more than metformin and gliclazide. In combination therapy, pioglitazone plus sulfonylurea reduced postload glycemia and increased CISI more than metformin plus sulfonylurea. Pioglitazone plus metformin also decreased postload glycemia and increased CISI more than gliclazide plus metformin.
CONCLUSIONS— Pioglitazone improves postload glycemia and CISI more than metformin or gliclazide when used as monotherapy or in combination therapy in patients with type 2 diabetes.
Addition of Primary Care–Based Retinal Imaging Technology to an Existing Eye Care Professional Referral Program Increased the Rate of Surveillance and Treatment of Diabetic Retinopathy
Authors: Wilson Charlton , Horton Mark , Cavallerano Jerry , Aiello Lloyd M. 
Published: March 2007

OBJECTIVE—Digital retinal imaging is a relatively new technology that can be used to assess patients for diabetic retinopathy. We evaluated the impact of adding a primary care–based retinal imaging technology to an existing eye care professional referral process on the rate of surveillance and treatment of diabetic retinopathy in a large, well-defined patient population over a 5-year period.
RESEARCH DESIGN AND METHODS—We performed systematic performance evaluations using a computerized patient information system and a comprehensive procedure log to describe annually the patient population, the number of patients with diabetes, and the proportion of patients with diabetes who received appropriate eye care services, including surveillance and laser treatment for diabetic retinopathy before and after implementation of a digital retinal imaging system at the Phoenix Indian Medical Center Primary Care Medical Clinic.
RESULTS—The rate of annual retinal examinations increased from 50% (95% CI 44–56%) to 75% (70–80%; P &lt; 0.000001), representing a 50% increase in the retinal examination rate. The rate of laser therapy increased from 19.6 per 1,000 patients with diabetes in 1999 to 29.5 per 1,000 in 2003 for a 51% increase in the laser treatment rate.
CONCLUSIONS—Implementing retinal imaging technology in a primary care setting resulted in a significant increase in the rate of diabetic retinopathy surveillance and a proportional increase in the rate of laser treatment for diabetic retinopathy for a large patient population. Application of this technology in primary care settings holds the potential to extend sight-preserving care by increasing access to appropriate retinal care.
Impaired Glucose Tolerance and Bone Mineral Content in Overweight Latino Children With a Family History of Type 2 Diabetes
Authors: Afghani Afrooz , Cruz Martha L. , Goran Michael I. 
Published: March 2007

OBJECTIVE—Research on the skeletal status of pre-diabetic (type 2 diabetic) children is warranted. We examined the hypothesis that bone mineral content (BMC) and bone mineral density (BMD) will be lower in children with impaired glucose tolerance (IGT) versus normal glucose tolerance (NGT).
RESEARCH DESIGN AND METHODS—Total body BMC and BMD of 184 overweight Latino children (106 boys, 78 girls, 11.9 ± 1.7 years) with a family history of type 2 diabetes were measured using dual-energy X-ray absorptiometry. Glucose tolerance was assessed by 2-h glucose after an oral glucose tolerance test. Area under the insulin curve (AUC) assessed the cumulative insulin response to oral glucose. Acute insulin response to glucose (AIR) was determined by an intravenous glucose tolerance test.
RESULTS—Partial correlations revealed an inverse relationship between BMC and AIR (r = −0.29, P = 0.00), AUC (r = −0.28, P = 0.00), fasting insulin (r = −0.16, P = 0.04), and 2-h insulin (r = −0.16, P = 0.04). There was no significant difference in BMC or BMD between children with IGT (n = 46) or NGT (n = 138). Stepwise multiple linear regression revealed that 89% of the variance in BMC is attributed to lean mass (87%), age (1%), and AIR (1%). BMD was explained by lean mass (69%), Tanner stage (3%), and AUC (2%).
CONCLUSIONS—The findings of this study suggest that in overweight children, lean mass is the primary predictor of BMC and BMD, whereas age, Tanner stage, and the acute and cumulative insulin responses to oral glucose make subtle independent contributions to the total variances. In addition, poor glycemic control does not seem to be detrimental to bone mass of pre-diabetic children.
Predicting the Development of Diabetes in Older Adults
Authors: Kanaya Alka M. , Fyr Christina L. Wassel , de Rekeneire Nathalie , Shorr Ronald I. , Schwartz Ann V. , Goodpaster Bret H. , Newman Anne B. , Harris Tamara , Barrett-Connor Elizabeth 
Published: March 2007

OBJECTIVE— To create a simple prediction rule that could perform as well as the 2-h postchallenge plasma glucose (PCPG) test to predict those at risk for diabetes. We created a prediction rule in one sample and prospectively validated it for incident diabetes in a separate cohort.
RESEARCH DESIGN AND METHODS— A cross-sectional analysis with data from the Rancho Bernardo Study (age 67 ± 11 years) to derive a rule predicting abnormal PCPG ≥140 mg/dl, using demographic, clinical, and laboratory data of nondiabetic participants with fasting plasma glucose (FPG) &lt;126 mg/dl. Data from the Health, Aging and Body Composition study (age 74 ± 3 years) were used to prospectively validate this rule for incident diabetes and compare it with the predictive ability of the PCPG test.
RESULTS— Of 1,549 RBS participants, 514 (33%) had PCPG ≥140 mg/dl. Female sex, age, triglycerides, and FPG were most significantly associated with abnormal PCPG. Based on standardized β-coefficients, we allotted 1 point for female sex, triglycerides ≥150 mg/dl, or FPG 95–104 mg/dl. Age ≥70 years or FPG 105–115 mg/dl were given 2 points, and FPG 116–125 mg/dl received 3 points. In the validation cohort, this simple prediction rule was as good as the 2-h PCPG test for predicting incident diabetes (C-statistic: 0.71 for both).
CONCLUSIONS— Advanced age, female sex, FPG, and triglycerides were able to predict adults at risk for diabetes equally well as the 2-h PCPG test. Using this rule, clinicians may better identify older persons who should receive intensive lifestyle intervention to prevent type 2 diabetes.
Household Income Is Associated With the Risk of Metabolic Syndrome in a Sex-Specific Manner
Authors: Dallongeville Jean , Cottel Dominique , Ferrières Jean , Arveiler Dominique , Bingham Annie , Ruidavets Jean Bernard , Haas Bernadette , Ducimetière Pierre , Amouyel Philippe 
Published: March 2007

OBJECTIVE—To assess the relationship between household income and metabolic syndrome in men and women.
RESEARCH DESIGN AND METHODS—A total of 1,695 men and 1,664 women, aged 35–64 years, from three distinct geographical areas of France were investigated. Waist girth, plasma triglycerides, HDL cholesterol, glucose, and systolic blood pressure were used to define metabolic syndrome according to the National Cholesterol Education Program (NCEP)/Adult Treatment Panel III (ATPIII) guidelines. Household income, educational level, occupational category, working status, consumption of psychotropic drugs, accommodation status, household composition, physical activity at work and during leisure time, alcohol consumption, and smoking habits were recorded with a standardized questionnaire.
RESULTS—There were 390 (23.0%) men and 381 (16.9%) women who satisfied NCEP/ATPIII criteria for metabolic syndrome. Household income (P &lt; 0.0001) and consumption of psychotropic drugs (P = 0.0005) were associated with metabolic syndrome in women but not in men. In contrast, educational level, occupational category, working status, and accommodation status were associated with metabolic syndrome in both men and women. After adjustment on lifestyle variables, household income (interaction P &lt; 0.004) remained inversely associated with metabolic syndrome in women but not in men.
CONCLUSIONS—These data suggest that limited household income, which reflects a complex unfavorable social and economic environment, may increase the risk of metabolic syndrome in a sex-specific manner.
Dosage Effects of Diabetes Self-Management Education for Mexican Americans
Authors: Brown Sharon A. , Blozis Shelley A. , Kouzekanani Kamiar , Garcia Alexandra A. , Winchell Maria , Hanis Craig L. 
Published: March 2007

OBJECTIVE—The objective of this study was to compare two diabetes self-management interventions designed for Mexican Americans: “extended” (24 h of education, 28 h of support groups) and “compressed” (16 h of education, 6 h of support groups). Both interventions were culturally competent regarding language, diet, social emphasis, family participation, and incorporating cultural beliefs.
RESEARCH DESIGN AND METHODS—We recruited 216 persons between 35 and 70 years of age diagnosed with type 2 diabetes ≥1 year. Intervention groups of eight participants and eight support persons were randomly assigned to the compressed or extended conditions. The interventions differed in total number of contact hours over the yearlong intervention period, with the major difference being the number of support group sessions held. The same information provided in the educational sessions of the extended intervention was compressed into fewer sessions, thus providing more information during each group meeting.
RESULTS—The interventions were not statistically different in reducing HbA1c; however, both were effective. A “dosage effect” of attendance was detected with the largest HbA1c reductions achieved by those who attended more of the extended intervention. For individuals who attended ≥50% of the intervention, baseline to 12-month HbA1c change was −0.6 percentage points for the compressed group and −1.7 percentage points for the extended group.
CONCLUSIONS—Both culturally competent diabetes self-management education interventions were effective in promoting improved metabolic control and diabetes knowledge. A dosage effect was evident; attending more sessions resulted in greater improvements in metabolic control.
Continuous Subcutaneous Insulin Infusion (CSII) of Insulin Aspart Versus Multiple Daily Injection of Insulin Aspart/Insulin Glargine in Type 1 Diabetic Patients Previously Treated With CSII
Authors: Hirsch Irl B. , Bode Bruce W. , Garg Satish , Lane Wendy S. , Sussman Allen , Hu Peter , Santiago Olga M. , Kolaczynski Jerzy W. ,   for the Insulin Aspart CSII/MDI Comparison Study Group
Published: March 2007

OBJECTIVE—Multiple daily injection (MDI) therapy of bolus insulin aspart and basal insulin glargine was compared with continuous subcutaneous insulin infusion (CSII) with aspart in type 1 diabetic patients previously treated with CSII.
RESEARCH DESIGN AND METHODS—One hundred patients were enrolled in a randomized, multicenter, open-label, crossover study. After a 1-week run-in period with aspart by CSII, 50 subjects were randomly assigned to MDI therapy (aspart immediately before each meal and glargine at bedtime) and 50 subjects continued CSII. After 5 weeks of the first treatment, subjects crossed over to the alternate treatment for 5 weeks. During the last week of each treatment period, subjects wore a continuous glucose monitoring system for 48–72 h.
RESULTS—Mean serum fructosamine levels were significantly lower after CSII therapy than after MDI therapy (343 ± 47 vs. 355 ± 50 μmol/l, respectively; P = 0.0001). Continuous glucose monitoring profiles over a 24-h time period showed that glucose exposure was 24 and 40% lower for CSII than MDI as measured by area under the curve (AUC) glucose ≥80 mg/dl (1,270 ± 742 vs. 1,664 ± 1,039 mg · h · dl−1; P &lt; 0.001) and AUC glucose ≥140 mg/dl (464 ± 452 vs. 777 ± 746 mg · h · dl−1, CSII vs. MDI, respectively; P &lt; 0.001). Similar percentages of subjects reported hypoglycemic episodes (CSII: 92%, MDI: 94%) and nocturnal (12:00 a.m. to 8:00 a.m.) hypoglycemic episodes (CSII: 73%, MDI: 72%). Major hypoglycemia was infrequent (CSII: two episodes, MDI: five episodes).
CONCLUSIONS—In a trial of short duration, CSII therapy with insulin aspart resulted in lower glycemic exposure without increased risk of hypoglycemia, as compared with MDI with insulin aspart and glargine.