bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the Impact of Podiatrist Care in the Primary Prevention of Foot Problems in Diabetic Subjects
Authors: Rönnemaa Tapani , Hämäläinen Helena , Toikka Tuula , Liukkonen Irmeli 
Published: March 2007

OBJECTIVE
To evaluate the influence of podiatrist activities on the outpatient care of diabetic patients in terms of knowledge of diabetic foot care, self-care, and minor foot problems.

RESEARCH DESIGN AND METHODS
There were 733 patients, aged 10–79 years, identified from the national diabetes register. Patients without recent visits to a podiatrist and without an obvious need for foot care were randomized into a podiatric care group (education and primary prevention measures, n = 267) and a control group (written instructions only, n = 263). The patients were examined by an independent study podiatrist at baseline and after 1 year.

RESULTS
Patients in the podiatrist group had greater improvement in knowledge of diabetic foot care (P = 0.004) and self-care (P &lt; 0.001) scores compared with control subjects. The prevalence of callosities in regions other than the calcaneal region decreased more (P = 0.009) in the podiatrist group (from 54.5 to 39.5%) than in the control group (from 51.3 to 48.2%), and the size of the callosities decreased more (P &lt; 0.001) in the podiatrist group than in the control group. Reduction in the prevalence of callosities was associated with younger age (&lt; 50 years).

CONCLUSIONS
Education and primary preventive measures provided individually by a podiatrist result in significant improvements in knowledge and foot self-care scores and in improvements in the prevalence of some minor foot problems. Long-term studies are needed to evaluate whether the intervention of podiatrists starting at an early phase would lead to a reduction in major foot problems.
The Cost to Health Plans of Poor Glycemic Control
Authors: Gilmer Todd P , O'Connor Patrick J , Manning Willard G , Rush William A 
Published: March 2007

OBJECTIVE
We tested the hypothesis that level of glycemic control is related to medical care costs in adults with diabetes.

RESEARCH DESIGN AND METHODS
Regression analysis was used to estimate the relationship between glycemic control and medical care charges for 3,017 adults with diabetes who were continuously enrolled in a large health maintenance organization (HMO) over a 4-year period. Diagnosis of diabetes was ascertained from diagnostic and pharmaceutical databases using a method with an estimated sensitivity of 0.91 and an estimated specificity of 0.99. Charges for care included defined outpatient and inpatient services. Patients who disenrolled or who died during the 4-year period were excluded from the main analysis.

RESULTS
Charges for medical care for patients with diabetes from 1993 to 1995 were closely related to HbA1c level in 1992 before and after adjustment for age, sex, coronary heart disease, and hypertension. Standardized 3-year estimates of charges ranged from $10,439 for patients without comorbid conditions to $44,417 for those with heart disease and hypertension. Medical care charges increased significantly for every 1% increase above HbA1c of 7%. For a person with an HbA1c value of 6%, successive 1% increases in HbA1c resulted in cumulative increases in charges of ∼ 4, 10, 20, and 30%. The increase in charges accelerated as the HbA1c value increased. For patients with diabetes only, or with diabetes plus other chronic conditions, the rate of increase in charges with HbA1c was consistent.

CONCLUSIONS
HbA1c provides useful information to providers and patients regarding both health status and future medical care charges. Economic data suggest that clinicians should assign high importance to low HbA1c results and aggressively maintain the HbA1c status of patients who have low HbA1c values. For economic as well as clinical reasons, it may be beneficial to lower HbA1c when it is &gt; 8% and to reduce cardiovascular risk factors. The medical charge data suggest that investment in clinical systems to improve diabetes care may benefit both payers and patients.
Comparison of Diabetes Diagnostic Categories in the U.S. Population According to 1997 American Diabetes Association and 1980–1985 World Health Organization Diagnostic Criteria
Authors: Harris Maureen I , Eastman Richard C , Cowie Catherine C , Flegal Katherine M , Eberhardt Mark S 
Published: March 2007

OBJECTIVE
To compare the 1997 American Diabetes Association (ADA) and the 1980–1985 World Health Organization (WHO) diagnostic criteria in categorization of the diabetes diagnostic status of adults in the U.S.

RESEARCH DESIGN AND METHODS
Analyses are based on a probability sample of the U.S. population age 40–74 years in the 1988–1994 Third National Health and Nutrition Examination Survey (NHANES III). People with diabetes diagnosed before the survey were identified by questionnaire. For 2,844 people without diagnosed diabetes, fasting plasma glucose was obtained after an overnight 9 to &lt; 24-h fast, HbA1c was measured, and a 2-h oral glucose tolerance test was administered.

RESULTS
Prevalence of diagnosed diabetes in this age-group is 7.9%. Prevalence of undiagnosed diabetes is 4.4% by ADA criteria and 6.4% by WHO criteria. The net change of −2.0% occurs because 1.0% are classified as having undiagnosed diabetes by ADA criteria but have impaired or normal glucose tolerance by WHO criteria, and 3.0% are classified as having impaired fasting glucose or normal fasting glucose by ADA criteria but have undiagnosed diabetes by WHO criteria. Prevalence of impaired fasting glucose is 10.1% (ADA), compared with 15.6% for impaired glucose tolerance (WHO). For those with undiagnosed diabetes by ADA criteria, 62.1% are above the normal range for HbA1c compared with 47.1% by WHO criteria. Mean HbA1c is 7.07% for undiagnosed diabetes by ADA criteria and 6.58% by WHO criteria.

CONCLUSIONS
The number of people with undiagnosed diabetes by ADA criteria is lower than that by WHO criteria. However, those individuals classified by ADA criteria are more hyperglycemic, with higher HbA1c values and a greater proportion of values above the normal range. This fact, together with the simplicity of obtaining a fasting plasma glucose value, may result in the detection of a greater proportion of people with undiagnosed diabetes in clinical practice using the new ADA diagnostic criteria.
Effects of Trp64Arg Mutation in the β3-Adrenergic Receptor Gene on Weight Loss, Body Fat Distribution, Glycemic Control, and Insulin Resistance in Obese Type 2 Diabetic Patients
Authors: Sakane Naoki , Yoshida Toshihide , Umekawa Tsunekazu , Kogure Akinori , Takakura Yasuto , Kondo Motoharu 
Published: March 2007

OBJECTIVE
To investigate the effects of Trp64Arg mutation in the β3-adrenergic receptor gene on weight loss, body fat distribution, glycemic control, and insulin resistance in obese type 2 diabetic patients.

RESEARCH DESIGN AND METHODS
We measured body weight, waist-to-hip ratio (WHR), adjusted resting metabolic rate, fasting blood glucose, fasting serum insulin levels, insulin resistance index (fasting glucose × fasting insulin/22.5), and HbA1c levels before and after 12 weeks of obesity treatment in 61 obese women with type 2 diabetes. The Mval polymorphism of the β3-adrenergic receptor gene was determined by polymerase chain reaction-restriction fragment length polymorphism analysis.

RESULTS
Of obese type 2 diabetic patients, those with the mutation (n = 24) had a higher WHR (P &lt; 0.001), a lower adjusted metabolic rate, and higher blood glucose levels, serum insulin levels, insulin resistance index (P &lt; 0.001), and HbA1c levels (P = 0.016). Furthermore, patients with the mutation had smaller decreases in body weight, WHR, insulin resistance index, and HbA1c levels after the weight-loss program compared with patients without the mutation (n = 37), even though food intake, exercise, and serum thyroid hormone levels were similar in both groups.

CONCLUSIONS
These present findings show that the Trp64Arg allele of the β3-adrenergic receptor gene may predict difficulty in losing body weight, lowering WHR, and improving glycemic control and insulin resistance in obese patients with type 2 diabetes.
Gait Abnormalities in Diabetic Neuropathy
Authors: Katoulis Evangelos C , Ebdon-Parry Mark , Lanshammar Hakan , Vileikyte Loreta , Kulkarni Jarne , Boulton Andrew J M 
Published: March 2007

OBJECTIVE
To investigate the effect of peripheral neuropathy on gait in diabetic patients.

RESEARCH DESIGN AND METHODS
Gait analysis was performed in the following groups matched for age, sex, and BMI: 20 normal healthy control subjects (NC), 20 non-neuropathic diabetic control subjects (DC), 20 neuropathic diabetic subjects (DN), and 20 neuropathic diabetic subjects with a history of foot ulceration (DNU). All subjects with orthopedic foot problems were excluded from the study. The following gait parameters were investigated: 1) walking speed; 2) stance phase duration; 3) joint angles and moment arms for the ankle, knee, and hip joints in both sagittal and frontal planes; 4) the components of the ground reaction force (GRF) vector; and 5) the ankle, knee, and hip joint moments originating from the GRF vector in both planes.

RESULTS
There were no statistical differences in any of the parameters studied between the NC and DC groups. Walking speed was significantly slower in the DNU group compared with the two control groups (P &lt; 0.02). The maximum knee joint angle was smaller in the sagittal plane for the DNU group compared with the DC group values (P &lt; 0.05). The maximum value of the vertical component of GRF was found to be higher (P &lt; 0.03) in the two control groups compared with the DNU group. The maximum value of the anteroposterior forces was also found to be higher (P &lt; 0.001) in the DC group compared with the DNU group. The maximum frontal plane ankle joint moment was significantly higher (P &lt; 0.05) in the DN compared with the NC group.

CONCLUSIONS
Diabetic subjects with peripheral neuropathy demonstrate alterations in some gait parameters during walking. These alterations could facilitate foot injuries, thus contributing to frequent foot ulceration.
Effects of Oral Erythromycin on Fasting and Postprandial Antroduodenal Motility in Patients With Type I Diabetes, Measured With an Ambulatory Manometric Technique
Authors: Samsom Melvin , Jebbink Rik J A , Akkermans Louis M A , Bravenboer B , Van Berge-Henegouwen Gerard P , Smout Andre J P M 
Published: March 2007

OBJECTIVE
The aim of this double-blind crossover study was to evaluate the effects of oral erythromycin (250 mg t.i.d.) on fasting and postprandial gastrointestinal motility and gastrointestinal symptoms in patients with type I diabetes.

RESEARCH DESIGN AND METHODS
Antroduodenal motility was recorded with an ambulatory manometric technique for a 20-h period, including a high-caloric high-fat dinner and a low-caloric low-fat breakfast and a long fasting period, after 2 weeks erythromycin and placebo treatment in 12 patients with type I diabetes. During the manometric study, plasma glucose concentrations were assessed by frequent self-testing. Gastrointestinal symptoms were scored daily to assess the severity of the symptoms (range 0–3).

RESULTS
Oral erythromycin decreased the migrating motor complex cycle length from 118.9 ± 46.0 to 86.2 ± 25.3 min (P = 0.03) by shortening phase II from 68.7 ± 23.5 to 48.5 ± 19.4 min (P &lt; 0.05). The total number of duodenal phase III increased from 48 to 62 (P = 0.075). However, the degree of antral participation to duodenal phase III did not increase. Erythromycin significantly decreased the duration of the postprandial period after dinner (from 417.0 ± 137.9 to 348.8 ± 93.8 min, P = 0.04). During this shorter postprandial period, the number of antral contractions (P &lt; 0.01) and the antral motility index increased (P &lt; 0.03), and early phase III activity at the level of the duodenum was abolished. In diabetic patients with antral hypomotility, after dinner, the mean symptom score improved significantly, from 2.07 ± 0.86 to 1.52 ± 0.63 (P = 0.018).

CONCLUSIONS
This ambulatory antroduodenal manometric study showed that oral erythromycin (250 mg t.i.d.) improves both fasting and postprandial antroduodenal motor activity after a high-caloric meal in patients with type I diabetes. Furthermore, in diabetic subjects with postprandial antral hypomotility, erythromycin reduces dyspeptic symptoms.
The Role of Footwear in the Prevention of Foot Lesions in Patients With NIDDM: Conventional wisdom or evidence-based practice?
Authors: Litzelman Debra K , Marriott Deanna J , Vinicor Frank 
Published: March 2007

OBJECTIVE
To conduct a prospective evaluation of footwear characteristics as predictors of diabetic foot wounds.

RESEARCH DESIGN AND METHODS
A total of 352 patients with NIDDM enrolled in a randomized controlled trial aimed at preventing diabetic foot lesions in an academic general medicine practice were studied. Foot wounds (n = 63) were modeled univariately and multivariably using generalized estimating equations. The dependent variable was a wound classified as a 1.2 or greater according to the Seattle Wound Classification System, indicating at least a superficial or healing minor lesion with no functional interruption of the protective cutaneous barrier. Independent variables included detailed measures of style and material of patients' indoor and outdoor shoes, appropriate length and width, sock fibers, whether the patient had bought new shoes in the past 6 months, and if the patient had been recommended for special shoes. Modeling controlled for intervention status and physiological measures (baseline wound, monofilament abnormalities, and serum HDL level).

RESULTS
Initial screening (P &lt; 0.20) suggested that a recommendation for special shoes, shoe length, and shoe width were indicative of wounds at follow-up (odds ratios [ORs] 2.19, 1.84, 1.86, respectively), while having bought shoes in the past 6 months was associated with no wound at follow-up (OR 0.60). The final multivariable model included only the recommendation for special shoes (OR 2.19; 95% CI 1.07–4.49).

CONCLUSIONS
Many variables commonly cited as protective measures in footwear for diabetic patients were not prospectively predictive when controlling for physiological risk factors. Rigorous analyses are needed to examine the many assumptions regarding footwear recommendations for diabetic patients.
Fasting Plasma Glucose as a Screening Test for Diabetes and Its Relationship With Cardiovascular Risk Factors in Hong Kong Chinese
Authors: Ko Gary TC , Chan Juliana CN , Lau Edith , Woo Jean , Cockram Clive S 
Published: March 2007

OBJECTIVE
To evaluate the use of fasting plasma glucose (FPG) in the diagnosis of diabetes and the relationship between FPG and various cardiovascular risk factors in a community-based Hong Kong Chinese population.

RESEARCH DESIGN AND METHODS
The results of 1,470 oral glucose tolerance tests from a prevalence survey for glucose intolerance and lipid abnormality in a Hong Kong Chinese working population were examined. Our previous report showed that an FPG of 5.7 mmol/l corresponded to a 2-h plasma glucose (PG) of 11.1 mmol/l, and we used this value as a cutoff value and examined the relationship between FPG and various cardiovascular risk factors in nondiabetic subjects.

RESULTS
An FPG cutoff value of 7.8 mmol/l gave a sensitivity of 20.0% and a specificity of 100% in the diagnosis of diabetes (defined as 2-h PG ≥ 11.1 mmol/l). We divided the non-diabetic subjects (FPG &lt; 7.8 mmol/l and 2-h PG &lt; 11.1 mmol/l) into two groups: subjects with FPG &lt; 5.7 mmol/l and those with FPG ≥ 5.7 mmol/l and &lt; 7.8 mmol/l. Subjects in the latter group were older, had higher blood pressure, BMI, waist-to-hip ratio, 2-h PG, fasting and 2-h insulin, fasting serum triglyceride, VLDL cholesterol, apolipoprotein B, and urinary albumin concentrations, as well as lower plasma HDL cholesterol and HDL2 cholesterol concentrations.

CONCLUSIONS
These findings suggest that an FPG cutoff value of 7.8 mmol/l, as recommended by the World Health Organization, was too high when applied to Chinese populations. As in the case of hyperlipidemia, plasma glucose concentration should be viewed as a continuum in terms of its relationship with cardiovascular risk.
Cumulative Incidence of Childhood-Onset IDDM is Unaffected by Pertussis Immunization
Authors: Heijbel Harald , Chen Robert T , Dahlquist Gisela 
Published: March 2007

OBJECTIVE
To identify a possible effect of pertussis vaccination in infancy on the risk for developing human IDDM.

RESEARCH DESIGN AND METHODS
A comparison was made of the cumulative incidence of IDDM in children age 0–12 years between two birth cohorts born before pertussis vaccination and two birth cohorts born after pertussis vaccination had been excluded from the Swedish national immunization program. The Swedish Childhood Diabetes registry was used to identify cases of IDDM. Yearly nurse reports on administered vaccines were used to determine coverage for diphtheria/tetanus/pertussis (DTP) and diphtheria/tetanus (DT) vaccines. Pertussis vaccine coverage was estimated based on number of doses of vaccine made available on license.

RESULTS
No difference in cumulative incidence rate of IDDM up to the age of 12 years was found when the birth cohorts for 1978 and 1979 with high DTP vaccination coverage were compared with the cohorts of 1980 and 1981 with low pertussis vaccination coverage.

CONCLUSIONS
The comparison of the cumulative incidence of IDDM, up to the age of 12 years, in birth cohorts with high and low exposure to pertussis vaccine does not support the hypothesis that pertussis could induce autoimmunity to the β-cell that may lead to IDDM.
The Prevalence of NIDDM and Associated Risk Factors in Native Canadians
Authors: Harris Stewart B , Gittelsohn Joel , Hanley Anthony , Barnie Annette , Wolever Thomas M S , Gao Joe , Logan Alexander , Zinman Bernard 
Published: March 2007

OBJECTIVE
To determine the true prevalence of impaired glucose tolerance (IGT), NIDDM, and associated risk factors by age and sex in an isolated native community.

RESEARCH DESIGN AND METHODS
A community-wide prevalence survey using a 75-g oral glucose tolerance test (OGTT) was undertaken in the remote native reserve of Sandy Lake, Ontario, Canada. Measurements for obesity included waist-to-hip circumference, BMI, and percentage body fat.

RESULTS
A total of 728 individuals were enrolled, representing a community participation rate of 72%. The overall crude prevalence of NIDDM was 17.2% (18.1% females and 16.0% males) and increased to 26.1% overall (28.0% females and 24.2% males) when age-standardized. The prevalence of IGT was higher in females compared with males (age-standardized prevalence of 19.8 vs. 7.1%, respectively). Females had a higher prevalence of obesity, IGT, and NIDDM occurring at younger ages. Measures of obesity and fasting insulin levels were significantly associated with NIDDM in the 18–49 age-group.

CONCLUSIONS
The prevalence rates of NIDDM in this study population are the highest reported to date in a Canadian native population and among the highest reported in the world. Females appear to be at much higher risk of developing obesity, IGT, and NIDDM and at a younger age. Due to the high prevalence rates of IGT and NIDDM in this young population, there is urgent need to develop culturally appropriate community-based public health intervention programs before the long-term complications of diabetes have a devastating effect on the residents.
Total Radical-Trapping Antioxidant Parameter in NIDDM Patients
Authors: Ceriello Antonio , Bortolotti Nadia , Falleti Edmondo , Taboga Claudio , Tonutti Laura , Crescentini Adriana , Motz Enrico , Lizzio Sebastiano , Russo Assunta , Bartoli Ettore 
Published: March 2007

OBJECTIVE
The existence of an oxidative stress in diabetes is still debated. This is largely due to the lack of good tools to assay the level of oxidative stress. The use of total radical-trapping antioxidant parameter (TRAP) has recently been proposed to explore the antioxidant property of a plasma sample. TRAP may be either directly measured by a fluorescence-based method (TRAPm) or calculated (TRAPc) by a mathematical formula, taking into account the serum levels of four natural antioxidants: protein-bound SH (thiol) groups, uric acid, vitamin E, and vitamin C. The difference between TRAPm and TRAPc is due to antioxidants, which are still unidentified, and to the possible synergism among the antioxidants.

RESEARCH DESIGN AND METHODS
In this study, we evaluated malondialdehyde (MDA), TRAPm, TRAPc, protein-bound SH groups, uric acid, vitamin E, and vitamin C in 40 NIDDM patients and 40 matched normal control subjects.

RESULTS
TRAPm and TRAPc were significantly lower in diabetic patients. A good correlation between TRAPm and TRAPc was found in both NIDDM patients (r = 0.68, P &lt; 0.0001) and control subjects (r = 0.74, P &lt; 0.0001). Protein-bound SH groups and uric acid were significantly lower in diabetic subjects, while MDA and vitamin E level were significantly higher. After correction for serum triglycerides (MDA) and cholesterol (vitamin E), MDA lost significance, while vitamin E did not. Vitamin C was not different in the two groups.

CONCLUSIONS
These data show decreased TRAP levels in NIDDM patients, suggesting the existence of lower antioxidant defenses in diabetes. The decrease appears to be due to various antioxidants, some of them not yet clearly defined. TRAP may represent a more reliable estimation of serum antioxidant capacity than the measurement of each known antioxidants. The correlation found between TRAPm and TRAPc values suggests that TRAPc, easier to measure than TRAPm, might be adequately reliable for routine assessment of oxidative stress in diabetic patients.
The Classification of Diabetes by Clinical and C-Peptide Criteria: A prospective population-based study
Authors: Service F John , Rizza Robert A , Zimmerman Bruce R , Dyck Peter J , O'Brien Peter C , Melton L Joseph 
Published: March 2007

OBJECTIVE
To evaluate both the concordance in the classification of diabetes by clinical and C-peptide criteria and, prospectively, the consistency of the classification by C-peptide.

RESEARCH DESIGN AND METHODS
Individuals with diabetes who were enlisted in the prospective epidemiological study of diabetic neuropathy (Rochester Diabetic Neuropathy Study [RDNS]) were classified clinically by National Diabetes Data Group (NDDG) criteria to IDDM and NIDDM at entry to the study. In addition, C-peptide response to 1 mg glucagon was measured at entry for the classification to IDDM (basal C-peptide, &lt; 0.17 pmol/ml; increment above basal, &lt; 0.07 pmol/ml) and NIDDM (all other responses) and for concordance with the clinical classification made. The consistency of the C-peptide response was assessed every 2 years for up to 8 years.

RESULTS
Among 346 individuals with diabetes, 84 were classified as IDDM and 262 as NIDDM by clinical algorithm. COncordance with the C-peptide response occurred in 89% of the patients and remained consistent during 8 years of follow-up. Among the 37 patients with discordant clinical and C-peptide classification, those considered clinically to have NIDDM had a consistent IDDM C-peptide response during follow-up, and most of those considered to have IDDM clinically eventually showed an IDDM C-peptide response during follow-up.

CONCLUSIONS
Clinical criteria for the classification of diabetes are highly correlated with the assessment of insulin secretory reserve. A small number of individuals considered to have NIDDM clinically or by C-peptide have or develop an IDDM peptide response.