bluuebunny/crossref_metadata_2025_split huggingface dataset:
High Incidence of Diabetic Nephropathy in Early-Onset Japanese NIDDM Patients: Risk analysis
Authors: Yokoyama Hiroki , Okudaira Maki , Otani Toshika , Watanabe Chizuru , Takaike Hiroko , Miuira Junnoske , Yamada Hitomi , Mutou Kazuko , Satou Akiko , Uchigata Yasuko , Iwamoto Yasuhiko 
Published: March 2007

OBJECTIVE
Because early-onset Japanese NIDDM patients (diagnosed before age 30 years) can develop diabetic end-stage renal failure (ESRF) in their thirties, this study was performed to elucidate the incidence and determinants for the development of diabetic nephropathy.

RESEARCH DESIGN AND METHODS
The incidence of diabetic nephropathy and its relationship to baseline characteristics and long-term metabolic control were determined in 426 early-onset Japanese NIDDM patients who were followed for a mean of 6.8 years.

RESULTS
Of these 426 patients, 41 developed diabetic nephropathy manifested by persistent proteinuria (incidence rate [95%CI]/1,000 person-years; 14.1 [10.4–19.1]). Among patients whose mean HbA1c (measured by a high-performance chromatography method that is standardized and comparable to the one used in the Diabetes Control and Complications Trial study) was around 7% or less, few developed nephropathy. The incidence of nephropathy increased with increasing mean HbA1c level in a dose-dependent manner (χ2 trend = 49.9, P &lt; 0.0001). Diastolic blood pressure and duration of diabetes at entry had significant predictive effects independent of metabolic control.

CONCLUSIONS
The incidence rate of diabetic nephropathy in early-onset Japanese NIDDM patients is potentially high, similar to or higher than that in Pima Indian NIDDM or Caucasian IDDM patients of comparable age. Diabetic nephropathy in NIDDM patients aged in their thirties or forties is likely to be an early feature that leads to ESRF, and this would contribute to the marked increase in the number of new patients with diabetic ESRF in Japan. NIDDM is a serious disease if near-normal glycemia is not achieved.
Use of the Physician Insurers Association of America Database as a Surveillance Tool for Diabetes-Related Malpractice Claims in the U.S.
Authors: Meredith Valerie , Cook Curtiss B , Penman Alan 
Published: March 2007

OBJECTIVE
To examine the available national surveillance data on malpractice claims associated with diabetes and to determine the medical specialties having the highest number of claims and the classes and costs of filed claims relating to diabetes.

RESEARCH DESIGN AND METHODS
Data was abstracted from the Data Sharing Reports (DSRs) of the Physicians Insurers Association of America (PIAA), as well as a search of the PIAA's computerized database for the period spanning 1 January 1985 to 31 December 1996. Data on numbers of claims, medical causes of loss, indemnity paid, demographics of claimants and physicians, severity, and medical specialties with diabetes-related claims were available.

RESULTS
A total of 906 diabetes claims were reported to PIAA, and the total indemnity paid was $26,892,848. A significant downward trend (P = 0.004) was noted for the period between 1993 and 1996. Diabetes claimants were older and predominately male, relative to all claimants. Ophthalmology, internal medicine, and general and family practice had the highest rates of reported claims at 16.5, 13.6, and 13.4 diabetes claims per 1,000 claims, respectively. Of the diabetes-related injuries, 44% occurred in the practitioner's office, as compared with 27% for all claims. A greater proportion of diabetes claims were associated with the highest level of severity of injury with respect to all claims compiled by the PIAA.

CONCLUSIONS
The database of the PIAA can be a useful resource to monitor trends in diabetes-related malpractice. Further study into whether claims result from lack of adherence to practice guidelines is needed. Prevention programs designed to reduce the liability among high-risk specialties may also lead to improved care for the patient with diabetes.
Factors Associated With Glycemic Control: A cross-sectional nationwide study in 2,579 French children with type 1 diabetes
Authors: Rosilio Myriam , Cotton Jean-BenoîT , Wieliczko Marie-Claire , Gendrault Bénédicte , Carel Jean-Claude , Couvaras Olga , Ser Nicole , Gillet Pierre , Soskin Sylvie , Garandeau Patrick , Stuckens Chantal , Le Luyer Bernard , Jos Joseph , Bony-Trifunovic Hélène , Bertrand Anne-Marie , Leturcq France , Lafuma Antoine ,   The French Pediatric Diabetes Group, Bougnères Pierre-François 
Published: March 2007

OBJECTIVE
To determine on a large scale the multiple medical and nonmedical factors that influence glycemic control in the general population of children with diabetes, we performed a nationwide French cross-sectional study.

RESEARCH DESIGN AND METHODS
We enrolled 2,579 patients aged 1–19 years with type 1 diabetes of &gt; 1 year's duration. The study was center based: 270 centers were identified, 206 agreed to participate, and 147 included at least 90% of their patients. Questionnaires were completed by physicians interviewing patients and family, and HbA1c measurements were centralized. To identify explanatory variables for HbA1c level and frequency of severe hypoglycemia, we performed multiple regression analysis using all the quantitative variables collected and stepwise logistic regression for the qualitative variables.

RESULTS
Mean HbA1c value for the whole population was 8.97 ± 1.98% (normal 4.7 ± 0.7% [SD]). Only 19 children (0.7%) had ketoacidosis during the 6 months before the study, whereas 593 severe hypoglycemia events occurred in 338 children (13.8%). Control was better in university-affiliated hospitals and centers following &gt; 50 patients, reflecting the importance of access to experienced diabetologists. Children had a mean of 2.3 injections, allegedly performed 2.8 glucose measurements per day, and were seen an average of 4.6 times per year at the center. In the multiple regression analysis, 94% of the variance of HbA1c was explained by our pool of selected variables, with the highest regression coefficient between HbA1c and age (Rc = 0.43, P &lt; 0.0001), then with daily insulin dosage per kilogram (Rc = 0.28, P &lt; 0.0001), mother's age (Rc = 0.26, P &lt; 0.0001), frequency of glucose measurements (Rc = 0.21, P &lt; 0.0001), and diabetes duration (Rc = 0.14, P &lt; 0.0001). Logistic regression identified quality of family support and dietary compliance, two related qualitative and possibly subjective variables, as additional explanatory determinants of HbA1c. The frequency of severe hypoglycemia was 45 per 100 patient-years and correlated with diabetes duration, but not with HbA1c levels or other variables.

CONCLUSIONS
Although overall results remain unsatisfactory, 33% of studied French children with type 1 diabetes had HbA1c &lt;8%, the value obtained in Diabetes Control and Complications Trial adolescents treated intensively. Diabetes management in specialized centers should be encouraged.
Effects of Diabetes and Level of Glycemia on All-Cause and Cardiovascular Mortality: The San Antonio Heart Study
Authors: Wei Ming , Gaskill Sharon P , Haffner Steven M , Stern Michael P 
Published: March 2007

OBJECTIVE
Although the level of hyperglycemia is clearly a risk factor for microvascular complications in diabetic patients, its role in macrovascular complications remains controversial. We followed 4,875 subjects (65% Mexican-American) for 7–8 years to investigate the effects of diabetes and hyperglycemia on all-cause and cardiovascular disease (CVD) mortality. These end points were also analyzed according to quartiles of baseline fasting plasma glucose among diabetic participants.

RESEARCH DESIGN AND METHODS
The Cox proportional hazards model was used to estimate the relative risks (RRs) for all-cause and CVD mortality.

RESULTS
Diabetes was significantly associated with increased all-cause mortality (RR [95% CI] = 2.1 [1.3–3.5] in men; 3.2 [1.9–5.4] in women) and increased CVD mortality (3.2 [1.4–7.1] in men; 8.5 [2.8–25.2] in women). Among diabetic subjects, those in quartile 4 had a 4.2-fold greater risk of all-cause mortality (P &lt; 0.001) and a 4.7-fold greater risk of CVD mortality (P = 0.01) than those in quartiles 1 and 2 combined. After further adjustment for other potential risk factors, subjects in quartile 4 had a 4.9-fold greater risk of all-cause mortality and a 4.9-fold greater risk of CVD mortality than those in quartiles 1 and 2. In addition, hypertension, current smoking, and cholesterol &gt;6.2 mmol/1 were significant predictors of CVD mortality using Cox models.

CONCLUSIONS
We conclude that diabetes is a predictor of both all-cause and CVD mortality in the general population and that both hyperglycemia and common CVD risk factors are important predictors of all-cause and CVD mortality in diabetic subjects.
Hyperinsulinemia and Carotid Atherosclerosis in Hypertensive and Control Subjects
Authors: Rantala Asko O , Päivänsalo Markku , Kauma Heikki , Lilja Mauno , Savolainen Markku J , Reunanen Antti , Kesäniemi Y Antero 
Published: March 2007

OBJECTIVE
To analyze the relationships between carotid atherosclerosis measured as intima-media thickness (IMT) and different measures of insulin in a population-based casecontrol study of men and women.

RESEARCH DESIGN AND METHODS
Carotid ultrasonographic measurements and 2-h oral glucose tolerance tests were performed in a random sample of 513 hypertensive subjects, aged 40–59 years, and in 518 age- and sex-matched control subjects. The associations between IMT and the different measures of insulin were analyzed through multiple regression and by insulin quintiles. The independent effect of insulin was estimated after concurrent adjustment for age, obesity, LDL cholesterol, and systolic blood pressure.

RESULTS
The most powerful correlates with IMT were LDL cholesterol, age, systolic blood pressure, pack-years of smoking, and of the different insulin parameters, 2-h post-load insulin. In stepwise regression analysis, the independent predictors of the mean IMT were LDL cholesterol, systolic blood pressure, pack-years of smoking, and age (P &lt; 0.0001) after adjustment for the independent predictors. In analysis of variance, no positive association of insulin parameters with IMT was found between the 2-h insulin quintiles after adjustment for the independent variables. The exclusion of diabetic subjects did not change the results.

CONCLUSIONS
The present study of a population-based sample of men and women found inconsistent associations between different insulin measures and IMT after adjustment for the independent variables.
Combined Use of a Fasting Plasma Glucose Concentration and HbA1c or Fructosamine Predicts the Likelihood of Having Diabetes in High-Risk Subjects
Authors: Ko Gary T C , Chan Juliana C N , Yeung Vincent T F , Chow Chun-Chung , Tsang Lynn W W , Li June K Y , So Wing-Yi , Wai Hendena P S , Cockram Clive S 
Published: March 2007

OBJECTIVE
To assess the validity of using fasting plasma glucose (FPG) concentrations in conjunction with HbA1c or fructosamine for the screening of diabetes in high-risk individuals.

RESEARCH DESIGN AND METHODS
In this study 2,877 Hong Kong Chinese (565 [19.6%] men; 2,312 [80.4%] women) with various risk factors for glucose intolerance underwent a 75-g oral glucose tolerance test (OGTT) for screening of diabetes. The risk factors included a family history positive for diabetes, a history of gestational diabetes or impaired glucose tolerance, and obesity.

RESULTS
Using World Health Organization (WHO) criteria, 1,593 (55.4%) had normal glucose tolerance, 657 (22.8%) had impaired glucose tolerance, and 627 (21.8%) had diabetes. When the 1997 American Diabetes Association (ADA) criteria were applied, 394 (13.7%) had diabetes with an FPG ≥ 7.0 mmol/l. Using multiple receiver operating characteristic curve analysis, the paired values of an FPG of 5.6 mmol/l and a HbA1c of 5.5% gave an optimal sensitivity of 83.8% and specificity of 83.6% to predict a 2-h plasma glucose (PG) ≥ 11.1 mmol/l. Likewise, the paired values of an FPG of 5.4 mmol/l and a fructosamine level of 235 mumol/l (n = 2,408) gave an optimal sensitivity of 81.5% and specificity of 83.2%. An FPG ≥ 5.6 mmol/l and an HbA1c ≥ 5.5% was 5.4-fold more likely to occur in diabetic subjects (based on the WHO criteria) compared with nondiabetic subjects. For paired parameters less than these values, the likelihood ratio of this occurring in diabetic subjects was only 0.11. Similarly, an FPG ≥ 5.4 mmol/l and a fructosamine ≥ 235 μmol/l was fivefold more likely to occur in diabetic subjects than in nondiabetic subjects, with both parameters less than these values having a likelihood ratio of 0.04. Using these paired values as initial screening tests, only subjects who had an FPG ≥ 5.6 mmol/l and &lt; 7.8 mmol/l and a fructosamine ≥235 μmol/1 (n = 526) required OGTT to confirm diabetes, meaning that 78.2% [(2,408 – 526)/2,408] of the OGTTs could have been saved. Based on the 1997 ADA criterion of an FPG cutoff value of 7.0 mmol/1, the corresponding numbers of OGTTs to be saved were 82.6% and 85.5%, respectively.

CONCLUSIONS
The paired values of FPG and HbA1c or FPG and fructosamine helped to identify potentially diabetic subjects, the diagnosis of which could be further confirmed by the 75-g OGTT. Using this approach ∼ 80% of OGTTs could have been saved, depending on the diagnostic cutoff value of FPG.
Is the Risk of Diabetic Retinopathy Greater in Non-Hispanic Blacks and Mexican Americans Than in Non-Hispanic Whites With Type 2 Diabetes?: A U.S. population study
Authors: Harris Maureen I , Klein Ronald , Cowie Catherine C , Rowland Michael , Byrd-Holt Danita D 
Published: March 2007

OBJECTIVE
To compare the risk for diabetic retinopathy in non-Hispanic white, non-Hispanic black, and Mexican-American adults with type 2 diabetes in the U.S. population.

RESEARCH DESIGN AND METHODS
Representative population-based samples of people aged ≥ 40 years in each of the three racial/ethnic groups were studied in the 1988–1994. Third National Health and Nutrition Examination Survey (NHANES III). Diagnosed diabetes was ascertained by medical history interview, and undiagnosed diabetes by measurement of fasting plasma glucose. A fundus photograph of a single eye was taken with a nonmydriatic camera, and a standardized protocol was used to grade diabetic retinopathy. Information on risk factors for retinopathy was obtained by interview and standard laboratory procedures.

RESULTS
Prevalence of any lesions of diabetic retinopathy in people with diagnosed diabetes was 46% higher in non-Hispanic blacks and 84% higher in Mexican Americans, compared with non-Hispanic whites. Blacks and Mexican Americans also had higher rates of moderate and severe retinopathy and higher levels of many putative risk factors for retinopathy. Blacks had lower retinopathy prevalence among those with undiagnosed diabetes. In logistic regression, retinopathy in people with diagnosed diabetes was associated only with measures of diabetes severity (duration of diabetes, HbA1c, level, treatment with insulin and oral agents) and systolic blood pressure. After adjustment for these factors, the risk of retinopathy in Mexican Americans was twice that of non-Hispanic whites, but non-Hispanic blacks were not at higher risk for retinopathy. These risks were similar when people with undiagnosed diabetes were included in the logistic regression models.

CONCLUSIONS
The prevalence and severity of diabetic retinopathy is greater in non-Hispanic blacks and Mexican Americans with type 2 diabetes in the U.S. population than in non-Hispanic whites. For blacks, this can be attributed to their higher levels of risk factors for retinopathy, but the excess risk in Mexican Americans is unexplained.
Adverse Effects of Diabetes on Multiple Cardiovascular Disease Risk Factors in Women: The Strong Heart Study
Authors: Howard Barbara V , Cowan Linda D , Go Oscar , Welty Thomas K , Robbins David C , Lee Elisa T ,   Strong Heart Study Investigators
Published: March 2007

OBJECTIVE
Many studies have shown that diabetes increases the risk of cardiovascular disease (CVD) in women to a greater extent than in men. One explanation could be that diabetes has more adverse effects on CVD risk factors in women than in men. We compared diabetes-associated differences in CVD risk factors in men and women in the Strong Heart Study, a population-based study of CVD and its risk factors in American Indians.

RESEARCH DESIGN AND METHODS
A total of 1,846 men and 2,703 women between the ages of 45 and 74 years from 13 American Indian communities in three geographic areas underwent an examination that included a medical history; an electrocardiogram; anthropometric and blood pressure measurements; an oral glucose tolerance test; and measurements of fasting plasma lipoproteins, fibrinogen, insulin, HbA1c, and urinary albumin.

RESULTS
Statistically significantly greater adverse differences in those with diabetes versus those without diabetes were observed in women than in men for waist-to-hip ratio, HDL cholesterol, apolipoprotein (apo)B, apoA1, fibrinogen, and LDL size. In multiple linear regression models adjusting for age, center, sex, and diabetes, the diabetes by sex interaction terms were statistically significant for waist-to-hip ratio, LDL cholesterol, HDL cholesterol, apoB, apoA1, fibrinogen, and LDL size.

CONCLUSIONS
Compared with diabetes-associated differences in men, diabetes in women was related to greater adverse differences in levels of several CVD risk factors. Although the magnitude of the individual diabetes-related differences between men and women was not large, the combined effects of these risk factor differences in diabetic women may be substantial. The apparent greater negative impact of diabetes on CVD risk factors in women may explain, in part, the greater risk for CVD in diabetic women.
Was There an Epidemic of Diabetes in Nonwhite Adolescents in Allegheny County, Pennsylvania?
Authors: Libman Ingrid M , LaPorte Ronald E , Becker Dorothy , Dorman Janice S , Drash Allan L , Kuller Lewis 
Published: March 2007

OBJECTIVE
To determine the incidence of IDDM in children aged &lt; 20 years at diagnosis in Allegheny County, Pennsylvania, for the period from 1 January 1990 to 31 December 1994 and to compare the incidence between whites and nonwhites in the same area and for the same time period.

RESEARCH DESIGN AND METHODS
All new patients diagnosed between January 1990 and December 1994 who were aged &lt; 20 years, on insulin, and residents of Allegheny County at diagnosis were identified from medical records of 23 hospitals in the Allegheny County area. To verify the completeness of the hospitals using the capture-recapture method, pediatricians and diabetologists were used as a secondary source.

RESULTS
A total number of 257 patients were identified. The overall age-standardized incidence rate was 16.7/100,000. Nonwhites had a slightly higher incidence (17.6/100,000) than whites (16.5/100,000). In the 15–19 years age-group, the incidence in nonwhites (30.4/100,000) was almost three times higher than that in white (11.2/100,000) and more than two times higher than that in the previous period (from 1985 to 1989) (13.8/100,000).

CONCLUSIONS
For the first time in the Allegheny County registry, and in any other registry, nonwhites showed a higher incidence of IDDM than whites. The high incidence in the 15–19 years age-group was responsible for this phenomenon. This epidemic of diabetes in adolescent nonwhites may be the result of a rising incidence of classical IDDM or another type of diabetes. Further studies using population-based registries are needed to determine whether this increase is being seen in other areas and other ethnic groups and to clarify the reasons for the increase in IDDM among blacks.
Further Evidence for a Central Role of Adipose Tissue in the Antihyperglycemic Effect of Metformin
Authors: Abbasi Fahim , Carantoni Marcello , Chen Y -D I , Reaven Gerald M 
Published: March 2007

OBJECTIVE
To evaluate further the relative roles played by liver and adipose tissue in the therapeutic response to metformin in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS
A total of 11 patients with diet-treated type 2 diabetes were given metformin for ∼ 3 months. Measurements were made before and after treatment of 1) fasting and postprandial plasma glucose, insulin, and free fatty acid (FFA) concentrations; 2) glucose appearance (Ra) and disappearance (Rd) rates measured overnight with 3-[3H]glucose; and 3) plasma FFA concentrations during a 195-min infusion period at relatively low insulin (∼ 12–24 μU/ml) concentrations.

RESULTS
Mean ± SEM fasting plasma glucose concentration was significantly lower (175 ± 11 vs. 224 ± 15 mg/dl; P &lt; 0.01) after treatment with metformin. Mean ± SEM insulin concentrations measured from 8:00 A.M. to 5:00 P.M. did not change with treatment. However, both glucose and FFA concentrations were significantly lower (P &lt; 0.01) when measured over the same time period, and the decreases in plasma FFA and glucose concentration were highly correlated (r = 0.81; P = 0.03). Overnight glucose turnover studies indicated that neither Ra (hepatic glucose production [HGP]) nor Rd changed significantly with treatment in association with metformin treatment. Since plasma glucose concentration was much lower after metformin treatment, the overnight glucose metabolic clearance rate (MCR) was significantly lower (P &lt; 0.01). Finally, the ability of insulin to inhibit isoproterenol-stimulated increases in plasma FFA concentration was enhanced in metformin-treated patients (P &lt; 0.05).

CONCLUSIONS
Metformin treatment was associated with significantly lower fasting plasma glucose concentrations and lower day-long plasma glucose and FFA concentrations. Although overnight HGP was unchanged after treatment with metformin, the overnight glucose MCR was significantly increased, and the antilipolytic activity of insulin was also enhanced. Given these findings, it is suggested that at least part of the antihyperglycemic effect of metformin is due to a decrease in release of FFA from adipose tissue, leading to lower circulating FFA concentrations and an increase in glucose uptake.