bluuebunny/crossref_metadata_2025_split huggingface dataset:
β-Score
Authors: Ryan Edmond A. , Paty Breay W. , Senior Peter A. , Lakey Jonathan R.T. , Bigam David , Shapiro A.M. James 
Published: March 2007

OBJECTIVE—Success after islet transplantation can be defined in terms of insulin independence, C-peptide secretion, or glycemic control. These measures are interdependent and all need to be considered in evaluating β-cell function after islet transplantation. For the current study, a composite β-score was developed that provides an integrated measure of β-cell function success after islet transplantation.
RESEARCH DESIGN AND METHODS—The proposed scoring system gave 2 points each for normal fasting glucose, HbA1c, stimulated C-peptide, and absence of insulin or oral hypoglycemic agent use. No points were awarded if the fasting glucose was in the diabetic range, the HbA1c was &gt;6.9%, C-peptide secretion was absent on stimulation, or daily insulin use was in excess of 0.24 units/kg. One point was given for intermediate values. The score ranged from 0 to 8 and was correlated with the glucose value 90 min after a standard mixed meal challenge (n = 218) in 57 subjects before and after islet transplantation. The score was also used to follow subjects for up to 5 years after islet transplantation.
RESULTS—The β-score correlated well with the plasma glucose level 90 min after a mixed meal challenge (r = −0.849, P &lt; 0.001). On follow-up, the β-score rose after the first transplant and was maintained up to 5 years, demonstrating continuing function of the transplanted β-cells.
CONCLUSIONS—The β-score provides a simple clinical scoring system that encompasses glycemic control, diabetes therapy, and endogenous insulin secretion that correlates well with physiological measures of β-cell function. On this basis, it is suitable as an overall measure of β-cell transplant function. The β-score gives an integrated measure of β-cell function as a continuum that may be more useful than simply assessing the presence or absence of insulin independence.
Chronic Vascular Inflammation in Patients With Type 2 Diabetes
Authors: Feng Lei , Matsumoto Carolyn , Schwartz Allan , Schmidt Ann Marie , Stern David M. , Pile-Spellman John 
Published: March 2007

OBJECTIVE—Chronic vascular inflammation may play a role in the development of macrovascular complications in diabetic patients. In this study, we examine the association of endothelial expression of two inflammatory mediators, receptor for advanced glycation end product (RAGE) and monocyte chemoattractant protein-1 (MCP-1), with type 2 diabetes using novel endothelial biopsy and RT-PCR techniques.
RESEARCH DESIGN AND METHODS—Endothelial samples are obtained from the aorta of 12 patients with type 2 diabetes and 23 control subjects who underwent cardiac catheterization for chest pain syndrome or heart transplant follow-up. Endothelial cells are purified using magnetic beads with adsorbed CD146 antibody and subjected to RT-PCR analysis of RAGE and MCP-1 transcripts. The association of RAGE and MCP-1 expression with type 2 diabetes is assessed with χ2 test and confirmed with in vitro experiments on human aorta endothelial cells.
RESULTS—RT-PCR reveals gene expression patterns in patient-derived endothelial cells. Strong associations are observed between induction of RAGE mRNA and diabetes (P &lt; 0.01) and between induction of RAGE and MCP-1 transcripts (P &lt; 0.05). Treatment of cultured human aortic endothelial cells with S100b induces the expression of MCP-1 and RAGE transcripts.
CONCLUSIONS—Endothelial cells can be harvested during cardiac catheterization and can be characterized with respect to molecular phenotypes under the influence of both genetic and environmental factors. Induction of RAGE and MCP-1 transcripts in patients with diabetes supports a role of chronic vascular inflammation in macrovascular complications.
Are Granulocyte Colony–Stimulating Factors Beneficial in Treating Diabetic Foot Infections?
Authors: Cruciani Mario , Lipsky Benjamin A. , Mengoli Carlo , de Lalla Fausto 
Published: March 2007

OBJECTIVE—To assess the value of granulocyte colony–stimulating factor (G-CSF) as adjunctive therapy for diabetic foot infections.
RESEARCH DESIGN AND METHODS—We systematically searched the medical literature (including Medline, Embase, LookSmart, and the Cochrane Library) for prospective randomized studies that used G-CSF as an adjunct to standard treatment for diabetic foot infections. Using a conventional meta-analysis, we pooled the relative risks (RRs) for outcomes of interest, including resolution of infection, wound healing, duration of antibiotic therapy, and need for various surgical interventions, using a fixed-effects model.
RESULTS—Five randomized trials, with a total of 167 patients, met our inclusion criteria. The methodological quality of the studies was satisfactory. The investigators administered various G-CSF preparations parenterally for between 3 and 21 days. The meta-analysis revealed that adding G-CSF did not significantly affect the resolution of infection or the healing of the wounds but was associated with a significantly reduced likelihood of lower extremity surgical interventions (RR 0.38 [95% CI 0.20–0.69], number of patients who needed to be treated: 4.5), including amputation (0.41 [0.17–0.95], number of patients who needed to be treated: 8.6). There was no evidence of heterogeneity among the studies or of publication bias, suggesting that these conclusions are reasonably generalizable and robust.
CONCLUSIONS—Adjunctive G-CSF treatment does not appear to hasten the clinical resolution of diabetic foot infection or ulceration but is associated with a reduced rate of amputation and other surgical procedures. The small number of patients who needed to be treated to gain these benefits suggests that using G-CSF should be considered, especially in patients with limb-threatening infections.
The Case for Biennial Retinopathy Screening in Children and Adolescents
Authors: Maguire Ann , Chan Albert , Cusumano Janine , Hing Stephen , Craig Maria , Silink Martin , Howard Neville , Donaghue Kim 
Published: March 2007

OBJECTIVE—Current guidelines recommend annual retinopathy screening 2 years after onset (for pubertal-onset type 1 diabetes) and after 5 years (or age 11, whichever is earlier) for prepubertal onset. Our aim was to describe the natural history of retinopathy and to explore optimal retinal screening intervals for children and adolescents (aged &lt;20 years) screened according to these guidelines.
RESEARCH DESIGN AND METHODS—More than 1,000 children and adolescents, followed longitudinally, were screened for retinopathy using seven-field stereoscopic fundus photography through dilated pupils. Of these, 668 had baseline and follow-up retinal screening. Using generalized estimating equations, we compared the risk of retinopathy with baselines at yearly intervals, in older and younger groups, in higher risk groups (diabetes duration &gt;10 years or HbA1c &gt;10% at any screening), and after stratification ≤10 and &lt;10 years in duration.
RESULTS—After 1 year, retinopathy did not increase significantly in the older group (n = 618, median HbA1c 8.7%, range 8.0–9.5), younger group (n = 50, median HbA1c 8.5%, range 8.0–9.2), or the higher-risk groups. Retinopathy increased significantly after 2 years in the older group (P = 0.003) but not until 6 years in the younger group (P = 0.01). In the group with HbA1c &gt;10% recorded at any visit, retinopathy increased significantly after 2 years (P = 0.001) but not until 3 years in the group whose HbA1c was always ≤10% (P = 0.003). After the second eye assessment, retinopathy did not increase significantly until 3 and 6 years later in the older and younger groups, respectively (P = 0.028 and 0.014).
CONCLUSIONS—These results suggest that adolescents (in reasonable metabolic control) could safely be screened every 2 years rather than the currently recommended 1-year interval. In younger children, the next screening interval could be &gt;2 years later. Individuals with especially poor control, duration &gt;10 years, or significant retinopathy should be screened more frequently.
Associations of Mortality and Diabetes Complications in Patients With Type 1 and Type 2 Diabetes
Authors: Cusick Michael , Meleth Annal D. , Agrón Elvira , Fisher Marion R. , Reed George F. , Knatterud Genell L. , Barton Franca B. , Davis Matthew D. , Ferris Frederick L. , Chew Emily Y. ,   Early Treatment Diabetic Retinopathy Study (ETDRS) Research Group
Published: March 2007

OBJECTIVE—Diabetes is a leading cause of morbidity and mortality. The purpose of this study is to assess the associations between diabetes complications and mortality in the Early Treatment Diabetic Retinopathy Study (ETDRS).
RESEARCH DESIGN AND METHODS—We examined demographic, clinical, and laboratory characteristics of the 3,711 subjects enrolled in the ETDRS, a randomized controlled clinical trial designed to evaluate the role of laser photocoagulation and aspirin therapy for diabetic retinopathy. The outcome assessed was all-cause mortality. Multivariable Cox proportional hazards regression was used to assess associations between diabetes complications and mortality for type 1 and type 2 diabetes separately.
RESULTS—The 5-year estimates of all-cause mortality were 5.5 and 18.9% for patients with type 1 and type 2 diabetes, respectively. In patients with type 1 diabetes, amputation (hazard ratio [HR] 5.08 [95% CI 2.06–12.54]) and poor visual acuity (1.74 [1.10–2.75]) remained significantly associated with mortality, after adjusting for other diabetes complications and baseline characteristics. In patients with type 2 diabetes, macrovascular disease and worsening levels of nephropathy, neuropathy, retinopathy, and visual acuity are associated with progressively increasing risks of mortality, after controlling for other baseline risk factors.
CONCLUSIONS—Amputation is the strongest predictor for mortality in patients with type 1 diabetes. All complications independently predict mortality in patients with type 2 diabetes. There is an increased risk for mortality as the degree of each complication worsens. Additional studies are needed to investigate the effectiveness of tertiary prevention to decrease mortality in these patients.
Cardiovascular Disease in U.S. Patients With Metabolic Syndrome, Diabetes, and Elevated C-Reactive Protein
Authors: Malik Shaista , Wong Nathan D. , Franklin Stanley , Pio Jose , Fairchild Carol , Chen Roland 
Published: March 2007

OBJECTIVE—C-reactive protein (CRP) independently predicts cardiovascular disease (CVD); whether it can stratify risk in those with metabolic syndrome and diabetes is not well documented. We evaluated whether elevated CRP levels modify the relationship of metabolic syndrome and diabetes with CVD in U.S. adults.RESEARCH DESIGN AND METHODS—In a cross-sectional study of 3,873 subjects (weighted to 156 million) aged ≥18 years participating in the National Health and Nutrition Examination Survey 1999–2000, subjects were classified as having diabetes, metabolic syndrome according to modified National Cholesterol Education Program criteria, or neither condition by low (&lt;1 mg/l), intermediate (1–3 mg/l), or high (&gt;3 mg/l) CRP levels. Logistic regression examined the odds of CVD by disease condition and CRP group.RESULTS—After adjusting for age, sex, smoking, and total cholesterol, compared with those with neither metabolic syndrome nor diabetes and low CRP levels, the odds of CVD were 1.99 (95% CI 1.10–3.59) for those with no disease and high CRP levels and 2.67 (1.30–5.48) for those with metabolic syndrome and intermediate CRP. Persons with metabolic syndrome but high CRP had an odds ratio (OR) of 3.33 (1.80–6.16), similar to those with diabetes and low CRP (3.21 [1.27–8.09]). The likelihood of CVD was highest in those with diabetes who had intermediate CRP levels (6.01 [2.54–14.20]) and in those with diabetes and high CRP (7.73 [3.99–14.95]).CONCLUSIONS—In this cross-sectional analysis, CVD is more common in those with metabolic syndrome or diabetes who have elevated CRP. Stratification by CRP may add prognostic information in patients with metabolic syndrome or diabetes.
A Systematic Review of Drug Therapy to Delay or Prevent Type 2 Diabetes
Authors: Padwal Raj , Majumdar Sumit R. , Johnson Jeff A. , Varney Janice , McAlister Finlay A. 
Published: March 2007

OBJECTIVE—To systematically review the evidence for the prevention of type 2 diabetes by pharmacological therapies.
RESEARCH DESIGN AND METHODS—Randomized controlled trials and cohort studies examining the effect of oral hypoglycemic agents, antiobesity agents, antihypertensive agents, statins, fibrates, and estrogen on the incidence of type 2 diabetes were identified from MEDLINE, EMBASE, the Cochrane Controlled Trials Registry, and searches of reference lists. Two reviewers independently assessed studies for inclusion and performed data extraction.
RESULTS—Ten studies of oral hypoglycemic agents and 15 studies of nonoral hypoglycemic agents were found. Oral hypoglycemic agents and orlistat are the only drugs that have been studied in randomized controlled trials with diabetes incidence as the primary end point. In the largest studies of 2.5–4.0 years’ duration, metformin (relative risk [RR] 0.69, 95% CI 0.57–0.83), acarbose (0.75, 0.63–0.90), troglitazone (0.45, 0.25–0.83), and orlistat (hazard ratio [HR] 0.63, 95% CI 0.46–0.86) have all been shown to decrease diabetes incidence compared with placebo; however, follow-up rates varied from 43 to 96%. Current evidence for statins, fibrates, antihypertensive agents, and estrogen is inconclusive. In addition, the critical question of whether drugs are preventing, or simply delaying, onset of diabetes remains unresolved.
CONCLUSIONS—Currently, no single agent can be definitively recommended for diabetes prevention. Future studies should be designed with diabetes incidence as the primary outcome and should be of sufficient duration to differentiate between genuine diabetes prevention as opposed to simple delay or masking of this condition.
The Relationship Between Knowledge of Recent HbA1c Values and Diabetes Care Understanding and Self-Management
Authors: Heisler Michele , Piette John D. , Spencer Michael , Kieffer Edie , Vijan Sandeep 
Published: March 2007

OBJECTIVE—Knowledge of one’s actual and target health outcomes (such as HbA1c values) is hypothesized to be a prerequisite for effective patient involvement in managing chronic diseases such as diabetes. We examined 1) the frequency and correlates of knowing one’s most recent HbA1c test result and 2) whether knowing one’s HbA1c value is associated with a more accurate assessment of diabetes control and better diabetes self-care understanding, self-efficacy, and behaviors related to glycemic control.
RESEARCH DESIGN AND METHODS—We conducted a cross-sectional survey of a sample of 686 U.S. adults with type 2 diabetes in five health systems who had HbA1c checked in the previous 6 months. Independent variables included patient characteristics, health care provider communication, and health system type. We examined bivariate and multivariate associations between each variable and the respondents’ knowledge of their last HbA1c values and assessed whether knowledge of HbA1c was associated with key diabetes care attitudes and behaviors.
RESULTS—Of the respondents, 66% reported that they did not know their last HbA1c value and only 25% accurately reported that value. In multivariate analyses, more years of formal education and high evaluations of provider thoroughness of communication were independently associated with HbA1c knowledge. Respondents who knew their last HbA1c value had higher odds of accurately assessing their diabetes control (adjusted odds ratio 1.59, 95% CI 1.05–2.42) and better reported understanding of their diabetes care (P &lt; 0.001). HbA1c knowledge was not associated with respondents’ diabetes care self-efficacy or reported self-management behaviors.
CONCLUSIONS—Respondents who knew their HbA1c values reported better diabetes care understanding and assessment of their glycemic control than those who did not. Knowledge of one’s HbA1c level alone, however, was not sufficient to translate increased understanding of diabetes care into the increased confidence and motivation necessary to improve patients’ diabetes self-management. Strategies to provide information to patients must be combined with other behavioral strategies to motivate and help patients effectively manage their diabetes.
Prevalence and Correlates of Depressive Symptoms Among Rural Older African Americans, Native Americans, and Whites With Diabetes
Authors: Bell Ronny A. , Smith Shannon L. , Arcury Thomas A. , Snively Beverly M. , Stafford Jeanette M. , Quandt Sara A. 
Published: March 2007

OBJECTIVE—Depression is associated with morbidity, mortality, and decreased quality of life and is a well-established complication among people with diabetes. Little is known about the prevalence and correlates of depressive symptoms among older adults living in rural communities, particularly among ethnic minority groups, who are at increased risk of developing diabetes and complications.
RESEARCH DESIGN AND METHODS—Data were analyzed from the ELDER (Evaluating Long-term Diabetes Self-management Among Elder Rural Adults) diabetes study in which face-to-face interviews were conducted with 696 older (≥65 years of age) African-American, Native American, and white men and women in two rural counties in central North Carolina.
RESULTS—Using a criterion of ≥9 on a modified CES-D (Center for Epidemiologic Study of Depression) scale, 15.8% of the sample had depressive symptoms. In bivariate analyses, depressive symptomatology was more common among women and individuals who were unmarried and had less than a high school education, fewer financial resources, more chronic conditions, more prescription medications, and lower physical functioning. In multivariate analyses, sex, education, living arrangement, BMI, number of prescription medications, number of chronic conditions, and physical functioning remained significant.
CONCLUSIONS—These results show that older rural adults with diabetes are at high risk for depressive symptoms, regardless of their ethnic group, and that certain demographic and health characteristics are important factors in this association. These findings add to the limited body of knowledge of comorbid depression in this population. Greater attention should be paid to diagnosing and treating this condition by those who provide care to these populations.
Depression Symptoms and Antidepressant Medicine Use in Diabetes Prevention Program Participants
Authors:   The Diabetes Prevention Program Research Group
Published: March 2007

OBJECTIVE—To assess depression markers (symptoms and antidepressant medicine use) in Diabetes Prevention Program (DPP) participants and to determine whether changes in depression markers during the course of the study were associated with treatment arm, weight change, physical activity level, or participant demographic characteristics.
RESEARCH DESIGN AND METHODS—DPP participants (n = 3,187) in three treatment arms (intensive lifestyle, metformin, and placebo) completed the Beck Depression Inventory (BDI) and reported on use of antidepressant medicines at randomization and subsequently at each annual visit (average duration in study 3.2 years).
RESULTS—On study entry, 10.3% of participants had BDI scores ≥11, which was used as a threshold for mild depression, 5.7% took antidepressant medicines, and 0.9% had both depression markers. During the DPP, the proportion of participants with elevated BDI scores declined (from 10.3% at baseline to 8.4% at year 3), while the proportion taking antidepressant medicines increased (from 5.7% at baseline to 8.7% at year 3), leaving the proportion with either marker unchanged. These time trends were not significantly associated with the DPP treatment arm. Depression markers throughout the study were associated with some participant demographic factors, adjusted for other factors. Men were less likely to have elevated depression scores and less likely to use antidepressant medicine at baseline (9.0% of men and 17.9% of women had at least one marker of depression) and throughout the study (P &lt;0.0001). Those with more education were less likely to have elevated symptom scores (P = 0.0007) but more likely to be taking antidepressant medicine (P = 0.002). Non-Hispanic white participants were less likely than African Americans to have BDI scores ≥11 (P = 0.03), but white participants were more likely to be taking antidepressant medicine than any other racial/ethnic group (P &lt;0.0001).
CONCLUSIONS—DPP participation was not associated with changes in levels of depression. Countervailing trends in the proportion of DPP participants with elevated depression symptoms and the proportion taking antidepressant medicine resulted in no significant change in the proportion with either marker. The finding that those taking antidepressant medicine often do not have elevated depression symptoms indicates the value of assessing both markers when estimating overall depression rates.
Coronary Artery Disease Is Common in Nonuremic, Asymptomatic Type 1 Diabetic Islet Transplant Candidates
Authors: Senior Peter A. , Welsh Robert C. , McDonald Charlotte G. , Paty Breay W. , Shapiro A.M. James , Ryan Edmond A. 
Published: March 2007

OBJECTIVE—Coronary artery disease (CAD) is the most common cause of death in patients with type 1 diabetes. Asymptomatic CAD is common in uremic diabetic patients, but its prevalence in nonuremic type 1 diabetic patients is unknown. The prevalence of CAD was determined by coronary angiography and the performance of noninvasive cardiac investigation evaluated in type 1 diabetic islet transplant (ITX) candidates with preserved renal function.
RESEARCH DESIGN AND METHODS—A total of 60 consecutive type 1 diabetic ITX candidates (average age 46 years [mean 24–64], 23 men, and 47% ever smokers) underwent coronary angiography, electrocardiographic stress testing (EST), and myocardial perfusion imaging (MPI) in a prospective cohort study. CAD was indicated on angiography by the presence of stenoses &gt;50%. Models to predict CAD were examined by logistic regression.
RESULTS—Most subjects (53 of 60) had no history or symptoms of CAD; 23 (43%) of these asymptomatic subjects had stenoses &gt;50%. CAD was associated with age, duration of diabetes, hypertension, and smoking. Although specific, EST and MPI were not sensitive as predictors of CAD on angiography (specificity 0.97 and 0.93, sensitivity 0.17 and 0.04, respectively) but helped identify two of three subjects requiring revascularization. EST and MPI did not enhance logistic regression models. A clinical algorithm to identify low-risk subjects who may not require angiography was highly sensitive but was applicable only to a minority (n = 8, sensitivity 1.0, specificity 0.27, negative predictive value 1.0).
CONCLUSIONS—Nonuremic type 1 diabetic patients with hypoglycemic unawareness and/or metabolic lability referred for ITX are at high risk for asymptomatic CAD despite negative noninvasive investigations. Aggressive management of cardiovascular risk factors and further investigation into optimal cardiac risk stratification in type 1 diabetes are warranted.