bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of Macrovascular Diseases in NIDDM Patients in Northern Taiwan: A 4-yr follow-up study
Authors: Fu Chen-Chung , Chang Chih-Jen , Tseng Chin-Hsiao , Chen Muh-Shy , Kao Chie-Shung , Wu Ta-Jen , Wu Huey-Peir , Chuang Lee-Ming , Chen Chien-Jen , Tai Tong-Yuan 
Published: March 2007

Objective— To assess the development of macrovascular diseases and explore major associative factors in NIDDM.
Research Design and Methods— A total of 479 NIDDM patients ≥ 40 yr of age were recruited from four community primary care health centers of northern Taiwan in July 1986 for a cohort study with a 4-yr follow-up. No patient required insulin therapy within 1 yr of diagnosis nor had a history of diabetic ketoacidosis. All were able to participate independently in the activities of daily living. BP and ECG were measured, and a structured questionnaire was asked of each patient. Venous blood after overnight fasting was collected every year to measure cholesterol, HDL cholesterol, plasma glucose, and HbA1c.
Results— The duration of diabetes was associated with the development of stroke with a relative risk of 1.063 for every 1-yr increment (P = 0.07). As for HVDs, the significant risk factors were serum cholesterol and HbA1c. For every 1-mg/dl increase in mean total cholesterol level, the relative risk of developing HVD increased 1.016-fold (P = 0.04). For every 1% increase in HbA1c, the relative risk of developing HVD increased 1.170-fold (P = 0.01). With regard to leg VDs, sex and cigarette smoking were significant risk factors. Women diabetic subjects had a higher relative risk than men. Cigarette smoking was significantly associated with leg VD with a relative risk of 6.9 for smokers compared with nonsmokers. The most significant risk factor for LVD was the total cholesterol level. For every 1-mg/dl increase in mean serum cholesterol level, the relative risk of LVD increased 1.013-fold.
Conclusions— In the prevention of macrovascular diseases, effective intervention of the nondiabetic cardiovascular risk factors may be as important as or even more important than the good control of diabetes.
A Search for Malnutrition-Related Diabetes Mellitus Among Ethiopian Patients
Authors: Lester Frances T 
Published: March 2007

Objective— To search for evidence of MRDM among Ethiopian patients.
Research Design and Methods— We reviewed the records from March 1976 to January 1991 of 1835 Ethiopian diabetic patients registered consecutively in the Diabetic Clinic of Yekatit 12 Hospital in Addis Ababa, Ethiopia.
Results— Of those aged 15–30 at onset, 41.3% had a BMI &lt;19 kg/m2 at diagnosis, and 55% of the latter had a history of normal weight before the onset of symptoms. The frequency of KA was similar in the very thin patients and others of the same age-group, and only 1 patient required &gt;1.5 IU insulin in 24 h. Pancreatic calcification was observed in only 4 middle-aged men with histories of alcohol abuse, and the very thin patients did not have other stigmata of malnutrition. Of the 1604 patients ≥18 yr of age at diagnosis, only 21 of 1116 who knew their previous weight had a BMI &lt;19 kg/m2 before the onset of diabetic symptoms, and most of the 178 patients with a BMI &lt;19 kg/m2 on treatment had been normal or even overweight. In regression analysis, the factors associated with weight loss before diagnosis were the duration of symptoms in type I diabetes patients and the need for insulin from diagnosis, poverty certification, and symptom duration in type II diabetes patients. Weight gain with treatment was related to female sex, the duration of symptoms, and the absence of tuberculosis in type I diabetes patients and related to an address/birthplace not in Addis Ababa in type II diabetes patients.
Conclusions— The undernutrition at presentation is probably caused by the untreated diabetic state and is reversible with treatment, even if the patient is poor and/or lives in a rural area. No convincing cases of MRDM fulfilling the published definition could be found.
Intensive Conventional Insulin Therapy for Type II Diabetes: Metabolic effects during a 6-mo outpatient trial
Authors: Henry Robert R , Gumbiner Barry , Ditzler Timothy , Wallace Penny , Lyon Rachel , Glauber Harry S 
Published: March 2007

Objective— To determine whether tight glycemic control can be obtained using intensive conventional split-dose insulin therapy in the outpatient management of type II diabetes without development of unacceptable side effects.
Research Design and Methods— Fourteen type II diabetic subjects were treated with an intensive program of conventional insulin (subcutaneous NPH and regular insulin before breakfast and supper) for 6 mo. Insulin dose adjustments were based on an algorithm built on frequent CPG measurements (4–6 times/day). Patients were monitored biweekly as outpatients and admitted 1 day/mo for metabolic evaluation.
Results— Glycemic control was achieved by 1 mo (mean plasma glucose fell from 17.5 ± 0.9 to 7.7 ± 0.7 mM, P &lt; 0.001) and remained in this range thereafter. Hypoglycemic events at 1 mo were infrequent (mean ± SE events per patient per month: 4.1 ± 0.3) and mild in nature, and progressively decreased to 1.3 ± 0.5 events/mo by 6 mo. After treatment, basal HGO fell 44% from 628 ± 44 to 350 ± 17 μmol·m−2·min−1 (P &lt; 0.001), and maximal rates of glucose disposal measured by hyperinsulinemic euglycemic clamp (1800 pmol·m−2·min−1) improved from 1418 ± 156 to 1657 ± 128 μmol·m−2·min−1 (P &lt; 0.05). The total dose of exogenous insulin required was 86 ± 13 U at 1 mo and 100 ± 24 U at 6 mo. During treatment, mean serum insulin levels increased from 308 ± 80 to 510 ± 102 pM (P &lt; 0.05), while body weight increased from 93.5 ± 5.8 to 102.2 ± 6.8 kg (P &lt; 0.001). Both pre- and posttreatment glucose disposal rates correlated with the total exogenous insulin dose required to achieve glycemic control (r = −0.75 and −0.78, both P &lt; 0.005). Weight gain was inversely related to the pretreatment glucose disposal rate (r = −0.53, P &lt; 0.05) and directly correlated with both mean day-long serum insulin level (r = 0.67, P &lt; 0.01) and total exogenous insulin dose (r = 0.62, P &lt; 0.02).
Conclusions— Intensive CIT, when combined with CBG measurements, can be used to rapidly improve glycemic control in type II diabetes without development of unacceptable hypoglycemia. This degree of metabolic improvement, however, requires large doses of exogenous insulin to overcome peripheral insulin resistance and results in greater hyperinsulinemia with progressive weight gain.
Cardiovascular Disease Among American Indians and Alaska Natives
Authors: Welty Thomas K , Coulehan John L 
Published: March 2007

Objective— To compare the regional differences in cardiovascular disease in AI/AN with the U.S. general population and determine the parity gap and preventable proportion of cardiovascular mortality.
Research Design and Methods— Age-adjusted cardiovascular disease mortality rates for 1981–1983 and hospital discharge rates for 1982–1984 reported by the IHS were compared with U.S. data for 1982 and 1983, respectively.
Results— Rates of ischemic heart disease and atherosclerosis were found to be generally low among AI/AN although those in the 25- to 44-yr age-group have higher death rates from cardiovascular disease than in the U.S. population. Although the mortality rate from cardiovascular disease in AI/AN is 19% lower than the rate for the general U.S. population, the parity gap in individual regions of the U.S. ranges from favorable to extremely unfavorable. There were also wide variations in the preventable gap theoretically possible by reduction of the three major risk factors.
Conclusions— Changing nutrition and exercise patterns and the increasing prevalence of diabetes in many Indian tribes may have adverse effects in the future, possibly increasing the prevalence of heart disease. Regional differences in the prevalence of some major cardiovascular risk factors (smoking, hypertension, hypercholesterolemia, and diabetes) are the probable explanation for these differences in cardiovascular morbidity and mortality rates. Prevention and treatment of these risk factors will have the greatest impact in attempts to reduce cardiovascular disease among AI/AN. In addition, moderation in the use of alcohol, or abstinence, may prevent sudden deaths resulting from acute intoxication.
Epidemiology of Lower-Extremity Amputations in the Indian Health Service, 1982–1987
Authors: Valway Sarah E , Linkins Robert W , Gohdes Dorothy M 
Published: March 2007

OBJECTIVE— To describe the LEA experience among IHS diabetic patients.
RESEARCH DESIGN AND METHODS— A cross-sectional study of hospital discharges for nontraumatic LEAs from 1982 to 1987 in four IHS areas was conducted.
RESULTS— Incidence rates of first LEA in the study period increased with increasing age. Compared with nondiabetic subjects, diabetic patients had increased risks in each age-group, with those between the ages of 15 and 44 yr having a 158-fold increased risk. The average annual age-adjusted incidence rates of all LEAs among diabetic subjects in the Tucson (240.8/10,000) and Phoenix (203.1/10,000) IHS areas were substantially higher than the rates for the U.S. (73.1/10,000), Navajo (74.0/10,000), and the Oklahoma (87.3/10,000) IHS areas.
CONCLUSIONS— LEA rates varied in different IHS areas. Reasons for these findings need to be evaluated, but may include IHS area differences in preventive health-care practices or risk factors for LEA.
Effect of Meal Frequency on Blood Glucose, Insulin, and Free Fatty Acids in NIDDM Subjects
Authors: Bertelsen Jette , Christiansen Christian , Thomsen Claus , Poulsen Per L , Vestergaard Svend , Steinov Alice , Rasmussen Lars H , Rasmussen Ole , Hermansen Kjeld 
Published: March 2007

Objective— We studied the effects of meal frequency on blood glucose, serum insulin, and FFAs in 12 NIDDM subjects.
Research Design and Methods— Subjects were assigned in random order to two 8-hr observation periods after an overnight fast. They received isocaloric diets with similar composition either as six small or as two large meals. At the end of each study period, an IVGTT was given.
Results— Two large meals induced an 84% greater maximum amplitude of glucose excursions than six small meals (6.1 ± 0.5 vs. 3.3 ± 0.5 mM, P &lt; 0.005) and higher insulin responses (P &lt; 0.03). The Kg response to an IVGTT did not differ in the two situations. The average FFA level was lowest in response to frequent meals (P &lt; 0.02).
Conclusions— A higher meal frequency acutely subdues glucose excursions and reduces insulin and FFA levels during the daytime in older NIDDM subjects.
Autonomic Function in Neuropathic Diabetic Patients With Foot Ulceration
Authors: Gilmore James E , Allen Judith A , Hayes John R 
Published: March 2007

Objective— The aim of this study was to compare peripheral autonomic function in neuropathic diabetic subjects with and without foot ulceration.
Research Design and Methods— Measurements were made on 57 diabetic subjects; 35 subjects had evidence of peripheral neuropathy, 14 of these had a history of foot ulceration, and 22 subjects had no evidence of peripheral neuropathy. No patient had peripheral vascular disease. Measurements were made of motor and sensory nerve conduction. Autonomic function was investigated by using standard cardiovascular reflex tests and by measuring blood flow variability in the foot. The vasoconstrictor responses to deep breathing and body cooling were measured by using venous occlusion plethysmography.
Results— Peripheral sympathetic function was significantly worse in the DU group. The vasoconstrictor response to deep breathing in the DU group was significantly smaller than the response in the DN group (15.3 ± 2.7 vs. 38 ± 4%, P &lt; 0.001). The response to body cooling in the DU group was significantly smaller than the response in the DN group (6.2 ± 3.1 vs. 20.8 ± 3.5%, P &lt; 0.01). Tests of cardiac autonomic function and measurements of motor and sensory nerve conduction were similar in both neuropathic groups.
Conclusions— Peripheral autonomic neuropathy is associated with the development of foot ulceration in diabetic subjects.
Prevalence of NIDDM and Impaired Glucose Tolerance in Aborigines and Malays in Malaysia and Their Relationship to Sociodemographic, Health, and Nutritional Factors
Authors: Ali Osman , Tan T T , Sakinah O , Khalid B A K , Wu L L , Ng M L 
Published: March 2007

Objective— To determine the prevalence of diabetes mellitus and IGT in different ethnic groups living in the same physical environment and to find their relationship to nutritional status and dietary intake.
Research Design and Methods— The study was conducted among Malays and Orang Asli in six rural and urban locations in Malaysia. OGTTs were performed on 706 adult subjects ≥ 18 yr of age. WHO criteria were used for diagnosing diabetes mellitus and IGT.
Results— The overall prevalence of diabetes mellitus and IGT among Orang Asli was 0.3 and 4.4% compared with 4.7 and 11.3%, respectively, among Malays. This increased prevalence of glucose intolerance among Malays was associated with higher levels of social development. Among rural Malays, the crude prevalence of diabetes in a traditional village was 2.8% and in the land scheme was 6.7%, whereas urban Malays had a prevalence of 8.2%. In contrast, the prevalence of IGT (10.5–14.8%) was higher among rural Malays, compared with 9.6% among urban Malays. Ethnic group, ≥ 40 yr of age, an income &gt; M$250, fewer daily activity, and obesity were associated with a higher prevalence of diabetes.
Conclusions— Diabetes mellitus and IGT, which were more common among Malays than Orang Asli, were associated with more affluent life-styles and modernization.
Prevalence of Microalbuminuria in Older-Onset Diabetes
Authors: Klein Ronald , Klein Barbara E K , Moss Scot E 
Published: March 2007

OBJECTIVE
To examine the prevalence of microalbuminuria and the relationships of microalbuminuria to blood pressure and other risk factors.

RESEARCH DESIGN AND METHODS
Individuals diagnosed with diabetes at ≥30 yr of age either taking insulin (n = 435) or not taking insulin (n = 363), who were participants in the population-based Wisconsin Epidemiologic Study of Diabetic Retinopathy, were examined during 1984-1986. Random urine samples were collected and an agglutination inhibition test was used to determine the presence of microalbuminuria, which is defined as ≥0.03 g/L but &lt;0.3 g/L.

RESULTS
The frequency of microalbuminuria was 29.2% in those individuals taking insulin and 22.0% in those not taking insulin. Microalbuminuria was significantly associated with the male sex, older age, higher systolic blood pressure, higher GHb, use of insulin, higher recent alcohol consumption, and a history of cardiovascular disease.

CONCLUSIONS
These findings suggest a relationship between controllable risk factors, blood pressure and GHb, and microalbuminuria in older-onset diabetic individuals.
Daily Vitamin E Supplements Improve Metabolic Control But Not Insulin Secretion in Elderly Type II Diabetic Patients
Authors: Paolisso Giuseppe , D'Amore Anna , Galzerano Domenico , Balbi Vinicio , Giugliano Dario , Varricchio Michele , D'Onofrio Felice 
Published: March 2007

OBJECTIVE
To investigate the potential metabolic benefits deriving from daily vitamin E administration in type II diabetic patients.

RESEARCH DESIGN AND METHODS
Twenty-five type II diabetic patients were invited to randomly take placebo or vitamin E (d-α-tocopherol; 900 mg/day) along a similar 3-mo period in a double-blind, crossover procedure. A wash-out period of 30 days separated the two treatment periods. At the end of each treatment period blood samples were drawn for plasma metabolites determination, and an intravenous glucose tolerance test (25 g of glucose as bolus in 3 min) was performed. During this study oral hypoglycemic agents were not discontinued or changed in their dosage.

RESULTS
Chronic vitamin E administration reduced plasma glucose (8.3 ± 0.3 vs. 7.5 ± 0.2 mM, P &gt; 0.05), triglycerides (2.27 ± 0.08 vs. 1.67 ± 0.09 mM, P &lt; 0.02), free fatty acids (786 ± 116 vs. 483 ± 64 mM), total cholesterol (6.74 ± 0.09 vs. 5.50 ± 0.10 mM, P &lt; 0.05), low-density lipoprotein cholesterol (4.73 ± 0.11 vs. 3.67 ± 0.07 mM, P &lt; 0.04), and apoprotein B (1.7 ± 0.3 vs. 1.0 ± 0.1 g/L) levels but did not affect β-cell response to glucose. HbA1 levels (7.8 ± 0.3 vs. 7.1 ± 0.5%, P &lt; 0.05) were also significantly lowered after chronic vitamin E administration.

CONCLUSIONS
Daily vitamin E supplements seem to produce a minimal but significant improvement in the metabolic control in type II diabetic patients. More studies are necessary before conclusions can be drawn about the safety of vitamin E during long-term administration.
Usual Dietary Fat Intake and Insulin Concentrations in Healthy Women Twins
Authors: Mayer Elizabeth J , Newman Beth , Quesenberry Charles P , Selby Joseph V 
Published: March 2007

OBJECTIVE
To evaluate the associations between the usual intake of dietary fats and insulin concentrations. Insulin concentrations and insulin resistance have been positively related to risk for NIDDM, obesity, hypertension, dyslipidemia, and coronary heart disease, yet little is known of the environmental risk factors for relative hyperinsulinemia. Insulin resistance can be induced by high-fat feeding in laboratory animals; therefore, high-fat diets may increase risks for developing NIDDM.

RESEARCH DESIGN AND METHODS
Subjects included 544 nondiabetic women who participated in the second examination of the Kaiser Permanente Women Twins Study (1989-1990). Fasting and 2-h post 75-g glucose load insulin levels were determined. Dietary fat intake was assessed by a food frequency questionnaire. Generalized least-squares regression analyses for unpaired twin data were used to determine the relationship between dietary fat intake and insulin levels after adjustment for total calories, age, several behavioral variables, and in some models, percentage of body fat and waist-to-hip ratio. Associations of dietary fat intake with insulin levels were also evaluated within the subset of monozygotic twin pairs (n = 164 pairs) after removal of genetic influences by regression analysis of intrapair differences.

RESULTS
Among the 544 individual women, a 20 g/day increase in total dietary fat was associated with a higher fasting insulin level (9% [P &lt; 0.001] before and 6% [P &lt; 0.01] after adjustment for the obesity variables). Higher intakes of saturated fat, oleic acid, and linoleic acid were each positively related to higher fasting insulin values. The relation of dietary fat with fasting insulin was significantly attenuated among physically active women compared with those who were sedentary (P = 0.04), even after adjustment for obesity. Only saturated fat intake was significantly associated with 2-h postglucose load insulin level before (P = 0.04) but not after adjustment for obesity. Within identical twin pairs, total dietary fat was positively related to fasting insulin before (P = 0.03) but not after adjustment for obesity (P = 0.11).

CONCLUSIONS
High intake of total dietary fat is positively related to relative fasting hyperinsulinemia in nondiabetic women, particularly those who are sedentary. This effect appears to be partly mediated by the relation of dietary fat with obesity.
Effects on Blood Pressure, Glucose, and Lipid Levels of High-Monounsaturated Fat Diet Compared With a High-Carbohydrate Diet in NIDDM Subjects
Authors: Rasmussen Ole W , Thomsen Claus , Hansen Klavs W , Vesterlund Margit , Winther Eva , Hermansen Kjeld 
Published: March 2007

OBJECTIVE
To compare the influence on blood pressure, glucose, and lipid levels of a diet rich in monounsaturated fatty acids with an isocaloric, highcarbohydrate diet in 15 NIDDM subjects.

RESEARCH DESIGN AND METHODS
A crossover design with diet interventions and wash-out periods of 3 wk was applied. The patients were randomly assigned to a 3-wk treatment with a high-carbohydrate diet containing 50% of energy as carbohydrate and 30% of energy as fat (10% of energy as monounsaturated fatty acids) or an isocaloric diet with 30% of energy as carbohydrate and 50% of energy as fat (30% of energy as monounsaturated fatty acids). On the last day of the two diets, 24-h ambulatory blood pressure was measured and day profiles of glucose, hormones, and lipids were performed to a test menu rich in carbohydrates.

RESULTS
The diet rich in monounsaturated fat reduced daytime systolic (131 ± 3 vs. 137 ± 3 mmHg, P &lt; 0.04) and 24-h systolic blood pressure (126 ± 8 vs. 130 ± 10 mmHg, P &lt; 0.03) as well as daytime diastolic (78 ± 2 vs. 84 ± 2 mmHg, P &lt; 0.02) and diurnal diastolic blood pressure (75 ± 6 vs. 78 ± 5 mmHg, P &lt; 0.03) as compared with the high-carbohydrate diet. Evidence of lowered blood glucose levels on the high-monounsaturated diet compared with the highcarbohydrate diet were found with lower fasting blood glucose (6.1 ± 0.3 vs. 6.8 ± 0.5 mM, P &lt; 0.05), lower average blood glucose levels (7.4 ± 0.5 vs. 8.2 ± 0.6 mM, P &lt; 0.04), and peak blood glucose responses (9.9 ± 0.6 vs. 11.3 ± 0.7 mM, P &lt; 0.02). The two diets had the same impact on lipid levels.

CONCLUSIONS
A diet rich in monounsaturated fat has beneficial effects on blood pressure and glucose metabolism, whereas no adverse effects on lipid composition in NIDDM subjects is detected.
The Relationship of Physical Fitness to Lipid and Lipoprotein(a) Levels in Adolescents With IDDm
Authors: Austin Audrey , Warty Vijay , Janosky Janine , Arslanian Silva 
Published: March 2007

OBJECTIVE
Increased physical activity and physical fitness are recommended therapeutic modalities in addition to insulin and diet in the management of children with IDDM. The aim of this study was to assess the fitness levels of adolescents with IDDM compared with healthy control subjects and to evaluate the relationship between physical fitness and metabolic control.

RESEARCH DESIGN AND METHODS
We studied 59 patients with IDDM, 28 boys and 31 girls, age 15.6 ± 2.5 yr, duration of diabetes 7.6 ± 3.5 yr, HbA1 10.6 ± 2.1% (mean ± SD), and compared them with 18 healthy, nondiabetic control subjects, 9 boys and 9 girls, matched for age, BMI, and Tanner stage. Physical fitness was measured by VO2max during progressive bicycle ergometry. HbA1 was used to determine glycemic control. Lipid profile included fasting total cholesterol, HDL, LDL, Lp(a), and TG levels.

RESULTS
Patients with IDDM had lower VO2max levels than control subjects (33.7 ± 7.0 vs. 41.0 ± 10.4 ml · kg−1 · min−1, P = 0.001). Males with IDDM had lower VO2max than male control subjects, but diabetic and control females showed no difference. In IDDM patients, VO2max correlated inversely with HbA1, insulin dose, cholesterol, LDL, TGs, and Lp(a), but did not correlate with HDL, which correlated inversely with BMI.

CONCLUSIONS
We conclude that the state of physical fitness is an important correlate of lipid levels and Lp(a) in adolescents with IDDM. We speculate that higher physical fitness levels in adolescents with IDDM may decrease the risk of CVD through modulating lipid levels.