bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cross-Sectional and Prospective Associations Between Proinsulin and Cardiovascular Disease Risk Factors in a Population Experiencing Rapid Cultural Transition
Authors: Hanley Anthony J.G. , McKeown-Eyssen Gail , Harris Stewart B. , Hegele Robert A. , Wolever Thomas M.S. , Kwan Jeremy , Connelly Philip W. , Zinman Bernard 
Published: March 2007

OBJECTIVE—To examine cross-sectional and prospective associations between proinsulin and cardiovascular disease risk factors using data from a population-based study of type 2 diabetes among Native Canadians.
RESEARCH DESIGN AND METHODS—Between 1993 and 1995, 72% of eligible members of a Native Canadian community participated in a baseline diabetes prevalence survey. Fasting samples were collected for glucose, C-peptide, proinsulin, lipids, and apolipoproteins. A 75-g oral glucose tolerance test was administered, and a second sample for glucose was drawn after 120 min. Blood pressure and waist circumference were determined. In the present study, subjects with normal glucose tolerance (NGT) (n = 505) and impaired glucose tolerance (IGT) (n = 74) were included in cross-sectional analyses. In 1998, 95 individuals who had IGT or NGT at baseline with an elevated 2-h glucose concentration (≥7.0 mmol/l) participated in a follow-up evaluation using the protocol used at baseline. Cross-sectional and prospective associations between proinsulin and cardiovascular risk factors were assessed using correlation and multiple linear regression analyses.
RESULTS—After adjustment for covariates including age, sex, C-peptide, waist circumference, and glucose tolerance status, fasting proinsulin concentration was significantly associated with concurrently measured lipid and apolipoprotein concentrations (triglycerides: r = 0.18, P &lt; 0.0001; total cholesterol: r = 0.10, P = 0.02; LDL cholesterol: r = 0.11, P = 0.01; HDL cholesterol: r = −0.16, P = 0.0002; apolipoprotein (apo) B: r = 0.17, P &lt; 0.0001; apoAI: r = −0.11, P = 0.008). In the adjusted prospective analysis, baseline triglycerides, HDL cholesterol, and apoB were associated with changes over time in proinsulin (r = 0.23, P = 0.04; r = −0.30, P = 0.01; r = 0.23, P = 0.04; respectively).
CONCLUSIONS—These results confirm previously reported cross-sectional associations between proinsulin and lipid concentrations. In addition, an unexpected association between baseline lipids and proinsulin change was documented.
Third-Trimester Maternal Glucose Levels From Diurnal Profiles in Nondiabetic Pregnancies
Authors: Parretti Elena , Mecacci Federico , Papini Marta , Cioni Riccardo , Carignani Lucia , Mignosa Marcella , La Torre Pasquale , Mello Giorgio 
Published: March 2007

OBJECTIVE—To assess the 24-h glucose levels in a group of nondiabetic, nonobese pregnant women and to verify the presence of correlations between maternal glucose levels and sonographic parameters of fetal growth.
RESEARCH DESIGN AND METHODS—A total of 66 Caucasian nonobese pregnant women with normal glucose challenge tests (GCT) enrolled in the study; from this population, we selected 51 women who delivered term (from 37 to 42 weeks completed) live-born infants without evidence of congenital malformations. The women were requested to have three main meals and to perform daily glucose profiles fortnightly from 28–38 weeks without modifying their lifestyle or following any dietary restriction. All subjects were taught how to monitor their blood glucose by using a reflectance meter. Fetal biometry was evaluated by ultrasound scan according to standard methodology at 22, 28, 32, and 36 weeks of pregnancy.
RESULTS—The overall daily mean glucose level during the third trimester was 74.7 ± 5.2 mg/dl. Daily mean glucose values increased between 28 (71.9 ± 5.7 mg/dl) and 38 (78.3 ± 5.4 mg/dl) weeks of pregnancy. We found a significant positive correlation at 28 weeks between 1-h postprandial glucose values and fetal abdominal circumference (AC). At 32 weeks, we documented positive correlations between fetal AC and maternal blood glucose levels 1 h after breakfast, 1 and 2 h after lunch, and 1 and 2 h after dinner. At 36 weeks, there was a positive correlation between fetal AC and 1- and 2-h postprandial blood glucose levels. In addition, there was a negative correlation between head-abdominal circumference ratio and 1-h postprandial blood glucose values.
CONCLUSIONS—This longitudinal study first provides a contribution toward the definition of normoglycemia in nondiabetic, nonobese pregnant women; moreover, it reveals significant correlations of postprandial blood glucose levels with the growth of insulin-sensitive fetal tissues and, in particular, between 1-h postprandial blood glucose values and fetal AC.
The Diabetes Network Internet-Based Physical Activity Intervention
Authors: McKay H. Garth , King Diane , Eakin Elizabeth G. , Seeley John R. , Glasgow Russell E. 
Published: March 2007

OBJECTIVE—Because of other competing priorities, physical activity (PA) is seldom addressed in a consistent way in either primary care or diabetes education . This 8-week pilot study evaluated the short-term benefits of an Internet-based supplement to usual care that focused on providing support for sedentary patients with type 2 diabetes to increase their PA levels.
RESEARCH DESIGN AND METHODS—A total of 78 type 2 diabetic patients (53% female, average age 52.3 years) were randomized to the Diabetes Network (D-Net) Active Lives PA Intervention or an Internet information-only condition. The intervention condition received goal-setting and personalized feedback, identified and developed strategies to overcome barriers, received and could post messages to an on-line “personal coach,” and were invited to participate in peer group support areas. Key outcomes included minutes of PA per week and depressive symptomatology.
RESULTS—There was an overall moderate improvement in PA levels within both intervention and control conditions, but there was no significant improvement in regard to condition effects. There was substantial variability in both site use and outcomes within the intervention and control conditions. Internal analyses revealed that among intervention participants, those who used the site more regularly derived significantly greater benefits, whereas those in the control condition derived no similar benefits with increased program use.
CONCLUSIONS—Internet-based self-management interventions for PA and other regimen areas have great potential to enhance the care of diabetes and other chronic conditions. We conclude that greater attention should be focused on methods to sustain involvement with Internet-based intervention health promotion programs over time.
Persistent Differences Among Centers Over 3 Years in Glycemic Control and Hypoglycemia in a Study of 3,805 Children and Adolescents With Type 1 Diabetes From the Hvidøre Study Group
Authors: Danne Thomas , Mortensen Henrik B. , Hougaard Philip , Lynggaard Helle , Aanstoot Henk-Jan , Chiarelli Francesco , Daneman Denis , Dorchy Harry , Garandeau Patrick , Greene Stephen A. , Hoey Hilary , Holl Reinhard W. , Kaprio Eero A. , Kocova Mirjana , Martul Pedro , Matsuura Nobuo , Robertson Kenneth J. , Schoenle Eugen J. , Søvik Oddmund , Swift Peter G.F. , Tsou Rosa M. , Vanelli Maurizio , Åman Jan ,   for the Hvidøre Study Group on Childhood Diabetes
Published: March 2007

OBJECTIVE—Twenty-one international pediatric diabetes centers from 17 countries investigated the effect of simple feedback about the grand mean HbA1c level of all centers and the average value of each center on changes in metabolic control, rate of severe hypoglycemia, and insulin therapy over a 3-year period.
RESEARCH DESIGN AND METHODS—Clinical data collection and determination of HbA1c levels were conducted at a central location in 1995 (n = 2,780, age 0–18 years) and 1998 (n = 2,101, age 11–18 years).
RESULTS—Striking differences in average HbA1c concentrations were found among centers; these differences remained after adjustment for the significant confounders of sex, age, and diabetes duration. They were apparent even in patients with short diabetes duration and remained stable 3 years later (mean adjusted HbA1c level: 8.62 ± 0.03 vs. 8.67 ± 0.04 [1995 vs. 1998, respectively]). Three centers had improved significantly, four centers had deteriorated significantly in their overall adjusted HbA1c levels, and 14 centers had not changed in glycemic control. During the observation period, there were increases in the adjusted insulin dose by 0.076 U/kg, the adjusted number of injections by 0.23 injections per day, and the adjusted BMI by 0.95 kg/m2. The 1995 versus 1998 difference in glycemic control for the seven centers could not be explained by prevailing insulin regimens or rates of hypoglycemia.
CONCLUSIONS—This study reveals significant outcome differences among large international pediatric diabetes centers. Feedback and comparison of HbA1c levels led to an intensification of insulin therapy in most centers, but improved glycemic control in only a few.
Evaluation of the Insulin Resistance Syndrome in 5- to 10-Year-Old Overweight/Obese African-American Children
Authors: Young-Hyman Deborah , Schlundt David G. , Herman Leanna , De Luca Francesco , Counts Debra 
Published: March 2007

OBJECTIVE—To characterize the insulin sensitivity of overweight and obese 5- to 10-year-old (Tanner stage 1–3) African-American children screened for participation in a diabetes prevention study and to identify the association of insulin sensitivity with obesity, hyperlipidemia, and hypertension.
RESEARCH DESIGN AND METHODS—Measures of insulin resistance (homeostasis model assessment) and insulin sensitivity (Matsuda and DeFronzo’s whole-body insulin sensitivity) were calculated from a 2-h oral glucose tolerance test in 137 African-American children recruited into a diabetes prevention study. Measures of lipids (LDL, HDL, total cholesterol, and triglycerides), blood pressure, and body composition were obtained for a subset of the children.
RESULTS—In response to a glucose challenge, girls and older and heavier children produced significantly more insulin. As BMI increased, there was a statistically significant decrease in insulin sensitivity, particularly in girls. Insulin sensitivity was inversely correlated with increases in blood pressure, triglycerides, subcutaneous fat, the percentage of total body fat, and Tanner stage, but it was not correlated with LDL and HDL.
CONCLUSIONS—Reduced insulin sensitivity and the cluster of risk factors known as the insulin resistance syndrome (IRS) are already apparent in these overweight African-American children. Young African-American girls, in particular, already show evidence of hyperinsulinemia in response to a glucose load, suggesting that the early stages of metabolic decompensation that lead to type 2 diabetes are already occurring. Monitoring of those risk factors known to be part of IRS should become part of routine medical care for overweight or obese African-American children.
Fasting Plasma Homocysteine Levels in the Insulin Resistance Syndrome
Authors: Meigs James B. , Jacques Paul F. , Selhub Jacob , Singer Daniel E. , Nathan David M. , Rifai Nader , D’Agostino Ralph B. , Wilson Peter W.F. 
Published: March 2007

OBJECTIVE—Insulin resistance, associated metabolic abnormalities, and elevated homocysteine levels are risk factors for cardiovascular disease (CVD). We examined relationships between homocysteine levels and features of insulin resistance syndrome (IRS).
RESEARCH DESIGN AND METHODS—We measured clinical characteristics, plasma levels of fasting homocysteine, folate, B vitamins, creatinine, and fasting and 2-h insulin and glucose levels after a 75-g oral glucose tolerance test in 2,214 subjects without CVD at the fifth examination (1991–1995) of the Framingham Offspring Study. After excluding 203 subjects with diabetes, the remaining 2,011 subjects were categorized as having none, one, two, or all three of the phenotypes of IRS: impaired glucose tolerance, hypertension, and/or a central metabolic syndrome (two or more traits: obesity, dyslipidemia, or hyperinsulinemia). In addition, in 1,592 subjects attending the sixth examination (1995–1998), we measured the urine albumin/creatinine ratio (UACR). Age-, sex-, creatinine-, vitamin-, and UACR-adjusted mean homocysteine levels or proportions with homocysteine &gt;14 μmol/l in each phenotypic category and differences between categories were assessed with regression models.
RESULTS—The mean age of the subjects was 54 years (range 28–82); 55% were women, 12.3% had hyperinsulinemia, and 15.9% had two or more of the IRS phenotypes. Adjusted mean homocysteine levels were higher comparing those with hyperinsulinemia (9.8 μmol/l) and those without (9.4 μmol/l, P = 0.04) and were higher among subjects with two or more IRS phenotypes (9.9 μmol/l) compared with those with 1 or no phenotype (9.3 μmol/l, P = 0.003). Mean UACR levels were also higher among subjects with two or more IRS phenotypes (7.2 mg/g) compared with those with 1 or no phenotype (5.5 mg/g, P = 0.007).
CONCLUSIONS—Hyperhomocysteinemia and abnormal urinary albumin excretion are both associated with hyperinsulinemia and may partially account for increased risk of CVD associated with insulin resistance. Because hyperhomocysteinemia and microalbuminuria also reflect endothelial injury, these observations also support the hypothesis that endothelial dysfunction is associated with expression of the IRS.
Impact of Diabetes on Long-Term Survival After Acute Myocardial Infarction
Authors: Mukamal Kenneth J. , Nesto Richard W. , Cohen Mylan C. , Muller James E. , Maclure Malcolm , Sherwood Jane B. , Mittleman Murray A. 
Published: March 2007

OBJECTIVE—To determine the effect of diabetes on long-term survival after acute myocardial infarction and to compare its effect with that of a previous myocardial infarction.
RESEARCH DESIGN AND METHODS—In a prospective cohort study, we followed 1,935 patients hospitalized with a confirmed acute myocardial infarction at 45 U.S. medical centers between 1989 and 1993, as part of the Determinants of Myocardial Infarction Onset Study. Trained interviewers performed chart reviews and face-to-face interviews with all patients. We analyzed survival using Cox proportional hazards regression to control for potentially confounding factors.
RESULTS—Of the 1,935 patients, 320 (17%) died during a mean follow-up of 3.7 years. A total of 399 patients (21%) had previously diagnosed diabetes. Diabetes was associated with markedly higher total mortality in unadjusted (hazard ratio [HR] 2.4; 95% CI 1.9–3.0) and adjusted (1.7; 1.3–2.1) analyses. The magnitude of the effect of diabetes was identical to that of a previous myocardial infarction. The effect of diabetes was not significantly modified by age, smoking, household income, use of thrombolytic therapy, type of hypoglycemic treatment, or duration of diabetes, but the risk associated with diabetes was higher among women than men (adjusted HRs 2.7 vs. 1.3, P = 0.01).
CONCLUSIONS—Diabetes is associated with markedly increased mortality after acute myocardial infarction, particularly in women. The increase in risk is of the same magnitude as a previous myocardial infarction and provides further support for aggressive treatment of coronary risk factors among diabetic patients.
Dermal Neurovascular Dysfunction in Type 2 Diabetes
Authors: Vinik Aaron I. , Erbas Tomris , Park Tae Sun , Stansberry Kevin B. , Scanelli John A. , Pittenger Gary L. 
Published: March 2007

OBJECTIVE—To review evidence for a relationship between dermal neurovascular dysfunction and other components of the metabolic syndrome of type 2 diabetes.
RESEARCH DESIGN AND METHODS—We review and present data supporting concepts relating dermal neurovascular function to prediabetes and the metabolic syndrome. Skin blood flow can be easily measured by laser Doppler techniques.
RESULTS—Heat and gravity have been shown to have specific neural, nitrergic, and independent mediators to regulate skin blood flow. We describe data showing that this new tool identifies dermal neurovascular dysfunction in the majority of type 2 diabetic patients. The defect in skin vasodilation is detectable before the development of diabetes and is partially correctable with insulin sensitizers. This defect is associated with C-fiber dysfunction (i.e., the dermal neurovascular unit) and coexists with variables of the insulin resistance syndrome. The defect most likely results from an imbalance among the endogenous vasodilator compound nitric oxide, the vasodilator neuropeptides substance P and calcitonin gene-related peptide, and the vasoconstrictors angiotensin II and endothelin. Hypertension per se increases skin vasodilation and does not impair the responses to gravity, which is opposite to that of diabetes, suggesting that the effects of diabetes override and counteract those of hypertension.
CONCLUSIONS—These observations suggest that dermal neurovascular function is largely regulated by peripheral C-fiber neurons and that dysregulation may be a component of the metabolic syndrome associated with type 2 diabetes.
Does Microalbuminuria Predict Diabetic Nephropathy?
Authors: Tabaei Bahman P. , Al-Kassab Abdul S. , Ilag Liza L. , Zawacki Catherine M. , Herman William H. 
Published: March 2007

OBJECTIVE—To describe risk factors associated with microalbuminuria (MA) in subjects with diabetes, investigate the predictive value of MA as a marker of risk for diabetic nephropathy (DN), and define risk factors associated with the development and progression of MA.
RESEARCH DESIGN AND METHODS—We conducted a prospective longitudinal study of 23 diabetic subjects with persistent MA and 209 diabetic subjects without MA who attended diabetes clinics at the University of Michigan Medical Center in 1989 and 1990. Both groups were examined at baseline and after 7 years. At baseline, urinary albumin–to–creatinine ratios were studied in random, first morning, and 24-h urine samples. At follow-up, a 12-h overnight urine sample was collected and analyzed for albumin and creatinine. At baseline, MA was defined by at least two separate urine specimens with albumin–to–creatinine ratios between 30 and 299 μg albumin per milligram of creatinine.
RESULTS—MA regressed in 56% of subjects with baseline MA without systematic application of corrective measures and developed in 16% of subjects without baseline MA. The predictive value positive of MA as a marker of risk for DN was 43%, and the predictive value negative was 77%. In the combined cohort, the incidence and progression of MA were significantly associated with poor glycemic control and duration of diabetes between 10 and 14 years.
CONCLUSIONS—MA may not be as sensitive and specific a predictor of DN as previously suggested. Other markers of risk for DN are needed for optimal clinical management.
Clinically Useful Estimates of Insulin Sensitivity During Pregnancy
Authors: Kirwan John P. , Huston-Presley Larraine , Kalhan Satish C. , Catalano Patrick M. 
Published: March 2007

OBJECTIVE—We examined whether selected indexes of insulin sensitivity derived from an oral glucose tolerance test (ISOGTT) or fasting glucose/insulin levels (ISQUICKI and ISHOMA) can be used to predict insulin sensitivity in women before and during pregnancy.
RESEARCH DESIGN AND METHODS—A 2-h euglycemic-hyperinsulinemic clamp (5 mmol/l glucose, 40 mU · m−2 · min−1 insulin) and a 120-min oral glucose tolerance test (75 g load pregravid, 100 g pregnant) were repeated on 15 women (10 with normal glucose tolerance [NGT] and 5 with gestational diabetes mellitus [GDM]) pregravid and during both early (12–14 weeks) and late (34–36 weeks) pregnancy. An index of insulin sensitivity derived from the clamp (ISCLAMP) was obtained from glucose infusion rates adjusted for change in fat-free mass and endogenous glucose production measured using [6,6-2H2]glucose.
RESULTS—Univariate analysis using combined groups and periods of pregnancy resulted in significant correlations between ISCLAMP and ISOGTT (r2 = 0.74, P &lt; 0.0001), ISQUICKI (r2 = 0.64, P &lt; 0.0001), and ISHOMA (r2 = 0.53, P &lt; 0.0001). The ISOGTT provided a significantly better correlation (P &lt; 0.0001) than either ISQUICKI or ISHOMA. Multivariate analysis showed a significant group effect (P &lt; 0.0003) on the prediction model, and separate equations were developed for the NGT (r2 = 0.64, P &lt; 0.0001) and GDM (r2 = 0.85, P &lt; 0.0001) groups. When subdivided by period of pregnancy, the correlation between ISCLAMP and ISOGTT pregravid was r2 = 0.63 (P = 0.0002), during early pregnancy was r2 = 0.80 (P &lt; 0.0001), and during late pregnancy was r2 = 0.64 (P = 0.0002).
CONCLUSIONS—Estimates of insulin sensitivity from the ISOGTT during pregnancy were significantly better than from fasting glucose and insulin values. However, separate prediction equations are necessary for pregnant women with NGT and women with GDM.
Insulin Resistance Syndrome Predicts Coronary Heart Disease Events in Elderly Type 2 Diabetic Men
Authors: Kuusisto Johanna , Lempiäinen Päivi , Mykkänen Leena , Laakso Markku 
Published: March 2007

OBJECTIVE—To investigate whether cardiovascular risk factors cluster with hyperinsulinemia in elderly type 2 diabetic subjects and, if so, whether this clustering predicts coronary heart disease (CHD) events during a 7-year follow-up.
RESEARCH DESIGN AND METHODS—Clustering of cardiovascular risk factors was analyzed by factor analysis. Cox regression models were used to investigate whether these clusters (factors) predict CHD events (CHD death or nonfatal myocardial infarction) during a 7-year follow-up in 229 type 2 diabetic subjects aged 65–74 years.
RESULTS—There were 70 CHD events (21 in men and 49 in women) during the follow-up period. In diabetic men, components of the insulin resistance syndrome (IRS) loaded on Factor 1 (the insulin resistance factor), which reflected high fasting insulin, obesity (high BMI), central obesity (high waist-to-hip ratio), high total triglycerides, and a short duration of diabetes. Only this IRS factor predicted CHD events in multivariate Cox regression analysis (hazard ratio [HR] 1.71, 95% CI 1.08–2.71, P = 0.022). In diabetic women, components of IRS loaded on two factors, none of which predicted CHD events. In women, only Factor 4, characterized by advanced age, left ventricular hypertrophy on electrocardiogram, high alcohol consumption, high systolic blood pressure, and albuminuria, predicted CHD events in multivariate Cox regression analysis (1.34, 1.03–1.74, P = 0.03).
CONCLUSIONS—IRS is a risk factor for CHD in elderly type 2 diabetic men.