bluuebunny/crossref_metadata_2025_split huggingface dataset:
Who Has Diabetes? Best Estimates of Diabetes Prevalence in the Department of Veterans Affairs Based on Computerized Patient Data
Authors: Miller Donald R. , Safford Monika M. , Pogach Leonard M. 
Published: March 2007

OBJECTIVE—To optimize methods for identifying patients with diabetes based on computerized records and to obtain best estimates of diabetes prevalence in Department of Veterans Affairs (VA) patients.
RESEARCH DESIGN AND METHODS—The VA Diabetes Epidemiology Cohort (DEpiC) is a linked national database of all VA patients since 1998 with data from VA medical visits, Medicare claims, pharmacy and laboratory records, and patient surveys. Using DEpiC, we examined concordance of diabetes indicators, including ICD-9-CM codes (250.xx), prescription drug treatment, HbA1c tests, and patient self-report. We determined the optimal criterion for identifying diabetes and used it in estimating diabetes prevalence in the VA.
RESULTS—The best criterion was a prescription for a diabetes medication in the current year and/or 2+ diabetes codes from inpatient and/or outpatient visits (VA and Medicare) over a 24-month period. This definition had high sensitivity (93%) and specificity (98%) against patient self-report, and reasonable rates of HbA1c testing (75%). HbA1c testing alone added few additional cases, and a single diagnostic code added many patients, but without confirmation (reduced specificity). However, including codes from Medicare was critical. Applying this definition for 1998–2000, we identified an average of 500,000 VA patients with diabetes per year. We also estimated high and increasing diabetes prevalence rates of 16.7% in FY1998, 18.6% in FY1999, and 19.6% in FY2000 and an incidence estimated to be ∼2% per year.
CONCLUSIONS—Development and evaluation of methodology for analyzing computerized patient data can improve the identification of patients with diabetes. The increasing high prevalence of diabetes in VA patients will present challenges for clinicians and health system management.
Cardiovascular Risk Factor Control Among Veterans With Diabetes
Authors: Smith Nicholas L. , Chen Leway , Au David H. , McDonell Mary , Fihn Stephan D. 
Published: March 2007

OBJECTIVE—To describe the extent to which hyperglycemia, hypertension, and dyslipidemia are currently detected, treated, and controlled in U.S. veterans with diabetes with and without ischemic heart disease (IHD).
RESEARCH DESIGN AND METHODS—A cohort of 3,769 veterans who self-reported diabetes and who received all health care from the Veterans Administration (VA) medical centers were selected from subjects enrolled in the Ambulatory Care Quality Improvement Project, a randomized health services intervention at seven VA primary care clinics. IHD was defined by a self-reported history of myocardial ischemia, infarction, or revascularization. Mean values of HbA1c, blood pressure, and cholesterol subfractions were collected from computerized laboratory databases. Medication data were collected from computerized pharmacy databases.
RESULTS—Mean HbA1c and optimal control (HbA1c &lt;7%) did not differ for those without and with IHD: 8.1 vs. 8.0%, and 26 vs. 24%, respectively. Veterans with IHD were more likely to have hypertension (73 vs. 64%), to be treated (88 vs. 78%), and to have optimal blood pressure control (19 vs. 10%) compared with veterans without IHD (all P values &lt;0.01). Veterans with IHD were more likely to have dyslipidemia (81 vs. 53%), were equally likely to be treated (54 vs. 50%), and were more likely to have optimal LDL levels (30 vs. 16%) compared with veterans without IHD, all P values &lt;0.01.
CONCLUSIONS—Optimal cardiovascular risk factor control was the exception in this cohort of diabetic veterans attending primary care clinics. More aggressive management of cardiovascular risk factors in veterans with diabetes may be warranted, especially among those without prevalent IHD.
Family History of Type 2 Diabetes Is Associated With Decreased Insulin Sensitivity and an Impaired Balance Between Insulin Sensitivity and Insulin Secretion in White Youth
Authors: Arslanian Silva A. , Bacha Fida , Saad Rola , Gungor Neslihan 
Published: March 2007

OBJECTIVE—Family history of type 2 diabetes is a major risk factor for type 2 diabetes in youth, which is increasing. This investigation aimed to evaluate the impact of family history of type 2 diabetes on insulin secretion relative to insulin sensitivity in healthy children. β-Cell compensation for insulin sensitivity was calculated as the product of insulin sensitivity × first-phase insulin secretion, termed glucose disposition index (GDI).
RESEARCH DESIGN AND METHODS—A total of 28 healthy white children (12 boys and 16 girls; 12.1 ± 0.5 years of age) with a positive family history of type 2 diabetes and 26 healthy white children (13 boys and 13 girls; 11.5 ± 0.4 years of age) with a negative family history of type 2 diabetes underwent a 3-h 40 mU · m−2 · min−1 hyperinsulinemic-euglycemic clamp to assess insulin sensitivity and clearance and a 2-h hyperglycemic clamp to assess insulin secretion. Body composition and visceral adiposity were evaluated with dual-energy X-ray absorptiometry and computed tomography at the L4-L5 intervertebral space.
RESULTS—Insulin sensitivity was lower in children with a family history of type 2 diabetes versus children without a family history (8.8 ± 0.9 vs. 12.2 ± 1.1 μmol · kg−1 · min−1 per pmol/l, P = 0.02). Similarly, insulin clearance was lower. First- and second-phase insulin levels were not different between groups with and without a positive family history. The GDI was lower in youth with versus youth without a positive family history (4.1 ± 0.3 vs. 5.2 ± 0.5 mmol · kg−1 · min−1, P = 0.039). IGF binding protein-1 (IGFBP-1) was 60% lower in youth with versus youth without the positive family history.
CONCLUSIONS—These results demonstrate that family history of type 2 diabetes in white children is associated with decreased insulin sensitivity and clearance, decreased IGFBP-1, and an impaired relationship between insulin action and β-cell compensation. Detection of these alterations in hormonal and metabolic parameters in children with a positive family history suggests that at least some of the determinants of GDI are genetic/heritable.
α-Glucosidase Inhibitors for Patients With Type 2 Diabetes
Authors: van de Laar Floris A. , Lucassen Peter L. , Akkermans Reinier P. , van de Lisdonk Eloy H. , Rutten Guy E. , van Weel Chris 
Published: March 2007

OBJECTIVE—To review the effects of monotherapy with α-glucosidase inhibitors (AGIs) for patients with type 2 diabetes, with respect to mortality, morbidity, glycemic control, insulin levels, plasma lipids, body weight, and side effects.RESEARCH DESIGN AND METHODS—We systematically searched the Cochrane Central register of Controlled Trials, MEDLINE, EMBASE, Current Contents, LILACS, databases of ongoing trials, and reference lists, and we contacted experts and manufacturers. Inclusion criteria were randomized controlled trials of at least 12 weeks’ duration, AGI monotherapy compared with any intervention, and one of the following outcome measures: mortality, morbidity, GHb, blood glucose, lipids, insulin levels, body weight, or side effects. Two independent reviewers assessed all abstracts, extracted all data, and assessed quality. We contacted all authors for data clarification. Continuous data were expressed as weighted mean differences and analyzed with a random-effects model. Possible influences of study characteristics and quality were assessed in sensitivity and meta-regression analyses.RESULTS—Forty-one studies were included in the review (30 acarbose, 7 miglitol, 1 voglibose, and 3 combined), and heterogeneity was limited. We found no evidence for an effect on mortality or morbidity. Compared with placebo, AGIs had a beneficial effect on GHb (acarbose −0.77%; miglitol −0.68%), fasting and postload blood glucose and postload insulin. With acarbose dosages higher than 50 mg t.i.d., the effect on GHb was the same, but the occurrence of side effects increased. Acarbose decreased the BMI by 0.17 kg/m2 (95% CI 0.08–0.26). None of the AGIs had an effect on plasma lipids. Compared with sulfonylurea, AGIs seemed inferior with respect to glycemic control, but they reduced fasting and postload insulin levels. For comparisons with other agents, little data were available.CONCLUSIONS—We found no evidence for an effect on mortality or morbidity. AGIs have clear beneficial effects on glycemic control and postload insulin levels but not on plasma lipids. There is no need for dosages higher than 50 mg acarbose t.i.d.
Relationships Between Hyperglycemia and Cognitive Performance Among Adults With Type 1 and Type 2 Diabetes
Authors: Cox Daniel J. , Kovatchev Boris P. , Gonder-Frederick Linda A. , Summers Kent H. , McCall Anthony , Grimm Kevin J. , Clarke William L. 
Published: March 2007

OBJECTIVE—Hyperglycemia is a common event among patients with type 1 and type 2 diabetes. While the cognitive-motor slowing associated with hypoglycemia is well documented, the acute effects of hyperglycemia have not been studied extensively, despite patients’ reports of negative effects. This study prospectively and objectively assessed the effects of hyperglycemia on cognitive-motor functioning in subjects’ natural environment.
RESEARCH DESIGN AND METHODS—Study 1 investigated 105 adults with type 1 diabetes (mean age 37 years and mean duration of diabetes 20 years), study 2 investigated 36 adults with type 2 diabetes (mean age 50 years and mean duration of diabetes 10 years), and study 3 investigated 91 adults with type 1 diabetes (mean age 39 years and mean duration of diabetes 20 years). Subjects used a hand-held computer for 70 trials over 4 weeks, which required them to complete various cognitive-motor tasks and then measure and enter their current blood glucose reading.
RESULTS—Hyperglycemia (blood glucose &gt;15 mmol/l) was associated with slowing of all cognitive performance tests (P &lt; 0.02) and an increased number of mental subtraction errors for both type 1 and type 2 diabetic subjects. The effects of hyperglycemia were highly individualized, impacting ∼50% of the subjects.
CONCLUSIONS—Acute hyperglycemia is not a benign event for many individuals with diabetes, but it is associated with mild cognitive dysfunction.
Mothers’ Experiences of Serious Life Events Increase the Risk of Diabetes-Related Autoimmunity in Their Children
Authors: Sepa Anneli , Frodi Ann , Ludvigsson Johnny 
Published: March 2007

OBJECTIVE—Stressful life events have been shown to constitute a risk factor for type 1 diabetes during childhood. Our aim was to investigate in the general child population (i.e., irrespective of genetic risk for type 1 diabetes) whether mothers’ experiences of serious life events, such as divorce and violence, were associated with diabetes-related autoimmunity in their children at age 2.5 years.
RESEARCH DESIGN AND METHODS—The study cohort was comprised of the first 5,986 consecutive children and their families from the prospective population-based All Babies in Southeast Sweden project for whom 2.5-year study data were available. Data were drawn from parental questionnaires that included questions about experiences of serious life events and the blood samples taken from the children when the children were age 2.5 years. The blood samples were analyzed for diabetes-related autoantibodies against tyrosine phosphatase and GAD.
RESULTS—Mothers’ experiences of divorce (odds ratio 3.6, 95% CI 1.4–9.6, P &lt; 0.05) and violence (2.9, 1.0–7.8, P &lt; 0.05) were associated with diabetes-related autoimmunity in the children, independent of a family history of type 1 diabetes.
CONCLUSIONS—The results support the β-cell stress hypothesis and suggest that maternal experiences of serious life events such as divorce and violence seem to be involved in the induction or progression of diabetes-related autoimmunity in children at age 2.5 years, independent of family history of type 1 diabetes.
Glycemic Status and Development of Kidney Disease
Authors: Fox Caroline S. , Larson Martin G. , Leip Eric P. , Meigs James B. , Wilson Peter W.F. , Levy Daniel 
Published: March 2007

OBJECTIVE—Diabetes is a major risk factor for the development of kidney disease and is the leading cause of end-stage renal disease in the U.S. Whether pre-diabetes is associated with the development of kidney disease is unclear.RESEARCH DESIGN AND METHODS—Subjects free of chronic kidney disease (CKD) were drawn from the Framingham Heart Study offspring cohort (1991–1995), given an oral glucose tolerance test, and followed for an average of 7 years for development of CKD (glomerular filtration rate [GFR] of &lt;59 ml/min per 1.73 m2 in women and &lt;64 ml/min per 1.73 m2 in men). Multivariable logistic regression models, adjusted for cardiovascular disease risk factors including age, sex, hypertension, smoking, BMI, total and HDL cholesterol levels, and prevalent myocardial infarction or congestive heart failure, were used to estimate the odds of patients developing kidney disease among glycemic categories.RESULTS—Of 2,398 subjects (53% women; mean age 54 years), 63% were normoglycemic, 29% had impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), 3.4% were newly diabetic, and 4.6% had known diabetes. By glycemic category, mean GFR at follow-up was 87, 85, 82, and 78 ml/min per 1.73 m2, respectively. The fully adjusted odds of developing CKD were 0.98 (95% CI 0.67–1.45), 1.71 (95% CI 0.83–3.55), and 1.93 (95% CI 1.06–3.49) among those with IFG or IGT, newly diagnosed diabetes, or known diabetes, respectively, compared with those who were normoglycemic at baseline. Among participants without diabetes, metabolic syndrome was not associated with kidney disease at follow-up (odds ratio 1.46, P = 0.06).CONCLUSIONS—Cardiovascular disease risk factors explain much of the relationship between prediabetes and the development of chronic kidney disease. Clinical trials are warranted to determine whether vascular risk factor modification can slow the decline of kidney function among those with pre-diabetes.
Incidence of Type 1 and Type 2 Diabetes in Adults Aged 30–49 Years
Authors: Bruno Graziella , Runzo Cristina , Cavallo-Perin Paolo , Merletti Franco , Rivetti Marina , Pinach Silvia , Novelli Giulia , Trovati Mariella , Cerutti Franco , Pagano Gianfranco ,   for the Piedmont Study Group for Diabetes Epidemiology
Published: March 2007

OBJECTIVE—Incidence of type 1 diabetes is considered to be low in adults, but no study has been performed in Mediterranean countries.
RESEARCH DESIGN AND METHODS—We extended the study base of the registry of the province of Turin, Italy, to subjects aged 30–49 years in the period 1999–2001 to estimate the incidences of type 1 and type 2 diabetes. Diagnosis of type 1 diabetes was based on permanent insulin treatment or a fasting C-peptide level ≤0.20 nmol/l or islet cell (ICA) or GAD (GADA) antibody positivities.
RESULTS—We identified 1,135 case subjects with high completeness of ascertainment (99%), giving an incidence rate of 58.0 per 100,000 person-years (95% CI 54.7–61.5). The incidence of type 1 diabetes was 7.3 per 100,000 person-years (6.2–8.6), comparable with the rates in subjects aged 0–14 and 15–29 years (10.3 [9.5–11.2] and 6.8 [6.3–7.4]). Male subjects had a higher risk than female subjects for both type 1 (rate ratio [RR] 1.70 [95% CI 1.21–2.38]) and type 2 (2.10 [1.84–2.40]) diabetes. ICA and/or GADA positivities were found in 16% of the cohort. In logistic regression, variables independently associated with autoimmune diabetes were age 30–39 years (odds ratio [OR] 2.39 [95% CI 1.40–4.07]), fasting C-peptide &lt;0.60 nmol/l (3.09 [1.74–5.5]), and BMI &lt;26 kg/m2 (2.17 [1.22–3.85]).
CONCLUSIONS—Risk of type 1 diabetes between age 30 and 49 years is similar to that found in the same area between age 15 and 29 years. Further studies are required to allow geographical comparisons of risks of both childhood and adulthood autoimmune diabetes, the latter being probably higher than previously believed.
Use of the Patient Assessment of Chronic Illness Care (PACIC) With Diabetic Patients
Authors: Glasgow Russell E. , Whitesides Holly , Nelson Candace C. , King Diane K. 
Published: March 2007

OBJECTIVE—There is a dearth of information on the extent to which diabetic patients receive care congruent with the chronic care model (CCM) and evidence-based behavioral counseling. This study evaluates a new instrument to fill this gap.
RESEARCH DESIGN AND METHODS—A heterogeneous sample of 363 type 2 diabetic patients completed the original Patient Assessment of Chronic Illness Care (PACIC), along with additional items that allowed it to be scored according to the “5As” (ask, advise, agree, assist, and arrange) model of behavioral counseling. We evaluated relationships between survey scores and patient characteristics, quality of diabetes care, and self-management.
RESULTS—Findings replicated those of the initial PACIC validation study but with a much larger sample of diabetic patients and more Latinos. Areas of CCM activities reported least often were goal setting/intervention tailoring and follow-up/coordination. The 5As scoring revealed that patients were least likely to receive assistance with problem solving and arrangement of follow-up support. Few demographic or medical characteristics were related to PACIC or 5As scores, but survey scores were significantly related to quality of diabetes care received and level of physical activity.
CONCLUSIONS—The PACIC and the new 5As scoring method appear useful for diabetic patients. Its use is encouraged in future research and quality improvement studies.
Elevated Homocysteine as a Risk Factor for the Development of Diabetes in Women With a Previous History of Gestational Diabetes Mellitus
Authors: Cho Nam H. , Lim Soo , Jang Hak C. , Park Hae K. , Metzger Boyd E. 
Published: March 2007

OBJECTIVE—To investigate the potential use of the plasma homocysteine level as a predictor of diabetes in women with a previous history of gestational diabetes mellitus (GDM).
RESEARCH DESIGN AND METHODS—At 6 weeks’ postpartum, baseline examination was performed in 177 GAD-negative subjects. Of these subjects, 7 who were diagnosed with diabetes at baseline were excluded from further evaluation, and 170 with normal or impaired glucose tolerance (IGT) at baseline were followed annually over 4 years. The follow-up examinations included 2-h 75-g oral glucose tolerance tests (OGTTs), lipid profiles, homocysteine levels, anthropometric measurements, history taking, diet, and lifestyle. During the OGTTs, insulin and glucose levels were assayed every 30 min. Plasma homocysteine levels were determined by ion-exchange chromatography.
RESULTS—Of the 170 women, 18 (10.6%) converted to diabetes during the 4-year follow-up period. Mean age, BMI, fasting insulin, and total cholesterol at baseline (6 weeks’ postpartum test) were similar in the three study groups (i.e., normal, IGT, and diabetes). Fasting glucose levels, insulin-to-glucose ratios, and homocysteine levels were significantly higher in the diabetic group (P &lt; 0.05). Higher glucose at the time of the diagnosis of GDM and higher homocysteine levels at baseline were independently associated with the onset of postpartum diabetes. These relationships were independent of age, BMI, and family history of diabetes.
CONCLUSIONS—This prospective study identified homocysteine level as a significant risk factor for development of diabetes in women with previous GDM.
Adherence to Statin Therapy and LDL Cholesterol Goal Attainment by Patients With Diabetes and Dyslipidemia
Authors: Parris Elizabeth S. , Lawrence David B. , Mohn Lisa A. , Long Laura B. 
Published: March 2007

OBJECTIVE—The purpose of this study was to assess the relationship between adherence to statin therapy and LDL cholesterol goal achievement in patients with diabetes and dyslipidemia.
RESEARCH DESIGN AND METHODS—The records of patients being medically treated for dyslipidemia in a managed care diabetes program from January 2001 to December 2002 were used to assess LDL cholesterol goal attainment (&lt;100 mg/dl) and to compute a 9-month medication possession ratio (percentage of days when medication was available [MPR], beginning with the first prescription in the database).
RESULTS—A total of 653 patient records was analyzed. The average MPR was significantly higher for men than for women (0.75 vs. 0.66, P &lt; 0.05). Overall, 44% (n = 290) of the patients achieved an LDL cholesterol level &lt;100 mg/dl (52% of men and 37% of women, P &lt; 0.05). A significant correlation emerged between MPR and plasma LDL cholesterol (P &lt; 0.001), and MPR was significantly higher in patients who achieved the LDL cholesterol target than in those who did not (0.82 vs. 0.61, P &lt; 0.05).
CONCLUSIONS— Although statins are highly effective for decreasing LDL cholesterol levels in patients with dyslipidemia, including those with diabetes, failure to reach LDL cholesterol targets remains common. Adherence to statin therapy, as reflected by MPR, is closely related to LDL cholesterol goal attainment in patients with diabetes and dyslipidemia. The probability of goal achievement appears to increase substantially when the MPR is &gt;0.80. Pharmacy records can be used to identify patients who are poorly compliant with statin therapy and at high risk for failure to attain LDL cholesterol goals. Because outcomes are directly related to patients’ medication-taking behavior, when clinical goals (such as serum cholesterol levels) are not being reached, adherence should be the first item assessed by the clinician.
The Association Between Glucose Abnormalities and Heart Failure in the Population-Based Reykjavík Study
Authors: Thrainsdottir Inga S. , Aspelund Thor , Thorgeirsson Gudmundur , Gudnason Vilmundur , Hardarson Thordur , Malmberg Klas , Sigurdsson Gunnar , Rydén Lars 
Published: March 2007

OBJECTIVE—Diabetes is an independent risk factor for heart failure, whereas the relation between heart failure and abnormal glucose regulation (AGR) needs further evaluation. We studied this combination in the Reykjavík Study.
RESEARCH DESIGN AND METHODS—The Reykjavík Study, a population-based cohort study during 1967–1997, recruited 19,381 participants aged 33–84 years who were followed until 2002. Oral glucose tolerance tests and chest X-rays were obtained from all participants. Cases were defined in accordance with World Health Organization criteria for type 2 diabetes or AGR (impaired glucose tolerance or impaired fasting glucose) and European Society of Cardiology guidelines for heart failure.
RESULTS—The overall prevalence of type 2 diabetes and heart failure was 0.5% in men and 0.4% in women, while AGR and heart failure were found in 0.7% of men and 0.6% of women. Among participants with normal glucose regulation, heart failure was diagnosed in 3.2% compared with 6.0 and 11.8% among those with AGR and type 2 diabetes, respectively. The prevalence of type 2 diabetes in the age-group 45–65 years increased in both sexes during the period (P for trend = 0.007). The odds ratio was 2.8 (95% CI 2.2–3.6) for the association between type 2 diabetes and heart failure and 1.7 (1.4–2.1) between AGR and heart failure.
CONCLUSIONS—There is a strong association between any form of glucometabolic perturbation and heart failure. Future studies in this field should focus on all types of glucose abnormalities rather than previously diagnosed diabetes only.