bluuebunny/crossref_metadata_2025_split huggingface dataset:
Macrovascular Risk and Diagnostic Criteria for Type 2 Diabetes
Authors: Jesudason David R. , Dunstan Kerrie , Leong Darryl , Wittert Gary A. 
Published: March 2007

OBJECTIVE—The use of fasting plasma glucose (FPG) level ≥7.0 mmol/l leads to underdiagnosis of type 2 diabetes compared with the oral glucose tolerance test (OGTT). The OGTT is of limited use for population screening. Most of the increase in cardiovascular risk in relation to increasing blood glucose occurs before the threshold at which the diagnosis of type 2 diabetes is made. The aim of this study was to evaluate the use of HbA1c and FPG as predictors of type 2 diabetes and cardiovascular risk and, accordingly, to develop a rational approach to screening for abnormalities of glucose tolerance.
RESEARCH DESIGN AND METHODS—OGTT and measurement of HbA1c and FPG levels were performed in 505 subjects screened for type 2 diabetes. Anthropomorphic measurements were obtained. A cardiovascular risk factor questionnaire was completed.
RESULTS—The subjects were aged 19–88 years (mean 53.8). The incidence of type 2 diabetes was 10.4% based on the OGTT and 4% based on an FPG level ≥7.0 mmol/l. Using high-performance liquid chromatography (HPLC), HbA1c of &lt;4.7 and ≥6.2% predicted with certainty the absence or presence of type 2 diabetes as defined by the OGTT. The corresponding cutoffs were &lt;5.0 and ≥6.8% for HbA1c (DCA2000 HPLC device; Bayer Diagnostics, Mulgrave, Australia) and &lt;4.7 and ≥6.4 mmol/l for FPG. However, 75–85% of subjects in each case had intermediate values, which were therefore nondiagnostic. Cardiovascular risk increased at least 2.2 times at an HbA1c level ≥6.2% (by HPLC), 1.8–2.2 times at an HbA1c level of 5.6–6.1% (by HPLC), 2 times at an FPG level ≥6.4 mmol/l, and 1.7–1.9 times at an FPG level of 5.6–6.3 mmol/l.
CONCLUSIONS—Measurement of FPG and HbA1c levels will diagnose or exclude type 2 diabetes with certainty in a minority (15%) of people. There is a continuous relationship between FPG and HbA1c and cardiovascular risk. Accordingly, we propose that there is a rational basis for using either FPG and HbA1c for purposes of screening and assigning risk. Individuals with an HbA1c level of 5.6–6.1% and an FPG level of 5.6–6.3 mmol/l are at greatest risk for cardiovascular disease and should be targeted for further evaluation. An algorithm outlining a cost-effective approach is presented.
Work Stress and Low Sense of Coherence Is Associated With Type 2 Diabetes in Middle-Aged Swedish Women
Authors: Agardh Emilie E. , Ahlbom Anders , Andersson Tomas , Efendic Suad , Grill Valdemar , Hallqvist Johan , Norman Anders , Östenson Claes-Göran 
Published: March 2007

OBJECTIVE—The risk of type 2 diabetes is suggested to be increased for individuals exposed to stress. We analyzed the association of work stress by high demands, low decision latitude, and job strain (combination of high demands and low decision latitude) with type 2 diabetes. We also studied low sense of coherence (SOC) (a factor for successful coping with stressors) in association with type 2 diabetes. Finally, we investigated the combination of SOC and demands or SOC and decision latitude in association with the disease.
RESEARCH DESIGN AND METHODS—This cross-sectional study recruited 4,821 healthy Swedish women (aged 35–56 years) residing in five municipalities in the Stockholm area. An oral glucose tolerance test identified 52 women with type 2 diabetes. Relative risks (RRs) with 95% CIs were estimated in a logistic multiple regression analysis.
RESULTS—No association was found between high demands and type 2 diabetes (RR 1.1 [CI 0.5–2.2]). Low decision latitude was associated with type 2 diabetes with a RR of 2.2 (1.0–4.8). The RR of type 2 diabetes with low SOC was 3.7 (1.2–11.2). The combination of low SOC and low decision latitude was associated with type 2 diabetes with a RR of 2.6 (1.2–5.7). Homeostasis model assessment revealed an association of 4.2 (1.2–15.0) between low SOC and insulin resistance.
CONCLUSIONS—This study provided new evidence that stress factors such as low decision latitude at work and low SOC were associated with type 2 diabetes in middle-aged Swedish women.
Smoking and Progression of Diabetic Nephropathy in Type 1 Diabetes
Authors: Hovind Peter , Rossing Peter , Tarnow Lise , Parving Hans-Henrik 
Published: March 2007

OBJECTIVE—Cigarette smoking contributes to development of diabetic nephropathy. However, long-term studies on the effect of smoking on decline in kidney function in diabetic nephropathy are lacking. We assessed the impact of smoking on progression of diabetic nephropathy in type 1 diabetic patients enrolled in a prospective observational cohort study started in 1983.
RESEARCH DESIGN AND METHODS—We identified all albuminuric type 1 diabetic patients (n = 301) followed for at least 3 years, median (range) 7 years (3–14), who underwent at least yearly measurement of glomerular filtration rate (GFR) by the 51Cr-EDTA plasma clearance technique (n = 8, range 3–24). In total, 192 men and 109 women were included (age [mean ± SD] 36 ± 11 years, duration of diabetes 22 ± 8 years); 271 patients were treated with antihypertensive drugs, predominantly ACE inhibitors in 179 patients. Patients were classified as smokers if they smoked more than one cigarette per day during a portion of or the entire observation period. Blood pressure, albuminuria, HbA1c, and serum cholesterol were measured every 3–4 months during the study.
RESULTS—In all 301 patients, the mean (SE) rate of decline in GFR (ΔGFR) was 4.0 (0.2) ml · min−1 · year−1 during the investigation period. No difference in Δ GFR was demonstrated between nonsmokers (n = 94), ΔGFR 4.5 (0.4), ex-smokers (n = 31), ΔGFR 3.1 (0.7), and smokers (n = 176), ΔGFR 3.9 (0.3) ml · min−1 · year−1, respectively (NS). Adjustment for other risk factors for progression of diabetic nephropathy did not alter the results: smoking was not associated with ΔGFR, whereas blood pressure, albuminuria, HbA1c, and serum cholesterol were demonstrated to be independent progression promoters.
CONCLUSIONS—In our study, smoking was not associated with decline in kidney function in type 1 diabetic patients with diabetic nephropathy.
Analysis of Metabolic Parameters as Predictors of Risk in the RENAAL Study
Authors: Appel Gerald B. , Radhakrishnan Jai , Avram Morrell M. , DeFronzo Ralph A. , Escobar-Jimenez Fernando , Campos M.M. , Burgess Ellen , Hille Darcy A. , Dickson Tania Z. , Shahinfar Shahnaz , Brenner Barry M. ,   for the RENAAL Study Investigators
Published: March 2007

OBJECTIVE—Metabolic factors such as glycemic control, hyperlipidemia, and hyperkalemia are important considerations in the treatment of patients with type 2 diabetes and nephropathy. In the RENAAL (Reduction of End Points in Type 2 Diabetes With the Angiotensin II Antagonist Losartan) study, losartan reduced renal outcomes in the patient population. This post hoc analysis of the RENAAL study reports the effects of losartan on selected metabolic parameters and assesses the relationship between baseline values of metabolic parameters and the primary composite end point or end-stage renal disease (ESRD).
RESEARCH DESIGN AND METHODS—Glycemic control (HbA1c) and serum lipid, uric acid, and potassium levels were compared between the losartan and placebo groups over time, and baseline levels were correlated with the risk of reaching the primary composite end point (doubling of serum creatinine, ESRD, or death) or ESRD alone.
RESULTS—Losartan did not adversely affect glycemic control or serum lipid levels. Losartan-treated patients had lower total (227.4 vs. 195.4 mg/dl) and LDL (142.2 vs. 111.7 mg/dl) cholesterol. Losartan was associated with a mean increase of up to 0.3 mEq/l in serum potassium levels; however, the rate of hyperkalemia-related discontinuation was similar between the placebo and losartan groups. Univariate analysis revealed that baseline total and LDL cholesterol and triglyceride levels were associated with increased risk of developing the primary composite end point. Similarly, total and LDL cholesterol were also associated with increased risk of developing ESRD.
CONCLUSIONS—Overall, losartan was well tolerated by patients with type 2 diabetes and nephropathy and was associated with a favorable effect on the metabolic profile of this population.
The Prevalence of and Factors Associated With Diabetic Retinopathy in the Australian Population
Authors: Tapp Robyn J. , Shaw Jonathan E. , Harper C. Alex , de Courten Maximilian P. , Balkau Beverley , McCarty Daniel J. , Taylor Hugh R. , Welborn Timothy A. , Zimmet Paul Z. ,   on behalf of the AusDiab Study Group
Published: March 2007

OBJECTIVE—To determine the prevalence and factors associated with diabetic retinopathy in the Australian population and to estimate the time difference between disease onset and clinical diagnosis of type 2 diabetes.
RESEARCH DESIGN AND METHODS—The Australian Diabetes, Obesity and Lifestyle study (AusDiab) included 11,247 adults aged ≥25 years in 42 randomly selected areas of Australia. Retinopathy was assessed in participants identified as having diabetes (based on self-report and oral glucose tolerance test), impaired fasting glucose, and impaired glucose tolerance and in a random sample with normal glucose tolerance. Data were available for 2,177 participants.
RESULTS—Overall, 15.3% of those with diabetes had retinopathy. The prevalence of retinopathy was 21.9% in those with known type 2 diabetes (KDM) and 6.2% in those newly diagnosed (NDM). The prevalence of proliferative diabetic retinopathy (PDR) was 2.1% in those with KDM. No cases of PDR were found in those with NDM. Untreated vision threatening retinopathy (presence of PDR or macular edema) was present in 1.2% (n = 4). Factors associated with retinopathy were duration of diabetes, HbA1c, and systolic blood pressure. Using linear extrapolation of the prevalence of retinopathy with diabetes duration, the onset of diabetes in this population was approximately the time of diagnosis.
CONCLUSIONS—This is one of the first national studies of diabetic retinopathy in a developed country. The prevalence of retinopathy was similar to that in other population-based studies. Vision threatening retinopathy was relatively rare; however, four untreated cases were identified. Regular screening for diabetic retinopathy and more aggressive management of modifiable risk factors could reduce the numbers of people who develop vision-threatening retinopathy.
Identification and Management of Diabetic Nephropathy in the Diabetes Clinic
Authors: Craig Kathrine J. , Donovan Kieron , Munnery Margaret , Owens David R. , Williams John D. , Phillips Aled O. 
Published: March 2007

OBJECTIVE—To examine the prevalence and management of diabetic nephropathy in a diabetes clinic.
RESEARCH DESIGN AND METHODS—Characteristics of nephropaths identified by existing screening practice (phase I, albuminuria &gt;20 mg/l in three separate urine samples), were compared with those identified by a nurse-led management program (phase II, in which screening for nephropathy was based on albumin-to-creatinine ratio in a single random urine specimen).
RESULTS—In phase I, 644 patients attended a diabetes clinic over a 6-month period. Microalbuminuria results were available for 485 patients (75%). A total of 115 patients were identified as nephropaths (prevalence 17.8%). Of these patients, 91% had type 2 diabetes. During phase II, prospective analysis of urinary albumin-to-creatinine ratio was carried out in 880 patients over 8 months. A total of 174 patients were identified as nephropaths (prevalence 20%). Of these, 134 patients had been identified by existing screening protocols. Forty had no previous record of microalbuminuria and were therefore newly identified by prospective screening. Systolic blood pressure guidelines were met in only 31% of all known nephropaths and 26.5% of newly diagnosed nephropaths. Diastolic blood pressure guidelines were met in 36% of all known and 38% of newly diagnosed nephropaths. In the patient group of known nephropaths from phases I and II, 62% were prescribed ACE inhibitors (ACEIs) or angiotensin II receptor (AIIR) antagonists. In the newly identified nephropathy patient cohort from phase II, 48% used ACEIs or AIIR antagonists.
CONCLUSIONS—Introduction of a nurse-led management program significantly improved detection of nephropathy. We are currently evaluating its impact on clinical management.
Köbberling Type of Familial Partial Lipodystrophy
Authors: Herbst Karen L. , Tannock Lisa R. , Deeb Samir S. , Purnell Jonathan Q. , Brunzell John D. , Chait Alan 
Published: March 2007

OBJECTIVE—The phenotypic expression of partial lipodystrophy is present in two familial syndromes: familial partial lipodystrophy type 1 (FPLD1), with fat loss from the extremities, and central obesity and FPLD type 2, with fat loss from the extremities, abdomen, and thorax. The latter disorder is associated with mutations in the LMNA gene. FPLD1 is thought to be rare. Here, we report 13 subjects with FPLD1, suggesting that this syndrome is more common than previously thought.
RESEARCH DESIGN AND METHODS—Fasting glucose, plasma lipids, leptin, HbA1c, and anthropomorphic measurements were evaluated in 13 subjects with clinical features of FPLD1 and are compared with two age-matched control groups, with and without diabetes.
RESULTS—Only women with clinical features of FPLD1 have been identified. Although they lack extremity and gluteal subcutaneous fat, they do have truncal obesity. Skinfold thickness on the arm and leg was significantly less than that in control subjects. The ratio of skinfold thickness from abdomen to thigh was significantly higher in subjects, suggesting an easy method for identifying affected patients. FPLD1 subjects also had components of the metabolic syndrome, including hypertension, insulin resistance, and severe hypertriglyceridemia resulting in pancreatitis. Premature coronary artery disease was present in 31% of subjects. None of the subjects had coding mutations in the LMNA gene or in the gene coding for peroxisome proliferator-activated receptor (PPAR)-γ.
CONCLUSIONS—FPLD1 is more common than previously described, but the diagnosis is often missed. Early recognition and intensive treatment of hyperlipidemia and diabetes in FPLD1 is important for prevention of pancreatitis and early cardiovascular disease.
Significance of Microalbuminuria in Long-Duration Type 1 Diabetes
Authors: Arun Chankramath S. , Stoddart James , Mackin Paul , MacLeod Jean M. , New John P. , Marshall Sally M. 
Published: March 2007

OBJECTIVE—The value of microalbuminuria (MA) in predicting renal disease and premature mortality in longer duration type 1 diabetes is unclear.
RESEARCH DESIGN AND METHODS—We followed 135 patients with long-standing type 1 diabetes (&gt;30 years’ duration) over a 7-year period, recording albuminuria and other clinical variables. Vital status was ascertained and cause of death was recorded.
RESULTS—A total of 27 of 135 patients (20%) died during the follow-up period. Patients with MA (10 of 30, 33.3%) or proteinuria (5 of 6, 83.3%) at initial examination were more likely to die during follow-up than patients who had normal albumin excretion at baseline (12 of 99, 12%; χ2 for trend 21.9, P &lt; 0.0001). The presence of abnormal albumin excretion and low BMI were independent risk factors of premature death. The causes of death were similar in patients with normal and abnormal urine albumin excretion. A total of 24.4% of initially normoalbuminuric survivors developed MA, and persistent proteinuria developed in 3.5%. Progressors had significantly higher albumin excretion rate at baseline compared with those who remained normoalbuminuric: 9.0 μg/min (3.8–18) vs. 4.0 μg/min (0.4–17.5); P &lt; 0.001. A total of 21% of patients with MA at baseline reverted to normoalbuminuria, and persistent proteinuria developed in 32%. The likelihood of progression to persistent proteinuria was significantly greater in those with baseline MA compared with those with normal albumin excretion (P &lt; 0.001).
CONCLUSIONS—Even in long-standing type 1 diabetes of &gt;30 years’ duration, MA and proteinuria predict all-cause mortality. MA is a good predictor of persistent proteinuria.
Prenatal Growth, BMI, and Risk of Type 2 Diabetes by Early Midlife
Authors: Hyppönen Elina , Power Chris , Smith George Davey 
Published: March 2007

OBJECTIVE—Small size at birth has been associated with increased risk of type 2 diabetes. Our aim was to evaluate how risk of diabetes associated with low birth weight is affected by accumulation of body mass from childhood to adulthood.
RESEARCH DESIGN AND METHODS—Subjects from the 1958 British birth cohort (born 3–9 March 1958) have been followed regularly since birth. In the survey at 41 years of age, 88 participants reported type 2 diabetes (n = 10,683).
RESULTS—Participants in whom diabetes developed weighed less at birth and had higher BMIs than the others. Birth weight (adjusted for gestational age and sex) was inversely related to risk of diabetes (odds ratio for 1-SD change 0.76, 95% CI 0.56–0.99). All diabetic participants in the lowest third of birth weight were in the highest third of weight gain by 23 years of age. An increased risk of diabetes was found for those in the lowest third of BMI at 7 years of age (2.84, 1.2–6.9), but diabetic participants in this group had excessive weight gain to 23 years of age. All but one diabetic participant in the highest third of childhood BMI remained in the highest third until 23 years of age. Risk of diabetes by BMI at 23 years of age was 22.9-fold (95% CI 12–42) for obese participants and 3.8-fold (2.1–6.9) for overweight participants compared with those of normal weight.
CONCLUSIONS—There was no increase in risk of diabetes for small size at birth without excessive postnatal weight gain. Adult obesity was the most important risk factor for type 2 diabetes developing by early midlife.
Risk Factors for Myocardial Infarction Case Fatality and Stroke Case Fatality in Type 2 Diabetes
Authors: Stevens Richard J. , Coleman Ruth L. , Adler Amanda I. , Stratton Irene M. , Matthews David R. , Holman Rury R. 
Published: March 2007

OBJECTIVE—Patients with diabetes have a higher case fatality rate in myocardial infarction (MI) or stroke than those without diabetes: that is, MI and stroke are more often fatal if diabetes is present. We investigated whether the risk of MI or stroke being fatal in type 2 diabetes can be estimated using information available around the time diabetes is diagnosed.
RESEARCH DESIGN AND METHODS—Analyses were based on 674 cases of MI (351 fatal) that occurred in 597 of 5,102 U.K. Prospective Diabetes Study (UKPDS) patients for whom covariate data were available during a median follow-up of 7 years. Multivariate logistic regression was used to examine differences in risk factors, measured within 2 years of diagnosis of diabetes, between fatal and nonfatal MI. Similar analyses were performed for 234 strokes (48 fatal) that occurred in 199 patients.
RESULTS—Patients with fatal MI had higher HbA1c than those with nonfatal MI (odds ratio 1.17 per 1% HbA1c, P = 0.014). Patients with fatal stroke had higher HbA1c than those with nonfatal stroke (odds ratio 1.37 per 1% HbA1c, P = 0.007). Other risk factors for MI case fatality included increased age, blood pressure, and urine albumin level.
CONCLUSIONS—The risk of MI or stroke being fatal in type 2 diabetes is associated with risk factors, including HbA1c, measured many years before onset of MI or stroke. Equations have been added to the UKPDS Risk Engine to estimate likely case fatality rates in MI and stroke.
Antihypertensive Therapy and Incidence of Type 2 Diabetes
Authors: Padwal Raj , Laupacis Andreas 
Published: March 2007

OBJECTIVE—To systematically review the available evidence examining the effects of the major antihypertensive drug classes on the incidence of type 2 diabetes.
RESEARCH DESIGN AND METHODS—The Cochrane Controlled Trials Register, Medline, and Embase were searched for English-language case-control, cohort, and randomized controlled trials involving the major antihypertensive classes and reporting type 2 diabetes as an end point. Reference lists of original studies and narrative reviews were also hand searched. One reviewer (R.P.) performed the electronic searches. Both reviewers independently extracted data and assessed all potentially relevant studies for inclusion and methodological quality. Abstracts were not included, and unpublished studies were not sought.
RESULTS—One case-control study, 8 cohort studies, and 14 randomized controlled trials met inclusion criteria. No study examined diabetes incidence as a primary end point. Poor methodological quality limits the conclusions that can be drawn from most nonrandomized trials. Evidence from randomized studies is also potentially limited by several sources of bias, including treatment contamination and bias inherent in post hoc analyses. Data from the highest-quality studies suggest that diabetes incidence is unchanged or increased by thiazide diuretics and β-blockers and unchanged or decreased by ACE inhibitors, calcium channel blockers, and angiotensin receptor blockers.
CONCLUSIONS—The major antihypertensive classes may exert differential effects on diabetes incidence, although current data are far from conclusive. Ongoing placebo-controlled randomized trials involving potentially beneficial drug classes and examining diabetes incidence as a primary end point should provide more definitive evidence.
Adiponectin Concentrations in Sera From Patients With Type 2 Diabetes Are Negatively Associated With Sympathovagal Balance as Evaluated by Power Spectral Analysis of Heart Rate Variation
Authors: Wakabayashi Sadao , Aso Yoshimasa 
Published: March 2007

OBJECTIVE—To investigate whether cardiac autonomic activity, particularly sympathovagal balance as estimated by power spectral analysis (PSA) of heart rate variation (HRV), is associated with serum adiponectin concentrations in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—We studied 105 patients with type 2 diabetes (51 women and 54 men). Serum adiponectin concentrations were measured by sandwich enzyme-linked immunosorbent assay. HRV was determined automatically every 5 min over 24 h using Holter electrocardiographic recording. PSA of R-R intervals was performed using fast Fourier transformation. Low-frequency (both sympathetic and parasympathetic activities), high- frequency (pure parasympathetic activity), and the ratio of low-frequency-to-high-frequency power (LF-to-HF ratio), an index of sympathovagal balance, were used as indexes of cardiac autonomic activity.
RESULTS—We found no significant correlation between serum adiponectin and low-frequency or high-frequency power in patients with diabetes. Serum adiponectin concentration correlated negatively with the 24-h LF-to-HF ratio (r = −0.343, P = 0.0009) and creatinine clearance (r = −0.411, P &lt; 0.0001). Serum adiponectin concentrations were significantly higher in patients with overt albuminuria than in those with normoalbuminuria or microalbuminuria. In multivariate analysis controlling for sex, BMI, glycemic control, lipid profile, and renal function, serum adiponectin concentration showed an independent negative association with 24-h LF-to-HF ratio (β = −0.332, P = 0.020). Furthermore, sex, HDL cholesterol, and renal function retained significant influence on the serum adiponectin concentration in patients with diabetes.
CONCLUSIONS—Sympathovagal balance favoring relative sympathetic activation was associated with low serum concentrations of adiponectin in patients with type 2 diabetes.