bluuebunny/crossref_metadata_2025_split huggingface dataset:
Women Living Alone Have an Increased Risk to Develop Diabetes, Which Is Explained Mainly by Lifestyle Factors
Authors: Lidfeldt Jonas , Nerbrand Christina , Samsioe Göran , Agardh Carl-David 
Published: March 2007

OBJECTIVE— The purpose of this study was to assess the role of household conditions for the progression to diabetes in women with impaired glucose tolerance (IGT).
RESEARCH DESIGN AND METHODS— A total of 461 women, aged 50–64 years, with IGT defined by an oral glucose tolerance test, had baseline advice on physical exercise, diet, smoking, and alcohol habits. Physical examination, blood tests, and questionnaires were completed at baseline and after 2.5 years. Household status was categorized into living alone or with a partner, other adults, or children.
RESULTS— Women living alone had a 2.68-fold increased risk (95% CI 1.02–7.05) of developing diabetes after adjustments for biological risk factors. Further stepwise adjustments for education, occupation, subjective mental health, exercise, diet, and alcohol showed remaining significant odds ratios (ORs), decreasing from 3.26 (1.19–8.96) to 3.03 (1.02–8.99). However, when smoking status was added, the OR became nonsignificant, 2.07 (0.62–6.88). More women who lived alone smoked and did not reduce their daily cigarette consumption compared with women in other household conditions. At follow-up, women living alone had reduced their alcohol consumption and were more often abstainers and fewer had healthy dietary habits or had improved their diet. Physical exercise did not differ among the groups. Separate analyses of any other household status did not show any excess risk for development of diabetes.
CONCLUSIONS— Women living alone had a higher risk to progress from IGT to diabetes, mostly explained by smoking, alcohol, and dietary habits. Household conditions should be accounted for when assessing future risk for diabetes.
Association Among Individual Deprivation, Glycemic Control, and Diabetes Complications
Authors: Bihan Hélène , Laurent Silvana , Sass Catherine , Nguyen Gérard , Huot Caroline , Moulin Jean Jacques , Guegen René , Le Toumelin Philippe , Le Clésiau Hervé , La Rosa Emilio , Reach Gérard , Cohen Régis 
Published: March 2007

OBJECTIVE—Previous studies have related poor glycemic control and/or some diabetes complications to low socioeconomic status. Some aspects of socioeconomic status have not been assessed in these studies. In the present study, we used an individual index of deprivation, the Evaluation de la Précarité et des Inégalités de santé dans les Centres d’Examens de Santé (Evaluation of Precarity and Inequalities in Health Examination Centers [EPICES]) score, to determine the relationship among glycemic control, diabetes complications, and individual conditions of deprivation.
RESEARCH DESIGN AND METHODS—We conducted a cross-sectional prevalence study in 135 consecutive diabetic patients (age 59.41 ± 13.2 years [mean ± SD]) admitted in the hospitalization unit of a French endocrine department. Individual deprivation was assessed by the EPICES score, calculated from 11 socioeconomic questions. Glycemic control, lipid levels, blood pressure, retinopathy, neuropathy, and nephropathy were assessed.
RESULTS—HbA1c level was significantly correlated with the EPICES score (r = 0.366, P &lt; 0.001). The more deprived patients were more likely than the less deprived patients to have poor glycemic control (β = 1.984 [SE 0.477], P &lt; 0.001), neuropathy (odds ratio 2.39 [95% CI 1.05–5.43], P = 0.037), retinopathy (3.66 [1.39–9.64], P = 0.009), and being less often admitted for 1-day hospitalization (0.32 [0.14–0.74], P = 0.008). No significant relationship was observed with either nephropathy or cardiovascular risk factors.
CONCLUSIONS—Deprivation status is associated with poor metabolic control and more frequent microvascular complications, i.e., retinopathy and neuropathy. The medical and economic burden of deprived patients is high.
The Impact of Insulin Resistance on Proinsulin Secretion in Pregnancy
Authors: Retnakaran Ravi , Hanley Anthony J.G. , Sermer Mathew , Zinman Bernard 
Published: March 2007

OBJECTIVE—Excessive secretion of the insulin precursor proinsulin, as manifested by an increased serum proinsulin-to-insulin ratio, has been associated with β-cell dysfunction. In women with gestational diabetes mellitus (GDM), previous studies of the proinsulin-to-insulin ratio have yielded conflicting results, despite the presence of β-cell dysfunction. The interpretation of the proinsulin-to-insulin ratio, however, may be confounded by the variable effects of hepatic insulin extraction. Thus, we sought to determine whether GDM is characterized by relative hyperproinsulinemia as measured by the proinsulin–to–C-peptide ratio, an alternate measure of proinsulin secretion that is not affected by hepatic insulin extraction.
RESEARCH DESIGN AND METHODS—Serum proinsulin, C-peptide, and insulin were measured in a cross-sectional study of 180 women undergoing oral glucose tolerance tests (OGTTs) in the late second or early third trimester. Based on the OGTT, participants were stratified into three groups: 1) normal glucose tolerance (NGT; n = 93), 2) impaired glucose tolerance (IGT; n = 39), and 3) GDM (n = 48). Insulin sensitivity (IS) was measured using the ISOGTT index of Matsuda and DeFronzo, which has been previously validated in pregnant women.
RESULTS—There were no significant differences in mean fasting proinsulin–to–C-peptide ratio between the three glucose tolerance groups (NGT, 0.024; IGT, 0.022; GDM, 0.019; P = 0.4). Furthermore, adjustment for age, weeks’ gestation, prepregnancy BMI, ethnicity, previous GDM, and family history of diabetes did not reveal any association between the proinsulin–to–C-peptide ratio and glucose tolerance status. Using Spearman univariate correlation analysis, fasting proinsulin–to–C-peptide ratio was significantly correlated with ISOGTT (r = 0.29, P &lt; 0.0001) and inversely related to the homeostasis model assessment of insulin resistance (r = −0.36, P &lt; 0.0001) and prepregnancy BMI (r = −0.23, P &lt; 0.005). On multiple linear regression analysis, ISOGTT emerged as the strongest independent correlate of the dependent variable proinsulin–to–C-peptide ratio. Furthermore, after adjustment for potential covariates, a stepwise decrease in proinsulin–to–C-peptide ratio was observed per decreasing tertile of ISOGTT (trend P = 0.0019), consistent with enhanced efficiency of proinsulin processing (i.e., reduced proinsulin–to–C-peptide ratio) as insulin resistance increases.
CONCLUSIONS—GDM is not independently associated with hyperproinsulinemia as measured by the proinsulin–to–C-peptide ratio. Instead, in pregnant women, increased insulin resistance is associated with decreased proinsulin–to–C-peptide ratio, independently of glucose tolerance status. These data suggest that relative proinsulin secretion in late pregnancy is primarily related to insulin resistance and does not necessarily reflect β-cell function.
Decreased Endogenous Secretory Advanced Glycation End Product Receptor in Type 1 Diabetic Patients
Authors: Katakami Naoto , Matsuhisa Munehide , Kaneto Hideaki , Matsuoka Taka-aki , Sakamoto Ken’ya , Nakatani Yoshihisa , Ohtoshi Kentaro , Hayaishi-Okano Rieko , Kosugi Keisuke , Hori Masatsugu , Yamasaki Yoshimitsu 
Published: March 2007

OBJECTIVE—The binding of advanced glycation end products (AGEs) to their receptor (RAGE) plays an important role in the development of diabetic vascular complications. In the present study, we examined circulating endogenous secretory RAGE (esRAGE) levels in subjects with type 1 diabetes and explored the possible association between esRAGE levels and the severity of diabetic vascular complications.
RESEARCH DESIGN AND METHODS—Circulating esRAGE levels in serum were examined in 67 Japanese type 1 diabetic patients (22 men and 45 women, age 24.0 ± 4.4 years [means ± SD]) and 23 age-matched healthy nondiabetic subjects (10 men and 13 women aged 24.9 ± 1.4 years). Daily urinary albumin excretion, the presence of retinopathy, and intima-media thickness (IMT) of the carotid artery were also evaluated. We further explored the association between esRAGE levels and severity of diabetic vascular complications.
RESULTS—Circulating esRAGE levels were significantly lower in subjects with type 1 diabetes than in nondiabetic subjects (0.266 ± 0.089 vs. 0.436 ± 0.121 ng/ml, respectively, P &lt; 0.0001) and was inversely correlated with HbA1c (A1C) levels (r = −0.614, P &lt; 0.0001). In addition, multivariate regression analysis demonstrated that A1C was an independent risk factor for a low esRAGE value. Furthermore, circulating esRAGE levels were inversely correlated with carotid IMT (r = −0.325, P = 0.0017) and was one of the independent risk factors for IMT thickening. Furthermore, there was a significant difference (P = 0.0124) in esRAGE levels between patients without retinopathy (0.286 ± 0.092 ng/ml) and those with retinopathy (0.230 ± 0.074 ng/ml).
CONCLUSIONS—Circulating esRAGE levels were significantly lower in type 1 diabetic patients than in nondiabetic subjects and were inversely associated with the severity of some diabetic vascular complications.
Predictive Value of Silent Myocardial Ischemia for Cardiac Events in Diabetic Patients
Authors: Valensi Paul , Pariès Jacques , Brulport-Cerisier Valérie , Torremocha Florence , Sachs Régis-Nessim , Vanzetto Gérald , Cosson Emmanuel , Lormeau Boris , Attali Jean-Raymond , Maréchaud Richard , Estour Bruno , Halimi Serge 
Published: March 2007

OBJECTIVE—Silent myocardial ischemia (SMI) in asymptomatic subjects with no history of myocardial infarction or angina is a frequent condition in diabetic patients. The aim of the study was to examine the predictive value of SMI for cardiac events in a multicenter cohort and to determine whether this value is higher in patients with a particular clinical profile.
RESEARCH DESIGN AND METHODS—A total of 370 asymptomatic diabetic patients with at least two additional cardiovascular risk factors was recruited in four departments of diabetology. SMI was assessed by either exercise or dipyridamole single-photon emission–computed tomography myocardial perfusion imaging with thallium-201. If dipyridamole stress was used, an electrocardiogram stress test was performed separately on another day. Follow-up duration was 3–89 months (38 ± 23 months).
RESULTS—There was evidence of SMI in 131 patients (35.4%) on at least one positive noninvasive test. The patients with SMI were significantly older and had significantly higher serum triglycerides and lower HDL cholesterol levels. Cardiac events occurred in 53 patients (14.3%). Major cardiac events (death or myocardial infarction) occurred in 38 patients (10%) and other events (unstable angina, heart failure, or coronary revascularization) occurred in 15 patients. The patients who had cardiac events were older and had higher serum triglyceride levels at baseline. There was a significant association between SMI and cardiac events (hazard ratio 2.79 [95% CI 1.54–5.04]) and in particular major cardiac events (3 [1.53–5.87]). In the patients &gt;60 years of age, the prevalence of SMI was higher (43.4 vs. 30.2% in those &lt;60 years). SMI was associated with a significant risk of cardiac events (2.89 [1.31–6.39]) and in particular major cardiac events (3.66 [1.36–9.87]) for the patients &gt;60 years old but not for those &lt;60 years old.
CONCLUSIONS—In asymptomatic diabetic patients with additional cardiovascular risk factors, SMI is a potent predictor of cardiac events and should be assessed preferably in the patients &gt;60 years of age.
Efficacy of Lifestyle Education to Prevent Type 2 Diabetes
Authors: Yamaoka Kazue , Tango Toshiro 
Published: March 2007

OBJECTIVE—To evaluate the efficacy of lifestyle education for preventing type 2 diabetes in individuals at high risk by meta-analysis of randomized controlled trials, as assessed by incidence and a reduced level of plasma glucose 2 h after a 75-g oral glucose load (2-h plasma glucose).
RESEARCH DESIGN AND METHODS—Through an electronic search, 123 studies were identified. A literature search identified eight studies that met strict inclusion criterion of meta-analysis for 2-h plasma glucose and five studies for the incidence of diabetes. All were randomized controlled trials of ≥6 months with lifestyle education that included a dietary intervention. Subjects were adults diagnosed as being at high risk for type 2 diabetes. The difference in mean reduction of 2-h plasma glucose from baseline to the 1-year follow-up and relative risk (RR) of the incidence of diabetes in the lifestyle education group versus the control group were assessed. Overall estimates were calculated using a random-effects model. Those estimates were confirmed by several models, and the possibility of selection bias was examined using a funnel plot.
RESULTS—Lifestyle education intervention reduced 2-h plasma glucose by 0.84 mmol/l (95% CI 0.39–1.29) compared with the control group. The 1-year incidence of diabetes was reduced by ∼50% (RR 0.55, 95% CI 0.44–0.69) compared with the control group. Results were stable and little changed if data were analyzed by subgroups or other statistical models. Funnel plots revealed no selection bias.
CONCLUSIONS—Lifestyle education was effective for reducing both 2-h plasma glucose and RR in high-risk individuals and may be a useful tool in preventing diabetes.
Race, Ethnicity, Socioeconomic Position, and Quality of Care for Adults With Diabetes Enrolled in Managed Care
Authors: Brown Arleen F. , Gregg Edward W. , Stevens Mark R. , Karter Andrew J. , Weinberger Morris , Safford Monika M. , Gary Tiffany L. , Caputo Dorothy A. , Waitzfelder Beth , Kim Catherine , Beckles Gloria L. 
Published: March 2007

OBJECTIVE—To examine racial/ethnic and socioeconomic variation in diabetes care in managed-care settings.
RESEARCH DESIGN AND METHODS—We studied 7,456 adults enrolled in health plans participating in the Translating Research Into Action for Diabetes study, a six-center cohort study of diabetes in managed care. Cross-sectional analyses using hierarchical regression models assessed processes of care (HbA1c [A1C], lipid, and proteinuria assessment; foot and dilated eye examinations; use or advice to use aspirin; and influenza vaccination) and intermediate health outcomes (A1C, LDL, and blood pressure control).
RESULTS—Most quality indicators and intermediate outcomes were comparable across race/ethnicity and socioeconomic position (SEP). Latinos and Asians/Pacific Islanders had similar or better processes and intermediate outcomes than whites with the exception of slightly higher A1C levels. Compared with whites, African Americans had lower rates of A1C and LDL measurement and influenza vaccination, higher rates of foot and dilated eye examinations, and the poorest blood pressure and lipid control. The main SEP difference was lower rates of dilated eye examinations among poorer and less educated individuals. In almost all instances, racial/ethnic minorities or low SEP participants with poor glycemic, blood pressure, and lipid control received similar or more appropriate intensification of therapy relative to whites or those with higher SEP.
CONCLUSIONS—In these managed-care settings, minority race/ethnicity was not consistently associated with worse processes or outcomes, and not all differences favored whites. The only notable SEP disparity was in rates of dilated eye examinations. Social disparities in health may be reduced in managed-care settings.
The Effect of Monochromatic Infrared Energy on Sensation in Patients With Diabetic Peripheral Neuropathy
Authors: Clifft Judy K. , Kasser Richard J. , Newton Timothy S. , Bush Andrew J. 
Published: March 2007

OBJECTIVE—The purpose of this study was to determine the effect of monochromatic infrared energy (MIRE) on plantar sensation in subjects with diabetic peripheral neuropathy.
RESEARCH DESIGN AND METHODS—In this randomized, double-blind, placebo-controlled study, 39 subjects with diabetic peripheral neuropathy completed the 8-week study. Subjects received 30 min of active or placebo MIRE three times a week for 4 weeks. Plantar sensation was tested with monofilaments at the beginning of the study (M1), following 4 weeks of treatment (M2), and after an additional 4 weeks of nontreatment (M3). The number of sites that could sense the 5.07 monofilament was totaled at M1, M2, and M3. Data were analyzed using a special repeated-measures statistic followed by a post hoc Tukey-Kramer test.
RESULTS—The average number of sites that patients could sense the 5.07 monofilament increased for both the active and placebo groups. There were significant gains from M1 to M2 (P &lt; 0.002), no significant gains from M2 to M3 (P = 0.234), and significant gains from M1 to M3 (P &lt; 0.002) for both the active and placebo groups. There were no significant differences between active and placebo groups at any measurement.
CONCLUSIONS—Thirty minutes of active MIRE applied 3 days per week for 4 weeks was no more effective than placebo MIRE in increasing sensation in subjects with diabetic peripheral neuropathy. Clinicians should be aware that MIRE may not be an effective modality for improving sensory impairments in patients with diabetic neuropathy.
Dietary Calcium, Vitamin D, and the Prevalence of Metabolic Syndrome in Middle-Aged and Older U.S. Women
Authors: Liu Simin , Song Yiqing , Ford Earl S. , Manson JoAnn E. , Buring Julie E. , Ridker Paul M. 
Published: March 2007

OBJECTIVE—To examine whether and to what extent intakes of calcium and vitamin D are related to the metabolic syndrome in middle-aged or older women.RESEARCH DESIGN AND METHODS—We analyzed data from 10,066 women aged ≥45 years participating in the Women’s Health Study who were free of cardiovascular disease, cancer, or diabetes and who never used postmenopausal hormones. We used multiple logistic regression models to estimate multivariable odds ratios (ORs) and 95% CIs comparing different dietary intake levels of calcium and vitamin D.RESULTS—In age- and calorie-adjusted analyses, higher intakes of total, dietary, and supplemental calcium were significantly and inversely associated with the prevalence of metabolic syndrome. After further adjusting for smoking status, exercise, alcohol intake, multivitamin use, and parental history of myocardial infarction before age 60 years, the ORs of having the metabolic syndrome for increasing quintiles of total calcium intake were 1.00 (reference), 0.82 (95% CI 0.70–0.97), 0.84 (0.71–0.99), 0.70 (0.59–0.83), and 0.64 (0.54–0.77) (P for trend &lt;0.0001). This association was not appreciably altered by additional adjustment for other dietary factors or total vitamin D intake. In contrast, neither total (P for trend = 0.13) nor supplemental (P for trend = 0.45) vitamin D was significantly associated with metabolic syndrome. Dietary vitamin D was inversely associated with prevalence of metabolic syndrome but was not independent of total calcium intake. Similar strong relations between intakes of dairy products and metabolic syndrome were also observed. After adjustment for lifestyle and dietary factors, the multivariable ORs comparing highest with lowest intake categories were 0.66 (0.55–0.80) (P for trend &lt;0.0001) for total dairy products and 0.85 (0.71–1.02) (P for trend = 0.05) for total milk intake.CONCLUSIONS—Our results indicate that intakes of calcium and dairy products may be associated with lower prevalence of the metabolic syndrome in middle-aged and older women.
Hypertension Prevalence, Awareness, Treatment, and Control in an Adult Type 1 Diabetes Population and a Comparable General Population
Authors: Maahs David M. , Kinney Gregory L. , Wadwa Paul , Snell-Bergeon Janet K. , Dabelea Dana , Hokanson John , Ehrlich James , Garg Satish , Eckel Robert H. , Rewers Marian J. 
Published: March 2007

OBJECTIVE—To compare the prevalence, awareness, treatment, and control of hypertension in a population-representative sample of adults with type 1 diabetes and comparable nondiabetic control subjects.
RESEARCH DESIGN AND METHODS—In 2000–2002, the Coronary Artery Calcification in Type 1 Diabetes Study enrolled 1,416 individuals aged 19–56 years with no known history of coronary artery disease: 652 type 1 diabetic patients (46% male, mean age 37 years) and 764 nondiabetic control subjects (50% male, mean age 39 years). Subjects were asked if they had been told by a physician that they had hypertension or were on a blood pressure medication. Blood pressure was measured using standardized Joint National Committee (JNC) protocol.
RESULTS—Type 1 diabetic subjects, compared with nondiabetic subjects, had higher rates of hypertension prevalence (43 vs. 15%, P &lt; 0.001), awareness (53 vs. 45%, P = 0.11), treatment (87 vs. 47%, P &lt; 0.001), and control (55 vs. 32%, P &lt; 0.001) for the JNC 6 goal (130/85 mmHg). Only 42% of all type 1 diabetic hypertensive subjects met the new JNC 7 goal (130/80 mmHg). Type 1 diabetic subjects had better blood pressure control (72 vs. 32%, P &lt; 0.0001), using 140/90 mmHg as a common measure. The majority of treated subjects were on a single antihypertensive agent (75 vs. 64%).
CONCLUSIONS—Subjects with type 1 diabetes have higher rates of hypertension prevalence, treatment, and control than nondiabetic subjects. However, hypertension remains largely uncontrolled, even if treated in high-risk populations, such as type 1 diabetic subjects and undiagnosed individuals in the general population. Achieving more stringent blood pressure goals will require increased attention and may necessitate the use of multiple antihypertensive agents.
Poor Pregnancy Outcome in Women With Type 2 Diabetes
Authors: Clausen Tine D. , Mathiesen Elisabeth , Ekbom Pia , Hellmuth Ellinor , Mandrup-Poulsen Thomas , Damm Peter 
Published: March 2007

OBJECTIVE— To evaluate the perinatal outcome and the frequency of maternal complications in pregnancies of women with type 2 diabetes during 1996–2001.RESEARCH DESIGN AND METHODS— Medical records of 61 consecutive singleton pregnancies in women with type 2 diabetes from 1996 to 2001 were studied. Pregnancy outcome was compared with that of pregnant women with type 1 diabetes during 1996–2000, the background population, and pregnant women with type 2 diabetes during 1980–1992 from the same department.RESULTS— The perinatal mortality in pregnancies complicated by type 2 diabetes (4/61, 6.6%) was increased four- and ninefold, respectively, and the rate of major congenital malformations (4/60, 6.7%) was more than doubled, although not statistically significant, compared with type 1 diabetic pregnancies and the background population. The glycemic control was similar or better in women with type 2 diabetes compared with women with type 1 diabetes. Multivariate logistic regression analysis in the pooled group of pregnancies with pregestational diabetes from 1996 to 2001 showed that high HbA1c at admission and type 2 diabetes were independently associated with a serious adverse fetal outcome (perinatal mortality and/or major congenital malformations). The perinatal mortality and the rate of major congenital malformations in type 2 diabetic pregnancies have increased during the last decade.CONCLUSIONS— The perinatal outcome of pregnancies in women with type 2 diabetes during 1996–2001 is poor. It is worse than the outcome of pregnancies in women with type 1 diabetes and the background population in the same period, as well as in women with type 2 diabetes studied during 1982–1990.