bluuebunny/crossref_metadata_2025_split huggingface dataset:
Self-Management Competence as a Predictor of Outcomes of Intensive Therapy or Usual Care in Youth With Type 1 Diabetes
Authors: Wysocki Tim , Harris Michael A. , Wilkinson Karen , Sadler Michelle , Mauras Nelly , White Neil H. 
Published: March 2007

OBJECTIVE—This article evaluates prediction of HbA1c during an 18-month randomized trial of intensive therapy (IT) versus usual care (UC) for type 1 diabetes in 142 youth.
RESEARCH DESIGN AND METHODS—Patients received a composite score for self-management competence (SMC) that combined standardized scores on baseline measures of diabetes knowledge, treatment adherence, and quality of health care interactions. They were categorized by tertiles split into low, moderate, and high SMC levels.
RESULTS—IT yielded very similar mean HbA1c levels in all three SMC groups. However, in UC patients, HbA1c increased markedly for low-SMC youth but not for moderate- and high-SMC youth during the trial. Compared with the mean HbA1c of their UC counterparts, low-SMC patients realized greater glycemic benefit from IT than did the moderate- or high-SMC youth. Baseline SMC was more strongly correlated with HbA1c for UC than IT.
CONCLUSIONS—All three SMC groups realized similar glycemic benefits from IT. The mean HbA1c levels of low-SMC patients in the UC group increased markedly over 18 months, whereas HbA1c levels of low-SMC patients in the IT group did not differ significantly from that of moderate- and high-SMC patients. Relative to their UC counterparts, low-SMC patients derived greater glycemic benefit from IT than did moderate- or high-SMC youth. SMC may be more critical to the success of UC than IT. Perhaps more importantly, patients should not be denied access to IT on the basis of limited competence in diabetes self-management.
Non-HDL Cholesterol and Apolipoprotein B in the Dyslipidemic Classification of Type 2 Diabetic Patients
Authors: Wägner Ana Maria , Pérez Antonio , Zapico Edgar , Ordóñez-Llanos Jordi 
Published: March 2007

OBJECTIVE—To compare non-HDL cholesterol (HDLc) and apolipoprotein B (apoB) in the identification of nonconventional high-risk dyslipidemic phenotypes in type 2 diabetic patients.
RESEARCH DESIGN AND METHODS—Total cholesterol and triglycerides, HDLc, LDL cholesterol, non-HDLc, apolipoprotein B (apoB), and LDL size were determined in 122 type 2 diabetic patients (68% male, aged 59.6 ± 9.7 years, and HbA1c 7.5% [range 5.2–16.0]). They were then classified as normo- and hypertriglyceridemic if their triglyceride concentrations were below/above 2.25 mmol/l, as normo/hyper-non-HDLc if non-HDLc concentrations were below/above 4.13 mmol/l, and as normo- and hyperapoB if apoB concentrations were below/above 0.97 g/l. Both classifications were compared (concordance assessed with the κ index), and low HDLc and LDL phenotype B were identified in each category.
RESULTS—A total of 26 patients were hypertriglyceridemic and 96 were normotriglyceridemic. All hypertriglyceridemic subjects had increased non-HDLc, whereas 24 had increased apoB (κ= 0.95). In the normotriglyceridemic group, 44 had increased non-HDLc, 68 had increased apoB, and 25 of the 52 patients with normal non-HDLc had increased apoB (κ= 0.587). Low HDLc and LDL phenotype B were similarly distributed into the equivalent categories.
CONCLUSIONS—Non-HDLc and apoB are equivalent risk markers in hypertriglyceridemic patients, but apoB identifies additional patients with high-risk dyslipidemic phenotypes in normotriglyceridemic type 2 diabetic patients.
Heart Rate Recovery Following Maximal Exercise Testing as a Predictor of Cardiovascular Disease and All-Cause Mortality in Men With Diabetes
Authors: Cheng Yiling J. , Lauer Michael S. , Earnest Conrad P. , Church Timothy S. , Kampert James B. , Gibbons Larry W. , Blair Steven N. 
Published: March 2007

OBJECTIVE—Heart rate recovery (HRR) is an independent prognostic indicator for cardiovascular disease (CVD) and all-cause mortality in healthy men. We examined the association of HRR to CVD-related and all-cause mortality in men with diabetes.
RESEARCH DESIGN AND METHODS—In this cohort study we examined 2,333 men with documented diabetes (mean age 49.4 years) that had baseline 5-min HRR measurement following maximal exercise (heart ratepeak − heart rate5 min of recovery) at The Cooper Clinic, Dallas, TX. We identified HRR quartiles as quartile 1 &lt;55, quartile 2 55–66, quartile 3 67–75, and quartile 4 &gt;75 bpm. Hazard ratios (HRs) for cardiovascular and all-cause death were adjusted for age, cardiorespiratory fitness, resting heart rate, fasting blood glucose, BMI, smoking habit, alcohol consumption, total cholesterol, triglyceride, and history of CVD at baseline.
RESULTS—During a median of 14.9 years follow-up, there were 142 deaths that were considered CVD related and 287 total deaths. Compared with men in the highest quartile of HRR, adjusted HRs in the first, second, and third quartiles were 2.0 (95% CI 1.1–3.8), 1.5 (0.8–2.7), and 1.5 (0.9–2.8), respectively, for cardiovascular death (P for trend &lt; 0.001). Similarly, for all-cause death, adjusted HRs in the first, second, and third quartiles were 2.0 (1.3–3.2), 1.5 (1.0–2.3), and 1.5 (1.1–2.3) (P for trend &lt; 0.001).
CONCLUSIONS—Among men with diabetes, a decreased HRR, even measured as long as 5 min after recovery, was independently predictive of cardiovascular and all-cause death.
Vascular Risk Factors and Markers of Endothelial Function as Determinants of Inflammatory Markers in Type 1 Diabetes
Authors: Schram Miranda T. , Chaturvedi Nish , Schalkwijk Casper , Giorgino Francesco , Ebeling Pertti , Fuller John H. , Stehouwer Coen D. ,   the EURODIAB Prospective Complications Study Group
Published: March 2007

OBJECTIVE—Inflammatory activity is increased in type 1 diabetes and may predispose to vascular disease. Its origin is not clear. We therefore investigated determinants of inflammation in type 1 diabetes.RESEARCH DESIGN AND METHODS—We performed a nested case-control study from the EURODIAB Prospective Complications Study of 543 European individuals having type 1 diabetes (278 men), diagnosed at &lt;36 years of age. Case subjects (n = 348) were those with one or more complications of diabetes; control subjects (n = 195) were all those with no evidence of any complication. We determined levels of C-reactive protein, interleukin-6, and tumor necrosis factor-α, combined them in a “general score of inflammatory markers,” and investigated their associations with vascular risk factors and markers of endothelial dysfunction by use of multiple linear regression analysis.RESULTS—Measures of inflammation were associated with sex, diabetes duration, glycemic control, the advanced glycation end product pentosidine, BMI, HDL cholesterol, triglycerides, and systolic blood pressure (standardized βs with the general score of inflammatory markers 0.15 [P = 0.002], 0.15 [P = 0.006], 0.18 [P &lt; 0.0001], 0.12 [P = 0.005], 0.10 [P = 0.057], −0.15 [P = 0.001], 0.16 [P &lt; 0.0001], and 0.09 [P = 0.042], respectively). In addition, measures of inflammation were strongly associated with markers of endothelial dysfunction, soluble vascular cell adhesion molecule-1, and soluble E-selectin (standardized βs with the general score of inflammatory markers 0.28 [P &lt; 0.0001] and 0.19 [P &lt; 0.0001]).CONCLUSIONS—We have shown that conventional risk factors for vascular disease and endothelial adhesion molecules are important determinants of inflammation in type 1 diabetic individuals, suggesting that strategies to decrease inflammatory activity in type 1 diabetes should focus not only on control of conventional risk factors, but also on improvement of endothelial function.
Insulin 70/30 Mix Plus Metformin Versus Triple Oral Therapy in the Treatment of Type 2 Diabetes After Failure of Two Oral Drugs
Authors: Schwartz Sherwyn , Sievers Richard , Strange Poul , Lyness William H. , Hollander Priscilla ,   For The INS-2061 Study Team
Published: March 2007

OBJECTIVE—Subjects (n = 188) with type 2 diabetes and inadequate response to two oral medications (A1C &gt;8.0%) were randomly assigned to treatment with either a third oral medication or an insulin 70/30 mix b.i.d. plus metformin for a comparison of efficacy, safety, and cost.
RESEARCH DESIGN AND METHODS—The protocol called for aggressive dose titration to achieve target values of fasting blood glucose (80–120 mg/dl), postprandial glucose (&lt;160 mg/dl), and A1C (&lt;7%). These efficacy parameters were evaluated at weeks 2, 6, 12, and 24 of therapy. If dose adjustments failed to achieve targeted glycemic control, subjects were switched to an alternate therapy.
RESULTS—At the end of study (week 24 of therapy), A1C and fasting plasma glucose (FPG) values showed comparable decreases in the two treatment groups. Only 31% (oral therapy) and 32% (insulin plus metformin) of subjects achieved target values of A1C (&lt;7%). A total of 10 of the 98 subjects randomized to triple oral therapy (10.2%) who failed to improve sufficiently were switched to insulin therapy. An additional four subjects dropped out of the oral treatment group due to adverse events felt to be potentially drug related. Only two of the subjects randomized to insulin plus metformin had to be switched to basal-bolus regimens (regular insulin and NPH insulin). Cost analysis determined that insulin plus metformin (mean cost $3.20/day) provided efficacy equal to that of a triple oral drug regimen ($10.40/day).
CONCLUSIONS—Insulin 70/30 mix plus metformin was as effective as triple oral therapy in lowering A1C and FPG values. The triple oral regimen was not as cost effective, and a high percentage of subjects (total of 16.3%) did not complete this regimen due to lack of efficacy or side effects.
Low–Glycemic Index Diets in the Management of Diabetes
Authors: Brand-Miller Jennie , Hayne Susan , Petocz Peter , Colagiuri Stephen 
Published: March 2007

OBJECTIVE—The use of diets with low glycemic index (GI) in the management of diabetes is controversial, with contrasting recommendations around the world. We performed a meta-analysis of randomized controlled trials to determine whether low-GI diets, compared with conventional or high-GI diets, improved overall glycemic control in individuals with diabetes, as assessed by reduced HbA1c or fructosamine levels.
RESEARCH DESIGN AND METHODS—Literature searches identified 14 studies, comprising 356 subjects, that met strict inclusion criteria. All were randomized crossover or parallel experimental design of 12 days’ to 12 months’ duration (mean 10 weeks) with modification of at least two meals per day. Only 10 studies documented differences in postprandial glycemia on the two types of diet.
RESULTS—Low-GI diets reduced HbA1c by 0.43% points (CI 0.72–0.13) over and above that produced by high-GI diets. Taking both HbA1c and fructosamine data together and adjusting for baseline differences, glycated proteins were reduced 7.4% (8.8–6.0) more on the low-GI diet than on the high-GI diet. This result was stable and changed little if the data were unadjusted for baseline levels or excluded studies of short duration. Systematically taking out each study from the meta-analysis did not change the CIs.
CONCLUSIONS—Choosing low-GI foods in place of conventional or high-GI foods has a small but clinically useful effect on medium-term glycemic control in patients with diabetes. The incremental benefit is similar to that offered by pharmacological agents that also target postprandial hyperglycemia.
Renoprotective Effects of Adding Angiotensin II Receptor Blocker to Maximal Recommended Doses of ACE Inhibitor in Diabetic Nephropathy
Authors: Rossing Kasper , Jacobsen Peter , Pietraszek Lotte , Parving Hans-Henrik 
Published: March 2007

OBJECTIVE—We evaluated the renoprotective effects as reflected by short-term changes in albuminuria of dual blockade of the renin-angiotensin system (RAS) by adding an angiotensin II receptor blocker (ARB) to treatment with maximal recommended doses of an ACE inhibitor (ACEI) in patients with type 2 diabetes and nephropathy.
RESEARCH DESIGN AND METHODS—A total of 20 patients (17 men and 3 women) with type 2 diabetes along with hypertension and nephropathy were enrolled in this double-blind, randomized, two-period, crossover trial of 8 weeks of treatment with the ARB candesartan 16 mg daily and placebo added in random order to existing treatment with lisinopril/enalapril 40 mg daily or captopril 150 mg daily. At the end of each treatment period, we evaluated albuminuria in three 24-h urinary collections by turbidimetry, 24-h ambulatory blood pressure (ABP) using the Takeda-TM2420, and glomerular filtration rate (GFR) by the 51Cr-EDTA plasma-clearance technique.
RESULTS—During monoblockade of the RAS by ACEI treatment, albuminuria was 706 (349−1,219) mg/24 h [geometric mean (IQR)]; 24-h ABP was 138 ± 3/72 ± 2 mmHg (mean ± SE); and GFR was 77 ± 6 ml · min−1 · 1.73 m−2 (mean ± SE). During dual blockade of the RAS by addition of candesartan 16 mg daily, there was a mean (95% CI) reduction in albuminuria of 28 (17−38) compared with ACEI alone (P &lt; 0.001). There was a modest reduction in systolic/diastolic 24-h ABP of 3/2 mmHg (−2 to 8 systolic, −2 to 5 diastolic; NS). Changes in albuminuria did not correlate to changes in ABP. Addition of candesartan 16 mg daily induced a small, insignificant decrease in GFR of 4 (−1 to 9) ml · min−1 · 1.73 m−2.
CONCLUSIONS—Dual blockade of the RAS provides superior short-term renoprotection independent of systemic blood pressure changes in comparison with maximally recommended doses of ACEI in patients with type 2 diabetes as well as nephropathy.
Increased Visceral Fat and Serum Levels of Triglyceride Are Associated With Insulin Resistance in Japanese Metabolically Obese, Normal Weight Subjects With Normal Glucose Tolerance
Authors: Katsuki Akira , Sumida Yasuhiro , Urakawa Hideki , Gabazza Esteban C. , Murashima Shuichi , Maruyama Noriko , Morioka Kohei , Nakatani Kaname , Yano Yutaka , Adachi Yukihiko 
Published: March 2007

OBJECTIVE—The purpose of this study was to investigate the association between visceral adiposity or triglyceride (TG) metabolism and insulin resistance in metabolically obese, normal weight (MONW) Japanese individuals with normal glucose tolerance.
RESEARCH DESIGN AND METHODS—We evaluated body fat areas, lipid profiles, and the glucose infusion rate (GIR) during a euglycemic-hyperinsulinemic clamp study in 20 MONW subjects (BMI &lt;25 kg/m2and visceral fat areas 100 cm2) with normal glucose tolerance. Body fat areas were measured by computed tomography scans. Control data were obtained from 20 normal subjects (BMI &lt;25 kg/m2 and visceral fat areas &lt;100 cm2).
RESULTS—MONW subjects showed a significant increase in fasting serum levels of TG (P &lt; 0.01) and a decrease in GIR (P &lt; 0.01) compared with normal subjects. There were significant correlations between visceral fat areas (r = −0.563, P &lt; 0.01) or serum levels of TG (r = −0.474, P &lt; 0.05) and GIR in MONW subjects. Multiple regression analyses showed that visceral fat areas (F = 7.702, P &lt; 0.02) and serum levels of TG (F = 7.114, P &lt; 0.05) were significantly associated with GIR in all (MONW and normal) subjects.
CONCLUSIONS—Increased visceral fat and serum levels of TG are associated with insulin resistance in Japanese MONW subjects with normal glucose tolerance. Excess visceral fat and elevated TG levels may play important roles in the development of insulin resistance in Japanese MONW subjects with normal glucose tolerance.
Does Low Bone Mineral Density Start in Post-Teenage Years in Women With Type 1 Diabetes?
Authors: Liu Emily Y. , Wactawski-Wende Jean , Donahue Richard P. , Dmochowski Jacek , Hovey Kathleen M. , Quattrin Teresa 
Published: March 2007

OBJECTIVE—Type 1 diabetes has been associated with decreased bone mineral density (BMD). However, the natural history and etiopathogenesis of osteoporosis in type 1 diabetes are not clear. The aims of this study were to assess BMD in a cohort of young women with type 1 diabetes compared with nondiabetic control subjects and to evaluate the possible association of BMD with diabetes duration, HbA1c, and biomarkers of bone metabolism.
RESEARCH DESIGN AND METHODS—BMD was measured by dual-energy X-ray absortiometry scan in 39 teenage (age 13–19 years) and 33 post-teenage females (age 20–37 years) with type 1 diabetes and 91 female age-matched control subjects. Serum osteocalcin, IGF-I, IGF binding protein-3 (IGFBP-3), HbA1c, and urine N-telopeptides were measured.
RESULTS—After adjustment for age and BMI, BMD values were significantly lower at the femoral neck and lateral spine in women with type 1 diabetes older than age 20 years compared with control subjects but not in the case subjects younger than age 20 years, nor at the anterio-posterior spine, wrist, or whole body. No association was found between BMD and diabetes duration or glycemic control. IGF-I, IGFBP-3, osteocalcin, and N-telopeptides were similar in diabetic subjects and control subjects.
CONCLUSIONS—This study indicates that women with type 1 diabetes exhibit BMD differences early in life with significant differences already present in the post-teenage years. Lower hip BMD in these young women may explain, in part, the higher incidence of hip fracture experienced in postmenopausal women with type 1 diabetes.
Microalbuminuria and Mortality in Long-Duration Type 1 Diabetes
Authors: Allen Kate V. , Walker James D. 
Published: March 2007

OBJECTIVE—Microalbuminuria is a recognized risk factor for increased mortality and renal failure in type 1 diabetes. Whether it remains a powerful predictor in patients with a long duration of type 1 diabetes is not known. We ascertained the prognostic significance of abnormal urinary albumin excretion in a cohort of patients with at least 30 years of type 1 diabetes.
RESEARCH DESIGN AND METHODS—A total of 190 patients with a disease duration of type 1 diabetes of at least 30 years with baseline and 5 years of follow-up.
RESULTS—At baseline 66% were normoalbuminuric, and at 5 years 11% of this cohort had died. Of the 22% who were microalbuminuric at baseline, 26% had died, and of the 8% with persistent proteinuria at baseline, 44% had died. Of the 4% with end-stage renal failure at baseline, 71% had died within 5 years. Death was attributable to a cardiovascular cause in two-thirds of the cases in all groups.
CONCLUSIONS—Even in those with a long duration of type 1 diabetes, the presence of abnormal urinary excretion remains a powerful predictor of increased mortality.
APOE Polymorphism and the Progression of Diabetic Nephropathy in Japanese Subjects With Type 2 Diabetes
Authors: Araki Shin-ichi , Koya Daisuke , Makiishi Tetsuya , Sugimoto Toshiro , Isono Motohide , Kikkawa Ryuichi , Kashiwagi Atsunori , Haneda Masakazu 
Published: March 2007

OBJECTIVE—The aim of this study is to clarify the conflicting results of the ε2/ε3/ε4 APOE polymorphism as a risk factor on diabetic nephropathy by a cohort study.
RESEARCH DESIGN AND METHODS—A total of 429 Japanese subjects with type 2 diabetes and with normoalbuminuria (n = 299) or with microalbuminuria (n = 130) were enrolled in a prospective observational follow-up study during 1995–1998 and followed until 2001 (for at least 3 years). The endpoint was the occurrence of a renal event defined as the progression to a higher stage of diabetic nephropathy.
RESULTS—During the study (the mean follow-up period: 4.4 ± 1.0 years), 31 of 429 subjects progressed: 21 from normoalbuminuria to microalbuminuria and 10 from microalbuminuria to overt proteinuria. The allele frequency of the APOE polymorphism was significantly different between the progressors and the nonprogressors. Eight of 42 ε2 carriers (19%) progressed, whereas 23 of 387 noncarriers (6%) progressed with a relative risk of 3.2 (95% CI 1.5–6.7). When subjects were stratified by renal status at baseline, each relative risk for the progression in the ε2 carriers was 2.7 (0.99–7.4) in those with normoalbuminuria and 4.2 (1.3–13.3) in those with microalbuminuria. Furthermore, when analyzed only in subjects with normoalbuminuria and short duration of diabetes (&lt;15 years) at baseline, the risk in the ε2 carriers became higher to 3.2 (1.2–8.8).
CONCLUSIONS—Our follow-up study indicates that the ε2 allele of the APOE polymorphism is a prognostic risk factor for both the onset and the progression of diabetic nephropathy in Japanese type 2 diabetes.
Effects of Clinical Nutrition Education and Educator Discipline on Glycemic Control Outcomes in the Indian Health Service
Authors: Wilson Charlton , Brown Tammy , Acton Kelly , Gilliland Susan 
Published: March 2007

OBJECTIVE—We used the Indian Health Service (IHS) Diabetes Care and Outcomes Audit to assess the effectiveness of clinical nutrition education in reducing HbA1c levels and to test the relative effectiveness of clinical nutrition education when it was delivered by a registered dietitian (RD) compared with an educator from another discipline (non-RD).
RESEARCH DESIGN AND METHODS—We examined clinical care data collected by the IHS Diabetes Care and Outcomes Audit of 7,490 medical records during 2001. Glycemic control was assessed by using the difference between the two most recent HbA1c levels during 2001. Age, BMI, duration of diabetes, type of treatment, proteinuria, and facility were included as covariates. Clinical nutrition education was defined as documentation in the record of any diet instruction and educator discipline classified as RD or non-RD. ANCOVA methods were used to assess the effects of diet education and educator discipline on differences between the two HbA1c measurements and to adjust for differences in the distribution of covariates among the education groups.
RESULTS—After adjustment for age, sex, type of treatment, duration of diabetes, BMI, initial HbA1c level, and clinical facility, clinical nutrition education and educator discipline were each associated with changes in HbA1c levels (P &lt; 0.001). Those receiving clinical nutrition education from an RD or from an RD as well as a non-RD had the largest improvements in HbA1c levels (−0.26 and −0.32, respectively) compared with those receiving either only non-RD or no clinical nutrition education (−0.19 and −0.10, respectively).
CONCLUSIONS—Clinical nutrition education in the IHS is associated with favorable trends in glycemic control. To be effective, clinical nutrition education should be delivered by an RD or a team that includes an RD.