bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Dual Blockade With Candesartan and Lisinopril in Hypertensive Patients With Diabetes
Authors: Andersen Niels H. , Poulsen Per. L , Knudsen Søren T. , Poulsen Steen H. , Eiskjær Hans , Hansen Klavs W. , Helleberg Kjeld , Mogensen Carl E. 
Published: March 2007

OBJECTIVE—To assess and compare the long-term effects of the combination of candesartan and lisinopril with high-dose lisinopril on systolic blood pressure in patients with hypertension and diabetes.
RESEARCH DESIGN AND METHODS—This was a prospective, randomized, parallel-group, double-blind, double-dummy study with a 12-month follow-up. Drug therapy was either lisinopril 40 mg once daily or dual-blockade treatment with candesartan 16 mg once daily and lisinopril 20 mg once daily. The study comprised 75 type 1 and type 2 diabetic patients aged 35–74 years. The main outcome measures were seated and 24-h ambulatory systolic blood pressure.
RESULTS—Reduction in systolic blood pressure (24-h systolic blood pressure) reduction was obtained in both treatment arms (mean reduction at final follow-up: dual blockade 6 mmHg vs. lisinopril 2 mmHg), but no significant difference was found between dual-blockade and lisinopril 40 mg once daily (P = 0.10). Both treatments were generally well tolerated, and similar low rates of side effects were found in the two groups.
CONCLUSIONS—There was no statistically significant difference between lisinopril 40 mg once daily and lisinopril 20 mg in combination with candesartan 16 mg once daily in reducing systolic blood pressure in hypertensive patients with diabetes.
Pro-Active Call Center Treatment Support (PACCTS) to Improve Glucose Control in Type 2 Diabetes
Authors: Young Robert J. , Taylor Jean , Friede Tim , Hollis Sally , Mason James M. , Lee Pauline , Burns Edna , Long Andrew F. , Gambling Tina , New John P. , Gibson J. Martin 
Published: March 2007

OBJECTIVE— To determine whether Pro-Active Call Center Treatment Support (PACCTS), using trained nonmedical telephonists supported by specially designed software and a diabetes nurse, can effectively improve glycemic control in type 2 diabetes.
RESEARCH DESIGN AND METHODS— A randomized controlled implementation trial of 1-year duration was conducted in Salford, U.K. The trial comprised 591 randomly selected individuals with type 2 diabetes. By random allocation, 197 individuals were assigned to the usual care (control) group and 394 to the PACCTS (intervention) group. Lifestyle advice and drug treatment in both groups followed local guidelines. PACCTS patients were telephoned according to a protocol with the frequency of calls proportional to the last HbA1c level. The primary outcome was absolute reduction in HbA1c, and the secondary outcome was the proportion of patients reducing HbA1c by at least 1%.
RESULTS— A total of 332 patients (84%) in the PACCTS group and 176 patients (89%) in the control group completed the study. Final HbA1c values were available in 374 patients (95%) in the PACCTS group and 180 patients (92%) in the usual care group. Compared with usual care, HbA1c improved by 0.31% (95% CI 0.11–0.52, P = 0.003) overall in the PACCTS patients. For patients with baseline HbA1c &gt;7%, the improvement increased to 0.49% (0.21–0.77, P &lt; 0.001), whereas in patients with baseline HbA1c &lt;7% there was no change. The difference in the proportions of patients achieving a ≥1% reduction in HbA1c significantly favored the PACCTS intervention: 10% (4–16, P &lt; 0.001) overall and 15% (7–24, P &lt; 0.001) for patients with baseline HbA1c &gt;7%.
CONCLUSIONS— In an urban Caucasian trial population with blood glucose HbA1c &gt;7%, PACCTS facilitated significant improvement in glycemic control. Further research should extend the validity of findings to rural communities and other ethnic groups, as well as to smoking and lipid and blood pressure control.
Acceptability and Satisfaction With a Telecarer Approach to the Management of Type 2 Diabetes
Authors: Long Andrew F. , Gambling Tina , Young Robert J. , Taylor Jean , Mason James M. ,   on behalf of the PACCTS Team
Published: March 2007

OBJECTIVE—To examine patients’ views of the acceptability of and satisfaction with telephone care center support provided to improve blood glucose control in type 2 diabetes.
RESEARCH DESIGN AND METHODS—The Pro-Active Call-Center Treatment Support (PACCTS) Trial randomized patients from 47 general practices in a deprived urban area in northwest England to usual care or to proactive call center support in addition to usual care. Satisfaction with care was assessed in all 591 patients at baseline and the end of the study using the Diabetes Satisfaction and Treatment Questionnaire (DTSQ). Acceptability was assessed in 394 intervention patients after at least three proactive calls from the call center and at the end of the trial. A purposive sample of 25 patients took part in in-depth semistructured interviews.
RESULTS—The response rates to the questionnaires were 79% (DTSQ) and 65% (acceptability). Persons receiving the intervention continued to report high levels of satisfaction with their treatment (95% CI 32.3–33.2 at 1 year), and &gt;90% strongly agreed or agreed that the telecarer approach was acceptable. Qualitative comments pointed to the importance of a personalized service; increased feelings of well-being, including confidence and self-control; help with problem-solving; and patients developing rapport and a strong bond with the telecarers.
CONCLUSIONS—A personalized PACCTS approach is acceptable to patients. A service giving priority to the interpersonal dimension leads to increased commitment from patients to improve long-term glycemic control.
Secondary Attack Rate of Type 1 Diabetes in Colorado Families
Authors: Steck Andrea K. , Barriga Katherine J. , Emery Lisa M. , Fiallo-Scharer Rosanna V. , Gottlieb Peter A. , Rewers Marian J. 
Published: March 2007

OBJECTIVE—Families of children diagnosed with type 1 diabetes require counseling concerning type 1 diabetes risk in nondiabetic siblings and parents. No U.S. population–specific life-table risk estimates are currently available for parents, and those for siblings (2–6% by age 20 years) are based on family studies completed before 1987.
RESEARCH DESIGN AND METHODS—We analyzed family histories of 1,586 patients in Colorado with type 1 diabetes (83% non-Hispanic white, 10% Hispanic, and 7% other) diagnosed before 16 years of age and interviewed during 1999–2002. Families of probands with type 2, undetermined, or secondary diabetes (n = 53) or those with incomplete data (n = 137) were excluded. The median age at onset of the proband was 7.1 years and the median diabetes duration 3.5 years. Cumulative risk estimates were calculated using survival analysis for 2,081 full siblings and 3,016 biological parents.
RESULTS—In siblings, the overall risk of type 1 diabetes by age 20 years was 4.4%, but it was significantly (P &lt; 0.0001) higher in siblings of probands diagnosed under age 7 years than in those diagnosed later. In parents, the overall risk by age 40 years was 2.6% and higher in fathers (3.6%) than in mothers (1.7%) of probands (P &lt; 0.001). Similar to siblings, the risk was also higher (P = 0.006) in parents of probands diagnosed &lt;7 years of age than in those diagnosed later.
CONCLUSIONS—Current risks of type 1 diabetes in Colorado siblings and parents of type 1 diabetic probands are higher than in the 1982 Pittsburgh study but similar to contemporary European rates. Recurrence risk of type 1 diabetes is significantly higher in first-degree relatives of probands diagnosed at a young age.
Residual β-Cell Function and Male/Female Ratio Are Higher in Incident Young Adults Than in Children
Authors: Bruno Graziella , Cerutti Franco , Merletti Franco , Cavallo-Perin Paolo , Gandolfo Enrico , Rivetti Marina , Runzo Cristina , Pinach Silvia , Pagano Gianfranco ,   The Piedmont Study Group for Diabetes Epidemiology
Published: March 2007

OBJECTIVE— The hypothesis of age-dependent variations in epidemiologic and clinical features at onset of type 1 diabetes has been assessed in the registry of the province of Turin, Italy.
RESEARCH DESIGN AND METHODS— The study base is the population 0–29 years of age of the province of Turin, in the period from 1984 to 2000. Islet cell antibody (ICA), GAD antibody (GADA), antibodies to protein tyrosine phosphatase (IA2), and C-peptide were measured in subgroups of the cohort.
RESULTS— One thousand fifty-six incident cases have been identified (completeness of ascertainment 98.1%). Rates per 100,000 person-years were similar in males and females in the age-group 0–14 years (10.7, 95% CI 9.5–12.0 vs. 9.8, 8.6–11.1). In the age-group 15–29 years, males had higher risk than females (7.7, 6.9–8.6 vs. 5.3, 4.6–6.1; rate ratio, 1.46, 95% CI 1.23–1.74; P = 0.00002). Fasting plasma C-peptide values (n = 575) were twofold lower in the age-group 0–14 years than in the age-group 15–29 years (0.10 vs. 0.23 nmol/l; P &lt; 0.0001). Frequencies of ICA and IA2 positivities (n = 183) decreased with increasing age, whereas frequency of GADA positivity increased. Idiopathic cases were 12.6% and had higher mean values of fasting (0.28 vs. 0.14 nmol/l; P = 0.043) and stimulated C-peptide (0.59 vs. 0.34 nmol/l; P = 0.05). In logistic regression analyses, subjects with fasting C-peptide values in the upper quartile had higher likelihood of being older (odds ratio 1.20 for year, 95% CI 1.11–1.28), ICA negative (0.26, 0.10–0.70), and female (1.29, 0.48–3.42).
CONCLUSIONS— This study shows 1) sex differences in incidence rates in young adults; 2) better preserved β-cell function in young adults, in idiopathic cases (12%), and in ICA-negative cases; and 3) lower frequencies of ICA and IA2 positivities and higher frequency of GADA positivity in young adults than in children.
Quality of Diabetes Care in U.S. Academic Medical Centers
Authors: Grant Richard W. , Buse John B. , Meigs James B. ,   for the University HealthSystem Consortium (UHC) Diabetes Benchmarking Project Team
Published: March 2007

OBJECTIVE— To assess both standard and novel diabetes quality measures in a national sample of U.S. academic medical centers.
RESEARCH DESIGN AND METHODS— This retrospective cohort study was conducted from 10 January 2000 to 10 January 2002. It involved 30 U.S. academic medical centers, which contributed data from 44 clinics (27 primary care clinics and 17 diabetes/endocrinology clinics). For 1,765 eligible adult patients with type 1 or type 2 diabetes with at least two clinic visits in the 24 months before 10 January 2002, including one visit in the 6 months before 10 January 2002, we assessed measurement and control of HbA1c, blood pressure, and cholesterol and corresponding medical regimen changes at the most recent clinic visit.
RESULTS— In this ethnically and economically diverse cohort, annual testing rates were very high (97.4% for HbA1c, 96.6% for blood pressure, and 87.6% for total cholesterol). Fewer patients were at HbA1c goal (34.0% &lt;7.0%) or blood pressure goal (33.0% &lt;130/80 mmHg) than lipid goals (65.1% total cholesterol &lt;200 mg/dl, 46.1% with LDL cholesterol &lt;100 mg/dl). Only 10.0% of the cohort met recommended goals for all three risk factors. At the most recent clinic visit, 40.4% of patients with HbA1c concentrations above goal underwent adjustment of their corresponding regimens. Among untreated patients, few with elevated blood pressure (10.1% with blood pressure &gt;130/80 mmHg) or elevated LDL cholesterol (5.6% with LDL &gt;100 mg/dl) were started on corresponding therapy. Patients with type 2 diabetes were no less likely to be intensified than patients with type 1 diabetes.
CONCLUSIONS— High rates of risk factor testing do not necessarily translate to effective metabolic control. Low rates of medication adjustment among patients with levels above goal suggest a specific and novel target for quality improvement measurement.
Comparison of Pioglitazone and Gliclazide in Sustaining Glycemic Control Over 2 Years in Patients With Type 2 Diabetes
Authors: Tan Meng H. , Baksi Arun , Krahulec Boris , Kubalski Piotr , Stankiewicz Andrzej , Urquhart Richard , Edwards Gareth , Johns Don ,   for the GLAL Study Group
Published: March 2007

OBJECTIVE—The hypothesis that pioglitazone treatment is superior to gliclazide treatment in sustaining glycemic control for up to 2 years in patients with type 2 diabetes was tested.
RESEARCH DESIGN AND METHODS—This was a randomized, multicenter, double-blind, double-dummy, parallel-group, 2-year study. Approximately 600 patients from 98 centers participated. Eligible patients had completed a previous 12-month study and consented to continue treatment for a further year. To avoid selection bias, all patients from all centers were included in the primary analysis (a comparison of the time-to-failure distributions of the two groups by using a log-rank test) regardless of whether they continued treatment for a 2nd year. By using repeated-measures ANOVA, time course of least square means of HbA1c and homeostasis model of assessment (HOMA) indexes (HOMA-%S and HOMA-%B) were analyzed.
RESULTS—A greater proportion of patients treated with pioglitazone maintained HbA1c &lt;8% over the 2-year period than those treated with gliclazide. A difference between the Kaplan-Meier curves was apparent as early as week 32 and widened at each time point thereafter, becoming statistically significant from week 52 onward. At week 104, 129 (47.8%) of 270 pioglitazone-treated patients and 110 (37.0%) of 297 gliclazide-treated patients maintained HbA1c &lt;8%. Compared with gliclazide treatment, pioglitazone treatment produced a larger decrease in HbA1c, a larger increase in HOMA-%S, and a smaller increase in HOMA-%B during the 2nd year of treatment.
CONCLUSIONS—Pioglitazone is superior to gliclazide in sustaining glycemic control in patients with type 2 diabetes during the 2nd year of treatment.
Effects of Exercise on the Absorption of Insulin Glargine in Patients With Type 1 Diabetes
Authors: Peter Rajesh , Luzio Stephen D. , Dunseath Gareth , Miles Andy , Hare Barry , Backx Karianne , Pauvaday Vassen , Owens David R. 
Published: March 2007

OBJECTIVE—To study the effects of exercise on the absorption of the basal long-acting insulin analog insulin glargine (Lantus), administered subcutaneously in individuals with type 1 diabetes.RESEARCH DESIGN AND METHODS—A total of 13 patients (12 men, 1 woman) with type 1 diabetes on a basal-bolus insulin regimen were studied. 125I-labeled insulin glargine at the usual basal insulin dose was injected subcutaneously into the thigh on the evening (2100) before the study day on two occasions 1 week apart. Patients were randomly assigned to 30 min intense exercise (65% peak oxygen uptake [Vo2peak]) on one of these visits. The decay of radioactive insulin glargine was compared on the two occasions using a thallium-activated Nal gamma counter. Blood samples were collected at regular intervals on the study days to assess plasma glucose and insulin profiles.RESULTS—No significant difference was found in the 125I-labeled insulin glargine decay rate on the two occasions (exercise vs. no exercise; repeated-measures ANOVA, P = 0.548). As expected, a significant fall in plasma glucose was observed over the exercise period (area under curve above fasting [ΔAUC] glucose: −0.39 ± 0.11 vs. −1.30 ± 0.16 mmol · l−1 · h−1; nonexercise vs. exercise; P = 0.001), but insulin levels did not differ significantly on the two occasions (ΔAUC insulin: −2.1 ± 3.9 vs. 1.5 ± 6.2 pmol · l−1 · h−1; nonexercise versus exercise; P = 0.507).CONCLUSIONS—An intense 30-min period of exercise does not increase the absorption rate of the subcutaneously injected basal long-acting insulin analog insulin glargine in patients with type 1 diabetes.
Diabetes and the Risk of Lung Cancer
Authors: Hall Gillian C. , Roberts C. Michael , Boulis Magdy , Mo Jingping , MacRae Kenneth D. 
Published: March 2007

OBJECTIVE—The incidence of some cancers has been reported to be higher in diabetic patients than in the general population. We estimated the incidence of lung cancer in diabetic patients and investigated the hypothesis that the rate of lung cancer is different in diabetic compared with nondiabetic patients.RESEARCH DESIGN AND METHODS—Diabetic patients and age-, sex-, and general practice-matched nondiabetic control subjects were identified from U.K. computerized general practice records (General Practice Research Database), and these records searched for any incident lung cancer, demographic details, and smoking status. Primary lung cancer incidence was calculated and rates compared between diabetic patients and nondiabetic control subjects using multivariate Cox regression, adjusting for age, sex, and smoking. The comparison was repeated for incident diabetic patients followed from diagnosis and after stratifying by diabetic treatment.RESULTS—The incidence of primary lung cancer in all 66,848 diabetic patients was 1.63 per 1,000 patient-years (95% CI 1.48–1.79) and 2.05 per 1,000 patient-years (1.76–2.38) among diabetic patients followed from diagnosis. When compared with nondiabetic control subjects, the hazard ratio was 0.88 (0.79–0.97) for all diabetic patients and 1.12 (0.95–1.34) for those followed from diagnosis. When observation was truncated to allow for shorter life expectancy, the hazard ratio for the total cohort was 0.98 (0.84–1.13), and no association was found with any treatment group.CONCLUSIONS—No increased risk of lung cancer in diabetes was found. We hypothesize that the lower incidence may be partly due to shorter life expectancy.
Clinical Inertia in Response to Inadequate Glycemic Control
Authors: Shah Baiju R. , Hux Janet E. , Laupacis Andreas , Zinman Bernard , van Walraven Carl 
Published: March 2007

OBJECTIVE—Diabetic patients with inadequate glycemic control ought to have their management intensified. Failure to do so can be termed “clinical inertia.” Because data suggest that specialist care results in better control than primary care, we evaluated whether specialists demonstrated less clinical inertia than primary care physicians.
RESEARCH DESIGN AND METHODS—Using administrative data, we studied all non-insulin-requiring diabetic patients in eastern Ontario aged 65 or older who had A1c results &gt;8% between September 1999 and August 2000. Drug intensification was measured by comparing glucose-lowering drug regimens in 4-month blocks before and after the elevated A1c test and was defined as 1) the addition of a new oral drug, 2) a dose increase of an existing oral drug, or 3) the initiation of insulin. Propensity score-based matching was used to control for confounding between groups.
RESULTS—There were 591 patients with specialist care and 1,911 with exclusively primary care. In the matched cohorts, 45.1% of patients with specialist care versus 37.4% with primary care had drug intensification (P = 0.009). Most of this difference was attributed to specialists’ more frequent initiation of insulin in response to elevated A1c.
CONCLUSIONS—Fewer than one-half of patients with high A1c levels had intensification of their medications, regardless of specialty of their physician. Specialists were more aggressive with insulin initiation than primary care physicians, which may contribute to the lower A1c levels seen with specialist care. Interventions assisting patients and physicians to recognize and overcome clinical inertia should improve diabetes care in the population.
Generalizability and Persistence of a Multifaceted Intervention for Improving Quality of Care for Rural Patients With Type 2 Diabetes
Authors: Johnson Jeffrey A. , Eurich Dean T. , Toth Ellen L. , Lewanczuk Richard Z. , Lee TK , Majumdar Sumit R. 
Published: March 2007

OBJECTIVE—Most quality improvement efforts for type 2 diabetes have neglected cardiovascular risk factors and are limited by a lack of information about generalizability across settings or persistence of effect over time.RESEARCH DESIGN AND METHODS—We previously reported 6-month results of a controlled study of an intervention that improved cardiovascular risk factors for rural patients with type 2 diabetes. We subsequently provided the identical intervention to the control region after the main study was completed. The primary outcome was 10% improvement in systolic blood pressure, total cholesterol, or HbA1c. We compared the previously reported 6-month effect of the original intervention with the effect of the crossed-over intervention to the former control region and remeasured outcomes in the original intervention region 12 months later.RESULTS—Our analysis included 200 original intervention and 181 crossed-over intervention subjects. The age of the population was 62.4 ± 12.4 years (mean ± SD), and 54.3% were women. A similar proportion of patients in the crossed-over intervention group achieved improvement in the primary composite outcome compared with the original intervention group (38 vs. 44%, respectively; P = 0.29). In adjusted analyses, we observed less improvement in blood pressure (adjusted odds ratio 0.40 [95% CI 0.17–0.75]) but greater improvements in total cholesterol (1.86 [0.93–3.7]) with the crossed-over intervention compared with the original intervention. We observed sustained improvements in total cholesterol and HbA1c levels in the original intervention group, whereas previous large gains in control of blood pressure diminished over time.CONCLUSIONS—We found that our intervention was generalizable across settings, and its effect persisted over time. Nevertheless, without ongoing intervention or reinforcement, we noted some loss of the original benefits that had accrued. Future translational work should incorporate interventions such as ours into ongoing systems of rural care.
Increased Urinary Albumin Excretion, Insulin Resistance, and Related Cardiovascular Risk Factors in Patients With Type 2 Diabetes
Authors: De Cosmo Salvatore , Minenna Antonio , Ludovico Oznelle , Mastroianno Sandra , Di Giorgio Anna , Pirro Leonardo , Trischitta Vincenzo 
Published: March 2007

OBJECTIVE—While the relevant role of insulin resistance in the pathogenesis of increased urinary albumin excretion (UAE) is well established in type 1 diabetes, its contribution in type 2 diabetes is controversial. Our aim was to investigate whether insulin resistance was associated with increased UAE in a large cohort of patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS— A total of 363 men and 349 women, aged 61 ± 9 years, with a disease duration of 11 ± 9 years and HbA1c levels of 8.6 ± 2.0% were included. Insulin resistance was derived from the homeostasis model assessment of insulin resistance (HOMAIR), and UAE was derived from the albumin-to-creatinine ratio (ACR) defined as increased if the value was ≥2.5 mg/mmol in men and ≥3.5 mg/mmol in women. ACR was correlated with HOMAIR (r = 0.15, P = 0.0001), independently of age, disease duration, blood pressure, HbA1c, triglycerides, waist circumference, and smoking.
RESULTS—When the two sexes were investigated separately, a significant correlation between ACR and HOMAIR was reached in men (n = 363; r = 0.21, P = 0.0001) but not women (n = 349; r = 0.08, P = 0.14), suggesting that insulin resistance and sex may interact (P for interaction = 0.04) in determining UAE. When men were subgrouped into quartiles of HOMAIR, those of the third and fourth quartile (i.e., the most insulin resistant) were at higher risk to have increased ACR than patients of the first quartile (third quartile: odds ratio 2.2 [95% CI 1.2–4.2], P = 0.01) (fourth quartile: 4.1 [2.2–7.9], P = 0.00002). Finally, ACR was significantly higher in men with two or more insulin resistance–related cardiovascular risk factors (i.e., abdominal obesity, dyslipidemia, and arterial hypertension) than in men with fewer than two insulin resistance–related cardiovascular risk factors (0.90 [0.2–115.1] vs. 1.56 [0.1–1367.6], respectively, P = 0.005).
CONCLUSIONS—In type 2 diabetic patients, increased UAE is strongly associated with insulin resistance and related cardiovascular risk factors. This association seems to be stronger in men than in women.