bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Burden of Diabetes-Associated Cardiovascular Hospitalizations in Veterans Administration (VA) and Non-VA Medical Facilities
Authors: Smith Nicholas L. , Maynard Charles 
Published: March 2007

OBJECTIVE—This study examines the relative burden of cardiovascular disease in diabetic and nondiabetic admissions to Veterans Administration (VA) and non-VA hospitals.
RESEARCH DESIGN AND METHODS—Calendar year 1997 hospitalization data were collected from the VA Patient Treatment File and the National Hospital Discharge Survey, National Center for Health Statistics. Discharge diagnoses based on ICD-9 codes were used to classify cardiovascular events and procedures and diabetes. Proportionate hospitalization ratios (PHRs) were calculated based on the number of cardiovascular hospitalizations from among all hospitalizations.
RESULTS—We identified 119,653 VA hospitalizations (19.1%) and 3,765,696 non-VA hospitalizations (16.8%) that coded diabetes among the discharge diagnoses. Cardiovascular hospitalizations, primarily coronary in origin, accounted for nearly 50% of all hospitalizations of persons with diabetes within VA and non-VA medical care systems. Coronary events and procedures (PHR = 1.85 and 1.68) and, to a lesser extent, cerebrovascular events and procedures (PHR = 1.55 and 1.33) were more common in VA hospitalizations where diabetes was listed as a comorbidity than in VA hospitalizations where diabetes was not listed. The burden of coronary hospitalizations was larger in VA than non-VA facilities for men (PHR = 1.82 vs. 1.66) and smaller in VA than non-VA facilities for women (PHR = 3.11 vs. 3.44) in age and race-standardized analyses. The burden of coronary hospitalization was higher for whites and blacks in VA facilities (PHR = 1.83 and 2.01) when compared with non-VA facilities (PHR = 1.68 and 1.84).
CONCLUSIONS—The burden of cardiovascular hospitalizations is not equally borne across hospitalizations with and without diabetes and across VA and non-VA facilities.
Quality Improvement Initiatives
Authors: Hayward Rodney A. , Hofer Timothy P. , Kerr Eve A. , Krein Sarah L. 
Published: March 2007

OBJECTIVE—To outline the principles that direct the Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) dedicated to diabetes quality improvement (QUERI-DM).
RESEARCH DESIGN AND METHODS—We discuss the VA initiatives aimed at improving diabetes care for veterans as well as general issues that should be considered in quality improvement initiatives. We specifically describe some of the epidemiological, statistical, and organizational issues that have guided our quality improvement (QI) programs.
RESULTS—The five principles that have guided the QUERI-DM process are: 1) treating clinical guidelines and goals distinct from quality standards and quality improvement priorities; 2) targeting high-risk patients and high-impact quality issues; 3) profiling processes over outcomes; 4) targeting processes that will improve patient outcomes; and 5) paying attention to the loci of practice variation.
CONCLUSIONS—The authors recommend that all five principles be considered when moving from practice guidelines to performance measures and QI initiatives. Targeting high-priority problems and high-risk groups can greatly improve the effectiveness and efficiency of QI interventions.
Diabetes Quality Improvement in Department of Veterans Affairs Ambulatory Care Clinics
Authors: Reiber Gayle E. , Au David , McDonell Mary , Fihn Stephan D. 
Published: March 2007

OBJECTIVE— To conduct a group-randomized clinical trial to determine whether regular feedback to primary care providers of synthesized information on patients’ health, function, and satisfaction would demonstrate improved outcomes for their patients with diabetes.
RESEARCH DESIGN AND METHODS—Patients in General Internal Medicine Clinics Department of Veterans Affairs (VA) Medical Centers were randomized into seven intervention or control firms. Patient self-reported information was collected by mail on general health, diabetes, and up to five other chronic conditions. Patients with diabetes received the Seattle Diabetes Questionnaire, the 36-item Medical Outcomes Study short form (SF-36), and a validated patient satisfaction questionnaire at regular intervals. Data from self-report, clinical, pharmacy, and laboratory sources were synthesized into patient-specific feedback reports that intervention providers received before patients’ visits.
RESULTS—The timely delivery to primary care providers of state-of-the-art patient-feedback reports that identified patient issues and areas for improvement did not result in significant improvements in patient outcomes between the intervention and control firms.
CONCLUSIONS—Outcomes in diabetic patients whose providers received synthesized patient data before visits were no better than in those receiving care from control firms. Future studies may benefit from substantial involvement in patients discussing, problem solving, and goal setting in addition to use of timely synthesized patient data.
Diabetes Process and Outcome Measures in the Department of Veterans Affairs
Authors: Sawin Clark T. , Walder Debby J. , Bross Dean S. , Pogach Leonard M. 
Published: March 2007

OBJECTIVE—To evaluate performance of process and outcome measures in the care of patients with diabetes seen in Department of Veterans Affairs (VA) facilities.
RESEARCH DESIGN AND METHODS—Retrospective audits of records and databases were conducted on randomly selected patients with diabetes over 5 years (1995 [baseline] and 1997–2000) in 22 VA networks. Performance on diabetes-specific and preventive processes was measured.
RESULTS—Nationally, significant improvements over time were observed for all measures (P &lt; 0.001). For example, the percentage of patients receiving a dilated retinal examination rose from 44% in 1995 to 67% in 2000. The percentage of patients who received a urinary protein test rose from 23% in 1997 to 54% in 2000. Those who received influenza vaccination rose from 34% in 1995 to 78% in 2000. However, there was significant regional variation among all measures.
CONCLUSIONS—Adherence to diabetes-specific and preventive care measures in the VA improved from 1997 to 2000 compared with a 1995 baseline. The improvement occurred in a setting of the provision of guidelines, the contractual setting of specific targets, and the timely feedback of results to medical center and network directors. Future studies are needed to determine whether adherence to these measures will decrease the rates of complications in VA patients with diabetes.
Metabolic Syndrome Variables at Low Levels in Childhood Are Beneficially Associated With Adulthood Cardiovascular Risk
Authors: Chen Wei , Srinivasan Sathanur R. , Li Shengxu , Xu Jihua , Berenson Gerald S. 
Published: March 2007

OBJECTIVE—Most epidemiologic studies have focused on the adverse impact of the metabolic syndrome on cardiovascular (CV) disease. However, information on the relationship between the clustering of metabolic syndrome variables at favorable levels in childhood and the measures of CV risk in adulthood is not known.
RESEARCH DESIGN AND METHODS—The study cohort included 1,474 individuals (552 blacks and 922 whites) who were examined for CV risk factors in childhood (aged 4–17 years) and again in adulthood (aged 19–41 years) in Bogalusa, Louisiana, during 1982–2003, with an average follow-up period of 15.8 years.
RESULTS—In childhood, 9.0% of the cohort displayed clustering of three- or four-criterion risk variables at the bottom quartiles of BMI, homeostasis model assessment of insulin resistance, systolic blood pressure, and total–to–HDL cholesterol ratio. The clustering was significantly higher than expected by chance alone (P &lt; 0.01). These children, compared with those having clustering of less than three risk variables at the bottom quartiles, had a lower prevalence of metabolic syndrome in adulthood (clustering at top quartiles) (3.8 vs. 14.6%, P &lt; 0.001). A higher prevalence of clustering of risk variables at low levels in childhood was associated with negative parental histories of coronary heart disease (9.4 vs. 5.0%, P = 0.024) and hypertension (10.5 vs. 6.6%, P = 0.012). Mean values of carotid intima-media thickness in adulthood decreased with an increasing number of risk variables clustering at the bottom quartiles in childhood (P for trend = 0.013).
CONCLUSIONS—The constellation of metabolic syndrome variables at low levels in childhood is associated with lower measures of CV risk in adulthood.
Antidiabetic Drugs and Heart Failure Risk in Patients With Type 2 Diabetes in the U.K. Primary Care Setting
Authors: Maru Shoko , Koch Gary G. , Stender Monika , Clark Douglas , Gibowski Laura , Petri Hans , White Alice D. , Simpson Ross J. 
Published: March 2007

OBJECTIVE—To assess the effects of antidiabetic drugs on the risk of heart failure in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—We conducted a retrospective cohort study with a newly diagnosed diabetes cohort of 25,690 patients registered in the U.K. General Practice Research Database, 1988–1999. We categorized person-time drug exposures to monotherapies in insulin, sulfonylureas (SUs), metformins, and other oral hypoglycemic agents (i.e., acarbose, guar gum) and combination therapy including insulin, combination therapy without insulin, and triple combination therapy with or without insulin. A drug-free time interval served as a reference category. Cox interval-wise (piece-wise) regression analyses were used. The main outcome was incident heart failure.
RESULTS—Among 43,390 drug exposure intervals for 25,690 patients who had a mean follow-up period of 2.5 years, 1,409 patients developed heart failure. Heart failure occurred most frequently in SU monotherapy exposure. After adjusting for duration of diabetes, the timing and order of treatments received, and known risk factors for heart failure, we found no differential effects among type-specific therapies. Patients with any drug use within the first year after diabetes diagnosis had a 4.75-fold higher risk (hazard ratio) for heart failure than those with drug-free status but had no increased risk during subsequent years.
CONCLUSIONS—In conclusion, the use of any pharmacological therapy for type 2 diabetes appears to be associated with an increased risk of heart failure. This risk does not persist beyond the first year after diagnosis of diabetes and does not appear to differ among the types of drug therapy examined. This observation suggests that the severity of diabetes or the preclinical duration of diabetes and the need for drug therapy, and not the therapy itself, is an explanation for heart failure in patients with type 2 diabetes.
Randomized Effectiveness Trial of a Computer-Assisted Intervention to Improve Diabetes Care
Authors: Glasgow Russell E. , Nutting Paul A. , King Diane K. , Nelson Candace C. , Cutter Gary , Gaglio Bridget , Rahm Alanna Kulchak , Whitesides Holly 
Published: March 2007

OBJECTIVE—There is a well-documented gap between diabetes care guidelines and the services received by patients in most health care settings. This report presents 12-month follow-up results from a computer-assisted, patient-centered intervention to improve the level of recommended services patients received from a variety of primary care settings.
RESEARCH DESIGN AND METHODS—A total of 886 patients with type 2 diabetes under the care of 52 primary care physicians participated in the Diabetes Priority Program. Physicians were stratified and randomized to intervention or control conditions and evaluated on two primary outcomes: number of recommended laboratory screenings and recommended patient-centered care activities completed from the National Committee on Quality Assurance/American Diabetes Association Provider Recognition Program (PRP). Secondary outcomes were evaluated using the Problem Areas in Diabetes 2 quality of life scale, lipid and HbA1c levels, and the Patient Health Questionnaire-9 depression scale.
RESULTS—The program was well implemented and significantly improved both the number of laboratory assays and patient-centered aspects of diabetes care patients received compared with those in the control condition. There was overall improvement on secondary outcomes of lipids, HbA1c, quality of life, and depression scores; between-condition differences were not significant.
CONCLUSIONS—Staff in small, mixed-payer primary care offices can consistently implement a patient-centered intervention to improve PRP measures of quality of diabetes care. Alternative explanations for why these process improvements did not lead to improved outcomes, and suggested directions for future research are discussed.
Hyperglycemia Is Associated With Adverse Outcomes in Patients Receiving Total Parenteral Nutrition
Authors: Cheung N. Wah , Napier Brett , Zaccaria Cathy , Fletcher John P. 
Published: March 2007

OBJECTIVE—Hyperglycemia is associated with poor clinical outcomes and mortality in myocardial infarction, stroke, and general hospital patients. However, there are few data regarding the effect of hyperglycemia on outcomes in patients receiving total parenteral nutrition (TPN), a therapy that predisposes patients to hyperglycemia. The aim of this study was to determine whether elevated blood glucose levels are associated with adverse outcomes in patients receiving TPN.RESEARCH DESIGN AND METHODS—A retrospective analysis was undertaken from the medical records of 111 patients (122 treatment episodes) receiving TPN. All patients had blood drawn daily for the measurement of blood glucose levels. Outcome measures were assessed as a function of mean daily blood glucose levels while receiving TPN.RESULTS—Increased blood glucose levels were associated with an increased risk of cardiac complications (odds ratio 1.61, 95% CI 1.09–2.37, P = 0.02), infection (1.4, 1.08–1.82, P = 0.01), systemic sepsis (1.36, 1.00–1.86, P = 0.05), acute renal failure (1.47, 1.00–2.17, P = 0.05), and death (1.77, 1.23–2.52, P &lt; 0.01). When the data were examined by quartiles of blood glucose levels, the mortality of subjects in the highest quartile was 10.9 times (95% CI 2.0–60.5, P &lt; 0.01) that of subjects in the lowest quartile, and the risk of developing any complication was 4.3 times higher (1.4–13.1, P &lt; 0.01). These effects were independent of age, sex, or prior diabetes status.CONCLUSIONS—Hyperglycemia is a predictor of poor outcomes in patients receiving TPN. The confirmation of a relation between blood glucose levels and adverse outcomes provides support for tight glycemic control in these patients.
Frequency and Timing of Severe Hypoglycemia Affects Spatial Memory in Children With Type 1 Diabetes
Authors: Hershey Tamara , Perantie Dana C. , Warren Stacie L. , Zimmerman Emily C. , Sadler Michelle , White Neil H. 
Published: March 2007

OBJECTIVE—Repeated severe hypoglycemia has been reported to reduce long-term spatial memory in children with type 1 diabetes. Early exposure to hypoglycemia may be more damaging to cognitive function than later exposure. Our goal was to determine whether the age at which severe hypoglycemia occurs modulates the impact of severe hypoglycemia frequency on long-term spatial memory.
RESEARCH DESIGN AND METHODS—We combined data from three independent studies to obtain a sample of children aged 6–18 years with type 1 diabetes (n = 103) and nondiabetic control subjects (n = 60). Each study evaluated previous severe hypoglycemia and tested short (5 s)- and long (60 s)-delay spatial memory with the spatial delayed response task. Type 1 diabetic participants were categorized as having zero, one to two, or three or more severe hypoglycemic episodes and as having their first severe hypoglycemic episode before or after 5 years of age. Information on chronic hyperglycemia (HbA1c values) was also collected.
RESULTS—We found that repeated severe hypoglycemia (more than three episodes) reduced long-delay spatial delayed response performance, particularly when severe hypoglycemic episodes began before the age of 5 years. Age of type 1 diabetes onset and estimates of chronic hyperglycemia did not influence performance.
CONCLUSIONS—High frequency of and early exposure to severe hypoglycemia during development negatively affects spatial long-term memory performance.
Dose Response of Inhaled Dry-Powder Insulin and Dose Equivalence to Subcutaneous Insulin Lispro
Authors: Rave Klaus M. , Nosek Leszek , de la Peña Amparo , Seger Mary , Ernest Charles S. , Heinemann Lutz , Batycky Richard P. , Muchmore Douglas B. 
Published: March 2007

OBJECTIVE—To determine the pharmacokinetic (PK) and glucodynamic (GD) dose response of human insulin inhalation powder (HIIP) delivered via AIR particle technology and dose equivalence to subcutaneous (SC) insulin lispro.
RESEARCH DESIGN AND METHODS—Twenty healthy, nonsmoking, male or female subjects (aged 29.6 ± 6.9 years, BMI 23.2 ± 2.3 kg/m2, means ± SD) with normal forced vital capacity and forced expiratory volume were enrolled in an open-label, randomized, seven-period, euglycemic glucose clamp, cross-over trial. Each subject received up to four single doses of HIIP (2.6, 3.6, 5.2, or 7.8 mg) and three doses of SC lispro (6, 12, or 18 units) from 5 to 18 days apart.
RESULTS—HIIP demonstrated a similar rapid onset but an extended time exposure and a prolonged duration of effect (late t50% 412 vs. 236 min, P &lt; 0.001) compared with SC lispro. The HIIP versus SC lispro doses of 2.6 mg vs. 6 units, 5.2 mg vs. 12 units, and 7.8 mg vs. 18 units achieved similar PK area under the serum immunoreactive insulin (IRI) concentration-versus-time curve from time zero until the serum IRI concentrations returned to the predose baseline value [AUC(0-t′)] and GD (Gtot) responses. The median insulin (tmax) was not different between HIIP and SC lispro (45 min for both), although the median time of return to baseline for PK was apparently longer for HIIP compared with SC lispro (480 vs. 360 min). Relative bioavailability and relative biopotency of HIIP were consistent across doses (8 and 9%).
CONCLUSIONS—While the time-action profile was longer for HIIP than for SC lispro, both treatments showed rapid initial absorption and similar overall PK exposure and GD effect. HIIP was as well tolerated as SC lispro, thereby offering a promising alternative to injectable insulin therapy.
Evaluating the Clinical Accuracy of Two Continuous Glucose Sensors Using Continuous Glucose–Error Grid Analysis
Authors: Clarke William L. , Anderson Stacey , Farhy Leon , Breton Marc , Gonder-Frederick Linda , Cox Daniel , Kovatchev Boris 
Published: March 2007

OBJECTIVE—To compare the clinical accuracy of two different continuous glucose sensors (CGS) during euglycemia and hypoglycemia using continuous glucose–error grid analysis (CG-EGA).
RESEARCH DESIGN AND METHODS—FreeStyle Navigator (Abbott Laboratories, Alameda, CA) and MiniMed CGMS (Medtronic, Northridge, CA) CGSs were applied to the abdomens of 16 type 1 diabetic subjects (age 42 ± 3 years) 12 h before the initiation of the study. Each system was calibrated according to the manufacturer’s recommendations. Each subject underwent a hyperinsulinemic-euglycemic clamp (blood glucose goal 110 mg/dl) for 70–210 min followed by a 1–mg · dl−1 · min−1 controlled reduction in blood glucose toward a nadir of 40 mg/dl. Arterialized blood glucose was determined every 5 min using a Beckman Glucose Analyzer (Fullerton, CA). CGS glucose recordings were matched to the reference blood glucose with 30-s precision, and rates of glucose change were calculated for 5-min intervals. CG-EGA was used to quantify the clinical accuracy of both systems by estimating combined point and rate accuracy of each system in the euglycemic (70−180 mg/dl) and hypoglycemic (&lt;70 mg/dl) ranges.
RESULTS—A total of 1,104 data pairs were recorded in the euglycemic range and 250 data pairs in the hypoglycemic range. Overall correlation between CGS and reference glucose was similar for both systems (Navigator, r = 0.84; CGMS, r = 0.79, NS). During euglycemia, both CGS systems had similar clinical accuracy (Navigator zones A + B, 88.8%; CGMS zones A + B, 89.3%, NS). However, during hypoglycemia, the Navigator was significantly more clinically accurate than the CGMS (zones A + B = 82.4 vs. 61.6%, Navigator and CGMS, respectively, P &lt; 0.0005).
CONCLUSIONS—CG-EGA is a helpful tool for evaluating and comparing the clinical accuracy of CGS systems in different blood glucose ranges. CG-EGA provides accuracy details beyond other methods of evaluation, including correlational analysis and the original EGA.
Longitudinal Predictors of Reduced Mobility and Physical Disability in Patients With Type 2 Diabetes
Authors: Bruce David G. , Davis Wendy A. , Davis Timothy M.E. 
Published: March 2007

OBJECTIVE—The purpose of this study was to determine longitudinal predictors of impaired mobility and physical disability in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—We studied patients with type 2 diabetes who participated in a prospective, community-based study. A wide range of baseline variables were examined to determine whether they predicted future difficulties with 1) mobility and 2) basic activities of daily living (ADLs) in patients free of ADLs difficulty at baseline. To study mobility impairment, subjects with baseline mobility problems were also excluded.
RESULTS—After an average 4.6 ± 2.3 and 4.8 ± 2.3 years of follow-up in 818 and 934 patients, respectively, 28.5% of subjects had developed new mobility impairment and 18.1% had developed new ADL disability. In Cox proportional hazards models, the risk of mobility impairment was significantly increased by older age (6%/year), peripheral neuropathy (40% increase), stroke history (123%), insulin treatment (117%), albuminuria, and arthritis (82%); taking exercise and being married lowered the risk (by 39 and 32%, respectively). The risk of new ADL disability was increased by baseline mobility problems (222% increase), stroke (92%), claudication (67%), and depression (41%) and was also influenced by age, smoking, lack of exercise, nonfluency in English, and indigenous Australian ethnicity.
CONCLUSIONS—Both mobility impairment and ADL disability in type 2 diabetes have multiple causes that are due to diabetes complications and common comorbidities. The specific causes of each functional problem are largely distinct, and different approaches may be required to prevent their onset or progression.