bluuebunny/crossref_metadata_2025_split huggingface dataset:
Manufactured Shoes in the Prevention of Diabetic Foot Ulcers
Authors: Uccioli Luigi , Faglia Ezio , Monticone Giovanna , Favales Fabrizio , Durola Laura , Aldeghi Antonio , Quarantiello Antonella , Calia Patrizia , Menzinger Guido 
Published: March 2007

OBJECTIVE
To evaluate the efficacy of manufactured shoes specially designed for diabetic patients (Podiabetes by Buratto Italy) to prevent relapses of foot ulcerations.

RESEARCH DESIGN AND METHODS
A prospective multicenter randomized follow-up study of patients with previous foot ulcerations was conducted. Patients were alternatively assigned to wear either their own shoes (control group, C; n = 36) or therapeutic shoes (Podiabetes group, P; n = 33). The number of ulcer relapses was recorded during 1-year follow-up.

RESULTS
Both C and P groups had similar risk factors for foot ulceration (i.e., previous foot ulceration, mean vibratory perception threshold &gt; 25 mV). After 1 year, the foot ulcer relapses were significantly lower in P than in C (27.7 vs. 58.3%; P = 0.009; odds ratio 0.26 [0.2–1.54]). In a multiple regression analysis, the use of therapeutic shoes was negatively associated with foot ulcer relapses (coefficient of variation = −0.315; 95% confidence interval = −0.54 to −0.08; P = 0.009).

CONCLUSIONS
The use of specially designed shoes is effective in preventing relapses in diabetic patients with previous ulceration.
The Interrelationship Between Ethnicity and Gestational Diabetes in Fetal Macrosomia
Authors: Homko Caril J , Sivan Eyal , Nyirjesy Paul , Reece E Albert 
Published: March 2007

OBJECTIVE
To determine the possibility of an ethnic influence on the development of macrosomia (birth weight &gt; 90th percentile for gestational age) in gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS
We prospectively followed all African-American and Latino women enrolled in the Temple diabetes-in-pregnancy program. GDM was diagnosed in 103 African-American and 36 Latino women during the study period (1991–1994) according to the criteria of Carpenter and Coustan. All women were treated according to our previously published protocols. Data were collected on gestational weight gain, previous history of macrosomia, body mass index (BMI), and level of maternal glycemic control.

RESULTS
Insulin therapy was required in 53 women (37.5%) to maintain fasting blood glucose levels at &lt; 95 mg/dl and 2-h postprandial levels at &lt; 120 mg/dl. Macrosomia developed in 50% of the neonates of Latino women versus 19% of neonates of African-American women (relative risk 2.68; 95% confidence interval 1.57–4.59). Potential confounding factors were not significantly different between the Latino and African-American women: mean blood glucose 96.6 ± 15.7 vs. 96.5 ± 22.4 mg/dl; BMI 29.0 ± 5.5 vs. 31.5 ± 8.2 kg/m2; pregnancy weight gain 29.2 ± 12.7 vs. 30.9 ± 20.5 lb; and parity 1.8 ± 1.5 vs. 1.6 ± 1.4, respectively.

CONCLUSIONS
We have demonstrated that Latino women with GDM are at higher risk for having macrosomic infants in comparison with African-American women. This ethnic variation in fetal growth may be due to varying influences of in utero growth promoters among these populations as well as underlying genetic factors.
Atropine Inhibits the Increase in Gastric Emptying During Hypoglycemia in Humans
Authors: Schvarcz Erik , Palmér Mats , Åman Jan , Berne Christian 
Published: March 2007

OBJECTIVE
To study the effect of a cholinergic muscarinic blockade on the gastric emptying rate during insulin-induced hypoglycemia in healthy subjects.

RESEARCH DESIGN AND METHODS
In eight healthy subjects, the rate of gastric emptying of an isotope-labeled meal was assessed by a scintigraphic technique during normoglycemia and hypoglycemia with simultaneous infusion of either atropine or saline. Blood glucose concentrations were controlled by an insulin-glucose clamp.

RESULTS
The median time for emptying 50% of the liquid phase from the stomach (T50) was 24.9 min (range 13.9−120.0) during normoglycemia compared with 8.1 min (range 3.6−16.5) during hypoglycemia without atropine infusion (P = 0.0005). The T50 for the solid phase was 26.8 min (range 9.7−74.0) and 43.1 min (range 29−57.8), respectively (P = 0.007). During hypoglycemia with atropine infusion, T50 was 40.7 min (range 10.0−120.0) for the liquid phase and 111.4 min (range 38.9−120.0) for the solid phase, not statistically different from normoglycemic examinations.

CONCLUSIONS
Cholinergic muscarinic blockade with atropine inhibits the increase in gastric emptying during hypoglycemia. Vagal activity seems to be an important determinant of gastric emptying during hypoglycemia.
Resource Utilization and Costs of Care in the Diabetes Control and Complications Trial
Authors:   The Diabetes Control and Complications Trial Research Group
Published: March 2007

OBJECTIVE
To describe in detail the resources used and costs incurred in the clinical management of patients with insulin-dependent diabetes mellitus (IDDM) in the Diabetes Control and Complications Trial (DCCT).

RESEARCH DESIGN AND METHODS
The resources used for intensive and conventional therapy and to deal with the side effects of therapy were assessed at each of the 29 DCCT clinics and summarized. Unit costs were derived from the DCCT, manufacturers, and Medicare and chosen to reflect what an item would cost to a single-payer national health system. Costs were calculated as the product of resources used and unit costs. The costs of the research component of the DCCT were not included.

RESULTS
In the DCCT, the annual cost of intensive therapy ($4,000 and $5,800/year for multiple daily injections and continuous subcutaneous insulin infusion, respectively) was ∼ three times the cost of conventional therapy ($1,700/year). A large portion of the difference in cost was related to the greater frequency of outpatient visits and the greater resources used in self-care.

CONCLUSIONS
DCCT intensive therapy is more expensive than conventional therapy, but it offers the hope of cost savings as a result of averted complications.
Cyclosporin A Does Not Delay Insulin Dependency in Asymptomatic IDDM Patients
Authors: Rakotoambinina Benjamin , Timsit Jose , Deschamps Ingeborg , Laborde Kathleen , Jos Joseph , Boitard Christian , Assan Roger , Robert Jean Jacques 
Published: March 2007

OBJECTIVE
To measure the effects of cyclosporin A (CyA) with no insulin therapy on glucose tolerance and β-cell function in the preclinical phase of insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS
β-cell responses to the intravenous glucose tolerance test (IVGTT), hyperglycemic clamp, intravenous arginine, and intravenous glucagon were evaluated before and after a 6-month course of CyA in seven patients (mean age 19.6 years) with asymptomatic IDDM.

RESULTS
Initial insulin secretory responses were severely decreased when the patients were compared with eight healthy control subjects: IVGTT (1 + 3 min): 106 ± 16 vs. 884 ± 190 pmol/l (P &lt; 0.001); hyperglycemic clamp: 102 ± 16 vs. 310 ± 42 pmol/l (P &lt; 0.001); intravenous arginine: 346 ± 72 vs. 1104 ± 168 pmol/l (P &lt; 0.01); and intravenous glucagon: 170 ± 37 vs. 247 ± 35 pmol/l (NS). The β-cell responses remained markedly abnormal after 6 months of CyA, although the response to intravenous glucose and oral glucose tolerance tests improved in three subjects. All the patients became insulin-dependent after 5–36 months.

CONCLUSIONS
CyA alone is not a suitable treatment for asymptomatic IDDM. Earlier identification of subjects with substantial β-cell secretory capacity and newer nontoxic intervention strategies are required for the prevention of IDDM.
Morbidity and Mortality in the Wolfram Syndrome
Authors: Kinsley Brendan T , Swift Michael , Dumont Raymonde H , Swift Ronnie G 
Published: March 2007

OBJECTIVE
To determine the major causes of morbidity and mortality in the autosomal recessive Wolfram syndrome, which is defined by diabetes and bilateral progressive optic atrophy with onset in childhood or adolescence.

RESEARCH DESIGN AND METHODS
We abstracted and reviewed the medical records of 68 confirmed cases of Wolfram syndrome identified through a nationwide survey of endocrinologists, ophthalmologists, institutes, and homes for the blind. We also reviewed all available autopsy records.

RESULTS
The most common causes of morbidity and mortality were the neurological manifestations of this syndrome and the complications of urinary tract atony. There was a lower frequency of diabetic ketoacidosis, no histologically proven diabetic glomerulosclerosis, and less severe, more slowly progressive, diabetic retinopathy than in classic type I diabetic patients. Mortality in Wolfram syndrome is much higher than in type I diabetes; 60% of Wolfram syndrome patients die by age 35. Recognition of these clinical differences from classic type I diabetes is important for the proper management of Wolfram syndrome patients.

CONCLUSIONS
Identification of Wolfram syndrome patients among all diabetic patients presenting in childhood or adolescence is important because the management of patients with this syndrome is different from that of patients with classic type I diabetes.
Exercise Testing as a Long-Term Predictor of the Development of Microalbuminuria in Normoalbuminuric IDDM Patients
Authors: O'Brien Sheila F , Watts Gerald F , Powrie Jake K , Shaw Kenneth M 
Published: March 2007

OBJECTIVE
To determine the association between exercise-induced albuminuria and the development of microalbuminuria over 10 years in subjects with insulin-dependent diabetes mellitus (IDDM) who were initially normoalbuminuric.

RESEARCH DESIGN AND METHODS
Thirty-two patients with IDDM and a resting urinary albumin/creatinine ratio (UA/UC) &lt;2.1 mg/mmol (&lt; 15 μg/min) were exercised after water loading on a treadmill for 20 min at double their resting heart rate. UA/UC was determined before and after exercise. The exercise test was considered positive if the UA/UC was &gt;4.3 mg/mmol (&gt;30 μg/min). Results were compared with resting UA/UC after a 10-year follow-up. Persistent microalbuminuria was defined as a UA/UC &gt;2.1 mg/mmol (&gt; 15 μg/min) in each of two early-morning urine collections.

RESULTS
Five patients developed persistent microalbuminuria after 10 years, and four patients were predicted by a positive exercise test. Two patients with positive exercise tests did not develop persistent microalbuminuria. The sensitivity of the exercise test for the development of microalbuminuria was 80% (95% confidence interval [CI] 65.8–94.2%) and the specificity was 92.9% (95% CI 83.9–100%). The postexercise UA/UC was positively associated with the UA/UC after 10 years (P = 0.005, R2 = 0.31). This association was independent of HbA1, systolic blood pressure, body mass index, and duration of diabetes, but HbA1 remained an independent predictor (P = 0.02) of UA/UC at follow-up.

CONCLUSIONS
Exercise testing may be useful for identifying normoalbuminuric IDDM patients who are susceptible to the later development of microalbuminuria.
Anti-Bovine Serum Albumin Antibodies: Genetic Heterogeneity and Clinical Relevance in Adult-Onset IDDM
Authors: Krokowski Marcin , Caillat-Zucman Sophie , Timsit José , Larger Etienne , Pehuet-Figoni Martine , Bach Jean Francois , Boitard Christian 
Published: March 2007

OBJECTIVE
To evaluate the prevalence of anti-bovine serum albumin (BSA) antibodies in patients with adult-onset insulin-dependent diabetes mellitus (IDDM) and investigate a possible link between their presence and genetic susceptibility or resistance determined by human leukocyte antigen (HLA) complex.

RESEARCH DESIGN AND METHODS
Sera from 60 recent-onset diabetic patients, 5 prediabetic subjects, and 102 healthy control subjects were tested using a radioimmunoprecipitation assay. HLA-DRB and -DQB alleles were determined by means of allele-specific oligonucleotide typing. Islet cell antibodies (ICAs) were assayed by indirect immunofluorescence.

RESULTS
Levels of anti-BSA antibodies were significantly higher in IDDM patients (18.1 ± 3.5%, n = 60) than in healthy control subjects (7.5 ± 1.2%, n = 102) (P &lt; 0.001), but in only 16.6% of IDDM patients (10 of 60) were the titers above the 95th percentik of control values. Anti-BSA antibody titers were higher in HLA-DR3 and/or -DR4 patients (23.4±4.9%, n = 41) compared with DR3 and/or DR4 control subjects (3.1 ± 1.0%, n = 10) (P &lt; 0.001). DR3 IDDM patients showed higher levels of anti-BSA antibodies (26.3 ± 6.3%, n = 30) than non-DR3 patients (9.9 ± 2.6%, n = 30) (p &lt; 0.01) and healthy control subjects. Only two out of five prediabetic subjects had significant anti-BSA levels before clinical onset of diabetes.

CONCLUSIONS
Our data confirm that antibodies to BSA are present in adult-onset IDDM patients, particularly in HLA-DR3-positive patients. However, the prevalence of anti-BSA antibodies was lower than previously reported in children, and there was a considerable overlap with healthy control subjects. Only two out of the five prediabetic patients demonstrated anti-BSA antibodies. Taken together, these results do not bring strong support to the clinical usefulness of anti-BSA antibodies as a relevant marker in diabetes prediction or diagnosis.
Insulin Sensitivity and Lp(a) Concentrations in Normoglycemic Men
Authors: Haffner Steven M , Karhapaa Pauli , Rainwater David L , Mykkanen Leena , Aldrete Gilbert , Laakso Markku 
Published: March 2007

OBJECTIVE
Increased lipoprotein(a) [Lp(a)] concentrations have been recognized as a risk factor for coronary heart disease. Little data exists on the relationship of Lp(a) concentrations to insulin resistance.

RESEARCH DESIGN AND METHODS
We examined insulin resistance (as determined by the euglycemic clamp) together with indirect calorimetry in relation to Lp(a) concentrations, apolipoprotein(a) [apo(a)] molecular weight, and apo(a) phe-notype in 87 normoglycemic men.

RESULTS
Lp(a) concentrations were significantly related to total (r = 0.225) and nonoxidative (r = 0.256) whole-body glucose disposal. These results suggest a positive but weak association between insulin sensitivity (restricted to the nonoxidative whole-body glucose disposal) and Lp(a) concentrations. However, after adjustment for apo(a) molecular weight [which accounts for some of the genetic influences on Lp(a) levels], total and nonoxidative body glucose disposal were not significantly related to Lp(a) concentrations.

CONCLUSIONS
Normoglycemic insulin-resistant subjects do not have elevated Lp(a) concentrations.
Digoxin Does Not Accelerate Progression of Diabetic Retinopathy
Authors: Gardner Thomas W , Klein Ronald , Moss Scot E , Ferris Frederick L , Remaley Nancy A 
Published: March 2007

OBJECTIVE
To test the hypothesis that digoxin, an inhibitor of Na+ -K+ -ATPase activity, accelerates the progression of diabetic retinopathy.

RESEARCH DESIGN AND METHODS
We compared the incidence and risk of retinopathy in 120 digoxin-taking vs. 867 non-digoxin-taking diabetic participants in the Wisconsin Epidemiologie Study of Diabetic Retinopathy (WESDR) and in 117 digoxin-taking vs. 1,883 non-digoxin-taking diabetic subjects in the Early Treatment Diabetic Retinopathy Study (ETDRS). In both studies, retinopathy was detected by grading stereoscopic color photographs using the modified Airlie House classification scheme, and a two-step difference in baseline retinopathy grade was considered significant.

RESULTS
After controlling for other risk factors, we found no statistically significant association with either 4-year incidence of retinopathy (WESDR) or progression of retinopathy (WESDR and ETDRS) in patients taking digoxin at baseline compared with those not taking digoxin.

CONCLUSIONS
These data suggest that digoxin therapy does not adversely affect the course of diabetic retinopathy.
Lower Limb Venous Pressure in Diabetic Neuropathy
Authors: Purewal Tejpal S , Goss David E , Watkins Peter J , Edmonds Michael E 
Published: March 2007

OBJECTIVE
Distended turgid veins have been noted in the feet of patients with diabetic neuropathy. This study assessed the supine venous pressure and its correlation with diabetic neuropathy and arteriovenous (AV) shunting in the feet of type I and type II diabetic subjects.

RESEARCH DESIGN AND METHODS
Seventeen patients with chronic Charcot joints, 11 patients with a history of neuropathic foot ulceration, 14 diabetic control subjects, and 11 normal control subjects were studied. Neuropathy was assessed by vibration and thermal thresholds and standard cardiovascular autonomie neuropathy tests. Supine venous pressure was measured by insertion of a 21-gauge needle connected to a strain gauge manometer into the veins on the dorsum of the foot. Venous Po2 was used as a measure of AV shunting.

RESULTS
Venous pressure was raised in the group with chronic Charcot joints (18.9 ± 4.2mmHg, P &lt; 0.001 vs. the diabetic control group [11.3 ± 2.6mmHg]), the normal control group (12.3 ± 2.3 mmHg, mean ± SD), and the diabetic group with a history of neuropathic foot ulceration (16.0 ± 3.7 mmHg, P = 0.008 vs. diabetic control subjects and P = 0.04 vs. normal control subjects), with a maximum of 28 mmHg. Venous pressure was correlated with heart rate variation to deep breathing, r = −0.61 (P = 0.001), vibration threshold, r = 0.56 (P = 0.001), Valsalva ratio, r = −0.64 (P = 0.001), warm threshold, r = 0.69 (P = 0.001), and venous Po2, r = 0.43 (P = 0.02). There was no correlation with skin temperature, duration of diabetes, age, HbAlc, random blood glucose, ankle/brachial Doppler index, height, or serum creatinine.

CONCLUSIONS
Venous pressure is much higher in the neuropathic diabetic limb and is correlated with the severity of neuropathy and with AV shunting.
A New and Simple Questionnaire to Identify People at Increased Risk for Undiagnosed Diabetes
Authors: Herman William H , Smith Philip J , Thompson Theodore J , Engelgau Michael M , Aubert Ronald E 
Published: March 2007

OBJECTIVE
To develop a simple questionnaire to prospectively identify individuals at increased risk for undiagnosed diabetes.

RESEARCH DESIGN AND METHODS
People with newly diagnosed diabetes (n = 164) identified in the Second National Health and Nutrition Examination Survey and those with neither newly diagnosed diabetes nor a history of physician-diagnosed diabetes (n = 3,220) were studied. Major historical risk factors for undiagnosed non-insulin-dependent diabetes were defined, and classification trees were developed to identify people at higher risk for previously undiagnosed diabetes. The sensitivity, specificity, and predictive value of the classification trees were described and compared with those of an existing questionnaire.

RESULTS
The selected classification tree incorporated age, sex, history of delivery of a macrosomic infant, obesity, sedentary lifestyle, and family history of diabetes. In a representative sample of the U.S. population, the sensitivity of the tree was 79%, the specificity was 65%, and the predictive value positive was 10%.

CONCLUSIONS
This classification tree performed significantly better than an existing questionnaire and should serve as a simple, noninvasive, and potentially cost-effective tool for diagnosing diabetes in the U.S.
Immunogenicity of Long-Term Intraperitoneal Insulin Administration With Implantable Programmable Pumps: Metabolic consequences
Authors: Lassmann-Vague Véronique , Belicar Pauline , Raccah Denis , Vialettes Bernard , Sodoyez Jean Claude , Vague Philippe 
Published: March 2007

OBJECTIVE
To assess immunogenicity of intraperitoneal insulin infusion via implanted pumps by two methods and to evaluate the possible influence of an increased antibody level on metabolic and clinical parameters.

RESEARCH DESIGN AND METHODS
We studied insulin antibody levels in 17 type I diabetic patients before and until 24 months after implantation of a programmable pump delivering insulin intraperitoneally. Antibody levels were determined by radioimmunoassay (RIA) and enzyme-linked immunosorbent assay (ELISA). They were correlated with HbA1c, insulin requirements, free insulin, and the incidence of hypoglycemia.

RESULTS
Insulin antibodies increased as soon as the 3rd month after implantation. This increase was sustained throughout the study period (month 0, 25.4 ± 16.2%; month 3, 41.2 ± 23.5%; month 12, 45.9 ± 26%; month 24, 48.7 ± 25%). The data was correlated with the two assay methods (RIA and ELISA). Postimplantation level was correlated with preimplantation level, which could indicate a predictive value of the latter. No correlation was observed with any metabolic parameters, particularly the number of hypoglycemic episodes.

CONCLUSIONS
Our results indicate that intraperitoneal insulin administration by implantable programmable pumps leads to an increase of insulin antibodies, which are probably high-affinity antibodies (recognized by both RIA and ELISA). This increase in insulin immunogenicity did not induce significant metabolic consequences, which is reassuring for the future of programmable insulin pumps.
Decreased Erythrocyte Membrane Fluidity in Poorly Controlled IDDM: Influence of ketone bodies
Authors: Candiloros Harilaos , Muller Sylvaine , Zeghari Nezha , Donner Mireille , Drouin Pierre , Ziegler Olivier 
Published: March 2007

OBJECTIVE
To examine the factors that might alter the fluidity of erythrocyte membrane in insulin-dependent diabetes mellitus (IDDM) patients.

RESEARCH DESIGN AND METHODS
The subjects were 10 health men and 30 IDDM mem: 10 with good blood glucose (BG) control (HbA1c 5.88 ± 0.60% [mean ± SD]), 10 with poor BG control (HbA1C 9.48 ± 1.05%), and 10 with poor BG control and mild to moderate diabetic ketoacidosis (DKA) (HbA1C 9.12 ±2.25%, strongly positive ketonuria 3+ and elevated plasma β-hydroxybutyrate). Erythrocyte membrane fluidity was determined by fluorescence polarization using 6-(9-anthroyloxy stearic acid as fluorescent probe.

RESULTS
Membrane fluidity was normal in the diabetic patients with good BG control but significantly lower in the two groups of patients with poor BG control than in the healthy subjects (P &lt; 0.01). The membrane fluidity in the poor BG control groups was also lower in the patients with DKA than in those without DKA (P &lt; 0.01).

CONCLUSIONS
The factors that most influence membrane fluidity in IDDM patients appear to be hyperglycemia and ketone bodies.
Alterations in the Patterns of Insulin Secretion Before and After Diagnosis of IDDM
Authors: O'Meara Niall M , Sturis Jeppe , Herold Kevan c , Ostrega Diane M , Polonsky Kenneth S 
Published: March 2007

OBJECTIVE
To study the natural history of β-cell dysfunction in an individual who developed insulin-dependent diabetes mellitus (IDDM) over a 13-month period while under observation.

RESEARCH DESIGN AND METHODS
Insulin secretion rates (ISR) in response to intravenous glucose and mixed meals were estimated by deconvolution of C-peptide levels.

RESULTS
When fasting glucose and glycosylated hemoglobin concentrations were still within the normal range, insulin secretory responses to intravenous glucose infusion were reduced, but 80- to 100-min secretory oscillations could still be detected. Sequential glucose infusion studies over a 3-month period demonstrated a progressive reduction in insulin secretion. The tight temporal coupling between ultradian oscillations in ISR and glucose observed in nondiabetic subjects was lost. In response to mixed meals, the oscillatory pattern of secretion was preserved, but the magnitude of the secretory responses was reduced.

CONCLUSIONS
Our results indicate that despite the lower absolute secretory rates, ultradian ISR oscillations persist in the period before and immediately after the onset of IDDM in this subject, but they are less tightly coupled to glucose than in nondiabetic subjects.