bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inflammation, Insulin Resistance, and Adiposity
Authors: Kriketos Adamandia D. , Greenfield Jerry R. , Peake Phil W. , Furler Stuart M. , Denyer Gareth S. , Charlesworth John A. , Campbell Lesley V. 
Published: March 2007

OBJECTIVE—Inflammatory markers such as C-reactive protein (CRP) are associated with insulin resistance, adiposity, and type 2 diabetes. Whether inflammation causes insulin resistance or is an epiphenomenon of obesity remains unresolved. We aimed to determine whether first-degree relatives of type 2 diabetic subjects differ in insulin sensitivity from control subjects without a family history of diabetes, whether first-degree relatives of type 2 diabetic subjects and control subjects differ in CRP, adiponectin, and complement levels, and whether CRP is related to insulin sensitivity independently of adiposity.
RESEARCH DESIGN AND METHODS—We studied 19 young normoglycemic nonobese first-degree relatives of type 2 diabetic subjects and 22 control subjects who were similar for age, sex, and BMI. Insulin sensitivity (glucose infusion rate [GIR]) was measured by the euglycemic-hyperinsulinemic clamp. Dual-energy X-ray absorptiometry determined total and abdominal adiposity. Magnetic resonance imaging measured abdominal adipose tissue volumes.
RESULTS—First-degree relatives of type 2 diabetic subjects had a 20% lower GIR than the control group (51.8 ± 3.9 vs. 64.9 ± 4.6 μmol · min−1 · kg fat-free mass−1, P = 0.04). However, first-degree relatives of subjects with type 2 diabetes and those without a family history of diabetes had normal and comparable levels of CRP, adiponectin, and complement proteins. When the cohort was examined as a whole, CRP was inversely related to GIR (r = −0.33, P = 0.04) and adiponectin (r = −0.34, P = 0.03) and positively related to adiposity (P &lt; 0.04). However, CRP was not related to GIR independently of fat mass. In contrast to C3 (r = 0.41, P = 0.009) and factor B (r = 0.43, P = 0.005), CRP was unrelated to factor D.
CONCLUSIONS—The insulin-resistant state is not associated with changes in inflammatory markers or complement proteins in subjects at high risk of type 2 diabetes. Our study confirms a strong relationship between CRP and fat mass. Increasing adiposity and insulin resistance may interact to raise CRP levels.
Haptoglobin Phenotype and Gestational Diabetes
Authors: Mustafa Stefan , Vukovich Thomas , Prikoszovich Thomas , Winzer Christine , Schneider Barbara , Esterbauer Harald , Wagner Oswald , Kautzky-Willer Alexandra 
Published: March 2007

OBJECTIVE—Haptoglobin (Hp), an Hb-binding plasma protein, exists in two major allelic variants. Hp1 has higher Hb binding and antioxidant capacity compared with Hp2. Individuals with Hp1 exhibit a lower incidence of angiopathies. Gestational diabetes mellitus (GDM) is an early manifestation of type 2 diabetes in pregnant women. It is usually confined to the time of gestation, but carries an increased risk to develop type 2 diabetes later in life.
RESEARCH DESIGN AND METHODS—From consecutive Caucasian pregnant women (n = 250) referred for oral glucose tolerance testing, the Hp phenotype was determined. Significance of distribution and odds ratios (ORs) associated with Hp phenotype were calculated for women with GDM (n = 110) and women with normal glucose tolerance (n = 140).
RESULTS—Frequency of GDM in Hp phenotype classes increased with the number of Hp2 alleles (P &lt; 0.001). ORs for GDM in women heterozygous and homozygous for Hp2 were 2.7 (95% CI 1.06–6.84) and 4.2 (1.67–10.55), respectively.
CONCLUSIONS—Hp phenotype is an apparent risk factor for the development of GDM in our study population. This might be due to the low antioxidative potential of Hp2 compared with Hp1.
Hepatitis C Infection and Type 2 Diabetes in American-Indian Women
Authors: Wilson Charlton 
Published: March 2007

OBJECTIVE—The aim of this study was to describe the association between hepatitis C virus (HCV) infection and type 2 diabetes among a group of American-Indian women who were screened for both conditions.
RESEARCH DESIGN AND METHODS—The study population was a convenience sample of women who were receiving prenatal care. All women were systematically screened for both HCV and diabetes.
RESULTS—A total of 426 women were included in the sample. HCV infection was detected in 13 (3.1% [95% CI 1.7–5.0]) and type 2 diabetes in 22 (5.2%, [3.3–7.6]) women. Women diagnosed with type 2 diabetes were more obese and had higher serum alanine aminotransferase activity compared with women without diabetes. Four of 13 (30.8% [10.6–58.7]) HCV-infected women and 18 of 413 (4.4% [2.7–6.7]) women without evidence of HCV infection had type 2 diabetes. (odds ratio 9.8 [95% CI 2.4–34.0], Fisher’s exact test P = 0.003). In a logistic regression model, increasing age (10-year increments), obesity (by standard deviations from the mean BMI), and positive HCV status were each independently related to the diagnosis of diabetes.
CONCLUSIONS—Among American-Indian women, type 2 diabetes is more common in those with than in those without HCV infection. This association and its potential mechanisms may have clinical implications. Investigation into the mechanisms linking HCV infection to the expression of type 2 diabetes may also help to define processes that promote the development of type 2 diabetes in susceptible individuals.
Prevalence of the Metabolic Syndrome and Its Components
Authors: Ilanne-Parikka Pirjo , Eriksson Johan G. , Lindström Jaana , Hämäläinen Helena , Keinänen-Kiukaanniemi Sirkka , Laakso Mauri , Louheranta Anne , Mannelin Marjo , Rastas Merja , Salminen Virpi , Aunola Sirkka , Sundvall Jouko , Valle Timo , Lahtela Jorma , Uusitupa Matti , Tuomilehto Jaakko ,   the Finnish Diabetes Prevention Study Group
Published: March 2007

OBJECTIVE—To assess the prevalence of the metabolic syndrome (MetS) in two independent Finnish study cohorts.
RESEARCH DESIGN AND METHODS—The prevalence of the MetS by modified World Health Organization criteria was analyzed in different categories of glucose tolerance in a cross-sectional, population-based sample of 2,049 individuals (FINRISK) aged 45–64 years and in 522 participants of the Finnish Diabetes Prevention Study (DPS) with impaired glucose tolerance (IGT).
RESULTS—In the FINRISK cohort, the MetS was present in 38.8% of the men and 22.2% of the women. The prevalence was 14.4 and 10.1% in subjects with normal glucose tolerance, 74.0 and 52.2% in subjects with impaired fasting glucose, 84.8 and 65.4% in subjects with IGT, and 91.5 and 82.7% in subjects with type 2 diabetes in men and women, respectively. Among women, the prevalence of the MetS increased with increasing age. In the DPS cohort, the MetS was present in 78.4% of the men and 72.2% of the women with IGT.
CONCLUSIONS—The MetS was extremely common in middle-aged subjects The high prevalence in men was mostly due to their high waist-to-hip ratio. The prevalence of the MetS increased in both sexes with deterioration in glucose regulation. Approximately 75% of the subjects with IGT had the MetS. Because the syndrome includes the major risk factors for atherosclerotic vascular diseases and is the major antecedent for type 2 diabetes, concerted preventive action should be targeted to control all the features of the MetS.
Relationship of Depression and Diabetes Self-Care, Medication Adherence, and Preventive Care
Authors: Lin Elizabeth H.B. , Katon Wayne , Von Korff Michael , Rutter Carolyn , Simon Greg E. , Oliver Malia , Ciechanowski Paul , Ludman Evette J. , Bush Terry , Young Bessie 
Published: March 2007

OBJECTIVE—We assessed whether diabetes self-care, medication adherence, and use of preventive services were associated with depressive illness.
RESEARCH DESIGN AND METHODS—In a large health maintenance organization, 4,463 patients with diabetes completed a questionnaire assessing self-care, diabetes monitoring, and depression. Automated diagnostic, laboratory, and pharmacy data were used to assess glycemic control, medication adherence, and preventive services.
RESULTS—This predominantly type 2 diabetic population had a mean HbA1c level of 7.8 ± 1.6%. Three-quarters of the patients received hypoglycemic agents (oral or insulin) and reported at least weekly self-monitoring of glucose and foot checks. The mean number of HbA1c tests was 2.2 ± 1.3 per year and was only slightly higher among patients with poorly controlled diabetes. Almost one-half (48.9%) had a BMI &gt;30 kg/m2, and 47.8% of patients exercised once a week or less. Pharmacy refill data showed a 19.5% nonadherence rate to oral hypoglycemic medicines (mean 67.4 ± 74.1 days) in the prior year. Major depression was associated with less physical activity, unhealthy diet, and lower adherence to oral hypoglycemic, antihypertensive, and lipid-lowering medications. In contrast, preventive care of diabetes, including home-glucose tests, foot checks, screening for microalbuminuria, and retinopathy was similar among depressed and nondepressed patients.
CONCLUSIONS—In a primary care population, diabetes self-care was suboptimal across a continuum from home-based activities, such as healthy eating, exercise, and medication adherence, to use of preventive care. Major depression was mainly associated with patient-initiated behaviors that are difficult to maintain (e.g., exercise, diet, medication adherence) but not with preventive services for diabetes.
Oxidative Stress and Antioxidant Defense in Relation to the Severity of Diabetic Polyneuropathy and Cardiovascular Autonomic Neuropathy
Authors: Ziegler Dan , Sohr Christoph G.H. , Nourooz-Zadeh Jaffar 
Published: March 2007

OBJECTIVE—Oxidative stress resulting from enhanced free-radical formation and/or a defect in antioxidant defenses has been implicated in the pathogenesis of experimental diabetic neuropathy. The objective of this study was to evaluate plasma levels of various biomarkers of oxidative stress in diabetic subjects in relation to the presence or absence of polyneuropathy (PN) and/or cardiovascular autonomic neuropathy (CAN).
RESEARCH DESIGN AND METHODS—Plasma 8-iso-prostaglandin F2α (8-iso-PGF2α), superoxide anion (O2·−) generation, lag phase to peroxidation by peroxynitrite (ONOO−), vitamin E-to-lipid ratio, and vitamin C were measured in nonsmoking diabetic patients without PN and CAN (PN−/CAN− group; n = 62), in a group with PN but without CAN (PN+/CAN− group; n = 105), in those with both PN and CAN (PN+/CAN+ group; n = 22), and in healthy control subjects (n = 85).
RESULTS—All three markers of oxidative stress were significantly increased, and both markers of antioxidant defense were decreased in the PN+/CAN− group compared with the control group (all P &lt; 0.05). PN−/CAN− subjects showed a significant increase compared with control subjects for 8-iso-PGF2α, O2·−, and ONOO− and a decrease for the vitamin E-to-lipid ratio (all P &lt; 0.05). In the PN+/CAN− group, a significant increase compared with the PN−/CAN− group was noted for O2·−, whereas the vitamin E-to-lipid ratio and vitamin C were reduced (all P &lt; 0.05). No significant differences were noted between the PN+/CAN− and PN+/CAN+ groups for each of the five markers of oxidative stress. In multivariate models, O2·− and ONOO− were independently associated with neuropathic deficits, but diabetes duration and triglyceride levels were also independent determinants.
CONCLUSIONS—Oxidative stress is enhanced in diabetic patients before the development of PN but to an even higher degree in those with PN, without further significant increase in relation to superimposed autonomic neuropathy. However, apart from oxidative stress, diabetes duration and triglyceride levels are also related to the severity of PN.
Diabetes in Nonveterans, Veterans, and Veterans Receiving Department of Veterans Affairs Health Care
Authors: Reiber Gayle E. , Koepsell Thomas D. , Maynard Charles , Haas Linda B. , Boyko Edward J. 
Published: March 2007

OBJECTIVE—To compare behavioral risk factors and health and disease characteristics among three groups of adults with diabetes: nonveterans, veterans not receiving Department of Veterans Affairs (VA) health care, and veterans using VA services.RESEARCH DESIGN AND METHODS—Two data sources were used to describe the veteran population. First, the 2000 Behavioral Risk Factor Surveillance System (BRFSS) characterized the U.S. adult population by preventive health practices and risk behaviors linked to chronic and preventable diseases. New to the 2000 survey were questions on veteran status, which were administered in all states. Second, VA administrative and veterans benefits data were analyzed to describe comorbidity, education services, and veterans benefits.RESULTS—The estimated prevalence of diabetes in male veterans receiving VA care was 16%. Male veterans with diabetes using VA care were more likely to be nonwhite, not employed, have lower income, lower health status, and more activity limitations than male veterans not using these services. Computerized records indicate VA users with diabetes also had high concurrent comorbidity. Frequency of VA diabetes and preventive care services, as measured by selected quality indicators, was equivalent to or higher than the levels reported by veterans not receiving VA care and nonveterans. In addition to health care, nearly one-fourth of veterans with diabetes also received monthly awards for compensation and pension.CONCLUSIONS—Males receiving VA care with self-reported diabetes indicated receiving preventive care services at equivalent or higher levels than their counterparts receiving care outside the VA and nonveterans.
The Epidemiology of Lower-Extremity Disease in Veterans With Diabetes
Authors: Mayfield Jennifer A. , Reiber Gayle E. , Maynard Charles , Czerniecki Joseph , Sangeorzan Bruce 
Published: March 2007

OBJECTIVE—To describe the epidemiology of lower-extremity complications of diabetes in veterans who are users of the Department of Veterans Affairs (VA).RESEARCH DESIGN AND METHODS—Hospital discharge records for care provided in all VA hospitals in 1998 were obtained. All hospitalizations for lower-extremity ulceration, peripheral vascular procedures, and amputation were analyzed using frequency tables. A diabetes denominator was defined as a veteran with at least three ambulatory care visits with at least one diabetes diagnosis code. Age-specific and total age-adjusted rates of discharge with ulceration, vascular procedures, and amputation were calculated.RESULTS—Veterans with diabetes comprised over half of all hospitalizations for lower-extremity ulceration, one-third of all hospitalizations for peripheral vascular procedures, and two-thirds of all hospitalizations for amputation. The age-specific discharge rate per 1,000 diabetic persons for age 0–64 years, 65–74 years, and 75 years and older for ulceration were 28.4, 31.0, and 37.9; for vascular procedures, the rates were 3.5, 4.4, and 4.4; and for amputation, the rates were 7.3, 9.0, and 10.0, respectively.CONCLUSIONS—Veterans with diabetes comprise a significant proportion of hospitalizations for lower-extremity ulceration, peripheral vascular bypass, and amputation. Age-specific rates of diabetic amputation in veterans are lower than U.S. rates.
Eye Disease in Veterans With Diabetes
Authors: Orcutt James , Avakian Arpenik , Koepsell Thomas D. , Maynard Charles 
Published: March 2007

OBJECTIVE—To describe the screening, prevalence, and management of eye disease in veterans cared for by the Veterans Affairs (VA) System.
RESEARCH DESIGN AND METHODS—Eye examinations, treatments, and diseases were identified in veterans with diabetes who received care in inpatient and outpatient VA settings during FY1998. Analysis was conducted to characterize the patient population and screened population and to compare them to the total VA patient population with diabetes. Logistic regression was performed to predict eye screening.
RESULTS—Overall 48% of veterans with diabetes had an eye examination in FY1998. One-third of all veterans had an eye condition and 8.6% of veterans had ophthalmic manifestations of diabetes. In addition 11% reported glaucoma and 17.8% reported cataract surgery. Approximately 11,500 (2.7%) veterans were blind.
CONCLUSIONS—Visual impairment is a common complication of diabetes. Half of this population of veterans had a visual examination recorded in VA. The VA is testing a more targeted screening and treatment approach for diabetic eye disease in order to prevent the serious eye complications.
Diabetes-Related Utilization and Costs for Inpatient and Outpatient Services in the Veterans Administration
Authors: Maciejewski Matthew L. , Maynard Charles 
Published: March 2007

OBJECTIVE—The purpose of this study was to calculate the total number of inpatient hospitalizations, outpatient clinic visits, and total direct health care costs associated with veterans with diabetes receiving care in Veterans Administration (VA) facilities.
RESEARCH DESIGN AND METHODS—The number of inpatient hospitalizations is tracked for years 1994–1998, and outpatient clinic visits are tracked for years 1997 and 1998. Trends in utilization across different age and racial groups, as well as total direct inpatient and outpatient costs for 1998, are presented.
RESULTS—Between 1994 and 1998, hospitalization rates decreased from 1.68 to 1.61. The average number of outpatient visits was 4.5 in 1997 and 4.6 in 1998. VA incurred $214.8 million in outpatient expenditures and $1.45 billion in inpatient expenditures for veterans with diabetes receiving VA care.
CONCLUSIONS—Health care delivery systems and payors track the cost and utilization of services by specific patient groups to support disease management, quality improvement, external reporting, and cost containment. Tracking the utilization and cost of diabetes care is necessary to understand the financial impact of diabetes on health care systems and the overall burden of diabetes on individuals.
Validity and Reliability of an Instrument for Assessing Health-Related Quality of Life and Treatment Preferences
Authors: Peyrot Mark , Rubin Richard R. 
Published: March 2007

OBJECTIVE—To provide a preliminary assessment of the validity and reliability of a new measure of health-related quality of life (HRQOL) and treatment preference for insulin delivery systems.
RESEARCH DESIGN AND METHODS—Study participants were 197 adults with type 1 or type 2 diabetes who completed the Insulin Delivery System Rating Questionnaire (IDSRQ), a self-administered questionnaire developed for this study. The IDSRQ assessed patient perceptions of treatment satisfaction, impact of treatment on daily activities, clinical efficacy, diabetes-related worries and social burdens, psychological well-being, and overall treatment system preference of patients using continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI).
RESULTS—The IDSRQ subscales had acceptable reliability (α = 0.67–0.92, median 0.82) and test-retest correlations (intraclass correlation coefficient 0.67–0.94, median 0.88). Floor effects (0–10%, median 0%) and ceiling effects (0–18%, median 4%) were minimal. There were statistically significant differences (P &lt; 0.05) between patients using CSII and MDI on all IDSRQ subscales except psychological well-being (P = 0.096); differences in means were 0.3–1.4 SD units (median 0.9). Multiple regression analysis (controlling for age, sex, and type of diabetes) showed that treatment satisfaction, perceived clinical efficacy, and psychological well-being were independently associated with overall treatment preference and accounted for half of the difference in preference between CSII and MDI patients.
CONCLUSIONS—Preliminary findings suggest that the IDSRQ is a valid and reliable measure of HRQOL and treatment preferences for insulin delivery systems. The subscales are comprehensive, sensitive to differences in user populations, and account for most of the preference for a particular insulin delivery system.
Diabetic Peripheral Neuropathy and Depressive Symptoms
Authors: Vileikyte Loretta , Leventhal Howard , Gonzalez Jeffrey S. , Peyrot Mark , Rubin Richard R. , Ulbrecht Jan S. , Garrow Adam , Waterman Christine , Cavanagh Peter R. , Boulton Andrew J.M. 
Published: March 2007

OBJECTIVE—We examined the association between severity of diabetic peripheral neuropathy and depressive symptoms and investigated the potential mediators of this association.
RESEARCH DESIGN AND METHODS—The Hospital Anxiety and Depression Scale (HADS) was used to assess depressive symptoms in 494 patients (mean age 62 years; 70% male; 72% type 2 diabetic) with diabetic neuropathy diagnosed by the Neuropathy Disability Score (NDS) and the Vibration Perception Threshold (VPT). Diabetic neuropathy symptoms, activities of daily living (ADLs), and social self-perception were measured by the neuropathy and foot ulcer–specific quality-of-life instrument, NeuroQoL; perceptions of diabetic neuropathy symptom unpredictability and the lack of effective treatment were assessed by the revised Illness Perception Questionnaire.
RESULTS—Both the NDS and VPT were significantly associated with the HADS after controlling for demographic and disease variables. Although diabetic neuropathy symptoms mediated this association, with unsteadiness being most strongly associated with HADS, the relationship between foot ulceration and depression was nonsignificant. The association between diabetic neuropathy symptoms and HADS was partially mediated by two sets of psychosocial variables: 1) perceptions of diabetic neuropathy symptom unpredictability and the lack of treatment control and 2) restrictions in ADLs and changes in social self-perception.
CONCLUSIONS—These findings establish the association between diabetic neuropathy and depressive symptoms and identify potential targets for interventions to alleviate depressive symptoms in persons affected by diabetic peripheral neuropathy.
Mortality in Childhood-Onset Type 1 Diabetes
Authors: Dahlquist Gisela , Källén Bengt 
Published: March 2007

OBJECTIVE—To describe the age- and sex-specific mortality in a cohort of young type 1 diabetic patients and to analyze the causes of death with special focus on suicide, accidents, and unexplained deaths.
RESEARCH DESIGN AND METHODS—A population-based incident childhood diabetes register, covering onset cases since 1 July 1977, was linked to the Swedish Cause of Death Register up to 31 December 2000. The official Swedish population register was used to calculate age- and sex-standardized mortality rates (SMRs), excluding neonatal deaths. To analyze excess risks for specific diagnoses, case subjects were compared with five nondiabetic control subjects, matched by age, sex, and year of death. Death certificates were collected for all case and control subjects. For case subjects with an unclear diagnosis, hospital records and/or forensic autopsy reports were obtained.
RESULTS—Mean age- and sex-SMR was 2.15 (95% CI 1.70–2.68) and tended to be higher among females (2.65 vs. 1.93, P = 0.045). Mean age at death was 15.2 years (range 1.2–27.3) and mean duration 8.2 years (0–20.7). Twenty-three deaths were clearly related to diabetes; 20 died of diabetic ketoacidosis. Only two case subjects died with late diabetes complications (acute coronary infarction). Thirty-three case subjects died with a diagnosis not directly related to diabetes; 7 of them committed suicide, and 14 died from accidents. There was no significant difference in traffic accidents (odds ratio 1.02 [95% CI 0.40–2.37]). Obvious suicide tended to be increased but not statistically significantly so (1.55 [0.54–3.89]). Seventeen diabetic case subjects were found deceased in bed without any cause of death found at forensic autopsy. Only two of the control subjects died of similar unexplained deaths.
CONCLUSIONS—In a well-developed health care system, there is still a significant excess mortality in young type 1 diabetic patients. We confirm a very large proportion of unexplained deaths in bed, which should be further studied. There is no clear excess death rate caused by suicide or traffic accidents among young diabetic subjects.