bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reduced Awareness of Hypoglycemia in Adults With IDDM: A prospective study of hypoglycemic frequency and associated symptoms
Authors: Clarke William L , Cox Daniel J , Gonder-Frederick Linda A , Julian Diana , Schlundt David , Polonsky William 
Published: March 2007

OBJECTIVE
To prospectively evaluate the frequency and severity of hypoglycemic episodes in IDDM subjects who declare themselves to have reduced awareness of hypoglycemia, to validate their self-designations in their natural environment, and to determine objectively the presence or absence of autonomic and neuroglycopenic symptoms associated with their low blood glucose (BG) levels.

RESEARCH DESIGN AND METHODS
A total of 78 insulin-dependent diabetes mellitus (IDDM) subjects (mean age 38.3 ± 9.2 years; duration of diabetes 19.3 ± 10.4 years) completed two sets of assessments separated by 6 months. The assessments included reports of frequency and severity of low BG, symptoms associated with low BG, and a BG symptom/estimation trial using a hand-held computer (HHC). Diaries of hypoglycemic episodes were kept for the intervening 6 months. HbA1 levels were determined at each assessment.

RESULTS
Of the subjects, 39 declared themselves as having reduced awareness of hypoglycemia (reduced-awareness subjects). There were no differences between these reduced-awareness subjects and aware subjects with regard to age, sex, disease duration, insulin dose, or HbA1. During the HHC trials, reduced-awareness subjects were significantly less accurate in detecting BG &lt; 3.9 mmol/l (33.2 ± 47 vs. 47.6 ± 50% detection, P = 0.001) and had significantly fewer autonomic (0.41 ± 0.82 vs. 1.08 ± 1.22, P = 0.006, reduced-awareness vs. aware) and neuroglycopenic (0.44 ± 0.85 vs. 1.18 ± 1.32, P = 0.004, reduced-awareness vs. aware) symptoms per subject. Prospective diary records revealed that reduced-awareness subjects experienced more moderate (351 vs. 238, P = 0.026) and severe (50 vs. 17, P = 0.0062) hypoglycemic events. The second assessment results were similar to the first and verified the reliability of the data.

CONCLUSIONS
IDDM subjects who believe they have reduced awareness of hypoglycemia are generally correct. They have a history of more moderate and severe hypoglycemia, are less accurate at detecting BG &lt; 3.9 mmol/l, and prospectively experience more moderate and severe hypoglycemia than do aware subjects. Neither disease duration nor level of glucose control explains their reduced awareness of hypoglycemia. Reduced-awareness individuals may benefit from interventions designed to teach them to recognize all of their potential early warning symptoms.
Tolrestat in the Primary Prevention of Diabetic Neuropathy
Authors: Giugliano Dario , Acampora Rita , Marfella Raffaele , Maro Giosué Di , Rosa Nicoletta De , Misso Lucio , Ceriello Antonio , Quatraro Antonio , D'Onofrio Felice 
Published: March 2007

OBJECTIVE
To compare the effects of tolrestat and placebo in patients with subclinical diabetic neuropathy.

RESEARCH DESIGN AND METHODS
Non-insulin-dependent diabetes mellitus (NIDDM) patients with early involvement of the autonomic nervous system were identified by only one pathological (outside the 99% confidence interval of the normal population) squatting test (vagal or sympathetic). Fifty-seven patients entered a randomized, placebo-controlled, double-blind, parallel 52-week study of tolrestat at a dose of 200 mg/day. Cardiovascular reflex tests (squatting vagal and sympathetic tests, pressure gain, deep breathing, lying-to-standing, Valsalva maneuver, and orthostatic hypertension), vibration thresholds, tendon reflexes, and muscle strength were assessed throughout the study.

RESULTS
At 12 months, nerve function significantly improved in patients receiving tolrestat and deteriorated in patients taking placebo. At baseline, the squatting vagal test was normal in 16 patients in the tolrestat group and in 15 patients in the placebo group. At 12 months, 25 patients taking tolrestat had a normalized squatting test, but only 6 patients taking placebo did (P = 0.02). Vibration perception threshold improved by a value of 6 ± 3 V in the tolrestat group (P &lt; 0.001) and deteriorated by a value of 3 ± 1.8 V (P &lt; 0.001) in the placebo group.

CONCLUSIONS
Tolrestat may be useful in the primary prevention of diabetic neuropathy.
Postural Stability in Diabetic Polyneuropathy
Authors: Boucher Pierre , Teasdale Normand , Courtemanche Richard , Bard Chantal , Fleury Michelle 
Published: March 2007

OBJECTIVE
To examine whether sensory changes in lower limbs associated with diabetic sensory polyneuropathy compromise postural stability in different visual sensory conditions.

RESEARCH DESIGN AND METHODS
The presence and seventy of sensory neuropathy was evaluated with a clinical scale and measures of nerve conduction velocity in the lower limbs. Balance control was evaluated by testing subjects' postural stability (with a force platform) with vision, without vision, and during a recovery period after being without vision.

RESULTS
Neuropathic patients showed larger ranges of sway, a faster sway speed, and a greater dispersion of sway than control subjects in all conditions. They also exhibited similar or less stable postural performance with vision than that of control subjects without vision. There was a strong relationship between the severity of the neuropathy and the postural stability.

CONCLUSIONS
This experiment highlights that even with vision, the postural stability of neuropathic patients is impaired and may put them at higher risk of falling when performing more challenging daily tasks.
Clinical Management of the NIDDM Patient: Impact of the American Diabetes Association Practice Guidelines, 1985–1993
Authors: Stolar Mark W ,   Endocrine Fellows Foundation Study Group
Published: March 2007

OBJECTIVE
To assess the impact of the American Diabetes Association's (ADA's) standards of care for patients with non-insulin-dependent diabetes mellitus (NIDDM) on practice patterns among university-based endocrine physicians and fellows.

RESEARCH DESIGN AND METHODS
This study represents a retrospective chart-based review of 790 patients with NIDDM conducted by endocrine fellows in training at 42 academic institutions. By using an ADA guidelines-based questionnaire, patient management and adherence to the guidelines were assessed by reviewing charts dating ≥3 years before, the year of, and 3 years after the guidelines' publication. All calculations were performed using the McNemar test, and all P values are two-sided.

RESULTS
The ADA standards of care have not had the significant impact in the clinical training setting that was anticipated. Deficiencies were noted in all aspects of the diabetic patient encounter and did not improve significantly following publication of the guidelines, except in the areas of foot care, eye examination, and lipid screening. Major deficiencies exist in areas of quality assurance and chart documentation, and these did not improve over time.

CONCLUSIONS
New strategies must be devised to increase awareness and implementation of these guidelines, both to enhance patient care and to improve the training of future diabetes caregivers.
The Epidemiology of Diabetes and Pregnancy in the U.S., 1988
Authors: Engelgau Michael M , Herman William H , Smith Philip J , German Robert R , Aubert Ronald E 
Published: March 2007

OBJECTIVE
To determine the prevalence of pregnancy complicated by diabetes in a representative sample of the U.S. population.

RESEARCH DESIGN AND METHODS
We analyzed data from a multistaged cross-sectional probability sample of live births recorded in the U.S. in 1988 for women 15–49 years of age. The main outcome measure was pregnancy complicated by diabetes.

RESULTS
Diabetes was present in congruent to 154,000 (4%) of all pregnancies in the U.S. Gestational diabetes mellitus (GDM) accounted for 135,000 of such pregnancies (88%), non-insulin-dependent diabetes mellitus (NIDDM) for 12,000 (8%), and insulin-dependent diabetes mellitus for 7,000 (4%). On average, the mothers with NIDDM (29.6 years) and GDM (29.3 years) were older than mothers whose pregnancies were not complicated by diabetes (26.2 years; P &lt; 0.05). In multivariate analyses, the odds of having a pregnancy complicated by GDM increased significantly with maternal age and body mass index.

CONCLUSIONS
Pregnancy is complicated by diabetes more often than was previously believed. More frequent testing may further increase the apparent prevalence of GDM.
High Incidence of Childhood-Onset IDDM in Kuwait
Authors: Shaltout Azza A , Qabazard Mariam A , Abdella Nabila A , LaPorte Ronald E , Arouj Mounira Al , Nekhi Abdulla Ben , Moussa Mohamed A , Khawari Mona A Al ,   Kuwait Study Group of Diabetes in Childhood
Published: March 2007

OBJECTIVE
To determine the incidence of insulin-dependent diabetes mellitus (IDDM) in children aged 0–14 years in Kuwait, as part of the World Health Organization Multinational Collaborative Study (DIAMOND), and to determine if the incidence rates have increased.

RESEARCH DESIGN AND METHODS
All cases of IDDM diagnosed before the child's 15th birthday between 1 January 1992 and 31 December 1993 were recorded. Prospective notification of all children with newly diagnosed diabetes who were admitted to hospitals and periodic review of hospital medical records provided the primary source; notification by physicians working in diabetic clinics, in which registry of all new cases is mandatory, provided the secondary source of ascertainment.

RESULTS
The degree of ascertainment was 92.2%. The annual incidence of IDDM for children aged 0–14 years over the 2-year period was 15.4/100,000 (95% confidence interval, 12.4–19), with a male:female ratio of 1.2:1. The age-specific annual incidence rates for the age-groups 0–4, 5–9, and 10–14 years were 12.8, 15.1, and 18.3/100,000, respectively, with a male:female ratio of 1.45:1 in the 0- to 4-year-old age-group and an equal sex ratio in the 5- to 9- and 10- to 14-year-old age-groups. No significant difference was detected between incidence rates of IDDM in boys and girls in the three age-groups. There was no significant linear trend toward an increase in IDDM incidence rates as age advanced. Compared with a previous study by Taha et al. (Taha T, Moussa M, Rashed A, Fenech F: Diabetes mellitus in Kuwait: incidence in the first 29 years of life. Diabetologia 25:306–308, 1983), there was a nearly fourfold increase of IDDM in the age-group 0–14 years, mainly in those children &lt; 5 years old, suggesting a rapid increase in a short period of time.

CONCLUSIONS
Kuwait has the highest incidence of IDDM in children in the region, and an apparently increasing incidence has been demonstrated over the last decade.
The Influence of Pregnancy on IDDM Complications
Authors: Hemachandra Anusha , Ellis Demetrius , Lloyd Cathy E , Orchard Trevor J 
Published: March 2007

OBJECTIVE
Although pregnancy has been associated with an increased progression of certain insulin-dependent diabetes mellitus (IDDM) complications, particularly retinopathy, both the short- and long-term relationships between pregnancy and both neuropathy and macrovascular disease are poorly documented. This study was conducted to comprehensively examine the influence of pregnancy on the development and progression of IDDM complications.

RESEARCH DESIGN AND METHODS
Using the Pittsburgh Epidemiology of Diabetes Complications Study population (childhood-onset IDDM), two nested, pair-matched case-control studies were conducted. Women who had completed at least one successful pregnancy (n = 80) were matched to women with no history of pregnancy by age, duration of IDDM, race, and marital history. The first nested study (study 1) compared the prevalences of five IDDM complications between case and control groups. The second nested study (study 2) compared the incidences of the same five complications over an approximate 2-year interval during which the case subjects (n = 30) completed a successful pregnancy.

RESULTS
There were no significant differences in the prevalence rates of coronary heart disease, neuropathy, proliferative retinopathy, lower extremity arterial disease, and overt nephropathy by case-control status, while parity did not predict any complication in multiple logistic analysis (study 1). In study 2, there were small but nonsignificant differences in incidence rates of overt nephropathy and lower extremity arterial disease between the groups, whereas case subjects had almost 3 times the incidence rate of proliferative retinopathy (P = 0.58) and 10 times the incidence rate of neuropathy (P &lt; 0.001) as did other matched control subjects. In multivariate analysis, parity predicted neuropathy incidence but did not predict the incidence of any other complication, including proliferative retinopathy.

CONCLUSIONS
Women with IDDM who experience a pregnancy may not be at an increased risk of diabetes complications later in life. However, in the short term, pregnancy may accelerate the development of some complications, such as neuropathy.
Angiotensin I-Converting Enzyme Gene Polymorphism Is Associated With Myocardial Infarction, but Not With Retinopathy or Nephropathy, in NIDDM
Authors: Fujisawa Tomomi , Ikegami Hiroshi , Shen Gong-Qing , Yamato Eiji , Takekawa Kiyoshi , Nakagawa Yusuke , Hamada Yoichi , Ueda Hironori , Rakugi Hiromi , Higaki Jitsuo , Ohishi Mitsuru , Fujii Kenshi , Fukuda Masakatsu , Ogihara Toshio 
Published: March 2007

OBJECTIVE
To clarify the relationship between the angiotensin I-converting enzyme (ACE) gene polymorphism and diabetic micro- and macroangiopathy in patients with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS
We examined 267 NIDDM patients with various stages of diabetic retinopathy, 61 patients with myocardial infarction (MI), and 136 patients without MI. An insertion/deletion polymorphism of the ACE gene was typed by polymerase chain reaction.

RESULTS
Although no association was found between ACE gene polymorphism and diabetic retinopathy or nephropathy, this polymorphism was associated with MI in the patients with NIDDM. Homozygotes for the deletion polymorphism (DD genotype) were found more frequently in diabetic patients with MI (31.1%) than in diabetic patients without ischemic heart disease (16.9%), with a relative risk of 2.22 (95% confidence interval 1.11–4.46, P = 0.024).

CONCLUSION
These data indicate that ACE gene polymorphism is associated with MI, but not with retinopathy or nephropathy, in patients with NIDDM and suggest that the ACE gene confers susceptibility to diabetic macroangiopathy but not to microangiopathy.
Exocrine Pancreatic and β-cell Function in Malnutrition-Related Diabetes Among North Indians
Authors: Bhatia Eesh , Baijal Sanjay S , Kumar K Ramesh , Choudhuri Gourdas 
Published: March 2007

OBJECTIVE
To compare the pancreatic exocrine and β-cell function in the two variants of malnutrition-related diabetes mellitus (MRDM): fibrocalculous pancreatic diabetes (FCPD) and protein-deficient pancreatic diabetes (PDPD).

RESEARCH DESIGN AND METHODS
Fecal chymotrypsin (FCT) and fasting C-peptide levels were measured in 20 consecutive patients with FCPD and 19 with PDPD. FCPD was diagnosed by pancreatic calcification on ultrasonography, while the diagnosis of PDPD was made on the basis of low body mass index, severe diabetes requiring insulin therapy, and ketosis resistance on interruption of insulin. Twenty patients with type I diabetes and 32 healthy subjects served as control subjects.

RESULTS
Both FCPD and PDPD patients had diminished levels of FCT when compared with those of control subjects and patients with type I diabetes. However, FCT levels were significantly lower in subjects with FCPD (median 0.4 U/g, range 0–8.9 U/g), in comparison with those with PDPD (4.7 U/g, 0.6–40.5 U/g; P &lt; 0.001). Of the FCPD patients, 13 of 20 (65%) had severe exocrine pancreatic deficiency (FCT &lt; 1 U/g) vs. 3 of 19 (15.8%) PDPD subjects (P &lt; 0.01). In comparison with control subjects, fasting serum C-peptide levels were significantly diminished in both MRDM groups. However, C-peptide levels in subjects with FCPD (mean ± SE, 0.22 ± 0.04 nmol/l) and PDPD (0.26 ± 0.04 nmol/l) were comparable.

CONCLUSIONS
Among the two variants of MRDM, subjects with FCPD have severe pancreatic exocrine deficiency in comparison with those with PDPD, even though their C-peptide levels are comparably diminished. This suggests that the pathogenesis of these two entities may differ or that the genetic and/or environmental factors leading to exocrine damage are different.
Nondiabetic Mexican-Americans Do Not Have Reduced Insulin Responses Relative to Nondiabetic Non-Hispanic Whites
Authors: Haffner Steven M , Miettinen Heikki , Stern Michael P 
Published: March 2007

OBJECTIVE
To study why Mexican-Americans have a threefold increase in NIDDM relative to non-Hispanic whites. The etiology of NIDDM is still controversial, with both insulin resistance and decreased insulin secretion proposed as precursors of NIDDM.

RESEARCH DESIGN AND METHODS
We examined possible ethnic differences in fasting insulin (as a marker of insulin resistance) and change in insulin-to-change in glucose ratio (ΔI30:ΔG30) during the first 30 min after oral glucose ingestion (as a marker of abnormal whites from the San AntonioHeart Study, a population-based study of diabetes and cardiovascular disease. Fasting insulin and ΔI30:ΔG30 were evaluated as continuous variables.

RESULTS
Mexican-Americans had increased insulin concentrations at fasting and 30, 60, and 120 min after an oral glucose load as well as an increased 0- to 30-min increment in insulin and ΔI30:ΔG30 relative to non-Hispanic whites. These results remained unchanged after adjustment for age, sex, obesity, body fat distribution, and glucose tolerance.

CONCLUSIONS
These results suggest that increased insulin resistance rather than decreased insulin secretion is characteristic of nondiabetic Mexican-Americans, a high-risk population for NIDDM.
Depression and Risk for Onset of Type II Diabetes: A prospective population-based study
Authors: Eaton William W , Armenian Haroutune , Gallo Joseph , Pratt Laurie , Ford Daniel E 
Published: March 2007

OBJECTIVE
To determine whether depression is associated with an increased risk for onset of diabetes.

RESEARCH DESIGN AND METHODS
In 1981, a total of 3,481 household-residing adults participated in the Epidemiologic Catchment Area (ECA) Program survey at the East Baltimore site. A follow-up of that cohort after 13 years completed 1,897 interviews, amounting to &gt;72% of survivors. In 1981, depression was assessed with the National Institutes of Mental Health (NIMH) Diagnostic Interview Schedule and diabetes, by self-report. This prospective analysis focused on subjects at risk for onset of diabetes by removing from the analysis individuals with diabetes in 1981.

RESULTS
There were 89 new cases of diabetes among 1,715 individuals at risk, yielding a 13-year cumulative incidence of diabetes of 5.2%. In logistic models, major depressive disorder, but not milder forms of depression or other forms of psychiatric disorder, predicted the onset of diabetes (estimated relative risk, 2.23; 95% CI 0.90–5.55). Controlling for age, race, sex, socioeconomic status, education, use of health services, other psychiatric disorders, and body weight did not weaken the relationship.

CONCLUSIONS
Major depressive disorder signals increased risk for onset of type II diabetes. Limitations of the findings arise from the difficulty in determining temporal order with two chronic conditions, even when the temporal order of measurement is clear. In addition, even though control variables were introduced for the use of health services, it is possible that the treatment for depression led to an earlier diagnosis of diabetes in this sample.
Fibrocalculous Pancreatic Diabetes: Long-term survival analysis
Authors: Mohan Viswanathan , Premalatha Gopal , Padma Audinarayanan , Chari Suresh T , Pitchumoni Capecomorin S 
Published: March 2007

OBJECTIVE
To determine the long-term survival and causes of death in fibrocalculous pancreatic diabetes, a form of diabetes secondary to tropical chronic pancreatitis.

RESEARCH DESIGN AND METHODS
A cohort of 370 patients with fibrocalculous pancreatic diabetes were analyzed with respect to survival time from the date of occurrence of the first symptom of the disease as well as after the onset of diabetes. The cause of death was analyzed in the patients who died. Cumulative survival rates were calculated by the actuarial method, and life table graphs were plotted by mathematical calculations.

RESULTS
Long-term survival of patients with fibrocalculous pancreatic diabetes is much better today than that described 30 years ago. About 80% of patients were alive 35 years after the first episode of abdominal pain. The median survival time after the diagnosis of diabetes was 25 years. These figures, however, are still considerably lower than the life expectancy of the age- and sex-matched general population. Diabetic nephropathy was the main cause of death. Pancreatic cancer and other chronic pancreatitis-related causes as well as malnutrition and infections were also important contributors to mortality.

CONCLUSIONS
The overall prognosis for patients with fibrocalculous pancreatic diabetes appears to have improved possibly because of earlier diagnosis, better management of diabetes, and improved nutrition.
Insulin-Induced Lipoatrophy in Type I Diabetes: A possible tumor necrosis factor-α-mediated dedifferentiation of adipocytes
Authors: Atlan-Gepner Catherine , Bongrand Pierre , Farnarier Catherine , Xerri Luc , Choux Régine , Gauthier Jean-Francois , Brue Thierry , Vague Philippe , Grob Jean-Jacques , Vialettes Bernard 
Published: March 2007

OBJECTIVE
To test the hypothesis that tumor necrosis factor (TNF)-α may mediate the loss and the dedifferentiation of subcutaneous fat tissue in the insulin-induced lipoatrophies of a diabetic patient who presented extensive lesions.

RESEARCH DESIGN AND METHODS
An in vitro exploration of cytokine production by peripheral blood mononuclear cells (PBMC) from the reported case was performed and compared with the same explorations of PBMC from three nondiabetic subjects and three diabetic patients without lipoatrophic lesions. A proliferation test and an evaluation of TNF-α and interleukin (IL)-6 production from PBMC in presence of insulin were studied.

RESULTS
The production of TNF-α and IL-6 by the macrophages of the patient in presence of insulin were dramatically increased in comparison with control subjects. This process needed cooperation with other lymphoid cells and was abrogated by dexamethasone.

CONCLUSIONS
In our reported case, a local hyperproduction of TNF-α from macrophages that was induced by the injected insulin could explain the dedifferentiation of the adipocytes of the subcutaneous tissue and the reversion that was induced by the local injection of dexamethasone.