bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can Motor Nerve Conduction Velocity Predict Foot Problems in Diabetic Subjects Over a 6-Year Outcome Period?
Authors: Carrington Anne L. , Shaw Jonathan E. , Van Schie Carine H.M. , Abbott Caroline A. , Vileikyte Loretta , Boulton Andrew J.M. 
Published: March 2007

OBJECTIVE—This study examined motor nerve conduction velocity (MNCV) and other peripheral nerve and vascular tests as predictors for foot ulceration, amputation, and mortality in diabetes over a 6-year follow-up period.
RESEARCH DESIGN AND METHODS—We recruited 169 diabetic subjects (without significant peripheral vascular disease with an ankle brachial pressure index [ABPI] ≥0.75) for the study and separated them into groups (to ensure diversity of nerve function). The control group consisted of 22 nondiabetic people. At baseline, all subjects underwent assessment of MNCV; vibration, pressure, and temperature perception thresholds; peripheral vascular function; and other diabetes assessments.
RESULTS—Over the 6-year outcome period, 37.3% of the diabetic subjects developed at least one new ulcer, 11.2% had a lower-limb amputation (LLA) (minor or major), and 18.3% died. Using multivariate Cox’s regression analysis (RR [95% CI] and removing previous ulcers as a confounding variable, MNCV was found to be the best predictor of new ulceration (0.90 [0.84–0.96], P = 0.001) and the best predictors of amputation were pressure perception threshold (PPT) (5.18 [1.96–13.68], P = 0.001) and medial arterial calcification (2.88 [1.13–7.35], P = 0.027). Creatinine (1.01 [1.00–1.01], P &lt; 0.001), MNCV (0.84 [0.73–0.97], P = 0.016), and skin oxygen levels (14.32 [3.04–67.52], P = 0.001) were the best predictors of mortality.
CONCLUSIONS—This study shows that MNCV, which is often assessed in clinical trials of neuropathy, can predict foot ulceration and death in diabetes. In addition, tests of PPT and medial arterial calcification can be used in the clinic to predict LLA in diabetic subjects.
Biological Variation of Homeostasis Model Assessment-Derived Insulin Resistance in Type 2 Diabetes
Authors: Jayagopal Vijay , Kilpatrick Eric S. , Jennings Paul E. , Hepburn David A. , Atkin Stephen L. 
Published: March 2007

OBJECTIVE—Individuals with type 2 diabetes are particularly vulnerable to cardiovascular disease. Insulin resistance is a major determinant of this increased risk and is a potential therapeutic target. This study was undertaken to establish the natural biological variation of insulin resistance in individuals with type 2 diabetes.
RESEARCH DESIGN AND METHODS—The biological variation of insulin resistance was assessed by measuring insulin resistance at 4-day intervals on 10 consecutive occasions in 12 postmenopausal women with diet-controlled type 2 diabetes and in 11 weight- and age-matched postmenopausal women without type 2 diabetes. Insulin resistance was derived using the homeostasis model assessment for insulin resistance (HOMA-IR) method.
RESULTS—The distribution of HOMA-IR was log Gaussian in the type 2 diabetic study group and Gaussian in the control group. The HOMA-IR in the type 2 diabetic group was significantly greater than that of the control group (mean ± SD: 4.33 ± 2.3 vs. 2.11 ± 0.79 units, P = 0.001). After accounting for analytical variation, the mean intraindividual variation was also substantially greater in the type 2 diabetic group than in the control group (mean 1.05 vs. 0.15, P = 0.001). Consequently, at any level of HOMA-IR, a subsequent sample must increase by &gt;90% or decrease by &gt;47% to be considered significantly different from the first.
CONCLUSIONS—HOMA-IR is significantly greater and more variable for individuals with type 2 diabetes. Therefore, this inherent variability needs to be accounted for in studies evaluating therapeutic reduction of HOMA-IR in this group.
Cardiac Events in 735 Type 2 Diabetic Patients Who Underwent Screening for Unknown Asymptomatic Coronary Heart Disease
Authors: Faglia Ezio , Favales Fabrizio , Calia Patrizia , Paleari Felice , Segalini Giovanni , Gamba Pier Luigi , Rocca Alberto , Musacchio Nicoletta , Mastropasqua Arturo , Testori Gianpaolo , Rampini Pietro , Moratti Flavia , Braga Anna , Morabito Alberto 
Published: March 2007

OBJECTIVE—To report the cardiac events in type 2 diabetic outpatients screened for unknown asymptomatic coronary heart disease (CHD) and followed for 5 years.
RESEARCH DESIGN AND METHODS—During 1993, 925 subjects aged 40–65 years underwent an exercise treadmill test (ETT). If it was abnormal, the subjects then underwent an exercise scintigraphy. Of the 925 subjects, 735 were followed for 5 years and cardiac events were recorded.
RESULTS—At the entry of the study, 638 of the 735 followed subjects had normal ETT, 45 had abnormal ETT with normal scintigraphy, and 52 had abnormal ETT and abnormal scintigraphy. The 52 subjects with abnormal scintigraphy and ETT underwent a cardiological and diabetological follow-up; the subjects with just abnormal ETT had a diabetological follow-up only. During the follow-ups, 42 cardiac events occurred: 1 fatal myocardial infarction (MI), 20 nonfatal MIs, and 10 cases of angina in the 638 subjects with normal ETT; 1 fatal MI in the 45 subjects with normal scintigraphy; and 1 fatal MI and 9 cases of angina in the 52 subjects with abnormal scintigraphy. In these 52 subjects all cardiac events were significantly more frequent (χ2 = 21.40, P &lt; 0.0001) but the ratio of major (cardiac death and MI) to minor (angina) cardiac events was significantly lower (P = 0.002). Scintigraphy abnormality (hazard ratio 5.47; P &lt; 0.001; 95% CI 2.43–12.29), diabetes duration (1.06; P = 0.021; 1.008–1.106), and diabetic retinopathy (2.371; P = 0.036; 1.059–5.307) were independent predictors of cardiac events on multivariate analysis.
CONCLUSIONS—The low ratio of major to minor cardiac events in the positive scintigraphy group may suggest, although it does not prove, that the screening program followed by appropriate management was effective for the reduction of risk of major cardiac events.
Combination of Insulin and Metformin in the Treatment of Type 2 Diabetes
Authors: Wulffelé Michiel G. , Kooy Adriaan , Lehert Philippe , Bets Daniel , Ogterop Jeles C. , Borger van der Burg Bob , Donker Ab J.M. , Stehouwer Coen D.A. 
Published: March 2007

OBJECTIVE—To investigate the metabolic effects of metformin, as compared with placebo, in type 2 diabetic patients intensively treated with insulin.
RESEARCH DESIGN AND METHODS—Metformin improves glycemic control in poorly controlled type 2 diabetic patients. Its effect in type 2 diabetic patients who are intensively treated with insulin has not been studied. A total of 390 patients whose type 2 diabetes was controlled with insulin therapy completed a randomized controlled double-blind trial with a planned interim analysis after 16 weeks of treatment.The subjects were selected from three outpatient clinics in regional hospitals and were randomly assigned to either the placebo or metformin group, in addition to insulin therapy. Intensive glucose monitoring with immediate insulin adjustments according to strict guidelines was conducted. Indexes of glycemic control, insulin requirements, body weight, blood pressure, plasma lipids, hypoglycemic events, and other adverse events were measured.
RESULTS—Of the 390 subjects, 37 dropped out (12 in the placebo and 25 in the metformin group). Of those who completed 16 weeks of treatment, metformin use, as compared with placebo, was associated with improved glycemic control (mean daily glucose at 16 weeks 7.8 vs. 8.8 mmol/l, P = 0.006; mean GHb 6.9 vs. 7.6%, P &lt; 0.0001); reduced insulin requirements (63.8 vs. 71.3 IU, P &lt; 0.0001); reduced weight gain (−0.4 vs. +1.2 kg, P &lt; 0.01); and decreased plasma LDL cholesterol (−0.21 vs. −0.02 mmol/l, P &lt; 0.01). Risk of hypoglycemia was similar in both groups.
CONCLUSIONS—In type 2 diabetic patients who are intensively treated with insulin, the combination of insulin and metformin results in superior glycemic control compared with insulin therapy alone, while insulin requirements and weight gain are less.
Insulin Resistance and Associated Compensatory Responses in African-American and Hispanic Children
Authors: Goran Michael I. , Bergman Richard N. , Cruz Martha L. , Watanabe Richard 
Published: March 2007

OBJECTIVE—The objective of this study was to compare insulin resistance relative to body fat and the associated compensatory responses in 57 healthy children living in Los Angeles, California (14 Caucasians, 15 African-Americans, and 28 Hispanics).
RESEARCH DESIGN AND METHODS—Insulin sensitivity and acute insulin response were determined by intravenous glucose tolerance test. Insulin secretion, hepatic insulin extraction, and insulin clearance were estimated by C-peptide and insulin modeling.
RESULTS—Insulin sensitivity was significantly lower in Hispanics and African-Americans compared with Caucasian children, and acute insulin response was significantly higher in African-American children. No ethnic differences were noted in the first-phase secretion, but second-phase insulin secretion was significantly higher in Hispanic children than in African-American children (200 ± 53 vs. 289 ± 41 nmol/min; P = 0.03). The greater acute insulin response in African-Americans, despite lower secretion, was explained by a lower hepatic insulin extraction in African-Americans compared with Hispanics (36.6 ± 2.9 vs. 47.3 ± 2.2%; P = 0.0006).
CONCLUSIONS—In conclusion, Hispanic and African-American children are more insulin resistant than Caucasian children, but the associated compensatory responses are different across ethnic groups.
Noninvasive Blood Glucose Monitoring With Optical Coherence Tomography
Authors: Larin Kirill V. , Eledrisi Mohsen S. , Motamedi Massoud , Esenaliev Rinat O. 
Published: March 2007

OBJECTIVE—To study the feasibility of noninvasive blood glucose monitoring using optical coherence tomography (OCT) technique in healthy volunteers.
RESEARCH DESIGN AND METHODS—An OCT system with the wavelength of 1,300 nm was used in 15 healthy subjects in 18 clinical experiments. Standard oral glucose tolerance tests were performed to induce changes in blood glucose concentration. Blood samples were taken from the right arm vein every 5 or 15 min. OCT images were taken every 10–20 s from the left forearm over a total period of 3 h. The slope of the signals was calculated at the depth of 200–600 μm from the skin surface.
RESULTS—A total of 426 blood samples and 8,437 OCT images and signals were collected and analyzed in these experiments. There was a good correlation between changes in the slope of noninvasively measured OCT signals and blood glucose concentrations throughout the duration of the experiments. The slope of OCT signals changed significantly (up to 2.8% per 10 mg/dl) with variation of plasma glucose values. The good correlation obtained between the OCT signal slope and blood glucose concentration is due to the coherent detection of backscattered photons, which allows measurements of OCT signal from a specific tissue layer without unwanted signal from other tissue layers.
CONCLUSIONS—This pilot study demonstrated the capability of the OCT technique to monitor blood glucose concentration noninvasively in human subjects. Further studies with a larger number of subjects including diabetic subjects are planned to validate these preliminary results.
Intrauterine Hyperglycemia Is Associated With an Earlier Diagnosis of Diabetes in HNF-1α Gene Mutation Carriers
Authors: Stride Amanda , Shepherd Maggie , Frayling Timothy M. , Bulman Mike P. , Ellard Sian , Hattersley Andrew T. 
Published: March 2007

OBJECTIVE—In animals, experimentally induced maternal hyperglycemia during pregnancy results in hyperglycemic offspring. Similarly, Pima Indian offspring with mothers who are diabetic at the time of pregnancy have increased risk of early-onset diabetes. We hypothesized that exposure to hyperglycemia in utero would decrease the age at diagnosis of diabetes in patients with maturity-onset diabetes of the young (MODY) due to a mutation in the hepatocyte nuclear factor 1α (HNF-1α) gene.
RESEARCH DESIGN AND METHODS—We analyzed the affect of maternal diabetes on age at diagnosis of diabetes in 150 HNF-1α gene mutation carriers from 55 families.
RESULTS—Age at diagnosis in HNF-1α mutation carriers was younger when the mother was diagnosed before pregnancy compared with when the mother was diagnosed after pregnancy (15.5 ± 5.4 vs. 27.5 ± 13.1 years, P &lt; 0.0001). This is unlikely to represent a generalized familial decrease in age at diagnosis due to a more severe mutation, because no difference was seen in age of the offspring at diagnosis of diabetes when the father was diagnosed at a young age, and a similar trend was seen when only the single common mutation, P291fsinsC, was analyzed.
CONCLUSIONS—We conclude that maternal hyperglycemia during pregnancy probably increases the penetrance of HNF-1α mutations. The potential role of exposure to hyperglycemia in utero in a monogenic diabetic subgroup warrants prospective study.
Determinants of the Development of Diabetes (Maturity-Onset Diabetes of the Young-3) in Carriers of HNF-1α Mutations
Authors: Klupa Tomasz , Warram James H. , Antonellis Anthony , Pezzolesi Marcus , Nam Moonsuk , Malecki Maciej T. , Doria Alessandro , Rich Stephen S. , Krolewski Andrzej S. 
Published: March 2007

OBJECTIVE—To determine the distribution of the age at onset of diabetes (maturity-onset diabetes of the young-3 [MODY3]) and to identify determinants of the onset of diabetes in carriers of HNF-1α mutations.
RESEARCH DESIGN AND METHODS—Extended families (n = 104) with type 2 diabetes inherited in a dominant pattern were recruited and screened for diabetes-causing mutations in HNF-1α.
RESULTS—HNF-1α mutations cosegregated with diabetes in only 13 families, all with a mean age at onset &lt;35 years. Insulin secretion was diminished or absent in mutation carriers (n = 101), and diabetes developed in 65% by age 25 years and in 100% by age 50 years. If the mutation was inherited from the mother, diabetes onset was very young in those exposed to diabetes in utero; 57 ± 8% were affected by age 15 years as compared with 0.0% in those not exposed (P &lt; 7 × 10−6). By age 25 years, the difference was reduced (85 ± 6 and 55 ± 12%, respectively; P = 0.02). If the mutation was inherited from the father, diabetes developed in 52 ± 8% by age 25 years. Age at diagnosis was shown to be highly heritable (h2 = 0.47, P = 0.003). When parent of origin was included in the analyses, the magnitude of genetic contribution increased markedly (h2 = 0.91).
CONCLUSIONS—Mutations in HNF-1α accounts for diabetes in a small proportion of families with a dominant pattern of inheritance. Age at onset of diabetes in MODY3 families varied widely and was influenced by familial factors (including modifying genes) and parent of origin (whether a mutation carrier was exposed to diabetes in utero).
Macular Edema Reflects Generalized Vascular Hyperpermeability in Type 2 Diabetic Patients With Retinopathy
Authors: Knudsen Søren T. , Bek Toke , Poulsen Per L. , Hove Marianne N. , Rehling Michael , Mogensen Carl E. 
Published: March 2007

OBJECTIVE—Diabetic maculopathy (DMa) is the most prevalent sight-threatening type of retinopathy in type 2 diabetes and a leading cause of visual loss in the western world. The disease is characterized by hyperpermeability of retinal blood vessels and subsequent formation of hard exudates and macular edema, the degree of which can be estimated by measurement of retinal thickness. We examined associations between retinal thickness as evaluated by optical coherence tomography scanning (OCT), glomerular leakage as evaluated by urinary albumin excretion rate (UAE), and general vascular leakage as evaluated by the transcapillary escape rate of albumin (TERalb) in type 2 diabetic patients with and without DMa.
RESEARCH DESIGN AND METHODS—In 20 type 2 diabetic patients with DMa and 20 type 2 diabetic patients without retinopathy matched for age, sex, and duration of diabetes, we performed OCT, fundus photography, fluorescein angiography, and 24-h ambulatory blood pressure measurement. UAE was determined by radioimmunoassay. TERalb was determined as the initial disappearance of intravenously injected 125I-labeled human serum albumin.
RESULTS—Patients with diabetic maculopathy had higher HbA1c (8.5 ± 1.5 vs. 7.4 ± 1.2%, P &lt; 0.05) and higher total cholesterol (5.8 ± 0.7 vs. 5.2 ± 0.9 mmol/l, P &lt; 0.05) than patients without retinopathy. UAE was higher in the DMa group than in the group with no retinopathy (9.3 ×/÷ 3.1 vs. 3.9 ×/÷ 1.9 μg/min, P &lt; 0.01). There was no difference in TERalb between the two groups (6.0 ± 1.6 vs. 6.6 ± 1.5%, NS). In the group with DMa, OCT, TERalb, and UAE correlated significantly (OCT versus TERalb: r = 0.55, P &lt; 0.05; OCT versus UAE: r = 0.58, P &lt; 0.01; UAE versus TERalb: r = 0.81, P &lt; 0.01). Conversely, there were no correlations between these three parameters in the group without retinopathy.
CONCLUSIONS—Macular edema seems to reflect a generalized vascular leakage in type 2 diabetic patients.
Culturally Competent Diabetes Self-Management Education for Mexican Americans
Authors: Brown Sharon A. , Garcia Alexandra A. , Kouzekanani Kamiar , Hanis Craig L. 
Published: March 2007

OBJECTIVE—To determine the effects of a culturally competent diabetes self-management intervention in Mexican Americans with type 2 diabetes.
RESEARCH DESIGN AND METHODS—A prospective, randomized, repeated measures study was conducted on the Texas-Mexico border in Starr County. A total of 256 randomly selected individuals with type 2 diabetes between 35 and 70 years of age, diagnosed with type 2 diabetes after 35 years of age, and accompanied by a family member or friend were included. The intervention consisted of 52 contact hours over 12 months and was provided by bilingual Mexican American nurses, dietitians, and community workers. The intervention involved 3 months of weekly instructional sessions on nutrition, self-monitoring of blood glucose, exercise, and other self-care topics and 6 months of biweekly support group sessions to promote behavior changes. The approach was culturally competent in terms of language, diet, social emphasis, family participation, and incorporation of cultural health beliefs. Outcomes included indicators of metabolic control (HbA1c and fasting blood glucose), diabetes knowledge, and diabetes-related health beliefs.
RESULTS—Experimental groups showed significantly lower levels of HbA1c and fasting blood glucose at 6 and 12 months and higher diabetes knowledge scores. At 6 months, the mean HbA1c of the experimental subjects was 1.4% below the mean of the control group; however, the mean level of the experimental subjects was still high (&gt;10%).
CONCLUSIONS—This study confirms the effectiveness of culturally competent diabetes self-management education on improving health outcomes of Mexican Americans, particularly for those individuals with HbA1c levels &gt;10%.
Erectile Dysfunction and Quality of Life in Type 2 Diabetic Patients
Authors: De Berardis Giorgia , Franciosi Monica , Belfiglio Maurizio , Di Nardo Barbara , Greenfield Sheldon , Kaplan Sherrie H. , Pellegrini Fabio , Sacco Michele , Tognoni Gianni , Valentini Miriam , Nicolucci Antonio ,   for the Quality of Care and Outcomes in Type 2 Diabetes (QuED) Study Group
Published: March 2007

OBJECTIVE—Within the context of a large, nationwide outcomes research program in type 2 diabetes, we assess the prevalence of self-reported erectile dysfunction and evaluate its impact on quality of life.RESEARCH DESIGN AND METHODS—The study involved 1,460 patients enrolled by 114 diabetes outpatient clinics and 112 general practitioners. Patients were asked to complete a questionnaire investigating their ability to achieve and maintain an erection. Various aspects of quality of life were also assessed depressive using the following instruments: SF-36 Health Survey, diabetes health distress, psychological adaptation to diabetes, depressive symptoms (CES-D scale), and quality of sexual life.RESULTS—Overall, 34% of the patients reported frequent erectile problems, 24% reported occasional problems, and 42% reported no erectile problems. After adjusting for patient characteristics, erectile dysfunction was associated with higher levels of diabetes-specific health distress and worse psychological adaptation to diabetes, which were, in turn, related to worse metabolic control. Erectile problems were also associated with a dramatic increase in the prevalence of severe depressive symptoms, lower scores in the mental components of the SF-36, and a less satisfactory sexual life. A total of 63% of the patients reported that their physicians had never investigated their sexual problems.CONCLUSIONS—Erectile dysfunction is extremely common among type 2 diabetic patients and is associated with poorer quality of life, as measured with generic and diabetes-specific instruments. Despite their relevance, sexual problems are seldom investigated by general practitioners and specialists.
Optimizing Insulin Secretagogue Therapy in Patients With Type 2 Diabetes
Authors: Schmitz Ole , Lund Sten , Andersen Per Heden , Jønler Morten , Pørksen Nils 
Published: March 2007

OBJECTIVE—Repaglinide, a novel antidiabetic agent that has a rapid onset and short duration of action, was developed for mealtime dosing. The purpose of this pharmacodynamic study was to validate a prandial regimen of repaglinide by comparing meal-related dosing with a regimen in which the same total daily dose was divided into only two doses at morning and evening meals.
RESEARCH DESIGN AND METHODS—The study was a double-blind, randomized, parallel-group trial in 19 antidiabetic agent-naive subjects with type 2 diabetes (mean age 58 years, known duration of diabetes 3.5 years, HbA1c 7.3%, and BMI 32 kg/m2). Patients were randomly assigned to receive repaglinide either before each of the three main meals or before breakfast and before the evening meal. Patients in both groups received the same total daily dose of repaglinide. Twenty-four hour profiles of blood glucose, plasma insulin, and plasma C-peptide concentrations were measured at baseline and after 4 weeks of treatment.
RESULTS—Repaglinide increased postprandial insulin levels and markedly reduced postprandial glucose levels relative to baseline in both groups. Significant reductions were also recorded in fasting blood glucose and HbA1c levels. The repaglinide regimen, in which a dose was taken before each main meal, was more effective in improving glycemic control (including postprandial glucose and HbA1c levels) than the same total dose of repaglinide divided into morning and evening mealtime doses.
CONCLUSIONS—These data support the strategy of mealtime dosing with repaglinide. The improvements in glycemic control observed in these patients are encouraging. In addition to classic parameters of glycemic control, improvements in postprandial glucose excursions may prove to be important because postprandial hyperglycemia has been suggested to be an independent risk factor for cardiovascular disease in diabetes.