bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Incidence of Retinopathy 10 Years After Diagnosis in Young Adult People With Diabetes
Authors: Henricsson Marianne , Nyström Lennarth , Blohmé Göran , Östman Jan , Kullberg Carin , Svensson Maria , Schölin Anna , Arnqvist Hans J. , Björk Elisabeth , Bolinder Jan , Eriksson Jan W. , Sundkvist Göran 
Published: March 2007

OBJECTIVE—To estimate the prevalence and severity of diabetic retinopathy (DR) 10 years after diagnosis in a nationwide population-based cohort study of young adult diabetic patients in Sweden.
RESEARCH DESIGN AND METHODS—The Diabetes Incidence Study in Sweden (DISS) aims to register all incident cases of diabetes aged 15–34 years in Sweden. In 1987–1988, 806 cases were reported, and 627 (78%) of them were followed up with regard to retinopathy 8–10 years later. The assessment was based on retinal photographs in most cases (86%).
RESULTS—Ten years after diagnosis, retinopathy was found in 247 patients (39%). The retinopathy was mild in 206 (33%), whereas 30 (4.8%) patients had moderate nonproliferative DR (NPDR) and 11 (1.8%) had proliferative DR (PDR). Patients with retinopathy had worse glycemic control during the years than patients without (HbA1c 8.1 ± 1.5% and 6.8 ± 1.2%, respectively; P &lt; 0.001). In a Cox regression analysis, time to retinopathy was related to high HbA1c (P &lt; 0.001) and high BMI (P = 0.001). Patients with type 2 diabetes had an increased prevalence of severe retinopathy (NPDR or PDR) compared with those with type 1 diabetes (14 of 93 [15%] versus no or mild 24 of 471 [5%], respectively; P &lt; 0.001).
CONCLUSIONS—Despite modern diabetes management, 39% of young adult diabetic patients developed retinopathy within the first 10 years of the disease. Nevertheless, compared with the prevalence of retinopathy (63%), after a similar duration of diabetes before the Diabetes Control and Complications Trial, this prevalence was clearly lower. Current treatment aimed to achieve strict glycemic control has reduced the risk for developing retinopathy.
Hypertension Management in Patients With Diabetes
Authors: Berlowitz Dan R. , Ash Arlene S. , Hickey Elaine C. , Glickman Mark , Friedman Robert , Kader Boris 
Published: March 2007

OBJECTIVE—Clinical trials have demonstrated the importance of tight blood pressure control among patients with diabetes. However, little is known regarding the management of hypertension in patients with coexisting diabetes. To examine this issue, we addressed 1) whether hypertensive patients with coexisting diabetes are achieving lower levels of blood pressure than patients without diabetes, 2) whether there are differences in the intensity of antihypertensive medication therapy provided to patients with and without diabetes, and 3) whether diabetes management affects decisions to increase antihypertensive medication therapy.
RESEARCH DESIGN AND METHODS—We abstracted medical records to collect detailed information on 2 years of care provided for 800 male veterans with hypertension. We compared patients with and without diabetes on intensity of therapy and blood pressure control. Intensity of therapy was described using a previously validated measure that captures the likelihood of an increase in antihypertensive medications. We also determined whether increases in antihypertensive medications were less likely at those visits in which the diabetes medications were being adjusted.
RESULTS—Of the 274 hypertensive patients with diabetes, 73% had a blood pressure ≥140/90 mmHg, compared with 66% in the 526 patients without diabetes (P = 0.04). Diabetic patients also received significantly (P = 0.05) less intensive antihypertensive medication therapy than patients without diabetes. Less intensive therapy in diabetic patients could not be explained by clinicians being distracted by the treatment for diabetes.
CONCLUSIONS—There is an urgent need to improve hypertension care and blood pressure control in patients with diabetes. Additional information is required to understand why clinicians are not more aggressive in managing blood pressure when patients also have diabetes.
Validation of a Counseling Strategy to Promote the Adoption and the Maintenance of Physical Activity by Type 2 Diabetic Subjects
Authors: Di Loreto Chiara , Fanelli Carmine , Lucidi Paola , Murdolo Giuseppe , De Cicco Arianna , Parlanti Natascia , Santeusanio Fausto , Brunetti Paolo , De Feo Pierpaolo 
Published: March 2007

OBJECTIVE—There is enough evidence that physical activity is an effective therapeutic tool in the management of type 2 diabetes. The present study was designed to validate a counseling strategy that could be used by physicians in their daily outpatient practice to promote the adoption and maintenance of physical activity by type 2 diabetic subjects.
RESEARCH DESIGN AND METHODS—The long-term (2-year) efficacy of the behavioral approach (n = 182) was compared with usual care treatment (n = 158) in two matched, randomized groups of patients with type 2 diabetes who had been referred to our Outpatient Diabetes Center. The outcome of the intervention was consistent patient achievement of an energy expenditure of &gt;10 metabolic equivalents (METs)-h/week through voluntary physical activity.
RESULTS—After 2 years, 69% of the patients in the intervention group (27.1 ± 2.0 METs × h/week) and 18% of the control group (4.1 ± 0.8 METs × h/week) achieved the target (P &lt; 0.001) with significant (P &lt; 0.001) improvements in BMI (intervention group 28.9 ± 0.2 versus control group 30.4 ± 0.3 kg/m2) and HbA1c (intervention group 7.0 ± 0.1 versus control group 7.6 ± 0.1%).
CONCLUSIONS—This randomized, controlled study shows that physicians can motivate most patients with type 2 diabetes to exercise long-term and emphasizes the value of individual behavioral approaches in daily practice.
Maggot Therapy for Treating Diabetic Foot Ulcers Unresponsive to Conventional Therapy
Authors: Sherman Ronald A. 
Published: March 2007

OBJECTIVE—To assess the efficacy of maggot therapy for treating foot and leg ulcers in diabetic patients failing conventional therapy.RESEARCH DESIGN AND METHODS—Retrospective comparison of changes in necrotic and total surface area of chronic wounds treated with either maggot therapy or standard (control) surgical or nonsurgical therapy.RESULTS—In this cohort of 18 patients with 20 nonhealing ulcers, six wounds were treated with conventional therapy, six with maggot therapy, and eight with conventional therapy first, then maggot therapy. Repeated measures ANOVA indicated no significant change in necrotic tissue, except when factoring for treatment (F [1.7, 34] = 5.27, P = 0.013). During the first 14 days of conventional therapy, there was no significant debridement of necrotic tissue; during the same period with maggot therapy, necrotic tissue decreased by an average of 4.1 cm2 (P = 0.02). After 5 weeks of therapy, conventionally treated wounds were still covered with necrotic tissue over 33% of their surface, whereas after only 4 weeks of therapy maggot-treated wounds were completely debrided (P = 0.001). Maggot therapy was also associated with hastened growth of granulation tissue and greater wound healing rates.CONCLUSIONS—Maggot therapy was more effective and efficient in debriding nonhealing foot and leg ulcers in male diabetic veterans than was continued conventional care.
Aging Per Se Does Not Influence Glucose Homeostasis
Authors: Imbeault Pascal , Prins Johannes B. , Stolic Manuela , Russell Anthony W. , O’Moore-Sullivan Trisha , Després Jean-Pierre , Bouchard Claude , Tremblay Angelo 
Published: March 2007

OBJECTIVE—To assess the effect of age on glucose metabolism by examining 1) glucose metabolism in young and middle-aged subjects when total or regional adiposity is taken into account and 2) in vitro glucose transport in adipose tissue explants from young and middle-aged women paired for total and abdominal adiposity.
RESEARCH DESIGN AND METHODS—Study 1: body composition, subcutaneous abdominal and visceral adipose tissue areas, and fasting and oral glucose–stimulated glucose and insulin were measured in 84 young and 81 middle-aged men and in 110 young and 91 middle-aged women. Study 2: glucose uptake in subcutaneous abdominal and visceral adipose tissue explants were measured in eight young and eight middle-aged women.
RESULTS—Study 1: young and middle-aged men showed similar subcutaneous abdominal tissue area, whereas fat mass and visceral adipose tissue were greater in middle-aged than in young men (P &lt; 0.01). Fat mass and subcutaneous and visceral adipose tissue areas were greater in middle-aged as compared with young women (P &lt; 0.01). Fasting plasma glucose and the glucose response to an oral glucose tolerance test were significantly higher in middle-aged than in young men and women (P &lt; 0.001). Statistical control for visceral adipose tissue area eliminated the difference seen in glucose response in men and women. Study 2: glucose transport in subcutaneous and omental adipose tissue did not differ between young and middle-aged women.
CONCLUSIONS—1) Visceral obesity, more than age per se, correlates with glucose intolerance in middle-aged subjects; 2) aging does not influence in vitro adipose tissue glucose uptake.
Quality of Care for Diabetic Patients in a Large Urban Public Hospital
Authors: Suwattee Pitiporn , Lynch J. Christopher , Pendergrass Merri L. 
Published: March 2007

OBJECTIVE—We compared diabetes quality-of-care indicators for patients receiving medical treatment in three practice settings of the same hospital.RESEARCH DESIGN AND METHODS—A cross-sectional medical record review for patients receiving care between 1 July 2000 and 30 June 2001 was conducted. Records were abstracted from three practice settings: the Diabetes Clinic (DIABETES), a general medicine clinic staffed by internal medicine residents (RESIDENT), and a general medicine clinic whose providers were medical school faculty physicians (FACULTY). Record review (n = 791) yielded data on diabetes indicators that were derived primarily from the Diabetes Quality Improvement Project.RESULTS—There were significant differences between the DIABETES, RESIDENT, and FACULTY clinics for the percentages of patients with HbA1c testing (94 vs. 92 vs. 76%, P &lt; 0.001), HbA1c &gt;9.5% (31 vs. 36 vs. 43%, P &lt; 0.05), nephropathy assessment (79 vs. 67 vs. 58%, P &lt; 0.001), lipid assessment (86 vs. 79 vs. 76%, P &lt; 0.050), LDL &lt;130 mg/dl (54 vs. 44 vs. 43%, P &lt; 0.05), blood pressure &lt;140/90 mmHg (63 vs. 55 vs. 49%, P &lt; 0.025), eye examinations (64 vs. 50 vs. 31%, P &lt; 0.001), foot examinations (97 vs. 55 vs. 24%, P &lt; 0.001), ACE inhibitor treatment (66 vs. 69 vs. 35%, P &lt; 0.001), and aspirin treatment (71 vs. 59 vs. 15%, P &lt; 0.001).CONCLUSIONS—There is considerable variation in diabetes management in different primary care settings of the same hospital. Although management in all settings was suboptimal, the results attained by the patients in the Diabetes Clinic represent minimal achievable goals for all diabetic patients in this hospital.
A Controlled Trial of Web-Based Diabetes Disease Management
Authors: Meigs James B. , Cagliero Enrico , Dubey Anil , Murphy-Sheehy Patricia , Gildesgame Catharyn , Chueh Henry , Barry Michael J. , Singer Daniel E. , Nathan David M. 
Published: March 2007

OBJECTIVE—To test effects of a web-based decision support tool, the diabetes Disease Management Application (DMA), developed to improve evidence-based management of type 2 diabetes.
RESEARCH DESIGN AND METHODS—We conducted a group randomized controlled trial of 12 intervention and 14 control staff providers and 307 intervention and 291 control patients with type 2 diabetes in a hospital-based internal medicine clinic. Providers were randomly assigned from May 1998 through April 1999 to have access to the DMA (intervention) or not to have access (control). The DMA displays interactive patient-specific clinical data, treatment advice, and links to other web-based care resources. We compared patients in the intervention and control groups for changes in processes and outcomes of care from the year preceding the study through the year of the study by intention-to-treat analysis.
RESULTS—The DMA was used for 42% of scheduled patient visits. The number of HbA1c tests obtained per year increased significantly in the intervention group (+0.3 tests/year) compared with the control group (−0.04 tests/year, P = 0.008), as did the number of LDL cholesterol tests (intervention, +0.2 tests/year; control, +0.01 tests/year; P = 0.02) and the proportions of patients undergoing at least one foot examination per year (intervention, +9.8%; control, −0.7%; P = 0.003). Levels of HbA1c decreased by 0.2 in the intervention group and increased by 0.1 in the control group (P = 0.09); proportions of patients with LDL cholesterol levels &lt;130 mg/dl increased by 20.3% in the intervention group and 10.5% in the control group (P = 0.5).
CONCLUSIONS—Web-based patient-specific decision support has the potential to improve evidence-based parameters of diabetes care.
Development of Congestive Heart Failure in Type 2 Diabetic Patients With Microalbuminuria or Proteinuria
Authors: Vaur Laurent , Gueret Pascal , Lievre Michel , Chabaud Sylvie , Passa Philippe ,   For the DIABHYCAR Study Group
Published: March 2007

OBJECTIVE—The DIABHYCAR (type 2 DIABetes, Hypertension, CArdiovascular Events and Ramipril) study allowed investigators to analyze factors leading to the development of congestive heart failure (CHF) in type 2 diabetic patients with abnormal urinary albumin concentration.
RESEARCH DESIGN AND METHODS—Type 2 diabetic subjects of both sexes aged ≥50 years who had a urinary albumin concentration ≥20 mg/l were randomly allocated to 1.25 mg/day ramipril or placebo in addition to their usual treatment and treated for 3–6 years in a double-blind fashion. Major outcomes including hospitalization for CHF were recorded during the follow-up.
RESULTS—Of the 4,912 included patients, 187 developed CHF during the study. There was no significant difference in the incidence of CHF between the two treatment groups. Using a multivariate analysis, independent risk factors for the occurrence of CHF were age, history of cardiovascular disease, baseline urinary albumin concentration, baseline HbA1c, and smoking habits. A total of 68 of the 187 patients (36.4%) died during the 12 ± 11-month period after the first hospitalization for CHF, whereas the annual mortality rate of the population who did not develop CHF was 3.2%.
CONCLUSIONS—Presence of atherosclerotic disease, baseline urinary albumin concentration, and HbA1c level were indicators for further development of CHF. Occurrence of CHF is a major prognostic turn in a diabetic patient’s life.
Contributions of Fasting and Postprandial Plasma Glucose Increments to the Overall Diurnal Hyperglycemia of Type 2 Diabetic Patients
Authors: Monnier Louis , Lapinski Hélène , Colette Claude 
Published: March 2007

OBJECTIVE—The exact contributions of postprandial and fasting glucose increments to overall hyperglycemia remain controversial. The discrepancies between the data published previously might be caused by the interference of several factors. To test the effect of overall glycemic control itself, we analyzed the diurnal glycemic profiles of type 2 diabetic patients investigated at different levels of HbA1c.
RESEARCH DESIGN AND METHODS—In 290 non–insulin- and non–acarbose-using patients with type 2 diabetes, plasma glucose (PG) concentrations were determined at fasting (8:00 a.m.) and during postprandial and postabsorptive periods (at 11:00 a.m., 2:00 p.m., and 5:00 p.m.). The areas under the curve above fasting PG concentrations (AUC1) and &gt;6.1 mmol/l (AUC2) were calculated for further evaluation of the relative contributions of postprandial (AUC1/AUC2, %) and fasting [(AUC2 − AUC1)/AUC2, %] PG increments to the overall diurnal hyperglycemia. The data were compared over quintiles of HbA1c.
RESULTS—The relative contribution of postprandial glucose decreased progressively from the lowest (69.7%) to the highest quintile of HbA1c (30.5%, P &lt; 0.001), whereas the relative contribution of fasting glucose increased gradually with increasing levels of HbA1c: 30.3% in the lowest vs. 69.5% in the highest quintile (P &lt; 0.001).
CONCLUSIONS—The relative contribution of postprandial glucose excursions is predominant in fairly controlled patients, whereas the contribution of fasting hyperglycemia increases gradually with diabetes worsening. These results could therefore provide a unifying explanation for the discrepancies as observed in previous studies.
A Prospective Study of Sugar Intake and Risk of Type 2 Diabetes in Women
Authors: Janket Sok-Ja , Manson JoAnn E. , Sesso Howard , Buring Julie E. , Liu Simin 
Published: March 2007

OBJECTIVE—To investigate prospectively whether intake of total or type of sugar is associated with the risk of developing type 2 diabetes. The contribution of sugar intake to the pathogenesis of type 2 diabetes has not been settled in the context of primary prevention because of limited prospective data.
RESEARCH DESIGN AND METHODS—The Women’s Health Study is a randomized controlled trial of aspirin and vitamin E in the prevention of cardiovascular disease and cancer. A validated semiquantitative food frequency questionnaire was completed by 39,345 women aged 45 years and older. The main outcome was the incidence of type 2 diabetes. The predictor was sugar intake, including sucrose, glucose, fructose, and lactose. Using Cox proportional hazard models, multivariate RRs of type 2 diabetes for increasing quintiles of sugar intake compared with the lowest quintile were estimated.
RESULTS—Compared with the lowest quintile of sugar intake, the RRs and 95% CIs for the highest quintiles were 0.84 (0.67–1.04) for sucrose, 0.96 (0.78–1.19) for fructose, 1.04 (0.85–1.28) for glucose, and 0.99 (0.80–1.22) for lactose, after adjustment for known risk factors for type 2 diabetes. Similar findings of no association were obtained in subgroup analyses stratified by BMI.
CONCLUSIONS—Intake of sugars does not appear to play a deleterious role in primary prevention of type 2 diabetes. These prospective data support the recent American Diabetes Association’s guideline that a moderate amount of sugar can be incorporated in a healthy diet.
Evaluation of a Nurse-Care Management System to Improve Outcomes in Patients With Complicated Diabetes
Authors: Taylor C. Barr , Miller Nancy Houston , Reilly Kelly R. , Greenwald George , Cunning Darby , Deeter Allison , Abascal Liana 
Published: March 2007

OBJECTIVE—This study evaluated the efficacy of a nurse-care management system designed to improve outcomes in patients with complicated diabetes.
RESEARCH DESIGN AND METHODS—In this randomized controlled trial that took place at Kaiser Permanente Medical Center in Santa Clara, CA, 169 patients with longstanding diabetes, one or more major medical comorbid conditions, and HbAlc &gt;10% received a special intervention (n = 84) or usual medical care (n = 85) for 1 year. Patients met with a nurse-care manager to establish individual outcome goals, attended group sessions once a week for up to 4 weeks, and received telephone calls to manage medications and self-care activities. HbAlc, LDL, HDL, and total cholesterol, triglycerides, fasting glucose, systolic and diastolic blood pressure, BMI, and psychosocial factors were measured at baseline and 1 year later. Annualized physician visits were determined for the year before and during the study.
RESULTS—At 1 year, the mean reductions in HbAlc, total cholesterol, and LDL cholesterol were significantly greater for the intervention group compared with the usual care group. Significantly more patients in the intervention group met the goals for HbA1c (&lt;7.5%) than patients in usual care (42.6 vs. 24.6%, P &lt; 0.03, χ2). There were no significant differences in any of the psychosocial variables or in physician visits.
CONCLUSIONS—A nurse-care management program can significantly improve some medical outcomes in patients with complicated diabetes without increasing physician visits.
Prognostic Value of Dobutamine Stress Echocardiography in Patients With Diabetes
Authors: Sozzi Fabiola B. , Elhendy Abdou , Roelandt Jos R.T.C. , van Domburg Ron T. , Schinkel Arend F.L. , Vourvouri Eleni C. , Bax Jeroen J. , De Sutter Johan , Borghetti Alberico , Poldermans Don 
Published: March 2007

OBJECTIVE—The aim of this study was to assess the incremental value of dobutamine stress echocardiography (DSE) for the risk stratification of diabetic patients who are unable to perform an adequate exercise stress test. Exercise capacity is frequently impaired in patients with diabetes. The role of pharmacologic stress echocardiography in the risk stratification of diabetic patients has not been well defined.
RESEARCH DESIGN AND METHODS—We studied 396 diabetic patients (mean age 61 ± 11 years, 252 men [64%]) with limited exercise capacity who underwent DSE for evaluation of known or suspected coronary artery disease (CAD). End points were hard cardiac events (cardiac death and nonfatal myocardial infarction) and all causes of mortality.
RESULTS—During a median follow-up of 3 years, 97 patients (24%) died (55 cardiac deaths), and 27 patients had nonfatal myocardial infarction. In an incremental multivariate analysis model, clinical predictors of hard cardiac events were history of congestive heart failure, previous myocardial infarction, hypercholesterolemia, and ejection fraction at rest. The percentage of ischemic segments was incremental to the clinical model in the prediction of hard cardiac events (χ2 = 37 vs. 18, P &lt; 0.05). Clinical predictors of all causes of mortality were history of congestive heart failure, age, hypercholesterolemia, and ejection fraction at rest. Wall motion score index at peak stress was incremental to the clinical model in the prediction of mortality (χ2 = 52 vs. 43, P &lt; 0.05).
CONCLUSIONS—DSE provides incremental data for the prediction of mortality and hard cardiac events in patients with diabetes who are unable to perform an adequate exercise stress test.
High Incidence of Tacrolimus-Associated Posttransplantation Diabetes in the Korean Renal Allograft Recipients According to American Diabetes Association Criteria
Authors: Cho Young Min , Park Kyong Soo , Jung Hye Seung , Jeon Hyun Jung , Ahn Curie , Ha Jongwon , Kim Sang Joon , Rhee Byoung Doo , Kim Seong Yeon , Lee Hong Kyu 
Published: March 2007

OBJECTIVE—The incidence of posttransplantation diabetes mellitus (PTDM) has been reported to vary according to different study populations or different definitions. In this study, using American Diabetes Association criteria, the incidence and clinical characteristics of PTDM in Korean renal allograft recipients undergoing tacrolimus-based immunosuppression were examined.
RESEARCH DESIGN AND METHODS—A total of 21 patients taking tacrolimus as primary immunosuppressant were recruited and tested with a serial 75-g oral glucose tolerance test at 0, 1, 3, and 6 months after renal transplantation.
RESULTS—The cumulative incidence of PTDM was 52.4% at 1 month and 57.1% at 3 and 6 months. The baseline characteristics of the PTDM group were old age (especially &gt;40 years), a high BMI, a high fasting glucose level, a high plasma insulin level, and increased insulin resistance. Among these parameters, old age was the only independent risk factor. The insulin secretory capacity in the PTDM group was maximally suppressed 3 months after transplantation. Thereafter, it was gradually restored along with dose reduction of tacrolimus.
CONCLUSIONS—Routine screening for PTDM is necessary in patients over 40 years of age who are undergoing a relatively higher dose tacrolimus therapy during the early course of postrenal transplantation.